Care Home: Sycamore Rise Residential Care Home

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What the care home does well Sycamore Rise provides a homely, safe and comfortable environment for the people who use the service. We found the care staff who work within the service to be professional and caring and the service was managed well. We spoke to several residents and visitors to the service who told us that the care within this service was good and that personal care issues were dealt with properly. One resident told us that the care was "smashing". Care planning was good and written recordings within the care plans that we saw were detailed and informative. The care of each resident was reviewed monthly to help ensure that individual care addressed current need and was consistent. We observed the care staff working within the home; the residents were cared for properly and politely whilst we were there. Overall, we found that the standard of personal care was good, and people were pleased with the level of care they received. The home was pleasantly situated just outside Colne, in Lancashire. There were nice views across the hills and the residents enjoyed the benefits of a nice garden. The home was clean and there were no unpleasant smells whilst we were there. A lot of work had been done to help ensure that the home looked better, and the owner of the service had invested in the furnishing, fabric and decoration of the home to bring it up to to scratch. Several training events had taken place since we last visited the service. A good training programme for the care staff helps to ensure that they have the skills and knowledge to offer a good standard of care. A number of people told us that the food was very good, and that they looked forward to meal times. Lunch was being served during our visit. This was served in peasant surroundings and looked tasty and nutritious. The cook told us that she frequently asked the residents about the food and whether they would like changes to the menu. We saw that fresh food deliveries were regular. Almost all of the people that we surveyed aid that they `always` or `usually` liked the meals that were served. The manager had a good knowledge of safeguarding procedures and the people who use the service were safer because of this. Appropriate guidance was available within the home and the care staff had been trained in safeguarding issues. There was information within the home regarding the Mental Capacity Act and the manager demonstrated that she had a good knowledge of this. What has improved since the last inspection? The owner, manager and staff of the home have worked hard to help ensure that standards have improved within this service. Our last full key inspection found several areas where standards needed to be better and these have been addressed properly, significantly improving outcomes for the people who use this service. New furniture, beds. carpets and soft furnishings have been bought for the home. Several areas of the home have been re-decorated and refurbished. We found during our last full inspection that the people who used the service were not having their continence needs addressed sufficiently. People are now better cared for, the home is cleaner and smells much nicer. Continence care has improved greatly and people are receiving a better standard of care. We also found that pressure area care was being addressed properly, and the care staff had a better knowledge of the care needs of each resident. We also found that, although there were still issues to address, prescribed medication was being handled more professionally and people who used the service were safer because of this. The manager now has an office on the ground floor where she is available to meet relatives, speak to residents and be available to offer advice and support to the care staff. The service was well staffed, and people`s assessed needs were being addressed more successfully because of this. The relatives of people who lived within this service were generally more positive about the standard of care that was being offered. What the care home could do better: Because this was a care home that offered care to people who had dementia we expected to find that the care staff had been recently trained in this area of care. This was not the case. The manager was aware of this and training was being planned. We received comments from relatives that showed that they were not entirely confident about the standard of dementia care, and that staff sometimes lacked knowledge regarding good practice in this area. Standards regarding the safe handling of medication had significantly improved, but there were still areas where this needed to be better to help ensure that the people who used the service were safer. Some of the double- glazed units were in need of attention in the lounge/dining area. An area of the first floor had also not been fitted with double -glazed windows. The manager told us that this had been noted by the owner and will be addressed in the near future. We also saw that there was a small, uncovered central heating radiator in one of the bathrooms, close to the shower. The radiator was quite hot when we felt this and could be a risk to those using the bathroom facilities, should someone fall against this. Training was required in food hygeine and first aid to help ensure that people lived in a safer home. Key inspection report Care homes for older people Name: Address: Sycamore Rise Residential Care Home Hill Lane Colne Lancashire BB8 7EF     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Christopher Bond     Date: 2 8 0 1 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 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. 