Inspection on 11/12/09 for Sainthill House

This is the latest available inspection report for this service, carried out on 11th December 2009.

CQC found this care home to be providing an Good service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 11/04/2010.

Key inspection report Care homes for older people Name: Address: Sainthill House Sainthill House Cowick Lane Exeter Devon EX2 9JG     The quality rating for this care home is:   two star good 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: Michelle Oliver     Date: 1 1 1 2 2 0 0 9 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 36 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Sainthill House Sainthill House Cowick Lane Exeter Devon EX2 9JG 0 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Vision Uk Name of registered manager (if applicable) Type of registration: Number of places registered: care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 12. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Sainthill House is a care home providing personal care to a maximum of 12 older people who may also have a physical disability. It is a large detached, extended property, standing in its own grounds on the outskirts of Exeter. Bedroom accommodation is provided on the ground and first floor and a sitting room and a dining room on the ground floor. Local G.P and community nursing services serve the Care Homes for Older People Page 4 of 36 Over 65 12 0 Brief description of the care home home. The service also comprises a cottage, Sainthill Cottage, which is attached to Sainthill House. Sainthill cottage is registered to provide care and accommodation for up to 5 younger people who have a learning disability. Accommodation includes 5 single rooms, 2 on the ground and 3 on the first floor,all equipped with ensuite facilities, a kitchen, dining area and lounge on the ground floor. There is also an office on the first floor. Care Homes for Older People Page 5 of 36 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: two star good 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: This inspection was unannounced and took place on Friday 12th December 2009 over a period of 9 hours. The managers of Sainthill House and Sainthill Cottage were present during the inspection of the services. During the inspection plans of care for a total of 7 people living at Sainthill House and Cottage, were looked at in detail. This helps us to understand the experiences of people using the service. A number of other people were met and spoke with during the course of the day. A considerable time was also spent observing the care and attention give by staff. Several staff were spoken with during the day, including care staff and the manager. Prior to the inspection questionnaires were sent to 10 people living at Sainthill house, 4 people living at Sainthill Cottage, 6 staff, 5 health care professional and 3 care Care Homes for Older People Page 6 of 36 manager to obtain their views of the service provided.We received responses from 2 members of staff. During the inspection we toured the premises and a sample number of records were inspected including care plans, medication records, staff recruitment files, and a record of accidents. Care Homes for Older People Page 7 of 36 What the care home does well: People who are considering making either Sainthill house or Sainthill Cottage their home, and their relatives/representatives, are given good information about the home before any decision to move in is made. A representative from the home will also carry out an assessment of individual health and social care needs before anyone is admitted to the home to ensure their needs can be met. People are also invited and encouraged to visit the home, meet others living there and staff before making a decision. People spoken to during the inspection talked about the process of choosing and moving into the service, and although few could recall the procedure they all expressed complete satisfaction with the outcome. The home has drawn up care plans covering aspects of care needs. Risk assessments have also been drawn up on aspects of health and personal care and clearly show how the home identifies potential health risks and puts preventative measures in place. The home has good links with all relevant health professionals and treatment has been provided where needed. Medications are stored safely and only experienced staff carry out the administration. Records of medicines administered have been generally well maintained. [ see what the service could do better] People expressed complete satisfaction in the way they are treated by the staff and confirmed that their privacy is respected at all times. The staff assisted people in a friendly, caring and respectful manner. People talked about how they are able to lead their lives just as they want, without unnecessary rules or restrictions. The home provides a range of activities to suit peoples interests. Arrangements are in place to ensure family and friends are made welcome at all times and are kept informed and involved in the daily life of the home. People praised the standard of meals provided. The home has a range of policies and procedures and staff have been given training and instruction on the policies to ensure they are followed correctly. People living at the home can feel confident that complaints and concerns will be addressed promptly and a satisfactory outcome reached. All areas of the home are clean, fresh safe and hygienic. Staff are competent and deliver care in a safe manner. There is an open and positive atmosphere throughout the home. Systems are in place to safeguard the health and safety of those living at the home Care Homes for