Inspection on 17/10/05 for Sandhurst

This inspection was carried out on 17th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Sandhurst 19/09/08

Sandhurst 20/09/07

Sandhurst 03/08/06

Sandhurst 07/02/05

Sandhurst 29/07/04

Sandhurst 30/03/04

Similar services:

2 Perhaver Park

The Vicarage

Fairfields Country Rest Home

St George`s

5 Seafield Road

Credence House

Poldhu

Queensmount

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

CARE HOMES FOR OLDER PEOPLE Sandhurst 49/51 Abbotsham Road Bideford Devon EX39 3AQ Lead Inspector Stephen Spratling Unannounced Inspection 17th October 2005 09:30 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 Sandhurst DS0000022118.V264132.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 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. Sandhurst DS0000022118.V264132.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Sandhurst Address 49/51 Abbotsham Road Bideford Devon EX39 3AQ 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) 01237 477195 01237 470601 Mr Klaus-Jurgen Gunter Kothe Mrs Victoria Caroline Kothe Care Home 21 Category(ies) of Dementia - over 65 years of age (20), Learning registration, with number disability over 65 years of age (20), Mental of places Disorder, excluding learning disability or dementia - over 65 years of age (20), Old age, not falling within any other category (21) Sandhurst DS0000022118.V264132.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th May 2005 Brief Description of the Service: Sandhurst is a care home providing accommodation and personal care for up to 21 people, over the age of 65 years. It is registered to admit people who need care as result of Old Age, Dementia, a Learning Disability and/or a Mental Disorder. The home is situated on the outskirts of Bideford and within walking distance of local shops and amenities. The 3-storey home consists of two adjoining houses, built in the Victorian era. There are 17 single bedrooms, and two double rooms. There is a lounge and a dining room on the ground floor. The 2nd floor (attic area) has room for 2 flatlets comprising of bedroom en suite and lounge. There are stair lifts between all three floors. Sandhurst DS0000022118.V264132.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspectors arrived at this home at about 09.30. During the inspection they spoke with 10 residents, four of the care staff and the cook. They looked around most areas of the building and read a variety of records kept at the home. Prior to the inspection commission questionnaires were sent out to some local GPs, District Nurses and Social Services Care managers. Three were received back from GPs and four from care managers. Since the inspection the inspector has spoken with three district nurses who have patients at the home. What the service does well: What has improved since the last inspection? What they could do better: Care plans need some more detail to make sure that all staff know what to do and to ensure all the needs each resident has are met. When residents need help to eat this help should be provided individually and sensitively by staff. Sandhurst DS0000022118.V264132.R01.S.doc Version 5.0 Page 6 Complaints must be fully investigated and proper records should be kept. Staff need to be absolutely clear on how to recognise abuse and what to do about it. More staff training is needed. Recruitment practices i.e. obtaining references and Criminal Records Bureau checks for new staff remain unsatisfactory and do not properly protect residents from people who may be unsuitable to work with vulnerable adults. Also the building is still not being safely maintained and decoratively it remains unsatisfactory. As both of these concerns have been raised following previous inspections and satisfactory compliance with Requirements has not been achieved, the commission is taking legal advice about options available to ensure future compliance and residents safety. 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. Sandhurst DS0000022118.V264132.R01.S.doc Version 5.0 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 Sandhurst DS0000022118.V264132.R01.S.doc Version 5.0 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): 3 Residents benefit from good admission and assessment practice, which helps to ensure that the home is able to meet their needs. EVIDENCE: Three residents’ assessments were looked at and found to have greatly improved since the last inspection. Those read presented detailed information about residents’ physical, psychological and social needs. Sandhurst DS0000022118.V264132.R01.S.doc Version 5.0 Page 9 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 & 10 Care planning is not adequate to provide staff with the information they need to satisfactorily care for residents. Residents’ health care needs are being met by staff who consult with and follow guidance from health care colleagues. Medications are now properly and safely managed. Residents benefit from being treated with respect. EVIDENCE: Whilst the home accumulates a great deal of evidence of service users’ needs in the assessment, this is not fully carried through into the care plans. There needs to be further detail of how service users’ needs are to be met. It was noted that some service users are identified as becoming agitated or upset at certain times but there is no guidance for staff to follow as to how they are going to support them. There is no evidence that service users had been involved in the completion of their care plans and service users themselves were unable to remember whether they were discussed with them. One service user did remember being asked about her likes and dislikes in relation to food. Sandhurst DS0000022118.V264132.R01.S.doc Version 5.0 Page 10 Of two GPs completing commission questionnaires; one indicated that the home does not always communicate clearly with them though indicated they think staff understand the needs of their patients and follow their advice; the other GP indicated that they are happy with communication from staff and the care provided to their patients. Community Nurses who spoke with the inspector reported that they feel that communication with the home has improved recently and when reviewing their patients of late they have been happy with the standard of care they are receiving. Medication storage and recording systems were looked at. With one isolated exception medicines administered had been properly recorded as had medicines received in to the home and those sent back to the pharmacy; medicines were properly and securely stored. Service users confirmed that staff knock on the door before they enter their rooms and that when they are providing personal care their privacy and dignity is maintained. One resident said “the staff treat you very well”, other residents clearly indicated that they are happy with way staff treat them. Sandhurst DS0000022118.V264132.R01.S.doc Version 5.0 Page 11 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): 12,13,14 & 15 Social activities are provided at the home and provide daily variation and interest for residents. Residents are helped to exercise control and choice over their lives. They benefit from the contact with family and friends, which is encouraged by the home. A varied balanced diet is provided, served in a pleasant atmosphere, but individual support is not given in a way, which is sensitive to individual needs. EVIDENCE: Service users enthusiastically told the inspector about the lady who comes in three times a week to do exercises with them and also art and craft. Several of the service users seem to enjoy these times and in the dining room there is a collage which they have completed. One service user was taken out after lunch by a member of staff for a walk because she likes to go for a walk. Service users confirmed that they are able to have visitors whenever they like and they can see them in their own room. Service users told the inspector that they enjoy the meals provided by the home. One inspector ate with residents at lunch time, the meal was hot and residents said they enjoyed it. The atmosphere in the dining room was relaxed Sandhurst DS0000022118.V264132.R01.S.doc Version 5.0 Page 12 with friendly conversations going on between residents and staff. One resident was assisted to eat but this was done intermittently by two different staff who did not sit with the resident while doing so, standing over the resident and walking off to do other duties on a number of occasions. Sandhurst DS0000022118.V264132.R01.S.doc Version 5.0 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 & 18 Complaints are not always handled properly; residents and relatives cannot be confident that their concerns will be properly addressed or listened to. Since the last inspection good work has been done to help make sure abuse of residents would be noticed and reported if it occurred; however further effort is needed before residents can be fully confident that staff will respond properly. EVIDENCE: A complaint received by the commission in August 05, elements of which were passed to the home for investigation, was not adequately investigated by the home; meaning further commission enquiry was required. The homes complaints recording system was not available for inspection. On this inspection a record book established for one particular resident who regularly expresses concerns had been established, which is a good practice, however the recording in the book lacked detail. This person’s daily diary sheet also contained inappropriate language regarding them expressing concerns; this was discussed with the deputy manger on duty. All four staff spoken with said they had recently received some training about recognition and reporting of abuse; one person said they did not feel the teaching was very clear; another staff member was clear about what they should do if they suspected a resident as being abused. Sandhurst DS0000022118.V264132.R01.S.doc Version 5.0 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 & 25 Some improvements to the building have been made. There are however a significant number of matters outstanding, which mean the home, is not as safe, attractive and comfortable an environment for residents to live in as it should be. EVIDENCE: In response to concerns raised by inspectors about the poor state of the home environment, in May 2005 the owner produced a plan of work to be