Inspection on 20/12/05 for Sage

This inspection was carried out on 20th December 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Sage 24/07/07

Sage 05/06/06

Sage 02/06/05

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 Golders Green London NW11 9AL Lead Inspector David Hastings Unannounced Inspection 20th December 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sage DS0000010546.V265221.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sage DS0000010546.V265221.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Sage Address 208 Golders Green Road Golders Green London NW11 9AL 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) 020 8201 8111 020 8201 8204 Service To The Aged (SAGE) Mrs Malli Asserson Care Home 61 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (41) of places Sage DS0000010546.V265221.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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. One specified service user who is under 65 years of age and has dementia may be accommodated in the home. Limited to 61 adults of either gender over the age of 65 years (OP) needing nursing care 20 of whom may have dementia. 2nd June 2005 Date of last inspection 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 areas 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 DS0000010546.V265221.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on Tuesday 20th December 2005 and lasted seven hours. 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. The inspector also spoke to a number of staff in private. A tour of the premises took place and care records were inspected. The inspector was assisted by the newly appointed manager to the home, who was open and helpful throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better: Two requirements have been restated regarding the storage of medication and updating nurses training. Six new requirements have been issued at this inspection. Care plans for residents with dementia must detail their strengths as well as their care deficits. The recording of medication given to residents must be more accurate. Sage DS0000010546.V265221.R01.S.doc Version 5.0 Page 6 Some curtains that have become worn or frayed must be replaced and residents must have net curtains in their rooms if they so wish. Night staff must undertake fire drills every three months and the fire procedures for the home must be reviewed with the appropriate professionals. The inspector is confident that these requirements will be complied with by the manager and providers within the timescales given. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Sage DS0000010546.V265221.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Sage DS0000010546.V265221.R01.S.doc Version 5.0 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 the following 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 DS0000010546.V265221.R01.S.doc Version 5.0 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 the following standard(s): 7, 8 and 9 Service users’ health, personal and social care needs are well documented in their plan of care. The safe and secure handling and administration of medicines is generally satisfactory. 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. There was also evidence that these plans were now being reviewed with the service user or their representative. This was a requirement from the last inspection that has now been complied with. Care plans examined for those people with dementia concentrated on care deficits of service users and did not make any reference to remaining strengths that the person may have. A requirement has been issued that staff record the remaining abilities and strengths for individuals with dementia in order to ensure service users are able to maintain as much independence as possible. There were records on the service user files inspected of a range of health care checks by external health professionals. These included opticians, chiropodists Sage DS0000010546.V265221.R01.S.doc Version 5.0 Page 10 and a speech and language therapists. There was evidence of regular input from G.P.’s including evidence of their attendance at the home. Three service users currently have pressure sores. There was evidence that the home regularly liaises with the local tissue viability nurse. A requirement that pressure relieving mattresses are set correctly and that this is recorded has now been complied with. Records relating to the receipt, administration and disposal of medication were examined. A number of minor discrepancies were noted in relation to the receipt and administration of medication. A requirement relating to this has been issued in the relevant section of this report. Medication histories were seen on all service user files examined. All controlled drugs seen were correctly labelled. These were two requirements from the last inspection that have now been complied with. The manager informed the inspector that the organisation was addressing the issue of temperature monitoring of medication rooms. This requirement from the last inspection has been restated. A requirement was issued at the last inspection that nurses at the home attend training to update their knowledge of new medications available and new uses for existing medications in the care of the elderly, including dementia. The registered manager informed the inspector that these courses were still being organised for nursing staff. The requirement is restated. Sage DS0000010546.V265221.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 14 and 15 The home provides varied activities for service users in keeping with the religious ethos of the home. The home encourages visitors and community events, which ensures an interesting and lively atmosphere. Service users are able to exercise choice and control over their lives. 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. The manager informed the inspector that carers are insured to take service users out of the home in wheelchairs. This was a requirement from the last inspection. The manager described to the inspector how service users are enabled to go out of the home with support from staff. The inspector was able to observe an activities meeting with the manager and staff and was pleased that further opportunities for service users to go out of the home were being planned. Sage DS0000010546.V265221.R01.S.doc Version 5.0 Page 12 A requirement was issued at the last inspection that written guidance should be developed for staff and relatives regarding information that can be shared concerning service user’s progress and well being. The manager informed the inspector that this issue has been addressed in staff meetings and in relative meetings. During the inspection visitors were observed meeting service users throughout the home and the visitors book confirmed that service users were able to maintain contact with their family and friends. This was clearly being encouraged by staff at the home. Service users that the inspector spoke with said they were satisfied with the way they are assisted to exercise choice and control over their lives. One service user commented, “I feel in control here”. Interests are listed in care plans as well as individual likes and dislikes. The home contracts out the catering to an external company. 