Care Home: Sylvan House

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What the care home does well Service users are treated with respect and their right to privacy is upheld. The systems in place for the administration of service users` medication are well managed. A range of social activities are provided which provides an interesting and stimulating environment. The food provided is varied and nutritious and service users` specific dietary requirements are met. The complaint procedure is available to service users and their relatives that they know what to do if they are happy with the standard of care they receive. The staff spoken to during the visit of said they enjoy their work and feel well supported in their role. What has improved since the last inspection? The standard of the service provided at Sylvan House remains the same. What the care home could do better: Service users` care needs are not properly assessed which means they may not receive the care and support they need. Care plans do not hold the necessary information which means staff cannot monitor and plan for service users` care properly. Some improvements need to be made to the condition of the building. The induction training programme needs to be developed so that staff are clear on their responsibilities and know how to work safely. Health and safety needs to be improved to ensure staff and service user safety. The staffing levels need to be improved to ensure service users receive the care they need. Key inspection report Care homes for older people Name: Address: Sylvan House 2 - 4 Moss Grove Prenton Wirral CH42 9LD     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: Ingerbritt Moynihan     Date: 0 4 0 5 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 26 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Sylvan House 2 - 4 Moss Grove Prenton Wirral CH42 9LD 01516081401 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Prime Care (UK) Ltd Name of registered manager (if applicable) Carol Dixon Type of registration: Number of places registered: care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is: 22 Date of last inspection Brief description of the care home Sylvan House is a large converted property situated in the Prenton area of Birkenhead, Wirral. It is close to local shops and bus routes to towns on the Wirral and Liverpool. The home offers care and support to 22 residents who are over the age of 65 years. This registration includes providing a service to 6 people who have dementia. Accommodation is provided on two floors with passenger lift and stair access. The Care Homes for Older People Page 4 of 26 Over 65 0 22 6 0 0 9 0 2 2 0 1 0 Brief description of the care home home has some shared bedrooms. On the ground floor there are two sitting areas and a separate dining room, some bedrooms, an adapted bathroom and toilets. Outside the home there are garden areas and some parking spaces. Basement areas in the home are used as an office, a staff room, a laundry and for storage. The weekly fees for the service range from GBP366.17 to GBP395.22. Additional charges are made for hairdressing and chiropody. A service user guide and a statement of purpose, which describe the services, offered is made available to people who are interested in using the service, their relatives and professionals before a person comes to live at Sylvan House. A copy of the most recent inspection report can be obtained from the manager. Care Homes for Older People Page 5 of 26 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: Information about the home was obtained through discussion with the acting manager and members of the staff team. Policies, procedures and supporting documentation were also looked at along with a selection of service users case files. We also obtained information from the Annual Quality Assurance Assessment (AQAA). The AQAA if a self assessment document that is filled in once a year by all providers. It is one of the ways that we get information from providers about how they are meeting outcomes for people using the service. A part of the inspection process includes sending surveys to service users and staff in order to obtain their views on the standard of the service provided. Nine staff surveys and nine service user surveys were returned to us. Comments made in these surveys are included in the report and contribute to the basis of any judgments made. Most of the service user surveys were completed with staff assistance. Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. 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 7 of 26 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 8 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users care needs are not properly assessed which means they may not receive the care and support they need. Evidence: Before a service is offered an assessment of service users care needs is carried out so they know they will receive the care and support they need. More detailed information needs to be gathered during the assessment process to ensure staff have the information they need on how to provide the right level of care. Without this information, important aspects of service users care needs may be missed and they could be left vulnerable to the risk of harm. Care Homes for Older People Page 9 of 26 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. Service users care needs are not clearly identified which means staff do not have clear instructions on how to provide the right level of care. Evidence: Information about service users care needs is documented and provides staff with guidance on how to look after the service users in line with their individual care needs. However a full and detailed care plan had not been drawn up for this information. Although assessments had been completed in some areas of care, this information had not been transferred into a care plan. The records lacked appropriate guidance which is necessary for staff so they can provide the right type of care. To ensure service users health care needs are met and planned for properly, records need to state clearly how service users will be supported while living at Sylvan House. This lack of information could leave service users vulnerable to the risk of harm and ill health. The service user surveys returned to us indicated they always receive the care and support they need. Six of the nine surveys indicated staff always act and listen to what they say, three surveys indicated this is usually the case. All but one survey Care Homes for Older People Page 10 of 26 Evidence: indicated they always get the medical care they need. One survey noted The staff are very kind to the residents of Silvan House. Staff surveys returned to us indicated the service users are well cared for. One survey noted The staff are caring towards the residents and it is a happy environment. Another survey noted The staff care about the well-being of all residents, ensuring they feel safe, secure and happy. Although it is acknowledged that service users and staff have made positive comments about the care, it