Inspection on 01/03/07 for Saltmarsh House

This inspection was carried out on 1st March 2007.

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

Saltmarsh House 29/01/09

Saltmarsh House 03/01/06

Saltmarsh House 07/09/05

Saltmarsh House 18/01/05

Saltmarsh House 05/07/04

Saltmarsh House 09/02/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Saltmarsh House 12 Saltmarsh Lane Hayling Island Hampshire PO11 OJT Lead Inspector Nick Morrison Unannounced Inspection 1st March 2007 10:00 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 Saltmarsh House DS0000011784.V327519.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. Saltmarsh House DS0000011784.V327519.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Saltmarsh House Address 12 Saltmarsh Lane Hayling Island Hampshire PO11 OJT 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) 023 9246 2183 karen.morriss-dixon@virgin.net Mrs Karen Dixon Mrs Karen Dixon Care Home 12 Category(ies) of Dementia - over 65 years of age (12), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (12), Old age, not falling within any other category (12) Saltmarsh House DS0000011784.V327519.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd January 2006 Brief Description of the Service: Saltmarsh House is a large detached property situated in a quiet, residential area of Hayling Island. The accommodation comprises of twelve single rooms, of which eight have en-suite facilities. The shared space within the home includes a large lounge, a conservatory and a dining room. Outside is an attractive well maintained garden to the rear of the house with tables, chairs and umbrellas. To the front of the house is a swimming pool, not currently used by residents. Saltmarsh House DS0000011784.V327519.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report represents a review of all the evidence and information gathered about the service since the previous inspection. This included a site visit that occurred on 1st March 2007 and lasted five hours. During this time the Inspector toured the premises, looked at a sample of six service users’ files and met with three of those people. All records and relevant documentation referred to in the report was seen on the day of inspection. The Inspector spoke with the Proprietor, as well as a sample of staff and other service users. What the service does well: What has improved since the last inspection? What they could do better: 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. Saltmarsh House DS0000011784.V327519.R01.S.doc Version 5.2 Page 6 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 Saltmarsh House DS0000011784.V327519.R01.S.doc Version 5.2 Page 7 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 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from having their needs assessed prior to moving into the home. EVIDENCE: Service users’ files showed records of assessments that had been completed by the manager prior to them moving into the home. The assessments were comprehensive. As well as covering essential information and assessing individual needs and requirements, there were assessments that identified each person’s strengths and abilities. All assessments contained review dates and they were all reviewed according to the dates identified. The home does not provide intermediate care. Saltmarsh House DS0000011784.V327519.R01.S.doc Version 5.2 Page 8 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from having their needs set out in a care plan and from having their healthcare needs met. They also benefit from being treated with respect and are protected by the home’s medication policies and practices. EVIDENCE: Care plans were in place for each service user. Records showed that they were reviewed on a regular basis. There was documentary evidence that service users and their families had been involved in devising the care plans and service users spoken with said they had been consulted about the care they required. The plans also contained risk assessments for service users and these were also kept under regular review. The regularity of review depended on the nature of the risk, but most risk assessments were reviewed every three months. An individual daily diary system was used to record information relevant to each person’s care. There were guidelines in place to assist staff in Saltmarsh House DS0000011784.V327519.R01.S.doc Version 5.2 Page 9 completing these records effectively. There were additional care plans in place for short-term illnesses that particular service users might experience from time to time. The healthcare needs of each service user were monitored on a monthly basis and records were kept. Healthcare appointments where necessary and service users were assisted to attend these either by family members or by staff from the home. Information and outcomes from all healthcare appointments were recorded. There was evidence that the home initiated liaison with relevant healthcare professionals on behalf of service users where necessary. Service users were supported to manage their own medication where possible and subject to an assessment of the risk. All medication coming into and out of the home was recorded and there were clear records of all medication administered by staff within the home. Medication was stored appropriately in a locked cabinet. The home’s medication policy was clearly written and staff involved in administering medication had all received training. The policy required two members of staff to be involved in administering each item of medication in order to double check each item and avoid errors. Service users spoken with said they always received their medication properly and said that staff “knew what they were doing”. The medication files contained information on each item of medication kept in the home so that staff could be aware of potential side effects. The home had sought input from the Pharmacist with their medication policies and practices. Service users’ preferred from of address was identified within the preadmission assessment and staff respected how service users wanted to be referred to. The induction training for all staff covered the need to treat all service users with respect at all times and staff observed on the day of the inspection visit demonstrated a respectful approach. All service users were supported to maintain their appearance and family members had highlighted this as a very positive demonstration of how service users were respected and valued. All service users spoken with said they felt staff were respectful to them at all times and one said, “You couldn’t fault them at all”. Saltmarsh House DS0000011784.V327519.R01.S.doc Version 5.2 Page 10 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from having excellent food and from having appropriate activities provided. They also