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. 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 DS0000010546.V265221.R01.S.doc Version 5.0 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 the following 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 an effectively trained staff team. EVIDENCE: The home’s record of complaints was examined. There was evidence that the manager had dealt with any complaints appropriately and written responses to complainants were detailed. The home has a satisfactory complaints procedure. Service users that the inspector met said that they had no complaints about the home and any concerns they did raise were acted upon and taken seriously by the management of the home. The home has a satisfactory Adult Protection Procedure and has dealt with adult protection matters in the past appropriately. The inspector saw evidence that staff have attended adult protection awareness training. Sage DS0000010546.V265221.R01.S.doc Version 5.0 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 the following standard(s): 19 and 26 The home is safe, clean and hygienic, well-maintained and decorated to a good 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 high standard. It was noted that a number of curtains throughout the home have become worn and need replacing. During the inspection a number of bedrooms did not have net curtains. Two requirements have been issued in this report that worn curtains in lounges and bedrooms are replaced and that where service users request net curtains in their rooms, that these must be supplied. 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. Sage DS0000010546.V265221.R01.S.doc Version 5.0 Page 15 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 commented that the home was always clean. Sage DS0000010546.V265221.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 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. Staff are appropriately trained and supported to carry out their work at the home. 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 requirement was made at the last inspection that written guidance is produced on how staff are to be protected from verbal abuse from a very small minority of relatives and visitors as well as a statement that verbal abuse will not be tolerated at the home. The inspector saw this written guidance and statements were seen displayed on all floors. These requirements have now been complied with. Staff interviewed had a good understanding of service user’s needs and were able to describe how recent training they have undertaken has informed their care practice. The inspector met with the training coordinator and records indicated that staff have good training opportunities including NVQ training. The training coordinator has developed a rolling programme of mandatory training for all staff. This was a requirement from the last inspection that has been complied with. The manager and training coordinator were able to describe how staff are continually supported to discuss any issues relating to the care of service users with dementia. This support is given in handovers and team meetings. The training coordinator also informed the inspector that she would be starting Sage DS0000010546.V265221.R01.S.doc Version 5.0 Page 17 monthly care supervision meetings with staff. This requirement has been complied with. Six staff files were examined. These all contained the information required by Regulation including CRB disclosures and references. The homes recruitment procedure is satisfactory and is being adhered to. Sage DS0000010546.V265221.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 The recently appointed manager carries out her duties in an open and professional manner. Service users have a say in the running of the home. Service users’ financial interests are safeguarded. In general there are good procedures to monitor health and safety compliance. However current fire procedures must be reviewed on a regular basis. EVIDENCE: Staff and service users that the inspector spoke with were very positive about the new manager of the home. Staff informed the inspector that the manager was very approachable and one service user commented that the manager should get “twelve out of ten”. Service users said they felt “listened to” and there was evidence that issues raised in relatives and service users meetings were acted upon. The manager informed the inspector that she operates an “open door” policy and it was clear throughout the inspection that this was the case. Sage DS0000010546.V265221.R01.S.doc Version 5.0 Page 19 Samples of service users’ finances were examined. The home does not generally hold money on behalf of service users. Instead service users or their representatives are invoiced monthly for minor expenses such as toiletries and newspapers. These invoices were detailed and clear audit trails were seen. Documentation was examined in relation to gas safety, electrical installation and portable appliances, hot water checks and Legionella checks. All this documentation was satisfactory. Fire procedures were generally satisfactory with two exceptions. Night staff are required to undertake fire drills every three months. The fire procedures including the emergency evacuation plan had not been reviewed in line with Regulation 23(4) of the Care Homes Regulations 2001. Two requirements relating to fire safety have been issued in the relevant section of this report. Sage DS0000010546.V265221.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Sage DS0000010546.V265221.R01.S.doc Version 5.0 Page 21 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 OP9 Regulation 13(2) Requirement The registered manager must ensure that all areas where medication is stored are maintained at 25oC or below. (Timescale of 01/09/05 not met) This requirement is restated. 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. (Timescale of 01/09/05 not met) This requirement is restated. The registered manager must ensure that all care plans for service users with dementia include details of their remaining strengths in order to maintain their independence as far as possible. The registered manager must ensure that all records of medication administration are accurately recorded. Timescale for action 01/05/06 2. OP9 13(2) 01/03/06 3. OP7 12(4) 01/03/06 4 OP9 13(2) 01/03/06 Sage DS0000010546.V265221.R01.S.doc Version 5.0 Page 22 5 OP19 23(2) 6 OP19 12(4) 7 OP38 23(4) 8 OP38 23(4) The registered manager must ensure that all worn and frayed curtains in lounges and bedrooms are replaced. The registered manager must ensure that where service users request net curtains for their bedrooms that these are provided. The registered manager must ensure that all night staff undertake fire drills at least every three months and that this is recorded. The registered manager must ensure that fire procedures including the emergency evacuation plan are reviewed with the appropriate professionals. 01/04/06 01/04/06 01/03/06 01/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Sage DS0000010546.V265221.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Southgate Area Office 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 DS0000010546.V265221.R01.S.doc Version 5.0 Page 24 - 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. You have been warned!