done. The plan was agreed by the commission and committed the owner to complete a large proportion of works required within three months (by mid August 2005). During this inspection progress on this planned work was assessed against the plan provided. Some work had been done; carpet had been replaced in the lounge and new chairs bought; some other decorative work and repair work had also been done. However the quality of some of the work was poor e.g. a radiator guard fitted in one room was already coming away from the wall and some painting appeared to have been done over blown plaster or bubbling wall paper. And much work that should have been completed had not been; this included Sandhurst DS0000022118.V264132.R01.S.doc Version 5.0 Page 15 decorative work e.g. ripped non-matching wallpaper in the lounge; maintenance work e.g. gutters have not been cleared and still have vegetation growing from them and a bathroom door that would not close at the last inspection still does not close; and work to ensure the building is safe for residents e.g. a fire door that did not close properly and windows that should have restricted opening had still not been addressed. Additional failures in the environment were also noticed during this inspection including one bedroom where none of the windows could be opened to provide ventilation and where the carpet was very worn and rucked. A new 1st floor lounge has been created which does give residents more choice about where to spend their day. Sandhurst DS0000022118.V264132.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 & 30 Recruitment procedures are not robust and do not offer protection to people living at the home. Staffing levels are adequate to help ensure staff have the time to care for resident properly. Some positive training has been done to develop staff but further work is needed to ensure residents receive a high quality safe service. Staff are caring and work hard to provide residents with a good service. EVIDENCE: Recruitment paperwork was seen for staff recruited since the last inspection (May 05). In many cases not all required documentation was available. In some cases Criminal Records Bureau checks (CRBs) had not been received and/or proper reference checks had not been made and/or they did not contain adequate proof of identity. Poor recruitment practice has been highlighted at the last two inspections. All staff spoken with indicated that there are now always enough staff on duty to care for residents properly and without rushing. They indicated that morale among staff has improved and confirmed that they feel well supported by senior staff. Residents told inspectors that there are always enough staff around to give them the help they need. One resident said “the staff treat you very well”. Two of the care managers responding to the commission questionnaire said that staff usually, though not always, demonstrate a clear Sandhurst DS0000022118.V264132.R01.S.doc Version 5.0 Page 17 understanding of the needs of residents. Three of four said that the home always informs them about significant events effecting their clients well being. Two of three staff asked about specific residents needs had a fairly clear understanding of what they were and how they should be met, one person was less confident. All staff spoken with said they had recently had some training about dementia and had been to some of the sessions run by a local district nurse. A relatively new member of staff described spending a week shadowing a colleague when first at the home but had not done a comprehensive structured induction as recommended. Two staff members spoken with had not done any formal manual handling training indicating they learnt by observing senior colleagues (see standard 38). Sandhurst DS0000022118.V264132.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38 Inadequate record keeping means that quality of care and safety of residents cannot be assured. The health and safety of residents is being put at risk, by the poorly maintained environment and inadequate risk management procedures. EVIDENCE: Some upper floor windows did not have restricted opening and no risk assessments were available regarding these windows; a fire exit was blocked by furniture and paint (a flammable material) was being stored in the boiler room; Immediate requirement notice to address these risks was issued by inspectors on the day of the inspection. The home fire risk assessment and fire fighting equipment maintenance log were not available for inspection as they should have been. Sandhurst DS0000022118.V264132.R01.S.doc Version 5.0 Page 19 Two staff spoken with had not had any formal training to ensure they know how to move and handle people safely (one of these people did confirm that they always do this work with a senior member of staff). When three staff were asked if a ground floor exit was a fire exit (which was obstructed) they did not know; a senior member of staff had not had fire training for 8 months. Entries into daily diary notes for some residents did not contain adequate detail and some of the language used was unprofessional and inappropriate. Sandhurst DS0000022118.V264132.