Inspection on 09/03/06 for 38 Sandgate

This inspection was carried out on 9th March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

38 Sandgate 30/04/09

38 Sandgate 14/04/08

38 Sandgate 09/08/07

38 Sandgate 09/08/06

38 Sandgate 11/12/05

38 Sandgate 14/02/05

38 Sandgate 05/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 38 Sandgate Kendal Cumbria LA9 6HT Lead Inspector Ray Mowat Unannounced Inspection 9 March 2006 03:30 th 38 Sandgate DS0000036570.V281020.R01.S.doc Version 5.1 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 38 Sandgate DS0000036570.V281020.R01.S.doc Version 5.1 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 Adults 18-65. 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. 38 Sandgate DS0000036570.V281020.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 38 Sandgate Address Kendal Cumbria LA9 6HT 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) 01539 733465 www.cumbriacare.org.uk Cumbria Care Care Home 3 Category(ies) of Learning disability (3), Learning disability over registration, with number 65 years of age (2) of places 38 Sandgate DS0000036570.V281020.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. A maximum of three younger adults with a learning disability (LD3) may be accommodated two of whom may be older with a learning disability (LD (E) 2). When single rooms of less than 12 sqm usable floor space become available they must not be used to accommodate wheelchair users, and where existing Wheelchair users are in bedrooms of less than 12 sqm they must be given the opportunity to move to a larger room when one becomes available. Staffing levels for the home must meet the Residential Forum Care Staffing Formula for younger adults. 3. Date of last inspection 11th December 2005 Brief Description of the Service: 38 Sandgate is a registered care home for up to three people with learning disabilities. At present the home is operated and managed by Cumbria Care, an independent business unit within Cumbria County Council’s contract services group. There were two residents in the home at the time of the inspection. Due to the high level of assessed needs of one of the residents, there is an additional sleep-in staff required, who is using the third bedroom. The home is in a quiet residential area on the outskirts of Kendal town, it is close to a bus route and local amenities. The home is a semi-detached property with a small front garden and a paved patio area to the rear. All the rooms are single occupancy with the bathroom and communal areas of the home being shared. Suitable adaptations to meet the needs of service users were in place. 38 Sandgate DS0000036570.V281020.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days so as not to disrupt previously planned activities. I spent time talking to the residents and four different staff who were on duty over the two days. I also spoke to a social worker who placed someone at the home and the supervisor. I looked at records that help staff to safely support people in the home and in the local community. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. 38 Sandgate DS0000036570.V281020.R01.S.doc Version 5.1 Page 6 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 38 Sandgate DS0000036570.V281020.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 38 Sandgate DS0000036570.V281020.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4,5. The home has clear policies and procedures in line with current good practice to assess the needs of prospective or existing residents on an ongoing basis. EVIDENCE: The organisation has a clear policy and procedure in place to guide staff and prospective residents through the admission procedure. Existing practice is for prospective residents to make short visits to the home possibly staying for a meal. This would be followed by overnight or short stays to enable an accurate assessment of need to be completed and to check out compatibility with existing residents. The home also works closely with other agencies, social workers and families during the assessment and admission procedure and then continues to liaise with them and other specialist services, ensuring suitable aids/adaptations and services are provided in response to individual needs. The contract of terms and conditions is being re-negotiated by the organisation with the new landlord. The organisation must ensure the new contracts honour their responsibilities under the Care Home Regulations. 38 Sandgate DS0000036570.V281020.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 10. The home provides consistent and appropriate support to residents to ensure their needs are met and their rights and choices are respected. EVIDENCE: Both residents have a detailed care plan which is kept under review with input from other agencies and specialist health services and family. A Multi agency review meeting is held on a regular basis and as needs change, thus ensuring the care plan is relevant and effective. Through this ongoing monitoring and liaison with other agencies and professionals, staff receive appropriate guidance and support and have therefore developed a clear understanding of people’s needs and preferences. With input from specialist services such as speech therapy, staff have developed good communication with the residents, which for one resident in particular has been very effective and has resulted in an improvement in