CARE HOMES FOR OLDER PEOPLE
Sandbanks Care Home Southville Road Bedfont Middlesex TW14 8AP Lead Inspector
Robert Bond Unannounced Inspection 15th February 2006 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 Sandbanks Care Home DS0000032618.V278342.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. Sandbanks Care Home DS0000032618.V278342.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Sandbanks Care Home Address Southville Road Bedfont Middlesex TW14 8AP 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) 0208 890 4872 0208 890 1160 paula.bilbie@hounslow.gov.uk London Borough of Hounslow Miss Paula Carol Bilbie Care Home 34 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (26) of places Sandbanks Care Home DS0000032618.V278342.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 12th August 2005 Brief Description of the Service: Sandbanks is a purpose built home, for thirty four older people. It is owned and managed by the London Borough of Hounslow. It is situated in a residential area of Bedfont and there are local shops and public transport within half a mile. The home is a two-storey residential home which is divided into four units, Swallows and the Intermediate Care unit on the ground floor, and Lapwings and Magpies on the first floor. These are pleasantly furnished in a domestic style. In each of the units there are kitchen facilities, a lounge, dining area, a bathroom and toilets. A large communal lounge on the ground floor is used for entertainment, functions and meetings. There is a coffee room adjacent to the lounge for visitors, residents and staff to use. A large well-furnished conservatory is next to the lounge. This is used as the smoking area. The Rehabilitation unit provides a short-term service for seven clients who require rehabilitation either before returning home from hospital or to remain at home. There is a maximum six week stay. This unit has its own manager and team of staff, which includes a physiotherapist and occupational therapist. The home also has a unit for 8 service users with dementia. The home has an extensive garden with a pond and seating. A corridor links the home with a day centre, which has its own separate entrance and facilities. There is adequate parking for staff and visitors, both in front of the home and in the nearby road. Sandbanks Care Home DS0000032618.V278342.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the second unannounced inspection of the year and as the previous inspection covered almost all of the Department of Health’s National Minimum Standards (NMS), this inspection concentrated upon certain key standards only. The Inspector met the Registered Manager, and the Administrator, and spoke to several other staff and service users. The staff and the service users expressed their satisfaction working or living at the home. The Inspector toured the premises and examined various files, records and policies. The Registered Manager reported that the home is full and has five staff vacancies caused by staff acting up elsewhere. The vacancies are covered by the use of agency staff. The Inspector assessed the performance of the home against 27 of the NMS, and found that the outcomes of 20 were fully met, whilst the outcomes of 7 standards were only partly met. The Inspector made 5 requirements and 2 recommendations. What the service does well: What has improved since the last inspection?
An eight place dementia unit has opened providing a much needed additional service. The unit concerned has been refurbished, and a secure garden area created. Staff in the unit have been trained by the Alzheimer’s Disease Society. Care plans for service users in the unit are person centred. Sandbanks Care Home DS0000032618.V278342.R01.S.doc Version 5.1 Page 6 Two vacant staff posts have been filled by permanent staff members. The number of staff who have NVQs in care has increased. The Registered Manager has obtained her Registered Managers Award. Five bedrooms have been refurbished. 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. Sandbanks Care Home DS0000032618.V278342.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 Sandbanks Care Home DS0000032618.V278342.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): 1, 2, 3, 5 and 6. Prospective service users are provided with suitable information. Service users are provided with written contracts but they are not always signed. The needs of prospective service users are assessed in advance in a satisfactory manner. Prospective service users are able to visit the home in advance to a satisfactory extent. The Intermediate care unit is working satisfactorily. EVIDENCE: NMS1: The Registered Manager provided the Inspector with a revised Service Users’ Guide that met the required standard. The Registered Manager reported that the home’s Statement of Purpose is currently being updated.