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 Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Sycamore Rise Residential Care Home Hill Lane Colne Lancashire BB8 7EF 01282864209 01282870897 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Crystal Care Homes Ltd Name of registered manager (if applicable) Mrs Michaela Rae Type of registration: Number of places registered: care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The registered person may provide the following categories of service only. Care home only - code PC, to people 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. Dementia - Code DE Mental disorder, excluding learning disability or dementia - Code MD The maximum number of people who can be accommodated is: 23 Date of last inspection Brief description of the care home Sycamore Rise is a care home that accommodates 23 residents including people who have dementia. The bedrooms are mainly single rooms and some of them have enCare Homes for Older People Page 4 of 30 Over 65 0 0 23 23 23 0 0 7 0 9 2 0 0 9 Brief description of the care home suite facilities. There are two shared double rooms. There are two lounges, one that doubles up as a dining area. There is a lift available that serves all floors. The home is situated in a rural setting on the outskirts of Colne, Lancashire. There are good views of the surrounding countryside and some of the rooms overlook the hills around the home. There are no services in the immediate vicinity of the home. There are, however, shops and other services in the local town. Bus services into the town are limited and the home does not have its own transport at present. Information relating to the homes Service User Guide and Statement of Purpose is included in the welcome pack, which is given to all prospective residents. This information explains the care service that is offered, who the owner and staff are, and what the resident can expect if he or she decides to live at the home. At the time of this visit the information given to the Commission showed that the fees for care at the home are from GBP 386.50 to GBP 465.00 per week, with added expenses for hairdressing and chiropody. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: As part of the inspection process an unannounced visit took place over a total of 6 hours on the 28th January 2010. A tour of the home was carried out, which included bedrooms, lounge, dining areas, and bathrooms. The residents personal files and care plans were examined. Care staff records and recruitment records were also looked at. Safety certificates and medication records for the home were also examined. The manager, residents and care staff were spoken to during the inspection to find out their views of the service. The Care Quality Commission sent out questionnaires, as part of a survey, to residents, their relatives, and care staff. This was to find out their views of the service; the results of which have been included in this report. Every year the Commission for Social Care Inspection sends out an Annual Quality Assurance Assessment for the owner or manager of the home to complete. This tells us about important aspects of the home and how it runs. From this we can also find out Care Homes for Older People Page 6 of 30 the things that have been happening within the service and what plans there may be for the future. The contents of this assessment have been used in the finalisation of this report. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? The owner, manager and staff of the home have worked hard to help ensure that standards have improved within this service. Our last full key inspection found several areas where standards needed to be better and these have been addressed properly, significantly improving outcomes for the people who use this service. New furniture, beds. carpets and soft furnishings have been bought for the home. Several areas of the home have been re-decorated and refurbished. We found during our last full inspection that the people who used the service were not having their continence needs addressed sufficiently. People are now better cared for, Care Homes for Older People Page 8 of 30 the home is cleaner and smells much nicer. Continence care has improved greatly and people are receiving a better standard of care. We also found that pressure area care was being addressed properly, and the care staff had a better knowledge of the care needs of each resident. We also found that, although there were still issues to address, prescribed medication was being handled more professionally and people who used the service were safer because of this. The manager now has an office on the ground floor where she is available to meet relatives, speak to residents and be available to offer advice and support to the care staff. The service was well staffed, and peoples assessed needs were being addressed more successfully because of this. The relatives of people who lived within this service were generally more positive about the standard of care that was being offered. 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. 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. Care Homes for Older People Page 9 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good information is available for prospective residents and their family to read before they make a decision as to whether the home is right for them. Peoples needs are assessed properly to help ensure that the home can meet their health and social requirements. Evidence: The manager had recently updated the information available about this home. She showed us the Service User Guide for the home and this document explained the services that were available and what people could expect if they chose to use this service. Prospective residents received a copy of this information which was clear and easily understood. We also looked at the Statement of Purpose for this service and found that there was some good information presented to tell people about the services that were offered. The