Inspection on 23/05/06 for Sandridge House Nursing Home

This inspection was carried out on 23rd May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Sandridge House Nursing Home 14/08/08

Sandridge House Nursing Home 14/08/07

Sandridge House Nursing Home 13/10/05

Sandridge House Nursing Home 19/04/05

Sandridge House Nursing Home 16/11/04

Sandridge House Nursing Home 19/08/04

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

CARE HOMES FOR OLDER PEOPLE Sandridge House Nursing Home London Road Ascot Berkshire SL5 8DQ Lead Inspector Stewart Mynott Unannounced Inspection 10:15 23rd May 2006 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 Sandridge House Nursing Home DS0000011014.V289924.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. Sandridge House Nursing Home DS0000011014.V289924.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Sandridge House Nursing Home Address London Road Ascot Berkshire SL5 8DQ 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) 01344 624404 01344 874474 Amberbrook Limited Mrs Gillian May Elston Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38) of places Sandridge House Nursing Home DS0000011014.V289924.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to 2 (two) service users within the overall registered numbers can be between the ages of 60 - 65 years. 13th October 2005 Date of last inspection Brief Description of the Service: Sandridge house is owned and managed by Amberbrook management Ltd, a private company, who are registered to provide nursing care for up to 38 older people. The property is a large old prestigious Victorian building that is situated in a prime location near to Ascot racecourse. Heatherwood Hospital 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 close by and there is access to public transport. The fees range from £475 to £695 per week depending on the level of care needs. Sandridge House Nursing Home DS0000011014.V289924.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an inspection process lasting for 5 days in duration. This included an unannounced visit to the site for 7 hours. During this time many service users were spoken to gain their views and experiences of the home. There were discussions with most of the staff on duty including the registered manager. Observations of the daily routines accounted for most of the site visit. In addition information was received from the manager as well as 5 service user surveys returned to the CSCI. What the service does well: What has improved since the last inspection? There is now a new registered manager in post. An action plan has been developed to review all care and management systems within the home to enable the best possible standards of care to be provided for all service users. A review of staff practises has already been undertaken in areas of numbers, deployment and support in supervision and regular meetings. Service users developments include the better methods of care planning and delivery to ensure all individual assessed needs will be met. The manager has begun a reassessment of service users who have significant memory problems, which may lead to changes to the service reflective of such service users identified needs. The health and safety of service users has also been reviewed and Sandridge House Nursing Home DS0000011014.V289924.R01.S.doc Version 5.1 Page 6 improvements to ensure safe moving and handling have been achieved by providing additional equipment and personal assessments of individual needs within the bedrooms for easy reference. Service users and staff were highly complimentary about the new manager and service users felt “she has time to visit and talk to us, and she listens”. The manager has already had a significant impact in the management and improvements to the standards of care within the home by providing a clear sense of direction and good leadership skills. Service users needs are being fully assessed prior to admission to ensure the home will be able to cater for their needs. Service users who have recently moved in commented, “it fully met my expectations, I am content”, “I didn’t know what to expect really, but I am happier than I thought I would be”, and “everything I need has been provided, so far”. What they could do better: The majority of service users that could express an opinion were very satisfied with the home, staff and their lifestyle. However two service users did comment that whist the staff are “kind and never grumble” that the mood of some staff is not consistent and “they could come in happy or very quiet, so I don’t always know what to expect”. In addition two other commented about being disturbed at night by associated noise from night staff routines. During lunch the inspector observed staff attending to service users that needed full assistance with feeding whilst having a general discussion with the visiting hairdresser. Further training and instruction is needed to ensure service users dignity, respect and privacy is never compromised. The arrangements for appropriate social care and activities does not meet the needs of those service users with memory problems that require staff support to occupy their time. Staffs rely on the activities organiser, who visits three times a week leading to long periods of inactivity. The registered manager is required to review these arrangements to ensure an appropriate activity program is devised and implemented. Care and senior staff should be involved alongside the activities organiser to monitor the activities program when reviewing social aspects of service users care plans. There is a need for further development of the monitoring and recording of the dietary intake for more vulnerable service users that do not eat in the dining room. It was unclear for one service user if they had received a sufficient intake as they did not eat their main meal and staff appeared unaware of this. A recent fire safety enforcement notice has identified some deficiencies to the building that are required to be rectified to comply with the relevant fire safety regulations. This work has now commenced. In addition it is awkward to manoeuvre moving and handling equipment in one of the downstairs toilets as evident by continual damage to the walls. The layout and size of this toilet should be reviewed. Sandridge House Nursing Home DS0000011014.V289924.R01.S.doc Version 5.1 Page 7 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. Sandridge House Nursing Home DS0000011014.V289924.