Care Home: WCS - Sycamores, The

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What the care home does well The home was pleasantly decorated, furnished and maintained and was clean and free of any offensive odour in the areas visited. The gardens were attractive and well maintained. The pictures hung throughout the communal areas included many that were reminiscent and nostalgic to the people living at the home such as old advertisement and film posters and pictures of film stars. This can be a helpful aid to those people with dementia. All residents were appropriately dressed and staff were kind and friendly. Preferred names of residents were recorded in the care file and were used by staff. From observations and discussion with residents and visitors there was further evidence that staff respected residents` privacy and dignity. Care files contained evidence of ongoing quality assurance practice. Each resident is asked a different Quality Assurance question each month and their response recorded. Further quality assurance measures were taken within the home in order to monitor the quality of the service offered by the home. One relative said that, "Mum loves them all". A resident said that she "couldn`t be looked after better" and "It`s a lovely place to live." Relatives and friends visiting on the day of the inspection and spoken with said that they were always made welcome. Observations showed that there was good interaction between visitors and the staff. All six bedrooms viewed were pleasantly decorated and furnished and contained personal possessions of the occupant. Residents and relatives confirmed that bringing in personal possessions was encouraged, and this helped residents to personalise their room. Residents said that they liked their rooms. Menus provided showed that there is a choice of meals. Residents spoken with said that they enjoyed the food, with comments such as, " The food is good", and "I always enjoy my meals." The kitchen was clean and well organised. A cleaning schedule was in place and completed by the catering staff on a daily basis, thereby maintaining a hygienic environment. The complaints records showed a proactive approach to dealing with complaints and ensuring that residents and relatives feel that their concerns were listened to. The manager advised that there continues to be 70% of the care staff with NVQ Level 2 in Care. The manager is aware of the home`s strengths and where there is room for improvement. What has improved since the last inspection? The manager of the home has completed the Registered Managers Award and therefore has the appropriate qualifications for this post. She has begun NVQ 5 training. The lounge/dining rooms on each of the three floors, and the corridors throughout the home had recently been redecorated and looked bright and attractive. New, comfortable and coordinating armchairs had been provided on the first and second floors. This gives the residents a cosy and pleasant living environment. As was required following the last inspection the manager, care manager and housekeeper hours are now recorded on a rota, which is recorded separately from rotas for other staff. All vacancies were filled at the time of the inspection following a high turn over of staff since the last inspection, agency staff only being required to cover unplanned absences such as sickness. This gives the residents continuity of care and enables team work amongst the staff group. The manager also described how she had been proactive in recruiting male care staff in order to offer personal care to residents from staff of the same gender. Three staff files were examined and all three contained the appropriate and required information including evidence of Criminal Records Bureau checks. Training other than NVQ in Care that had been undertaken in the past year included Moving and Handling, First Aid, Infection Control, Protection of Vulnerable Adults, Medication refresher training, Dealing with Behaviour Issues and Health and Safety. This gives the staff knowledge, awareness and skills required to care for and protect the people living at the home. The manager has recently introduced residents` meetings to gain further information about what residents think of, and to give them the opportunity to be involved in decisions about, the service they receive. Relatives and friends are also invited to these meetings as a notice displayed in the home showed. The manager has also recently implemented a book for people at the home to contribute suggestions and ideas to further involve residents, their friends and relatives and staff in the home. The manager advised that formal staff supervision now takes place with care staff six times a year and records in the staff files confirmed this. Staff supervision allows staff to discuss training needs, care practice and the philosophy of the home. CARE HOMES FOR OLDER PEOPLE WCS - Sycamores, The Sydenham Drive Leamington Spa Warwickshire CV31 1PB Lead Inspector Lesley Beadsworth Key Unannounced Inspection 11:00 9th March 2007 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 WCS - Sycamores, The DS0000004269.V308587.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. WCS - Sycamores, The DS0000004269.V308587.