Older People Page 8 of 36 and staff. Comments from 2 staff who responded to surveys included Vision UK are trying very hard with improvements theyre doing;when they are done I think the clients will really benefit from the changes and another I enjoy working at Sainthill. It is very friendly and feels like a real home. everyone cares about everybody else. I like the new rooms. In response to what does the home do well comments included Training, looks after the clients, looks after the staff, we enjoy working in a nice environment, good food, improving the rooms for residents and another care for our clients in a homely and friendly environment and good home cooking in a relaxed atmosphere. What has improved since the last inspection? What they could do better: No requirements have been made following this inspection. Recommendations for good practice have been made. The Statement of Purpose should include details of staff qualifications and experience of staff working at the home and the Service User Guide, and complaints procedure should include contact details of the CQC, to ensure that people considering making Sainthill their home are provided with accurate information. Continued improvement to care planning will further ensure that peoples individual health needs are met, monitored and reviewed and assessment of risks presented by the use of bed rails should be assessed before they are used for individuals. All staff should comply with the services policies and procedures in relation to recording of medication and records of all medications leaving the home should be maintained. A procedure for ensuring that creams/ointments/lotions when opened are not used past their shelf life should be developed and when prescriptions are hand written on medication records by staff this should always be checked and signed by two to promote accuracy and safety. The service should continue with plans to introduce a more varied choice of activities at the home. Although no complaints have been made directly to the service prior to this inspection, arrangements should be made for the recording of complaints, actions taken and outcomes. Arrangements should be in place to ensure that sufficient staff are available at all times to meet peoples needs. Care Homes for Older People Page 9 of 36 The service should continue with plans to provide appropriate training to all staff. The service should develop a quality assurance monitoring system to ensure that people living at the service have a say in the running of the home and the outcome of surveys should then be made available to interested parties. 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 10 of 36 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 11 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering moving to Sainthill are provided with sufficient information to enable them to make an informed choice. The service does not admit people who require intermediate care. Evidence: The service has developed a Statement of Purpose and a Service User guide to provide people considering making Sainthill their home with information to enable them to make a choice. We were told that the service is intending to further develop its Service User Guide, to include pictures, to make it easier for some people to understand. The Statement of Purpose included information that indicated 3 care staff are on duty during the morning; however it did not make clear that one of the care staff undertook cooking duties. We were told that the service is due to employ a cook when Care Homes for Older People Page 12 of 36 Evidence: an extension, which will include a dining room and a kitchen, has been completed. Also the Statement of Purpose did not include details of qualifications and experience of staff employed at the home. The Service User did not include details of the Care Quality Commission to enable people to contact us if they wish. We spoke to a person who had recently been admitted to the home. They told us they had been provided with sufficient information about Sainthill to enable them to make a choice. The manager and one of the directors also visited them, told them about the home in order to make the move easier. They told us the move to the home had been successful and that they were happy living there. None of the other people we spoke to could recall their admission to Sainthill. The manager told us the service has a policy and procedure for admissions to the service. This includes providing people with written information, visiting them at home or in hospital, undertaking an assessment of their individual health and social care needs and inviting them to visit Sainthill, meet other residents and have a meal. The service does not admit people who need intermediate care. Care Homes for Older People Page 13 of 36 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the service benefit from their health and social care needs being met. Continued improvement to, and review of, care plans will ensure that staff are provided with information relating to acute needs to ensure they will be monitored. Evidence: All people living at Sainthill have individual files that include information relating to the admission, assessments of their health and social care needs, assessments of risks and care plans. We looked at 6 care plans during this inspection. All plans were generally informative and staff confirmed the plans enabled them to meet the assessed needs of people living at the home. Care plans are the end point of the assessment of the persons health and social care needs and should show what care must be delivered in accordance with the service user plan for that individual. The plan becomes the yardstick for