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sandridge House Nursing Home DS0000011014.V289924.R01.S.doc Version 5.1 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 the following standard(s): 3 and 4 Quality in this outcome area is good. Service users can be confident that their needs will be fully assessed prior to their admission and that these needs will be met. EVIDENCE: Four service users who had moved into the home since the last inspection discussed their experiences about the admission process. All four service users recollected choosing the home, relying on relatives to assist them. Service users were positive about their experiences and felt the choice of home has met their personal circumstances. Service users stated, “it fully met my expectations, I am content”, “I didn’t know what to expect really, but I am happier than I thought I would be”, and “everything I need has been provided, so far”. The records for the admission process demonstrated that an assessment of need was conducted by the home and this is recorded in a pre admission assessment. Further reports including care management and health reports have also been received. Sandridge House Nursing Home DS0000011014.V289924.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 and 10 Quality in this outcome area is good. However further training is required to ensure that all service users are comfortable with the approach of staff and to ensure their duties are not intrusive to resident’s privacy at night. EVIDENCE: The registered manager has recently reviewed the format of how service users care plans are recorded and reviewed. The sample seen evidenced a more person centred approach, only recording relevant and specific information pertaining to the individual (as opposed to generic documentation) including personal, social and healthcare needs. Of the service users spoken to six care plans were viewed and the current documentation used did meet the required standards, although information in the files was not “user friendly”. The nursing staff have been allocated the task of redeveloping the care plans and all spoken to were clear on the objectives and timescales as discussed in a recent senior team meeting with the manager. Six service users confirmed that they feel the staff have a good knowledge of their care and support needs and all comments received were positive. One service user stated, “The staff know what I cant do and help me, I am always clean and fresh which is so important to me, it makes me feel comfortable”. Sandridge House Nursing Home DS0000011014.V289924.R01.S.doc Version 5.1 Page 11 Service users were not aware directly of the content of their care plans, however did not want involvement in this area as they felt all their needs are being met. Care staff spoken to were able to describe the personal care and support required by these six services users. The information discussed was recorded in care documentation and agreed with comments received by those service users earlier. This demonstrated a good understanding of service users needs and abilities. Service users felt that their health needs were attended to by the nursing staff and when necessary by their GP or referrals to more specialist services. One service user stated “I needed physiotherapy and the home arranged this and I went to a hospital”. The records for six service users that were focussed on demonstrated improved, clearer methods for the recording of all health input and treatment by the GP recently developed by the registered manager. A record of ongoing assessments for tissue viability, wound management plans, continence, falls risk assessments, nutritional and weights were also viewed and all of which are kept under regular review. The medication is now administered by both RGN’s from two trolleys to ensure service users receive their medication at appropriate times to prevent morning medication to be given too close to lunchtime. In addition one RGN now provides clinical care during the morning for service users to ensure such needs are met. Better methods of communication are used to track required clinical duties and nursing staff spoken to felt the review of their morning duties was more beneficial to providing “better and more organised clinical care”. The registered manager is driving forward the reassessment of service users with significant memory impairment with the GP to review their diagnosis to ensure their psychological needs can be met. At present the home is not registered for dementia care and at the end of this review services and facilities will be re-evaluated to ensure the home can cater for such needs. A variation may be required to the registration of the home at this time to reflect such a change. Service users confirmed that they felt treated with dignity and respect. At a recent staff meeting, maintaining dignity was discussed to ensure best practise is followed. Observations revealed that staff address service users appropriately and respect their privacy to include knocking on doors before entering and confirmation that screens are used in shared rooms when assisting with personal care tasks. Four service users spoken to had their own personal telephones in their rooms and confirmed that they receive their post unopened. Service users were positive about the staff stating, “the staff are professional and kind to me” and “they are helpful”. However two service users did state whilst staff were “good” and “they never grumbled when their busy” that their “mood” was not always consistent and “they could come in really happy or very quiet, so I don’t always know what to expect”. Two other service Sandridge House Nursing Home DS0000011014.V289924.R01.S.doc Version 5.1 Page 