CARE HOMES FOR OLDER PEOPLE
Sandrock Nursing Home 1-3 Sandrock Road New Brighton Wallasey Wirral CH45 5EG Lead Inspector
Mrs Christine Marshall Unannounced Inspection 3rd December 2005 08:30 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 Sandrock Nursing Home DS0000064921.V270071.R01.S.doc Version 5.0 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. Sandrock Nursing Home DS0000064921.V270071.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Sandrock Nursing Home Address 1-3 Sandrock Road New Brighton Wallasey Wirral CH45 5EG 0151 630 3254 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) Prasur Investments Limited Karen Dorothy Lea Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Sandrock Nursing Home DS0000064921.V270071.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 05/11/04 Brief Description of the Service: Sandrock Nursing Home provides general nursing care for up to 28 people, and is situated in a quiet area of New Brighton, a popular seaside town. The home offers single and twin bedded rooms on all three floors, and has assisted bathing and toileting facilities with call alarm in all areas. The home has a large lounge, divided into two main areas, a dining room and a conservatory, which opens out onto a patio area in the back garden. Sandrock benefits from being close to all amenities and is a few minutes walk from local bus stops. The registered providers are Prasur Investments Ltd and the proposed registered manager is Karen Lea. Sandrock Nursing Home DS0000064921.V270071.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the first of two unannounced inspection visits, scheduled from 1st April 2005 to 31st March 2006. Eighteen standards were assessed during this visit. The inspector will refer to the people living at Sandrock as residents. This unannounced inspection took place from early morning to after lunch. The inspector undertook a full tour of the home, including bedrooms, lounge and dining areas and bathrooms. All areas were clean and hygienic. The inspector looked at the policies, procedures and administration records for the management of the home, and comments on this are to be found in the body of this report. The inspector spoke with a small number of the residents, and a visiting relative. Each resident seemed to be well cared for and said that they were happy with the care at the home. The visiting relative readily praised the home and the staff for their care. The owners, nurses and care staff spoke with the inspector and showed that there is a very good team approach to the care given to the residents. The inspector noted that the registration certificate did not reflect the category of one of the residents at the home and this has been passed on to the Commission’s regulation manager to investigate. What the service does well:
The home has a very quiet and friendly ambiance. The owners, manager and staff are very friendly and welcoming to visitors and relatives of the residents. Residents appeared to be warm, nicely dressed and contented when approached by the inspector. There is a portable nurse-call unit in each room so that residents can have them by their side wherever they might be sitting or lying. Sandrock Nursing Home DS0000064921.V270071.R01.S.doc Version 5.0 Page 6 The registered provider has a definite plan of refurbishment for the home. What has improved since the last inspection? What they could do better:
Care plans should be signed by the residents or their relatives to make sure that the agreed and right care is being given. Bathrooms are in need of refurbishment and redecoration. The base of the bath hoist in one bathroom is chipped and rusty and in need of repair. Carpets in the lounge are rather grubby and in need of a thorough cleaning. The registered provider told the inspector that there were plans to replace this carpet. Staff handbook should be developed so that nurses and carers can be made aware of the home’s policies and procedures. A copy of the General Social care Council’s Code of Conduct for Carers should be given to each carer so that they are aware of the guidelines for caring and ensuring quality care for older people. General induction pack/programme must be developed: Staff must be given basic training in health, safety and care practises so that they are confident and competent in their duties. Training programmes must be developed. Staff must be given full training in basic care, moving and handling, health and safety, food hygiene and infection control; this will then promote and maintain the safety and welfare of the residents living at Sandrock. Sandrock Nursing Home DS0000064921.V270071.R01.S.doc Version 5.0 Page 7 Not all of the staff have undertaken abuse awareness training. This must be addressed to make sure that the people living at the home are protected and supported. The manager must be allocated sufficient supernumerary hours so that she can fulfil her duties as registered manager of the home: These duties include recruitment, training and supervision of staff. Supervision programmes must be developed so that staff are monitored and supported in their work. Recruitment files must contain records according to Schedule 2 of the care Homes Regulations 2001 (amended 2003). This schedule includes proof of identity (photograph), written references, health declarations confirming that they are fit both mentally and physically and Criminal records Bureau (CRB) checks. If a robust recruitment policy is not followed then the residents may be at risk of abuse. Criminal records Bureau (CRB) checks have not always been obtained before people have been employed at the home; these must be completed before any member of staff commences work at the home. Gas safety certificate must be obtained to ensure that the home is safe for the people who live there. Hairdressing arrangements should be reviewed because currently the hairdresser users a resident’s room; this might be encroaching on the privacy of that resident. 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. Sandrock Nursing Home DS0000064921.V270071.R01.S.doc Version 5.0 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 Sandrock Nursing Home DS0000064921.V270071.R01.S.doc Version 5.0 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 Pre-admission assessments are undertaken, which means that residents will receive the care that they need when they enter the home. EVIDENCE: Three resident’s files were looked at and each contained a pre-admission assessment. These included physical, mental, social and nursing aspects of care and were completed in a satisfactory way. Individual personal assessments are done before any person is admitted to the home, so that a clear picture of the care that is needed by each individual is prepared. Due to varying levels of confusion, residents were unable to confirm that they had undergone a pre-admission assessment. Sandrock Nursing Home DS0000064921.V270071.R01.S.doc Version 5.0 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, 9 & 10 Residents’ health care needs are met through planned care that is recorded and reviewed regularly. EVIDENCE: Care plans are written records of the care that are given to each person that lives at the home and the inspector looked at three; each of these plans was informative and gave a clear picture of the care that was being given. Each had been regularly reviewed to make sure that the right care was being given. The inspector advised the manager that residents or their relatives or representatives should sign the plans of care to make sure that the right care is being given. Medication systems are safe and inspection of the Medication Administration Records (MAR) sheets showed that all tablets and medicines that are given are recorded properly.