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 X X X X X 1 X STAFFING Standard No Score 27 3 28 X 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X 1 1 Sandhurst DS0000022118.V264132.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 (1) & (2) Timescale for action Unless it is impracticable to carry 17/01/05 out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (“the service user’s plan”) as to how the service users needs in respect of his health and welfare are to be met.2 The registered person shall –(a) make the service user’s plan available to the service user(b) keep the service user’s plan under review(c) where appropriate and, unless it is impracticable to carry out such consultation, after consultation with the service user or a representative of his, revise the service user’s plan: and(d) notify the service user of any such revision Care plans must be more detailed describing how all residents needs should be met.(previous requierment timescale of 14/04/05 and then 09/06/05 not fully met.) Requirement Sandhurst DS0000022118.V264132.R01.S.doc Version 5.0 Page 22 2 OP16 22 (3) (8) The registered person must ensure that any complaints made under the complaints procedure is properly investigated. The registered person should supply the commission at its request a statement containing a summary of the complaints made during the preceding twelve months and the action that was taken in response. The premises to be used as a care home should be of sound construction and kept in good state of repair externally and internally (previous requierment timescale of 14/04/05 and 09/06/05 not met.) The commission is now taking legal advice regarding what further action should be taken to ensure complinance with this requierment. The registered person must not employ a person to work in the care home unless he has obtained in respect of that person all the information and documents specified in schedule 2 of these regulations. (previous requirement timescales of 07/03/05 and 30/06/05 not met.) The commission is now taking legal advice regarding what further action should be taken to ensure compliance with this requirement. 17/01/06 3 OP19 23 (2) (b) 30/11/05 4 OP29 19 (1) (b) 30/11/05 Sandhurst DS0000022118.V264132.R01.S.doc Version 5.0 Page 23 5 OP37 17 (2) 6 OP38 23 (4) The registered person must maintain in the care home records specified in Schedule 4 of these regulations Specifically: 11. A record of all complaints 14. A record of every fire practice, drill or test of fire equipment conducted in the care home and of any action taken to remedy deficits. 4) The registered person shall after consultation with the fire authority – (b) provide adequate means of escape; (c) make adequate arrangements - (iv) for the maintenance of all fire equipment; and (v) for reviewing fire precautions, and testing fire equipment, at suitable intervals; (d) make arrangements for persons working at the care home to receive suitable training in fire prevention; and (e) to ensure, by means of fire drills and practices at suitable intervals, that the persons working at the care home and, so far as practicable, service users, are aware of the procedure to be followed in case of fire, including the procedure for saving life. [An immediate requirement was issued regarding clearing fire exits] 30/11/05 30/11/05 Sandhurst DS0000022118.V264132.R01.S.doc Version 5.0 Page 24 7 OP38 13 (4) The registered person shall ensure that – (a) all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety; unnecessary risks to health and safety should be identified and so far as possible eliminated.(e.g. damaged carpets that are trip hazards should be replaced; upperfloor windows should be risk assessed and suitably restricted where indicated) [An immediate requirement was issued regarding removing flammable materials from boiler room and restricting opening of some windows] 30/11/05 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 3 4 5 Refer to Standard OP7 OP15 OP18 OP25 OP30 Good Practice Recommendations It is recommended that more detail is contained in the care plans. Where service users need help to eat this should be provided discreetly and sensitively. All staff should be clear on how to recognise and respond to concerns about abuse. All rooms should be naturally ventilated (it should be possible to open a window in a bedroom) All new staff should receive a structured induction. Staff should receive training to ensure that they are able to meet all the varied need of residents accommodated at this home (e.g. re Mental health/Learning disabilities) Sandhurst DS0000022118.V264132.R01.S.doc Version 5.0 Page 25 6 OP37 Records required by regulation for the protection of service users and for the effective and efficient running of the business should be maintained, up to date and accurate. (e.g. fire records) Individual records should be properly maintained (appropriate language should be used) All care staff should receive training regarding the moving and handling of people from a suitably qualified and skilled trainer. 7 OP38 Sandhurst DS0000022118.V264132.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Sandhurst DS0000022118.V264132.R01.S.doc Version 5.0 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!