Care Home: Sycamore & Poplars Care Centre

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What the care home does well The buildings provide a safe and well-maintained environment for older people and the enclosed rear gardens are safe and accessible. Care planning and risk assessments are developing in a person centred way showing that the staff listen to people and record what is important to the person from their viewpoint. The staff team are trained in the care of older people with Dementia which makes sure people receive the right support to maintain their abilities as long as possible. Staff address people respectfully and know how to protect vulnerable people from abuse. People using the service tell us they feel safe and properly cared for by the staff. What has improved since the last inspection? There is now a registered manager in place who values and encourages suggestions for improvement through regular meetings with people living at the home, their representatives and the staff team. The care planning has improved providing more information on the person and their wishes about how they want to be supported. There is improved assessment of risk, improved management of medicines and staff recruitment is now robust. What the care home could do better: The numbers of staff must be sufficient to meet the needs of people at the home and there must be consideration for peak times of activity such as assisting people to get up in the morning and supporting people at mealtimes. CARE HOMES FOR OLDER PEOPLE Sycamore & Poplars Care Centre High Street Market Warsop Nottinghamshire NG20 0AA Lead Inspector Mary O`Loughlin Unannounced Inspection 4th March 2009 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sycamore & Poplars Care Centre DS0000024656.V371406.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sycamore & Poplars Care Centre DS0000024656.V371406.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sycamore & Poplars Care Centre Address High Street Market Warsop Nottinghamshire NG20 0AA 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) 01623 847303 01623 847396 the.sycamores@ashbourne.co.uk Exceler Healthcare Services Limited Andrew Stewart Care Home 72 Category(ies) of Dementia (72), Old age, not falling within any registration, with number other category (72) of places Sycamore & Poplars Care Centre DS0000024656.V371406.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 The service users of the following gender: Either Whose primary care needs on the admission to the home are within the following categories: Old age, not falling within any other category - Code OP, Dementia Code DE The maximum number of service users who can be accommodated is 72. 13th November 2007 2. Date of last inspection Brief Description of the Service: Sycamore and Poplars Care Centre was opened in 1991 and consists of two buildings, which share the site. Sycamore unit caters for up to 40 people, offering both nursing and personal care, whereas Poplars unit offers dementia care for up to 34 service users. The home provides short and long term care and operates a respite service and will accept emergency admissions. The home is located in the centre of Warsop and is close to shops, pubs, the post office and other amenities. Sixty-nine of the home’s bedrooms are single and seven of the bedrooms have en-suite facilities, six of which are single rooms and the other a double room. Bedrooms are located on two floors on both units and access is facilitated by a shaft lift. The home has a garden area that is well maintained and easily accessible. There is a good-sized car park to the front of each building. The current weekly fee range is £349.00 - £501.80. Additional costs are made for hairdressing, personal toiletries, newspapers and chiropody. Information about the home and the services available are available in the home along with the last inspection report. Sycamore & Poplars Care Centre DS0000024656.V371406.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. One inspector conducted the unannounced visit. The main method of inspection used was called ‘case tracking’ which involved selecting three people and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. 2 people were resident within the Poplars unit and 1 person in the Sycamores unit. We spoke to 5 people randomly who were able to give an account about the care they receive. The 3 people case tracked had limited ability to give a clear account of their care at the home but we observed how they were supported in conjunction with speaking to relatives and from reading records. The manager, members of staff and visitors to the home were spoken with as part of this visit. Documents were read as part of this visit and medication management was inspected to form an opinion about the health and safety of residents at the home. A review of all the information we have received about the home since the last inspection was considered in planning this visit and this helped decide what areas were looked at. A range of additional information was used to determine the outcome of this visit, including information provided by the registered provider within an Annual Quality Assurance Assessment (AQAA). The quality rating for this service is 2 star this means that people who use the service experience good quality outcomes. Sycamore & Poplars Care Centre DS0000024656.V371406.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The numbers of staff must be sufficient to meet the needs of people at the home and there must be consideration for peak times of activity such as assisting people to get up in the morning and supporting people at mealtimes. Sycamore & Poplars Care Centre DS0000024656.V371406.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Sycamore & Poplars Care Centre DS0000024656.V371406.R01.S.doc Version 5.2 Page 8 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 & Poplars Care Centre DS0000024656.V371406.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1-3-6 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. There are suitable policies and procedures in place to make sure people have a proper assessment of their needs before admission but there are some shortfalls in the consistency of writing up a plan of care. Intermediate care is not provided. EVIDENCE: We looked at the way people were assessed before they were admitted to the home and saw that in 4 out of 5 cases the staff had ensured that the homes policies had been followed to obtain all the required information about a person before they came to stay. Sycamore & Poplars Care Centre DS0000024656.V371406.R01.S.doc Version 5.2 Page 10 One person admitted for respite care had not got a suitable care plan in place. Although she did feel that staff were meeting her needs. The manager made sure that a plan was drawn up during the inspection. The admission assessments for the 4 other people were completed and also using a person centred approach within a personal preference plan; the information recorded gave a description of the person and what their choices and preferences were. This gives the staff information about how people want to be supported by the home. Where people had been unable to provide their own information staff had asked the person’s representative. We saw how Southern Cross provide anyone interested in living at the home with detailed information about the company and the home, giving people information in a format that they can understand to make sure they have enough information on which to base a decision to come in. Sycamore & Poplars Care Centre DS0000024656.V371406.