judging whether Care Homes for Older People Page 14 of 36 Evidence: appropriate care is delivered to the individual and will reflect changes as regular assessment of the person shows changing needs. Care plans at the service are developed from the initial assessment of needs undertaken prior to admission. A further assessment is undertaken throughout the first 72 hours of moving to the home. We looked at one 72 hour assessment and noted that staff had recorded that a person was concerned the bed and chair provided in their room were too low for the person to stand easily from a sitting position. We later spoke to this person and they confirmed that their bed was too small. Details of a referral to an occupational therapist to assess the person in relation to the best height for their bed and chair to be had been made. Care plans were generally informative and included details of individual needs of people but did not include details of what a person could actually do for themselves and chose to continue to do to retain their independence or what their aims or goals were. For example one person had been assessed as not being independent with personal hygiene, however no details of what they could do for themselves, if anything, had been recorded.The person told us they were able to do some things for themselves. Although plans of how health and social care needs had been developed plans had not been undertaken when some changes had taken place. For example, staff had noted a change in the condition of a persons skin, a district nurse had been asked to visit the person to assess and treat. However no plan of care that staff at Sainthill were to deliver or observations to be recorded had been undertaken. Another care plan we looked at was comprehensive, person centred and written in a format that could be easily understood by the person. Details included potential side effects of medication taken by the person, however the side effect had not been monitored. Staff told us they were aware of the side effect and although not recorded this was monitored. There was no evidence to suggest that this care plan had been reviewed to enable staff, and the person, to be aware of any changes in the persons general well being or Care Homes for Older People Page 15 of 36 Evidence: needs. Once again, staff described care needs and strengths of this person and it was evident staff closely monitor individual health and social care needs. We were told that plans of care are reviewed regularly; however there was no evidence that people are involved in this review of their care. Those people spoken to could not remember being involved in this but were confident that they are well cared for and their needs are met by the home. Assessment of potential risks to people living at the home is undertaken as part of the care planning process and kept under review. This includes the risks of falling and nutrition. During this inspection we noted that bed rails were being used on two beds to prevent people from the risk of falling. However, no assessments of the risks presented by the rails, such as entrapment. risk of injury to limbs, had been undertaken. People benefit from regular opportunities to make their changing needs known. Staff confirmed this when they told us that people speak openly to staff and staff have good communication with all those living at the home and with members of management to whom they report any concerns. The home monitors peoples dental and optician checks and chiropodists are used according to peoples needs. During this visit a person was asked to attend an appointment at very short notice. Transport was arranged quickly to enable the person to attend this appointment. This means that they benefit from the involvement of health care professionals to ensure that health care needs are met. Medication is generally well managed at the home. Medicines are stored securely and records were generally accurate, up to date and indicated that medication is generally appropriately administered. We noted that not all hand written prescriptions are signed by two members of staff to confirm accuracy. Although we were told that all medication that is no longer required at the home is returned to a local pharmacy the home did not have a record of this. Medication is securely stored at the service, in a locked cabinet in a room that is locked when not in use. We checked the medication charts for the people we case tracked against the actual number of medications to check accuracy. We found that some medicines had not been given as they remained in the original packaging, although the medication records indicated that they had been given. This means that Care Homes for Older People Page 16 of 36 Evidence: there is a potential risk of people not receiving medication as prescribed. During this inspection we noted that a dosage of medication had been increased for a person. However, there was no evidence of additional medication received at the service to enable the increased dose to be administered, which the medication record indicated had been undertaken. We saw several containers of creams/ ointments in individual rooms, which were being used. No indication of the date of either opening or expiry had been recorded. This means that creams/ointments are at risk of being used beyond their shelf life. We were told that the service is working towards providing lockable medicine cupboards in each room and that people who express a wish to, and are assessed as competent to do so, will be encouraged and supported to look after their own medicines. People living at Sainthill told us their privacy was respected and we saw staff knocking on doors and waiting to be invited in before doing