Inspection on 28/02/07 for Sandilands Lodge

This inspection was carried out on 28th February 2007.

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 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 Michael Williams Key Unannounced Inspection 28th February 2007 10:10a 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.V331296.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.V331296.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.V331296.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th April 2006 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 so this home is not suitable for people with mobility problems. 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 are from approximately £450 per month. Sandilands Lodge DS0000007207.V331296.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key, unannounced inspection was conducted on 28th February 2007 by Mr Williams and Mrs Saimbi (inspectors). Since the last key inspection in April 2006 further visits were necessary on 7th June; 5th October and 5th/6th December. The primary focus of this inspection was to monitor the various requirements issued by the Commission in 2006. Information was collated, or triangulated, by speaking to residents, staff and a consultant who was acting temporarily as manager whilst the proprietor Ms Williams was on holiday. Information was also cross-referenced by asking service users their experience of living in Sandilands Lodge and this was ‘tracked’ by examining records and documentations and speaking to staff. The site visit also included a tour of the premises. In compiling this report the Commission has also taken in account any information it has received from visitors and professionals in touch with the service and consolidates information gathered during several visits in 2006. What the service does well: What has improved since the last inspection? What they could do better: It remains the case that the Commission is not confident that Ms Williams has the necessary skills and competence to continue and sustain the current improvements introduced by the consultant. A person with the necessary time and Sandilands Lodge DS0000007207.V331296.R01.S.doc Version 5.2 Page 6 skills to manage the home is indicated if this home is to achieve and maintain acceptable standards throughout. 16 requirements and 4 recommendations are made in this report. This reflect improvements but most area require improvement from the initial assessment of service before entering the home; better care-planning and an improvement regime of activity and occupation is needed, the approach to complaints needs improving as does the training of staff in protecting service users from abuse. The environment is limited by age and general layout, it has inadequate storage space and poorly adapted for people with mobility problems. Staffing levels have improved but still does not reflect the gender and cultural background of most residents. Training needs to be improved with better pro-active approach to the planning of training, simply who has had what training and who needs training and refresher courses and supervision. The overall management of this home has been very poor for many years and it is only with the considerable assistance of a consultant that this home has made some improvements in recent months - but the Commission is not confident this improvement will be sustained without a suitably competent person leading a team of properly recruited and experienced staff. 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.V331296.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.V331296.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): NMS 3 - Quality in this outcome area adequate. This judgement has been made using available evidence including a visit to this service. The proprietor has given assurances that prospective service users will not be admitted in future without a full assessment of their needs including mental health, social and mobility needs. The improved record keeping suggests standard 3 can be met whilst the proprietor is assisted by a consultant, so prospective residents and their representatives will know a needs assessment will be undertaken prior to admission. EVIDENCE: The proprietor is using consultant to help her improve all areas of Sandilands Lodge and this includes the records and documentation associated with the admission of new residents. It is important that prospective service users have information about the home they may choose to live in and they must be assured that their needs can be met in the home. After many months of preparation a Service User Guide is now available and a copy placed in each of the bedrooms in addition to any other copies given to relatives. Sandilands Lodge DS0000007207.V331296.R01.S.doc Version 5.2 Page 9 The proprietor has also arranged for an Occupational Therapist to assess the home to gauge how older people with mobility problems might manage in Sandilands Lodge. The home is not well adapted for any person with restricted mobility – it has no lift for example and there are steps into the building and between lounge and toilets. Only residents who can manage stairs with a care worker’s help and should be admitted above ground floor level. Areas of strength are the availability of information for prospective service about Sandilands Lodge and matters requiring improvement include the need to ensure no residents are admitted whose needs cannot be fully met, whether mental health, social or mobility needs. Progress in this key standard has been made because the proprietor has had the help, advice and direction of competent consultant but the Commission is not confident this improvement can be sustained without such support. This section, about choice of admission, is assessed as adequate. Sandilands Lodge DS0000007207.V331296.