Inspection on 19/04/06 for Sandilands Lodge

This inspection was carried out on 19th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 10/01/08

Sandilands Lodge 25/09/07

Sandilands Lodge 28/02/07

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 Michael Williams Unannounced Inspection 19th April 2006 9:50am 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.V287786.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V287786.R01.S.doc Version 5.1 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 BMWilliamstconnect.com Miss Barbara Williams Mr Richard Trusty Miss Barbara Williams Care Home 15 Category(ies) of Dementia - over 65 years of age (15) registration, with number of places Sandilands Lodge DS0000007207.V287786.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th November 2005 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 (aged 65 and over) 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. There is no passenger lift and the home has no standing/lifting hoists - so this home is not suitable for people with any form of mobility problem. The home has a small kitchen and a laundry room and has recently installed a sluice. 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 fees, as at April 2006, are from £411 to £475 per week. Sandilands Lodge DS0000007207.V287786.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted on 19th and 20th April 2006. In addition to this inspection visit, which lasted approximately 13 hours, 50 questionnaires were distributed to interested parties; 12 to residents, 12 to relatives/friends, 6 to care managers, 6 to health professionals and to all staff working in the home. The information received into the commission included details of complaints, untoward incidents and general correspondence. During the course of this inspection all residents were given the opportunity to contribute and several staff were interviewed. The premises were toured and documentation, including records, checked. The contribution of all at Sandilands Lodge is acknowledged. What the service does well: What has improved since the last inspection? What they could do better: There is a great deal this home could do better to improve the quality of care and the lifestyle for service users; in general the management of this home must improve, many requirements remain outstanding from the previous inspection and many are critical to the wellbeing of service users. Six ‘immediate requirements’ were issued at the time of this inspection - indicating a need for the manager to give urgent attention to matters such as the safe administration of medication; improving fire safety, particularly fire doors which must be in good working order and not wedged open; Staff recruitment is also unsafe because staff are being employed without the manager making all the checks required to ensure staff have not been previously barred from Sandilands Lodge DS0000007207.V287786.R01.S.doc Version 5.1 Page 6 working with vulnerable people; record keeping is poor - such as the lack of an adequate record of food provided to residents; the residents case files are not well maintained and in particular there is still no ‘service user guide’ and there is a lack of proper review of the care needs of residents. One over-arching requirement is for the home to have in place its own quality assurance system so that the manager can monitor all these points herself. A number of comments were sent directly to the Commission on behalf of service users and they indicate that there is insufficient activity in the home and that, although the home is kept clean, staff are “not always available when needed” and there are “never any activities to take part in”. Commentators note the environment is poor in places, improvements are being made but bedrooms are not always well maintained and some are used to store materials that do not belong to the residents in the room. The questionnaires also confirmed other inspection findings such “no contract” and “not enough information is provided about the home”, or “information is difficult to obtain from the home”; possibly a reference to the lack of a Service User Guide and perhaps not enough meetings involving residents and their family or representatives. A general comment arising from questionnaires was that this care home “did not give value for money”. 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. Sandilands Lodge DS0000007207.V287786.R01.S.doc Version 5.1 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.V287786.R01.S.doc Version 5.1 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): 123 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Prospective service users cannot be assured that they will receive all the information they might need before deciding whether or not to move into the home because the service user guide is still not ready for circulation and there was no evidence that all service users have received either a copy of the ‘Terms & Conditions’ (Contract) or a copy of the agreement the home has with the placing authority in respect of their placement. Nor can the service users be assured that their needs will be fully assessed and that those assessments will be held safely and securely by the home for future use. Standard 6 is not applicable to this home. EVIDENCE: A number of service user case files were checked, residents were given the chance to offer