so and offering personal care in a discreet manner. Care Homes for Older People Page 17 of 36 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. People benefit from flexible routines at the home and from being supported to exercise control over their daily lives. Social activities generally meet peoples expectations and preferences and people enjoy a balanced diet which takes into account the likes and dislikes of individuals. People benefit from being encouraged and supported to maintain contact with family and friends. Evidence: People living at Sainthill told us they are encouraged and supported to live their lives as they wish. When we arrived at the home at 09:30 several people were still in bed, and told us this was their choice and others had been assisted to sit out in their room to have breakfast. The service employs an activities coordinator who works with people living at the home three days each week and who, we were told, takes people out to do anything Care Homes for Older People Page 18 of 36 Evidence: they like. We were told that the coordinator is due to complete a monthly plan of activities but this had not been completed at the time of this inspection. This means that when complete people will be made aware of activities that are available on a daily basis. We asked staff how they ensure that people who choose to stay in their rooms do not become socially isolated. Staff told us those people are offered hand massages, time spent with staff on a 1:1 basis, the service has a house cat which some people enjoy visits from and pets are also brought into the home. Staff confirmed that people are encouraged to continue with hobbies and interests they had before making Sainthill their home and recently some people enjoyed taking part in an art class. We spoke to a person who had recently moved to Sainthill, who chose to spend time in their room. They told us they do not feel isolated and prefer to stay in their room to read or listen to music. They said they felt secure as they could ring for assistance when needed and staff look in on them regularly. We looked at the care plan for this person and noted that they do take part in social activities including a recent trip out, attending a birthday party and also details of activities they had chosen not to take part in. Information received from the service prior to this inspection states the service would like to offer a wider range of activities, however this involves working with residents over a long period of time and understanding their needs. The service has introduced personal profiles for each resident to enable staff to know people living at the service and their interests and plans to expand upon the range of activities offered at Sainthill. During this inspection we looked at information for 4 people currently living at Sainthill and saw that staff had begun to gather this information. We spoke to some people who told us they are taken to Exeter shopping, and one person who undertakes voluntary work. We were told that additional staff are brought in to the home for some people who have 1:1 time allocated for activities. The service has the use of a mini bus which is shared between Sainthill and another service owned by Vision UK Ltd. During this inspection transport was arranged to take a person to an appointment. Care Homes for Older People Page 19 of 36 Evidence: The home has an open door policy and relatives, visitors and friends are welcome at any time, made to feel welcome and have a meal if they wish. People are given the choice of being served their meals either in their rooms or in the comfortable dining room. Lunch served during this inspection was well presented and nutritious. Staff asks each person living at the home what they would like for lunch and are given a choice of main meal. Staff supported people, needing assistance with eating, sensitively and discreetly. Comments about the food provided included food is very good. All meals are cooked on the premises and use mainly fresh ingredients. Hot and cold drinks are available throughout the day. At the time of this inspection the service did not employ a cook; one of the 3 care staff on duty at the home throughout the morning undertakes the preparation of meals served at the home. During this visit we noted that this member of staff was not only preparing a meal but also undertook a caring role. For example we noted they were assisting a person living at the home with personal care and also gave out medications. We discussed this with one of the Directors who told us that when the dining room and kitchen extension are completed the service will be employing a cook. We asked staff how they prevent people who prefer to stay in their room from the risk of social isolation. We were told that staff visit them frequently, talk to them about daily events, their interests and tell them what activities are taking place so that they may change their minds. During this inspection we saw care staff visiting people who preferred to spend time in their rooms to make sure they were comfortable and did not need anything. All rooms have a nurse call system, which means that people can call for staff when they wish. Several people spoke about how their relatives/ visitors are made to feel welcome at the home. Visitors are offered drinks and are made to feel at home. We looked at the visitors book and it was clear that many people received visitors and they came at Care Homes for Older People Page 20 of 36 Evidence: different times of the day. People moving into Sainthill are encouraged to bring personal possessions and small items of furniture with them to make their rooms feel homely and this is agreed before admission. All of