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Inspection on 26/02/06 for Sandringham Care Home with Nursing

Also see our care home review for Sandringham Care Home with Nursing for more information

This inspection was carried out on 26th February 2006.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents said they enjoyed living at the home, and that the staff was kind and helpful. The staff were motivated and enthusiastic they receive regular, appropriate training and support in caring for older people. Staff were seen caring for residents in a supportive and discrete way. There was a friendly, happy and busy atmosphere in the home. The home was clean and tidy with no unpleasant odours. Staff said they enjoyed working at the home and it was evident that the staff were working hard as a team to provide care and support for the people who live at the home. A recently appointed activities organiser has been a real success, and residents said there was always `plenty of things organised` if they wanted to join in. The home was lovely and clean and comfortable, one service users said `it`s a pleasure to live in such a nice place`

What has improved since the last inspection?

Since the last inspection an activities organiser has been appointed. She divides her time between the units. Sometimes group activities are organised and on other occasions individual sessions are organised. All trained staff have been reminded about the safe administration of service users medication. The manager has introduced a quality assurance questionnaire to gain service users and relatives views in all aspects of the care home.

What the care home could do better:

Whilst every resident at the home has a care plan, the recording and review of the plans needs to be better. This is to make sure that identified care needs are met. Better recording is also needed in care plans about risk assessments, and how risk is managed. The deployment of staff needs to be reviewed to make sure that there is enough staff to meet the assessed needs of service users. The manager needs to review the amount of accidents that have occurred over the past month and look at a strategy for reducing this number.