their quality of life. Within the care plans are detailed programmes and strategies to guide staff through people’s daily routines. Consistency is very important to the residents so the development of these strategies has been crucial in providing a service that meets their needs. The care plan and strategies have been kept under regular review. The care plans are becoming very large documents and contain some information that is no longer relevant, which makes it harder to 38 Sandgate DS0000036570.V281020.R01.S.doc Version 5.1 Page 10 find the pertinent information. It is recommended the content of the care plans are reviewed and only current information retained on the file. A daily record is maintained to document significant events throughout a shift and share relevant information to maintain a continuity of care. These contained personal and confidential information but were left in the kitchen and were not securely stored. It is recommended all confidential information is securely stored at all times. All other confidential information is either securely stored in a locked filing cabinet in the home or held in a locked filing cabinet in a central office at Peat Lane House that is operated by Cumbria Care. Some information may also be held on computer, which is also securely stored as it is password protected. 38 Sandgate DS0000036570.V281020.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 17. Residents are enjoying a fulfilling lifestyle based on their needs and preferences. EVIDENCE: Both residents continue to attend the local day service five days each week, Monday to Friday. This provides them with a range of educational and leisure activities and community involvement. They are also able to socialise with their peers and develop friendships outside the home. They are involved in inhouse activities such as social and domestic activities, in addition to more active community activities, such as sailing, horse riding, day trips and visits to the amenities of the nearby town of Kendal. Both the residents maintain contact with friends and family with support from staff, this may involve visits to the home or alternatively residents going out to visit or keeping in touch by phone. Menus are agreed with residents on a weekly basis, with staff supporting residents with their shopping. However meals and mealtimes are very flexible depending on what is happening on a particular day. A record is maintained of meals provided to enable staff to ensure a healthy and nutritious diet is maintained with fresh fruit and healthy options available. 38 Sandgate DS0000036570.V281020.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 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, 21 The home works closely with other agencies ensuring health and personal care needs are responded to appropriately. EVIDENCE: Residents personal and healthcare needs continue to be closely monitored with the home working closely with other agencies and specialist services to meet individual needs. The majority of medication administered in the home is managed using the monitored dosage system, the contents were checked against the medication record and found to be in order. If personal or family preferences are made in relation to people’s wishes upon death, then they are recorded within the care plan. The organisation has an appropriate policy in relation to dealing with death and dying, with support systems in place for residents and staff. 38 Sandgate DS0000036570.V281020.R01.S.doc Version 5.1 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were met at the last inspection and there have been no recorded incidents since the last inspection. EVIDENCE: 38 Sandgate DS0000036570.V281020.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29. Although the physical environment is not suitable for one resident the home continue to monitor the situation to minimise any hazards. The repairs and maintenance of the home are poor and must improve. EVIDENCE: Some progress has been made since the last inspection with some work completed and other projects planned. A shower/toilet system has been removed from one bedroom and a gate has been fitted to the side of the home, securing the back garden. The kitchen flooring has been ordered to replace the existing flooring, which has ripped and the cooker is to be repaired/replaced. The organisation is currently negotiating with the new landlord regarding responsibility for various aspects of the repairs and maintenance of the home. However the organisation has responsibilities under the Care Home Regulations irrespective of these negotiations. The home must now produce a programme of repairs and renewal based on the condition of the home. This is subject to a requirement. This must include timescales for the completion of work and take into account the décor and replacement of floor coverings. The painting of the outside of the home is due this year. The kitchen units are chipped and their was a cupboard door missing. The kitchen must be kept in a good state of repair at all times. This is subject to a requirement. 