Inspection on 10/01/08 for Sandilands Lodge

This inspection was carried out on 10th January 2008.

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

Sandilands Lodge 22/04/08

Sandilands Lodge 25/09/07

Sandilands Lodge 28/02/07

Sandilands Lodge 19/04/06

Sandilands Lodge 24/11/05

Sandilands Lodge 23/11/04

Sandilands Lodge 17/06/04

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

CARE HOMES FOR OLDER PEOPLE Sandilands Lodge 228 Carshalton Road Sutton Surrey SM1 4SA Lead Inspector Mohammad Peerbux Key Unannounced Inspection 10th January 2008 10:30 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 Sandilands Lodge DS0000007207.V357361.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. Sandilands Lodge DS0000007207.V357361.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sandilands Lodge Address 228 Carshalton Road Sutton Surrey SM1 4SA 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) 020 8643 6291 020 8642 3788 bmwilliams@btconnect.com Ms Barbara Williams Ms Barbara Williams Care Home 15 Category(ies) of Dementia - over 65 years of age (15) registration, with number of places Sandilands Lodge DS0000007207.V357361.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 Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE (E) (of the following age range: 65 years and over) The maximum number of service users who can be accommodated is: 15 25th September 2007 2. Date of last inspection Brief Description of the Service: Sandilands Lodge was co-owned by Mr Richard Trusty and Miss Barbara Williams, however, Mr Trustys interest in the business is at present represented by a Trustee in Bankruptcy but the home is still registered with the CSCI and remains in full operation. Miss Williams is the registered manager. The home is registered to provide residential care for up to fifteen older peoples with dementia. The home is a large detached house situated on the Carshalton Road close to local shops and bus routes between Wallington and Sutton. It is an old property in need of refurbishment and difficult to adapt to modern standards of comfort and disability access. There are three single and six double bedrooms located over two floors. The home has a separate lounge and dining room on the ground floor. There are bathrooms and toilet facilities located on both floors. The home has a small kitchen and a laundry room. The office is also very small, too small to effectively manage the home. A small patio area and raised garden is to be found at the rear of the property and parking space to the front. The range of weekly fees is between £417 and £455. Sandilands Lodge DS0000007207.V357361.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit to the home was undertaken as a part of the inspection process for the year 2007/2008. In writing the report consideration has also been given to information received throughout the year such as comments from people who use the service, reports of incidents and complaints. This was the home’s second inspection for the year 2007/08. It took place over six hours. Some times were spent looking at records, talking to staff and registered manager. Some of the residents were spoken to however due to their cognitive ability it was difficult to seek their views. A tour of the building was also carried out. They are all thanked for their time and all of those who provided feedback for their support in the inspection process. There have been some concerns raised as far as Safeguarding Adult is concerned and the Local Authority is carrying out an investigation at present. However most relatives have commented positively on the care the home provides to the care manager during residents’ reviews, which were carried out as part of the investigation. What the service does well: What has improved since the last inspection? There has been significant improvement made with regards to the environment of the home. A number of rooms have been redecorated and the flooring in a number of bedrooms has been replaced. The recordings of administration of medication have also improved and medications are being kept locked in accordance to the requirements of the Medicines Act 1968, guidelines from the Sandilands Lodge DS0000007207.V357361.R01.S.doc Version 5.2 Page 6 Royal Pharmaceutical Society and the requirements of the Misuse of Drugs Act 1971,for the health and safety of residents. 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. The summary of this inspection report can be made available in other formats on request. Sandilands Lodge DS0000007207.V357361.R01.S.doc Version 5.2 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 Sandilands Lodge DS0000007207.V357361.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home undertakes an assessment of the healthcare needs of residents prior to their admission to ensure that their needs would be met. EVIDENCE: It was previously required that the needs assessment must be considered against the statement of purpose to ensure that the service is able to meet the needs of the new resident as the home does not have a lift and will not be able to meet residents with mobility difficulties. There has not been any admission since the last inspection so it was difficult to assess if this requirement has been met in full however the manager stated that the needs assessment are being reviewed to make them more comprehensive. However the manager is reminded that needs assessment must be completed in full so that the needs Sandilands Lodge DS0000007207.V357361.R01.S.doc Version 5.2 Page 9 of the residents could be met. This will be reassessed at the inspection. The home has now installed a stair lift to help residents with mobility difficulties to go upstairs. The home does not offer intermediate care. Sandilands Lodge DS0000007207.V357361.R01.S.doc Version 5.2 Page 10 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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ care plans do not always cover all their care needs. However these are being reviewed to ensure they cover all aspects of their health, personal and social care needs and set out in detail the action, which needs to be taken by care staff to ensure these are met. EVIDENCE: Requirements made at the last inspection with regards to residents’ care plans have not been assessed in full during this inspection as the registered manager stated that she is receiving help and advice from the Local Authority in developing care plans which will be more comprehensive and will cover all aspects of the residents’ health, personal