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): NMS 7 8 9 10 - Quality in this outcome area adequate. This judgement has been made using available evidence including a visit to this service. Improvements in key standards of this section indicate that the arrangements for care planning, the provision of health care and the procedures for dealing with medication are adequate so as to ensure the social, and health care of service users can be met. EVIDENCE: In assessing and cross-checking or ‘tracking’ the experience of service users living in Sandilands Lodge a sample of their case files were checked and service users were given the chance to comment. Staff were observed at frequent intervals in their day to day care of service users; records and care plans were checked; care staff commented on these standards and the person temporarily in charge (the consultant) 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 case files of service users are better ordered and in particular the procedures for dealing with medication which were a serious problem in the three preceding inspections are now much improved – again this is with the Sandilands Lodge DS0000007207.V331296.R01.S.doc Version 5.2 Page 11 oversight of the consultant who has improved documentation and procedures for administering medication - for example two members of staff now check medication in an effort to reduce the many problems identified in the past such as failing to sign after administering medication; failing to order stock in a timely manner; failing to administer medication in accordance with the doctor’s prescription and so forth. The records show that residents keep in touch with health care professionals as the need arises and this will include local General Practitioners, Nurses, Opticians and other professionals. Because the home is so poorly adapted to supporting residents with mobility problems the Commission required that the premises be assessed by a qualified Occupational Therapist to advise on precisely what limitations there are and what aids and adaptations might be used to reduce hazards to both residents and staff. A report of findings is awaited but the inspectors were advised that an assessment visit has been made. It remains the case the baths and the bathrooms are small and bedrooms, mostly double are not suited to people using wheelchairs. The home now a hoist to assist in the process of moving and handling residents. The home also has a portable ramp for the steps leading into the home but these appear to be very steep and possibly hazardous in themselves but it is acknowledged that the acquisition of such aids is leading to improvements in this area. Sandilands Lodge does however remain unsuitable for residents with mobility problems – a point confirmed by observing how difficult it was for some residents to ascend the stairs and manoeuvre walking frames through from the lounge to the toilet. Areas of strength include the service users’ access to health care services and the gradual improvement of aids and adaptations and matters requiring improvement include the need to act upon the Occupational Therapists’ findings, sustain improvements in the administration of medication, to ensure only residents with reasonable mobility are admitted, and remain living in Sandilands Lodge. Whilst improvements are noted the Commission is not confident that standards will be maintained without the help of competent person in charge of the home and so this section, about health and personal care, is assessed as adequate. Sandilands Lodge DS0000007207.V331296.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): NMS 12 – 15 - Quality in this outcome area 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 fully met, but residents appeared content with life in Sandilands Lodge. Visitors are welcomed. EVIDENCE: The findings in respect of this group of standards are improved from the previous inspections. In respect of Standard 12, which is about social activities, this area is assessed as still not fully met because there was still very little indication that service users actually do have a greater choice or control about how they can spend their day - it remains the case the residents sit 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 in 2006 tended 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 was “Never”. During the course of the visit for this Springtime inspection little evidence of social/recreational activity was seen. Sandilands Lodge DS0000007207.V331296.R01.S.doc Version 5.2 Page 13 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. Some engagement was noted between staff and residents but not nearly enough. The proprietor has stated that social activities such as Bingo, music, television, table-top games and manicures as well as conversation with staff are available. 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 rather surprising statement that activities were “not compulsory”. The proprietor 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 she said. 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. The Alzheimer Society may be able to offer advice and help in this respect. Standard 15 is about meals and it failed to be fully met last time because there was not record of nutrition but the manager has now put in place a record of meals provided to the service users. This record must be in sufficient detail, not just listing the choice offered but the actual intake, so as to be able to gauge whether or not service users’ nutritional needs are being met. The main meal on the day, spicy chicken, appeared adequate and plentiful and some service users said they enjoyed it but the second choice was sandwiches which is not an acceptable second choice for the main meal of the day – particularly if older residents don’t like spicy foods. The cook stated that she was a carer working in the kitchen because there was no trained cook that day. She also conceded that she was not a cook and that the meal was not home-made but chilled/re-heated and the soup from a packet. Meals in this home are often very good so today’s choices were an exception nevertheless improvement on today’s standard is needed. An area of strength is the relaxed atmosphere, relatives have commented upon the friendliness of the home and say they are always made to feel welcome when visiting, 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 - so this section, about daily activities and social life, is assessed as adequate. Sandilands Lodge DS0000007207.V331296.