Inspection on 20/09/07 for Sandhurst

This inspection was carried out on 20th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Sandhurst 19/09/08

Sandhurst 03/08/06

Sandhurst 17/10/05

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 Victoria Stewart Unannounced Inspection 20th September 2007 10:10 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.V342633.R01.S.doc Version 5.2 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.V342633.R01.S.doc Version 5.2 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 Kim Rosalie Cox Care Home 23 Category(ies) of Dementia - over 65 years of age (23), Learning registration, with number disability over 65 years of age (23), Mental of places Disorder, excluding learning disability or dementia - over 65 years of age (23), Old age, not falling within any other category (23) Sandhurst DS0000022118.V342633.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia aged 65 years and over (Code DE(E)) Mental disorder aged 65 years and over, excluding learning disability or dementia (Code MD(E)) Learning disability aged 65 years and over (Code LD(E)) The maximum number of service users who can be accommodated is 23. 2. Date of last inspection Brief Description of the Service: Sandhurst is a care home providing accommodation and personal care for up to 23 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 Illness. The home is situated on the outskirts of Bideford. The 3-storey home consists of two adjoining houses, built in the Victorian era. The rooms are mainly single but some doubles are available. 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. The fees currently charged by this service are between £303 to £372. Chiropody, toiletries, newspapers/magazines, personal items, clothing and hairdressing are additional costs which are not included in the fees. Copies of the inspection report are kept in the office of the home but are available on request. Sandhurst DS0000022118.V342633.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A total of 12 hours were spent at Sandhurst over a period of two days on 20 September and 25 September 2007. The home had a previous key inspection on 3 August 2006 when several requirements and recommendations were made. A further random inspection took place on 25 April 2007 to monitor the progress the home had made to achieve these. Several weeks before this inspection took place an Annual Quality Assurance Assessment (AQAA) document, which contains general information about the home and the people living there, was completed by the registered manager of the home and returned to the CSCI. From this information, survey forms were then sent out to residents, relatives, health/social care professionals and staff. Few responses were received but of those 3 were from residents, 2 were from relatives, 1 was from a staff member and 3 were from health/social care professionals. We spoke with a further 2 relatives and 7 members of staff during our visit to the home. At the time of the visit, there were 22 people living at the home with one vacancy. We looked closely at the care given to three specific people living at the home, looked at a selection of records (including residents’ files, staff files, medication records, staff training records, quality assurance records, health and safety records) and undertook a tour of the premises. All of this evidence has been used and included in this report to help form the judgements and findings of this inspection. On the first day of inspection, the manager was not on duty but came in during the morning to assist with the inspection. The manager was present on the second day of inspection. The outcome of the inspection was fed back and discussed before we left the home. What the service does well: Care is taken to ensure that all prospective new residents thinking of living at Sandhurst have an assessment carried out to make sure the home can meet their needs. Good information is shared with the prospective resident and their family/representatives. The Manager or a senior member of staff will visit them prior to them moving into the home. Trial visits are offered and people are invited to spend time at the home, participating in a meal or just a drink. People are encouraged to bring personal and sentimental items in with them to make their private rooms homely. Resident’s families and friends are encouraged to visit regularly and take a part in the care of their loved ones. Residents enjoy the food and meals served to Sandhurst DS0000022118.V342633.R01.S.doc Version 5.2 Page 6 them. The dining room is nicely laid out and residents take part in a chatty, social gathering. The home has good procedures in place to deal with complaints, concerns and comments. One complaint had been received by the home since the last inspection which related to an environmental/health and safety issue. Residents said that they felt confident that they could raise any concerns with the staff of the home and these would be dealt with properly. Staff undergo a thorough recruitment procedure and staffing levels are good and meet the needs of residents. Staff receive a lots of training and regular updates in health and safety related topics and also subjects relevant to the health and care needs of the residents. Residents and health care professionals spoke very highly of staff who are described as kind, caring and friendly. New staff receive good induction training. The home is well managed. Staff and residents expressed complete confidence in the manager. What has improved since the last inspection? What they could do better: 4 requirements were made following this inspection. 2 were with regard to medication and the environment. 2 were with regard to quality assurance and health and safety. These last 2 requirements are outstanding from previous reports and have been carried forward for urgent attention. 