Care Home: Sydney House

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What the care home does well What has improved since the last inspection? What the care home could do better: CARE HOMES FOR OLDER PEOPLE Sydney House Brumstead Road Stalham Norwich Norfolk NR12 9BJ Lead Inspector Jenny Rose Unannounced Inspection 8th October 2007 09.45 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 Sydney House DS0000034885.V352509.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. Sydney House DS0000034885.V352509.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sydney House Address Brumstead Road Stalham Norwich Norfolk NR12 9BJ 01692 580520 01692 583014 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) www.norfolk.gov.uk Norfolk County Council-Community Care Mrs Gillian Margaret Medland Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Sydney House DS0000034885.V352509.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Rooms numbered 22, 23, 27, 39, 41, 52, 53, 63, 64, 70 and 71 are not suitable for use by wheelchair users at point of admission. 5th December 2006 Date of last inspection Brief Description of the Service: Sydney House is a large, detached, two-storey residential care home that was built in the late sixties and is owned and operated by Norfolk County Council. It is registered to provide personal care and accommodation for a maximum of forty older people. The home has single occupancy bedrooms on both floors that all contain a washbasin and there is a shaft lift to the first floor. There is communal use of a dining room, five lounge areas/rooms, three bathrooms one of which has a shower and ten toilets. The home is sited in its own grounds and is surrounded by pleasant walking and seated areas and has parking to the front and side of the building. It is situated on the outskirts of Stalham, but within walking distance of the shops and other facilities. The current weekly scale of charges for the home is £368.72. Sydney House DS0000034885.V352509.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care Services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out, by using information from previous inspections, information from the providers, the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the service and the current judgements for each outcome group. This was a key, unannounced inspection carried out over a period of 8 hours, during which time a partial tour of the premises was undertaken, care plans, staff files and records for regulation were examined. A newly appointed Care Co-ordinator was available at the beginning of the Inspection and the Manager was available later in the day. The majority of the thirty nine people living in the Home on the day were seen and several were spoken to in passing. Discussions took place in private with three residents, four members of staff on duty, two visitors and several people in passing. The Annual Quality Assurance Assessment (AQAA) as well as eleven comment cards from residents and seven from relatives/friends had been returned to the Commission prior to the Inspection providing useful information which is reflected in this Report. What the service does well: • The Home stands in large gardens for which there are plans to make them more user friendly, designating part of the area to be a sensory garden. Relatives and residents speak of the staff being helpful, caring and kind, within their given time constraints. Fifty percent of staff are taking, or have completed, their NVQ2; training opportunities are available in other areas and new staff must be willing to undertake this training. Relatives and friends are able to visit whenever they wish and are made welcome; two rooms are designated for residents to see their visitors, other than in their bedrooms, should they wish. • • • Sydney House DS0000034885.V352509.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? One requirement from the previous Inspection has been complied with: • The Statement of Purpose and Service Users’ Guide are factually correct. • Two new assisted baths have been installed and there is new flooring laid in some toilets and bathrooms. However, for some residents, a wet room in one of the existing unmodernised bathrooms would better meet their needs. Corridors have been redecorated and new pictures purchased and there are new chairs in a recessed area. Automatic door closures have been fitted to all residents’ doors and fire doors have been upgraded to appropriate fire resistant standards. There is a new ramp for wheelchair access at rear fire exits. Weekly medication audits take place and new assessments and reviews for self administration of medication. New ‘user friendly’ locks have been installed on toilet doors to safeguard residents’ privacy. There are lockable cupboards in all bedrooms, in addition to lockable drawers. An Annual Quality Assurance has been completed together with an Annual Development Plan. Staff training and assessments of residents is taking place in the use of the MUST (Malnutrition Universal Screening Tool). • • • • • • • What they could do better: • • It is anticipated that work to replace the inadequate metal window frames over a period of the next three years should start “soon”. In the meantime problems still remain with the heating in some residents’ and some communal rooms caused by the old system together with problems from draughty windows. It is anticipated that the new windows will help to resolve some of