is vitally important that detailed care plans are recorded so that staff have all the information they need on how to provide the right level of care. It is only by doing this can staff plan and meet service users care needs properly. Without this information, important aspects of their care needs could be missed and they could be left vulnerable to the risk of harm. Systems are in place for the administration of service users medication. Appropriate facilities are provided for the safe storage of medication and supporting policies and procedures are available to staff if they need clarification on a specific issue. The medication administration record sheets were accurately maintained and staff who administer medication are trained in this area. Medication is regularly audited to ensure it is being managed efficiently and effectively. There are currently only two members of staff who can administer medication. Consequently they have to return to the home after their shift has finished to give the evening medication. This means staff are not getting a proper break from their work. Alternative arrangements should be made for this area of care to be managed more efficiently. Staff spoken to during the visit demonstrated an understanding of how they ensure service users are treated with respect and their right to privacy is upheld. One of the service user surveys returned to us noted The staff work very hard together and are very kind and helpful. Staff interacted with service users in a polite and friendly manner during the visit. Care Homes for Older People Page 11 of 26 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. The homes routines are flexible and service users are helped to exercise choice and control in their lives. Evidence: A range of social activities is provided. This includes exercise, artwork, reminiscence groups, local history and beauty therapy. This gives service users an opportunity to meet the people living in the home and prevents them from becoming bored. A religious service providing communion is held each week. Friends and relatives can visit at any time so that service users can maintain personal relationships and continue to be part of family life. The homes routines are flexible and service users are encouraged to make their own decisions to maintain their independence. A varied and nutritious diet is provided and service users individual dietary needs are catered for. The cooks have completed training in food hygiene. They confirmed the food delivered to the homes of a good quality and there is always enough for the number of people living at the home. On the day of the visit the kitchen was clean and tidy; regular cleaning schedules are in place. All of the service user surveys returned Care Homes for Older People Page 12 of 26 Evidence: to us indicated they always enjoy the meals provided. Care Homes for Older People Page 13 of 26 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. Systems are in place to ensure service users are protected from abuse and they know how to make a complaint. Evidence: A complaint procedure is available to service users and their relatives so they know what to do if they are unhappy with the standard of the care they receive. We have not received any complaints about the standard of the service provided at Silvan House. The manager has not received any complaints. The staff spoken to during the visit confirmed they know what to do if they receive a complaint. This was also noted in the staff surveys returned to us. All of the service user surveys indicated there is someone they can speak to informally if they are unhappy. Six of the nine service user surveys indicated they know how to make a formal complaint. A copy of the Wirral adult protection procedure is in place and the acting manager is clear on the procedure to be followed in the event of an allegation of abuse being made. Most staff are trained on how to safeguard service users from abuse. The staff spoken to during the visit gave a basic understanding of the different types of abuse that can occur and the action they should take if they suspect or know abuse is happening. There is currently one safeguarding issue being investigated at the home. Care Homes for Older People Page 14 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall the building is well maintained, however some improvements need to be made to provide a more comfortable environment for service users to live. Evidence: Overall the home is well maintained and provides a comfortable and homely environment for the service users to live. Service users bedrooms are clean and tidy and they have personalise their rooms with their own belongings. There is a large lounge and dining room along with a small sitting-room on the ground floor which service users can use if they want to spend time alone. These rooms are decorated in a traditional and homely way. A number of issues arose during the visit that require improvement. The front of the building is shabby. The paintwork is flaking, the fencing around the bins is damaged, unused planters are stacked untidily and are full of weeds as is the car park. The garden at the side of the building which service users could use when the weather is good is untidy. The grass needs cutting and the borders are full of weeds. The garden furniture is dirty and rubbish is stored in small piles. Inside the home some of the bathrooms need redecorating particularly the bathroom on the middle floor. The wardrobe door in one bedroom is missing, in another bedroom the vanity unit is damaged and drawer handles are missing. The window in Care Homes for Older People Page 15 of 26 Evidence: one bedroom could not be opened because the beading on the glass had come away and this posed a dangerous risk. To ensure service users safety and comfort these issues should be addressed. One of the service user surveys returned to us noted, when asked what could the home do better, Tidy the front of the house and provide better access to the garden for residents. Systems are in place to prevent the spread of infection and there are sufficient laundry facilities for the people living at the. The home is clean and tidy and it is clear the domestic staff are working hard to maintain high standards throughout the home. Care Homes for Older People Page 16 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are insufficient staff on duty which means service users may not be looked after properly. Evidence: Seven of the nine staff surveys returned to us raised a concern about the staffing levels. While they acknowledged that service users are well looked after they commented that more staff are needed. One survey noted Staff are overworked due to shortages ie sickness, and there are not enough to cover all of the shifts. Another survey noted when asked what could the home do better Have more staff so the staff can take proper time off. Some staff are feeling unwell because of all the hours they are working. During the visit staff reported they were working too many hours (see standard 9). Four service user surveys