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): NMS 16 18 - Quality in this outcome area adequate. This judgement has been made using available evidence including a visit to this service. No Quality Assurance process is in place so service users cannot be assured that their voice will be listen to but information about complaining is contained in the Service User Guide. It remains uncertain whether or not all staff have received training in respect of the protection of vulnerable adults from abuse and the reporting of such matters, so service users cannot be assured they will be protected. EVIDENCE: Whilst the home has a complaints procedure the record of complaints has just one entry and that is about a health matter rather than the quality of services provided in the home. It was also noted that a complaint made to the Social service Department in 2006 was not entered into the home’s record of complaints. In February 2007 during the course of the latest inspection another anonymous complaint was received, about the provision of hot water and the general heating of the home by day and night, this matter is being investigated but again points to a lack of confidence in the in-house procedures for dealing with deficiencies. That complainants felt unable to make themselves known and the fact that 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 and problems addressed in timely and effective manner. Sandilands Lodge DS0000007207.V331296.R01.S.doc Version 5.2 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 during 2006 confirmed relatives 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. 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 they “never arrange activities [for residents] 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. 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. I note however that at least one relative meeting has been held and proved popular and helpful with relatives. 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 it was not confirmed that 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 limited 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. That complaints are being made outside the home is indicate of limited response within the home - so this section, about complaints and protection, is assessed as improved but still only adequate. Sandilands Lodge DS0000007207.V331296.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 19 22 26 - Quality in this outcome area adequate. 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 nor does it meet modern standards in respect of shared accommodation 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 national minimum standards have been modified to take account of that. Sandilands Lodge has not been altered in any substantial manner since the introduction of the standards for older people and does not meet modern conditions for the residents. This home is not entirely safe for residents because the accident record for 2006 shows that service users have been falling when ascending the stairs – there is no passenger or stair lift. Staff are also apprehensive that they will hurt themselves, their backs in particular, and have complained to the manager that it is difficult for them to assist residents when they fall to the floor. The Sandilands Lodge DS0000007207.V331296.R01.S.doc Version 5.2 Page 17 staff records include comments from staff about back injuries – leading to periods of sick leave they would claim. The home now has a hoist to assist in the moving and handling of residents. It also has a portable ramp to help residents in wheelchairs get in and out of the home but this appears to be very steep and may itself be hazardous. The proprietor has arranged, as required, for an Occupational Therapist to assess the premises. It would clearly be in the interests of the proprietor to heed any advice given by the O.T. The bathroom and toilet facility are not ideal, they are very small rooms and gain would not be ideal for residents with mobility problems. The ground floor toilet and bathroom are at some distance from the lounge and dining room and 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. It was noted that radiators have wooden protective covers but in one instance it was loose. The arm of window has also fallen from the rotten window frame in one toilet. Once gain a bedroom door was not fully closing to its stops. In some bedrooms the décor needs redecorating - where walls have been damaged for example. The proprietor says she 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 but this was not the case at the time of inspection in February 2006. It follows that the current range of shared rooms may not always suite prospective residents who may prefer single rooms with ensuite toilet facilities - which are not available in this home. Bedrooms furniture is old and worn and in some cases quite inadequate - for example chest of drawers with missing handles – wardrobes/cupboards are still being used for communal storage and indicates a that too many residents are being accommodated in this home of this size and with limited storage space; it is undignified for residents to be storing communal stocks in their private rooms. It was pleasing to hear that service users spend time in the garden they would have enjoyed the Spring flowers in bloom out there. 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 laundry is itself quite unsuitable for residents to use and does not lend itself to residents maintaining skills in this area. For a similar reason the narrow kitchen would not be safe for residents to maintain cooking and kitchen skills. 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 is not a suitable location for reasons of hygiene and the potential for cross-infection. Areas of strength are the familylike atmosphere of this type of home but matters requiring improvement include the need to make bedrooms more dignified and with better furniture; so this section, about the environment, is assessed as adequate. Sandilands Lodge DS0000007207.V331296.