these issues, but some residents need to use portable fan heaters, and some have purchased their own, which is unsatisfactory. Sydney House DS0000034885.V352509.R01.S.doc Version 5.2 Page 7 • • A wet room, in one of the existing bathrooms would better meet some residents’ needs, particularly those in wheelchairs. Care plans provide sufficient information from which staff can work, but there is room for improvement, particularly in the areas of indexing for ease of reference for staff, the linking of life histories and a structured activities programme, keeping up to date and cross referencing with the Daily Records and in preassessment information being kept together with the care plans. Several comment cards and residents spoken to expressed dissatisfaction with the main meal of the day, although there was evidence that in the last few months there were more compliments than complaints. Several comment cards expressed a view that there were sometimes staff shortages and consequent changing roles have caused gaps in care plan recording and instances of miscommunication with relatives. Several comment cards expressed the view that there were still not enough activities during the day, although there have been some improvements; building upon the details of personal life histories, with the resident’s permission, in conjunction with a structured activities programme would provide more person centred, holistic care. • • • 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. Sydney House DS0000034885.V352509.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 Sydney House DS0000034885.V352509.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): 3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have their needs assessed prior to admission to ensure the Home is suitable for them, but if preassessment information were kept in the care plans, it would further ensure that care plans were based on assessed needs. The Home does not provide intermediate care. EVIDENCE: From the previous inspections there is evidence that prospective residents’ have their needs assessed prior to admission to ensure the Home is able to meet those needs. The AQAA states that prospective residents and relatives are encouraged to visit the Home. Two care plans of recently admitted residents were examined and there was information separately available from the placing Social Care Worker and other Health and Social Care Professionals where appropriate, as well as evidence that the process had involved the resident and relatives. However, there is a recommendation that consideration should be given to preassessment information being kept Sydney House DS0000034885.V352509.R01.S.doc Version 5.2 Page 10 together with the care plans, to further ensure that the care plans are based on assessed needs. (See also in this Report under Health and Personal Care). One resident spoken to who had recently been admitted to the Home felt that her needs were being met and that she felt fortunate to be cared for where she had visitors every day. Following a requirement from the previous inspection, the Manager has ensured that the information in the Statement of Purpose and Service User Guide is factually correct particularly in regard to the description of bathing facilities available in the Home. A further requirement from the previous inspection regarding not admitting anyone into the Home who has a diagnosis of dementia at the time of admission is being complied with and staff have received training in Dementia in order to better support and recognise the needs of some residents. Relative’s Comment Cards “Staff have made my Mum feel very welcome”. “I visited a few care homes before. I can honestly say Sydney House is far better than others I have visited. Much more friendly and understanding. My Mum is very happy there”. Sydney House DS0000034885.V352509.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. People living in the Home are satisfied with the delivery of their care and respect for their privacy and dignity. However, more efficient auditing of care plans and attention to individual details will further improve the quality of the service. EVIDENCE: Four care plans examined all contained a photograph of the respective resident and details necessary to enable staff to deliver the particular care needed. One frequent visitor who comes at different times of the day confirmed that his relative received good personal and healthcare. Her room is always tidy and she receives appropriate assistance with her meals. He and another relative confirmed that they are always informed of any medical problems. Comment cards overall were positive concerning the standard of care received. However, although two care plans contained individual’s personal preferences in various respects, for example, preferred times for daily routines, one care plan contained few details of life history, social contacts and interests. There is Sydney House DS0000034885.V352509.R01.S.doc Version 5.2 Page 12 therefore a recommendation in this area. The care plans seen were signed by the resident and/or relative as appropriate. Risk assessments are in place where necessary and these were discussed with the resident and/or relative as appropriate Information on weight and nutrition was included in the care plans and staff have and are undertaking training in this area. However one MUST Review had not been completed for the month of September. Although there was evidence available