CARE HOME ADULTS 18-65
Sandgate Manor 46 Military Road Sandgate Folkestone Kent CT20 3BH Lead Inspector
Wendy Mills Unannounced Inspection 24th January 2006 09:30 Sandgate Manor DS0000023523.V277830.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 Sandgate Manor DS0000023523.V277830.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. Sandgate Manor DS0000023523.V277830.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Sandgate Manor Address 46 Military Road Sandgate Folkestone Kent CT20 3BH 01303 248313 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) leselle4@yahoo.com MNP Complete Care Group Mrs Lesley Ruth Rudd Care Home 19 Category(ies) of Physical disability (19) registration, with number of places Sandgate Manor DS0000023523.V277830.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 12th May 2005 Brief Description of the Service: Sandgate Manor is part of the MNP Complete Care Group. It is a residential home providing care and support for up to nineteen people with a range of learning and physical disabilities. It is a large and well-maintained manor house that has been adapted to be wheelchair accessible. It is situated in Sandgate, about half a mile from the local shops and seafront. The house has spacious accommodation and large grounds. The residents all lead busy lives and many attend colleges and adult education centres in nearby Folkestone. The registered manager is Mrs Lesley Rudd, an experienced home manager, who has been at Sandgate Manor for over a year. Mrs Rudd also takes responsibility as lead manager for the NMP Group in the Folkestone area. Sandgate Manor DS0000023523.V277830.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection lasted four hours. Mrs Lesley Rudd, the registered manager assisted the inspector throughout and she is thanked for her help. During the course of the inspection the inspector spoke to five residents and six members of staff. Detailed discussions were held in private with three members of staff and the registered manager. A tour of the home was undertaken, key documentation inspected and sample care plans examined in detail. Both direct and indirect observations were made throughout the inspection. The Home continues to maintain a high quality of care that meets the National Minimum Standards. The residents all appear well cared for and say that they like living in the home. They are able to put their views forward and participate in the running of the home if they wish to and are able to do so. The accommodation and grounds are spacious and allow for easy access and movement for all wheelchair users. The Home is well maintained and well decorated. At present three lodges are under construction in a previously unused part of the grounds. These lodges will provide accommodation for those people with profound disabilities who, nevertheless, wish to live more independently. What the service does well:
The Home provides an accessible, comfortable and well-decorated environment in which the residents are able to maximise their independence. Many residents have complex disabilities and require very specialised equipment. The Home is proactive in its approach to accessing the necessary specialist equipment, such as individually adapted wheelchairs and communication equipment, and staff training, in order to minimise these problems. The Home accesses a wide range of activities on behalf of the residents. These activities are tailored to meet individual needs. In addition, it offers good support to relatives and friends who visit the Home. The internal long-term planning and quality assurance systems are excellent. The home reports concerns to the advice of appropriate authorities when necessary. It takes advice and action to rectify any mistakes made. For example, when a medication error occurred it was reported immediately. Procedures were then reviewed and action taken to prevent a similar error occurring in the future. The residents are able to participate in the running of the home to the maximum of their abilities. Some residents advocate on behalf of other residents whilst others help out with household tasks.
Sandgate Manor DS0000023523.V277830.R01.S.doc Version 5.1 Page 6 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. Sandgate Manor DS0000023523.V277830.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 Sandgate Manor DS0000023523.V277830.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): None of these standards was inspected at this visit. Previous inspections have shown that the home meets the standards in this section and no new residents have been admitted since the last inspection. EVIDENCE: Sandgate Manor DS0000023523.V277830.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, 8, 9 & 10 The residents know that the Home will respect their confidentiality and value their views and respect their choices. However, staff must understand when it is necessary to report concerns appropriately, for the protection of the individual. There is a clear and consistent care planning process that the residents and their supporters understand and records are maintained securely. EVIDENCE: There are regular house meetings and residents told the inspector that they can discuss ideas for improving the Home and any other general concerns at these meetings. There is a key worker system and staff said that they support the needs and decision making of those residents who are unable to communicate their own needs. Care plans contain detailed information about life histories and choices. Risk assessments are in place for individual activities Staff are clear about their responsibility in respect of confidentiality and record storage. However, evidence was found that a very senior member of staff did not appropriately report concerns that had an adult protection implication because she had not fully understood the confidentiality policy and procedure.