their opinions throughout the two-day visit, staff were interviewed and these standards were discussed with the manager. The commission concludes that the service user guide is not ready for circulation to current and prospective service users. This is confirmed by the fact that they are not with the service user nor in their case file and the manager concedes Sandilands Lodge DS0000007207.V287786.R01.S.doc Version 5.1 Page 9 that they are still not fully compliant with Regulation 5 and Standard 1 so she has not given out the guide to service users. Questionnaires also indicate that relatives do not get enough information about the home and the care of their relative/resident. It was also noted that after checking a sample of three personal files in detail, and others more briefly, there were many instances when the service users’ case files did not contain evidence that a full assessment had been undertaken, by a person qualified to do so, at the time of admission to the home; two files did however hold the new comprehensive assessment that care managers should now provide upon placement. Many files lacked any evidence that the residents or their representatives had received a contract or a copy of the agreement specifying the arrangements between the home and the placing authority, that is, the social services department of the local authority. The manager confirmed that the files checked during the inspection was “the all documentation held by the home on behalf of residents” and that they were “not complete as they should be”. The service users themselves do not keep any of the assessment and care planning documents in their bedrooms and this tends to confirm that documentation and information for service users is limited. Areas of strength are the warmth of welcome when people choose to move into Sandilands Lodge but matters requiring improvement are the documentation to support the decision to admit and the inadequate information provided to prospective residents - so this section, about choice of home, is assessed as poor. Sandilands Lodge DS0000007207.V287786.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care planning in this home is inconsistent, assessment forms are not being fully completed and so it cannot be confirmed that service users’ health care needs can be fully met. Medication procedures were found to be unsafe for service users. There were instances when service users could not be assured their privacy and dignity would be respected as fully as might be. EVIDENCE: In assessing these standards to confirm findings service users were given the chance to comment and staff were observed at frequent intervals in their day to day care of service users; case files and care plans were checked; care staff commented on these standards and the manager was also invited to comment - including her arrangements for care planning and for the administration of medication. The premises were also checked to ascertain how the environment helped, or hindered, in the fulfilment of these standards. The home has a variety of assessment tools that could be used to monitor the health and social care needs of residents but in many instances these documents were not fully completed or they were not being properly reviewed when they were in place. In particular there were two clear examples where Sandilands Lodge DS0000007207.V287786.R01.S.doc Version 5.1 Page 11 the assessment was incomplete. Reviews of service user care were also inconsistent and completely absent in some cases. In many instances the review was merely a date used to confirm ‘no changes’ to the original care plan – for example, a resident was admitted in 1999, the care plan dated 2000 and further dates for 2003, 2004 and 2005 inserted without any evidence of a thorough review involving the resident, the relatives and the care manager. In respect of the ordering, storing and administration of medication a number of serious anomalies were identified. These include errors in counting the number tablets remaining; errors in signing for medication given (or not given); extra doses of medication given beyond that prescribed; medication not being given because the home was ‘out of stock’ and did not have in place a procedure for the prompt renewal of repeat prescriptions. This matter was so serious that an immediate requirement was issued by the Commission for corrective measures to be taken by the manager without delay. In respect of the privacy and dignity of residents a mixed picture emerges; some very good practice was noted such as staff waiting outside the bathroom door so residents could use the facility in some privacy whilst being kept under supervision; staff asked service users before adjusting their clothes and similar instances of staff sensitivity to residents’ well being and dignity. There were however some instances where the rights of services users were not so effectively managed – for example a case file records that a resident was not to be offered a key because, to quote the entry, “…staff prefer not to give her one in case she loses it…”. Without any evidence of a serious risk associated with giving the resident a key this completely overlooks the resident’s right to have a key and possibly lose it. It is also noted that there are just three single and six shared bedrooms with no permanent curtain screens in these rooms (although portable, hospital-style ones are available) and there was little evidence that residents have a choice about sharing either at the time of admission (or when one of the two residents in each shared room leaves) given the very limited scope to do otherwise in this home. This home cannot at this stage demonstrate that it can fully meet the needs of service users. Areas of strength are somewhat limited in this section, some good practice was noted but matters requiring improvement are the need to maintain and review care plans more efficiently, to ensure medication is more safely administered and that residents’ right to privacy and dignity is more carefully managed - so this section, about health and person care, is assessed as poor. Sandilands Lodge DS0000007207.V287786.