Care Home: Sycamore Lodge

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What the care home does well Prospective residents are assessed prior to admission to ensure the home is able to meet their needs. Overall the service user plans viewed were up to date, personalised and evidenced that there had been input from the residents or their representatives. Medications are being well managed in the personal care units. There is good liaison with health and social care professionals to ensure these needs are met. Staff care for residents in a gentle and professional manner, respecting their privacy and dignity. The activity provision in the home is varied and strives to effectively meet the collective and individual needs of the residents. The home has an open visiting policy and visiting is encouraged. Contact information regarding advocacy services is available in the home and representatives from advocacy services meet and talk with representatives. The food provision at the home is good, offering variety and choice. The home has clear procedures for the management of complaints and safeguarding adults issues, and these are adhered to. The home provides an excellent standard of accommodation and is clean and fresh. Procedures are in place and being followed for infection control. The home is being appropriately staffed to meet the needs of the residents and this is kept under review. The employment procedures in place for Servite Houses have recently been reviewed to ensure all required checks are carried out and these are now being adhered to. The Manager is approachable and listens to people, and works with the staff to maintain good standards throughout. Overall there is a good system in place for quality assurance to maintain the quality of the service. Staff receive regular supervision, thus providing a forum to discuss Sycamore Lodge DS0000071570.V375690.R01.S.doc Version 5.2 current good practice and developmental needs. There are induction programmes in place for all staff to ensure they receive an appropriate induction into working effectively at the home. Comments received included: They take a personal interest in each residents happiness as far as time allows, i.e. not just physical care. Activities – quite a wide variety. Offer a warm, comfortable and homely environment. Makes all the residents feel at home and comfortable. Maintain a high level of care standards for the residents. Active involvement and interesting activities on a regular basis with strong participation from residents. Regular meetings with residents and family members. The service provides the service users with excellent care. The staff are well trained to deal with people with dementia. What has improved since the last inspection? Risk assessments for falls and bedrails had been completed and all healthcare assessments viewed were up to date. Progress has been made in the discussing and recording of the wishes of residents and their families in respect of health deterioration and end of life care, and training for staff had been arranged. The AQAA was much more comprehensively completed and provided a good picture of the home. The health & safety requirements had been addressed, although it was noted that a few issues such as fire doors closing effectively had re-occurred. This was addressed at the time of inspection. Action has been taken to better control the spread of smoke and also identify the smokers rooms so that staff and visitors are aware. What the care home could do better: Several shortfalls were identified on the nursing units with the management of medications and this must be addressed without delay. Work is still ongoing to address the issues with clinical room temperatures and fridge temperature monitoring on all units, however it is acknowledged that action had been taken following the last inspection to try and address these issues. The staff routines on the nursing units need to be reviewed to ensure residents receive assistance with their meals in a timely manner. There were also shortfalls identified with the management of residents records on the nursing units, and again, this must be promptly addressed. Key inspection report CARE HOMES FOR OLDER PEOPLE Sycamore Lodge 1 Edgecote Close Acton London W3 8HP Lead Inspector Clare Henderson-Roe Unannounced Inspection 10:45 15 & 16th June 2009 th DS0000071570.V375690.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Sycamore Lodge DS0000071570.V375690.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Sycamore Lodge DS0000071570.V375690.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sycamore Lodge Address 1 Edgecote Close Acton London W3 8HP Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8752 8280 campionm@servitehouses.org.uk www.servitehouses.org.uk Servite Houses Campion John Mead Care Home 77 Category(ies) of Dementia (77), Old age, not falling within any registration, with number other category (77) of places Sycamore Lodge DS0000071570.V375690.