Inspection on 02/06/05 for Sage

This inspection was carried out on 2nd June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 but made no statutory requirements on the home.

Other inspections for this house

Sage 24/07/07

Sage 05/06/06

Sage 20/12/05

Sage 20/12/04

Sage 10/05/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE SAGE 208 Golders Green Road London NW11 9AL Lead Inspector David Hastings Announced 2 June 2005 at 09.30am 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 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. SAGE Version 1.10 Page 3 SERVICE INFORMATION Name of service SAGE Address 208 Golders Green Road, London NW11 9AL Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8201 8111 020 8201 8204 Dr M Sinclair for SAGE Mrs Mali Asserson N Care Home with Nursing 61 Category(ies) of OP Old age (41 beds) registration, with number DE(E) Dementia over 65 (20 beds) of places SAGE Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1 Limited to 61 adults of either gender over the age of 65 years (OP) needing nursing care, 20 of whom may have dementia. 2 One specified service user who is under 65 years of age and has dementia may be accommodated in the home. 3 The home must inform the regulating authority at such time as the specified service user vacates the home or attains the age of 65 years. Date of last inspection 20 December 2004 Brief Description of the Service: Sage is a registered charity and the home that it operates is a registered care home with nursing. A major objective of the home is to allow service users to follow the Jewish way of life and it accepts people from the Jewish community who have varying levels of religious observance. The home is purpose built on four floors and was originally built twelve years ago. An additional wing was added approximately six years ago that increased its registered capacity to the current sixty-one places. The ground floor contains the main communal areas with the upper three floors accommodating the service user bedrooms, each floor containing an additional lounge and kitchenette. All bedrooms have an en-suite toilet and hand washbasin and approximately two thirds have either an en-suite bath or shower. The home is situated in Golders Green and is close to all the area’s shopping and cultural/ religious resources. Relatives and visitors to the home described it as a valued resource by the local Jewish community. The stated objectives of the home are to provide service users with an excellent standard of care, to be treated with respect and dignity and to be able to follow the Jewish way of life. SAGE Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place on 2nd June 2005 and lasted eight hours. The inspector was assisted by the registered manager who was open and helpful throughout the inspection. The inspector spoke with nine of the residents during the inspection and the feedback was generally very positive regarding the management and staff at the home. A tour of the premises took place and care records were inspected. Seven comment card were received by the CSCI from relatives, nine comment cards were received from residents including three poems and one comment card was received from a care professional. Comments from relatives and residents were generally positive regarding the service and issues/concerns highlighted have been addressed in this report. What the service does well: What has improved since the last inspection? What they could do better: Although pressure care management has improved minor issues still need to be addressed. There needs to be better communication and a more open approach between staff and relatives. Residents and / or their representatives need to be more involved and have more input in their plans of care. SAGE Version 1.10 Page 6 Residents who use wheelchairs must be able to go out of the home and visit the local community if they wish to. Staff must be better protected from verbal abuse from a small minority of visitors to the home. Mandatory training must be seen as a priority and staff must be provided with ongoing support to care for residents with dementia. In addition to these seven requirements four more requirements relating to medication have been issued as a result of this inspection. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. SAGE Version 1.10 Page 7 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 Standards Statutory Requirements Identified During the Inspection SAGE Version 1.10 Page 8 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 standard(s) 3 The home carries out detailed assessments on all potential service users so they know that the home is able to meet their needs before they move in. EVIDENCE: Copies of pre admission assessments were seen on the service user files inspected. This included assessments from social workers where they were involved in the admission. All files seen contained pre-admission assessments undertaken by qualified staff from the home. SAGE Version 1.10 Page 9 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 standard(s) 7, 8, 9 and 10 Service users’ health, personal and social care needs are well documented in their plan of care. Service users must be more involved in reviewing their care plan if they so wish. The safe and secure handling and administration of medicines is generally satisfactory with one exception. The medication is regularly being stored above the temperature recommended by the manufacturers. Medication histories for each service user should be introduced to ensure a