within the care plans indicating the involvement of healthcare professionals and that the Home seeks their views as part of the Quality Assurance process, the relevant information in some cases was not filed in an ordered way and neither cross referenced, nor indexed clearly, which was potentially confusing for staff in the on-going recording process. Some Daily Notes seen were incomplete, which could have resulted in the failure to follow up a particular condition. One of the comment cards, subsequently followed up by telephone gave details of miscommunication from staff to relatives regarding a hospital appointment, which had been later resolved, but had caused some anxiety at the time. The Manager said all these instances had occurred due to the changes in staff roles and there is a requirement regarding this. In addition, the recommendation from the previous inspection remains. This is regarding the information needing to be included in residents’ Daily Records and to remind staff that residents can look at what has been written about them at any time. On the day of the Inspection two members of staff of the PCT were visiting to inspect the administration of medication and to report to the respective surgeries and pharmacy involved. It is anticipated that this will eventually be an annual inspection. Observation of the medication round demonstrated that medication was appropriately stored and the temperature of the room and the medicine refrigerator was monitored. Good hygiene practices are encouraged by the use of gel for sterilising hands and gloves being available on the medication trolley. Staff who administer medication have appropriate training and the Manager audits the process on a regular basis to ensure that good practice is maintained, as well as weekly audits taking place. Risk assessments are in place for those residents who are self medicating and one such resident offered to show his medication in the locked drawer in his room. The Medication files were well kept, clearly indexed and also contained residents’ photographs, ensuring accuracy insofar as possible. Sydney House DS0000034885.V352509.R01.S.doc Version 5.2 Page 13 There was an example of good practice on the day of the Inspection. Each resident received a Privacy Notice – hotel style – for hanging outside their bedroom door. One resident chooses to keep his door locked, whilst others prefer to keep their door open. Fire door closers have been installed on all doors. Residents are able to make telephone calls from several points in the Home, some residents have phones in their rooms, whilst others choose to use mobile phones. Residents spoken to were satisfied with the manner in which staff respected their dignity and privacy. Residents’ Comments: “Very pleased with arrangements made for me to keep a hospital appointment”. Relatives’ Comments Telephone call following up comment card: “My relative is looked after fantastically well and she is happy there.” “The care provided supports her in her life, but this is not the life she would choose.” “I do not think it could improve. Everything is very good” Sydney House DS0000034885.V352509.R01.S.doc Version 5.2 Page 14 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 adequate. This judgement has been made using available evidence including a visit to this service. People living in the Home have choice in their lifestyle, but there is room for improvements in activities and meals. EVIDENCE: Since the last inspection, improvements have taken place in activities in the Home; exercise classes take place, as well as Bingo and knitting on a regular basis, which many residents enjoy and also outings. A senior member of staff has completed a course in “Reminiscence” and there are items associated with this displayed in the front hall. Five residents go out to social clubs; religious services are held in the Home as well as musical entertainments. One relative spoken to said that his relative appreciated the opportunity to express her views at the Residents’ Meetings which are held on a regular basis; the Minutes of these meetings were seen. Some residents choose not to take part in activities, but would prefer to spend time in their room reading the newspaper. One relative spoken to brings in a lap-top computer to keep his relative up-to-date with family activities through videos and photographs. There is a shopping trolley from which residents can purchase toiletries and confectionery. Sydney House DS0000034885.V352509.R01.S.doc Version 5.2 Page 15 Although activities are recorded in the Activities Book in a general way there is no structured activities programme; therefore there is a recommendation that consideration should be given to designating an Activities Organiser to develop the activities programme in line with the needs, wishes and life histories of the people living in the Home. Two relatives spoken to (one by telephone following up a comment card), said that they were made welcome in the Home at any time and this was also confirmed by two residents who said that they had frequent visitors. The Manager reported that one relative looked after the garden pond area, as well as the plants in the reception area of the Home. Discussions with residents and staff also demonstrated that people living in the Home have autonomy and choice in their personal routines. The residents’ rooms seen contained personal possessions and photos of family and friends. Historically there have been