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP 2. Dementia - Code DE The maximum number of service users who can be accommodated is: 77 21st July 2008 Date of last inspection Brief Description of the Service: The home has been purpose built to meet the National Minimum Standards for Older People. It is situated in a residential area of Acton, and is easily accessed via public transport. There are shops and a Post Office within walking distance to the home. The home comprises of 5 units, 3 of which can accommodate 15 residents and 2 of which can accommodate 16. All bedrooms are single with en suite toilet, wash hand basin and shower facilities. Each unit has a communal sitting/dining area with a kitchen area plus a separate quiet room and activities room. Two of the units are registered to provide dementia care and three units are registered to provide general care. Each unit is individually staffed. The home accommodates residents placed by the Borough of Ealing. The following information regarding fees has been provided by Servite Houses: ‘Sycamore Lodge was developed under the Governments Private Finance Initiative and capital costs are met in this way. Ealing Council pays a unitary charge, which covers all the services the council receives from Ealing Care Alliance. It covers the costs of care and the provision of facilities management services to the day care service and accommodation. It is not possible to separate these out to identify how much each residential care and nursing care placement costs. The fee payable to the council by residents who fund themselves in full is Sycamore Lodge DS0000071570.V375690.R01.S.doc Version 5.2 Page 5 £526.00 per week for residential care. The fee payable to the council by residents who fund themselves in full is £651.00 per week for nursing care. Deducted from that will be the ‘free nursing care’ amount of £125.00 (high) and £83.00 (medium and low). Private funders are also welcomed for which a fee is negotiated based on individual care/nursing needs.’ Sycamore Lodge DS0000071570.V375690.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was an unannounced inspection carried out as part of the regulatory process. A total of 26 hours was spent on the inspection process, and was carried out by 2 Inspectors. We carried out a tour of the home, and service user plans, medication records & management, staff rosters, staff records, financial & administration records and maintenance & servicing records were viewed. 25 residents, 12 staff and 2 visitors were spoken with as part of the inspection process. The CQC Annual Quality Assurance Assessment (AQAA) document completed by the home, plus comment cards from residents, representatives, staff and health and social care professionals have also been used to inform this report. Comments and suggestions received via the surveys were fed back to the Manager in general terms and some general comments are included below. It must be noted that it is sometimes difficult to ascertain the views of residents with dementia care needs. What the service does well: Prospective residents are assessed prior to admission to ensure the home is able to meet their needs. Overall the service user plans viewed were up to date, personalised and evidenced that there had been input from the residents or their representatives. Medications are being well managed in the personal care units. There is good liaison with health and social care professionals to ensure these needs are met. Staff care for residents in a gentle and professional manner, respecting their privacy and dignity. The activity provision in the home is varied and strives to effectively meet the collective and individual needs of the residents. The home has an open visiting policy and visiting is encouraged. Contact information regarding advocacy services is available in the home and representatives from advocacy services meet and talk with representatives. The food provision at the home is good, offering variety and choice. The home has clear procedures for the management of complaints and safeguarding adults issues, and these are adhered to. The home provides an excellent standard of accommodation and is clean and fresh. Procedures are in place and being followed for infection control. The home is being appropriately staffed to meet the needs of the residents and this is kept under review. The employment procedures in place for Servite Houses have recently been reviewed to ensure all required checks are carried out and these are now being adhered to. The Manager is approachable and listens to people, and works with the staff to maintain good standards throughout. Overall there is a good system in place for quality assurance to maintain the quality of the service. Staff receive regular supervision, thus providing a forum to discuss Sycamore Lodge DS0000071570.V375690.R01.S.doc Version 5.2 Page 7 current good practice and developmental needs. There are induction programmes in place for all staff to ensure they receive an appropriate induction into working effectively at the home. Comments received included: They take a personal interest in each residents happiness as far as time allows, i.e. not just physical care. Activities – quite a wide variety. Offer a warm, comfortable and homely environment. Makes all the residents feel at home and comfortable. Maintain a high level of care standards for the residents. Active involvement and interesting activities on a regular basis with strong participation from residents. Regular meetings with residents and family members. The service provides the service users with excellent care. The staff are well trained to deal with people with dementia. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Sycamore Lodge DS0000071570.V375690.R01.S.doc Version 5.2 Page 8 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Sycamore Lodge DS0000071570.V375690.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sycamore Lodge DS0000071570.V375690.