5 recommendations were also made with regard to care records, a medication fridge, activities programme, choice of lunchtime meal and the environment. A good system for planning care is in place but more attention needs to be taken to ensure that these records are fully completed and reviewed appropriately. Some improvements are needed in the handling of medicines to make sure that people are not put an unnecessary risk of harm. Whilst some social and recreational activities for residents are in place, these are limited and could be expanded upon. Records relating to personal monies for residents need re-organising. Sandhurst DS0000022118.V342633.R01.S.doc Version 5.2 Page 7 Residents need to be involved more in the running of the home and a system established for regularly reviewing the quality and facilities of the service it offers. Some parts of the communal and private areas of the home are in need of refurnishing and refurbishing. Much work still needs to be done to ensure that all of these areas are also safe for residents to use and do not pose unnecessary health and safety issues. 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. The summary of this inspection report can be made available in other formats on request. Sandhurst DS0000022118.V342633.R01.S.doc Version 5.2 Page 8 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.V342633.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 5 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Surveys received from both people living at the home and relatives showed that they had all received enough information about this home before deciding to live there. We looked at the care files of three people living at the home and all contained an assessment of their needs. These assessments had been either completed by a health or social services professional, completed by the home or by both. This contained all the information the home needed to assess whether they could meet the person’s care needs fully. The home also carefully considers whether the prospective person would get on with the other people living in the home. One recently admitted person confirmed that he/she had visited the home twice before he/she came to live there. Sandhurst DS0000022118.V342633.R01.S.doc Version 5.2 Page 10 The manager or a member of senior staff visits all prospective people who may wish to live at the home. These people and their friends/relatives are encouraged to visit the home and participate in having a meal or a drink there. The home acknowledges that it is difficult for people to move into a care home and with that in mind, the manager would like to encourage people to visit the home for longer periods and visit more often to make the transition period easier for them. The manager also wants to produce a more up to date brochure with relevant information and pictures included. Sandhurst DS0000022118.V342633.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs are met by staff who treat them with respect and dignity. However, care planning records need more improvement to make sure they are up to date. Medications are well managed but some improvements are required in record keeping to ensure that residents’ are not put at unnecessary risk of harm. EVIDENCE: Surveys received from people living at the home and relatives showed that they were happy with the care and support provided. On the days of inspection all residents appeared comfortable, happy and confirmed that their needs were being well met by staff. One relative also told us of how impressed he/she was with the home and how he/she felt it had improved. Comments included “the girls are lovely”, “no home is better” and “can’t fault it”. We looked at the care files of three residents, which clearly showed that they and/or their relatives had been involved with the care planning process. These contained information under “My view, my care”. As well as how staff must Sandhurst DS0000022118.V342633.R01.S.doc Version 5.2 Page 12 meet care needs, these files also contained a history of the individual person’s life and a summary of their personal life. These care files also contained suitable risk assessments with regards to hazards identified and any appropriate action recorded that needed to be taken. Two out of the three files were up to date and complete but one care file was only partly up to date and some dates, reviews, risk assessments and other information missing. Care files did not always contain enough detail to show care staff how to look after residents, for example one person had a catheter in place and no guidance was written down for staff to show them how to do this properly. Care files showed that residents receive regular support from various healthcare professionals. These people spoke very highly of the home. Three health care professionals stated that the home always communicates clearly with them and that staff understand the needs of residents. One health care professional confirmed in his/her survey that “care has improved significantly since the new manager has taken over. She always strives to maintain the best care practice” and another said “They (the home) inform the District Nurses if there are concerns about the patient’s health in a prompt and appropriate manner”. During the visit to the home, two further health care professionals commented that specialist advice is always sought. They considered that close working relationships have developed and their offers on training undertaken by the care staff. The home recently looked after a person at the home through the last stages of life. The staff found it distressing on occasions but one professional commented “the care and attention was commendable”. We looked at the management of residents’ medication. A local pharmacy delivers the medication on a monthly monitored dosette system. We looked at the Medication Administration Record (MAR) and saw when some dosages of medication had been amended/altered, the reasons why, when or on who’s directions this had happened were not documented. It was also not possible to determine from the MAR chart if medicines prescribed for external use, such as creams, had been used as prescribed. Several records showed various gaps in the application of creams with no explanation as to why they had not been used as prescribed. Staff confirmed that these are being used but not recorded. We discussed how to manage these types of medicines more safely and appropriately and record their application. The home does not have a designated drugs fridge to store unopened medication in. The fridge in the kitchen is used and medication such as eye drops kept in a separate container which was dirty. Also no checking or recording of this fridge’s temperature was kept and we saw that some medicines not requiring refrigeration were kept in the