and social care needs to ensure these are met. However the manager is reminded that the care plans must be drawn up with the involvement of the resident, recorded in a style accessible to the resident; agreed and signed by the resident whenever capable and/or Sandilands Lodge DS0000007207.V357361.R01.S.doc Version 5.2 Page 11 representative (if any). Requirements made will be repeated and reassessed at the next inspection. Generally the resident’s health is monitored and appropriate action taken. The home seeks professional advice on health care issues, acts upon it. However last year there were concerns raised by the local care management team that there was a delay in seeking medical advice for one resident and this is presently being investigated. The home has a medication policy which is accessible to staff, medication records are generally up to date for each resident and medicines received, administered and disposed of are recorded. The administration/nonadministration of all medication is being recorded accurately at all times for the health and safety of residents. This is in line with a requirement made at the last inspection. All prescribed medication in the custody of the home are now being kept locked in accordance to the requirements of the Medicines Act 1968, guidelines from the Royal Pharmaceutical Society and the requirements of the Misuse of Drugs Act 1971.The medication profiles of the residents have also been updated. The manager stated that she had requested the General Practitioners to visit the home to review the medication of all the residents. Observation of the staff team interacting with the residents showed that the carers were mindful how they addressed residents, and they were seen to be polite and friendly. The home arranges for residents to enjoy the privacy of their own rooms and provides screens in shared rooms. Some of the residents were spoken to however due to their cognitive ability it was difficult to seek their views regarding the care and support they receive. One resident stated, “I don’t talk to strangers”. A number of residents have had their reviews carried out recently and the care manager stated that their relatives commented positively on the care the home provides. Sandilands Lodge DS0000007207.V357361.R01.S.doc Version 5.2 Page 12 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 and 15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home tries to be flexible and attempts to provide a service, which is as individual as possible. Dietary needs are well catered for and a well balanced diet is provided, to ensure health and enjoyment of food. EVIDENCE: In respect of Standard 12, which is about social activities, this area is assessed as still not fully met as the activities records were not up to date and it was difficult at times to identify what activities the residents have been involved in. Some engagement was noted between staff and residents on the day of inspection. Family and friends feel welcome and know they can visit the home at any time. The design of the home provides seating areas within the communal areas of the home where residents can entertain their visitors, in addition to the privacy Sandilands Lodge DS0000007207.V357361.R01.S.doc Version 5.2 Page 13 of their own room. It is clear that the home encourages individuals and groups from the community to visit the home. The assistant manager stated that residents are being supported to exercise choice and control over their lives in so far as they wish and are able to do so. Residents have the choice to bring an amount of small personal belongings with them on admission and are encouraged to keep personal items, which are important to them in their own room. It was clear from the menus that a wide variety of different food options were available in the home with a lot of consideration given to the nutritional value of the meals provided. The menus offer a choice of meals, and when the published menu options are not desired on the day, alternatives are offered. It was positively noted that consideration is also given to residents from ethnic minority groups as far as the menu is concerned. Sandilands Lodge DS0000007207.V357361.R01.S.doc Version 5.2 Page 14 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 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints are generally managed well, which should ensure that residents’ and relatives’ concerns are listened to. However there have been concerns raised with regards to the care being provided in the home, which might put residents as risk. EVIDENCE: The home has a complaints procedure which explains how to make a complaint and that the complainant can expect a response about the outcome of any investigation to a complaint within 28 days. The current complaints procedure is good and gives a clear step-by-step guide of how to make a complaint. The manager stated that there is now a folder in place where relatives, visitors and other professionals can make comments about the care the home provides. The manager informed that most of the staff have had abuse training. Presently there is an ongoing investigation by the Local Authority concerning the care of one resident who was living at the home last year. Sandilands Lodge DS0000007207.V357361.R01.S.doc Version 5.2 Page 15 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): 19,22,24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment does not always meet the residents’ needs however there is a rolling programme in place to improve the decoration, fixtures and fittings and general environment. EVIDENCE: There has been significant improvement to the environment since the last inspection. The home has an on-going maintenance programme in place. There has been a stair lift installed to help residents with mobility difficulties to go to the first floor. The Local Authority is making arrangement for an occupational therapist to visit the home and to carry out an assessment in order to advise what improvements are needed with regards to the environment and general needs of the residents. Sandilands Lodge DS0000007207.V357361.R01.S.doc Version 5.2 Page 16 The manager has replaced a number of fixtures and fittings in the home. Some of the rooms have also been redecorated. The staff now ensure that call bells are within the reach of the residents so that they have a mean to call for assistance. This is in line with a requirement made at the last inspection. The home is kept clean and hygienic and free from offensive odours throughout. Systems are