Inspection on 05/06/06 for Sage

This inspection was carried out on 5th June 2006.

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 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 avid Hastings Key Unannounced Inspection 09:30 5th & 6th June 2006 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.V287876.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 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.V287876.R01.S.doc Version 5.1 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.V287876.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 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. 20th December 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. 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.V287876.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken as part of the annual inspection programme and took place on Monday 5th June 2006 / Tuesday 6th June 2006 and lasted twelve hours. The inspector spoke with fourteen service users, ten care staff and three relatives. A partial tour of the premises took place and care records were inspected. The inspector was assisted by the manager who was open and helpful throughout. What the service does well: What has improved since the last inspection? What they could do better: One requirement relating to the accurate administration of medicines has been restated. Unmet requirements impact upon the welfare and safety of service users. Failure to comply by the revised timescales will lead to the Commission for Social Care Inspection considering enforcement action to secure compliance. Sage DS0000010546.V287876.R01.S.doc Version 5.1 Page 6 A further requirement has also been issued relating to the receipt of medication at the home. In addition to these requirements three new requirements have been issued at this inspection relating to the registration of the manager, quality assurance and staff awareness of fire procedures in the home. One recommendation has been issued relating to resident’s views about their care. 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.V287876.R01.S.doc Version 5.1 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.V287876.R01.S.doc Version 5.1 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 (6 not applicable) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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: The files of three service users 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 service user and their relatives after a trial admission period of between four to six weeks. Sage DS0000010546.V287876.R01.S.doc Version 5.1 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, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ health, personal and social care needs are well documented in their plan of care. Service users have good access to health care professionals. The safe and secure handling and administration of medicines is generally satisfactory. Service users are treated with respect and their right to privacy is upheld. 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 are reviewed on a monthly basis. Care plans also detailed service user’s remaining abilities and strengths as well as care needs. This was a requirement from the last inspection. The manager has instigated review meetings with service users recently admitted to the home and their relatives. As a result of these meetings important information regarding the care needs of individual service Sage DS0000010546.V287876.R01.S.doc Version 5.1 Page 10 users is being recorded in care plans. This is very good practice and would benefit all service users in the home. 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. No service users currently have pressure sores. 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 service users 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. A requirement relating to this has been issued in the relevant section of this report. Records in relation to the administration of medication were accurate. However one member of the nursing team on the third floor informed the inspector that she had already recorded the administration of medication for lunchtime although these medications had not been given as yet. This practice is not acceptable and the inspector informed the nurse that medication must only be recorded when it is actually given to service users. The manager was informed and has taken immediate action. A requirement that all records of medication administration are accurately recorded was made at the last inspection and has been restated. 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. This was a requirement from the last inspection that has now been complied with. A requirement was issued at the last inspection that all nursing staff must receive training updates with regard to medication for service users with dementia. The manager informed the inspector that the senior pharmacist for the home would be carrying out this training. Service users that the inspector spoke with said the staff treated them with respect and maintained their privacy. This was confirmed by direct observation of staff interacting with service users. Staff interviewed had a good understanding of the need to treat service users in a respectful manner and were able to give examples of how they maintain service users’ privacy. Sage DS0000010546.V287876.R01.S.doc Version 5.1 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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. This is particularly important for service users with more advanced dementia who are enabled by staff to continue to follow Jewish customs and religious observances. Sage DS0000010546.V287876.R01.S.doc Version 5.1 Page 12 The manager informed the inspector that carers are insured to take service users out of the home in wheelchairs. A number of service users told the inspector they had been taken out shopping on the days of the inspection. 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. Maintaining contact with family and friends is being encouraged by staff at the home. Relatives that the inspector met were generally positive about 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. Interests are listed in care plans as well as individual likes and dislikes. Staff were observed offering choice to service users throughout the inspection. 