CARE HOMES FOR OLDER PEOPLE
Sandridge House London Road Ascot Berks SL5 8DQ Lead Inspector
Sandra Grainge Unannounced 19 April 2005 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 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. H52-H01 S11014 Sandridge House V221729 190405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Sandridge House Nursing home Address London Road, Ascot, Berks, SL5 8DQ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01344 624404 01344 874474 Amberbrook Management Ltd Application to be made Care Home with nursing (N) 38 Category(ies) of Old age, not falling within any other category registration, with number (OP) of places H52-H01 S11014 Sandridge House V221729 190405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: 25 places are registered to provide nursing care for Older People; the remainder are registered for provision of personal care. Date of last inspection 16.11.04 Brief Description of the Service: Sandridge house is owned and managed by Amberbrook management Ltd, a provate company, who are registered to provide personal care for up to 38 older people and nursing care for up to 25 persons. The property is a large old prestigious Victorian building that is situated in a prime location near to Ascot racecourse. Heatherwood Hospitall and the premises of the primary care trust are also in the immediate vicinity. The home is clearly signposted and there is space for car parking on the site. Ascot village is closeby and there is access to public transport. H52-H01 S11014 Sandridge House V221729 190405 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that was carried out by a locum inspector who had reviewed previous inspection reports and the homes’ file prior to the inspection that commenced at 9.30 am on a weekday morning and took seven hours. Daily activities in the home were observed and views were sought from Service Users and a visiting relative; the comments made were positive and the kindness and friendliness of the staff were appreciated. The registered manager had resigned in June 04. An application for registration had been received from the next person to be appointed to the position but this application was withdrawn in February 2005. Another Nurse in charge has been appointed; at the time of the inspection she had been in post for five weeks and was on duty at the time of this inspection. An application for her registration has not yet been received. Two of the directors of the company were in the premises during part of the day. The inspector was only able to give the briefest of summaries to one of them during the afternoon because they were busy and this was an unannounced inspection. The property has been registered for many years and was not purpose built. During this time the proprietors have made considerable effort to achieve national minimum standards and health and safety requirements. The service was fully staffed and there was pleasant atmosphere in the home. Staff were observed to be polite, friendly, caring and attentive to the needs of the service users. The Nurse in Charge/Matron was new but had taken control of the service and demonstrated that she was able to provide leadership and direction. She already knew the service users and their needs and had assessed the practice and facilities available in the service. Requirements from the previous inspection were considered and evaluated against the action plan that had been sent in response by the Group Manager. All required action had been taken or was in progress. The risk of scalding or burning from hot water had been reduced; a staff-training plan was in place; medication records on the day were complete; a quality assurance system was being implemented and will be continued with the new Nurse in charge. Infection control training had been arranged for all staff and improved practice was seen in the way in which they were cleaning the home. In view of this it was disappointing to find that although a working sluice machine was available the floor of the sluice room was dirty and soiled equipment was stacked on it waiting for disinfection. A review of this situation has been required. Senior staff were named on a board in the entrance hall to help service users and visitors to the home to recognise staff and a plan was in progress to assist them further by the provision of staff name badges and a display staff photos. H52-H01 S11014 Sandridge House V221729 190405 Stage 4.doc Version 1.20 Page 6 What the service does well: What has improved since the last inspection? What they could do better:
The practice of infection control in the sluice room was poor. The sluice machine did not appear to have the capacity for the number of items to be disinfected and soiled items waiting for treatment were stacked on a dirty floor. Commodes were provided in bedrooms located in each “wing” of the building and as a consequence soiled pots and equipment had to be carried past the dining room or kitchen doors to be disinfected in the sluice room. The management must review the adequacy of the provision of sluice facilities so that staff are not tempted to resort to the previous bad practice of cleaning equipment in the bathrooms. There were two electrical wires trailing across the centre of a bedroom; this was a hazard for service users and staff . Staff must give attention to health and safety practice during daily operation of the home. Bed rails were fitted to