12 users stated “the night staff are too noisy” and “they disturb my sleep at times, they need to be quieter in the next room”. However other service users felt satisfied that their privacy was not intruded upon at night. The manager is required to review these issues to ensure all service users feel comfortable with staff approach and practise. Sandridge House Nursing Home DS0000011014.V289924.R01.S.doc Version 5.1 Page 13 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 and 15 Quality in this outcome area is adequate. The manager is required to devise and implement a suitable activities program for those service users with a significant memory problem to ensure their social and psychological needs are met. Improvements are required to ensure those service users not eating in the dining room receive the correct level of support to be able to eat their meals, and staff are aware of their dietary intake through appropriate monitoring and recording. During mealtimes staff must ensure their actions do not compromise service users respect or dignity. EVIDENCE: Several service users confirmed that they feel very satisfied and entirely happy with their daily life at the home. Service users spoken to in their rooms felt that they were “entirely comfortable” and “ feel very satisfied” with their daily life at the home. Service users confirmed that they were free to follow their own pass times and occupy their own day, observations revealed a good range of personal activities including reading newspapers and books to listening to radio broadcasts which were individual to their identified needs. One service user enjoyed playing board games prior to admission as recorded in their preassessment documentation. The service user confirmed that the activities organiser visits to play scrabble and these visits are recorded in their personal activity notes. Service users were aware of organised group activities and Sandridge House Nursing Home DS0000011014.V289924.R01.S.doc Version 5.1 Page 14 confirmed they had the choice to attend, as one service user stated “there is no pressure to join in activities downstairs, I am happy here in my room”. Service users that were able also stated that their care is received flexibly with a choice of timings for personal care. Staff were able to evidence that service users are always given a choice of the sequence of their care and support needs, for example, whether to get dressed before breakfast, what time to prepare for bedtime and choice of where and when service users ate their meals. Service users that were able to comment confirmed such choice and control. Service users confirmed that they are able to maintain their contact with friends and relatives as they wish. One service user stated, “There is no limitation on receiving visitors”. Service users confirmed that visitors could use the main lounge or their rooms for privacy. During the inspection the majority of service users were in the lounge with a few service users in the main reception and conservatory. Service users in the lounge appeared to be more physically frail or have significant memory problems resulting in an inability to occupy their own time without staff support. Staff were kind and attentive yet focussed on personal and health care needs of each service user. During the morning the visiting hairdresser was providing this service in the corner of the lounge. (Service users, who were able to, stated they were happy with this arrangement.) One staff member told the inspector that service users enjoyed watching the hairdresser as an activity. However this was not apparent with most service users either asleep or not aware of the hairdresser when asked and this should not be considered to be a meaningful social activity. Staff revealed that they rely on the visiting activities organiser to provide much of the social care. As such, more dependant service users may experience long periods of inactivity and may not be provided with a sufficient range and frequency of relevant activities and stimulation to meet their social and psychological needs. It is a requirement that this area is reviewed and a program of appropriate activities is developed and implemented. Care and senior staff should be involved alongside the activities organiser to monitor the activities program when reviewing social aspects of service users care plans. The manager was aware of the need for this review and had invited the activities organiser to attend the last staff meeting to give the staff team a greater awareness of her role and the importance of social care and activities. Staff commented that this had been very helpful. During the afternoon the activity organiser had arranged a group activity for service users in the dining room. Those in attendance appeared to enjoy this experience and for those not able to directly comment, signs of positive wellbeing such as smiling and engagement were observed. The activities organiser had expressed that some service users with significant memory problems would not participate or engage in activities. It is recommended that Sandridge House Nursing Home DS0000011014.V289924.R01.S.doc Version 5.1 Page 15 some activities are organised in the lounge within the service users immediate environment so as to maximise their opportunity to engage by being able to view what was on offer, as some may find it difficult to understand the explanation given. Service users were complimentary about the food confirming that it is well prepared and there is always a choice from the menu. Three service users did comment that more fresh fruit would be welcomed and this comment was also noted from the minutes of the recent relatives meeting. The chef described a 6-week menu rotation and that preferences can be catered for. In addition the chef now asks all service users their menu choices and demonstrated that she had received useful feedback from service users about the menu. Lunchtime was viewed with service users having a choice of where they preferred to eat their meals. The majority of service users ate in the dining room and staff were seen to be