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users in this home have dementia so it was not possible to confirm that their expectations are being fulfilled and the limited information in care plans made it difficult to confirm that standards in this area are being met, but residents appeared content with life in Sandilands Lodge. Visitors are welcomed. No record of food was available but the meal on the day was wholesome and plentiful and service users said they enjoyed it. EVIDENCE: The findings in respect of this group of standards are little improved from the previous inspection and the requirements are re-stated. In respect of Standard 12, which is about social activities, this area is assessed as not fully met because there was very little indication that service users have a great deal of choice about how they can spend their day - it is usually in the one lounge, seated with the other service users in the usual serried circle. Nor is it clear that the home assists service users to sustain personal skills and abilities for as long as possible. Written comments sent to the Commission tend to support the observations made during the visit – for example, to the question ‘Are there activities arranged by the home that you can take part in?’, one answer given is “Never”. The same correspondent says that she “usually” likes the meals and that she “sometimes” receives the care she needs. Sandilands Lodge DS0000007207.V287786.R01.S.doc Version 5.1 Page 13 During the course of the two-day visit for this Springtime inspection little evidence of social/recreational activity was seen. Once again there were occasions when the service users sat without staff support and supervision, up to about 10 minutes at a time; they sat unattended listening to music. The manager states that social activities such as Bingo, music, table-top games and manicures as well as conversation with staff are available. The staff team said some activities were available and cited an example when earlier in the week the service users had spent time in the garden and had fun being entertained by piano playing. However, the list of weekly activities submitted to the Commission appeared limited, repetitive and unrealistic - including for example ‘gardening’ in the winter months – although it was noted that the list concluded with the statement that activities were “not compulsory”. The manager explained this rather odd statement was intended to indicate that such activities were the choice of service users. “It was up to them whether or not they took part” the manager says. A recommendation to improve leisure, recreational activity and opportunities for stimulation is restated; in particular staff need to be trained so as to offer opportunities for stimulation and activity including contact with the wider community and opportunity to keep personal skills so far as practicable. Standard 15 is about meals and it failed to be fully met last time and once again the manager concedes that she has not put in place a record of meals provided to the service users. This record needs to be in sufficient detail so that the nutrition of each service user can been evaluated if and when the need arises, a relative, care manager, a doctor or the Commission may wish to review the meals taken by a particular service user and this is not possible at present. A requirement for this record is therefore repeated with some urgency. An area of strength is the relaxed atmosphere that prevails but matters requiring improvement are the need for clearer information in care plans about service users’ expectations, what their wishes and preferences actually are, or were; the need for a better programme of activities and a record of meals provided - so this section, about daily activities and social life, is assessed as adequate. Sandilands Lodge DS0000007207.V287786.