H52-H01 S11014 Sandridge House V221729 190405 Stage 4.doc Version 1.20 Page 7 a variety of beds to prevent falls. The use of these rails was properly documented following assessment of risk; however, there was no evidence of routine maintenance and safety checks of the rails. Most service users were disabled or in need of physical assistance due to age or illness. The building has two floors and several wings on different levels that are reached by stairs. Service users commented that they were unable to move freely about building and garden. In addition, the passages and doorways in the communal areas were not designed to accommodate walking frames, wheelchairs and hoists. Two members of staff working on the ground floor found it difficult to transfer a service user into a toilet using a hoist. This was due to a narrow doorway and lack of space. The toilet wall was damaged at the level of the hoist, indicating that this was not a new problem. The proprietors have been asked in the past to consider the design and structure of the building and plan adaptation to better accommodate disabled access to all public areas and the garden. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. H52-H01 S11014 Sandridge House V221729 190405 Stage 4.doc Version 1.20 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection H52-H01 S11014 Sandridge House V221729 190405 Stage 4.doc Version 1.20 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4,and 5. Standard 6 is not applicable to this service. EVIDENCE: The outcomes were met for standards 3 and 5. There was an improvement in the assessment of needs process since the last inspection; a newly admitted service user and her relative described the pre admission process. The recently appointed nurse in charge demonstrated that she had already carried out a comprehensive needs assessment prior to the admission of a new resident to the service. Service user care needs were incorporated in the care plans that were sampled and the NHS nursing needs had been assessed using the Department of health guidance. The staff on duty demonstrated that they had the skill and experience to provide care; disabled service users considered that hey had restricted access to some of the building due to the numbers of stairs and their need to use a wheel chair so consequently standard 4 was not met in full. H52-H01 S11014 Sandridge House V221729 190405 Stage 4.doc Version 1.20 Page 10 H52-H01 S11014 Sandridge House V221729 190405 Stage 4.doc Version 1.20 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) standards 7, 8,9 and 10 were included in this inspectionand were met. EVIDENCE: Some care plans were sampled and these included comprehensive assessment of service user need and plans for staff to take action to meet the needs. The Nurse in charge aims to include detail of service user involvement in the care planning process. The care plans contained evidence of assessment of nutrition, pressure area care, incontinence, mental health and ability to carry out personal hygiene. Each person had an individual plan and referrals were made to other health professions when appropriate. A new member of nursing staff correctly demonstrated the administration of medication and the records inspected were found to be in order. During the inspection staff were seen to knock on service user’s doors before entering. Service users confirmed that they were treated with respect and care was always given in a way that gave them as much privacy as possible. Screening curtains were in use in the shared bedrooms. H52-H01 S11014 Sandridge House V221729 190405 Stage 4.doc Version 1.20 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 standard(s) 12 , 13,,and 15. Standard Standards 13 and 15 were met; standard 12 was partially met met because of the restriction felt by service users who did not have easy access to all areas of the building. EVIDENCE: Service users and a visiting relative commented that the staff try to meet needs and give them as much choice as their disability allows. Two residents who were physically disabled expressed sadness that hey were unable to return to their rooms during the day without staff assistance and both commented that they liked looking at the garden but seldom went out because access was difficult. The proprietor has been required to look at the building and seek ways to improve access and provide additional assistance to increase the provision for those who cannot walk or climb stairs unaided. During the day staff were seen to be taking some service users out through the front entrance using wheelchairs. They were commended for the way in which they assisted the occupants of the chairs to use the wheelchair footplates for safety. Visitors commented that they were welcomed to the home and were able to visit their relative in private if they wished. Staff made arrangements for this to be possible for those in shared rooms. One visitor commented that he was aware of the activities in the home and had been encouraged to participate if he wished.