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 27 to 30 - Quality in this outcome area adequate. 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, competent 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 and the person in charge whilst the proprietor is absent on holiday. In 2006 questionnaires were 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 day of this inspection visit. A mixed picture emerges; some improvements are noted such as the employment of cleaner plus the administrator and the consultant – all part of the support team which should have been addressed a long time ago. 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 day of the inspection in February 2007 there were three carers plus the person in charge; a fourth carer was on duty as the cook and was required to do the cook midday and evening meals. The home now employs a Sandilands Lodge DS0000007207.V331296.R01.S.doc Version 5.2 Page 19 cleaner. The proprietor will need to monitor cleaner hours to ensure they are sufficient to undertake the many ancillary tasks - which includes laundry work as well as cleaning the whole home every day. The appointment of a cleaner is long overdue but still commendable as it releases care staff for the main duty to care for and supervise the residents - it is to be hoped that the home can now develop an improved range of activities and opportunities for residents and increase contact with their family and friends. It was also noted that most service users are white European, mainly English people whilst the staff team is not, many come from Jamaica and some from the Philippines and therefore do not reflect the same diversity of gender, culture and background as the residents. In 2006 it was a matter of considerable concern to the Commission 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. This matter has now been addressed and all staff files have the required police check [CRB] in place. The staff files are now much better organised; staff files had a checklist which could be a valuable tool for monitoring the recruitment process - but it was not being used effectively. This allowed 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 historically unsound and it may not be possible to bring all files up to an acceptable standard given the passage of time since some staff were recruited. However with the help of the consultant the files and now much better organised and even the deficiencies such as the lack of a photograph and poor references and are much easier to identify. Supervision is another matter planned for but not in place – all staff received a supervision meeting just after the previous inspection in October but none since then; there should be six such sessions as a minimum each year. This is another example of the inability of the proprietor to sustain improvements even when arrangements are in place. In respect of training, there is no overall strategy to staff training, no matrix to show who has had what training and when refresher course will need to be arranged. The system is ad hoc and inefficient. Staff are clearly going on training courses, as shown by the training certificates. This was required in the previous inspection but the person in charge could not, using the staff files, deduce whether or 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. Sandilands Lodge DS0000007207.V331296.R01.S.doc Version 5.2 Page 20 The recruitment and induction process for staff in this home needed to be overhauled and with the help of the consultant progress is being made but this progress must be sustained 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 improved to an adequate standard. Sandilands Lodge DS0000007207.V331296.R01.S.doc Version 5.2 Page 21 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): NMS 31 33 35 36 38 - Quality in this outcome area adequate. This judgement has been made using available evidence including a visit to this service. This home is not being well managed by the proprietor but with the help of a consultant management of the home is improving but the Commission is not confident service users are 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 but improving and so generally service users are not being safeguarded by good management. EVIDENCE: A general observation in the comments sent directly to the Commission in 2006 was that this care home “did not give value for money”. To establish how well this home is being run the staff team was consulted, residents were given a chance to air their views and were observed receiving care and to see how they spent their day in the home; many of the records required to be kept Sandilands Lodge DS0000007207.V331296.R01.S.doc Version 5.2 Page 22 in a care home were checked including care plans, staff files, accident, fire safety checks, complaints, money records and so forth. In summary, the proprietor 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 year’s six inspection visits. It is to the proprietor’s credit that she has accepted the help of a consultant with the skill to support, advice and assist for a short while in the running of the home – for this reason the quality rating has improved from poor to adequate over the course of the last few months as her input has shown positive results. 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 administration of medication was a serious shortcoming that needed to be addressed without delay – improvements are noted and a more robust system for administering medication is in place – requiring two staff to undertake the task to avoid errors. The historically poor recruitment processes meant the proprietors was not making sound judgements when appointing staff but improvements are noted at least in the staff files, which will help better recruitment in future. Training is not well organised and supervision is still not in place. 