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users do not have clear and simple information, which should be in their service user guide. So they are not assured that they will be listened to and their complaints dealt with effectively and in a timely manner. Not all staff have undertaken training in the protection of vulnerable adults, so residents cannot be assured that they will be protected from abuse or that the correct procedures will be followed if abuse is suspected. EVIDENCE: Whilst the home has a complaints procedure the document held in a few of the service users’ case files is out date and makes no reference to timescales, nor does it refer to the Commission and makes no reference to other agencies they may contact such as the care manager. The record of complaints has just one entry since the last inspection and that is about a health matter rather than the quality of services provided in the home. The Commission has received one anonymous complaint since the previous inspection and because this alleged that the safety and well being of service users was being compromised the Social Service Department will investigate the complaint. It is noted that this complaint – whatever the eventual outcome - has not yet been entered into the home’s record of complaints. That the complainant felt unable to make him or herself known (neither to the manager of the home nor to the Commission) and just one complaint is logged in the record of complaints suggests that the home is not as open to criticism as the manager would claim. It does not suggest that concerns will be listened to. Sandilands Lodge DS0000007207.V287786.R01.S.doc Version 5.1 Page 15 Under the management heading of this report the need for a system of internal quality assurance is identified so that anyone who wishes to contribute to the improvement of the home may do so without fear of recrimination. No complaints arose during the course of the inspection; service users appeared content with their lot and the few questionnaires received by the Commission at the time of compiling this report confirmed they knew how to complain. In respect of the protection from abuse - some staff have received training in this aspect of care but not all staff have; this is confirmed in the staff training files, by the staff themselves and by the manager who reports that she has booked staff onto courses later this year. The inspector noted that some staff were not clear that they must report suspicions of abuse of residents to the manager, or other relevant authority, and not confront the alleged abuser and ‘give them a chance to reform’ as one member of staff suggested. As the local Social Service Department is undertaking an investigation of an allegation of abuse the Commission cannot confirm at this stage that the home protects residents from abuse. The inspector has on several visits discussed with the manager the value of putting in place a quality assurance system, possibly using a consultant to advise, so that the manager can monitor the home’s shortcoming and address them in a more timely manner. A number of comments were sent directly to the Commission and they indicate that there is insufficient activity in the home and that although the home is kept clean staff are “not always available when needed” and the are “never any activities to take part in”. Commentators note the environment is poor in places but improvements are being made. Bedrooms are not always well maintained and some are used to store materials that do not belong to the residents in the room. The questionnaires also confirmed other inspection findings such “no contract” and “not enough information is provided about the home”, possibly a reference to the lack of a Service User Guide and possibly not enough meetings involving residents and their family/representatives. An area of strength is the accessibility of the owner/manager to staff, relatives and residents but this standard is assessed as not fully met because not all staff know the correct procedures for dealing with allegations of abuse. Nor is the standard on Complaints fully met because the information provided to residents is inadequate and there is no provision for providing information in a modified form that residents with dementia may comprehend as might be expected of a home adapting to the equality rights of service users with diverse needs - so this section, about complaints and protection, is assessed as poor. Sandilands Lodge DS0000007207.V287786.R01.S.doc Version 5.1 Page 16 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 20 21 22 23 24 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. This home is not well adapted to the needs of service users so they cannot be assured that they are living in an entirely safe and comfortable environment that is well adapted to their varying needs but the home is reasonably clean and tidy. EVIDENCE: This is an ‘existing’ care home and the standards have been modified to take account of that and so Sandilands Lodge does not meet modern standards for the residents. This home is not entirely safe for residents because the accident record shows that service users have been falling when ascending the stairs – there is no passenger or stair lift. Staff also fear they will hurt themselves, their backs, and have complained to the manager that it is difficult for them to assist residents when they fall to the floor. The home only has limited lifting aids (for example two slide sheets and a pneumatic cushion lift) available for staff when manoeuvring residents. It was noted that some staff did not even know there Sandilands Lodge DS0000007207.V287786.R01.S.doc Version 5.1 Page 17 were aids for moving and handling in the home and did not know how to correctly use the limited equipment that was available there. The bathroom and toilet facility are not ideal, they are very small rooms and the home lacks hoists and have limited aids for those with mobility problems so they are not entirely safe facilities for people with disabilities. The ground floor toilet and bathroom are at some distance from the lounge and dining room so residents need to negotiate a step along