indicated the staff are always available when needed, five surveys indicated this was usually the case. There is training to the National Vocational Qualification standards which is a recognised qualification for staff involved in the care profession. Staff are provided with training to support them in their role and keep them up to date with new ways of working. Further training is being planned for the forthcoming year. Staff are provided with training when they are first employed. This was confirmed in the staff surveys returned to us. The induction training programme is not in line with Care Homes for Older People Page 17 of 26 Evidence: Skills for Care which is the recognised training programme for staff involved in the care profession; this involves assessing staffs competence and ability to carry out their work. To ensure staff are competent in their role and are fully aware of their responsibilities, this induction programme should be developed to be in line with Skills for Care. Care Homes for Older People Page 18 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements need to be made to the management systems to ensure the efficient and effective running of the service and the safety and welfare of service users and staff. Evidence: The registered manager of the service is currently unavailable. A senior member of staff is acting as manager. It is acknowledged that she is working very hard to ensure the service users are well looked after and the home is managed efficiently. Although there are systems in place to monitor the standard of the care provided, there have been no improvements to the service since the last visit in September 2009. In light of the manager not being available, the registered owner should be proactive in developing the service so that issues do not repeatedly arise during visits. Again the registered provider should produce a development plan for the future development and ongoing improvement of the home. Service users weekly money is managed by staff. All records were accurately Care Homes for Older People Page 19 of 26 Evidence: maintained. The records should record more clearly the in/out balance and be audited regularly to minimise the risk of abuse. The staff spoken to during the visit said they enjoy their work and feel well supported in their role. They confirmed the manager and senior member of staff are available for support and advice at all times. The acting manager confirmed that formal supervision is not provided, rather staff are supervised informally on the job. Six of the staff surveys returned to us indicated the manager regularly gives them enough support and meets with them to discuss how they are working. Four surveys indicated this sometimes happens. To ensure staff have an opportunity to develop in their role, a system of formal supervision should be introduced. The health, safety and welfare of both staff and service users is promoted through the provision of staff training, supporting policies and procedures and health and safety checks around the building. a number of issues arose which require attention. For service users safety a lock should be fitted to the kitchen doors to prevent them from accessing this area. The thermometer in one bathroom could not be used as the temperature gauge numbers had worn away. It was not possible therefore to take an accurate temperature of the water. The electrical wiring certificate identified that one area of the buildings electrics should be monitored. There was no evidence to demonstrate this was being done. All of these issues must be addressed as they potentially place both staff and service users at the risk of harm. Care Homes for Older People Page 20 of 26 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 3 15 A detailed assessment of service users care needs must be completed. This will ensure staff have the information they need on how to look after the service users properly. 08/01/2010 2 7 15 Detailed care plans, including 08/01/2010 risk assessments, must be documented for each service user. This will ensure staff have the information they need on how to look after the service users properly and minimise the risk of accidents happening. 3 7 18 Staff must be provided with training on care planning. This will ensure service users health care needs are monitored and planned for properly. 08/01/2010 4 33 10 The management systems 08/01/2010 should be changed and improved. A development plan should be produced and shared with the service users, their relatives and Page 21 of 26 Care Homes for Older People 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 staff to show what the future plans are for the home are. This will ensure the effective and efficient running of the home. Care Homes for Older People Page 22 of 26 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 10 The management systems 30/06/2010 must be changed and improved. A development plan should be produced and shared with the service users, their relatives and staff to show what the future plans are for the home. This will ensure the ongoing improvement of the service and the efficient and effective running of the home. 2 3 15 A detailed assessment of service users care needs must be completed. This will ensure staff have the information they need on how to look after the service users properly. 30/06/2010 3 7 15 Detailed care plans, including risk assessments, must be documented for each service user. 30/06/2010 Care Homes for Older People Page 23 of 26 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 will ensure staff have the information they need on how to look after the service users properly and minimise the risk of accidents happening. 4 18 13 Staff must be provided with 30/06/2010 training on how to safeguard service users from abuse and harm. This will ensure service users safety and welfare. 5 27 18 Appropriate staffing levels should be provided at all times. This will ensure service users care needs are met properly and staff are not working excessive hours. 6 38 13 All parts of the home to which service users have access to must be free from hazards. This will ensure staff and service user safety. 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 14/06/2010 14/06/2010 1 19 Improvements need to be made to some parts of the home both inside and out. Page 24 of 26 Care Homes for Older People 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 2 30 The staff induction training programme should be in line with Skills for Care which is the recognised induction training programme for staff involved in the care profession. This will ensure staff are competent in their role. 3 35 More detailed information needs to be recorded in service users financial records. These records should be regularly audited. This will minimise the risk of potential abuse. 4 36 Staff should be provided with regular formal supervision. This will give them an opportunity to develop in their role. Care Homes for Older People Page 25 of 26 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). 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