CARE HOMES FOR OLDER PEOPLE Sandringham Care Home with Nursing Sandringham Care Home with Nursing Escomb Road Bishop Auckland Co Durham DL14 6HT Lead Inspector Bridgit Stockton Unannounced Inspection 26th February 2006 09:30 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 Care Home with Nursing DS0000063946.V275546.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 Care Home with Nursing DS0000063946.V275546.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Sandringham Care Home with Nursing Address Sandringham Care Home with Nursing Escomb Road Bishop Auckland Co Durham DL14 6HT 01388 660930 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) Ladhar Group Homes Joan Purcell Care Home 90 Category(ies) of Dementia (31), Dementia - over 65 years of age registration, with number (35), Old age, not falling within any other of places category (24) Sandringham Care Home with Nursing DS0000063946.V275546.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate named individuals as set out in the letters to the registered person dated 14 June, 29 July & 8 August 2005 which establishes the basis on which the individuals` needs will be met by the home. Where necessary the homes statement of purpose shall reflect any changes in service provision required for this arrangement. This condition may not apply to anyone else, other than the named individuals who fall outside the registered category. 10th August 2005 Date of last inspection Brief Description of the Service: Sandringham Care home is a care home with Nursing including Dementia opened in May 2005 and provides accommodation for 90 older persons. The building is purpose built and provides accommodation on three floors. The home is located near to the general hospital and town centre. All service areas are located on the ground floor. The home provides safe accessible outdoor areas with seating for service users to enjoy. Sandringham Care Home with Nursing DS0000063946.V275546.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over a period of 7 hours on the 28th February 2006. The home did not know the inspection was going to take place. The plan for the inspection was to check whether the home had implemented the requirements and recommendations made at the previous inspection; to talk with the residents about living in the home; to meet with care staff and the home’s management team; and to look at records. The home has just opened in May of 2005 and is still developing and evolving. There has been a gradual intake of service users since May 2005, and the home has now opened the middle floor for service users. This is the final stage in the opening of the home. What the service does well: What has improved since the last inspection? Since the last inspection an activities organiser has been appointed. She divides her time between the units. Sometimes group activities are organised and on other occasions individual sessions are organised. All trained staff have been reminded about the safe administration of service users medication. The manager has introduced a quality assurance questionnaire to gain service users and relatives views in all aspects of the care home. Sandringham Care Home with Nursing DS0000063946.V275546.R01.S.doc Version 5.1 Page 6 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 Care Home with Nursing DS0000063946.V275546.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 Care Home with Nursing DS0000063946.V275546.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): None of these outcomes were assessed on this occasion EVIDENCE: Sandringham Care Home with Nursing DS0000063946.V275546.R01.S.doc Version 5.1 Page 9 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 Whilst all service users had a care plan, in some instances they did not give an accurate account of the care required to meet all of the service users needs. EVIDENCE: Four care plans of existing service users at the home were examined, in addition as a result of a complaint prior to the inspection, a further three others were also inspected. Staff had clearly put a lot of work into developing these, and some good information was available. Staff were updating and recording in the contact sheet on a regular basis. However, there was no reference in any of the files inspected about the social and psychological needs of service users. This was of particular concern where service users suffer from dementia. The care plans in place, which gave details about pressure sore treatment and intervention, were lacking in information. Upon reading the plans it was unclear as to what type of dressings were currently being used and how frequently the dressings were being renewed. Some risk assessments were in place but had not been reviewed when the service users needs changed; in particular when service users had suffered Sandringham Care Home with Nursing DS0000063946.V275546.R01.S.doc Version 5.1 Page 10 several falls. The manager said that service users were referred to the “falls assessment co-ordinator”, but the referrals took time and when equipment did arrive such as hip protectors and helmets service users would not wear them. Entries made by trained nursing staff within the daily statements sometimes used negative language, such as ‘ told you will have to wait, we are busy with poorly people’. The manager said that this service user had started to become verbally challenging to staff, however such recording demonstrates a lack of respect and understanding for service users, and read as if the needs of people with challenging behaviour were not fully understood or considered when providing care. The manager must address this without delay. All staff who are designated to administer medication had been issued a reminder about the homes medication policy and procedure, this was following the previous inspection of the home and a complaint surrounding the bad practice of medication administration and recording. Archived medication administration records showed that they were completed properly and staff files contained a record that during supervision these issues surrounding medication administration had been discussed. Sandringham Care Home with Nursing DS0000063946.V275546.R01.S.doc Version 5.1 Page 11 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 Service users are offered a range of organised recreational activities, which helps to keep them active and prevent boredom. EVIDENCE: Residents confirmed that they could have as many visitors as they like and at any time they chose. The visitors are made to feel welcome during their visits and there were several visitors coming and going during the inspection. An activities organiser has been appointed to the home and a variety of activities are taking place such as board games, planting seeds and card games. During the inspection some service users were gathered together in one of the lounges enjoying a game of beetle. One service user said she enjoyed sitting in her room and listening to music, whilst another said ‘I really don’t