CARE HOME ADULTS 18-65
Sandhills Lower Road Stalbridge Sturminster Newton Dorset DT10 2NJ Lead Inspector
Marion Hurley Unannounced Inspection 24th October 2005 10:00 Sandhills DS0000020490.V252719.R01.S.doc Version 5.0 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 Sandhills DS0000020490.V252719.R01.S.doc Version 5.0 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. Sandhills DS0000020490.V252719.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Sandhills Address Lower Road Stalbridge Sturminster Newton Dorset DT10 2NJ 01963 362247 01305 252001 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) Dorset Residential Homes Mrs Margaret Cooper Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Sandhills DS0000020490.V252719.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 21st March 2005 Brief Description of the Service: Sandhills is located on the outskirts of Stalbridge in North Dorset, and is a registered care home providing nursing and personal care to 10 learning disabled adults, (nine long term beds and one short term bed), some of whom have additional physical and/or sensory impairments. The home is operated by Dorset Residential Homes, a registered charitable trust that operates a number of care services across Dorset. The home is a detached property that has been extended and converted to meet the needs of service users. Sandhills is registered to provide nursing care specific to learning disability, and there is therefore a registered nurse on duty at all times. The age range that the home can accommodate are adults aged 18 – 65 years; some of the current service users are now over the age of 65, however, their needs continue to be met appropriately within the home. Sandhills DS0000020490.V252719.R01.S.doc Version 5.0 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. Sandhills was assessed according to the Care Home for Adults (18-65) National Minimum Standards. The overall time spent to complete the inspection process was a total of six hours, two of which were spent at the Home. The Registered Manager, and one member of staff were available throughout the inspection. Two residents were at home but did not join in the inspection process. A partial tour of the premises took place and records/documentation were all readily available for inspection. This was a positive inspection of a service that continues to provide a high standard of personal care to a group of residents with varying abilities and complex needs. The inspection process was assisted by the openness of the staff and the inspector was grateful for their time and commitment. What the service does well:
Sandhills succeeds in providing a genuine needs-led service through flexible routines provided by a positive staff team. The management has a commitment to staff supervision, training and support and this helps to ensure all the residents receive continuity of care and support and equally maintains staff knowledge and good practice in the delivery of services. The team are currently working with each resident to complete his or her own “My Life and Support plan”. These Plans highlight the resident’s abilities; goal plans and cover all aspects of their daily living needs. Those completed are well written and clearly identify the residents’ needs and the support they require to achieve and maintain a level of interdependence. Regular reviews and monitoring ensure any changing needs are recorded and plans adjusted to reflect the support required. The residents live comfortably in the local community accessing a variety of facilities and services and are well supported by family and friends. The manager and staff team work well and form a valuable part of the multi agency services in the area. Sandhills DS0000020490.V252719.R01.S.doc Version 5.0 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. Sandhills DS0000020490.V252719.R01.S.doc Version 5.0 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 Sandhills DS0000020490.V252719.R01.S.doc Version 5.0 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): • • Since the last inspection there have been no admissions. None of the above standards were assessed at this inspection. EVIDENCE: Sandhills DS0000020490.V252719.R01.S.doc Version 5.0 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 • Individual Life & Support Plans clearly identify the resident’s abilities and needs and regular reviews ensure any changes are reflected in their Plans. • Residents are encouraged to make decisions about their own lives based on comprehensive risk assessments which help promote a sense of shared and individual responsibility for everyone living at Sandhills. EVIDENCE: The residents, manager and key workers are currently in the process of developing Life Support Plans with each resident. The existing style Care Plans are being replaced with very comprehensive folders for each resident entitled “My Life and Support Plan”. Several have already been completed and one of these was read in detail. The folder was clearly set out and divided into sections for easy use e.g. section one Personal details “ Who I am and how to understand me”. The identified Daily Activities cross reference with detailed and personalised checklists “Evidence of participation to preferred lifestyles”. At this stage the resident’s keyworker on behalf of the resident completes the chart but the manager hopes to encourage the residents to complete their own self-monitoring and eventually take “real ownership“ of their folders.