38 Sandgate DS0000036570.V281020.R01.S.doc Version 5.1 Page 15 The organisation has had discussions with the landlord about alterations to the downstairs to create an en-suite facility but so far without success. Moving one of the residents up and down stairs remains problematical and a potentially hazardous activity, resulting in personal care being provided downstairs. The provision of the en-suite facility would be an ideal solution as both residents are settled in their home, which is a credit to the staff team. Alternative accommodation is also being considered with residents having been to visit another home. It was evident from my discussion with one resident that they thought they would be moving quite soon. However the move is dependent on factors beyond the control of the organisation, which needs to be explained to residents and their representatives. 38 Sandgate DS0000036570.V281020.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 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, 32, 33, 34, 35, 36. On the whole staff provide a consistent and reliable service and most are suitably trained and experienced, all staff must receive suitable induction training. EVIDENCE: It was evident the staff team work well together and are supportive of each other. There is a high level of commitment from the staff and they are very effective in providing a consistent level of support to both residents. This has had a positive affect on the quality of life of the residents and is a credit to the staff team. At present there are two vacant positions in the home, these are currently being covered by permanent and relief staff. These positions are being advertised and should be filled in the near future. The organisation has robust recruitment policies and procedures in line with current good practice. This involves a formal interview with all necessary checks completed and suitable information and contracts supplied to new employees. A relief member of staff on duty on the day of the inspection has not had any formal training or completed the LDAF induction and foundation. (This is subject to a requirement.) However they had been inducted to the home and the residents and had developed good relationships with the residents. Staff records were not available in the home as they are held at a central office. 38 Sandgate DS0000036570.V281020.R01.S.doc Version 5.1 Page 17 Staff spoken to during the inspection told me they had “regular supervision on a monthly basis”. They said they could discuss any issues of concern and training and personal development issues. Staff meetings were also held on a regular basis and were valued by staff. They said the meetings had an “open agenda” and were also used for information sharing and training in relation to specific strategies or changes within the home, to ensure a consistent approach is maintained. 38 Sandgate DS0000036570.V281020.R01.S.doc Version 5.1 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 40, 41, 42, 43 The management arrangements of the home are not clear and must be clarified to ensure adequate support. EVIDENCE: The manager’s post has been vacant for sometime with the manager of another nearby Cumbria Care establishment managing the home on a day-today basis, with support from a supervisor. Due to ongoing restructuring in the organisation and an ongoing application for de-registration, a permanent appointment has not been made. This situation must now be addressed. The residents are enjoying a very settled period in their lives and despite the environmental issues the home is providing them with a good quality of life. The continuity of care provided by the staff team has been a fundamental factor in this and must be taken into consideration with regard to any future planning. The home has suitable policies and procedures in place to maintain the safety and welfare of residents and staff. The resident’s rights and best interests are central to any decisions made about the running of the home. 38 Sandgate DS0000036570.V281020.R01.S.doc Version 5.1 Page 19 There were no obvious hazards noted during the inspection and records relating to the health and safety of the environment and maintenance and servicing of equipment were up to date. 38 Sandgate DS0000036570.V281020.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 X 3 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 1 25 3 26 2 27 2 28 3 29 1 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 X 2 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 3 3 2 3 X 3 3 2 3 38 Sandgate DS0000036570.V281020.R01.S.doc Version 5.1 Page 21 Yes Are there any outstanding requirements from the last inspection? 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 YA24 Regulation 23 Requirement The home must now produce a programme of repairs and renewal based on the condition of the home. (The original timescale of 1st May 05 was not met) The kitchen must be kept in a good state of repair at all times. Staff must receive training appropriate to the work they are to perform. Timescale for action 01/06/06 2 3 YA24 YA35 23 18 (c) 01/06/06 01/07/06 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 2 Refer to Standard YA6 YA10 Good Practice Recommendations It is recommended the content of the care plans are reviewed and only current information retained on the file. It is recommended all confidential information is securely stored at all times. 38 Sandgate DS0000036570.V281020.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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 38 Sandgate DS0000036570.V281020.R01.S.doc Version 5.1 Page 23 - 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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