the rooms seen during this inspection were personalised and people spoke about the pleasure having their own things around them gave them. Most of the people spoken to during this inspection said that the food served was very good. People living at Sainthill are offered a choice of meals at each meal. People can choose to have their meals in the dining room or in their rooms if they wish. The meal served during the day of this inspection was well presented, hot and nutritious. i. Care Homes for Older People Page 21 of 36 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. The home has a satisfactory complaints procedure. Staff are aware of the procedure to follow to protect people from abuse or harm. Evidence: The service has introduced a complaints procedure, which includes timescales for investigating complaints, is prominently displayed for all those living at the Home and visitors to see and is included in the homes statement of purpose. However, details need to be updated to include information relating to contact details for the Care Quality Commission, if they choose not to make the complaint to the service in the first instance. We were told the service documents any complaints and regularly review their processes and had not received any complaints within the last 6 months, since Vision UK Ltd have taken over the service. The service has not yet developed a system for recording complaints, investigations undertaken and outcomes. The manager told us all complaints would be taken seriously and acted upon and a record would be kept of all actions taken. All people we spoke to during this inspection told us they would feel comfortable making a complaint if they were unhappy about anything at the home and that they knew who to speak to if unhappy. Care Homes for Older People Page 22 of 36 Evidence: Both staff who responded to surveys confirmed they knew what to do if anyone was unhappy about anything at the home. Information provided by the service prior to this inspection states it has introduced safeguarding policies and the service plans to provide more training for staff in safeguarding adults. Staff we spoke to during this inspection were able to describe what would constitute poor practice. Staff were also aware of the homes whistle blowing policy and told us they would not hesitate to report any concerns they had if they witnessed or suspected poor practice. All those living at Sainthill, who we spoke to during this inspection, confirmed they are well cared for and felt safe living at Sainthill. Care Homes for Older People Page 23 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the service benefit from doing so in a well maintained, comfortable, hygienic, fresh environment, which they can personalise to make it their home. Evidence: Sainthill House is registered to provide care and accommodation for up to 12 older people. In November 2009 Vision UK Ltd made an application to the CQC to provide care and accommodation for up to 5 younger people with a learning disability in Sainthill Cottage. Sainthill Cottage is attached to Sainthill House but is managed separately to Sainthill House. Accommodation at both Sainthill House and Sainthill Cottage is comfortable and well maintained. Sainthill Cottage was completely refurbished to a high standard before people moved in. It consists on 5 individual room all with ensuites, a spacious and well equipped sitting room and a spacious dining area. The standard of decoration, furnishings and fittings throughout both premises are of a high standard. At the time of this inspection we were shown the large, light and airy conservatory extension that will be provide a large area for dining, activities and relaxing. This extension will also include a state of the art kitchen, replacing the existing kitchen. Since taking over Sainthill house Vision UK has undertaken a programme of Care Homes for Older People Page 24 of 36 Evidence: refurbishment. we looked at several rooms, with the agreement of people living at the service, and all were comfortable, warm, well furnished and personalised with peoples personal possession. All people living at the home who spoke to us told us that they are happy with the quality of the accommodation provided. Equipment and aids required to maximise peoples independence and meet assessed needs, such as hoists, handrails, raised toilet seats, pressure relieving equipment and adapted baths, are available at the service. At the time of this inspection both premises were clean and fresh, and people living there confirmed that this was always the case. Laundry facilities at Sainthill House are situated on the top floor and is equipped with 2 washing machines and a drier. The room was clean and well organised at the time of this inspection. Staff told us how they manager laundry at the home and this complies with good hygiene standards. Staff told us protective clothing, including gloves and aprons are freely available at the home and hand washing facilities are provided to ensure that the risk of infection is minimised. Care Homes for Older People Page 25 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff employed are competent in their roles to ensure that people living at Sainthill House and Sainthill Cottage are safe and well cared for. Recruitment practices ensures that they are also protected from potentially unsuitable staff. Evidence: Information provided by the service states staffing numbers and skill mix of staff are appropriate to the assessed needs of the service users, the size, layout and purpose of the home, at all times. At the time of this inspection 3 care staff and a manager were on duty at Sainthill House to provide care and undertake laundry tasks. We were