manager also explained the process of admittance and how she visited people to Care Homes for Older People Page 11 of 30 Evidence: assess their needs before the decision was made that the home was right for them. We looked at some of the pre-admission assessments that had been completed by the manager. Things such as mobility, health care needs and social needs were looked at and peoples health and social needs were written down clearly and precisely. This information helped the manager to decide if the home had the facilities to care for the person properly. The residents care could be planned properly using this information. The manager also told us that the people who were thinking about using the service were invited to view the service before they made a decision as to whether or not the home was right for them. This service did not supply intermediate care and this standard has not been assessed. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care is planned properly, and their needs are being met because of this. The residents are treated with respect and are looked after properly. Evidence: Everyone who lived within this service had a plan of care that was regularly updated and reviewed. We looked at six of the care plans and looked at the information that was available about each person. This included information on mobility, personal hygiene, health needs, social needs and nutrition. There was also some good information regarding the residents skin condition, and a nationally recognised tool was being used to assess this. The plans also explained clearly the individual attention that people needed and what care the people who used this service should receive. The residents individual weight was regularly recorded and a careful eye was kept on this information regarding rapid weight loss or gain. We noticed that this was being done in line with instructions written within the care plans. Special equipment was available within this home for those who had a physical disability, and those who needed pressure area care. Care Homes for Older People Page 13 of 30 Evidence: We saw evidence that showed that each care plan was reviewed on a regular basis to help ensure that all the information that was held was current, and that health and social needs were regularly assessed. Changes were made within the plans to reflect the findings of the review. There was also information in the care plans about visits by health care professionals, such as the district nurse, or the doctor. We also found information about peoples nutritional needs and any special diets that people needed, such as those with diabetes. A District Nurse was visiting the service during our inspection to treat someone who needed pressure area care. This was a home that cared for people who had Alzheimers Disease and dementia. We found that there were some activities available for those with this condition: it is important that people are stimulated and have appropriate, specialised activities to address this. We looked at the training records for the service and the care staff had not had any recent training in Dementia Awareness. This is an important area for any home that cares for people with this condition. We sent out surveys to the relatives of people who use this service to hear their views. There were some positive comments made about the standard of care. Two people, however, told us that they found the care of those with Dementia or Alzheimers could be better. One relative commented, I feel that a lot of staff dont really know much about dementia, it would benefit staff to have proper training, then maybe they would know to treat those with dementia in the proper manner. Another relative commented, There needs to be more assistance for people with Alzheimers, eg. encouragement to eat their food. There also needs to be more activities suitable for stimulating those with Alzheimers. Overall we found that the personal care of the residents at Sycamore Rise had improved since our last visit to the service. Continence needs were being dealt with properly, and the manager of the service kept a close eye on the standard of care and the way people were being cared for and addressed. The managers office had been moved to the main area of the home so that staff could be supervised at all times. A relative of one of the residents told us, It is a friendly place that employs caring staff, my mother is as content as she could be. We observed the care staff during our visit, all were polite, courteous and respectful. The people who used the service were receiving individual attention, and people were being assisted to move around the home with patience and consideration. We saw that people were being asked if they wanted to use the toilet facilities. There were plenty of care staff around and the general atmosphere was relaxed and pleasant. Care Homes for Older People Page 14 of 30 Evidence: We looked the arrangements for handling peoples medicines and found that although there were areas for improvement, overall suitable arrangements were in place. All staff handling medicines had completed certificated medicines training, but there were not always staff trained in medicines administration on duty at night. The manager said that training was planned for night staff, this will help ensure choice and flexibility in the times that medicines are administered. Staff were aware that some medicines needed to be given before food and explained that they tried to make sure these medicines were given first. However, no formal arrangements were in place to ensure this always happened. This needs to be addressed to reduce the risk that these special instructions will be missed. Similarly, there was sometimes a lack of guidance for staff about the use of when required medicines, when they may be needed, and how this need may be communicated. People wishing to self-administer