Inspection on 07/11/06 for Sandringham

This inspection was carried out on 7th November 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

Sandringham 21/10/08

Sandringham 03/02/06

Sandringham 19/09/05

Sandringham 07/12/04

Sandringham 03/06/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Sandringham 5-7 Westcliff Avenue Westcliff On Sea Essex SS0 7QR Lead Inspector Sarah Buckle Unannounced Inspection 12:00 7 November 2006 th 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 Sandringham DS0000015471.V291895.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. Sandringham DS0000015471.V291895.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Sandringham Address 5-7 Westcliff Avenue Westcliff On Sea Essex SS0 7QR 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) 01702 352911 01702 430650 Darby and Joan Organisation Mrs Anna Searle Care Home 20 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (20) of places Sandringham DS0000015471.V291895.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd February 2006 Brief Description of the Service: Sandringham provides accommodation for up to twenty older people. In addition the home is registered to take those people who have a formal diagnosis of dementia. The home is situated close to the towns of Southend, Westcliff and Leigh and a short distance from the seafront. The homes facilities include a lounge, dining area, conservatory/quiet area and twenty single bedrooms with en-suite facilities. The home has a passenger lift, which provides access to all floors. The home offers a small rear garden and there is limited off street parking to the front of the premises. The current scale of charges at Sandringham range from £369.32 to £476.00 per week. This information was made available to the Commission in the preinspection information, which was provided in June 2006. Additional charges are made for the chiropodist, who costs £6.00 and for the hairdresser, which costs £5.00. Other items such as newspapers, transport and toiletries are available at cost price. Sandringham DS0000015471.V291895.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced site visit, which forms part of the overall inspection. The site visit was undertaken by Sarah Buckle and was completed in four hours. At the last key inspection Sandringham did not receive any requirements. Prior to the site visit the Sandringham completed a pre-inspection questionnaire, which provided information about the home. During the site visit a tour of the premises was undertaken, records and documents were examined, and residents were observed within their home environment. Two members of staff were spoken with, as was one resident. All of the information gathered in relation to this inspection will be reflected within the report. What the service does well: Pre admission processes within the home are thorough. Residents’ needs are clearly identified. Care plans sampled were well organised and reflected the abilities and the support needs of the residents. These were regularly updated. Health and welfare needs were well documented. Activities within the home are undertaken by the care staff on a twice daily basis. Family involvement is positively encouraged within the home. The food provided within Sandringham is appealing and demonstrates a healthy diet. The dining room surroundings are pleasant with all tables laid appropriately. There have been no complaints since the last inspection. One newly employed staff member was clearly aware of the POVA procedure. Sandringham has a relaxed and homely atmosphere. It is clean and tidy. All residents have the choice to personalise their bedrooms. The recruitment procedure within the home is well managed. Each staff member has an individual training file and this demonstrated that mandatory training was undertaken and updated, and that some specialist training was completed. Sandringham DS0000015471.V291895.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Sandringham DS0000015471.V291895.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sandringham DS0000015471.V291895.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Pre-admission assessments of individuals needs were thorough. Resident’s and their representatives have adequate information to make an assessment about the home. EVIDENCE: The pre-admission information was examined for the newest resident to the home. It was positive to note that this was comprehensive and included their personal details, next of kin, information about their partner, legal instructions, ability to communicate, allergies, medication on admission, specialist diet, GP, social worker, distinctive features, height, weight, social contacts etc. The resident’s date of admission was recorded and the registered manager had completed and signed the information. A COM5 from social services was included in the care plan. This also contained detailed information and was dated 27/07/06. A COM7 was also included dated 11/09/06. Sandringham DS0000015471.V291895.R01.S.doc Version 5.1 Page 9 A staff member spoken with stated that the resident and a relative had visited the home prior to admittance and had met with staff and other residents. They also viewed the room to be occupied, the communal areas and were invited to take a meal. The resident’s file contained a record of this introductory visit. Sandringham DS0000015471.V291895.