attentive explaining the choices given. Assistance for those service users that required it was given in a discreet manner. In the main lounge a few service users remained and required full assistance with eating their lunch, which was provided in a calm manner. However it was disappointing that staff engaged in a conversation with the hairdresser, which was not inclusive of service users compromising their dignity and respect. One service user ate their meal in the main reception where they prefer to sit. The care assistant presented the main meal and dessert together without explaining the choice but did provide assistance so that the service user had a knife and fork. However due to evident memory problems the service user became confused only eating the dessert. Within 10 minutes another care assistant took the tray away and presented the service user with a cup of tea whist they were still drinking some juice. Staff were unaware that this service user had not eaten their main meal when asked and it was not clear whether this service users dietary needs had been met. It is a requirement that systems are developed to ensure food and drink is presented to service users so as to meet their individual needs and understanding, and they are provided with the correct level of support to eat their meal. Staff must be made fully aware of the dietary intake of service users that are not seated in the main dining room and for those service users their dietary intake must be appropriately recorded. Sandridge House Nursing Home DS0000011014.V289924.R01.S.doc Version 5.1 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. Service users views are taken seriously and acted upon. Staff have received training and with the policies in the home this serves to protect service users from abuse. EVIDENCE: There is a clear and comprehensive complaints policy available within the service users guide. The manager has recently sent out questionnaires to seek views about the quality of the service. Some relatives were unclear of the complaints procedure and the manager has ensured that an up to date copy has been sent out to them. Service users spoken to felt that they could complain if the need arose and felt confident that their views would be taken seriously by the staff team and the “new manager”. Staff spoken to appeared to understand the importance of listening to concerns and reporting them to resolve any issues. The complaints book revealed that there had been five recorded complaints this year. All of which had been investigated and resolved within a timely fashion, in line with the homes complaint policy. Staffs spoken to confirmed that they have received protection of vulnerable adults training and were able to describe the recognition of signs of abuse and how to report any suspicions. Training records reveal most staff have received this training. Service users spoken to confirmed that they feel safe and secure. The home has appropriate policies and procedures to safeguard service users from harm and abuse. Sandridge House Nursing Home DS0000011014.V289924.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24 and 26 Quality in this outcome area is adequate. Work is required to comply with the recent fire safety officer’s enforcement notice. The size and layout of the downstairs toilet should be reviewed to ensure safe moving and handling of service users occurs without damage to the walls. EVIDENCE: The registered manager facilitated a full tour of the building. Downstairs is the communal lounge and dining room that service users were using. Service users that were able to comment stated they were satisfied with these areas and observations revealed that the communal areas were appropriately furnished, clean with a reasonable standard of décor. A few service users enjoy sitting in the entrance/conservatory stating they prefer this area to the main lounge, as the other residents are more “dependant”. It was observed and later confirmed by staff that the service users do not particularly enjoy the company of other service users in this area and as such close the door to the main reception. It was noted that the conservatory was very warm, as with the door closed there was poor ventilation. It is required that there is sufficient ventilation provided in this area to prevent the temperature becoming too hot in the summer months. Sandridge House Nursing Home DS0000011014.V289924.R01.S.doc Version 5.1 Page 18 Service users bedrooms were viewed and seen to be clean, tidy and appropriately furnished. Several service users confirmed that they are very satisfied with their rooms and the “cleaners come everyday to keep it nice”. It was noted that bedroom 22 was very small with little usable floor space. As such the bedroom chair could only be positioned under the sink and the bed is in an unusual position. It is recommended that that the future of this room being used as a bedroom is reviewed particularly as it remains empty. Toilets and bathrooms were also examined and found to be clean. It was noted that both downstairs toilets are narrow and cause problems with manoeuvring of manual handling equipment at times as evidenced in the damage to walls. Staff also commented that manoeuvring of equipment was “difficult at times”, “you just have to cope with it” and “damage to the walls is unavoidable”. A review of this had been recommended in the previous inspection when the adjacent room became available. However this apparently did not occur and is now occupied by another service user. This recommendation should be reviewed to ensure staff and service user safety in regards to moving and handling. The manager has identified a program of repairs and renewals including equipment, which are recorded on a “refurbishment program”, agreed with the group manager. It is evident that the new manager/group manager has purchased and provided more specialist equipment to assist in the care of service users. Staff felt the increase in manual handling equipment was very positive and beneficial contributing to safety and efficiency. An enforcement notice has been served by