like to mix with others; there is generally always something to do. The staff ask if I want to join in, I never do, you don’t have to do anything you don’t want’ Sandringham Care Home with Nursing DS0000063946.V275546.R01.S.doc Version 5.1 Page 12 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): The residents concerns are dealt with and their interests are safeguarded. EVIDENCE: The home has a complaints policy with time-scales for the resolution of these displayed in all of the service users bedrooms. It is also included in the statement of purpose. The residents and staff confirmed their knowledge of these procedures and felt confident that their concerns were dealt with in a speedy and professional manner. The manager needs to make sure that accurate records are kept of all complaints about the home including what action has been taken to investigate and resolve such complaints; in some instances this was not being done. Staff training has taken place in the protection of vulnerable adults in abuse. Staff recruitment procedures were adequate and staff were employed and deployed following appropriate CRB and POVA checks. The manager and staff team were clear and confident in the protection of vulnerable adult procedures. Sandringham Care Home with Nursing DS0000063946.V275546.R01.S.doc Version 5.1 Page 13 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, 20,24,25,26 Service users can be assured that the home is a clean and comfortable place to live. EVIDENCE: Some service users bedrooms and all the communal areas and bathrooms were inspected. These were all nice and clean and fresh. One service users said ‘ this place is always spotless, my room get cleaned everyday’ The bedrooms and communal areas were comfortably furnished, and all the dining rooms were bright and airy and the tables set with fresh table linen and looked inviting. The staff room at the home is non smoking so the staff who do smoke go outside the main entrance to smoke, consequently the front entrance is littered with cigarette ends, in addition a service users bedroom window that was directly above the entrance had been opened, on entering the room it smelt of smoke, this is not acceptable, and the manager must review this. Sandringham Care Home with Nursing DS0000063946.V275546.R01.S.doc Version 5.1 Page 14 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): The recruitment and training of staff is good which contributes to the ongoing safety of service users. EVIDENCE: Staff are employed in sufficient numbers to meet the current service user group, however the building is very large and spread out, on one floor care staff were sat in the lounge area with service users for close supervision, this is good practice, however this was not the case on the other floors. In addition when the inspector arrived at the home although a member of staff opened the door and allowed entry, no identification was asked for, and the inspector was allowed to wander the building unchallenged. The manager needs to consider how staff are deployed to ensure the supervision and safety of service users. One service users said ‘if I need help I generally always get it, I would like them to talk to me more, but I don’t like to bother them’ another said ‘ I really like living here, the staff are always around if I need help’ There is a commitment to having a fully trained workforce. 14 care staff out of 27 are trained to NVQ2 or above in care. Staff confirmed that Sandringham Care Home is ‘a good place to work,’ and that they are offered lots of training and given the opportunity to attend external courses. Two of the staff that were on duty during the inspection were from an agency. They said that they had been given good information on the service users who they were looking after, and that they had been given a ‘ mini induction’ to the home on the first shift they had worked, this included fire safety and infection control. Sandringham Care Home with Nursing DS0000063946.V275546.R01.S.doc Version 5.1 Page 15 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): EVIDENCE: The home does not manage any service users finances. A good system of quality assurance had been introduced which included service user and relative feedback to inform the development process. The commission has not received any records of visits undertaken by the responsible individual for the home. Health and safety checks were being conducted as required, bed rails were being checked regularly and were found to be safe. 58 accidents to service users and staff had been recorded between the dates of 8/1/06 and 10/2/06. this is excessive. The manager said that she did look at all of the accident records, however an audit of accidents as yet had not taken Sandringham Care Home with Nursing DS0000063946.V275546.R01.S.doc Version 5.1 Page 16 place. This would be good practice in trying to put in place a strategy to reduce the amount of accidents happening. Sandringham Care Home with Nursing DS0000063946.V275546.R01.S.doc Version 5.1 Page 17 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X 2 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 X X 3 X 3 X X 3 Sandringham Care Home with Nursing DS0000063946.V275546.R01.S.doc Version 5.1 Page 18 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. Standard OP7 Regulation 14 &15 Requirement Timescale for action 31/05/06 2. OP8 15 3 OP33 26 4 OP10 12 The manager must review all care plans to ensure that the plan is up to date with the care that service users are receiving. In addition risk assessments and strategies need to be documented clearly when an area of risk has been identified that may effect the safety and well being of a service user. The manager must ensure that a 31/05/06 Care plans contain more in depth information with regard to pressure sore assessment and treatment. The responsible individual must 31/03/06 carry out audit visits to the home and supply a record of such visits to the Commission Service users must be treated 28/02/06 with respect, and the daily records written in such a way which reflects that this is the case Sandringham Care Home with Nursing DS0000063946.V275546.R01.S.doc Version 5.1 Page 19 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 2 Refer to Standard OP24 OP16 Good Practice Recommendations It is recommended that staff are allocated another area away from the main entrance of the home if they wish to smoke. It is recommended that the manager completes accurate records of all complaints about the home including what action has been taken to investigate and resolve such complaints It is recommended that the manager reviews the deployment of staff at the home in order that service users are safe It is recommended that the manager audits all accidents that happen in order that a strategy can be drawn up to reduce the number of accidents 3 4 OP273 OP38 Sandringham Care Home with Nursing DS0000063946.V275546.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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