clearer audit trail. Service users are treated with respect and their privacy is maintained. EVIDENCE: Six service user files were inspected. All contained detailed care plans covering a range of assessed needs and describing how these should be met. These were informed by risk assessments that were also seen on the service user files inspected. There was evidence that all care plans were reviewed on a monthly basis. Staff interviewed had a good understanding of the needs of service users as described in their individual plan of care. There was evidence that reviews were being carried out by the placing authorities. SAGE Version 1.10 Page 10 Some service users commented that they did not always feel involved in reviewing their care plans. Care plans are reviewed monthly and service users must be involved in this process. It service users are unable to take part in reviewing care plans then their representative must have input where appropriate. A requirement relating to this has been made in the relevant section of this report. There were records on the service user files inspected of a range of health care checks by external health professionals. These included opticians, chiropodists and a speech and language therapists. There was evidence of regular input from G.P.’s including evidence of their attendance at the home. The number of service users with pressure sores has reduced since the last inspection and three service users currently have pressure sores. There was evidence that the home regularly liases with the local tissue viability nurse. Three requirements were issued at the last inspection relating to pressure care. The home has complied with two of these. However the requirement that records are maintained of pressure care mattress settings has not been complied with and is restated. A requirement that the monthly records of service users’ weight are maintained has been complied with. The CSCI pharmacist inspector carried out an inspection of the medication in the home. Below is a summary of her findings. The home medicines policy is satisfactory. Agreement and assessment forms have been completed for the service users who are administering their own medication. A record is maintained by the home of their current medication. The receipt, administration and disposal of medication records are generally satisfactory. Medication histories for each service user were not available in a separate document. The label for one of the medicines checked was found to differ from the administration record chart. This was because the dose had been changed by the service user’s GP from the dose prescribed and dispensed by the hospital. In another case a nasal ointment was not being administered to a service user but staff were unable to confirm if this had been discontinued or not. One of the Controlled Drugs was labelled ‘to be given as directed by the doctor’ and not with the full administration instructions. The storage of medication is in suitable cupboards, fridges and trolleys but the temperatures of all the storage areas were found to be 26-30oC. When staff were asked if they had attended any courses recently that included updates in new medication or new uses for existing medication they stated that they had not. Four requirements have been issued as a result of the pharmacist’s visit. Service users spoken to individually throughout the inspection confirmed that the personal care given to them was sensitive and that their privacy and dignity were respected. Records seen on service user files regarding personal care were suitably detailed. Staff were observed knocking on service users bedroom doors before entering. SAGE Version 1.10 Page 11 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 standard(s) 12, 13 and 15 The home provides varied activities for service users in keeping with the religious ethos of the home. Service users in wheelchairs should be enabled to go out of the home more if they wish to. The home encourages visitors and community events but procedures need to be implemented to provide better communication between staff and relatives. The home provides service users with a wholesome appealing balanced diet in pleasant surroundings. EVIDENCE: There was evidence that the home organises a wide variety of activities at the home. Service users that the inspector met confirmed that there were lots of activities at the home. Service users past and present preferences were recorded on their files that were inspected. Service users spoken to were keen to inform the inspector of a range of Jewish customs and observances in their day-to-day lives and how the home helped them maintain these including observance of the Sabbath and celebration of Jewish holidays. Some service users commented that the communal areas could be quite noisy at times. A number of service users and relatives informed the inspector that there was limited opportunity to go out of the home. Staff interviewed were concerned about insurance issues in taking service users in wheelchairs out of the home. The registered manager must ensure that insurance is in place to SAGE Version 1.10 Page 12 enable staff to take service users out of the home. The registered manager informed the inspector that there are a number of activities for service users outside the home including attending local functions, local community services and trips to the local park. The manager indicated that some other outside activities do incur an additional cost to provide escorts and that some relatives have refused to pay any additional