CARE HOME ADULTS 18-65
Sandbourne House 1 Sandecotes Road Parkstone Poole Dorset BH14 8NT Lead Inspector
Sophie Barton Unannounced Inspection 25 January 2006 01:30
th DS0000004080.V280699.R01.S.doc Version 5.1 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 DS0000004080.V280699.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 Adults 18-65. 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. DS0000004080.V280699.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Sandbourne House Address 1 Sandecotes Road Parkstone Poole Dorset BH14 8NT 01202 742284 01202 742284 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) Mrs Helen Vivien Somerville Mrs Janet Lesley Young Miss Lisa Toms Care Home 8 Category(ies) of Learning disability (8) registration, with number of places DS0000004080.V280699.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. To accommodate one named service user (as known to the CSCI) prior to their eighteenth birthday. 26th September 2005 Date of last inspection Brief Description of the Service: Sandbourne House accommodates 8 adults, with a purpose of providing care and support to residents who have a learning disability. It is owned by Mrs Helen Somerville and Mrs Janet Young. The registered manager is Miss Lisa Toms and she works in the home full time. The home was first registered in 1997, and the majority of the residents have lived there since it opened. It is a large family style house in a residential area of Lower Parkstone. The shopping areas of Parkstone are walking distance away and there is accessible public transport to the towns of Poole and Bournemouth. The house comprises of a lounge, separate diner and kitchen, bathroom, separate WC and each resident has their own bedroom. 4 of the bedrooms have en-suite facilities. Through the kitchen is an office, staff sleeping in room, shower and toilet. The home has a well-kept garden. The home is staffed 24 hours of the day, with at least two staff on duty when the service users are at home, except at night when only one sleep in member of staff is needed. There is no structured day care provided by the registered owners, as all the current residents attend day centres run by different agencies. DS0000004080.V280699.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection has been undertaken as part of the statutory inspection process in accordance with the Care Standards Act 2000. This was an unannounced inspection on Wednesday 25th January 2006 at 1.30pm to 5.30pm. The Registered Manager was available for the majority of the inspection. As well as examining care files, policies and other records five service users were seen and spoken with informally. The inspector was made very welcome by staff and service users and the Manager assisted the Inspector in all aspects of the inspection. Eighteen key standards were assessed at this inspection. Two of these standards were assessed as having a significant shortfall, four with minor shortfalls and the remaining twelve were met in full. What the service does well: What has improved since the last inspection?
The Manager is aware of the areas of practice that need improving and is addressing these through a development plan and prioritising. NVQ training is being set up for staff, although there remains a significant shortfall in staff having appropriate qualifications. The manager has completed her NVQ 4 management training. The previous recommendations and requirements in relation to service user finances have been met, with adequate records now being kept in the home.
DS0000004080.V280699.R01.S.doc Version 5.1 Page 6 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. DS0000004080.V280699.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000004080.V280699.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4 and 5 Systems are in place to ensure that prospective service users’ needs are fully assessed and known to the home, enabling service users to be appropriately placed. However, the admissions procedures followed have not allowed for full consultation or choice by service users. EVIDENCE: Since the last inspection a new service user has moved into the home. The home appropriately obtained a completed ‘Initial Assessment Form/Referral Form’ prior to the service user moving into the home and obtained the Care Management Care Plan and Assessment for this service user. These documents detailed the service users needs in full. The home has begun developing their own assessment and care plan for the service user. There has also been a review held to discuss the service users placement to ensure that the placement continues to be appropriate. In discussion with the Registered Manager it was shown that the decision making involving the service users move into the home was led by the Social Services Department rather than the Manager ensuring that she planned and met the appropriate regulations and good practice recommendations. The service user did not have any overnight stays in the home as a trial, and there was no evidence that the service user was consulted about her wishes and feelings. Advocacy support was not suggested by the home. A contract with the service user has not yet been agreed or developed. DS0000004080.V280699.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 The care planning systems are good, allowing staff to have full knowledge of how to meet the service users’ needs. The home is proactive in ensuring that risks are managed appropriately, effectively balancing service users right to independence and safety. EVIDENCE: Each service user has a care plan developed by the home and agreed by the service user setting out their needs and how these are to be met by the home. There is evidence that staff have read and understood the plans, and the daily records seen by the Inspector evidenced that staff are working towards the service user’s care plan goals. There have been regular reviews of the care plans. The Inspector noted on one file that the care plan detailed how specialist needs are to be met and how any challenging behaviour is to be managed. The inspector was shown risk assessments for each service user. These were appropriate and documented the risks well. In relation to the newest admission, the Care Manager had been requested to detail and assess risks prior to admission. The home manages the identified risks well, and works with the service user to ensure that appropriate support is given to minimise the risks but to also avoid limiting the service user’s preferred activity and