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service WCS - Sycamores, The Address Sydenham Drive Leamington Spa Warwickshire CV31 1PB 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) 01926 420964 01926 833591 Warwickshire Care Services Limited Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places WCS - Sycamores, The DS0000004269.V308587.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Manager achieves the Registered Manager`s Award (Adults) by April 2006. 13th March 2006 Date of last inspection Brief Description of the Service: The home is situated the outskirts of Leamington Spa, within a housing estate and adjacent to an industrial estate. Close by is a small parade of shops, including a post office. The Sycamores care home is managed by Warwickshire Care Services. The Sycamores is registered as a care home providing personal care to 36 older people. On the ground floor of the premises there is accommodation for ten service users. The first and second floors can be accessed by means of a shaft lift or stairs and can accommodate a further 26 service users. Each floor has a lounge/diner, which have been extended and fitted with kitchenettes. On each floor there is also one bathroom and one shower room. Leamington Spa’s main shopping centre is within five-minute bus journey; the bus stop is directly outside the home. There is limited parking space for staff and visitors to the rear and side of the home. The fees for the home are £430 per week. There are additional charges for chiropody, the optician and dentist (depending on personal finances), newspapers, toiletries and hairdressing. WCS - Sycamores, The DS0000004269.V308587.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first key inspection to The Sycamores for this inspection year. Records examined during this inspection, included, care records, staff recruitment records, training records, social activity records, staff duty rotas, health and safety records and medication records. Three residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to their families (where possible) about their experiences, looking at resident’s care files and focusing on outcomes. Additional care records were viewed where issues relating to a resident’s care needed to be confirmed. A social worker and three relatives visiting the home were also spoken with during the visit. Two questionnaires were issued to visitors and one was returned prior to the completion of this report. The comments made during the conversations and in the questionnaire are reflected in this report. The inspection process consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. This inspection took place between 11am to 8pm. What the service does well: The home was pleasantly decorated, furnished and maintained and was clean and free of any offensive odour in the areas visited. The gardens were attractive and well maintained. The pictures hung throughout the communal areas included many that were reminiscent and nostalgic to the people living at the home such as old advertisement and film posters and pictures of film stars. This can be a helpful aid to those people with dementia. All residents were appropriately dressed and staff were kind and friendly. Preferred names of residents were recorded in the care file and were used by staff. From observations and discussion with residents and visitors there was further evidence that staff respected residents’ privacy and dignity. Care files contained evidence of ongoing quality assurance practice. Each resident is asked a different Quality Assurance question each month and their response recorded. Further quality assurance measures were taken within the home in order to monitor the quality of the service offered by the home. One relative said that, “Mum loves them all”. A resident said that she “couldn’t be looked after better” and “It’s a lovely place to live.” WCS - Sycamores, The DS0000004269.V308587.R01.S.doc Version 5.2 Page 6 Relatives and friends visiting on the day of the inspection and spoken with said that they were always made welcome. Observations showed that there was good interaction between visitors and the staff. All six bedrooms viewed were pleasantly decorated and furnished and contained personal possessions of the occupant. Residents and relatives confirmed that bringing in personal possessions was encouraged, and this helped residents to personalise their room. Residents said that they liked their rooms. Menus provided showed that there is a choice of meals. Residents spoken with said that they enjoyed the food, with comments such as, “ The food is good”, and “I always enjoy my meals.” The kitchen was clean and well organised. A cleaning schedule was in place and completed by the catering staff on a daily basis, thereby maintaining a hygienic environment. The complaints records showed a proactive approach to dealing with complaints and ensuring that residents and relatives feel that their concerns were listened to. The manager advised that there continues to be 70 of the care staff with NVQ Level 2 in Care. The manager is aware of the home’s strengths and where there is room for improvement. What has improved since the last inspection? The manager of the home has completed the Registered Managers Award and therefore has the appropriate qualifications for this post. She has begun NVQ 5 training. The lounge/dining rooms on each of the three floors, and the corridors throughout the home had recently been redecorated and looked bright and attractive. New, comfortable and coordinating