medication were supported to do so, but a written assessment had not been completed for someone who chose to manage their own inhaler. It is important that assessments are completed to help ensure people receive any support they may need. We looked at how medicines were recorded and found recent records of medicines administration and disposal to be generally clear and accurate. But, it was not always possible to account for (track) the safe handling of medicines at the home because where medicines were received outside the main monthly delivery a receipt record was not always made. Also, the quantities of any medicines carried forward to the next month were not shown. This makes it difficult for the home to audit (check) the handling of medication and should be addressed. We found information from health care professionals was mostly clearly recorded, but on occasion these entries were missed. It is important that advice is consistently recorded to help ensure advice is promptly followed and changes to peoples medicines can be tracked. Written audits (checks) of medication handling were not completed. This is recommended to help ensure that the homes policies are consistently followed and should any shortfalls arise, ensure they will be promptly addressed. We spoke to three people who used this service during our visit. All three were pleased with the standard of care that they received, one person described their care as Smashing, first rate. Seven residents were able to tell us their thoughts about the service via a Care Quality Commission survey. All of the completed surveys that we received were positive regarding the standard of personal care that people received at Sycamore Rise. People told us that they always or usually received the care and support they needed. We were also told that the people who use the service always or usually ensures that people receive the medical care that they need. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples social needs are being addressed and activities are available to help enhance peoples lives. Catering arrangements are good, meaning that people look forward to mealtimes. Evidence: Several people told us during our visit that the food that was served was good. Information about the residents likes and dislikes were recorded and the staff of the service had built up a good knowledge of peoples preferences. There were regular deliveries of fresh produce and the menus told us that there was a good choice of nutritious food served. One resident told us that the food was excellent. A visitor to the service told us that she was frequently around when meals were being served and that the food always looked well presented and delicious. Our survey told us that the people who used this service always or usually liked the meals at the home. We spoke to the cook, who told us about the arrangements that were made for special diets. She said that the residents were asked individually and during residents meetings about what they would like to see on the menu. We visited this service whilst people were having lunch; the food looked wholesome and nutritious and was served in pleasant surroundings. Care Homes for Older People Page 16 of 30 Evidence: We were told via a survey that was returned to us by a relative that they were disappointed about the provision of a soft diet that was required for their mother. We looked into this and found that the person concerned was receiving a good selection of food that was blended to ensure that it could be eaten easily. Instructions for this were recorded within the care plan. Both the cook and the manager of the service confirmed that this diet was provided on a daily basis. We looked at the activities that were available for the people who lived within this service. It was good to see that there was a daily activities programme that helped the residents to remain both physically and mentally active. Provision for those with dementia was, however, limited. We discussed this with the manager during our visit and these will hopefully be introduced on a more regular basis. The manager also told us that training for the care staff in dementia awareness was planned and will be taking place shortly. This is important because Sycamore Rise is a service that is registered to care for people with this condition. We saw that peoples interests, hobbies and life histories were recorded in their care plan. This helped the care staff to have more information about the people who used the service, and were more able to meet their specific social needs. There were visitors to the home whilst we were there. One person told us that they were always made very welcome and were offered privacy and refreshments. The manager told us that visitors were always made welcome and were encouraged: this helped to enhance the residents wellbeing. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Concerns and complaints are taken seriously, meaning that people feel that they are listened to. Good training and staff knowledge means that people live in a safer home. Evidence: The manager of this home had ensured that training was available to help ensure that people are safeguarded from harm. Most of the care staff that were working in the home during our visit had undergone this training. Other care staff had covered this whilst undertaking a nationally recognised qualification in care (National Vocational Qualification level 2 or 3). There were robust policies and procedures available to instruct the care staff in safeguarding issues. The manager was fully aware of her responsibilities regarding reporting incidents of a safeguarding nature, should they occur, and aware of the role of the local authority in helping to ensure people are protected from harm. There was a copy of the latest safeguarding policies and procedures from the local authority and the manager had a good