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the home is kept up to date so that prospective residents and people living at the home are kept informed about the facilities and services available. Residents are fully assessed prior to admission to the home, to ascertain that the home is able to meet their needs. EVIDENCE: Since the last inspection the Statement of Purpose and Service User Guide documents have been updated to reflect changes in staffing and other relevant changes in the home. Copies of both these documents were available throughout the home and are made available to prospective residents and their representatives. Sycamore Lodge DS0000071570.V375690.R01.S.doc Version 5.2 Page 11 The home has a pre-admission assessment that is carried out for all routine admissions to the home. These were seen in some of the service user plan documentation viewed and were comprehensive, giving a clear picture of the resident and their needs. Copies of Social Services and Primary Care Trust assessments, plus hospital discharge information were also available. In addition to this the resident is reassessed upon admission to the home to ascertain if any new needs have been identified. On one nursing unit the preadmission assessment carried out by the home could not be found and there appeared to be some confusion as to whether the assessment was actually carried out. A social services assessment was available. Sycamore Lodge DS0000071570.V375690.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service user plans had been formulated to meet the identified needs, thus providing staff with information to care for the residents, however some shortfalls in health information and documentation could place residents at risk. Medications are being well managed on the personal care units, however shortfalls identified on the nursing units could place residents at risk. Staff care for residents in a gentle and professional manner, respecting their privacy and dignity. Work is being undertaken in respect of determining the wishes of residents and their families in relation to health deterioration and end of life care, to ensure these wishes are identified and can be respected. EVIDENCE: Service user plans were sampled on each unit. On the units providing personal care only care plan documentation was comprehensive and up to date, giving a clear picture of the residents needs and how these are to be met. Individual Sycamore Lodge DS0000071570.V375690.R01.S.doc Version 5.2 Page 13 likes, dislikes and preferences had been clearly recorded. There was evidence of monthly updates. Risk assessments for falls had been completed and a falls monitoring document is in place and updated following any falls. There was evidence of input from residents and/or their representatives into the service user plans. On the nursing units service user plans were in place. Risk assessments for falls were in place. There was evidence of input from residents and/or their representatives in the service user plans viewed. Care plans were in place for identified needs, however in some instances there were 2 care plans for the same need, only one of which was fully accurate. For one resident a particular instruction was inaccurate and could have placed the resident at risk. The need to ensure all care plans are accurate and up to date was discussed with the Head of Nursing, and we recommended that any inaccurate care plans should be identified as such and then archived. Overall the information was satisfactory, however more attention is required to ensure that records are managed in line with current legislation and guidance. In addition the audits of the service user plan documentation were not always fully completed and therefore shortfalls had not always been clearly identified. A requirement is made under Standard 37 as it is acknowledged that the issues identified involved the nursing units only. We viewed wound care documentation on the nursing units. One skin risk assessment was inaccurately scored and this was addressed at the time of inspection. Turning charts were not always in place for residents who required a strict turning regime. Dressings had not always been completed in accordance with the intervals stipulated in the care plan. In one instance a health monitoring procedure was being carried out, however there was little evidence as to the reason why. Assessments for continence, nutrition and moving & handling were complete, and care plans had been formulated where needs were identified. Moving and handling assessments and mobility care plans identified all equipment to be used in respect of moving and handling. Residents are weighed monthly and more often if a problem is identified. Risk assessments for the use of bedrails and wheelchair lap straps were in place and signed consents were available. Risk assessments for other identified risks were not always available on the nursing units, for example, smoking. There was evidence of input from healthcare professionals to include GP, tissue viability nurse, podiatrist, dentist and optician. CQC surveys were received from 4 health and social care professionals, all of whom spoke positively about the care provision at the home. We viewed medication management at the home. The home uses the Monitored Dosage System for medication management. A list of staff signatures was available. On some units only initials were available. We suggested that they have a consistent approach throughout the home and that both initials and staff signatures are recorded. Approved lancing devices for blood glucose monitoring were in use and the District Nurse now visits daily to Sycamore Lodge DS0000071570.V375690.R01.S.doc Version 5.2 Page 14 administer insulin on the personal care units. For residents who are selfmedicating, clear risk assessments are now in place. Liquid medications and boxed medication had been dated when opened. We found that receipts had been recorded and with one exception all disposals had been recorded. On the personal care units all receipts and disposals had all been recorded along with any stock balances that had been carried forward. In addition an ongoing stock balance sheet was available for each medication supplied in a box, so that stock levels are monitored daily. On the general nursing unit for 1 resident there were