charge. The home organises a number of events where service users can meet and interact with people from the local community. The inspector saw a large number of visitors to the home and the visitors’ book indicated that the home receives lots of visitors. Service users confirmed that they were able to receive visitors at any reasonable time. A small number of relatives who spoke to the inspector said that staff were sometimes reticent to inform them of their relatives general progress at the home. It appears that some staff are unclear regarding the amount of information they can give relatives relating to privacy and medical issues. This has led to unfortunate breakdowns in communication between some relatives and staff. The registered manager informed the inspector that Sage operates an “open door policy” for both relatives and staff however some relatives did not appear to be aware of this. The registered manager must produce clear guidelines for staff and relatives relating to information that can be given to relatives. The registered manager told the inspector that all relatives are invited to reviews. There is no reason why care staff can not comment on how the service users is doing generally and that nursing staff can provide information relating to clinical issues if this is agreed by the service user. The home contracts out the catering to an external company and the area manager of that company attended the home for the inspection. The home operates a strict Kosher kitchen that is appropriately equipped and divided into separate milk and meat kitchens that are fully colour coded to show the difference, as are the crockery and utensils in the dining area. The menus cover a four-week period and are agreed with the home in advance. There is a choice of main meal and a separate soft food option. The kitchen was clean and tidy, the food stored appropriately and was in date and matched what was recorded on the menu. Fridge and freezer temperatures are recorded daily as are the temperature of the meals when they are served and these records were seen and were satisfactory. The inspector noted that pureed meals are now being labelled before they are frozen. This was a requirement from the last inspection that has now been complied with. Service users confirmed that the food was very good at the home and that they always get enough to eat. The inspector sampled the lunch and found it to be very pleasant. The atmosphere in the dining area was lively and sociable. Staff were observed offering discreet assistance to service users where appropriate. SAGE Version 1.10 Page 13 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 standard(s) 16 and 18 The home takes complaints seriously and investigates concerns in line with their written complaints policy. Service users are protected from abuse by the homes polices and procedures and by the professional and thorough approach of the registered manager. EVIDENCE: A requirement was issued at the last inspection that written records of complaints include the response from the home as well as the outcome of the home’s investigation. Records of complaints examined showed that this requirement has been complied with. A number of relatives and service users that spoke with the inspector detailed a number of concerns they had about the home. It was apparent that there was some reticence to make official complaints to the manager. There is no reason for this as the manager clearly encourages feedback from relatives and the relatives would have clear, written response to their concerns. All relatives spoken to confirmed that they had a copy of the homes complaints procedure. Service users spoken to said their concerns were always acted upon and taken seriously. The home has had a number of adult protection issues in the last year. The registered manager is to be commended for her swift and open approach to these issues and as a result has ensured that service users are protected. The registered manager has dealt with these adult protection matters in line with the local authorities’ adult protection procedure and has liased with the appropriate professionals. SAGE Version 1.10 Page 14 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 standard(s) 19 ad 26 The home is safe, clean and hygienic, well-maintained and decorated to a high standard. EVIDENCE: The home was purpose built approximately twelve years ago and had an additional wing added approximately six years ago. The service users’ bedrooms have been redecorated and the communal facilities are decorated and equipped to a particularly high standard. The kitchen has been totally refurbished including the addition of a blast-chill machine. The gardens are attractive with a conservatory and in the summer has a gazebo where service users and visitors can relax when the weather is fine. The grounds and the building are secure with a CCTV system for monitoring the front and rear entrances to the building. The home has appropriate laundry and sluicing facilities and appropriate infection control policies. On a tour of the premises the home was seen to be clean and free from offensive odours. All service users and relatives commented that the home was always clean. SAGE Version 1.10 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 30 Service users’ needs are met by the numbers and skill mix of staff. Service users are protected by the home’s recruitment procedures. Further mandatory training is required and more robust and transparent support systems are needed for staff. EVIDENCE: Service users that the inspector spoke with said they were satisfied with the level of staffing at the home. The staffing levels of the home are in line with the Department of Health’s “No regression” policy. A few staff members informed the inspector that a small minority of visitors to the home had been abusive to them and this abuse was sometimes racist in nature. This has been an issue in the past. The registered provider and registered manager must ensure that staff are protected from abusive behaviour and a clear statement that this will not be tolerated must be made. Staff should be able to report this to the management of the home and direct action must be taken to support staff. A requirement relating to this issue has been made in the relevant section of this report. It should be noted that the majority of comments from service users and relatives was very positive regarding the care provided by staff at the home and it was clear that the registered manager thought very highly of the staff team. A requirement was issued at the last inspection that all staff must have CRB checks before they are able to work with the service users. The inspector examined six staff files from the most recently employed staff. All files examined contained all the information required by this Standard. SAGE Version 1.10 Page 16 The inspector spoke with the training coordinator. She has updated staff training records and training needs can now be better identified. This was a requirement from the last inspection that has now been complied with. Records indicated that not all staff have undertaken mandatory training such as moving and handling. A requirement that all staff undertake mandatory training has been made in the relevant section of this report. Dementia training has been organised to take place in July of this year. The registered manager informed the inspector that this training would be ongoing. This was a requirement from the last inspection that has been complied with. Training is very important as twenty of the service users have dementia and some have very challenging behaviour. As well as ongoing training the registered manager must ensure that staff are supported and able to discuss issues in regular team meetings. This will enable staff to share information and skills with each other in order to improve the standard of care to the service users as well as reducing the levels of stress on staff. SAGE Version 1.10 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These key standards will be assessed at the next inspection. (These key standards will be assessed at the next inspection). EVIDENCE: N/A SAGE Version 1.10 Page 18 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x x SAGE Version 1.10 Page 19 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 8 Regulation 13(1)(b) Requirement The registered provider must ensure that staff are aware of the setting of any pressure mattress used in relation to the service users’ weight. This must be recorded so that any accidental change of settings can be corrected. (Timescale of 01/02/05 not met) This requirement is restated. The registered manager must ensure that all service users are assisted to take part in the review of their care plans if they so wish. The registered manager must ensure that there is an easily accessible medication history for each service user to ensure it is clear when a medication has been discontinued or changed. The registered manager must ensure that all areas where medication is stored are maintained at 25oC or below. The registered manager must ensure that all Controlled Drugs are labelled with the full dosage instructions. Timescale for action 01/08/05 2. 7 15(2) 01/08/05 3. 9 13(2) 01/08/05 4. 9 13(2) 01/09/05 5. 9 13(2) 01/08/05 SAGE Version 1.10 Page 20 6. 9 13(2) 7. 13 16(2)(m) 8. 13 15(1) 9. 27 12(5) 10. 30 18(1) 11. 30 18(1)(a) The registered manager must ensure that the nurses attend courses that include updates on new medications available and new uses for existing medication in the care of the elderly, including dementia. The registered manager must ensure that insurance is in place to enable service users who use wheelchairs to be taken out of the home and that staff are aware that this is the case. The registered manager must produce clear written guidance for staff and relatives about information that can be shared regarding the service users progress and well being. The registered provider must provide clear writtten guidance on how staff working at the home are to be protected from any form of verbal abuse. Statements must also be issued that any form of vebal abuse towards staff will not be to tolerated by the organisation. The registered manager must ensure that all staff undertake the requirered manditory training including manual handling. A programe of these training requirements must be sent to the CSCI The registered manager must ensure that all staff are given ongoing support and a regular forum where they can disscuss, share ideas and knowledge regarding the management and care of service users with dementia. 01/09/05 01/08/05 01/08/05 01/08/05 01/08/05 01/08/05 SAGE Version 1.10 Page 21 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 Good Practice Recommendations SAGE Version 1.10 Page 22 Commission for Social Care Inspection Solar House 1st Floor, 282 Chase Road Southgate London N14 6HA 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 SAGE Version 1.10 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. 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