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. This judgement has been made using available evidence including a visit to this service. The needs of residents were clearly identified in their care plans. The health care needs of residents were adequately met and well recorded. The management of medication was not adequate. Residents were appropriately treated with respect and dignity. EVIDENCE: Two care plans were sampled during the inspection. One of these was for the newest admitted resident. It was positive to note that this was a comprehensive document, which clearly identified their abilities and areas of required support i.e. in the section concerned with sleeping routines it states “Cup of tea at biscuits at 6am then staff allow (the resident) to rise at his own pace, 8am staff assist”. Changes in need were also recorded within the document i.e. under observations on 08/08/06 it states “Anxious and constipated. Quite happy to reside in residential care”, and on 18/10/06 it Sandringham DS0000015471.V291895.R01.S.doc Version 5.1 Page 11 states “Constipation has subsided due to regular fruit and change of medication”. All of the sections within the care plan were completed and demonstrated a thorough knowledge of the resident. Doctor’s notes were recorded and demonstrated that the residents’ healthcare needs were being attended to. Risk assessments in relation to pressure sores and manual handling were completed appropriately. A formal dependency profile was also completed and it was positive to note that this was reviewed on a monthly basis. Individual risk assessments were completed and showed that independence and choice were encouraged even if there was a degree of risk i.e. one risk assessment in relation to choking stated that the resident was at low risk, but that they liked to eat dinner in the room. The actions to be taken to minimise this risk were clear and instructive. For other risks, triggers were identified and action to be taken to minimise risk recorded appropriately. One staff member spoken with had awareness of the resident’s needs and the actions taken in relation to any changes in these. The second care plan sampled showed a consistent approach and was equally thorough and detailed. Sandringham uses the Boots monitored dosage medication system (blister packs). The medication is stored in a trolley, a medication cupboard and a medication fridge. The fridge temperature was checked and recorded on a daily basis. In the main part the temperature was within the specified range. On two occasions in September it was recorded as being 7 degrees, which is 1 degree too high. However, the fridge was turned up to deal with this. Ten residents profiles were examined within the medication administration record file. Of these, two had a number of omissions. One resident had ‘take daily’ calcium carbonate medication, which was not signed as given on either the 30/10/06 or 31/10/06. There was a further omission of Dipyridamole with aspirin at 08:30 on 06/11/06 and an omission of Atorvastatin 20mg at 20:30 on 02/11/06. A second resident had one omission on their medication administration record on 30/10/06. However, it was positive to note that a resident in receipt of Warfarin had printed information placed onto the medication profile indicating the level of the medication required. The medication trolley was secured to the wall and locked. The controlled drugs within the home are stored appropriately. One resident was currently taking a controlled drug. The amount of medication available Sandringham DS0000015471.V291895.R01.S.doc Version 5.1 Page 12 did tally with that recorded in the register, however, on 04/11/06 the drug was administered but there was no witness signature. Residents were observed interacting with staff within the home in a relaxed and familiar manner. One resident spoken with stated that she could not fault the care that she receives within the home and that the staff are all very good. Sandringham DS0000015471.V291895.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 good. This judgement has been made using available evidence including a visit to this service. Opportunities are available on a regular basis for residents to participate within an activity programme. Residents are enabled to access the local community whenever possible and family links are positively encouraged. Meals are provided in a pleasant environment and residents receive a wholesome, appealing diet. EVIDENCE: Sandringham does not employ a designated activities co-ordinator. Instead, the staff team undertake activities with the residents every morning and afternoon. During the site visit a sing-a-long was in progress in one of the lounges. Once a week someone visits the home to offer an exercise class to residents and during the week they are involved in activities such as using musical instruments and drawing. One staff member spoken with stated that entertainers visit the home a few times each year. She also stated that families are involved within the home and that a recent benefit dance was well attended and raised over £500.00. Sandringham DS0000015471.V291895.R01.S.doc Version 5.1 Page 14 In the summer, residents are taken to the Cliffs Pavilion for a cup of tea. A lot of relatives also take residents out. For example, one resident has a family member who takes him to all of his doctor and hospital appointments. One resident spoken with said that her family visit her each weekend and that she has a telephone in her room so that she can contact them in the evenings. One meal was observed and sampled during the course of the site visit. The dining room was pleasantly laid for lunch and the food provided a wellbalanced, nutritious diet and was of a good quality. Residents were observed to be comfortable and to be appropriately assisted when required. They also had the choice of whether to eat in the dining room or in their own room. Sandringham DS0000015471.V291895.R01.S.doc Version 5.1 Page 15 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. This judgement has been made using available evidence including a visit to this service. Complaints within Sandringham are well managed. Residents are adequately protected from potential harm and abuse. EVIDENCE: There have been no complaints received since the last inspection. One staff member spoken with who had worked in the home for a short while was aware of the POVA procedure and explained clearly what to do if an incident of abuse were suspected or alleged. They were booked to attend adult protection training in December 2006. It was positive to note that out of twenty staff training profiles that were examined all bar one of these demonstrated current POVA training. Sandringham DS0000015471.V291895.