the corridor on their way. It was observed how potentially hazardous this is for residents who use walking frames – even when being assisted by a member of staff. The need for such close supervision also leads to an inevitable reduction in residents’ opportunity to maintain independence when using the toilet. The home does not have specialised equipment such as lifting and standing hoists, there is no passenger lifts and no adapted baths (with built-in hoists) but it is acknowledged that the manager says an Occupational Therapist has advised on the installation of some minor adaptations to assist residents such as grab rails in the bathroom and it is acknowledged that the home does have sheets used for moving and handling and a cushion that is designed to help residents rise to a sitting positions from the floor. However, the accident records show that service users are falling as they ascend the stairs and have also been hurt when being turned in bed by staff. The staff records include comments from staff about back injuries – leading to periods of sick leave they would claim. The manager plans to change the layout of bedrooms, to reduce the number of shared rooms, so as to more nearly meet the standard about providing safe, comfortable bedrooms that suite the residents. It follows that the current range of shared rooms may not always do so – prospective residents may prefer single rooms with ensuite toilet facilities. A trip hazard was identified in one bedroom where the carpet is joined and is now separating and lifting. In other bedrooms, doors were wedged open and a door closure completely missing. It was pleasing to hear that service users spent some time in the garden this week, enjoying the Spring flowers in bloom out there. But the garden is not entirely free of hazards such as discarded bricks, pieces of wood and ladders. Some parts of the garden are nice, such as the flower beds, but other areas, around the laundry extension for example, are less inspiring and not suitable or safe for this client group who are apt to wander and tamper with things. The home was found to be reasonable clean and tidy and a sluice has been installed for the proper cleanings of commodes – regrettably it has been placed in the laundry room which it not a suitable location for reasons of hygiene and the potential for cross-infection. Areas of strength are the family-like atmosphere of this type of home but matters requiring improvement include the need to ensure the safe manoeuvring of residents - so this section, about the environment, is assessed as poor. Sandilands Lodge DS0000007207.V287786.R01.S.doc Version 5.1 Page 18 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 28 29 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There were sufficient numbers of staff on duty so as to meet the needs of service but the staff recruitment practices and the incomplete training programme means that service users cannot be assured that they are in safe hands at all times. EVIDENCE: To evaluate this section a range of staff were interviewed to according to their various roles, including some carers, cleaner, administrator, decorator, and the manager. Questionnaires were also circulated to 50 relevant people including visitors and professionals. All available staff files were examined in detail and the day to day routine of staff was observed throughout the two days of this inspection visit. A mixed picture emerges. Staff were seen to be kind and caring during the inspection. Some new staff, from the Philippines, seemed very popular with service users. They are qualified midwives in their own country and whilst they cannot yet practice in this country they do bring a degree of professionalism to their role as carers and this is most welcome and no doubt to the benefit of residents. On the two days of this inspection there were at least three carers plus the manager and a cleaner but one of the carers is required to do the cooking midday and evening meals. It was also noted that most service users are white European, mainly English people whilst the staff team is not, many come from Sandilands Lodge DS0000007207.V287786.R01.S.doc Version 5.1 Page 19 Jamaica and some from the Philippines and therefore do not reflect the same diversity of culture and background as the residents. It is a matter of considerable concern that not all staff have completed the necessary checks before being employed to work in the home - in particular, the police checks. A requirement was made at the time of the inspection to address this critical shortcoming as a matter of urgency. The staff files were not well organised; it was noted that not all staff had a staff file to be examined and for those that had a file they had a checklist which could be a valuable tool for monitoring the recruitment process - but it is not being used effectively. This allows shortcomings in recruitment to emerge. References for example are of doubtful value because the referees are not confirming their role, their relationship to the subject, and the establishment they speak for. This is due to the poor reference questionnaires sent out by Sandilands Lodge - which does not ask these vital questions. The application form used by Sandilands Lodge is just one page and does not require the applicant to provide a full employment history as required by regulation. These shortcomings make recruitment