fridge. The home uses controlled drugs, which were managed satisfactorily, with the exception of the procedure for returning controlled drugs to the pharmacy. Sandhurst DS0000022118.V342633.R01.S.doc Version 5.2 Page 13 The home is currently caring for someone who has a terminal illness, with specialist input from the GP, district nurses and hospice nurses. The records relating to this person’s medication were not clear, up to date and not recorded correctly as to the specialist’s instructions. We had much discussion with the manager and staff about how this medication must be clearly monitored, reviewed and recorded. On the second day of inspection, we saw that changes in practice had been put into place with the handling, administering and recording of medications. The AQAA states that the home has addressed peoples’ privacy and dignity and that staff always knock on doors before entering and resident’s confirmed that this does happen. We saw that residents were treated with respect and dignity from staff and that staff spoke to residents in the way in which they wanted. Sandhurst DS0000022118.V342633.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The open, friendly atmosphere helps both residents and relatives feel welcome and at home. Residents’ benefit from food which is homemade and varied. Residents’ enjoy taking part in some social activities but these could be expanded upon. EVIDENCE: Residents confirmed that there is enough to do in the home and undertake activities that suit them. The home does have a limited activities programme with activities such as singing, exercise, memories, hairdresser and foot/nail care being undertaken. The manager does acknowledge that there has been some improvement with the activities programme and more people are becoming involved. However, she would like to develop this further and arrange for outside activities to take place where possible and consider setting up the internet for residents who may have families that live abroad to enable them to keep in touch. Visitors confirmed that they are welcome at any time and staff treat them as “part of the family”. Residents confirmed that they can choose what they want to do with their day and we saw that one resident choose to stay in her Sandhurst DS0000022118.V342633.R01.S.doc Version 5.2 Page 15 room in her nightwear for the day and another resident chose not to get up until nearly lunchtime. The home has recently employed a new cook and residents confirmed that they liked the food served. We ate lunch with residents on the first day of inspection and enjoyed a very sociable, pleasant and jovial atmosphere. Food was served hot and was tasty and nutritious. Tables were nicely decorated and a menu board was placed in the dining room which some residents make use of. However, a number of residents did not know what was for lunch and therefore did not have an opportunity to choose an alternative if they did not like it. Any assistance was given discreetly by staff. One resident enjoys his/her meals/drinks at a special table made for him/her to use so that he/she can access it from his/her wheelchair. We saw this resident freely having drinks throughout the day when he/she asked for them. Some residents choose to eat in their rooms but most like the atmosphere of the dining room. The dessert is simple for the main meal at lunch for example yoghourt or icecream but a homemade dessert is given at teatime when residents have more of a ‘snack’ meal such as soup, sandwiches but served with a hot crumble. Cooked breakfasts are offered twice a week which some residents enjoy and we saw that fresh fruit is available on the dining room tables for residents to have when they wish. Sandhurst DS0000022118.V342633.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be confident that concerns and complaints will be listened to and acted upon and that they are protected from staff who have a good knowledge of adult protection issues. EVIDENCE: All residents and relatives confirmed that they knew how to make a complaint and who to speak to if they were unhappy. Residents also confirmed that they felt that staff listen to them and act on what they say. Health/social care professionals confirmed that the service has responded appropriately if concerns had been raised about a resident’s care. The Commission had received no complaints since the last inspection. One complaint had been received by the home from a health care professional about two environmental issues which posed a health and safety issue. This was investigated and appropriate action taken at the time (see Standard 19 and 38). Staff spoken with confirmed that they had received training about recognition and reporting of abuse. Records confirmed their attendance on appropriate courses. All staff confirmed that the home is now more open and issues are often discussed. This means that communication has been improved between management and staff and staff feel able to talk about any issues that may arise. Sandhurst DS0000022118.V342633.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Despite improvements to some areas of the home, not all people living there are provided with safe, comfortable and welcoming surroundings. EVIDENCE: On both days of inspection we looked around the home. Improvements had taken place since the last inspection, including new dining room chairs and tables, carpets replaced, carpets cleaned, new lounge chairs and fencing put up. However, parts of the home are still in need of repair and refurbishment and some of these are simple such as doorknobs missing or not fitting properly. The hallway of the home is particularly unwelcoming with poor decoration, radiators missing off walls and creates a bad impression of the home. At both the back and front of the home are small entrance type conservatories/sun rooms. However, because they are unheated, bare and contain items stored in there, do not provide the extra living accommodation that the people who live there might wish to use. For example, the home Sandhurst DS0000022118.V342633.R01.S.doc Version 5.2 Page 18 accepts people who smoke and due to the new smoking laws residents go outside to one of these cold, bare areas. Bathrooms in the home are particularly unwelcoming with old, tired bathroom suites, pipe work showing, panels missing off baths and poor choice of cold