knowledge of these and her responsibilities should a safeguarding issue arise. The home had a clear and understandable complaints procedure. The manager told us that people were encouraged to voice their views on the service they received. Two of the residents that we spoke to were aware of whom to speak to should they be unhappy about anything at the home. The instructions about making a complaint were Care Homes for Older People Page 18 of 30 Evidence: clearly displayed on the wall of the home. They were also written down in the information they gave out to prospective residents and their families/ carers. The procedure had recently been updated and simplified to assist the residents and their representatives. Regular house meetings took place where the people who used this service were encouraged and enabled to voice their opinions about daily life within the home. All of the people who replied to our survey said that they were aware of how to make a complaint about the service, should they wish to do so. One complaint had been received by the Care Quality Commission since our last inspection activity. The manager had taken this seriously and was in the process of investigating this. There was information within the home regarding the Mental Capacity Act and the manager demonstrated that she had a good knowledge of this. The manager should consider training in this area, particularly with regard to deprivation of liberty safeguards. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a surroundings that are homely, comfortable, clean and warm. Evidence: The manager of the service showed us round the home; this included a tour of the bedrooms and the communal areas. In the bedrooms that we viewed there were personal possessions, such as pictures, photographs and ornaments that helped to make peoples space more individual and homely. Some of the bedrooms had pleasant views of the surrounding hills. It was a cold day and the main communal areas were warm and pleasant. There was a nice garden area to the rear of the property and there was space for people to sit out in good weather. Overall the communal areas were quite homely. Generally, people that we spoke to thought that the facilities within this home were good. We spoke to three of the residents and one person told us that they thought that their bedroom was very nice. The owner of the service had invested in new beds and bedroom furniture. Several areas of the home had had new carpets fitted and areas of the home had been redecorated. Two large flat-screen televisions had been fitted in the main lounge areas and new easy chairs had been purchased. Care Homes for Older People Page 20 of 30 Evidence: Our last key inspection found that the environment of this home was poor: the owner home has invested heavily to ensure that the home is now a nice place to live. The home looks much cleaner and there are no unpleasant smells. We did find, however, that some of the double- glazed units were in need of attention in the lounge/dining area. An area of the first floor had also not been fitted with double -glazed windows. The manager told us that this had been noted by the owner and will be addressed in the near future. We also saw that there was a small, uncovered central heating radiator in one of the bathrooms, close to the shower. The radiator was quite hot when we felt this and could be a risk to those using the bathroom facilities, should someone fall against this. The manager was aware that the exterior of the building needed some attention. There had been no painting done to the outside of the building for some considerable time. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were protected by good staffing numbers and well trained care staff. Good recruitment practices helped to make sure that only suitable people are employed to work at the home. Evidence: There were enough care staff on duty during the inspection to ensure that the assessed needs of the residents were adequately dealt with. The staff rotas showed that staffing was good and that there were plenty of staff on each shift to ensure that people were being properly looked after. The rota also showed that the residents were being properly supported at night. Most of the care staff had achieved a nationally recognised qualification in care (National Vocational Qualification level 2 or 3). Those that had not yet achieved this qualification had been enrolled. There was also a good training programme to ensure that the care staff were able to improve their skill and learn new ways to care for people. There had been a number of training events at the home since we last visited. The manager had a training matrix to show which staff had been trained in certain areas. Certificates were also available on file regarding completed training events. As previously stated, the manager should ensure that all of the care staff are adequately trained in dementia awareness due to the nature of the care offered at Sycamore Rise. Care Homes for Older People Page 22 of 30 Evidence: Staff records showed that new carers had been properly checked before starting their jobs, including obtaining Criminal Records Bureau disclosures. This helped to make sure that the residents were safer by ensuring that only suitable staff are employed. There was evidence within the care staff files to show that the correct information had been gathered prior to employment. There was a good induction process for new care staff ensuring that staff were taught how the care home operated before starting to care for people and being included on the rota. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home is managed well and is run in the best interests of the people who live there. The residents live in a safe home where the care staff are aware of health and safety matters. Evidence: A new manager for this service has been registered since our last inspection activity. The current manager is experienced in running a care home and has had a number of years working in care settings for the elderly. She has achieved a nationally recognised managerial qualification. We found that the management of this home has significantly improved and outcomes for the people who live there have been greatly enhanced. An office for the manager had been added to the ground floor. This meant that the manager was available and visible at all times to offer support and advice to the care staff. It was also clear that visitors to the home were able to speak to the manager in privacy and receive information and vice on the care and welfare of their relative or Care Homes for Older People Page 24 of 30 Evidence: friend. Good records were being kept of safety checks within the home. These showed that professional trades people were checking the lift, utilities and the fire alarm system regularly. This helped to ensure that the residents lived in a safe home. Trained maintenance people were also checking the lifting equipment in the home on a regular basis. Risk assessments were available on the residents personal files to help ensure that they lived in a safer home. Staff were being instructed in safety aspects within the service. They were being shown how to move those residents, who had difficulty in supporting their own weight, safely and respectfully. Other safety training included fire safety awareness, and health and safety. All of the care staff that were spoken to were able to confirm that they had received safety training. The manager of the service needs to ensure that all of the care staff receive mandatory training in food hygiene to help ensure that risks are minimised in the kitchen area. There has been no training in first aid for the care staff since our last inspection activity, and this should be rectified. There was evidence on the carers personal files to show that everyone was being supervised properly. Time was set aside for regular one to one meetings with the staff to ensure that they were happy and doing there jobs successfully and professionally. Staff were able to discuss their performance and training needs. There were several quality checks undertaken by the manager on all aspects of the running of the home. These checks helped to ensure that the people who used the service lived in a safe and clean environment. The information that was currently available about the functions and services that the home provided (the Service User Guide and Statement of Purpose) had recently been reviewed and updated. This meant that only current information was available about the home, which ensured everyone had good information. The service has staff meetings and informal residents meetings and these are recorded. The home gave out an annual customer satisfaction survey to relatives and advocates to find out their opinions and comments on the service being provided .The manager should look at ways to make sure the results of their satisfaction surveys are made available to current and prospective users of their service and any other interested parties. This way, people taking part can also see what effect their views have had on the service. The policies and procedures of the service had also recently been reviewed and updated, which meant that the manager and care staff had good, current information available to help them provide a good service. Small amounts of money were kept by Care Homes for Older People Page 25 of 30 Evidence: the service for the residents. The manager checked this monthly to ensure that this was being handled properly and safeguarded. The owner of the service visited on a regular basis, sometimes unannounced, to check the quality of the care. Reports were completed by the owner and were kept on file. We were able to view these reports during our visit. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 13 Training must be made 23/04/2010 available for the care staff in dementia awareness. This is to help ensure that people with this condition receive care from trained and knowledgeable staff to improve outcomes. 2 9 13 Where people self26/03/2010 administer medication written assessments and care plans need to be completed and kept under review. This is to help ensure people receive any support they need to safely self-administer their medicines. 3 9 13 Records of the quantities of all medicines received into the home must be made. 26/03/2010 Care Homes for Older People Page 28 of 30 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to enable the safe handling of medicines to be accounted for. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 Where medicines are prescribed when required there should be written guidance for staff about when they may be needed and how this need is made known. The owner of the home should consider replacing the double glazed units in the dining area that have failed. Single glazed units on the first floor should also be replaced to ensure that the service remains warm and draft free for all residents. A risk assessment should be completed on the radiator in the first floor bathroom, and measures implemented to minimise risk. This is to help ensure that people do not burn themselves unnecessarily. 2 19 3 19 4 30 Training in food hygiene should be available for all of the care staff within the service and refreshed on a regular basis. This is to help ensure that the people who use the service are not put at risk by poor hygiene practice. 5 38 First aid training should be made available as a mandatory area of learning for the care staff. This is to help ensure that basic first aid can be administered during emergencies and accidents prior to calling the appropriate services. Care Homes for Older People Page 29 of 30 Helpline: 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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