Inspection on 24/07/07 for Sage

This inspection was carried out on 24th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 05/06/06

Sage 20/12/05

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 Mr David Hastings Key Unannounced Inspection 09:30 24 and 25th July 2007 th 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.V354752.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sage DS0000010546.V354752.R01.S.doc Version 5.2 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 polly@thesagehome.com Service To The Aged (SAGE) Mrs Polly Landsberg 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 Physical disability (1) Sage DS0000010546.V354752.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Limited to 61 adults of either gender over the age of 65 years (OP) needing nursing care 20 of whom may have dementia. One specified service user who is under 65 years of age and has dementia may be accommodated in the home. 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 (1) place for a service user under the age of 65, with a physical disability, can be accommodated. 5th June 2006 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. The current scale of charges range from £450 to £1050 per week. A copy of this report is available on the CSCI website or/and from the home. Sage DS0000010546.V354752.R01.S.doc Version 5.2 Page 5 Sage DS0000010546.V354752.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on 23rd and 24th July 2007 and lasted ten hours. I was assisted throughout the inspection by the registered manager who was open and helpful. I spoke with six staff, six visitors and fourteen residents of the home. I inspected the building and examined various care records as well as a number of policies and procedures. All of the residents I spoke with said they were very happy with the care and support they received. One resident told me the staff were, “Very kind”. What the service does well: What has improved since the last inspection? What they could do better: One requirement has been restated that the nursing team must accurately record the amount of medication coming into the home. This will ensure that the staff know when residents’ medication may be running out and so they can Sage DS0000010546.V354752.R01.S.doc Version 5.2 Page 7 order more. Another requirement has been issued at this inspection that staff files must contain two written references before any staff can start working at the home. This should further protect residents. Three good practice recommendations have been issued as a result of this inspection. The staff should ask residents how they feel about the care provided to them every time care plans are reviewed. The staff should develop a care plan summary for all residents, which gives a clear overview of how they would like their care to be delivered. The staff should look for signs of “well being” and “ill being” in the people at the home with more advanced dementia. This should enable staff to have an understanding of how to keep people with more advanced dementia suitably occupied and engaged. 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. The summary of this inspection report can be made available in other formats on request. Sage DS0000010546.V354752.R01.S.doc Version 5.2 Page 8 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.V354752.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (6 not applicable) People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home carries out a comprehensive assessment of individual’s needs so that they know that the home is suitable for them before they decide to move in on a trial basis. EVIDENCE: The files of three people whom have recently been admitted to the home were examined. All files seen contained pre-admission assessments undertaken by qualified staff from the home. These assessments were detailed and outlined the physical, emotional and recreational needs of the individual. There was evidence that reviews take place with the person using the service and their relatives after a trial admission period of between four to six weeks. People I spoke with said they were satisfied with the admission procedures in the home and had felt welcomed and supported by the staff team. Sage DS0000010546.V354752.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans clearly set out residents’ health, personal and social care needs so that staff know how best to support everyone at the home. Residents have good access to health care professionals and they are treated with respect. Residents get the medication they require, at the right times and by appropriately trained staff. EVIDENCE: Eleven care plans were inspected. All contained detailed information 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 residents’ care plans inspected. There was evidence that all care plans are reviewed on a monthly basis. It would be good practice to review care plans with the individual so that the home can judge how well the home is meeting peoples’ needs. A recommendation has been reissued in the relevant section of this report. Sage DS0000010546.V354752.R01.S.doc Version 5.2 Page 11 There were records on the residents’ 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 doctors including evidence of their attendance at the home. People I spoke with were very positive about the doctors who visit the home. One person told me, “The doctor comes to see me here”. Residents told me that their health care needs were being met by the home. A large number of people supported at Sage have very complex needs and care plans reflected the complex nature of the support required. A good practice recommendation has been issued that all residents of the home should have a summary of their care needs developed which includes