Sandbanks Care Home DS0000032618.V278342.R01.S.doc Version 5.1 Page 9 NMS2: The Inspector examined (case-tracked) a service user’s file chosen at random. He found that although it contained a written statement of terms and conditions, the document had not been signed by anyone. Requirement 1. NMS3: The Inspector examined the admission papers of a service user who had moved in two months before. A variety of papers were found which added together produced a full assessment picture. The assessment document does not request information about social, religious or cultural needs. A separate ‘cultural and personal issues’ form collects this information. See Recommendation 1. NMS5: The Registered Manager reported that pre-admission visits take place. NMS6: The Registered Manager reported in detail the working and success of the Rehabilitation (intermediate care) unit. Sandbanks Care Home DS0000032618.V278342.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 11. Service users each have a satisfactory ‘health and social care plan’. Service users in the dementia care unit have in addition an appropriate ‘life plan’ that follows the person-centred planning model. Service users’ health needs are not fully met. Service users’ are not sufficiently protected by the home’s policies and procedures for dealing with medicines. Appropriate records are maintained concerning service users wishes at the time of their death. EVIDENCE: NMS7: The care file that the Inspector case-tracked contained a ‘health and social care plan’ that had been prepared the day before the service user’s admission to the home. The service user, who is in the dementia care unit,
Sandbanks Care Home DS0000032618.V278342.R01.S.doc Version 5.1 Page 11 also had a ‘life plan’ prepared for her that was in a person centred format that is commended. See Recommendation 2. NMS8: The same care file contained a manual handling assessment, a medication assessment, and a ‘my health today’ section. The standard however is not fully met due to a serious concern the Inspector identified when inspecting the medication records (see below) which could have had a serious impact on the health of a the service user concerned. NMS9: The Inspector inspected the medication storage facility and medication records in the dementia care unit. He found the storage to be satisfactory but he found the entry for one service user showed that she had not received any of her medication for several days as none had been supplied for that period by the surgery or pharmacist. The medication has now recommenced. The Registered Manager reported that she had not however been made aware of the gap by the member of staff whose responsibility it was to deal with reordering of medication, and hence she had not made emergency arrangements to obtain the necessary medication. The Inspector has requested a full report on the circumstances. It may be that the home’s medication policy requires amendment in the light of the findings of this investigation, and that relevant staff will need to receive additional training. Requirements 2, 3 and 4. NMS11: The file that was case-tracked contained a ‘cultural and personal issues’ form that provided details of funeral wishes etc. Sandbanks Care Home DS0000032618.V278342.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 The menu choice of food served is satisfactory. EVIDENCE: The Inspector examined the current menu and found the variety, choice and quality of food on offer was good. Sandbanks Care Home DS0000032618.V278342.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 Complaints are recorded and investigated in a satisfactory manner. Service users are not sufficiently protected from neglect. EVIDENCE: NMS16: The Inspector examined the home’s complaints reporting information, and the record of complaints made. One complaint had been made and had been satisfactorily recorded and investigated. NMS18: The home has in place the London Borough of Hounslow’s Adult Protection procedure. The incident reported above of medication not being obtained and hence not provided to a service user could be seen as neglect. The incident had not been reported to the Registered Manager of the home, had not been reported as a potential adult protection issue, and had not been reported to the Commission of Social Care Inspection as a Regulation 37 issue. Requirement 5. Additional staff training in adult protection will be necessary. Requirement 4. It is also required that the existing London Borough of Hounslow’s Adult Protection procedure is supplemented by the home devising its own policy and procedure for staff to report appropriate instances of potential abuse or neglect to the Registered Manager. Requirement 4. Sandbanks Care Home DS0000032618.V278342.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 to 26 All the outcomes to the above standards are fully met, with the exception that unless cleaning chemicals are locked away when not in use, the home is not as safe as it should be. EVIDENCE: The Inspector toured the premises in the company of the Registered Manager. He found the home to be well designed and maintained, well decorated, furnished and equipped, clean and hygienic. In one unit, the Inspector found that the COSSH cupboard containing cleaning chemicals was unlocked. This was corrected immediately, hence no requirement is made. Sandbanks Care Home DS0000032618.V278342.