benefit from being able to exercise control over their own lives and from being supported to maintain contact with families and friends. EVIDENCE: The home employs a number of different entertainers to come in and entertain service users on a regular basis. Service users spoken with said they really enjoyed these events. One said that he had heard tunes he had not heard for years and found that the sessions brought back memories from when he was younger. He also said the musicians involved were very good. Some service users were supported to go out to a daytime club on some days during the week where they could meet other people. There were also activities provided within the home. The lounge area had a separate part where there was a table for activities and there were games and books in this area for people to use. The home also gave service users access to a book club that brought books to the house periodically for service users to buy if they Saltmarsh House DS0000011784.V327519.R01.S.doc Version 5.2 Page 11 wanted to. Staff in the home were clear about the need to ensure that service users received sufficient stimulation throughout the day and made themselves available to do individual activities with people who wanted to. Newspapers were available in the lounge and staff discussed news items with service users. The home had a visitors’ policy that encouraged visitors at any time, except for mealtimes unless it was arranged in advance. There were records on service users’ files that showed that the home liaised with families on a very regular basis and maintained regular contact. Service users were also supported to maintain contact with their families and friends. One service user spoken with said that his friends were always made to feel welcome by the staff whenever they visited him in the home. Daily notes kept in each service user’s file showed that people were able to choose what time they got up and what time they went to bed and whether or not to be involved in particular activities on certain days. Service users spoken with confirmed that they were always able to make their own decisions about their own lives and that staff respected this. Staff induction training covered the need to respect service users’ individual choices and those staff observed on the day of the inspection visit demonstrated that they had no difficulty doing this throughout all aspects of their work. Service users were able to bring their own possessions with them to the home. One person living there had brought his own organ, which was kept in the conservatory for him to play. Evidence from service users’ files showed that they were supported to vote in elections and postal voting was organised where necessary. The home’s approach to providing food for service users was excellent. Information on individual dietary preferences and requirements was assessed on admission and this information was passed on to the kitchen staff. There were recipes and information kept for different dietary needs. The kitchen was well organised and food was stored well. Menus were written and the meals for each day were written on a white board in the entrance hall outside the dining room. Records were kept of all food provided and these demonstrated that the meals were varied and nutritious. Most food was made from scratch from fresh ingredients and the cook was proud of providing good, home-cooked food for service users. On the day of the inspection visit service users could choose from homemade macaroni cheese, pork, jacket potatoes, vegetables, baked beans and salad. They were able to make up their own meals from any combination of the food on the menu or were able to have a bit of everything. They were also able to be very specific about exactly what they wanted, for example, whether or no they wanted a jacket potato with cheese on or one without cheese and whether or not they wanted a serving of macaroni cheese with or without the tomato on top. Service users appeared used to being very specific about what they wanted and staff were extremely responsive to any requests. The cook explained that if any service user did not want any of the food on offer, a separate meal would be prepared for them, for example, an omelette. The table was laid before service users came to eat and included napkins, three choices of drinks, a basket of crusty bread and fresh flowers. Saltmarsh House DS0000011784.V327519.R01.S.doc Version 5.2 Page 12 A member of staff served each person’s meal individually. Where people needed some of their food cut up for them, this was done discreetly before it was served so that they did not have to have it cut up in front of them. All service users were encouraged to maintain independence in eating, but support was available where necessary. The owner of the home, who lives on site, sat down to eat with service users, as did the care staff on duty. The mealtime was a very sociable occasion and staff ensured that service users were included in conversation. The atmosphere was very relaxed, comfortable, civilised and stimulating for service users. All service users spoken with were very complimentary about the food. One service user said she had lived in the home for nearly three years and every meal she had in that time was excellent. Saltmarsh House DS0000011784.V327519.R01.S.doc Version 5.2 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. 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. Service users benefit from being able to complain about aspects of their care if they need to and are protected by the home’s practices and policies on protecting vulnerable adults. EVIDENCE: None of the service users spoken with had ever had to make a complaint about the home, but all were sure that the home would respond very well if they did ever have to complain. One service user said she could not imagine that she would ever to make a complaint about the home. She said that staff in the home and the manager were very responsive to any requests and always “got things sorted out” so that there would not be a reason to complain. The home has a complaints policy in place and a system for recording and responding to any complaints should they arise. Staff had all received training in adult protection and were aware of adult protection issues and how to respond to any suspected instances. Service users spoken with said that they felt very safe in the home and did not feel at risk of abuse in any way. The rights of service users were promoted in the home and the home has adult protection and whistleblowing policies in place. Saltmarsh House DS0000011784.V327519.R01.S.doc Version 5.2 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. 