a brief “person centred” description of how the individual usually spends their day (for example what time the individual generally likes getting up in the morning). There was evidence that the home regularly liaises with the local tissue viability nurse when required. The home employs part time physiotherapists. It was clear that residents benefit from their input at the home. Records relating to the receipt, administration and disposal of medication were examined. A number of minor discrepancies were noted in relation to the receipt of medication on the third floor. These discrepancies did not directly affect the safety of residents. A requirement relating to this has been reissued in the relevant section of this report. The manager was able to explain the cause of these discrepancies and has taken steps to ensure this does not reoccur. Accurate records were examined in relation to the administration of medication. This was a requirement from the last inspection that has now been complied with. Records in relation to controlled drugs were accurate. All medication storage cupboards have been fitted with air conditioning and as a result medication is now being stored at 25 degrees or below. Throughout the inspection I saw examples of staff treating people with respect and upholding residents’ privacy. For example staff were seen to be knocking on people’s doors before going in. People I spoke with confirmed that they were treated with dignity and staff upheld their need for privacy. Staff I interviewed were able to give practical examples of when they have upheld peoples’ privacy. Sage DS0000010546.V354752.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides varied activities for people who use the service in keeping with the religious ethos of the home. The home encourages visitors and community events, which ensures an interesting and lively atmosphere. Residents are able to exercise choice and control over their lives. The home provides people with a wholesome appealing balanced diet in pleasant surroundings. EVIDENCE: There was evidence that the home organises a wide variety of activities for people who use the service. I saw a number of activities going on during the inspection including singing and exercises. People’s individual preferences were recorded on their files that were inspected. Residents told me about the 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. This is particularly important for people with more advanced dementia who are enabled by staff to continue to follow Jewish customs and religious observances. I spoke with the activities coordinator and we discussed the need to keep those people with more advanced dementia suitably occupied and Sage DS0000010546.V354752.R01.S.doc Version 5.2 Page 13 engaged. I also discussed with the manager the current best practice care for people with dementia. I have issued a recommendation relating to identifying “well being” and “Ill being” in the outcomes of care for those people with more advanced dementia. The manager has instigated a number of training courses for staff in supporting people with dementia. This has had a positive effect for people with dementia who live at the home. The record of visitors indicated that residents could have visitors at any reasonable time. Visitors I spoke with said they were always made welcome and offered tea or coffee when they visited. Residents I spoke with confirmed that visitors were welcomed and during the two days of the inspection I saw a large number of visitors to the home. Sage is clearly a major part of the local community and residents benefit from this lively and interesting atmosphere. Residents confirmed that they were able to have choice and control over their lives at the home. Residents told me they could do what they liked and were not “bossed about” at all. Staff I interviewed were able to give examples of how they ensure people are able to exercise choice and control within their daily routines. One resident told me, “They treat me very well”. 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. People who use the service confirmed that the food was very good at the home and that they always get enough to eat. Staff were observed offering discreet assistance to residents where appropriate. I was particularly impressed by the relaxed pace at lunchtime. People were able to take their time and enjoy the sociable atmosphere. Sage DS0000010546.V354752.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Complaints are taken seriously and responded to in a professional manner. Residents are protected from abuse by clear policies and procedures and by an appropriately trained staff team. EVIDENCE: The home has satisfactory policies and procedures in relation to complaints and the protection of residents from abuse. The record of complaints received by the home since the last inspection were examined. These records indicated that the manager had dealt with these in an open and professional manner. The manager told me that she tries to ensure that face to face meetings are held with all complainants in order that people know their complaint is being taken seriously. All the residents I spoke with said they had no complaints about the service but were clear that they would say something if they had a concern. Staff were able to describe to me how vulnerable people could be at risk of abuse in a residential care setting. All staff were clear of their responsibility to report any suspicions of abuse to the appropriate authorities. Residents that I spoke to said they felt safe and well supported at the home. Records indicated that most staff have undertaken training in the protection of vulnerable people. The manager informed me that a number of refresher courses have been booked for the year. Sage DS0000010546.V354752.