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. Staff were observed offering discreet assistance to service users where appropriate. The inspector was particularly impressed by the relaxed pace at lunchtime. Service users were able to take their time and enjoy the sociable atmosphere. Sage DS0000010546.V287876.R01.S.doc Version 5.1 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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. Staff interviewed had a good understanding about the protection of vulnerable people in their care. Sage DS0000010546.V287876.R01.S.doc Version 5.1 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is safe, clean and hygienic, well-maintained and decorated to a good standard. EVIDENCE: A partial tour of the premises took place. Service users rooms that the inspector visited were well maintained and individualised with personal possessions. Communal areas were also well maintained and decorated to a high standard. New curtains have been ordered for some communal areas and service users have been consulted about the provision of net curtains in their rooms. These were both requirements from the last inspection. The manager has reviewed the layout in the two main lounges in order to provide better access for people who use wheelchairs. 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.V287876.R01.S.doc Version 5.1 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 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, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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. One service user described the staff as “very good”. The staffing levels of the home are in line with the Department of Health’s “No regression” policy. 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. Fifteen staff at the home currently have NVQ level 2 or equivalent with a further six staff undertaking the training this year. The home is working towards meeting this standard. The training coordinator has developed a rolling programme of mandatory training for all staff. 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. Staff interviewed were very positive regarding the training offered to them at the home. Sage DS0000010546.V287876.R01.S.doc Version 5.1 Page 16 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.V287876.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 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 all staff must be aware of the home’s fire procedures. 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 staff member commented that the manager was, “very hardworking”. The manager has also recently attended a dementia conference and as a result has instigated some new ideas for activities for service users with dementia. Sage DS0000010546.V287876.R01.S.doc Version 5.1 Page 18 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. The manager must apply to be registered with the CSCI. A requirement relating to this has been made in this report. The manager holds relatives meetings every six weeks 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. Service users confirmed the manager asks how they feel about the care provided by the home. Although quality systems are in place, further work needs to be undertaken by the registered provider and manager to formalise the quality assurance systems including providing surveys for service users and their representatives and publishing the results of these surveys. A requirement relating to quality assurance has been made in the relevant section of this report. A recommendation has also been made that service users are asked for their views about care provision when care plans are being reviewed each month. This would enable service users to have a say about the care provided by the home on a regular basis. Staff should look at non-verbal communication indicators for service users with communication difficulties. 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. Two requirements were issued at the last inspection relating to fire safety. Night staff are taking part in fire drills every three months and the fire procedures have been reviewed. The local fire officer inspected the home on 30th May 2006. The manager informed the inspector that all recommendations made at that visit have been addressed. The provider has also obtained a detailed fire risk assessment from a private fire safety company. Both requirements have now been complied with. It was noted that at a recent fire drill not all staff were fully aware of the home’s fire procedures. A requirement has been issued relating to this issue. Sage DS0000010546.V287876.R01.S.doc Version 5.1 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 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Sage DS0000010546.V287876.R01.S.doc Version 5.1 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 manager must ensure that all records of medication administration are accurately recorded. (Timescale of 01/03/06 not met) This requirement is restated. 2. OP9 13(2) The manager must ensure that systems in relation to the receipt of medication at the home are reviewed to provide greater accuracy of recording. The manager must ensure that a training plan is prepared detailing when the home expects to meet the requirements of Standard 28 in terms of 50 of care staff completing NVQ level 2. A copy of this training plan must be sent to the CSCI. The registered provider must ensure that the manager applies to be registered wit the CSCI. 01/07/06 Timescale for action 01/07/06 3. OP28 18 01/08/06 4. OP31 10 01/08/06 Sage DS0000010546.V287876.R01.S.doc Version 5.1 Page 21 5. OP33 24(1) 6. OP38 23(4) d, e The manager must ensure that the quality assurance system is formalised and includes outcomes of any service user/representatives questionnaires being published to interested parties. The manager must ensure that all staff are fully aware of the homes’ fire procedures and are clear about what action they must take in the event of a fire. 01/09/06 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. Refer to Standard OP33 Good Practice Recommendations The manager 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. Sage DS0000010546.V287876.R01.S.doc Version 5.1 Page 22 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.V287876.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. 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!