in the home unsound and does not ensure the safety and well being of service users. In respect of training, once again the records, the staff files in this case, are incomplete and haphazard; staff are clearly going on training courses, as shown by some training certificates. This was required in the previous inspection but not all staff have received training - for example, in the protection of adults from abuse. The staff files contain an induction checklist that is adequate but it was seen to have been correctly used just once – in many cases there is no indication that staff have received any induction training other than their verbal confirmation that have had some introduction to their job. Only two examples of supervision being given to staff were recorded in their files and they were both dated April 2005. The requirement is for six such meetings each year for each member of staff. The regulations allow, in certain urgent situations, for staff to be employed whilst their police check is being processed but the home must have as a minimum a ‘POVA First’ [Protection of Vulnerable Adults list] check, that is, a check of the list of persons not suitable to work with vulnerable adults. Some staff in the past have had such checks but several members of current staff team have neither check, not a CRB nor a POVA, in place. A requirement was made at the time of the inspection for this to be resolved as a matter of urgency. The recruitment and induction process for staff in this home needs to be overhauled to ensure service users will be safe in their hands. Areas of strength are the friendly and relaxed attitude of staff but matters requiring improvement are poor recruitment practices and the incomplete training programme - so this section, about staff, is assessed as poor. Sandilands Lodge DS0000007207.V287786.R01.S.doc Version 5.1 Page 20 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): 31 33 35 37 38 Quality in this outcome area is poor. This judgement has been made using available evidence including two visits to this service and information from previous inspections where requirements remain unresolved. This home is not being well managed so service users are not benefiting from a well run care home. Services users’ money is being managed satisfactorily. There are shortcomings in respect of the environment and in respect of training for staff so this has implications for the welfare of service users and staff. Record keeping is inadequate and so service users are not being safeguarded by good management in this area. EVIDENCE: A general observation in the comments sent directly to the Commission was that this care home “did not give value for money”. To establish how well this home is being run 50 questionnaires were circulated to relevant parties; the staff team was consulted, residents were given a chance to air their views and were observed receiving care and to see Sandilands Lodge DS0000007207.V287786.R01.S.doc Version 5.1 Page 21 how they sent their day in the home; many of the records required to be kept in a care home were checked including care plans, staff files, accident, fire safety checks, complaints, money records and so forth. In summary, the manager concedes that she has had difficulty for many years maintaining all aspects of the home’s administration. In general, their was no evidence to suggest that the manager is anything other than a hardworking individual who loves working with elderly people but she would acknowledge that she lacks organisational skills and therefore many weaknesses in the running of the home have come to light during this inspection. There have been critical failings in respect of matters that affect the well being of both residents and the staff team. For example, the poor adminisration of medication is a serious shortcoming that needs to addressed without delay; the poor recruitment process may lead to errors of judgement when considering prospective staff for employment. The premises themselves are old and not well adapted to frail, elderly service users and this is an issue affecting the home’s ability to provide equality, for example, access to all parts of the home, for people with disabilities. It will also affect the well being of staff if they do not have the correct equipment to use when moving residents. The accident record shows that residents are falling as they ascend the stairs and the staff have complained that helping service users to get up when they fall down is hurting their backs. It was noted that in one bedroom the carpet is lifting at the join and is now a potential trip hazard. Fire safety hazards were noted such as the lack of a self closing device on a bedroom, several doors wedged open, several doors not closing fully and automatically. The garden is not entirely free of hazards such as builders’ rubble and planks of wood lying around. A number of other management issues arose that the home will need to address - such as the bankruptcy of one of the partners and the personal details of the other owner need to be brought up to date on the registration certificate. This will require the home to submit a request for a variation to registration. The manager would claim that Sandilands Lodge is being run in the best interests of the service users but this is not always the case. Areas of strength are difficult to identify in this section other than the