told one member of staff undertakes the preparation of meals as the home does not employ a cook. Two care staff and a manager were providing care and support at Sainthill Cottage. People living at the Cottage are supported and encouraged to maintain independence and as such all are included in grocery shopping, cooking, laundry and cleaning tasks in their home. We saw staff attending to peoples individual health and social care needs in Sainthill Care Homes for Older People Page 26 of 36 Evidence: House and Cottage in a professional and friendly way and people living at the service told us their care needs are met by staff. However, although 3 carers are on duty at Sainthill House one undertakes the role of cook. During this inspection we saw all 3 carers undertaking care tasks and the person who at lunch time. We were told that at lunch time the assistance of the cook was needed as people needed assistance from 2 carers with personal needs and some needed assistance to eat. We were also told that when the dining room extension is completed the service will be employing a cook. A cleaner is also employed at the home for 3 hours a day, 5 days a week. During this inspection we looked at recruitment files for 3 staff employed at the service. All included evidence that the service operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of people using the service. Files included references, proof of identity, police checks and records of qualifications. hen staff are employed at the service they undertake a period of induction training. the time this takes will depend on the qualifications and experience of individuals. We have been told that the service ensure that there is a staff training and development programme which meets NTO workforce training targets and ensures staff fulfill the aims of the home and meet the changing needs of service users. We looked at 3 staff training records, which indicated that staff had undertaken training in the management of medication, fire safety and epilepsy awareness.There was no evidence to suggest that staff had received manual handling training. We were told that staff are provided with this training during the induction training and all staff receive training when new equipment is used. Information provided by the service indicates that more training is planned for all staff and a training matrix, which highlights the training needs for the home, has been introduced since Vision UK took over the service. Since taking over the service Vision UK has also employed a professional service to advise and provide information on all health and safety and employment policies and procedures and they are also members of the Registered Nursing Homes association who provide assistance with all nursing and care requirements. The service tells us that it plans to offer and sign up for more training for all staff to Care Homes for Older People Page 27 of 36 Evidence: enhance their knowledge base and build upon their existing skills. Care Homes for Older People Page 28 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sainthill house and Sainthill Cottage are currently well managed and run in the best interest of those living there. Evidence: Sainthill House and Sainthill Cottage each has a manager, both of whom have recently been employed and are yet to be registered with the Care Quality Commission. We were told that applications are to be submitted soon. Both managers confirmed they are well supported by the Directors of the Company. The manager of Sainthill House has been in post since August 2009. Prior to being employed by Vision UK Ltd they were employed as a deputy manager at a nursing home, they also undertook 1 year of nurse training and have experience of community hospitals and agencies. They are working towards a qualification in health and social care, which is equivalent to a nationally recognised qualification at level 3 and they have had experience in care home settings for 6 years. Care Homes for Older People Page 29 of 36 Evidence: The manager of Sainthill Cottage has experience in caring for people with learning disabilities and has managerial experience. Staff at both services confirmed that the managers operate an open door policy and are approachable and supportive. Vision UK became the registered providers for Sainthill House in August 2009 and since then a number of improvements in the environment have taken place and plans to further improve the environment and communal space are being undertaken. People living at the home and staff told us that they were aware of planned changes and were kept informed, involved and were happy with this. The Directors of the Company visit the home often and during their visits spend time talking to people living there and staff. It is during these conversations that people are encouraged to let them know their views and wishes. A formal Quality Assurance audit has not been undertaken since the Company took over ownership. One of the directors told us one is planned to be undertaken, which will mean that the views of people living at the home, in relation to the running of, and the quality of life experienced at, the home, will be gathered. The service plans to arrange regular meetings when people living at the service can meet and discuss any issues or wishes for the continuing development of the service. We were told by people we spoke to that if they have any issues they can speak to the manager and they were confident that any issues would be dealt with. We saw evidence of this in a persons plan of care. The temperature of hot water in bathrooms is checked before a person is bathed to ensure they are protected from the risk of scalds. All first floor windows checked