discrepancies in the administration and recording of 2 medications, to include the omission of one medication that was actually available in the home. The Manager said that this would be reported and investigated. We found that on the general nursing unit that there were inconsistencies in the use of codes for medications that had been refused or omitted, and there was no clear explanation as to why medication had been omitted. An issue with the controlled drugs cupboard was identified, and 3 cabinets were in use, however the system in use did not comply with the storage requirements of the Misuse of Drugs Act. The Manager said that this would be promptly addressed. Medication audits were being undertaken however it was not clear that the shortfalls identified on the general nursing unit at the inspection had been identified through the audit process. Minimum, maximum and actual fridge temperatures plus clinic room temperatures were being recorded daily. New fridge thermometers had been purchased, however these did not appear to be being used consistently and recordings were therefore inaccurate at times. We discussed the need to provide staff with training to use the thermometers correctly. Following the last inspection a water-cooled fan system had been purchased for use in the clinic room. Room temperatures were still sometimes above the safe level of 25° centigrade and the fan unit available did not appear adequate to keep the temperature under control. The Manager is therefore making enquiries as to what systems could be more appropriate for use in the clinic room environment. It is acknowledged that action was taken to address the requirement in the last report, however the system is not currently robust enough. Staff were seen caring for residents in a gentle, friendly and professional manner, respecting their privacy and dignity. Residents spoken with expressed their satisfaction with the care provided at the home, and praised the staff for their hard work, dedication and very caring attitudes. There was a cheerful and content atmosphere throughout the home. Residents clothing viewed was labelled, and recent issues with the laundry are being addressed. Residents were well groomed and dressed to reflect individuality. The home has weekly visits from the hairdresser and fortnightly visits from the barber. Bedrooms viewed were personalised and homely, and residents can have their own telephones, either land line or mobile. Residents are encouraged to bring in personal items in accordance with fire safety requirements. On the dementia nursing unit both the radio and television were on in one room, creating a lot Sycamore Lodge DS0000071570.V375690.R01.S.doc Version 5.2 Page 15 of noise that could cause distress to residents who are already cognitively impaired. The importance of ensuring that the wishes of the residents are ascertained and entertainment to meet their needs in this way is provided was discussed. Service user plans viewed did not always provide details of residents’ wishes in the event of health deterioration and end of life. In some instances information was clear, however other records viewed were very brief and in some instances had only been part completed. Training with the palliative care nurse specialist for Ealing PCT is commencing throughout the Servite Homes in Ealing on 22nd June 2009. Following the last inspection, the importance of ascertaining and recording the wishes of residents and their families in respect of this topic was discussed at a relatives meeting, so the home has taken action to raise awareness with families. It is acknowledged that work has been progressed since the last inspection and this standard will be examined in more detail at the next inspection. Sycamore Lodge DS0000071570.V375690.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activity provision for the home is very good, stimulating activities and outings to meet the individual needs, abilities and wishes of the residents. The home has an open visiting policy, thus encouraging residents to maintain contact with family and friends. Advocacy arrangements are in place, thus ensuring the residents rights, choices and opinions are heard and respected. The food provision in the home is of a good standard, offering variety and choice, to meet individual needs and preferences. EVIDENCE: The home has a full time activities co-ordinator. The programme of activities is displayed in areas throughout the home and additional information for residents and visitors is also displayed in areas such as the lift. There is a range of activities to include group and individual sessions. The co-ordinator explained that there are 3 programmes of activities in place: one for the unit staff, one for outings and one covering the activities the co-ordinator leads. Each unit has an activities room and the activities co-ordinator explained that Sycamore Lodge DS0000071570.V375690.R01.S.doc Version 5.2 Page 17 there are plans in place for each unit to have a ‘themed room’, for example a movie and reminiscence room, a library and games room, a music room and an International room. She is completing a training course specific to activities provision and has also started up an activities committee to promote activities as part of the daily routine of the residents. Work is also being undertaken to create a sensory garden and children from The Princes Trust are assisting with this, under the supervision of the co-ordinator. There is a life history document for each resident, however not all these had been completed. This was discussed with the Manager who said this would be followed up and addressed. Information was seen in the service user plans viewed regarding residents interests and hobbies. We observed some of the