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 mobile hoist will help in this matter and no doubt the Occupational Therapist will be able to offer some advice but the premises remain not entirely suitable for the client group. The accident record shows that residents have been 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. As the hoist cannot be used on stairs, nor on the first floor, the issue of moving and handling is not entirely without problems still. A number of other management issues remain and which the proprietor will need to address - such as the bankruptcy of the partner who, the proprietor states, still has a financial interest represented by a Trustee. 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 proprietor’s employment of a consultant – improvements are therefore reliant upon professional input from such consultancy. 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 improved from poor to adequate. Sandilands Lodge DS0000007207.V331296.R01.S.doc Version 5.2 Page 23 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 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 2 2 X X 2 X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 2 X 2 Sandilands Lodge DS0000007207.V331296.R01.S.doc Version 5.2 Page 24 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 OP3 Regulation 14(1)(d) Requirement Assessment: The home must ensure that a suitable assessment of each prospective resident is undertaken b a person qualified to do so and that the home confirms in writing that it can meet the assessed needs of the service user including mobility and mental heal needs. Care Plans: The home must ensure that all care plans include the wishes and preferences of service users and that a plan of occupation and recreation is included to help service maintain skills and abilities and relieve boredom. Care Plans must be updated monthly and thoroughly reviewed annually. Falls: The home must make adequate provision to minimise the risk of falls, including an Occupation Therapist’s assessment of the premises and training for staff in falls prevention and protective measures to minimise injury. DS0000007207.V331296.R01.S.doc Timescale for action 30/05/07 2 OP7 15(1) 16(2)(m), (n) 30/05/07 3 4 OP7 OP8 15(2)(b) 13(4)(a), (b),(c) 30/05/07 30/05/07 Sandilands Lodge Version 5.2 Page 25 5 OP10 16(2)(c) 6 OP12 OP14 16(2)(m), (n) 7 OP15 16(2)(i) 8 OP16 22(1)to(8) 9 OP18 OP30 OP28 13(6) 18 10 OP19 16(2)c Privacy and Dignity: The home must ensure that all windows in toilets and bathrooms have curtains or blinds and that floor coverings are of dignified appearance for the client group. Routines of daily living: The home must, through adequate care planning, ensure all residents, individually and as a group, are offered suitable forms of activity and choice that will maintain their physical and mental health. Meals must be prepared by a person competent to do so and must provide adequate choices for residents that includes a minimum choice of two hot meals for the main midday meal of the day and a freshly prepared snack in the evening. Complaints: the home must improve to make clear to all those involved in Sandilands, Residents, relatives, staff and professional visitors that complaints will be handled competently and professionally and issued raised will be addressed where possible. 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, 30/6/06 and 28/02/07 but it is acknowledged that it is now underway. This also affects Standard 28 about service users being safe in the hands of staff. Bedrooms: all areas of the home must be maintained in good order. In bedrooms, loose vinyl pieces are hazardous and DS0000007207.V331296.R01.S.doc 30/05/07 30/05/07 30/05/07 30/05/07 30/05/07 30/05/07 Sandilands Lodge Version 5.2 Page 26 11 OP22 23(2)(n) 12 OP29 19 13 OP31 9(2)(b)(i) 14 OP33 24(1),(2) & (3) bedroom doors are not closing fully, window cills damaged, window catches off and broken furniture, damaged bedroom walls for example. These and other matters of maintenance must be addressed without delay. Staff need to be more aware of and act upon deficiencies they identify each day – either report or fix problems. Aids and Adaptations: The home must review the premises and the aids and equipment used to assist service users. A copy of the report supplied by the Occupational Therapist must be supplied to the Commission with an action plan to address recommendations. Staff recruitment: staff must be recruited in accordance with regulation 19 and evidence of all the checks and documentation required by regulation and schedules 2 and 4 must be in place in the home and available for inspection. Manager: the proprietor must appoint a person with the qualifications, skills and experience to manage Sandilands Lodge. 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 requirement from 31/3/05 and revised dates 30/05/06 and 28/2/07. The commission accepts that the employment of a consultant may address this matter in due course of time. DS0000007207.V331296.R01.S.doc 30/05/07 30/05/07 30/05/07 30/05/07 Sandilands Lodge Version 5.2 Page 27 15 OP36 18(2) 16 OP38 13(4) (a) (b) and (c) 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. Outstanding from 30/06/06 and 28/02/07. Health and safety: The home must make provision for the safety of both staff and residents in particular falls prevention and the safe manoeuvring of service users. 30/05/07 30/05/07 Sandilands Lodge DS0000007207.V331296.R01.S.doc Version 5.2 Page 28 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 and in bathrooms that have glazed doors curtains should be fitted to 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 as the provision of more single bedrooms with better facilities, is pursued. 2. OP8 3. OP10 4. OP23 Sandilands Lodge DS0000007207.V331296.R01.S.doc Version 5.2 Page 29 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. Extracts may not be used or reproduced without the express permission of CSCI Sandilands Lodge DS0000007207.V331296.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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