difficulties in the delivery of meals to the satisfaction of the majority of the residents. However, since the Manager has negotiated with the agency which supplies the kitchen staff regarding more consistency of staffing, there appears to be some improvement in resident satisfaction with meals. This was also confirmed by some comment cards. In 28 entries in the compliments and complaints book for food since 25.12.06, there were 11 compliments, the majority occurring in the period since March 2007. Residents were observed on the day of the Inspection making a choice from two dishes. Two residents spoken to felt that the cook on duty on the day of the Inspection produced good meals, although one resident spoken to had found her meal bland; she said that she knew she could have chosen something else. She also said that sometimes the plates were too hot to touch, which was an improvement on plates being cold. Residents have the choice of eating meals in a pleasant, light dining room, where those residents needing assistance with eating are helped discreetly by staff; or some residents take meals in their rooms. Staff have undertaken MUST training (see Health and Personal Care) and special diets are catered for. Owing to the mixed response to the question of meals, the requirement still remains that the meals provided are wholesome and nutritious as well as varied and appetising and are according to residents’ choice. Residents’ Comments regarding activities “Would like some more activities so that the day is not so long” “I am content” Sydney House DS0000034885.V352509.R01.S.doc Version 5.2 Page 16 Relatives’ Comment Cards regarding activities “Residents need more internal activities and stimulation. This seems to be lacking since reorganisation of staffing levels”. In response to the question: Does the service support people to live the life they choose? “With so many people to care for, I fully appreciate this is difficult to always achieve”. “The care provided supports her in her life, but this is not the life she would choose.” Residents’ Comment Cards regarding meals 10 comment cards gave negative opinions of the food, for example: 3 concerning hot food on cold plates 2 concerning the undercooking of vegetables 1 concerning portion size for special diets Relatives’ Comment Cards regarding meals “We feel that the standard of meals for people with dietary needs could be better catered for. We feel that the choice offered could be wider”. “At times the food needs to improve, although at the moment they have a very good cook; when she is on duty the food is excellent…” (Three residents spoken to, as well as members of staff, endorsed this view.) Sydney House DS0000034885.V352509.R01.S.doc Version 5.2 Page 17 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 living in the Home feel that complaints and concerns are listened to and acted up and that the Home’s policies and procedures ensure that residents are safeguarded. EVIDENCE: All residents and visitors spoken to, together with the comment cards demonstrated that the complaints procedure was well known and that the management was approachable. Since the last Inspection 8 complaints had been dealt with by the Home appropriately and in one instance, the County Council had been involved in action to resolve the issue. Examination of training records and speaking to staff confirmed that staff have received training in recognising the signs and symptoms of abuse and all residents felt they were well treated by staff. The AQAA states that the Home plans to improve the complaints procedure by asking residents if they have any concerns at their monthly reviews and that complaints and concerns would be a permanent item on every residents’ meeting agenda. There was evidence that this is already being put into practice from the Minutes of a Residents’ Meeting in August 2007. Relatives’ Comment Cards Apart from comments about the food: “otherwise neither I nor my relative have absolutely no complaints”. Sydney House DS0000034885.V352509.R01.S.doc Version 5.2 Page 18 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 adequate. This judgement has been made using available evidence including a visit to this service. Since the last inspection there have been improvements to the Home which offers the people living there a reasonable standard of living, but the replacement of the windows and consequent improvement to the efficient heating of the building will hopefully enable residents to have choice and control over heating levels in their rooms. EVIDENCE: The Home is situated in large gardens with pleasant views from some windows in the Home. There are plans to make a sensory garden with the help of a local Charity. In the last twelve months several areas of the Home have been improved. Notably, there are now three modernised bathroom as well as new flooring laid in some toilets and bathrooms, together with ‘user friendly’ locks for toilet doors. The Manager is of the opinion that one of the two other bathrooms should be a walk-in shower, especially as there is one resident with very Sydney House DS0000034885.V352509.R01.S.doc Version 5.2 Page 19 restricted mobility who cannot bend his legs to get into the existing shower. There is therefore a requirement to this effect. The corridors have been pleasantly redecorated, new pictures have been purchased and automatic door closures have been fitted to all residents’ doors. Fire doors have been upgraded to appropriate