Inspection on 05/08/09 for Sainthill House

This inspection was carried out on 5th August 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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Extracts from inspection reports are licensed from CQC, this page was updated on 11/04/2010.

Random inspection report Care homes for older people Name: Address: Sainthill House Sainthill House Cowick Lane Exeter Devon EX2 9JG new service which has yet to be given a quality rating The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Michelle Oliver Date: 0 5 0 8 2 0 0 9 Information about the care home Name of care home: Address: Sainthill House Sainthill House Cowick Lane Exeter Devon EX2 9JG 0 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Elizabeth Juggins Type of registration: Number of places registered: Conditions of registration: Category(ies) : Vision Uk care home 12 Number of places (if applicable): Under 65 Over 65 12 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is 12. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Care Homes for Older People Page 2 of 12 What we found: This random unannounced inspection was undertaken following information and allegations of poor practice, received from a person who wishes to remain anonymous. We arrived at the home at 6am and the inspection was carried out over 6 hours. Both providers, the registered provider and the manager/ person who responsible for day to day running of the home, were present throughout most of the inspection. During this inspection we looked at care plans for the two people who are got up early and one other person, in detail, as part of this inspection. Since the providers have taken over the service a new format for care planning has been intoduced. However, this format is not currently in place. The care plans we looked at were not detailed, did not include information to enable staff to know how to meet individuals health and social care needs and did not include assessments of risks or hazards, such as risk of falls or nutritional risks. There was no evidence of involvement of individuals in the planning or review of their care and no indication of the setting of any personal goals or aims. One person, who had recently been admitted to the home, is registered blind and no plan of how this will be managed at the home has been recorded. It was alleged that a member of staff has refused to allow a person living at the home to have a commode in their room, resulting in the person having to walk down a corridor to get to a toilet. This was discussed at a meeting held to discuss staff issues, during which it was alleged the manager was resistant to a commode being used as they smell. We looked at the plans of care for this person, who had recently been admitted to the home, and found no information relating to how the health and social care needs of this person were to be met at the home. We spoke to the person themselves and were told that they did not want a commode, they wanted to be as indepenedent as they could for as long as they were able. However, they would like to know how to find the toilet at night as they were registered blind. We discussed this with the provider, registered manager and manager. They agreed that information should be recorded to enable staff to be informed about how to meet the assessed needs of this person. They agreed that they would take action to ensure that the person would be able to find their way to a toilet. We were also told that the manager had not objected to the use of a commode, their concerns were that staff had used a commode belonging to another person and the concerns related to the risk of cross infection. We have been told that a community nurse visits a person at the home to apply dressings. It is alleged that a dressing had to be removed on one occasion and as care staff are not supposed to apply dressings staff wrote in the persons record that the dressing needed to be replaced. It is alleged that a named member of staff had been Care Homes for Older People Page 3 of 12 given this information, however the dressing was not replace for two days. We looked at the daily records for this person and saw several reports of dressings being removed and replaced by staff at the home. We did not see an entry relating to a dressing needing to be replace d and this not being done for two days. We also looked at the plans of care maintained by the community nurse. We noted an entry stating that the nurse had to use a different type of dressing during one visit to the home because staff had used all the dressing which had been left at the home and the nurse had none with them at the time of that visit. It was also alleged there had been a medication error at the home. It was alleged that two people were prescibed the same medication but one was prescibed a higher dose. Allegedly a member of staff gave the higher dose medication to the wrong person and signed the medication record but had not given out the medication. The manager told us that two people were on the same medication. We looked at the records of the administration of the medication and checked the amount indicated on the record with the actual amount of medication stored. The balance was accurate. This means that there is no indication that the record had been signed and a dose not being given. It is not possible to determine whether a higher dose had been given to a person. The procedure for the administration of medicines at the home has been improved since the providers have taken over the service. Medications are stored in a locked drug trolley, a member of staff undertakes the administration by dispensing individual medications, taking them in pots to the individual and only when the medication has been taken is the medication record signed. One of the allegations made was that night staff were required to get two people living at the home washed, dressed and sat out of bed before the day staff came on duty. We were told that staff needed to start getting these two people up as early as 6am. We arrived at Sainthill at 6am on the day of this inspection. We asked a carer on duty whether any people living at the home had been washed and dressed. We were told that one person had been and staff were just getting another person up. We checked and found one person dressed, sitting in a chair in their room, hunched over and sleeping. Another person was lying on their bed being washed and dressed. We later saw this person had been sat out in a chair and was hunched over and sleeping. We asked at what time had staff started to assist these people and were told that they had started at 5:30am We asked staff whether these people chose to be assisted out of bed at this time in the morning. Staff told us they had been told they had to get these two people up each morning before day staff came on duty. We were told that one of the two people often made it known they didnt want to get up. This was confirmed when we looked at reports written by night staff. Comments included not pleased to get up this morning, but washed, dressed and put in her chair, up dressed in chair but not very happy to be up this morningand was very upset about getting up this morning and tried to swipe at carer. Care Homes for Older People Page 4 of 12 We spoke to both people; one was not able to speak to us and the other person confirmed that they didnt like being got out of bed in the mornings. We discussed the allegations and our findings with one of the providers, the registered manager and the manager of the home. We were told