colours. The home had dealt with a complaint from a health care professional who had cut his leg whilst kneeling down to tend to a resident due to broken tiles in one of these bathrooms. These tiles were replaced but the rest of the bathroom was not updated. The electric hoist in one of the bathrooms was showing exposed wires (see Standard 38), which could potentially prove a danger to both staff and residents. One of the resident’s en-suites had bare floorboards, no toilet seat and was really unusable due to potential health and safety issues (see Standard 38). The manager explained that this en-suite was in the process of being updated and redecorated but could not identify how long it would take due to the absence of a permanent member of staff to do repairs such as this. One other room had also been refitted with a ‘non-slip’ floor covering but we felt that this was actually very slippy underfoot and could be a hazard to the person who lived in that room (see Standard 38). The manager explained that this flooring had been really expensive and had been purchased as special ‘non-slip’. Staff agreed that it was slippy and the manager was going to query this with the company that supplied it. The home does employ a person to do some repairs but this is on an as-andwhen basis as this person has employment elsewhere. This causes problems for both staff and residents as there is no one to do any minor repairs, redecoration or maintenance of the property when they occur. As a result of not having a planned maintenance programme for the home, there is a general continual deterioration of the property. The home has recently taken one member of care staff off duty for one day to do any essential repairs in the home that are needed by residents, for example one resident wanted his/her radiator cover removing and his/her wardrobe moving but had to wait for the care assistant to do it for him/her. Having moved this furniture, it was then left on the corridor near his/her room in pieces along with a television set that was also cluttering up the landing. Another example is a radiator that had been removed from the hall because it did not work and as a result left a large area showing a different type of scruffy wallpaper. When we visited on the first day, the garden was very overgrown with bushes covering the main path into the house and piles of leaves on the floor. Both of these were serious safety issues for residents, relatives and staff (see Standard 38). When we visited on the second day, these bushes had been cut back and leaves picked up which made a big difference. The home does employ a gardener but the manager thought that he was only employed to cut the lawn but after discussion with the owner, realised he could be used for other garden maintenance. Within the complaint as discussed before (see Standards 16 and 38), part of it referred to the bushes and leaves at that time Sandhurst DS0000022118.V342633.R01.S.doc Version 5.2 Page 19 being overgrown and making the path slippy. The manager sorted this out at the time but this has obviously not been kept up to. Staff themselves felt that the décor of the home let the home down and would like to see some more general improvements for the people who live there. Despite the obvious need for improvement, the home is kept very clean and residents confirmed that it is usually like this. The home is short of storage space for equipment. For example the medication room is situated on the ground floor underneath the stairs. This is cramped and the light fitting is dangerously low in height which is potentially a hazard. Also there is no storage space for wheelchairs and other aids for when they are not being used. Improvements had been made to the kitchen and dining room areas and a recent visit from the Environmental Health Officer confirmed that this was now satisfactory. A new cooker had been purchased and a dishwasher was waiting to be fitted which has improved the facilities of the kitchen giving benefit to residents. The home’s laundry is situated outside of the building and contains the equipment necessary to maintain resident’s clothing satisfactorily. The home has a clinical waste contract. However we saw no yellow bags used in bathrooms. We were told that used incontinence pads were placed into normal bin bags and then emptied into the yellow clinical waste bags. We discussed how this system could be improved with the manager. Sandhurst DS0000022118.V342633.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 &30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from suitable numbers of well trained, kind and caring staff who care for them as individuals. The staff recruitment procedures are generally good, but need to be consistent to fully protect residents at the home. EVIDENCE: Staff spoken with said that they felt that the care had improved since the staffing levels had increased. All felt that they now have time to spend with the residents. Four care staff are on duty from 7.30am until 2pm, three care staff are on duty from 2pm until 5pm, and two waking night care staff from 9pm until 7.30am. The home also employs domestic staff from 8am to 1pm, a laundry assistant for 3 hours a day and a cook from 8am to 1pm. Staff are now encouraged to take part in training from various professionals and have had significant training recently. This has included catheter care, infection control, healthy eating, breathing problems, diabetes, dementia, palliative care, skin care, bereavement, first-aid as well as fire, manual handling, health and safety and Protection of Vulnerable adults. Some of this training has been by outside professional training agencies but some has been delivered by health care professionals. These professionals felt that “staff had responded well to the teaching sessions” organised by them and that they were well attended. Residents were very complimentary of the staff and we Sandhurst DS0000022118.V342633.R01.S.doc Version 5.2 Page 21 saw good, friendly, warm staff/resident interactions, with people living in the home being treated as individuals. Comments from residents/relatives included: “like it here”, “no place better” and “treats XXXX as one of the family”. Healthcare professionals also responded positively about care staff and believed that “they (staff) treat people as individuals”, “have developed