fire resistant standards including smoke seals and there has been a new ramp installed for wheelchair access at rear fire exits and plastic kick plates on doors. Lockable medication cabinets have been fitted in residents’ rooms for topical medicines and a number of items of equipment have been purchased, including profile beds, fire resistant curtains and new furniture in communal and individual rooms. There are a number of communal rooms, which were seen to be well kept, including two rooms where residents may receive visitors privately, one as an overnight room. In addition there is a smoking room, hairdressing room and staff training room. However, the heating in the visitors’ room, used on the day of the Inspection by the Inspector to interview residents in private, had to be augmented with a portable fan heater. This the case for many areas of the Home which has been an issue for several inspections. It is hoped that the heating problems will be solved by the replacement of ill-fitting, metal windows being replaced as part of a 3 year replacement plan starting before Christmas 2007. However, in the meantime, the two requirements regarding the heating and the draughts from ill-fitting metal windows remain. It is planned to install a new lift to allow for wheelchair users. as well as to improve the decoration of the entrance hall, lighting and recarpeting if funding allows. The Regulation 26 reports confirm that the requirement from the previous inspection that areas of the Home to which residents have access are free from hazards as far as possible and that cupboards which are kept locked because of their content, is complied with and there were no issues on the day of this Inspection. A maintenance person is employed on a regular basis and amongst his duties is the redecoration of residents’ bedrooms, particularly when they become vacant and as part of a rolling programme. Staff are aware of infection control issues and work hard to keep a good standard of cleanliness and hygiene. Residents’ Comment Cards “I love my new bedroom”. Sydney House DS0000034885.V352509.R01.S.doc Version 5.2 Page 20 Relatives’ Comment Cards “Sydney House is always very clean” Sydney House DS0000034885.V352509.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. 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. People living in the Home are satisfied with the delivery of their care, but recent changes in staff roles means that there is room for improvement. EVIDENCE: All the residents spoken to, together with the comment cards received were positive about the staff team and the care they deliver, although two comment cards recognise that there were constraints on staff time and that sometimes it appeared that staff were overstretched. The Manager explained that recently there had been staff vacancies, due to retirement in one case, and consequent changes in staff roles, particularly among the senior carers. The Manager also said that to ease the situation that she had created three new posts from two existing ones. In addition, there were also time delays in new staff being able to start work because of the time taken in receiving Police checks. (see elsewhere in this Report: Health and Personal Care and Daily Living). There were three staff vacancies on the day of the Inspection. There is therefore a requirement in this area. From observation on the day and from speaking with staff privately there was evidence that staff enjoyed working with residents in a caring and respectful way, promoting individual’s dignity and choice. From staff files seen all staff complete Induction training and are offered varied training opportunities such Sydney House DS0000034885.V352509.R01.S.doc Version 5.2 Page 22 as training in an Introduction to Dementia, MUST training and a Diversity Workshop. Training takes place both in-house and externally. The Annual Development Plan states there are fifty percent of staff taking, or who have completed their NVQ2; two have an NVQ3. The staff files examined demonstrated that all of the documents and information needed prior to appointment were in place before a new member of staff started work. Staff have received training in Safeguarding Adults and all members of staff spoken to were aware of the issues involved. There is a keyworker system which appeared to be working well in some cases, And two residents in particular spoke of how they but there is a this could be developed in conjunction with a more structured activities programme, taking into account each individual’s needs and wishes. Staff supervision takes place on a regular basis, together with staff meetings staff appraisals, which two members of staff said they found helpful. Staff spoken to felt that there is sufficient time at the beginning and end of shifts and support within the staff team which enables them to carry out their work in a competent manner. Residents’ Comments “The staff here are very good and also the office staff”. “They do their best to do whatever they can and have to do”. “I am very satisfied with everything. The staff are very kind”. Relatives’ Comments “Staff have made my Mum feel very welcome”. I give the carers 10 out of 10”. “I recognise constraints of time imposed on staff. Within them they do a good job”. “Staff are very caring, jovial and respectful” “I now know my Mum is in safe hands”. “The care staff are very good but do seem to be stretched at times”. Sydney House DS0000034885.V352509.