Sandrock Nursing Home DS0000064921.V270071.R01.S.doc Version 5.0 Page 11 Controlled drugs such as Temazepam (sleeping tablets) are stored according to the Misuse of Drugs Act guidelines. The medication fridge and room temperature is recorded daily to make sure that eye drops and creams are stored according to the manufacturers instructions. The inspector observed that the residents’ privacy and dignity was maintained by the staff, however it was noted that the hairdresser uses one resident’s room as a salon when she visits the home. The inspector advised that this be reviewed as it may encroach on that resident’s right to privacy. Sandrock Nursing Home DS0000064921.V270071.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): X No judgement has been made. EVIDENCE: No standards have been assessed on this visit. Sandrock Nursing Home DS0000064921.V270071.R01.S.doc Version 5.0 Page 13 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): 18 Residents must be protected from abuse and training programmes to promote this must be developed. EVIDENCE: The inspector noted that not all of the staff have undertaken abuse awareness training. This must be addressed to make sure that the people living at the home are protected and supported. Sandrock Nursing Home DS0000064921.V270071.R01.S.doc Version 5.0 Page 14 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, 23, 24, 25 & 26 Residents are provided with clean and homely surroundings and bedrooms are personalised and comfortable; this means that people feel at home with their photographs and belongings around them. EVIDENCE: Bathroom 1 needs to be fully refurbished; the bathing hoist base is rusted and needs repainting. Bathroom M1 is not used for bathing residents; it is currently being used as a storeroom. Bathroom T1 is available for resident bathing, but has no bathing aids and is not used very often. All bathrooms would be improved if a more homely aspect was provided, for example curtains or blinds to the windows. The inspector looked at all lounge areas, bedrooms, bathrooms and toilets and found that all areas were mostly clean and hygienic. Bedrooms are personalised and furnished to a satisfactory standard.
Sandrock Nursing Home DS0000064921.V270071.R01.S.doc Version 5.0 Page 15 The lounge is quite congested with residents who both sit and eat in their chairs; there is a large conservatory/dining area that could be used to expand the room for each resident. The registered provider told the inspector that plans to do this were in place, as were plans to replace the lounge carpet, which is rather grubby and in need of a clean. Generally the home is kept clean and hygienic. Sandrock Nursing Home DS0000064921.V270071.R01.S.doc Version 5.0 Page 16 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, 29 & 30 A robust recruitment policy needs to be followed and residents need to be supported by trained and competent care staff. EVIDENCE: The list of staff on duty showed that there are satisfactory levels of carers and domestic staff on duty at the home. The inspector spoke to carers and the kitchen staff, who were very helpful and showed that there is a good mix of people in place. Inspection of the staff recruitment files showed that there are staff working at the home who do not have two written references and who have not had a Criminal Records Bureau (CRB) check. The application form needs to be reviewed to incorporate a health declaration. A photograph as proof of identity must be in each staff member’s file. Inspection of the staff training and supervision files showed that the manager needs to develop training and supervision programmes and put this information onto a graph that shows at a glance which staff have had training and in what areas, for example food hygiene or first aid: This makes sure that the staff have the training and supervision that they need to be able to take care of the residents properly. Sandrock Nursing Home DS0000064921.V270071.R01.S.doc Version 5.0 Page 17 Discussions with the manager showed that she is not allocated enough time on her rota to undertake her duties as a manager because she working as the registered nurse on duty at the home. The inspector identified that because of this, the staff training and supervision was not developed, as it should be. The registered provider discussed this with the inspector and agreed to review the manager’s supernumerary hours so that she could attend to management duties. Sandrock Nursing Home DS0000064921.V270071.R01.S.doc Version 5.0 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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, 36 & 38 The registered providers must make sure that the best interests of the residents are protected and that there must be regular and safety checks that focus on the best interests of the residents. EVIDENCE: The registered manager is not able to fulfil her duties in respect of staff induction, training and supervision because she is allocated only 6 hours a week supernumerary from nursing duties. Staff supervision programmes are not in place and nurses and carers are not having the monitoring and support that they need to make sure there are good care practises at the home. The home’s gas safety certificate was not current and must be addressed as a matter or priority.
Sandrock Nursing Home DS0000064921.V270071.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 2 3 3 3 3 3 2 3 STAFFING Standard No Score 27 X 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X 2 X 2 Sandrock Nursing Home DS0000064921.V270071.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP18 Regulation 18 Requirement All staff must have abuse awareness training. A programme must be developed to achieve this. The lounge carpet must be cleaned or replaced. Bathrooms must be refurbished to standard that promotes health and hygiene. A plan for the achievement of this must be developed. All staff files must contain the records as specified in Schedule 2 of the Care Homes regulations amended 2003 The registered manager must be allocated enough supernumerary hours to ensure that the staff are given induction, training and supervision programmes. All staff must have regular supervision. A plan for the achievement of this must be developed. All health and safety certificates must be current. Timescale for action 31/01/06 2 3 OP19 OP21 23 23 31/01/06 31/01/06 4 OP29 17 Schedule 2 10 31/01/06 4 OP30 31/01/06 5 OP36 18 31/01/06 6 OP38 13 31/12/05 Sandrock Nursing Home DS0000064921.V270071.R01.S.doc Version 5.0 Page 21 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 OP7 OP10 Good Practice Recommendations Care plans should be signed by the resident, or their relatives or representatives. Hairdressing facilities should be provided rather than using a resident’s bedroom. Sandrock Nursing Home DS0000064921.V270071.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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