a friendly environment for residents” and “ask for help appropriately”. They also commented that Sandhurst “is a pleasure to visit”, “residents seem happy within the home” and “is a homely atmosphere with very caring staff”. We looked at the recruitment records of three members of staff. All these files showed that staff had been employed with the suitable pre-employment checks being undertaken. We noticed that another member of staff who had recently been employed had not had a PoVA or CRB check completed. The manager was unaware that this had to be done for an employee under 18 years. This person is now no longer working at the home. All new staff employed undergo a thorough induction programme based on the Skills for Care recognised training programme. This ensures that all new staff learn how to care for residents appropriately and safely. We saw the records of this induction programme on the last person to be employed at Sandhurst and it had been completed well. Sandhurst DS0000022118.V342633.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager has a good understanding of the areas in which the home needs to improve. These include providing a more safe and improved environment for residents to live in, updating records for the handling of residents’ personal monies and developing more effective ways of seeking the views of people living at the home. EVIDENCE: Residents, relatives, staff and professionals were very complimentary of the manager who has now been in post about two years. She will shortly complete the NVQ 4 in care. She has already obtained the Registered Manager’s Award which is a recognised professional qualification for people managing care homes such as Sandhurst. The manager is described as approachable, caring and supportive and staff felt that the home now has an open environment and any issues are discussed as a team. This is helped by the regular staff Sandhurst DS0000022118.V342633.R01.S.doc Version 5.2 Page 23 meetings held about every 6 weeks which provides a forum for staff to bring up issues. Improvements to the managing of the home continue to happen for example a new complaints form has been put into place which is simple, easy to read and accessible for residents to use. She is committed to improving the service and is trying other ways of encouraging residents to air their views to improve the home. Resident and relative meetings do not take place but this is something she would like to try in the future. The home has a suggestion box and produces a newsletter about 4 times a year which tells relatives and residents of news and planned events. A questionnaire had been sent out by the home some months ago to residents, which highlighted some issues/improvements, needed. However, as the manager had not analysed or collated these comments yet, no improvements to services/facilities have been made. We looked at the systems for handling the pocket monies of residents. Whilst these were essentially adequate, we discussed how the handling, signing and recording could be improved upon. As mentioned earlier in the report, some areas of the home relating to poor maintenance pose a potential hazard to the health and safety of people living there (see individual Standards). The home had recently had an inspection by the Health and Safety Executive Environmental Health Department who looked at the health and safety of the care home - the maintenance/service contracts of equipment and electrical systems, home risk assessments and fire records. We saw a report that had been written by them dated 20 September 2007 which showed a positive feedback. We undertook a random check of the fire equipment testing staff fire training records and fire alarm testing which was satisfactory. Sandhurst DS0000022118.V342633.R01.S.doc Version 5.2 Page 24 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 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X 2 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 2 Sandhurst DS0000022118.V342633.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? YES 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 OP9 Regulation 13 (2) Requirement Timescale for action 25/10/07 2. OP19 23 (2)b c d 3. OP33 24 When medication is given to people who use the service, it must be given in the appropriate dose prescribed. Any changes in the dose must be clearly written, signed for and dated as to the reason why to ensure that people receive the correct levels of medication. The temperature of the fridge must be regularly recorded to ensure that medication is being kept properly. The premises must be kept in a 25/09/08 good state of repair both externally and internally, equipment must be maintained in good working order and all parts of the home kept reasonably decorated. This is to ensure that the home provides a warm, welcoming and safe place for people to live in. There must be a formal system 01/01/08 in place to review the facilities and services that the home offers. This must provide consultation with residents and their representatives and a copy of this report must be sent to the DS0000022118.V342633.R01.S.doc Version 5.2 Sandhurst Page 26 4. OP38 13 (4) a b c Commission and a further copy available for other people to look at. This is to ensure that the home is providing good facilities and services for the people that live there. (Previous timescale of 03/02/07 and 25.4.07 not met) All parts of the home which residents use and have access to must be safe and free from any hazards to their safety. This is to ensure that residents do not have unnecessary injuries caused to themselves. (Previous timescale of 03.10.06 and 25.4.07 not met) 25/11/07 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 OP9 OP12 OP15 OP19 Good Practice Recommendations It is recommended that residents’ care files are reviewed and kept up to date It is recommended that a separate designated medication fridge is used It is recommended that the activities/recreational/social programme is reviewed It is recommended that residents are given a choice of their main lunchtime meal It is recommended that a programme of routine maintenance and renewal of the fabric and decoration of the home is produced and adhered to Sandhurst DS0000022118.V342633.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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