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is safe and cleaned and maintained to a very good standard. EVIDENCE: A partial tour of the premises took place. People’s rooms that I visited were well maintained and individualised with personal possessions. The home employs a maintenance person and communal areas were well maintained and decorated to a high standard. 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 people I spoke with commented that the home was always clean. One person told me that, “The cleanliness is superb”. Records indicated that staff have received infection control training. Sage DS0000010546.V354752.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. All the staff at the home work very hard to meet the needs of residents and are provided with good training opportunities to further enhance their knowledge and skills. Recruitment practices are generally in order to protect residents at the home. EVIDENCE: The staffing levels remain as at the last inspection and meet the current residents needs. People I spoke with were positive about the staff team. One resident told me, “l can’t fault the staff”. Another resident told me that the staff are, “Very kind and loving”. People said they were satisfied with the numbers of staff on duty. Six staff files were examined. Five of these files contained the information required by Regulation including CRB disclosures and references. One file did not contain a second reference. A requirement has been issued that recruitment systems be reviewed to ensure that no one is employed at the home without first having all the required checks carried out. Records indicated that over 50 of care workers have now completed NVQ level 2 or equivalent. Staff were very positive about the training offered to them and staff training profiles examined indicated that staff at the home receive the training required to do their jobs effectively. Sage DS0000010546.V354752.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager of the home knows the residents very well and understands their needs. Residents have opportunities to have a say in how the home is run. Residents’ financial interests are being safeguarded. The health and safety of residents and staff are promoted and protected. EVIDENCE: Staff and residents that I spoke with were very positive about the manager of the home. One resident told me the manager is, “Very good indeed”. The manager is now registered with the CSCI and attends training with her staff as required. The manager’s commitment to improving standards at the home and her professional approach to both staff and residents is to be commended. Sage DS0000010546.V354752.R01.S.doc Version 5.2 Page 18 People who use the service said they felt “listened to” and there was evidence that issues raised in relatives and service users meetings were acted upon. The manager holds regular relatives meetings and the registered provider visits the home every month and produces a report to the CSCI as part of the home’s quality assurance programme. Residents confirmed the manager asks how they feel about the care provided by the home. The homes quality assurance systems have been formalised and are now published and made available to all interested parties. This ensures that residents, their relatives and other stakeholders have good information about how well the home is doing to meet people’s needs. Samples of residents’ finances were examined. The home does not generally hold money on behalf of residents. Instead residents 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 fire safety, gas safety, electrical installation and portable appliances, hot water checks and Legionella checks. All this documentation was satisfactory. Staff interviewed had a good understanding of the fire procedures and what their responsibilities were in the event of a fire. This was a requirement from the last inspection that has now been complied with. The home has recently been inspected by the local Environmental Health department. The report was satisfactory and there was evidence that minor issues identified in the report are being addressed. Sage DS0000010546.V354752.R01.S.doc Version 5.2 Page 19 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 Sage DS0000010546.V354752.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement The registered person must ensure that systems in relation to the receipt of medication at the home are reviewed to provide greater accuracy of recording. (Timescale of 01/07/06 not met) This requirement is restated. The registered person must ensure that recruitment systems are reviewed to ensure that no one is employed at the home without first having all the required checks carried out. Timescale for action 01/09/07 2. OP29 19(1) b 01/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Sage DS0000010546.V354752.R01.S.doc Version 5.2 Page 21 1. OP33 The registered person should ensure that service users are asked about their views of the quality of care provided by the home during the monthly reviews of their care plans. The registered person should ensure that all residents of the home have a summary of their care needs developed which includes a brief “person centred” description of how the individual usually spends their day (for example what time the individual generally likes getting up in the morning). The registered person should review the care plans of those people with more advanced dementia and ensure that the overall goal of well being is developed. Plans should describe how staff are to work towards individuals continued well being. Issues of occupation and engagement should be explored on an individual basis. 2. OP7 3. 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