activity sessions taking place and it was clear that the residents were participating in an animated manner and really enjoying the activity. Representatives from several different religious groups visit the home on a regular basis. Where residents had identified specific faith and cultural needs, the co-ordinator had taken action to contact the relevant religious organisation and request input. The home has an open visiting policy and visiting is encouraged. Visitors spoken with and those who completed CQC surveys commented that they are made welcome at the home and kept up to date with any issues. Information regarding advocacy services to include Alzheimers Concern, Age Concern and financial advocacy services was on display in the home. We were informed that where residents do not have any next of kin, an application has been made for an independent advocate to be provided to represent them. The Manager has attended training on the Mental Capacity Act 2005 and Deprivation of Liberties, and appropriate referrals are being made for any residents where this has been identified as a need. We viewed the kitchen and it was clean and tidy. There was a good supply of fresh, frozen, tinned and dried foodstuffs, and evidence of stock rotation. Food is appropriately stored and a twice daily record of fridge and freezer temperatures is maintained. There is a 4 week menu which provides a good variety of meals. Residents are offered a choice of meals each day, and a record of their choice options is made and sent to the kitchen so their wishes are known and catered for. Residents confirmed that they are offered a choice of meals and that they enjoy the meals provided at the home. The evening meal was being prepared when we visited the kitchen, and homemade soup, sandwiches and other light options were available, plus homemade cakes. Residents were seen enjoying their lunch, however we did note that on the nursing units timings need to be reviewed to ensure staff have enough time to assist those residents who need it in a timely manner. We sampled the lunchtime meal and the sandwiches during the 2 days of inspection, and the food was well presented and tasty. Sycamore Lodge DS0000071570.V375690.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a clear complaints procedure which is followed, thus ensuring any issues are being fully addressed. There are clear systems in place for safeguarding adults, to include education for staff and residents, thus keeping them protected and informed. EVIDENCE: The home has a clear complaints policy and this is displayed throughout the home. Residents spoken to said that they felt able to raise any issues they have and staff listen to them, and CQC surveys received also confirmed this. The home has received 5 complaints in the past year and documentation sampled showed that complaints are investigated and responded to in a timely manner. The home has procedures for safeguarding adults and also follows the Ealing Safeguarding Adults protocols. Since the last inspection all relevant incidents, to include resident aggression towards another resident, are being reported to the safeguarding team. There was evidence that staff had received training in safeguarding adults, and the first day of inspection fell on ‘World Adult Abuse Awareness Day’ and several of the residents attended a talk on the importance of safeguarding adults, which they found very interesting and informative. Sycamore Lodge DS0000071570.V375690.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 and 26. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has been purpose built to a high standard, providing residents with a clean, homely and quality environment to live in. Infection control procedures are in place and are followed, thus protecting residents, staff and visitors. EVIDENCE: We carried out a tour of each unit. The home has been purpose built to a high standard. The home was opened in March 2008 and is still going through the ‘snagging’ process, and 10 weeks have been set aside in the near future to complete this work. There was evidence that some carpets have already been replaced, plus some redecoration has taken place when rooms become vacant. The Manager said that a redecoration and refurbishment plan would be Sycamore Lodge DS0000071570.V375690.R01.S.doc Version 5.2 Page 20 commenced once all the ‘snagging’ work has been completed. Following the last inspection the fire doors were reviewed to ensure they close properly, however some issues were noted at this inspection due to new carpets, and the Manager took action to get this issue addressed. All bedrooms are single and have en suite facilities to include toilet, wash hand basin and shower. There are also assisted bathrooms and toilets on each unit. We viewed the laundry and it was clean and tidy. There are 2 washing machines and the home has the Otex disinfection system in place, which enables items to be washed at lower temperatures whilst still effectively cleaning them. There are also 2 tumble dryers. Protective clothing is available to include gloves and aprons, and the home has infection control policies and procedures in place, plus good practice instructions and information on display in the laundry. The home was clean and generally smelled fresh throughout. Sycamore Lodge DS0000071570.V375690.