the Fire Safety Officer in March 2006 detailing the necessary action required to ensure the premises meets the relevant fire safety regulations. The manager confirmed that this work has commenced. It is a requirement that the CSCI are informed on completion of these works. In addition the weekly fire alarm tests identify two bedrooms where the alarm cannot be easily heard. It is a requirement that this issue is rectified. It was noted that the keypad entry system to the main entrance has been removed. The manager explained that the fire safety officer had advised this as the keypad was not linked to the fire system and would not open automatically in the event of a fire. However the door is now locked at all times for security and staff use a key to unlock the door to allow for entry and exit. It is recommended that an alternative to the current system be sought to meet the expectations of visitors and service users. Staff were observed to follow good cross infection procedures throughout the inspection when attending to service users personal care needs and cleaning up a spillage that occurred in the dining room. Housekeeping arrangements in the home are satisfactory with a good standard of cleanliness seen throughout the home, supported by an established housekeeping team. Sandridge House Nursing Home DS0000011014.V289924.R01.S.doc Version 5.1 Page 19 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 and 30 Quality in this outcome area is good. Staff are provided in sufficient numbers to meet the expectations of service users. Staff receive a good range of training and support to meet the personal and healthcare needs of service users. EVIDENCE: During the inspection there were 2 RGN’s and six care assistants during the morning period reducing to five care assistants for the afternoon/evening period. In addition there were sufficient ancillary staff to support the home during the inspection. The rotas for the past 4 weeks and random weeks from earlier this year were viewed. The staffing level has remained fairly constant with a slight increase with six care staff noted on most days. Service users confirmed that they feel that there are enough staff to cater for their needs and that call bells are always answered promptly including during more busy periods. The manager has reviewed the deployment of staff during the busier morning period to ensure a more efficient and better service for service users. Staff spoken to felt that this is an improvement. There are currently seven care staff that have completed NVQ level 2 or above with a further three staff studying towards this qualification expecting to complete this year. This will mean that the home will have achieved over a 50 qualified care staff ratio. The manager is responsible for the recruitment of new staff to the home following the homes recruitment procedures, including ensuring all pre Sandridge House Nursing Home DS0000011014.V289924.R01.S.doc Version 5.1 Page 20 employment checks are undertaken and received to protect service users. The manager has identified in an action plan that a full audit of all staff personnel files will be taking place in the near future to ensure all documentation and checks are in place for staff. Currently one member of staff is working with a POVA First clearance whilst awaiting their full CRB. It was noted that at a recent staff and senior team meeting that procedures for supervision of staff awaiting full disclosures was discussed to ensure service users remain protected. Staff spoken to were able to confirm that they receive a good level of training to support them in their role. This included mandatory topics and more specialist topics in relation to the care of older persons. The nursing staff also commented that update training in clinical skills has been arranged to ensure their clinical skills conform to best practise. The registered manager provided details of training arranged for this year demonstrating that a good range of courses will be provided to the staff team this year. Individual staff training profiles have been recently developed by the manager that detail training undertaken this year. A selection of these confirmed staffs comments. The manager has reviewed the induction training for new staff and discussions with the senior team confirmed they are clear on how to provide a good standard of induction for new staff. A fairly new member of care staff confirmed that they had received a good induction and have been supported by the staff team. Sandridge House Nursing Home DS0000011014.V289924.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38 Quality in this outcome area is good. The new registered manager has had a positive impact to improving the standards of care and outcomes for service users with clear leadership and sense of direction. EVIDENCE: The new manager has been in post for a short time and has registered with the CSCI. The registered manager has responsibility for two homes within the company. The registered manager is qualified and highly experienced. A deputy who has been promoted this year within the home supports the registered manager in the running of the home. Service users and staff were complimentary about the new manager describing her arrival as both positive and beneficial. Service users confirmed that the manager is approachable and friendly making time to speak to them. Staff felt that there has already been significant changes and development, which are Sandridge House Nursing Home DS0000011014.V289924.R01.S.doc Version 5.1 Page 22 understood and are supportive for both service users and staff. Staff confirmed the manager has a clear sense of direction and good leadership skills. The registered manager has a comprehensive action plan for achieving objectives within the home based on re evaluating the quality of operating systems within the home. At the time of the inspection this action plan was seen to have progressed within timescales. The manager has actively sought the opinions of service users and relatives and has recently sent out questionnaires seeking the views as to their experiences