armchairs had been provided on the first and second floors. This gives the residents a cosy and pleasant living environment. As was required following the last inspection the manager, care manager and housekeeper hours are now recorded on a rota, which is recorded separately from rotas for other staff. All vacancies were filled at the time of the inspection following a high turn over of staff since the last inspection, agency staff only being required to cover unplanned absences such as sickness. This gives the residents continuity of care and enables team work amongst the staff group. The manager also WCS - Sycamores, The DS0000004269.V308587.R01.S.doc Version 5.2 Page 7 described how she had been proactive in recruiting male care staff in order to offer personal care to residents from staff of the same gender. Three staff files were examined and all three contained the appropriate and required information including evidence of Criminal Records Bureau checks. Training other than NVQ in Care that had been undertaken in the past year included Moving and Handling, First Aid, Infection Control, Protection of Vulnerable Adults, Medication refresher training, Dealing with Behaviour Issues and Health and Safety. This gives the staff knowledge, awareness and skills required to care for and protect the people living at the home. The manager has recently introduced residents’ meetings to gain further information about what residents think of, and to give them the opportunity to be involved in decisions about, the service they receive. Relatives and friends are also invited to these meetings as a notice displayed in the home showed. The manager has also recently implemented a book for people at the home to contribute suggestions and ideas to further involve residents, their friends and relatives and staff in the home. The manager advised that formal staff supervision now takes place with care staff six times a year and records in the staff files confirmed this. Staff supervision allows staff to discuss training needs, care practice and the philosophy of the home. What they could do better: The care files examined covered all areas of need in the assessments but some statements requiring a score were not sufficiently specific and did not always identify the need of the resident. The complexity of the assessment form could result in staff, especially new or temporary staff, finding it difficult to extract necessary information. There was no evidence that assessments are reviewed or updated thereby creating the risk of needs being overlooked. Notices regarding personal care were displayed in one of the communal toilets. These impinge on the dignity of the residents and gave an institutional appearance. Disposable gloves and aprons used for protection against cross infection were stored indiscreetly in this toilet and added to an institutional appearance. Discussion with the manager, relatives and residents indicated that there is insufficient activity or occupation taking place to offer adequate stimulation to the people living at the home. The home does not have a designated activity coordinator and therefore any activities are organised by the care staff, although one relative described some of the activities that she had also initiated to entertain residents. One resident spoken with said that she would like someone to take her out sometimes. The manager took one resident to the WCS - Sycamores, The DS0000004269.V308587.R01.S.doc Version 5.2 Page 8 shops during the inspection, which suggested that there are opportunities for trips out. One care plan included instructions from a resident’s family for the home to stop a relative from visiting. The manager needs to be confident that this is also the wish of the resident and their wishes must be recorded. One relative felt that there was not sufficient choice for people with diabetes. Whilst the manager advised that there are several choices offered verbally, these choices are not included in the written menu, thereby not adequately advising the relevant residents or relatives. Residents were seen to be using plastic beakers for cold drinks. Some of these had become ‘cloudy’ and crazed/cracked. Plastic beakers are not considered to be age appropriate and should not be used unless a risk assessment or care plan suggests a reason that individual residents need them. The damaged beakers need to be disposed of. Given that the accommodation is over three floors and considering the needs of the current residents the registered persons need to assess the adequacy of two care staff during the night. The manager had not completed the registration process but an application had been submitted to the Commission. The Registered Provider is required to undertake monthly and unannounced monitoring visits to the Home and provide a written report of this visit to the manager and the Commission. These reports are seen as an important way to demonstrate a commitment to quality assurance and the service given at the home. No reports have been received recently. 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. WCS - Sycamores, The DS0000004269.V308587.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection WCS - Sycamores, The DS0000004269.V308587.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. People’s needs are assessed with regard to their move into the home with some shortfall in the assessment format used. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care files were examined as part of the case tracking process. All three contained pre-admission assessments and care plans that had been devised from the information from these and, where appropriate, assessments and care plans provided by the referring social work team. It was not clear if prospective residents had been informed of the outcome of a pre-admission assessment. The assessment format used in the home was a comprehensive and complex system that relies on the scoring of each need area, similar to tick boxes, to identify the needs the resident. The information is then converted into a “traffic light” dependency care plan, with red, amber and green sections to be competed accordingly. The care files examined covered all areas of need in the assessment but some statements requiring a score were not sufficiently WCS - Sycamores, The DS0000004269.V308587.R01.S.doc Version 5.2 Page 11 specific and did not always identify the need of the resident, for example, “Medication managed by self or staff” did not inform staff which of these applied and the same score was reached whether the resident required assistance with medication or not. The complexity of the assessment form could result in staff, especially new or temporary staff, finding it difficult to extract necessary information. There was no evidence that assessments are reviewed or updated which could result in unidentified or unrecorded residents’ needs not being met. Although there are currently no residents at the home with specific religious or cultural needs discussion with the manager demonstrated that the appropriate considerations and action would be taken. WCS - Sycamores, The DS0000004269.V308587.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All care files contained a care plan but with a shortfall in detail and update and in event recording. Residents are cared for in a respectful manner. EVIDENCE: The manager advised that some progress had been made with the care plans, with all the residents on the ground floor having completed care plans. However she stated that care plans of residents on the other two floors continued to need more attention. This was confirmed on looking at care files from the three floors. All three care files looked at contained a care plan devised from the home’s, and where appropriate, care management’s assessments. The care plan format was similar in style to the assessment with how needs were to be met based on a tick box-type scoring process. Any need identified in the assessment as high input/care were related to statements in the red area of the care plan; amber and green areas of the care plan contained statements identifying less input by staff. WCS - Sycamores, The DS0000004269.V308587.R01.S.doc Version 5.2 Page 13 It was seen that two of the three care plans did not reflect changes in the residents needs. Both residents had sustained fractures. There was no evidence of these on their care plans or of the changes in care required as a result of the fractures, including pain relief, mobility, seating and transfer arrangements and personal hygiene needs. One of these residents was seen to have foot care problems and her visitor confirmed this. There was no reference to this in the care plan. Statements such as “limited assistance” in the care plan statements did not inform staff of the type of assistance required As with the assessments, care plans were complex. Although comprehensive and containing a great deal of detail it could be difficult for care staff to extract the necessary information to meet the needs of the residents and the manager advised that staff take some time to get used to them. This would create particular difficulties for temporary and new staff. There is no evidence in the care plans to show that residents and/or their representative have been involved with drawing them up or with the reviews, although the manager said that care staff involve the residents by discussing their needs with them. One of the relatives spoken with during the visit said that she had not been involved in any care plans and residents spoken with were not able to recall any involvement. Two of the three care plans had not been reviewed for two months. The manager advised that she audits care plan documentation, although records were not viewed on this occasion. Records are not completed on a daily basis. The manager advised that the organisation has ‘diary entries’ that are completed only when an ‘event’ takes place. The case files looked at contained brief notes, with little or no reference to the care plans. A bathing register in each care file indicated when a resident had had a bath or shower but no information regarding personal care needs on the days this was not taken, particularly relevant to a resident unable to bathe due to a fracture; another resident, whose final review regarding the placement at The Sycamores took place on the day of the inspection, had had no diary events added to her care file for ten days beforehand therefore no up to date record was available regarding her settling into the home or whether her needs could be met; no entries had been made in one care file for a three day period which included the day the resident had sustained a fracture, the first reference to it being the return from hospital. Two of the three care files