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, 29 and 30 There are sufficient staff deployed in running the home, and the skill mix is adequate. The home’s recruitment policy and practices protect service users. Not all staff are adequately trained. EVIDENCE: NMS27: The Inspector examined a staff rota. The Registered Manager reported that there are 5 vacant posts that are covered by agency staff. NMS29: The Inspector case-tracked a recent recruitment file and found that all appropriate checks had been undertaken. NMS30: The Inspector examined individual and collective training profiles. The Registered Manager reported an increase in the number of staff who have obtained NVQ level 2 or 3 in Care. However the non-reporting of the medication issue referred to in NMS 9 strongly suggests that further training in medication and protection issues, and the role of the CSCI, is required. Requirement 4. Sandbanks Care Home DS0000032618.V278342.R01.S.doc Version 5.1 Page 16 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, 35, 36 and 38 The Manager is a fit person to manage the home. Service users’ personal allowances are properly administered. Staff members receive professional supervision at the required frequency. The health, safety and welfare of service users are not sufficiently promoted. EVIDENCE: NMS31: The Registered Manager reported that she had obtained the Registered Manager’s Award. The Inspector examined minutes of a senior staff meeting that showed consultation and information flow are occurring appropriately.
Sandbanks Care Home DS0000032618.V278342.R01.S.doc Version 5.1 Page 17 NMS35: The Inspector examined a sample of service user’s personal allowance records and found them to be well maintained and demonstrating that money was being spent appropriately. NMS36: The Inspector examined staff supervision records and found that staff were being professionally supervised on a regular basis. NMS38: The issue of unavailable medication for one service user affects the outcome of this standard as well as other standards. Also of concern, the Inspector asked to see the home’s current certificate to show that the water supply had been tested for Legionella and was safe. A problem had existed in May 2005 and although the Registered Manager subsequently informed the Inspector that it had been corrected, the dating of the certificates seen in the home appeared to show that the all clear certificate pre-dated the report saying there was a problem. The Registered Manager agreed to investigate and send a report to the Inspector. A certificate was subsequently sent to the Inspector by the Registered Manager that showed that water sampling had taken place on 19th May 2005 and a report issued on 3rd June 2005 that showed a satisfactory test result. Sandbanks Care Home DS0000032618.V278342.R01.S.doc Version 5.1 Page 18 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 3 2 3 x 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 X 15 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x 3 3 x 2 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 Sandbanks Care Home DS0000032618.V278342.R01.S.doc Version 5.1 Page 19 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. 1 Standard OP2 Regulation 5 (1) (b) Requirement The registered person shall provide written terms and conditions for each service user (which should be signed and dated in the form of a contract) The registered person shall make arrangements for service users to receive the medication they require. The registered person shall make arrangements for the safe handling and administration of medication by having a suitable policy in place. The registered person shall make arrangements by training staff and by having a suitable policy in place to prevent service users being placed at risk of harm or neglect(by their need for medication not being met) The registered person shall give notice to the Commission of any event in the care home which adversely affects the well being or safety of any service user. Timescale for action 01/04/06 2 OP9OP8 13 (1) and (2) 13 (2) 01/03/06 3 OP9 01/04/06 4 OP38OP30 OP18OP9 13 (6) 01/04/06 5 OP18 37 01/03/06 Sandbanks Care Home DS0000032618.V278342.R01.S.doc Version 5.1 Page 20 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 2 Refer to Standard OP3 OP7 Good Practice Recommendations The management of the home should consider whether the assessment document used should be revised so that one document collects all the information that is required. Person centred planning should be extended throughout the care home. Sandbanks Care Home DS0000032618.V278342.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection West London Area Office 58 Uxbridge Road Ealing London W5 2ST National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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