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. Service users benefit from living in a clean, comfortable, well-maintained and safe home. EVIDENCE: The home keeps records of all maintenance issues that arise and the records showed that these issues were responded to in a timely manner. There were no outstanding maintenance issues observed on the day of the inspection visit. Service users spoken with said there were no maintenance issues outstanding. The home was kept clean and hygienic throughout while still managing to retain a comfortable and homely ambience. Infection control procedures were in place and no hygiene issues were observed on the day of the visit. The laundry area was clean, spacious and well organised. Service users spoken with said they never had any problems with their laundry. Protective clothing Saltmarsh House DS0000011784.V327519.R01.S.doc Version 5.2 Page 15 was available for staff and there were wearing it when necessary on the day of the inspection visit. Saltmarsh House DS0000011784.V327519.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 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users benefit from being supported by sufficient numbers of well trained staff and are protected by the home’s recruitment policies and practices. EVIDENCE: There had been a requirement from the previous inspection that the manager must ensure that the records of recruitment are held for each person including evidence of CRB and POVA checks. Records showed that since that time the home now uses the Hampshire Care Association as an umbrella organisation through which they follow up Criminal Records Bureau and Protection of Vulnerable Adults checks. The records showed that these were in place prior to new members of staff beginning work in the home. Staff files also contained identification and references. Observation of the staff working in the home on the day of the inspection visit showed them to be extremely conscientious about their work and very respectful to service users. All service users spoken with spoke very highly of all the staff in the home. One said “they would do anything for you” and another said “they are all perfect”. The staff were calm, competent and efficient and very focussed on providing excellent care to people living in the Saltmarsh House DS0000011784.V327519.R01.S.doc Version 5.2 Page 17 home. They had a good knowledge of the needs of each service user and appeared skilled in responding to needs. Staff training covered a wide range of general skills in working with older people as well as more specific training related to the needs of people living in the home. This included training in challenging behaviour, Parkinson’s disease, Dementia, Pressure Care, Stoma Care, Continence and Risk Assessment. Good records were kept of all training provided to staff in the home. Staff said they were able to access the training they thought they needed and that the manager was always very supportive and keen on ensuring that staff were well trained. Training needs were alo identified through regular one-to-one sessions with the manager and through annual staff appraisals. Information about planned training was shared at staff meetings, which occurred every three months. The families of service users were invited to some training events within the home, for example, a talk on Dementia. Service users spoken with said that staff appeared to be very competent at carrying out their work. The home employs two care staff throughout the day and night. These are supported by a full-time manager as well as a cook, a relief cook and domestic staff. There has been very little staff turnover and many staff have worked in the home for many years. There were task lists to detail what each member of staff needed to do during each shift and it was obvious that staff were clear about what they needed to do and were able to get on with it in an efficient manner. Saltmarsh House DS0000011784.V327519.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from living in a very well managed home. The interests of service users underpin every aspect of the service and the health, safety and welfare of service users and staff is protected by the home’s policies and practices. EVIDENCE: The manager of the service is registered and has demonstrated that she has the skills, qualifications and experience to manage the home. The manager was on leave on the day of the inspection visit, but the home ran very well in her absence. There is an obvious leadership throughout all aspects of the home that places a high importance on ensuring the service is responsive to the Saltmarsh House DS0000011784.V327519.R01.S.doc Version 5.2 Page 19 needs and wishes of the people who use it. This is reflected in policies, management, training, supervision and particularly through care practices. Service users are encouraged on a daily basis to comment on the service and said that staff and the manager always ask them if everything is satisfactory or if the service needs to be improved. There is a newsletter every four months, which explains to service users and their families what developments there are within the service and encourages them to comment on these. The staff concentrate throughout their working day on ensuring that service users have all that they need and are happy with the service. All service users spoken with said they could not think of any ways in which the service could be better. The home does not manage the finances of service users. Where they need to keep amounts of money for some service users, there are clear accounting procedures and records. All fire equipment was regularly checked and records were kept. Staff fire training was up to date and there were records of regular fire drills. All staff had up to date health and safety training and were clear about their responsibilities within this. There were no health and safety concerns highlighted on the day of the inspection visit. All equipment brought in by service users, such as beds, chairs and electrical goods, were checked for safety. Incident and accident records were kept and these were regularly monitored and analysed. There were hazard analyses ion place to cover food, hygiene and substances that might be hazardous to health. Incidents and accidents were recorded and monitored and there was evidence that alterations to the building had been made, where necessary, in response to these. Saltmarsh House DS0000011784.V327519.R01.S.doc Version 5.2 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 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 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 Saltmarsh House DS0000011784.V327519.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 Saltmarsh House DS0000011784.V327519.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Saltmarsh House DS0000011784.V327519.R01.S.doc Version 5.2 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. 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