contained a detailed life history including details of the residents preferred daily routine such as time of getting up, going to bed, and hobbies enjoyed. A summary of retained skills and abilities was also recorded in these two files. The third file belonged to a recently admitted resident. Evidence was available in care files, the pre-inspection questionnaire and discussion with the manager and relatives to demonstrate those residents’ WCS - Sycamores, The DS0000004269.V308587.R01.S.doc Version 5.2 Page 14 ongoing health needs were being met by visits to/by dentists, chiropodists, GP, District Nurse, Community Psychiatric Nurse and optician. Care files contained evidence of ongoing quality assurance practice. Each resident is asked a different Quality Assurance question each month and their response recorded. Care files looked at contained records of assessment of pressure sore risk in order to identify risk and prevent the occurrence of pressure sores. Nutritional assessments were also present in the care files with residents being weighed at monthly intervals. The manager advised that currently medication audits are carried out at weekly intervals to ensure the correct stock is available. However these do not include staff drug audits to ascertain the competence of individual staff members. There is a medication room and medication trolley on each floor and medications are kept securely. Medication Administration Record Sheets were examined and no inappropriate gaps were seen. The systems in place were discussed. Records are kept of receipt and disposal of medication. Storage was not fully assessed on this occasion. Time was spent observing care staff in their care delivery and staff/residents interaction. All residents were appropriately dressed and residents were cared for in a respectful manner and staff were kind and friendly. From observations and discussion with residents and visitors there was evidence that staff also respected residents’ privacy and dignity. Preferred names were recorded in the care file and were used by staff. One relative said that, “Mum loves them all”. A resident said that she “couldn’t be looked after better” and “It’s a lovely place to live.” Notices regarding personal care were displayed in one of the communal toilets. These impinged on the dignity of the residents and gave an institutional appearance. Disposable gloves and aprons used for protection against cross infection were stored indiscreetly in this toilet and also added to an institutional appearance. Some residents take advantage of having a telephone installed in their room with responsibility for any costs incurred. WCS - Sycamores, The DS0000004269.V308587.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. 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. There is insufficient activity to stimulate the residents, which could be improved by having designated activity coordinator. People living at the home are able to make some choices in their daily lives. Residents enjoy the food provided. EVIDENCE: Discussion with the manager, relatives and residents showed that there is insufficient activity or occupation taking place to offer adequate stimulation to the people living at the home. The home does not have a designated activity coordinator and therefore any activities are organised mainly by the care staff, although one relative described some of the activities that she had initiated to entertain residents. One resident spoken with said that she would like someone to take her out sometimes, although other people spoken with said that residents go out sometimes. The manager took a resident to the shops during the inspection. During the day of the inspection there were several relatives, friends and social workers visiting the people living at the home. Those spoken with said that they were always made welcome and staff were seen to interact well with them. The manager said that there were no restrictions to visiting other than those imposed by the residents. However one care plan included instructions WCS - Sycamores, The DS0000004269.V308587.R01.S.doc Version 5.2 Page 16 from family to stop a relative from visiting one of the residents. The manager needs to be clear that this is also the wish of the resident and that their wishes are recorded. All six bedrooms viewed contained personal possessions of the occupant and residents and relatives confirmed that bringing in personal possessions was encouraged. Care plans and discussion with the manager indicated that times of getting up and going to bed was at the choice of each resident. However this was not clear following discussion with residents as responses were vague. Menus provided showed that there is a choice of meals. Residents spoken with said that they enjoyed the food, with comments such as, “ The food is good”, and “I always enjoy my meals.” One relative felt that there was not sufficient choice for people with diabetes. Whilst the manager advised that there are several choices verbally offered to people with diabetes, these choices are not included in the written menu, thereby not adequately advising the relevant residents or relatives. Each of the three floors in the home has an attractive dining area off the lounge with an attached kitchenette. There is not sufficient seating if all residents chose to eat in the dining rooms but several residents preferred to take