DS0000004080.V280699.R01.S.doc Version 5.1 Page 10 independence. Examples included doing full assessments of the service user’s ability to go out independently, administering their own medication and managing their own finances. Daily records also showed that staff encourage service users to make their own decisions (relating to spending their money, going out on activities, their daily routines). Where limitations are made on the service user’s rights or choice these are clearly documented and discussed with all relevant professionals. DS0000004080.V280699.R01.S.doc Version 5.1 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 15 and 17. Service users’ rights are respected and the home’s practices promote independence and individual choice allowing service users the opportunity for personal development. The service users are supported well by staff in maintaining appropriate personal and family relationships. The meals in the home are good offering both choice and variety, and promoting service users wellbeing. EVIDENCE: The daily care notes and care plans read evidenced that service users are encouraged to be as independent as possible with daily living tasks and personal care. Staff are proactive in helping service users with emotional issues, listening and talking through issues with service users and referring for specialist help where appropriate. Staff also teach service users practical life skills (cooking, cleaning, road safety). Service users are further encourage to attend social events, develop new relationships with other people and foster
DS0000004080.V280699.R01.S.doc Version 5.1 Page 12 current relationships with family and friends outside of the home. The home provides transport where necessary to help promote contact with others. Service users confirmed that they attend outside clubs and social events (Football club, Blue Dolphin, Gateway, Fourways, Church), and that they see family when needed. The Manager has attended Personal Relationships training. The service users also informed the Inspector that meals in the home were good, and that a choice is offered. The Inspector examined the record of passed menus and these showed that the food is nutritious and varied, with individual preferences being met by the home. A member of staff also showed the Inspector how service users choose the weekly menu, using pictures to help in making informed choice. One service user has been fully supported by staff to have a lower fat diet, and informed the Inspector that as a consequence she is now more fit and healthy. Service users stated that they can choose where to eat their meal. DS0000004080.V280699.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 The medication procedures followed in the home are good ensuring safe practice and appropriate administration of medication. EVIDENCE: The Manager has carried out a risk assessment for all service users in relation to whether they can administer their own medication. Individual procedures are in place for each service user as to the level of support they are given with their medication. Medication is kept in a locked cabinet and there are appropriate records kept of the receipt, administration and disposal of medicines. The Manager has made a record of what medication each service user is prescribed, what it is for and any side effects. DS0000004080.V280699.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 Adult Protection training and the home’s policy needs to be improved, to ensure service users are better protected from harm. EVIDENCE: The home has a policy statement relating to the awareness and protection of abuse for service users and staff to familiarise themselves with. There is also the ‘No Secrets’ guidance kept within the home. The home’s written procedures for reporting abuse of vulnerable adults would benefit from being more detailed, to include recording factual events, referring immediately (latest 24 hours) to social services and notifying the Commission. The Registered Manager has undertaken Adult Protection training, however staff members need to do some refresher training and for the manager to consider obtaining external training in the Protection of Vulnerable Adults. There have been no adult protection concerns in the home since the last inspection. DS0000004080.V280699.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 25, 27 and 30 Service users are living in a homely domesticated environment, which is kept clean and hygienic. Bedrooms are personalised with the accommodation meeting individual and group needs. EVIDENCE: The Inspector was shown the communal areas and a service user’s bedroom. Each service user has a single bedroom, one has an en suite and all have wash hand basins. Those service users that choose to can lock their bedrooms. There is ample communal space, an open plan kitchen diner, and a lounge all with ample seating for the service users. Service users have a choice in how their bedrooms are decorated and furnished, and are provided with appropriate furniture. The bedroom seen had storage for personal belongings, and staff had assisted the service user in making it homely. Staff have an adequate room for sleep-ins and for storing their belongings. The home’s furnishings and fixtures are domesticated. There is no designated private space for meeting with visitors. Meetings can take place in the office or a staff sleep in room. On the day of the unannounced inspection the home was found to be clean and tidy. There is an infection control policy kept in the home and staff have undertaken infection control training. There has been a recent Environmental Health inspection of the home which was satisfactory.