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Manager and Senior staff provide leadership to the staff team to ensure the people living in the Home receive a good standard of care. EVIDENCE: The Manager has been in post for some years and has the NVQ4 Registered Managers Award and is undertaking her NVQ4 in Care. Together with other members of staff she has recently undertaken a course in Dementia. On the day of Inspection the Manager was undertaking interviews and a newly appointed Care Co-ordinator stepped into her role in an efficient manner. It was evident from observation and talking to staff, relatives and residents that they found the Manager and Senior Staff approachable. One of the Care Coordinators spoken to had completed a Supervision course and explained that the three Care Co-ordinators, although working as a team with Senior Carers, Sydney House DS0000034885.V352509.R01.S.doc Version 5.2 Page 24 also have special areas of responsibility, such as overseeing care plans and staff rotas. The quality of the service provided is monitored by the Local Authority, which includes questionnaires to residents, their relatives and other interested parties. The Manager has also completed the AQAA and an Annual Development Plan. There are also staff questionnaires. A newsletter for the Home has recently been introduced and this is appreciated as a means of improving communications, as well as regular Staff, Senior Staff and Residents’ meetings, copies of the Minutes of the latter were seen. Regular Regulation 26 visits take place and copies of these are sent to the Commission. Residents’ finances are audited regularly by the Local Authority and every resident has the facility for secure storage of valuables if required. Staff files contained evidence that all staff receive training relating to Moving and Handling, First Aid, Food Hygiene, Fire Safety and Infection Control; this was confirmed by members of staff spoken to. Accidents and Incidents were seen to be recorded and Regulation 37 forms are completed as appropriate. Door closers have been fitted on all doors in the Home and Fire Alarms are tested weekly, one taking place on the morning of the Inspection. The Maintenance Person undertakes weekly flushing of the water system for Legionella and records the weekly and monthly checks. Staff Comments: “The Management are very supportive” Sydney House DS0000034885.V352509.R01.S.doc Version 5.2 Page 25 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 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 X X X 3 Sydney House DS0000034885.V352509.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES 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 OP19 Regulation 23.2.b Requirement Ill-fitting, draughty metal windows should be replaced to ensure that the heating system within the Home meets the needs of the people living there. Previous timescales of 31st December 2005, 1st June 2006 and 1st October 2007 have not been met. This is part of a 3 year plan beginning November 2007 Meals provided in the Home should be wholesome and nutritious as well as varied and appetising to meet the needs of the people living there. This is repeated. The heating system within the Home must meet the needs of the people living there. This relates to having adequate heating in all parts of the home and have a heating system in bedrooms that can be adjusted by the resident. This is repeated Adequate bathing facilities must be provided in the Home and DS0000034885.V352509.R01.S.doc Timescale for action 30/11/07 2. OP15 16(i) 08/10/07 3. OP25 23.2(p) 08/10/07 4. OP21 23.2(j) 31/03/08 Sydney House Version 5.2 Page 27 that these are available to people with special needs. This relates to the provision of a wet room for wheelchair users who are unable to access a normal shower room. 5. OP7 12.1 All people living in the Home must have an up to date, detailed care plan with actions care staff must take based on the assessed needs of each individual. This relates to the cross referencing of Daily Notes and actions to be taken regarding any necessary medical intervention. This will ensure that all people using the service have their needs met Staffing ratios must be determined according to the assessed needs of residents and and additional staff are on duty at peak times of activity during the day, including keyworking and social activity. This will ensure that the needs of the people living in the Home come first. . 08/10/07 6. OP27 18(1)(a) 31/12/07 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 OP7 Good Practice Recommendations It is recommended that care plans are further developed to contain as much relevant information needed to meet the service users needs. This particularly relates to gathering information with the resident’s permission on life history, social contacts and interests. DS0000034885.V352509.R01.S.doc Version 5.2 Page 28 Sydney House 2. OP7 It is recommended that the manager discuss with staff what information needs to be included in service users running records and to remind them that service users can look at what has been written about them at any time. Consideration should be given to developing the present activities programme in line with the needs, wishes and life histories of the people living in the Home. 3. OP12 Sydney House DS0000034885.V352509.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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. 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