that a meeting had been held within the last 10 days when staff requested the provider meet with them to discuss some issues they were not happy with. During this meeting staff voiced their concerns at having to get two people out of bed early in the morning. The provider told us they had told staff that they were not to do anything that people living at the home did not agree to. The provider and managers were confused as to why staff were continuing with this practice and assurred us that they will be investigating the reasons this has continued since they had been told not to. It was alleged that meals for two people, which up to recently were just mashed to make them more easily chewed, are now liquidised. We were told there has been no consultation with appropriate health care professionals, such as doctors or speech and language therapists prior to the diets being changed. Allegedly a member of staff was responsible for changing the way the meals were served. We spoke to a member of staff who was preparing breakfasts at the time of this inspection. We asked whether a record was kept of various diets that people may require. We were told that no record was kept. We asked whether the two people in question received a liquidised diet and were told that they did. When asked why they had their meals served in this way we were told because it is easier. We looked at the care plans for the two people in question and there were no records or risk assessment relating to either of them. We discussed this with the provider, registered manager and manager. They agreed that if these people had trouble eating a multi diciplinary approach should have been undertaken. The Registered manager assurred us that this would be undertaken. It was alleged that the person who ran art sessions once a week at the home had their contract terminated when the service was taken over by the current providers. Allegedly a person living at the home , who has an interest in art and enjoys painting, was very upset by this and is now depressed and spends most of the time in their room. We spoke to the providers and manager and were told that the person who ran the art sessions never had a contract with the home. The arrangement was terminated for a number of personal reasons. the providers are currently looking to re instate the sessions and are trying to recruit a person from an art school. We spoke to the person who allegedly is depressed and stays in their room. They confirmed they had enjoyed the art sessions and did miss them but they were not depressed. They had not been told that the providers were working towards re introducing art sessions at the home. We spoke to all people living at the home at the time of this inspection. Those that were able to communicate confirmed that they are very happy living there. One person said there had been changes lately but they were hopeful that life would Care Homes for Older People Page 5 of 12 improve further. Although not everyone that was able to communicate were aware of the homes complaints procedure they told us that they would complain to staff or their relatives if they were unhappy about anything at the home. all those who were able to express themselves told us the home was lovely and staff were very kind. Staff have not received formal Safeguarding Adults training.the provider told us that they had spent time with staff individually and discussed what would constitute abuse and what action to take if they suspected abuse or poor practice. It was alleged that a hoist was not available for one person at the home and that not all staff have been trained to use the hoist. During this inspection we saw two new hoists at the home, one on the first floor and one in a persons bedroom on the ground floor. The manager told us that all staff had received training in the use of the hoist when they were delivered by the suppliers. We were told that staff had manual handling training in February 2009, prior to the current owners took over the service. Plans have been made for this to be updated. the manager has undertaken training recently and told us they supervise staff. It has been alleged that a cleaner has had their contract terminated since the new providers have taken over the service. The providers told us there was never a permanent cleaner at the home. An external cleaner is currently contracted to visit the home once a week to undertake deep cleaning. Care staff undertake routine cleaning at the home throughout the day. The home was very clean and fresh at the time of this inspection. It was alleged that 3 staff have terminated their employment since the providers have taken over the home. We were told that one person left to take up nurse training, another left because they did not want to work so many hours and another left as they were offered a higher salary elsewhere. It is alleged that Elizabeth Juggins is hardly ever at the home. When the service was registered it was agreed that although Elizabeth Juggins was to be registered as manager the home would be managed by another member of staff with appropriate experience and training. Issues have been raised relating to the management of the home on a day to day basis. These issues were discussed with the providers, registered manager and the person who undertakes the day to day running of the service. The Registered manager assurred us that they will be investigating these allegations and will be keeping the CQC up to date with their findings. Care Homes for Older People Page 6 of 12 What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 12 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 12 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 All people living at the home 07/09/2009 must have a plan of how their health, welfare and socail care needs will be met at the home. The individuals must be involved in the initial drawing up of the plan, if they are able and wish to, and in the following regular reviews. To ensure that people have a say in how they spend their lives. 2 8 12 Arrangements must be made 07/09/2009 for people living at the home to receive advice and other services from any health care professionals. This relates to people who may require a special diet. To promote health and welfare 3 8 13 Unecessary risks to people living at the home must be identified. 07/09/2009 Care Homes for Older People Page 9 of 12 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To promote health and welfare. 4 9 13 arrangements must be made 07/09/2009 for the safe recording of medicines received into the home. to promote health and safety. 5 10 12 The registered persn must enable people to make decisions in respect to the care they are to receive. To maintain dignity and choice. 6 12 11 For the purpose of providing care to people and making proper provision for their health and welfare, their wishes and feelings must be taken into account. To ensure that people are given a say in how they live their lives. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 07/09/2009 07/09/2009 1 2 3 15 21 32 Meal times should not be rushes and independent eating should be encouraged for as long as possible. Toilets should be close to peoples accommodation and they should be assisted to access them. People living at the home and staff should benefit from the Page 10 of 12 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations ethos, leadership and management approach of the home. Care Homes for Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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