their meals in their bedrooms and this was confirmed during discussion with some of them. Residents were seen to be using plastic beakers for cold drinks. Some of these had become ‘cloudy’ and crazed/cracked. Plastic beakers are not considered to be age appropriate unless a risk assessment or care plan suggests a reason that individual residents need them. The damaged beakers need to be disposed of. The kitchen was clean and well organised although some of the roasting and cake tins were past their best. The manager advised that new ones were currently being costed. It was also noted that sacks of potatoes were stored directly on the floor. All food needs to be stored off the floor to prevent contamination. Food was stored appropriately and fridge and freezer temperatures were taken and recorded. Temperatures of cooked food were also taken and recorded and were within acceptable levels. A cleaning schedule was in place and completed by the catering staff on a daily basis, thereby maintaining a hygienic environment. WCS - Sycamores, The DS0000004269.V308587.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. The home has a proactive approach to dealing with complaints and staff know how to recognise and report suspicions of abuse so that people are properly protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a complaints procedure that was clearly written and with appropriate timescales. The records showed that the home had received six complaints since the last inspection. These were recorded in the complaints register and the action taken and outcome were also recorded. Concerns included medication errors and inappropriate verbal interaction from staff to residents. Where these had been substantiated appropriate disciplinary and adult protection action had been taken. The complaints records showed a proactive approach to dealing with concerns and ensuring that residents and relatives feel that they were listened to. However one relative said that she had not been told the outcome of one complaint made about her relative’s care to the organisation. Examination of records and discussion with the manager showed that well managed investigations following two incidents had taken place since the last inspection, resulting in the referral of two members of staff to the Protection of Vulnerable Adults register Some of the staff had undertaken training related to vulnerable adults or adult protection and staff spoken with evidenced that they knew what adult abuse WCS - Sycamores, The DS0000004269.V308587.R01.S.doc Version 5.2 Page 18 was and what to do about any suspicion or allegation of abuse to a resident. This training needs to be taken by all staff to ensure that they have the appropriate knowledge to recognise and protect residents from abuse. WCS - Sycamores, The DS0000004269.V308587.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 26 Quality in this outcome area is good. The service provides safe, wellmaintained, comfortable and pleasant indoor and outdoor surroundings This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was pleasantly decorated, furnished and maintained and was clean and free of any offensive odour in the areas visited. The manager advised that there was a plan for maintenance, redecoration and refurbishment but this was not examined on this occasion. A décor and furniture audit was due to be carried out by the organisation in order to prioritise any further improvements. The gardens were attractive and well maintained. Pictures hung throughout the communal areas included many that were reminiscent and nostalgic to the people living at the home such as old advert and film posters and pictures of film stars. WCS - Sycamores, The DS0000004269.V308587.R01.S.doc Version 5.2 Page 20 The latest fire service inspection report was made available and was satisfactory. Other fire prevention records were in good order but not all staff have undertaken fire training to give them the awareness required in the event of a fire in the home. The lounge/dining room on each of the three floors, and the corridors throughout the home had recently been redecorated and looked light and attractive. New, comfortable and coordinating armchairs had been provided on the first and second floors. One communal shower/toilet room did not have soap or towels for hand washing purposes for both staff and residents. The manager said that she would address this. All other communal toilets viewed had soap dispensers and disposable towels to enable staff and residents to maintain infection control. Suitable protective clothing was readily available for staff to use in order to prevent cross infection. The laundry area met the requirements for infection control with a clear ‘dirty to clean’ procedure to prevent contamination. Washing machines had the appropriate programmes. Sluicing facilities were available in the home. WCS - Sycamores, The DS0000004269.V308587.