were fitted with window restrictors promoting safety within the home by reducing the risk of residents falling from them. Fridge and freezer temperatures are recorded which is good practice. Staff involved in food preparation confirmed that they had food hygiene qualifications. Most people living at the home choose to have personal finances looked after by their family or legal representatives. The home will keep small amounts of money for Care Homes for Older People Page 30 of 36 Evidence: people who receive services such as hairdressing, chiropody and other personal items that may be needed. Clear records and receipts are kept of all outgoings. All staff spoken to confirmed that they had all had up to date training in relation to Moving and Handling, although training records did not always reflect this. Risks to people living at Sainthill House and Cottage are individually assessed and documented with an agreed plan in place to minimise risks where possible. Some improvement has been recommended in relation to the assessment of risks presented by the use of bed rails. Information received before this inspection indicated that all equipment is well maintained regularly all of which contributes towards ensuring that Sainthill House and Sainthill Cottage are safe places for people to live. Comments from 2 staff who responded to surveys included Vision UK are trying very hard with improvements theyre doing;when they are done I think the clients will really benefit from the changes and another I enjoy working at Sainthill. It is very friendly and feels like a real home. everyone cares about everybody else. I like the new rooms. In response to what does the home do well comments included Training, looks after the clients, looks after the staff, we enjoy working in a nice environment, good food, improving the rooms for residents and another care for our clients in a homely and friendly environment and good home cooking in a relaxed atmosphere. Care Homes for Older People Page 31 of 36 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 7 15 All people living at the home 07/09/2009 must have a plan of how their health, welfare and socail care needs will be met at the home. The individuals must be involved in the initial drawing up of the plan, if they are able and wish to, and in the following regular reviews. To ensure that people have a say in how they spend their lives. 2 8 12 Arrangements must be made 07/09/2009 for people living at the home to receive advice and other services from any health care professionals. This relates to people who may require a special diet. To promote health and welfare 3 8 13 Unecessary risks to people living at the home must be identified. To promote health and welfare. 07/09/2009 4 9 13 arrangements must be made 07/09/2009 for the safe recording of medicines received into the home. Care Homes for Older People Page 32 of 36 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 to promote health and safety. 5 10 12 The registered persn must enable people to make decisions in respect to the care they are to receive. To maintain dignity and choice. 6 12 11 For the purpose of providing care to people and making proper provision for their health and welfare, their wishes and feelings must be taken into account. To ensure that people are given a say in how they live their lives. 07/09/2009 07/09/2009 Care Homes for Older People Page 33 of 36 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The Statement of Purpose should include details of staff qualifications and experience of staff working at the home. The Service User Guide should include details of the CQC. 2 7 Continued improvement to care planning will further ensure that peoples individual health needs are met, monitored and reviewed. Assessments of potential risks to people living at the home should be undertaken. This relates to assessments of potential risks presented by bed rails not being undertaken. 3 7 4 9 A procedure for ensuring that creams/ointments/lotions when opened are not used past their shelf life should be developed. Hand written prescriptions on medication records should always be checked by two people and signed by two to promote accuracy and safety. The registered person should ensure that staff follow the procedure for the administration of medication.. Page 34 of 36 5 9 6 9 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 this relates to medication recorded as being given when it has not. 7 8 9 10 11 12 13 9 12 16 16 16 16 18 Records of all medications leaving the home should be maintained. The service should continue with plans to introduce a more varied choice of activities at the home. The complaints procedure should be updated to include contact details for the CQC. Arrangements should be made to record complaints, actions taken and outcomes. The homes complaints procedure should include contact details of the Care Quality Commission. Arrangements should be made for the recording of complaints, actions taken and outcomes. The service should continue with plans to provide training to staff in relation to safeguarding adults and management of complaints to ensure they are Arrangements should be in place to ensure that sufficient staff are available at all times to meet peoples needs. The service should continue with plans to provide appropriate training to all staff. The service should develop a quality assurance monitoring system, the outcomes of which should be made available to people living at the home and other interested parties, including the Care Quality Commission. 14 15 16 27 30 33 Care Homes for Older People Page 35 of 36 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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