H52-H01 S11014 Sandridge House V221729 190405 Stage 4.doc Version 1.20 Page 13 At lunchtime it was clear that the staff knew the likes and dislikes of each individual. Encouragement was given to those who needed assistance to eat and records of intake were kept for those who were at risk of malnutrition. H52-H01 S11014 Sandridge House V221729 190405 Stage 4.doc Version 1.20 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 standard(s) 16,17 and 18 by reviewing records and speaking to the sevice users and staff these standards were met. EVIDENCE: Service users knew how to make a complaint if they so wished. No new complaints had been received since the last inspection and the registered individual had responded to earlier complaints. Protection of vulnerable adult training had been provided for staff. H52-H01 S11014 Sandridge House V221729 190405 Stage 4.doc Version 1.20 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Standards 19,21,22,24,25,and 26 were included in this inspection ; methods used inclluded observation during the tour of the premises and listening to service user views. Standard 19, 21 and 22 were partially met because of lack of assisted access to some bedrooms and the limited access to some areas of the home. standard 24 was met -the home was very clean and comfortably furnished;some beds were fitted with bedrails,it is recommended that these are serviced on a regular basis. Standard 25 was met-The registered peron had just completed a programme of work to protect the service users from scalding in the bath. standard 26 partilaly met-the sluice room contained soiled pots that were stacked on the floor; Standard EVIDENCE: H52-H01 S11014 Sandridge House V221729 190405 Stage 4.doc Version 1.20 Page 16 Standard 19-Service users said that they were restricted by the structure of this older house because they cannot manage the stairs unaided and doorways are not easy to negotiate by the disabled who are in wheelchairs or use walking frames. Standard 21 -The access to the ground floor toilet near the dining room was limited and moving and handling equipment had caused damage to the wall. The only sluice room provided in this home did not have the capacity to process all the soiled commode pots which were stacked on a dirty floor waiting for treatment. H52-H01 S11014 Sandridge House V221729 190405 Stage 4.doc Version 1.20 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) The outcomes for these standards were met; the service users felt that the staff were meeting their needs. EVIDENCE: Standard 28 -The correct numbers of staff were on duty at the time of the inspection and the duty rotas confirmed this. Recruitment practice was satisfactory and a staff-training programme had been proposed and was being implemented by the new nurse in charge who places great importance on training and education for staff. H52-H01 S11014 Sandridge House V221729 190405 Stage 4.doc Version 1.20 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Standards 31, 32,33,36,and 38 were considered and the outcomes were met There was a new nurse in charge in the home who had no yet made application for registration, however service users felt safe in her care. EVIDENCE: It was apparent that staff were being supervised and working well under the new leadership. Analysis of recent accidents in the home had resulted in a drop in the number of falls that were occuring. H52-H01 S11014 Sandridge House V221729 190405 Stage 4.doc Version 1.20 Page 19 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 2 x 2 2 x 2 3 2 STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 2 3 3 x x 3 x 3 H52-H01 S11014 Sandridge House V221729 190405 Stage 4.doc Version 1.20 Page 20 Are there any outstanding requirements from the last inspection? 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. 2. Standard 21 22 Regulation 23(1,2,a,j ) 23(2a,f,n) Requirement review the provision of toilet facilities to ensure that they meet the needs of service users Have the premises reviewed to ensure that service users have equipment such as ramps and chair lifts that they require to maximise their independence and access to communal areas via doorways that are of sufficient width to allow wheelchair access. review capacity and use of sluice machine and provide a plan to prevent backlog of contaminated equipment stored on floor. clean sluice room floor immediately There must be a registered manager for the service Timescale for action action plan by 30.6.05 report and action plan by 30.6.05 3. 26 23,(2,k) action plan by 30.6.05 immediate application to be made by 31.5.05 4. 5. 26 31 23,(2.k) 8,(1,b) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations
H52-H01 S11014 Sandridge House V221729 190405 Stage 4.doc Version 1.20 Page 21 1. 2. 12 38 provide name badges for staff as planned review safety checks for use of bed rails H52-H01 S11014 Sandridge House V221729 190405 Stage 4.doc Version 1.20 Page 22 Commission for Social Care Inspection 2nd Floor 1015 Arlington Business Park Theale RG7 4SA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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