DS0000004080.V280699.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 35 There is a lack of qualified staff within the home, so although basic support needs are met the staff will lack the competency to meet any challenging or specialist needs. EVIDENCE: The Registered Manager stated that staff have been given the opportunity to do NVQ training but the majority of staff have not taken up this opportunity. No care staff have an NVQ 2 or equivalent qualification. The Manager did confirm that three members of staff will be shortly enrolling on an NVQ 2 course, and have done the Learning Disabilities Award Framework training but this is still not sufficient to meet the training requirements. The Manager has completed NVQ 4 training and updated her knowledge in specific areas, i.e. Dementia and Challenging Behaviour which is beneficial to service users. New staff have appropriately undertaken induction and foundation training which meets TOPSS specifications. A number of service users have specialist needs (challenging behaviour, mental health) but staff have not undertaken training in being able to meet these needs in a competent way or aware of current good practice in providing care to service users who have a learning disability. DS0000004080.V280699.R01.S.doc Version 5.1 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 and 42 The Manager appropriately reviews aspects of the home’s performance through a programme of review, monitoring and consultation, which includes views of service users and relatives. A higher priority needs to be given to health and safety checks within the home to ensure service users welfare is protected. EVIDENCE: The manager showed the inspector the development plan for the home, setting out the areas that needed developing and whether these have been satisfactorily met. Areas of shortfall have been appropriately identified and action taken to address them. Service users and their relatives have been asked to complete questionnaires about the quality of care provided by the home. The service users’ annual reviews also indicate whether the home is achieving outcomes for service users. The Inspector examined health and safety certificates and records. Checks on fire equipment had been undertaken regularly and staff had received fire
DS0000004080.V280699.R01.S.doc Version 5.1 Page 18 training. There is a fire risk assessment completed for the home. Drills and evacuations are carried out at regular intervals, although one has not been done in the evening or early morning. A recent electrical or gas safety certificate could not be found. Water temperature checks have not been undertaken to ascertain whether the water temperatures remain at a safe temperature. Risk assessments have been carried out on safe working practices, and staff are up to date on their training in first aid, manual handling and infection control. DS0000004080.V280699.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 Adults 18-65 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 x 2 3 3 x 4 2 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 x 23 2 ENVIRONMENT Standard No Score 24 x 25 3 26 x 27 3 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 1 33 x 34 x 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 3 12 x 13 x 14 x 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x 3 x x x 3 x x 1 x DS0000004080.V280699.R01.S.doc Version 5.1 Page 20 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 YA32 Regulation 18 Requirement There must be suitably qualified staff working in the care home to meet the needs of service users. There must be a gas and an electrical safety check and service undertaken on the home’s appliances. Regular water temperature checks must be taken. Timescale for action 01/07/06 2 YA42 12 01/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Registered Manager should ensure that prospective service user’s introductions to the home are based on good practice and planned well. The Registered Manager should evidence that service users are fully consulted about moving into the home, and refer for advocacy support where appropriate. The Manager should consider advocacy support for service users moving into the home (repeated from the inspection report dated September 2005) Service users (and/or their representative) should agree a contract with the home prior to the service user moving into the home.
DS0000004080.V280699.R01.S.doc Version 5.1 Page 21 1. YA4 2 YA5 3 YA23 4 5 YA35 YA42 All staff should attend training in the ‘Protection of Vulnerable Adults’. The home’s procedures for reporting abuse need to be in more detail and to include the need to record events and notify the Commission. The staff should undergo training linked to the service users’ needs. A fire drill/evacuation should be carried out in the evening or early morning. DS0000004080.V280699.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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