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care staff have achieved the appropriate qualification for their role. The recruitment procedure is sufficiently robust to protect the people living in the home EVIDENCE: Discussion with the manager and examination of the pre-inspection questionnaire indicated that there has been a big turnover of staff and thus the need for high use agency staff since the last inspection. The manager advised that the recruitment and replacement of appropriate staff had been a major concern and therefore a priority for her throughout the year. As a result all vacancies were filled at the time of the inspection, agency staff only being required to cover unplanned absences such as sickness. This gives the residents continuity of care and enables team work amongst the staff group. The care manager had also recently been replaced and a new housekeeper was due to commence employment the week following the visit. The manager also described how she had been proactive in recruiting male care staff in order to offer personal care to residents from staff of the same gender. Relatives spoke and wrote in the questionnaire of their concerns about the staffing levels and of long-term staff having left the home. The manager had looked at the reasons for staff leaving and her explanations appeared satisfactory and in keeping with records examined. Rotas looked at, and WCS - Sycamores, The DS0000004269.V308587.R01.S.doc Version 5.2 Page 22 discussion showed, that there are six care staff on duty throughout the day and two during the night from 10pm to 8am. The manager felt that there were sufficient staff for the current number and needs of residents and for the layout of the building but following comments made by relatives discussion took place regarding the number of staff during the night. Given that the accommodation is over three floors and the needs of the current residents the registered persons need to demonstrate that two care staff during the night are sufficient. As was required following the last inspection the manager, care manager and housekeeper hours are now recorded on a rota, which is separate from the rota for other staff. Three staff files were examined and all three contained the appropriate and required information including evidence of Criminal Records Bureau checks demonstrating that the recruitment procedure protects residents from the employment of inappropriate staff at the home. The original Criminal Records Bureau disclosures are kept at the central office of the organisation. One member of staff had only been at the home for a short time. A satisfactory Protection of Vulnerable Adults First check had been received before she started her employment and the manager confirmed that she would be supervised until the full Criminal Records Bureau disclosure had been received. This was further evidenced by a risk assessment in her file and observations made of her work during the visit. Files of recently appointed staff also included evidence of Induction training having been undertaken. A visitor spoken with said about the staff that her relative “loves them all” and, “there’s some really lovely care”. The manager advised that there continues to be 70 of the care staff with NVQ Level 2 in Care. Other training that has been undertaken, in addition to induction training by new staff by some staff in the past year includes, Moving and Handling, First Aid, Infection Control, Protection of Vulnerable Adults, Medication refresher training, Dealing with Behaviour Issues and Health and Safety; there has been no training in Food Hygiene. All staff must have received up to date training in these Health and Safety areas in order to ensure that the health and safety of residents and staff is protected. A few members of staff have undertaken training in specialist needs such as Diabetes and Continence and catheter care. The home has a resident with specific mental health needs but staff have not undertaken related training creating the risk of her needs not being met. At the time of the inspection continuing care was providing one to one support to her for part of the waking day following recent changes in her state of health. WCS - Sycamores, The DS0000004269.V308587.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is managed by a person who has appropriate experience and qualifications and in a manner that includes the views of the people living and working there. The health and safety of the residents and staff is in the main protected but this is limited due to not all staff having undertaken relevant training. EVIDENCE: The manager of the home has completed the Registered Managers Award and therefore has the appropriate qualifications for this post. She has begun NVQ 5 training. She not yet completed the registration process but an application has now been submitted to the Commission. She had been at the home for just over a year and has previous experience of managing homes for older people. The manager is aware of the home’s strengths and where there is room for improvement. A care manager responsible for care, and a housekeeper WCS - Sycamores, The DS0000004269.V308587.R01.S.doc Version 5.2 Page 24 responsible health and safety and environment issues support her as part of the management team. The new housekeeper was due to commence employment the following week but the main health and safety checks had been carried out with the help of a housekeeper from another home in the organisation in the meantime. Social workers spoken with made positive comments about the home and the way in which it was managed. The home continues to have a Quality Assurance programme, which includes, housekeeping, medication, food safety, and care plan audits in order to ensure that practice is in line with the expected standards. These records were not examined at this visit. Each care