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall the home is appropriately staffed, however more work is needed to keep staffing levels under review, to ensure that the needs of the residents can be met at all times. The systems in place for vetting and recruitment have been reviewed in order to ensure they are robust and safeguard residents. Training provision in the home is good, thus providing staff with the skills and knowledge to meet the residents’ needs effectively. EVIDENCE: Since the last inspection the staffing has been reviewed in line with resident dependency. Currently the day time staffing for the 16 bedded nursing units is 3 care staff and one registered nurse. It was noted on the general nursing unit that some residents had to wait some time to be assisted with their lunch and this was discussed with the Manager. Work is to be undertaken to review the routines on the nursing units to ensure that the assessed needs of the residents are being fully met. The staff on the personal care units felt that generally they could manage the workload, as long as any complex situations that arise are managed promptly. We also discussed the general need to ensure the staffing is reviewed on an ongoing basis to meet the changing Sycamore Lodge DS0000071570.V375690.R01.S.doc Version 5.2 Page 22 dependency levels on each unit. Ancillary staff are employed in such numbers as to appropriately meet the needs of the home. Care staff are encouraged to undertake NVQ qualifications from level 2 to level 4, with some staff wishing to progress further. Several of the domestic staff have undertaken NVQ 2 in housekeeping and the administrator has completed her NVQ 2 in hospitality and administration. We viewed 3 sets of staff records. There is a checklist in each file which confirms that the required documentation has been obtained for each member of staff prior to commencing employment at the home. In one instance it was not clear if a reference had been requested from the previous employer. The majority of documentation required was available to view. The Human Resources department at Servite Houses head office carries out the employment process. Following recent inspections of other Servite Houses homes has been made aware of the need to ensure they follow the requirements of Schedule 2 of the Care Homes Regulations 2001. Servite Houses have an induction programme that incorporates the Skills for Care common induction standards. Staff spoken with confirmed that they received induction training when they started working at the home, and that they undertake regular training sessions. 10 staff have undertaken dementia care mapping training plus other training has been provided for the nursing and care staff in topics relevant to the diagnoses and needs of the residents, and this provides them with up to date knowledge and skills to care for the residents effectively. The implementation of the dementia care training was being done to particularly good effect on the personal care dementia unit, with staff interacting very well with the residents and providing good outcomes for them. Sycamore Lodge DS0000071570.V375690.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 & 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Manager has the skills, experience and knowledge to manage the home effectively, and does so in an open and approachable manner. Systems for quality assurance are in place, thus providing an effective ongoing process of procedure and practice review. Resident monies are well managed and securely stored. Staff receive regular supervision, thus keeping individual practice, training & development under review and promoting current good practice. Shortfalls were identified in the management of resident documentation on the nursing units, placing residents at risk. Overall systems for the management of health and safety throughout the home are good, thus safeguarding residents, staff and visitors. EVIDENCE: Sycamore Lodge DS0000071570.V375690.R01.S.doc Version 5.2 Page 24 The Manager has 8 years management experience. He has completed the Registered Managers Award and has also more recently undertaken training to include health & safety topics, dementia care mapping and also other training in recent changes to legislation, for example, Deprivation of Liberties training. He has also undertaken training in specific areas of care to include skin care and prevention of pressure sores, to broaden his knowledge in specialist care areas. In addition he is continuing to undertake training in other topics relevant to his management role. Staff spoken with said that the Manager is supportive and approachable. Comments received about the Manager from residents and representatives were very positive and it is clear that he is managing the home effectively and has the welfare of the residents as his top priority. The home has a system in place for quality assurance. Regular staff meetings take place for all groups of staff and minutes are recorded. Resident meetings take place monthly on each unit and again these are minuted. 2 relatives meetings have been held since the home opened and it was clear from the minutes that information is provided to keep representatives up to date with what is going on at the home. In addition representatives from Alzheimers Concern and Age Concern had attended a meeting to discuss what help they can offer to families. Several monthly care audits are carried out to include pressure sores, weights and accidents. Other areas audited include health & safety, cleanliness, maintenance, activities and staff files. The Manager was able to give examples of the action taken to address shortfalls found by specific audits. The home has a monthly Key Performance Assessment, and this is carried out as part of the contractual agreement with Ealing Social Services. This provides a comprehensive review of all aspects of the home. The AQAA submitted by the home provides clear information to show the progress being made by the home in each area, and what further improvements are planned. Regulation 26 unannounced monthly visits are carried out on behalf of the registered person and a report is completed. The home holds small