owner/manager’s stated intention to strive for improvements. Matters requiring improvement are more readily identified and include the need for better administration of documentation and more careful attention to matters of safety - so this section, about management and administration, is assessed as poor. Sandilands Lodge DS0000007207.V287786.R01.S.doc Version 5.1 Page 22 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 1 1 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 2 2 2 2 2 X 3 STAFFING Standard No Score 27 3 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 1 1 1 Sandilands Lodge DS0000007207.V287786.R01.S.doc Version 5.1 Page 23 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 OP1 Regulation 5 Requirement Service User Guide: this must be kept up to date and must include all the matters listed in Standard 1 and Regulation 5, including a summary of the statement of purpose, contract, inspection report, complaints procedure, and agreement with the local authority. This is outstanding from 23/11/04 and an immediate requirement was made at the time of the inspection to address this matter without further delay. Contract and Agreement: Each service user must be provided with contract and if funded by a local authority then a copy of the agreement between the home and that authority. Data Protection: confidential information, including personal documentation and computer screens, must be maintained secure, private and confidential. It is acknowledged that the manager is seeking to improve the layout of the home so as to increase office space but DS0000007207.V287786.R01.S.doc Timescale for action 30/05/06 2 OP2 5 30/06/06 3 OP10 12(4) 30/08/06 Sandilands Lodge Version 5.1 Page 24 4 OP15 17 5 OP30 18 6 OP18 13(6) 7 OP29 13(6) 8 OP33 24(1),(2) & (3) this is an outstanding requirement from 30/03/06. Food records: A detailed record of food provided must be maintained in accordance with Schedule 4:13 which requires sufficient detail to detemine that service users are receiving an adequate diet. This is an outstanding requirement from 30/03/06 and an immediate requirement was made at the time of the inspection. Protection: All staff, including the manager, must complete training, and periodic refresher training, in the procedures for dealing with allegations of abuse, this must include training in the local vulnerable adult protection procedures. outstanding from 31/3/05, but it is acknowledged that it is underway. This also affects standard 28 about servce users being safe in the hands of staff. Each member of staff to be given a summary of Vulnerable Adult Protection procedures, this is outstanding from 31/3/05, but it is acknowledged that it is underway. Protection: Each member of staff to be given a copy of the GSCC (General Social Care Council) Code of conduct and a copy of the homes whistle-blowing policy. Quality Assurance: The registered person must establish a system for reviewing and improving the quality of care provided. A copy of the report of this review must to be made available for service users and a copy submitted to CSCI. This remains an outstanding DS0000007207.V287786.R01.S.doc 30/05/06 30/06/06 30/06/06 30/06/06 30/05/06 Sandilands Lodge Version 5.1 Page 25 9 OP37 17 and Schedule 2 requirement from 31/3/05 and an immediate requirement has been made to address this requirement without further delay. Records: the registered person must maintain all those records listed in the Schedule 2 and Schedule 4.6, staff records, and shall maintain them complete, up to date and accurate. This remains an outstanding requirement from 30/03/06 and an immediate requirement was made at the time of the inspection. Records: the registered person must maintain all those records and details listed in Schedule 3 (service users case files) as they apply to the service users in this home and shall maintain them complete, up to date and accurate. This remains an outstanding requirement from 30/03/06 and an immediate requirement was made at the time of the inspection. Records: Service users assessments must be properly reviewed, at least monthly. More detailed reviews, annually for example, must include consultation with the service user or their representative. These reviews must be readily accessible for the service user, the staff and must be available for CSCI inspection to assess whether or not service users’ care needs are being periodically re-assessed and care plans modified accordingly. This also reflects standard 8 about demonstrating that the home is 30/05/06 10 OP37 17 30/05/06 11 OP7 17 30/07/06 Sandilands Lodge DS0000007207.V287786.R01.S.doc Version 5.1 Page 26 meeting service users’ needs. 