Sandgate Manor DS0000023523.V277830.R01.S.doc Version 5.1 Page 10 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, 12, 13, 14, 16 & 17 The home offers excellent opportunities for personal development and is proactive in the way it assists and encourages the residents to lead fulfilling lives. The quality of meals is very good and special diets are catered for when indicated. EVIDENCE: Inspection of care plans and activity schedules showed that the residents continue to lead busy lives and have a wide range of both educational and leisure opportunities. Over the Christmas period the home had a party and put on a pantomime in addition to going to the local theatre. There are spacious and comfortable dining areas in the home. Many of the residents require a lot of help and care with eating. Indirect observation showed that staff give this help with great care and expertise. Inspection of the kitchen and conversation with the cook confirmed that there is a plentiful supply of good quality produce. Sandgate Manor DS0000023523.V277830.R01.S.doc Version 5.1 Page 11 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): 18, 19, 20 & 21 Personal support is offered in a way that protects the privacy and dignity of the residents and promotes their independence. There are clear and comprehensive systems for the management and administration of medicines but senior staff must be clear about their duty to report errors appropriately. The home handles end of life issues well but should take steps to ensure that the residents’ wishes, and those of their families, are respected when terminal care is indicated. EVIDENCE: Staff understand the need to respect the confidentiality of the residents, however, evidence was found to suggest that a very senior staff member did not report serious concerns to the registered manager because she misinterpreted the confidentiality policy. Since the last inspection there has was a serious medication error and flaws were found in the reporting mechanism within the home. The home quickly identified the problems and reported them immediately to the appropriate authorities. This resulted in an adult protection team investigation. The home
Sandgate Manor DS0000023523.V277830.R01.S.doc Version 5.1 Page 12 has now produced a clear action plan and put systems in place to prevent a further occurrence. The home has policies and procedures to cover end of life issues, however, discussion with the registered manager suggested that the home is unclear about the wishes of some residents and their families should terminal care be indicated. The home should ensure that the wishes of the residents and their families in this respect are fully documented and that staff are aware of the actions they should take. Sandgate Manor DS0000023523.V277830.R01.S.doc Version 5.1 Page 13 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): 22 & 23 Most staff have good knowledge and understanding of Adult Protection issues and how to protect the residents from all forms of abuse. However, some senior staff failed to report concerns appropriately. This puts the residents at risk of serious harm. EVIDENCE: The residents said that they could talk to the staff if they are worried. There is a complaints policy and procedure but most concerns are about day-to-day issues and are dealt with immediately by the registered manager. However, evidence was found to suggest that staff have not reported concerns on behalf of residents in accordance with the home’s policies and procedures. The home undertakes adult protection training and includes this as part of the induction process. However, they way senior staff handled a recent complaint and a medication error gave rise to an adult protection alert. The matters are now resolved, senior staff understand the consequences of their failure to follow correct procedures and an action plan, aimed at preventing further such problems, is in place. Despite a requirement from the last inspection, that one-to-one supervision should be established, the home has failed to introduce a system that ensures all staff receive at least six sessions of one-to-one supervision each year. This means that future adult protection issues may still go unreported or may be again handled inappropriately. The home must establish a system of one-to-one supervision for all staff as a matter of urgency. Sandgate Manor DS0000023523.V277830.R01.S.doc Version 5.1 Page 14 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): 24, 28 & 30 The standard of the environment within the Home is very good and provides the residents with an attractive and homely place to live. The layout of the Home promotes the independence of the residents. EVIDENCE: A tour of the Home was undertaken. All areas of the home were comfortable, clean and free from offensive odours. The laundry has been moved from the basement to an outbuilding in the grounds. This has significantly improved the efficient management of laundry and infection control. The improvement in working conditions has raised the morale of the laundry assistant and care staff. The outside environment of the home has been improved since the last inspection. A new drive with an entrance and exit has been created. The front garden has been tidied and now gives an attractive approach to the home. Three lodges are under construction in an unused part of the grounds. When complete these lodges will provide accommodation for profoundly disabled people who wish to live more independently. Sandgate Manor DS0000023523.V277830.R01.S.doc Version 5.1 Page 15 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): 31, 32, 33, 34 & 36 There is an enthusiastic workforce that positively promotes the residents’ independence. Staffing levels are good. There is a good training and development programme. However, the home has put residents at risk by its failure to establish regular one-to-one supervision for all staff. EVIDENCE: Staff generally expressed a high degree of satisfaction in their work but oneto-one supervision is not yet properly established. This means that training needs may be unidentified and that opportunities are being last for staff to express concerns or put forward their views for improving the home. Staffing levels at the home are generally good, although some difficulty has been experienced in obtaining additional funding for some residents whose dependency levels have increased. Staff training continues to be given a high priority by the home and a new appointment has been made to ensure staff training is organised and monitored. Sandgate Manor DS0000023523.V277830.R01.S.doc Version 5.1 Page 16 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): 37, 38 &40 The Home is generally well managed but lack of support from some senior members of staff has led to recent problems. The home provides a caring and supportive service that promotes the independence, health, safety and welfare of the residents. There are excellent external quality assurance systems. EVIDENCE: Mrs Rudd, the registered manager, has many years experience in care and in managing care homes. She has responsibilities for managing Sandgate Manor and overseeing other homes in the group. Recent events in the home, that are described under standards 10, 22, 23 and 36, demonstrated that some senior staff did not support Mrs Rudd and act appropriately in reporting serious concerns. One very senior staff member staff did not adhere to the confidentiality and whistle-blowing policies in that she did not communicate concerns appropriately to the registered manager. Other senior staff failed to use the home’s reporting policies and procedures when a medication error
Sandgate Manor DS0000023523.V277830.R01.S.doc Version 5.1 Page 17 occurred. This lack of support on behalf of senior staff is disappointing but it is good to note that the difficulties have been resolved. Mrs Rudd has worked hard to investigate the issues and has been open and honest about the concerns. An action plan is now in place but this must include a system for regular one-to-one supervision. The CSCI receives regular reports from the registered providers in accordance with regulation 26. A new post of home administrator has been created. Part of this role is to ensure recruitment procedures are followed and that the selection process for the appointment of staff is more rigorous. Sandgate Manor DS0000023523.V277830.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 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 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 2 32 1 33 2 34 3 35 X 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 2 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 2 2 3 X 2 X X X Sandgate Manor DS0000023523.V277830.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? N/A 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 OP10 Regulation 12 Requirement The home must ensure that all staff understand the confidentiality policy and procedure and communicate concerns appropriately The home must ensure that all staff follow the home’s complaint’s procedure when making a complaint on behalf of a resident. The home must ensure all senior staff adhere to the home’s adult protection procedures. One-to-one supervision must be established for all staff. This was a recommendation made at the previous inspection and is now made as a requirement. Timescale for action 01/02/06 2 OP22 12, 22 01/02/06 3 4 OP23 OP36 12, 13 18 01/02/06 31/03/06 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 Sandgate Manor DS0000023523.V277830.R01.S.doc Version 5.1 Page 20 Sandgate Manor DS0000023523.V277830.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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