amounts of personal monies on behalf of residents. Clear records of income and expenditure are kept, and receipts are available. We sampled 5 residents monies and the balances were correct. It is noted that for 2 of them the actual monies held were slightly over the recorded amounts, but there was a clear explanation for this and the administrator was already aware that the monies were still to be deducted for very recent expenditure. Clear supervision records are held in each staff members employment file. This includes a supervision contract between supervisor and supervisee. Staff confirmed that they do receive supervision on a regular basis, and topics such as learning and development, best practice and resident care are discussed. As identified under Standard 7, there were some issues identified with the management of care records, to include the standard of auditing, on the Sycamore Lodge DS0000071570.V375690.R01.S.doc Version 5.2 Page 25 nursing units. Also, one pre-admission assessment could not be found and staff did not seem clear as to whether a pre-admission assessment had been completed. The need to ensure that all records are completed and maintained in accordance with relevant legislation and guidance was discussed with the Manager and also the Regional Manager, who stated that work would be undertaken to improve the processes on these units. It is acknowledged that the standard of the care records on the personal care units was good. We sampled the maintenance and servicing records. The maintenance records were up to date, however some of the servicing was overdue, and there was some confusion as to whether the emergency lighting had been serviced. The shortfall in ensuring all servicing is kept up to date was also identified in a recent health & safety audit, and the importance of ensuring all servicing is planned in a timely manner was discussed with the Manager. There were some issues identified with the fire doors, and this was identified as being due to new areas of carpet. Action was taken promptly to address this when some were found not to close fully when the fire alarm sounded. The fire risk assessment had been reviewed and updated in May 2009 and there was evidence that points on the action plan were being addressed within the timescales stipulated. There is also a recovery plan to cover emergencies, for example, gas or electric failure. Risk assessments for equipment and safe working practices were in place and had been reviewed recently. Since the last inspection extractor fans have been placed in the bedrooms of people who smoke, plus signage has been placed on the doors alerting staff and visitors to the fact they are smoking areas. There was evidence of staff undertaking training in health & safety topics and staff spoken with confirmed this. The Manager was aware of ensuring that staff complete all areas of health & safety training and updates within the required timescales. Overall health & safety is being well managed at the home and shortfalls identified should be easy to address. Sycamore Lodge DS0000071570.V375690.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 4 4 X 4 X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 2 2 Sycamore Lodge DS0000071570.V375690.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 17 Requirement Documentation in respect of wound care must be up to date and evidence that treatment and care is being carried out in accordance with the instructions. This is to promote optimum healing. Risk assessments for each resident must include all identified risks. This is to minimise the risk to the resident. All medication receipts must be clearly recorded so that medication stocks are identified clearly. Residents must receive their medication as prescribed to maintain their health. Where codes are being used for omitted medication, these must be clear with a single explanation for each code in use. This is to clearly identify each the reason for omission on each occasion a medication is omitted. Medications must be stored in accordance with the Misuse of Drugs Act. This is to ensure they are securely stored at all times. DS0000071570.V375690.R01.S.doc Timescale for action 01/07/09 2. OP8 13(4) 01/07/09 3. OP9 13(2) 19/06/09 4. 5. OP9 OP9 13(2) 13(2) 19/06/09 19/06/09 6. OP9 13(2) 17/06/09 Sycamore Lodge Version 5.2 Page 28 7. OP9 13(2) 8. OP9 13(2) 9. OP27 18 10. OP37 17 11. OP38 18 Further action must be taken to ensure that all medications are being stored in temperatures below 25° centigrade. This is to ensure medications are stored safely. Staff must receive training in the use of the medication fridge thermometers and temperatures must be maintained at between 2°–8° centigrade. This is to ensure medications are stored safely. The staff routines on the nursing units must be reviewed to ensure residents receive assistance with their meals in a timely manner. All resident records must be managed in accordance with current legislation and guidance. This is to safeguard all resident documentation. The home must ensure that servicing of systems and equipment is carried out in accordance with relevant legislation and guidance. This is to safeguard the home. 01/08/09 01/07/09 01/07/09 17/06/09 01/07/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP3 OP10 Good Practice Recommendations Staff should ensure that all assessments carried out are appropriately filed for ease of access. The use of the TV and radio in the day room should be reviewed to ensure that appropriate entertainment is provided and excess noise that could cause heightened confusion is avoided. Sycamore Lodge DS0000071570.V375690.R01.S.doc Version 5.2 Page 29 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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