12 OP37 17 Records: the registered person must maintain all those records listed in the Schedule 4 (records required to be maintained in care homes) as they apply to this home and shall maintain them complete, up to date and accurate; including service user guide and food record. This remains an outstanding requirement from 30/03/06 and an immediate requirement was made at the time of the inspection. Fire Safety: Fire doors must close automatically and fully to their stops. No fire doors, including bedroom doors, are to be propped open unless held open by a magnetic door holder that respnds to the fire warning system. This is an outstanding requirement from 30/03/06. An immediate requirement was made at the time of the inspection. Care Assessments: The home shall not accommodate service users unless the needs of service users have been assessed. This assessment must be readily accessible for the service user to whom they refer, to the staff and for CSCI inspection. Medication: The home shall make arrangements for the safe recording, handling, storing and administration of medication. In view of the many errors identified in the inspection an immediate requirement was made to address these matters without delay. Complaints: Service users must be provided with an updated complaints procedure that DS0000007207.V287786.R01.S.doc 30/05/06 13 OP38 23(4) 30/05/06 14 OP3 14(1)(2) 30/06/06 15 OP9 13(2) 30/05/08 16 OP16 22(1) to (8) 30/06/06 Sandilands Lodge Version 5.1 Page 27 17 OP19 16(2)c 18 OP20 23(2)o 19 OP21 23(2)j 20 OP22 13(5) 21 OP29 19 includes such details as timescales for action and to whom service and their representatives may complain including the Social Service Department. The details of the Commission must be included. Bedrooms: matters of maintenance were noted in bedrooms, loose carpet and missing door closure for example and must be addressed without delay. Garden: the garden must be cleared of rubbish and hazards such as the bricks, old wood, ladders and rubbish noted during the inspection. Toilets and Lavatories: Whilst the small toilets and bathrooms will be difficult to improve the current facilities must be maintained in good order such as ensuring toilet seats are not loose and toilets have suitable hand-washing facilities. Personal property of residents such as skin treatments and toothbrushes must not be left in areas for communal use (bathrooms). Aids and adaptations: The (limited) equipment available for moving and handling residents in this home must be made known to all staff and staff must have suitable training in the use of that equipment. Recruitment: Staff must not be employed in the home to work with vulnerable residents unless all required checks have been completed and as a minimum this must include the POVAFirst (Protection of Vulnerable Adults list) and their proper supervision pending police check. An immediate requirement was DS0000007207.V287786.R01.S.doc 30/05/06 30/06/06 30/06/06 30/06/06 30/05/06 Sandilands Lodge Version 5.1 Page 28 22 OP36 18(2) made at the time of the inspection to address this matter without delay. Staff supervision: Staff are to be supervised, one to one private meetings with each member of staff, at least six times a year. Such supervision to cover all aspects of practice; philosophy of care in the home; career development. These supervision meetings are to be recorded in writing and evidence of the meetings made available for CSCI inspection. Health & Safety: the manager must put a place system for monitoring health and safety in the home so as to ensure the welfare of residents, staff and visitors. Manager’s competence; the manager must carry on the home with care, competence and skill and to do so must from time undertake such training, commensurate with her managerial and business responsibilities, as is appropriate. Evidence must be available for the Commission to demonstrate that such training is taking place. Fitness of Provider: The owner, Miss Williams must formally advise the Commission of any changes to her circumstances that differ from the information provided at the time of her registration, in particular those details listed in Schedule 2. A request for a Variation is advised. 30/06/06 23 P38 13(4), (5) and (6) 30/06/06 24 OP31 10 30/12/06 25 OP31 7(1), (2), (3) 30/06/06 Sandilands Lodge DS0000007207.V287786.R01.S.doc Version 5.1 Page 29 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 Refer to Standard OP12 Good Practice Recommendations Activities: It is recommended again that the range of activities be reviewed and revised so as to meet the specialist needs of people with dementia and reflects their choices and known preferences. The revised range of opportunities should be suitable for residents to maintain their skills and abilities and for enjoying fulfilling and social activities and this programme be made known to service users and their visitors. Staff Training: Training is being implemented for all care staff including training in Dementia care; First Aid; Moving and Handling; Medication; Fire Safety; protection from abuse procedures. It is recommended that the staff and management records in respect of training, planned, underway and given, be better arranged so that the CSCI can inspect these records. Privacy and Dignity: It is recommended that the home is conducted in a manner that respects the privacy and dignity of service users, the provision of keys should be reviewed based upon the residents’ wishes and welfare and not the preferences of staff (as currently identified in case notes). It is also recommended that privacy within bedrooms is improved with permanently installed curtains that offer greater privacy. Bedrooms: the CSCI endorses the manager’s plans to improve private accommodation (bedrooms) and recommends that proposals to make further improvements such the provision of more single rooms with better facilities is pursued. 2 OP8 3 OP10 4 OP23 Sandilands Lodge DS0000007207.V287786.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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. 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