of the service. The manager has also recently organised a relatives meeting to gain views and involvement within the home, which will now occur on a regular basis. The minutes from this meeting were examined. This information is being used to measure the success of the homes aims and to plan for future development and quality initiatives. Further reviews of staff practises have already been reviewed in areas of numbers, deployment and support in supervision and regular meetings. Service users developments include the re evaluation of care planning and delivery and the reassessment of service users who have significant memory problems which may lead to changes to the service reflective of identified needs. The manager has had a positive and significant impact in enhancing the quality of the service. The home provides a facility for safe keeping of some service users personal allowances. Two transaction sheets were viewed and there is a clear record of monies received and expenditure for additional items with receipts retained. These had been recently checked and the individual balances were signed by the registered manager to confirm their correctness. The registered manager has recently reviewed the health, safety and welfare of service users and staff within the home. Examples of improved risk assessments for safe working practise were viewed and staff appeared to have an awareness of their existence. Nurses felt that improvements in moving and handling were required and the manager has organised appropriate staff training and provided additional equipment. Individual service users risk assessments are within service users bedrooms detailing the methods and equipment need to ensure safe moving. This was highlighted by staff as a positive development. Staff confirmed that they receive update training in health and safety topics and a selection of training records confirmed this. Sandridge House Nursing Home DS0000011014.V289924.R01.S.doc Version 5.1 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 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 3 2 3 X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X 3 X X 3 Sandridge House Nursing Home DS0000011014.V289924.R01.S.doc Version 5.1 Page 24 Are there any outstanding requirements from the last inspection? No 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 OP4 Regulation 12(1) and 14(1) Requirement The registered persons must complete the review process of service users with significant memory problems to establish those service users with a diagnosis of a dementia. After this review an application to vary the category of registration to include any service users with a dementia must be submitted to the CSCI. The registered manager must provide further instruction and training for staff to prevent any service users dignity, respect and privacy being compromised, specifically in relation to • The approach of staff when attending to service users in their rooms, • Mealtimes, • Ensuring any noise created by night staff in the course of their duty is kept to a minimum and does not disturb any service user. DS0000011014.V289924.R01.S.doc Timescale for action 31/08/06 2. OP10 12(4)(a) 31/07/06 Sandridge House Nursing Home Version 5.1 Page 25 3. OP12 4. OP15 5. OP25 6. OP19 The registered manager must review the range and frequency of activities for service users with a significant memory problem and then implement an appropriate activities program to ensure that such service users social and psychological needs are fully met. 12(1)(a) The registered manager must and 17(2) ensure that systems are developed to ensure food and drink is presented to service users so as to meet their individual needs and abilities, and they are provided with the correct level of support to eat their meal. Mechanisms must be developed to ensure staff monitor and record the dietary intake of service users that are not seated in the main dining room and appropriate action is taken when needed. 23(2)(p) That the registered persons ensure there is sufficient ventilation provided in the conservatory/entrance when the door to the main reception is closed by service users, to prevent excessive temperatures in the summer months. 23(4)(a-c) That the registered persons ensure that the CSCI is notified upon the completion of the works identified in the fire safety officer’s enforcement notice. Steps also needs to be taken to ensure those occupants in rooms 44 and 45 can clearly hear the fire alarm. 16 (2)(n) 31/08/06 15/07/06 15/07/06 31/07/06 Sandridge House Nursing Home DS0000011014.V289924.R01.S.doc Version 5.1 Page 26 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 OP7 Good Practice Recommendations That the registered manager considers involving senior and care staff in the monitoring of service users social care/activities programs, alongside the activities organiser, to evaluate their effectiveness when reviewing the social aspects of care plans. Consideration should be given to also provide group activities in the lounge where service users with significant memory problems are located, to assist them to engage in organised activities. The registered persons consider replacing the lock and key entry system to a more “user friendly” door entry system, which conforms to fire safety requirements. That the provision of adequate toilet facilities on the ground floor are reviewed when the adjacent bedroom becomes vacant to ensure the ease of manoeuvring moving and handling equipment without continuous damage to the walls. That the future use of bedroom 22 is considered due to the small amount of usable floor space and awkward positioning of the furniture. 2. OP12 4. 5. OP19 OP21 6. OP24 Sandridge House Nursing Home DS0000011014.V289924.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA 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. Extracts may not be used or reproduced without the express permission of CSCI Sandridge House Nursing Home DS0000011014.V289924.R01.S.doc Version 5.1 Page 28 - 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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