in place to control infection in accordance with relevant legislation and published professional guidance. Sandilands Lodge DS0000007207.V357361.R01.S.doc Version 5.2 Page 17 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff numbers are of sufficient to meet the residents’ needs and provide consistency and to ensure their safety. The home’s recruitment procedures protect the residents through vigorous staff vetting. EVIDENCE: The staff rotas show well thought out and creative ways of making sure that the home is staffed efficiently, with particular attention given to busy times of the day and changing needs of the residents. The manager stated that she is in the process of recruiting more staff. The manager stated that 5 staff have NVQ level 2 qualifications and 5 are undertaking the course. Another two staff are undertaking NVQ level 3 courses. Recruitment procedures seemed appropriate. Staff files were examined at random and found to contain all the information required by the Care Homes Regulations 2001 including a completed job application, terms and conditions of employment, an enhanced CRB check and proof of their identity. Sandilands Lodge DS0000007207.V357361.R01.S.doc Version 5.2 Page 18 The home ensures that all staff within its organisation receives relevant training that is targeted and focussed on improving outcomes for residents. The manager is aware that there are some gaps in the training programme. These are being addressed and further training sessions have been arranged. There is now a staff training and development programme in place. Sandilands Lodge DS0000007207.V357361.R01.S.doc Version 5.2 Page 19 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): 31,33,35,36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. One-to-one supervision sessions are still not being held with staff on a regular basis, this could affect the staff’s ability to consistently meet the service users’ needs. EVIDENCE: Since the last inspection there has been significant improvement made with regards to the general management, environment and some of the paperwork and the Commission acknowledges this. The manager and assistant manager are still working towards improving the service being provided. They are aware Sandilands Lodge DS0000007207.V357361.R01.S.doc Version 5.2 Page 20 of the areas where they need to make improvements and have an action plan for undertaking the work. The general management of the home will be reassessed at the next key inspection. It was previously required that the home must be run in the best interests of the residents and work to the basic processes set out in the NMS. This has been partially met, as improvement is ongoing. The registered manager informed that she has access to a mentor for support and supervision in relation to her professional practice. This is in line with a recommendation made at the last inspection. The assistant manager has also attended a course in dementia. Effective quality assurance and quality monitoring systems, based on seeking the views of residents, are now in place to measure success in meeting the aims, objectives and statement of purpose of the home. The manager stated that the home does not handle residents’ monies. Three staff supervision records were sampled and it was noted that progress still need to be made regarding this issue. The manager is reminded that formal supervision sessions must be held with all care staff at least six times a year for the delivery of good quality services. The manager informed that action is being taken to resolve this on-going issue. It was previously recommended that the home carry out a risk assessment on all uncovered hot pipes in the building for the safety of residents. It was positively noted that a number of hot pipes have been covered to minimise the risk of residents being scalded from hot surfaces. A number of requirements were made at the last inspection with regards to health and safety and the registered provider has met all of them. Records with regards to health and safety are of a good standard and are routinely completed. Certificates relating to health and safety were up to date servicing certificates. The fire extinguishers were being serviced on the day of the inspection. Sandilands Lodge DS0000007207.V357361.R01.S.doc Version 5.2 Page 21 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X 2 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 3 Sandilands Lodge DS0000007207.V357361.R01.S.doc Version 5.2 Page 22 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 OP7 Regulation 15(1) Requirement Residents’ care plan must cover all aspects of their health, personal and social care needs and set out in detail the action, which needs to be taken by care staff to ensure these are met. (Previous timescale of 30/11/07 not met). Residents’ care plan must meet relevant clinical guidelines produced by the relevant professional bodies concerned with the care of older people, and includes a full risk assessment, with particular attention to prevention of falls. (Previous timescale of 30/11/07 not met). Residents’ care plan must be drawn up with the involvement of the resident, recorded in a style accessible to the resident; agreed and signed by the resident whenever capable and/or representative (if any). (Previous timescale of 30/11/07 not met). DS0000007207.V357361.R01.S.doc Timescale for action 10/03/08 2. OP7 15(1) 10/03/08 3. OP7 15(1) 10/03/08 Sandilands Lodge Version 5.2 Page 23 4. OP7 15(2) Residents’ care plans must be reviewed at least once a month, updated to reflect their changing needs and current objectives for health and personal care. (Previous timescale of 30/11/07 not met). Residents need to be offered suitable forms of activity for them to enjoy a full and stimulating life style with a variety of options to choose from. (Previous timescale of 30/11/07 partially met). The home must be run in the best interests of the residents and work to the basic processes set out in the NMS. (Previous timescale of 25/10/07 partially met). Formal supervision sessions must be held with all care staff at least six times a year for the delivery of good quality services. (Previous timescale of 30/11/07 not met). 10/03/08 5. OP12 16(2)(m), (n) 10/03/08 6. OP31 12 10/03/08 7. OP36 18(2) 10/03/08 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 Sandilands Lodge DS0000007207.V357361.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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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