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7-8-9-10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service is developing a person centred care planning approach that records how people want to be supported to stay healthy, safe and well. People are protected by the policies and procedures for dealing with medicines. EVIDENCE: We looked at how care was planned and delivered to 3 people living at the home. We found that each person had a record of their personal preferences in how they wished to be supported in the home and who was their advocate if they required one. The manager also told us how care plans are being developed to be more person centred which is a really good way to help people take control of their lives and have a say in what is important to them. Sycamore & Poplars Care Centre DS0000024656.V371406.R01.S.doc Version 5.2 Page 12 We saw that the staff complete assessments for each person every month for any risks to their health and wellbeing and any identified risk is then recorded into a plan that tells staff how best to support the person safely. We saw evidence that people had been invited to review care plans but the records did not reflect what people’s views were and whether they felt things were working well or needed to change. The manager completes an audit of falls and accidents that occur each month and we saw this in place, he uses the information to inform what may need to change to reduce potential risks for people. We saw how a person who was at risk of falling was regularly reviewed to make sure the risk of injury was as far as possible eliminated. The care plan for the person did not include the significant event of a fall and injury which was a key event and important for staff planning the care. In practice the person was receiving the correct support and staff were able to tell us how they supported the person safely. We spoke to 5 people using the service who were all very happy with their life at the home, they felt that staff respected their dignity and were always helpful and friendly. Relatives we spoke with also said they were satisfied with the service provided. The way people receive their medicine is safe. We looked at records of administration, receipt and disposal of medicines and saw that staff are trained to undertake medicine administration and regularly receive refresher training, they told us their practices are regularly audited and accurate records are kept of all administration. Sycamore & Poplars Care Centre DS0000024656.V371406.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12-13-14-15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff recognise the importance of maintaining people’s independence and identity through suitable care planning and the provision of activities. The management of nutrition shows that staff recognise the importance of making sure that people enjoy their food and eat a healthy, balanced diet. EVIDENCE: Each care plan we looked at had a record of the person’s previous interests and a plan describing the support the person needed when entering the home, this tells us that staff recognise how important it is for people to maintain their skills when carrying out everyday activities. People have access to a range of events and activities and posters advertising these are displayed clearly around the home. The activities taking place during our visit corresponded with the events calendar displayed. Sycamore & Poplars Care Centre DS0000024656.V371406.R01.S.doc Version 5.2 Page 14 We observed a mealtime and saw in written records that each person had been asked about his or her dietary preferences showing that the service recognises the importance of providing people with a suitably healthy diet that they enjoy. The care plans and nutritional assessments show that staff know how each person needs supporting to make sure they receive a good level of nutrition and we saw staff supporting people sensitively and discreetly with their meals. The numbers of staff available during the mealtime caused delays in being able to provide assistance to people promptly, despite this staff provided a calm unhurried approach and when people were agitated staff did not try to feed them, they allowed them space and freedom to walk around which is considered good practice. Sycamore & Poplars Care Centre DS0000024656.V371406.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16-18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are listened to and action is taken in response to concerns raised. The staff team work to robust procedures to protect people from any abuse. EVIDENCE: Over the last 12 months there has been 1 complaint received by the commission, which were referred to the provider for investigation. The manager investigated the complaint upholding part of the concerns and we saw that the appropriate actions had been undertaken during this inspection. The provider has an appropriate complaint policy and procedure, which is provided to each person living at the home and is also displayed for people to access. The manager said he had not received any complaints since the last inspection. There are also robust procedures in place to deal with any suspicion of abuse and the manager has shown us through a recent allegation that he is aware of and works to the recognised local policies for alerting any allegation or suspicion of abuse. This investigation is not yet completed. A previous safeguarding alert was made by the commission and following investigation alternative care was provided for a person who’s needs the home could not meet. Sycamore & Poplars Care Centre DS0000024656.V371406.R01.S.doc Version 5.2 Page 16 We saw within staff records and from speaking to staff that they have been trained in all issues of protecting vulnerable people. They have also been trained to deal appropriately with any aggression to safeguard people from harm. 5 people living at the home were asked if they felt safe and each person said that they felt cared for and safe. Sycamore & Poplars Care Centre DS0000024656.V371406.