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. The environment within Sandringham is safe and well maintained. The home is clean and hygienic. EVIDENCE: A tour of the premises was undertaken. In the main part Sandringham was observed to be comfortable, homely and maintained to a good standard. All of the resident’s bedrooms that were seen were personalised to their individual tastes with objects and artefacts of their choice. One toilet on the ground floor was in need of some refurbishment as there was wheelchair damage to the door and the wall. There were wheelchairs and other items inappropriately stored in a first floor bathroom. This bathroom had a clinical atmosphere and would benefit from some adornments to make it more appealing to residents. Sandringham DS0000015471.V291895.R01.S.doc Version 5.1 Page 17 The home was clean and hygienic on the day of the site visit and there were no apparent odours. Sandringham DS0000015471.V291895.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of residents are adequately met by the number of staff on duty. The recruitment process within the home is robust. Staff members receive appropriate mandatory training and this is updated accordingly. EVIDENCE: Four weeks worth of staff rotas were examined during the inspection and these demonstrated that staffing levels were consistent within the home. During the site visit, the staff on duty appropriately attended to the needs of resident’s. Pre-inspection information received by the Commission stated that seven of the current staff team have NVQ level 2 or above. This is just under the specified 50 , however, the information was received in June 2006 and during the site visit a staff member explained that two further staff have been registered for the NVQ3 and were awaiting a visit from their assessor. The staff recruitment file was examined for a recently employed staff member and it was positive to note that this contained all of the required information. Staff training records were examined and demonstrated that the home has a positive approach to ensuring staff members undertake mandatory training Sandringham DS0000015471.V291895.R01.S.doc Version 5.1 Page 19 and updates. Staff files had evidence of training in POVA, manual handling, food hygiene, first aid, fire training, COSHH and health and safety. Some staff members also had specialist training, including dementia, palliative care, stoma care and nutritional needs of the elderly. It was positive to note that a lot of the care staff had undertaken dementia training, however, as the home is registered for 20 residents in the dementia category, it would be good practice for all staff members to be trained in dementia care. The registered manager had undertaken manager’s dementia training. One staff member spoken with stated that all of the staff members that administer medication have completed medication training. Staff training records demonstrated that some staff had Boots medication training and that others had completed a course at Chelmsford College. One staff member spoken with stated that she had only worked at the home for a short while, however she had already completed training in key areas and was booked to attend more. Sandringham DS0000015471.V291895.R01.S.doc Version 5.1 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sandringham is a well run and managed home. The financial interests of residents are adequately safeguarded. The health and safety of residents and staff is protected. EVIDENCE: The registered manager has completed her NVQ4 in care and her registered managers award. Two staff members spoken with stated that they find the registered manager both supportive and approachable. Evidence that the home is well managed is demonstrated in this report and in the fact that all outcomes for residents are rated as good. Sandringham DS0000015471.V291895.R01.S.doc Version 5.1 Page 21 One staff member spoken with stated that quality assurance is carried out within the home. Previous inspection reports also demonstrate that this is the case, however, the registered manager was not available during the site visit and the staff member on duty was unable to find the documents relating to this. Resident’s monies are managed in the main part by the head office. A staff member stated that relatives bring in pocket money for the residents and this is put in their pocket money tin. Once a week head office staff come to the home and tally the money. They then take the money and put it into the residents account. Various health and safety certificates were examined and these were seen to be up to date. Sandringham DS0000015471.V291895.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Sandringham DS0000015471.V291895.R01.S.doc Version 5.1 Page 23 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 OP9 Regulation 13(2) Requirement The registered person must ensure that arrangements are made for the safekeeping, safe administration and disposal of medication. This is in relation to a number of omissions in relation to medication on two residents MAR sheets and to an administered controlled drug not being witnessed as given on one occasion. Timescale for action 31/01/07 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 OP19 Good Practice Recommendations The downstairs toilet would benefit from refurbishment where wheelchairs have damaged the wall and door. The inappropriately stored items in the upstairs bathroom should be removed, and the room would benefit from some form of refurbishment to make it less clinical. DS0000015471.V291895.R01.S.doc Version 5.1 Page 24 Sandringham 2. OP30 All of the care staff within the home would benefit from undertaking dementia training. Sandringham DS0000015471.V291895.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 Sandringham DS0000015471.V291895.R01.S.doc Version 5.1 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!