file looked at evidenced that a quality assurance question is asked of residents each month in order to gain feedback on the service they receive. The manager has recently introduced residents’ meetings to gain further information about what residents think of, and to give them the opportunity to be involved in, the service they receive. Relatives and friends are also invited to these meetings as a notice displayed in the home showed. The manager has also recently implemented a book for people at the home to contribute suggestions and ideas to further involve people in the home and to get feedback on the service. The Registered Provider is required to undertake monthly and unannounced monitoring visits to the Home and provide a written report of this visit to the manager and the Commission. These reports are seen as an important way to demonstrate a commitment to quality assurance and the service given at the home. No reports have been received recently. The Home’s administrator is responsible for handling all finances and records regarding resident’s personal allowance. These were not examined at this visit. The manager advised that formal staff supervision takes place with all care staff six times a year and records in the staff files looked at confirmed this. Staff supervision allows staff to discuss training needs, care practice and the philosophy of the home. Fire prevention records were looked at and were in good order apart from fire training for staff working at the home. This had not taken place since 2005 other than during induction training for new staff. Fire alarm testing was carried out weekly and fire drills every three months. Following each fire drill the housekeeper completes a report as to the how the drill was carried out. It would be useful if staff attending signed the report to demonstrate that they participated. Emergency lights were tested monthly and were serviced six monthly. However the records regarding the most recent service was not available. Not all staff have undertaken fire training to have the knowledge and WCS - Sycamores, The DS0000004269.V308587.R01.S.doc Version 5.2 Page 25 awareness necessary to prevent risk of fire or how to respond in the event of a fire at the home. Maintenance records were made available. Those looked at showed that the hoist and passenger lift services were up to date and serviced appropriately. Portable electrical appliance testing was carried out in July 2006. WCS - Sycamores, The DS0000004269.V308587.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X 3 X 2 WCS - Sycamores, The DS0000004269.V308587.R01.S.doc Version 5.2 Page 27 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 OP3 Regulation 14(2) Requirement The manager must ensure that information is easily accessible from assessment records and that they are reviewed and revised as necessary. Care plans must be up to date and reflect the current needs of individual residents. These must be reviewed monthly as a minimum with evidence to demonstrate that residents an/or their representatives have been involved in the care planning process. (Outstanding since17/04/06) Daily records should be linked to care plans and demonstrate the actions that staff are taking to deliver the prescribed care. (Outstanding since 17/04/06) 4. OP12 12,16 Evidence must be available to demonstrate that activities take place that are suited to the wants and needs of residents. DS0000004269.V308587.R01.S.doc Timescale for action 23/04/07 2. OP7 15 23/04/07 3. OP7 15 23/04/07 23/05/07 WCS - Sycamores, The Version 5.2 Page 28 5. OP13 12 6. OP27 18 (Outstanding since 17/04/06) The manager must ensure that 23/04/07 any restrictions imposed on who visits are in accordance with the wishes of the resident and that these wishes are recorded. The registered person need to 23/05/07 demonstrate that there are sufficient night care staff to meet the assessed needs of the residents and to suit the size and layout of the building. Any appropriate action must be taken. (Outstanding since 17/04/06) The registered person must ensure that staff have the appropriate training to meet the specialist needs of residents including training related to mental health. The registered manager must ensure that staff undertake up to date training related to health and safety practice. A copy of the training plan should be forwarded to the Commission for Social Care Inspection. 23/06/07 7. OP30 14,18 8. OP38 13,16, 23 23/05/07 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 OP10 Good Practice Recommendations The registered manager must ensure that notices in private or communal areas do not compromise the dignity of the people living at the home. DS0000004269.V308587.R01.S.doc Version 5.2 Page 29 WCS - Sycamores, The 2. 3. 4. OP10 OP18 OP33 Drinking ware should be age related to respected adults unless an individual’s risk assessment suggests otherwise. All damaged A whistle blowing procedure should be available to enable staff to report poor practice The registered provider or representative should make an unannounced visit to the home on a monthly basis and provide the manager and the Commission with a written report. WCS - Sycamores, The DS0000004269.V308587.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI WCS - Sycamores, The DS0000004269.V308587.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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