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19-26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a suitably maintained environment with efficient procedures in place that control infection. EVIDENCE: The 2 separate buildings, Sycamores and Poplars were found to be clean and well maintained. There are private secure gardens with a summerhouse and seating for people to access safely. Raised flowerbeds and a sensory garden help provide a pleasant place in the summer where people can take part in planting flowers. Inside the home there are separate lounge areas that provide people with privacy and each person has a suitably furnished bedroom that has a call bell, Sycamore & Poplars Care Centre DS0000024656.V371406.R01.S.doc Version 5.2 Page 18 regulated hot water for their safety and a range of equipment they need to support their everyday lives. The staff records show that they are trained in how to control infection and the AQAA tells us that the manager has obtained the required guidance from the Department of Health on managing and auditing the homes infection control procedures. A complaint was received about the malodour on the premises, which the manager investigated accordingly; he made changes to the management of dirty linen to make sure that it was dealt with in a suitable time to prevent odour problems. We found that malodour still exists in parts of the home but the manager is aware of the problem and cleaning schedules are in place. Sycamore & Poplars Care Centre DS0000024656.V371406.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27-28-29-30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff team are suitably trained but the numbers of people on duty may not meet people’s needs efficiently or safely at peak times of activity. EVIDENCE: We saw that improvements have been made to the recruitment practices in the home since our last inspection. We examined 3 staff files and found that the manager has ensured the recruitment process is now robust; he obtains all the required information before people commence work to ensure that vulnerable people are safe from anyone known to be unsuitable to work with them. We identified that staff have a suitable induction to make sure they are not put in situations they cannot manage at the start of their employment. From training records and talking to staff we identified that the manager knows the importance of a well trained staff team, ensuring that they receive regular updates on subjects such as how to move people safely and how to maintain safe food hygiene practices. Sycamore & Poplars Care Centre DS0000024656.V371406.R01.S.doc Version 5.2 Page 20 Staff are also trained to National Vocational levels in care, which ensures that people are in safe hands from skilled staff. We spoke to people using the service and they told us that the staff are on hand and that they do receive the care and attention they expect. We observed over the lunchtime on Poplars unit that staff were unable to provide an efficient support to everyone who needed help with their meal, some people were waiting for 20minutes at the table. The staff duty records indicated that on each shift a member of staff was allocated as required to work solely with one person who needed constant care. There was no evidence that any consideration is given to peak times of activity such as when people get up or at mealtimes. The manager said that the numbers of staff are calculated as 1 to 7 but this number does not allow for the dependency and needs of those accommodated. Furthermore the number of people actually on duty did not meet the described calculation, which may not ensure that people receive the support they need. Sycamore & Poplars Care Centre DS0000024656.V371406.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31-33-35-38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from the leadership and management of approach within the home and are encouraged to make suggestions for improving the service. EVIDENCE: The manager is registered with the commission and has 15years experience in caring for older people. He is a trained Nurse on the General part of the register. The manager sent us the AQAA within the timescale and it contained relevant information about how the home had improved and where they still need to make improvements. Sycamore & Poplars Care Centre DS0000024656.V371406.R01.S.doc Version 5.2 Page 22 To ensure the quality of the services provided at the home the manager undertakes monthly assessments including medicine audits to make sure staff follow the homes procedures and any required changes are identified and addressed to improve the service. The manager said he regularly consults with people who use the service, both formally by sending out satisfaction surveys and informally on a daily basis. There are also regular meetings held with staff, people living at the home and their representatives. Staff told us that the manager was an approachable person who gives them feedback on the quality of their work. The records of accidents were seen to be fully recorded and a suitable audit of accidents is undertaken to make sure any risks identified can be dealt with to improve on people’s safety and wellbeing. The management of health and safety is robust with suitable records seen of regular Fire testing, fire risk assessments and hot water regulation. We examined how 3 people had access to their personal finances and saw that the home’s administrator keeps electronic records of each person’s cash flow, retaining receipts of any expenditure to provide a suitable and safe accounting system. Where a person lacked capacity to manage their own property and affairs we saw how the person was being represented by a relative who had applied for an enduring power of attorney as required. Sycamore & Poplars Care Centre DS0000024656.V371406.R01.S.doc Version 5.2 Page 23 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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 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 X X 3 Sycamore & Poplars Care Centre DS0000024656.V371406.R01.S.doc Version 5.2 Page 24 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 OP27 Regulation 18 Requirement You must ensure that sufficient numbers of staff are on duty to meet the needs of people at all times and with regard to peak times of activity. Timescale for action 30/04/09 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. Refer to Standard OP3 Good Practice Recommendations You must ensure that each person has an appropriate assessment and care plan in place from the point of admission. Improve how care plans are reviewed to show that they are centred on the person and their view of the service, what is working well and what needs to change. Make sure key events such as serious injuries are recorded within the care plan. Make sure that key events such as falls are not lost within daily records ensure they are recorded in the appropriate care plan review section and the plan updated to reflect DS0000024656.V371406.R01.S.doc Version 5.2 Page 25 2. 3. 4. OP7 OP8 OP8 Sycamore & Poplars Care Centre 5. 6. OP8 OP33 what needs to be done. Contact the falls team for advice and details of assessment for people who are at increased risk of falling. Make sure you record within the AQAA any improvements that are made in respect of Requirements and recommendations that are set at the last inspection and any improvements made as a result of complaints about the service. Sycamore & Poplars Care Centre DS0000024656.V371406.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Sycamore & Poplars Care Centre DS0000024656.V371406.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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