Sandhills DS0000020490.V252719.R01.S.doc Version 5.0 Page 10 Risk assessments are part of the Health & Safety Well Being Section/Plan and link to everyday activities in the home and when the resident is out and about. Each risk assessment is based on the resident’s personal vulnerability and abilities, and specific needs. Where possible the risk assessments are signed by the resident. Additional sections include “ Why is it a Risk to me? How does it affect me, how is it managed and barriers I may meet in achieving my preferred lifestyle.” These sections help the resident understand the hazard and the specific risk which may affect them in everyday situations and demonstrated the care and time staff were taking to get the assessments right for each resident. Further information described a typical day and “what I have done today, how I communicate, menu choices and favourite things”. The folder had been illustrated throughout with pictures of the resident’s interests. There was evidence the Plans were being regularly reviewed and adjusted where appropriate. Please note it was not possible to discuss any of the Life Support Plans with residents at this inspection however, it is hoped to achieve this at the next inspection visit. Sandhills DS0000020490.V252719.R01.S.doc Version 5.0 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): 12, 13 & 14 • All the residents are encouraged to lead active meaningful lives, which includes attendance at day services and accessing the local community. • Links with the community are excellent and enrich residents’ social opportunities. EVIDENCE: Evidence for these standards were obtained from reading the residents Life and Support Plans and from discussions with the manager and staff. On the day of the inspection three residents with three members staff were off for a trip to the Swanage Railway. Extra staff had volunteered to work ensuring there would be sufficient staff for the trip and for those residents who remained home. All the residents attend Day Services travelling either to Sherborne or Sturminster Newton with some going daily and others on a part time basis. Residents have busy but flexible routines and it was clear from discussions that residents and staff work closely with day service staff ensuring residents can take full advantage of any local opportunities and “exercise choice” when they arise. Some of the residents are members of the local Gateway Club, one is a
Sandhills DS0000020490.V252719.R01.S.doc Version 5.0 Page 12 regular Church goer and this leads to other social events, another enjoys regular walks, another goes to Clubs in Shaftesbury & Sherborne. A record of the many and varied activities is recorded and kept in the Residents Life Support and Plan. The home has a League of Friends, which was established many years ago by local people. Members of this group visit the home monthly and enjoy the company of the residents either at home or when they are out and about. The manager produces a regular newsletter informing all friends and relatives of social events. A very successful summer barbecue was held and there are plans for a Christmas event. Sandhills DS0000020490.V252719.R01.S.doc Version 5.0 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): 18 &19 • The home provides a high level of personal flexible support to residents taking into account each resident’s preferences and needs. • Residents’ healthcare needs are provided for including those with more complex health and emotional needs. EVIDENCE: Resident’s personal care needs are clearly recorded in their Life Support Plans and described in the first person stating exactly how the resident likes to receive his/her support in order to manage their daily needs. Each resident has a named designated nurse and support/key worker. This helps to provide consistency and continuity of support to the residents. There was clear evidence of regular health checks and reviews with health care professionals including GP, Dentist, and Optician. The GP completes the resident’s medication reviews and all contacts are recorded. The physiotherapist, occupational therapist and psychologist offer support and guidance to individual residents as and when required. It is good to note that residents access community resources and go to local Opticians and Dentists where possible. All the residents have an annual health assessment /review which is co-ordinated by a multi-agency team and staff from Sandhills. Sandhills DS0000020490.V252719.R01.S.doc Version 5.0 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): None of these standards were assessed at this inspection. EVIDENCE: Sandhills DS0000020490.V252719.R01.S.doc Version 5.0 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): 24 & 30 • Residents live in a comfortable home, which on the day of the inspection was clean and hygienic throughout. EVIDENCE: Signpost Housing Association owns the property and has responsibility for the general maintenance of the property while Dorset Residential Homes provides and maintains the furniture and personal fittings. This system appears to work well though there is some outstanding work to be completed however the manager understands funding has been agreed and the proposed work is now scheduled. Sandhills has a comfortable feel and provides a homely and safe environment for both the residents and staff to live and work in. Two bedrooms have full en-suite facilities one on the ground floor and one on the first floor. No bedrooms were viewed on this occasion, as there were no residents available to give their permission. Sandhills DS0000020490.V252719.R01.S.doc Version 5.0 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, 34, 35 & 36 • Residents’ benefit from continuity and stability of the staff who are accessible and approachable and undertake regular training to ensure high standards of good practice. • Staff recruitment practices are thorough. • All staff receive regular supervision, training and the support they need to carry out their jobs and this contributes to maintaining a quality staff team working for the benefit of all the residents. EVIDENCE: Since the last inspection two new night staff have been recruited and the recruitment records of one of these was read. The records and details of all references and checks had been comprehensively completed. All new staff receive induction training which includes all statutory training requirements and training on Vulnerable Adults. The manager has delegated the task for maintaining staff training records to a team member and the file was well presented with individual records for all the staff showing details of all training completed. Dorset Residential Homes is committed to staff training with staff completing/completed LDAF and NVQ training. Staff spoke very positively and knowledgably about their work and appeared to have a very sensitive and caring approach to meeting the different and
Sandhills DS0000020490.V252719.R01.S.doc Version 5.0 Page 17 sometimes complex needs of the residents living at Sandhills. The manager has an open and positive attitude and is committed to the residents. Supervision is conducted regularly with minutes from the sessions signed and dated. Sessions are booked into the staff rota, which reflects both the manager and staff commitment to this practice. In addition there are both qualified staff meetings, and full staff meetings and regular resident meetings. Four residents are able to verbally join in whilst others participate in their own way. Sandhills DS0000020490.V252719.R01.S.doc Version 5.0 Page 18 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): 42 • Records checked at this inspection reflected safe working practices for the benefit of both residents and staff. EVIDENCE: The manager completes a weekly Health & Safety Audit with a more in depth audit being conducted every quarter. Fire records were noted and found on the day of the inspection to be up to date with all staff undertaking regular training and practical sessions including regular drills and evacuations involving the residents. Sandhills DS0000020490.V252719.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 Score x x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 x x Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x 3 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score x 3 x 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Sandhills Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x DS0000020490.V252719.R01.S.doc Version 5.0 Page 20 NO Are there any outstanding requirements from the last inspection? 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 Sandhills DS0000020490.V252719.R01.S.doc Version 5.0 Page 21 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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