Inspection on 28/05/08 for Sandylee House

This inspection was carried out on 28th May 2008.

CSCI found this care home to be providing an Poor service.

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

Sandylee House 04/11/09

Sandylee House 20/09/06

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Sandylee House 54 Stafford Road Uttoxeter ST14 8DN Lead Inspector Dawn Dillion Key Unannounced Inspection 28th May 2008 10:00 Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 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 Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 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 Adults 18-65. 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. Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sandylee House Address 54 Stafford Road Uttoxeter ST14 8DN 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) 01889 567360 F/P 01889 567360 Dunstall Enterprises Limited Mr John Matthew Wade Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th September 2006 Brief Description of the Service: Sandylee is a care home for six people with learning disabilities and complex needs. The home was registered in April 2006 and is a modern detached building on the outskirts of Uttoxeter. The location of the home enables easy access to public transport. The centre of Uttoxeter is within walking distance where there is a range of facilities for leisure and shopping. The home has three floors; on the ground floor, there is the shared living accommodation. There is a lounge, a large kitchen with dining facilities, games room with a full size Pool table and a large conservatory and utility room. The garden area has decking and a range of garden furniture. There is a farm to the rear and neighbours do not overlook the property. There is a driveway to the front and side of the property for six cars, and a double garage with plumbing and electrics fitted. There are two large en-suite bedrooms on the first floor, and two rooms have the use of a shared bathroom. On the second floor, there are two large ensuite rooms. Staffing is provided on a 24-hour basis to ensure the total supervision and support of people living in the home. The fees charged for service provided at Sandylee is from £1,000.00p – £2,000.00p per week. This information applied at the time of our inspection the reader should contact the service for more up-to-date information. Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 Star. This means the people who use this service experience poor quality outcomes. The unannounced key inspection of Sandylee was conducted within nine hours. The emphasis of the inspection is to look at the outcomes with regards to people’s lifestyle and practices and procedures that promote equality and diversity. The inspection methodologies that were used to establish the quality of care provided and the effectiveness of the management of the home entailed the examination of the records, relating to the homes policies and procedures. During the inspection, discussions took place with two people that accessed the service and four staff members, to gather an overview of the quality of the service provided by the home. Information contained within the home’s Annual Quality Assurance Assessment, (AQAA). The AQAA is a self-assessment tool that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. Questionnaires received from people who use the service are also included within the report. A tour of the property was undertaken, to ensure that the environment and systems in operation were safe and suitable in meeting the needs of the people who use the service. The Registered Manager was not present on the day of the inspection. What the service does well: General observations during the process of the inspection identified that staff were attentive to the needs of the people who accessed the service. People living in the home were provided with assistance to access leisure services within their local community and were able to attend church to continue to practice their religious faith. Information extracted from service user surveys are as follows: “I like all the staff, especially the night staff.” “9 out of 10 staff treat me well.” Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 Page 6 “I like living here to some extent but I would like a house of my own.” “I am happy and settled in my new home.” What has improved since the last inspection? What they could do better: The homes Service User Guide did not provide relevant information in a format suitable to promote the understanding of people who use the service. The registered person should ensure that people wishing to use the service are provided with relevant information, in a format suited to their needs so that they have the information they need to determine whether the home would be able to meet their needs. There was an assessment tool in place, but there was no evidence to show this had been completed therefore the home could not demonstrate they have the capacity to meet the needs of people who choose to live at the home. People must have their care and support needs assessed so that they can be confident their needs will be met. One out of three care plans that we looked at were out of date, all three care plans failed to provide in depth information relating to the care needs of the individual or the level of support and assistance the person required to promote their independence. The home’s medication practices and systems were not entirely thorough to ensure that people received their medicines as directed by the General Practitioner. The registered person must review the medication system and take action to ensure people receive the support they are assessed as needing to manage their medication. People living in the home did not have access to a clear and effective complaint’s procedure. The people using the service must have access to a complaint’s procedure that is published in a format that people who use the service can understand. All complaints should be recorded and should any measures taken to resolve the concern or complaint. Staff recruitment practices failed to demonstrate that the appropriate security checks were undertaken which are necessary to ensure the safety of people living at the home. Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 Page 7 The general environment was comfortable and clean, however, more attention needed to be focused on health and safety. For example, the home’s risk assessment identified the need for windows restrictors but these had not been fitted. We found that effective quality assurance monitoring processes were not in place which means the service is not undertaking any self monitoring which is necessary to identify any shortfalls in service provision and to ensure the service is being managed in the best interests of the people who use it. We found that the service is not doing all that it should to promote fire safety this means that people who use the service, staff and visitors are being placed at risk. 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. The summary of this inspection report can be made available in other formats on request. Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are not necessary provided with information in a format to enable them to understand or to assist them to make a decision of whether the home would be suitable to meet their needs to ensure their health and welfare. People who wish to use the service are not entirely assured that their needs would be catered for to promote their wellbeing. EVIDENCE: The home’s Service User Guide provides brief information relating to the service and provisions available within the home. Albeit that the Service User Guide was published in English and in a symbolic format, the document was not user friendly and was non functional in promoting the understanding of people who use the service. Hence, people did not have access to clear suitable information, to enable them to have a choice of where they lived or if the home would be suitable to meet their assessed needs. Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 Page 10 We spoke to two staff members who confirmed that if the written English was removed from this document they would not be able to understand the symbols. One person informed us that they had lived at the home since it had opened; we showed this person a copy of the Service User Guide who said that they had never seen it before. With reference to what the home could do better, the homes Annual Quality Assurance Assessment stated, “In the process of making a new brochure for prospective clients.” The examination of three care plans identified that there was an assessment tool in place, however these had either not been completed or not been fully completed to demonstrate that people were subject to an assessment prior to being admitted to the home. This does not ensure that the service had the capacity to meet the individuals care needs, to promote their general health and welfare. One staff member told us, “We haven’t got any direction.” This evidently had a negative impact on the consistency of care provided in promoting peoples welfare. Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The care people receive is not always based on their wishes. People who use the service are not always able to make choices about their lifestyle or to take an informed risk to promote their independence. EVIDENCE: There was no evidence that people living in the home had a complete assessment of their needs carried out. Hence, we were not able to establish the basis of where information had been collated to develop the care plan. Discussions with a staff member confirmed that, “Care planning is not a strong point, we just have to use our past experience and training and muddle through.” Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 Page 12 Three care plans were randomly selected for examination, one of which was out of date and provided very little information relating to the specific care needs of the person and also failed to identify the level of support and supervision required to promote their health, welfare and independence. For example, a Support Worker informed us of the support this person required when suffering a seizure and told us that this person’s seizures were quite frequent. The information the Support Worker shared with us was not contained within the care plan, however, the care plan did identify that this person required 24 hours support and stated the degree of risk as high. The health condition of this person and discussions with them showed their frustration at being denied their independence. This person informed us that due to suffering with epilepsy, “The staff are stubborn, I am not able to sit in the front of the car, staff sit outside the bathroom door when I am having a bath.” We acknowledge that there may be safety reasons for this person being denied their independence, but these restrictions were not identified within the care plan. We asked this person if they had a care plan and explained what this was, they said, “I’ve never seen one.” The previous inspection report dated 20 September 2006 identified that there was no evidence that people were involved in the development of their care plan. People are not being provided with the support and encouragement to be actively involved in areas affecting their healthcare, to promote their independence and welfare. The home’s Annual Quality Assurance Assessment identified that, “Each service user has input into their individual care plan and a compromise agreed if there is conflict in agreement.” A Support Worker informed us that one person living in the home self harms, she stated that, “When X self harms, we take their attention away and X calms down.” However, the care plan and risk assessment relating to this person provided conflicting information, which compromised the quality of care provided to ensure this persons wellbeing. It is also of concern that during the process of the inspection a Support Worker was seen walking into the office with a sharp knife and explained that they had to hide it away because this person would harm them self with it. We did not observe this information within the care plan or risk assessment to ensure that all staff were aware of importance of keeping sharp objects away from this person to safeguard them from harm. Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 Page 13 One care plan provided no information relating to the care needs of the individual or the level of support and assistance required in promoting their welfare. It is of concern that the care plan and risk assessment identified that this person suffered with epilepsy but there was no appropriate information relating to the support this person required whilst in the home or in the community, to ensure their safety and welfare. With reference to decision-making, discussions with one person who accessed the service and staff confirmed that people living in the home are not involved in meetings, to enable them to participate in the running of the home or to be kept up to date with any imminent changes to the service. One staff member told us that, “The service is not service user led.” A staff member told us that the home had commenced support meetings with people who use the service. We looked at information obtained from one meeting, which provided more up to date information relating to the persons care needs and aspirations. Information obtained from a service user survey stated, “Sometimes staff help me to make a decision.” Risk assessments provided insufficient information relating to potential hazard and the necessary control measures. For example one person suffering with epilepsy, the control measure stated, “Staff to be aware of safety issues when X is in seizure.” There was no clear directive to what safety issues staff should be aware of, or any training staff required regarding epilepsy or when it would be necessary to obtain medical intervention. We did not have access to staff training records to establish if all staff had received training about epilepsy. Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have access to various social activities to promote their wellbeing. Staff approach and routines within the home may impinge on people’s rights of choice. EVIDENCE: General observations during the process of the inspection evidenced that people’s needs were quite varied requiring different levels of support and supervision to engage them in social activities. One person who used the service was fairly independent and worked on a voluntary basis twice a week at the British Heart Foundation and was also able to access local amenities. Information extracted from a service user survey regarding this person stated, “I go on the bus on my own or with my friends.” Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 Page 15 The risk assessment did not incorporate information relating to social activities within the community to ensure this persons safety and to promote their independence. A person who used the service told us of his plans to enrol at the local college to learn new skills and his future aspiration to find employment, “I would like a job doing wood work.” Another person attended day care service twice a week. On the day of our inspection, a staff member assisted two people to attend their local church for coffee morning. We also heard staff planning an evening out to play bowls. Discussions with people that use the service, staff members and observations during the process of the inspection evidenced that people do have access to local leisure services. However, comments received from a staff survey identified, “More staff would be helpful when service users want to do different activities – someone always needs to stay in the home for phone calls, make the dinner etc.” One staff member told us that; “Staffing levels are OK when no activities have been planned, difficult when going out.” The Annual Quality Assurance Assessment identified that they did well to, “Enable and support service users to develop and maintain social emotional and independent living skills.” During the inspection, it was noted that a staff rota was in place to identify when people living in the home could access the television room to watch the television. Staff informed us that this was because one person would spend all their time watching television. However, televisions were situated in a number of communal areas and bedrooms, so this would not pose a problem to other people who use the service. Discussions with one person who lived at the home and a staff member confirmed that they had access to a self-advocate, information of which was displayed on the board in the office. People living in the home were able to maintain contact with their family and friends; one person informed us that staff would take him to visit his mother. There were various communal areas within the home where people could entertain their guests in private. All bedrooms were of single occupancy and were fitted with a locking device to promote the individuals privacy. One person who accessed the service confirmed that they had a key to their bedroom door but not to the front door of the home. Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 Page 16 Staff were observed to interact with people living in the home in a positive manner. However, it was noted that one person was addressed by their surname. We asked this person if they liked being addressed in this manner and they remarked “no” they preferred to be called by their “Christian name”. We dined with people having their lunch, we observed that people were able to sit where they so wished; it was one person’s preference to eat their meal in the conservatory. We observed positive interaction by staff with people who lived at the home. Gentle prompts were given to encourage one person to eat their meal and an alternative cutlery was offered to aid this person to eat. One person who lived in the home told us that he helped to cook the meal. The atmosphere was warm, relaxed and supportive. The home had a white board located in the kitchen with hand drawn pictures of the meals available for the day. The wrong date was on the board (Monday 26 instead of Wednesday 28). It has been identified as a recommendation that an appropriate method should be introduced to ensure that people are able to choice what meals they want to reflect their likes and dislikes. One staff member informed us that people were involved in the development of the menus. However, discussions with one person who use the service said, “Menus are done between the staff, odd occasions they may take it up with us.” “The menus are made up on the computer.” Another member of staff told us that occasionally people may be asked what meals they would like when the menus are being made up. We looked at a number of menus that identified that a varied diet was provided. The menu incorporated the name of the person who would be cooking that day and their speciality. Menus did not identify an alternative. We asked one person if they enjoyed the meals and they said, “Yes.” Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is not based on their current needs to ensure their wellbeing. Medication practices are not thorough and do not ensure that people receive their medication to promote their general health which places them at risk. EVIDENCE: Care plans did not reflect the current needs of people and failed to provide a clear guidance to staff, with regards to what level of support the individual required to maintain their care needs and to promote their independence. As previously mentioned within the contents of this report, information given to us by care staff relating to the support a person required with regards to their epilepsy and one person who self harmed, conflicted with information contained within the care plan. Hence, the home was not able to demonstrate that people were provided with the necessary personal support to promote the health, welfare and independence. Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 Page 18 Observations showed us that staff were attentive to peoples needs but did not have any written guidance to the specific support the individual required. One staff member told us, “We need a manager.” “We haven’t got a clue.” Further discussions with staff confirmed they did their best for people who used the service without the guidance of a care plan or management support. “We all have a different approach when looking after people.” A care plan looked at identified the need for female staff to assist with the personal care needs of a female who lived at the home, to promote her dignity. Records examined, discussions with people that use the service and staff confirmed that people had access to relevant healthcare services for routine health checks to promote their mental and physical health. One person confirmed to us that ‘they had contact with a nurse’. The Annual Quality Assurance Assessment identified that, “If required service users receive support from occupational therapists, community practice nurses, chiropodist and advocates.” With reference to the home’s medication practices, we looked at medicines in storage. There were eight boxes of prescribed medicines in storage dating back from 2007, which had been discontinued. There were nine boxes of prescribed medicines for another person dating back 2006 and the home continued to collect this medicine from the pharmacy on a monthly basis. A prescribed cream and tablets were in storage that did not identify the person’s name and in one case the dosage and intervals were not stated. We asked two staff members if they knew whom the medicines belonged to and whether they were currently being used. Both staff members were not aware of whom the medicines had been prescribed for or whether they were in use. This could compromise the health and safety of people receiving medication as without full instructions a medication error could occur. The examination of the medication administration record identified that one person had not received their prescribed cream for three days (16, 26 and 27 May 2008) therefore the person may not have received their medication as prescribed. We asked about the security of the medication cabinet; there was movement with the door when locked, if accessed by people living in the home this could have a negative impact on their health. One staff member spoken to said they had received medication training. Discussions with two other staff members did not confirm that they had received medication training. Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 Page 19 One person who uses the service told us they had managed their own medication since they were eight years old, but although it was their preference to do so they were not allowed to do so. Which means that this person’s independence is not being promoted. We identified that the service was not following safe handling of medication practices or guidelines due to the over supply of medicines in storage. We asked staff how they would know if medicines went missing, they said, “We wouldn’t.” Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service are not able to express their concerns and do not have access to a clear and effective complaint’s procedure to protect their rights. People are not safeguarded by the home’s staff recruitment practices to ensure their welfare. EVIDENCE: People who lived at the home did not have access to a complaint’s policy, information relating to the home’s complaint’s procedure was identified within the Service User Guide, we showed a person who lived at the home a copy of the Service User Guide and they informed us that they had never seen it before. Information recorded on a service user survey raised concerns that the water temperature was not warm enough to have bath. We spoke to the person during the inspection and they told us they had raised their concerns with the manager and staff, and said, “They take no notice”. We looked at the home’s records relating to hot water distribution temperatures, which identified that checks had not been carried out for two months. Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 Page 21 Staff told us complaints were not recorded. “We will discuss it with them.” People living in the home do not have access to a complaint’s procedure to promote their rights and ensure their protection. The home’s Annual Quality Assurance Assessment stated, “The company holds a ‘Grumble’ book where the staff can decide whether this goes into the book or not, either way all complaints are taken seriously.” Information obtained from service user surveys with regards to who people would speak to if they were not happy, included the following comments: “The staff.” “Not sure, I do ring my mum if I have a problem.” At the time of our inspection we not received any concerns, complaints or safeguarding issues relating to Sandylee. Staff informed us that the home did have a safeguarding policy but they did not know where it was located. Hence, did not have access to guidance or contact details in the event or suspicion of abuse, to ensure that the appropriate actions would be carried out, to safeguard people living in the home. Systems and practices to safeguard peoples’ finances were confusing and not entirely thorough to protect people from abuse. A staff member informed us that three out of four people living in the home required assistance with managing their financial affairs. Staff were aware that one person had a saving account and that a large amount of funds had been withdrawn by this persons representative but they had no idea where it had been deposited. There was no evidence that this person had an appointee or was under a guardianship order. Two out of three balance sheets checked against the cash held in the home were correct; a small discrepancy of a few pence over was identified with one fund. Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The design and layout of the home ensures peoples’ comfort but the lack of emphasis focused on health and safety may compromise the welfare of people who use the service. EVIDENCE: Sandylee is a three storey, detached property providing four bedrooms located on the first floor and a loft conversation providing an additional two bedrooms. Bedrooms were only accessible via the stairways; there were no lifts or specialist aids provided. However, this was not necessary to meet the current needs of the people living in the home. The design and layout of the loft bedrooms were awkward for example, dormer-windows provided adequate lighting but denied people a view out of the window. Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 Page 23 All bedroom doors were fitted with a locking device. Our previous inspection report dated 20th September 2006 identified that a person living in the home had requested a lockable facility within their bedroom. We did not look to see if this had been addressed but when we asked a person who lived at the home if they had been provided with this facility and they said no. Observations in one room showed the bed was not fitted with a headboard, we asked this person about this and, they replied, “I don’t know, I’ve never had one” We asked whether he would like a head board and he said he would. Staff were not able to give an explanation to why this person’s bed wasn’t fitted with a headboard. Freestanding wardrobes were not secured to the walls to ensure the safety of people using the service. Holes were also noted in the walls of a bedroom and the fire door did not closely properly to provide a seal in the event of a fire. Five bedrooms were provided with en-suite; a bathroom was located directly next door to the bedroom that was not equipped with an en- suite. It was noted that even though the windowpane in the bathroom was patterned there was no privacy screening at the window to promote the privacy of people using this facility. The hot water in the bathroom was tested and was not hot enough for people to have a comfortable bath. Water temperature monitoring checks had not been carried out for two months. It was also noted that the taps were fitted back to front regarding the turning motion, which may make them difficult for people to manage. There was a toilet on the ground floor for staff use only and people who lived at the home had to go to their en suite facility when they needed the toilet. On the day of the inspection, we observed a person indicating to staff that they needed the toilet urgently and ran up the stairs. This person had to walk up three flights of stairs to get to their en- suite. There were no window restrictors fitted on the first floor even though, a risk assessment dated 08/05/06 stated, “Safety film applied and restraint to prevent window opening fully.” On the first floor, there was small room with a portable television and a settee. We noticed that the intermittent strip was coming away from the fire door preventing it from closing properly in the event of a fire. If there were to be a fire people would be at greater risk of harm or injury. The property also provides an activity room, lounge, kitchen and a conservatory. Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 Page 24 People living in the home had access to a well-maintained garden. The cleanliness and hygiene standard within the home was good. One comment from a service user survey identified that, “We all help to clean the house, I like the house to be clean and fresh.” “I enjoy cleaning my bedroom.” Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People are not assured that they will be assisted by skilled staff to meet their physical and mental health needs to guarantee their general welfare. The homes recruitment procedure and practices do not safeguard people from abuse. EVIDENCE: Staff left in charge of the home on the day of the inspection did not have access to staff training records. However, one staff informed us that they had received training in epilepsy, first aid, food and hygiene and infection control. There is further work required in this area to ensure that all staff have the training needed to meet the needs of the people using the service. For example, care planning, risk assessment, safe handling of medicines and equality and diversity. Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 Page 26 The Annual Quality Assurance Assessment stated that, “We have had no staff turnover within the last twelve months and three of our staff members have enrolled on the National Vocational Qualification Level 3 course.” The Annual Quality Assurance Assessment stated that, “We obtain all the necessary background checks prior to the commencement of work.” We found that this information was not correct. We looked at three files belonging to people working in the home. The file for one staff member, contained no evidence to show that a Criminal Record Bureau (CRB) disclosure had been sought or a Protection of Vulnerable Adults (PoVA first) check made. Discussions with the Registered Provider after the inspection confirmed the safety checks required for this person had not been undertaken and the security checks were now being sought. In a second file inspected, there was only one reference, which provided information about their previous employment including their role. The gaps in the home’s staff recruitment practices do not ensure that all the staff employed are suitable to work with vulnerable people or promote peoples’ safety and welfare. Discussions with one person who used the service and staff confirmed that people living in the home were not involved in the employment of staff so they were unable to influence decisions about the people employed to support them. Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People’s care, health and welfare may be compromised by a management style that does not promote the individual’s health, safety and their involvement in key areas of their life to promote the individuals welfare. EVIDENCE: The registered manager was not present on the day of the inspection. Discussions with staff showed a lack of guidance and a structured management style, to promote the welfare of all people accessing the service for example they told us that; “ They did not have a clue” about some things and “Muddled through” with others, effective management systems would ensure that staff know exactly what to do to care for the people living within the service. Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 Page 28 The Annual Quality Assurance Assessment identified that the registered manager had achieved the National Vocational Qualification Level four and the Registered Managers Award. The home’s Annual Quality Assurance Assessment stated that the information supplied was, “Based on feedback from service users, their families and advocates.” Information contained within the Annual Quality Assurance Assessment did not provide sufficient information to show how the home would achieve quality standards or include any future plans to improve outcomes for people who use the service. The home does not a quality assurance tool to monitor the standard of the service being provided. Poor care planning, risk assessments, medication practices, shortfalls in staff recruitment practices, the lack of people’s involvement in areas affecting their lifestyle provides poor outcomes for people who use the service. One person who lived at the home told us the water was not warm enough for bathing. Records we looked at and sampling ‘by touch’ showed us that the bath water temperature was not warm enough to ensure that people were able to have a bath in comfort. This shows that even when issues are raised with the manager he does not take the action needed to ensure the service is run in the best interests of the people who use it. Two staff surveys identified the need for more staff meetings so that staff are kept up to date with care reviews and other issues that may affect the people using the service. The Annual Quality Assurance Assessment did not provide accurate information, for example with reference to staff recruitment it stated that, “We obtain all the necessary background checks prior to the commencement of work.” We looked at one staff file, which did not evidence this, and further discussions with the Registered Provider confirmed that the necessary safety checks had not been undertaken for this person. Systems and practices necessary to maintain the health, safety and welfare of people living in the home were not sufficiently robust. For example, the fire register was not maintained to reflect the number of people in the home, which could place people at risk if a fire occurred, as the service would not be able to accurately account for how many people were in the building. We can confirm this, as when we entered the premises on one asked us to sign in. Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 Page 29 The fire risk assessment was not dated so we were unable to determine whether it was up to date and could ensure the safety of the people in the home. As previously mentioned in the ‘Environment’ section of this report the intermittent strip was coming away from the fire door, preventing it from being effective in the event of a fire. We saw that some fire doors did not close properly. These shortfalls in fire prevention and spread place people who use the service and others who access the premises at risk The home’s fire records showed that the fire alarm should be tested every Friday; the last recorded test was carried out on May 2nd 2008, which does not give confidence that the service works to their own processes to protect people who use the service from harm or risk. Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 1 1 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 2 1 X 1 X 1 X X 1 X Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 Page 31 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 YA6 Regulation Requirement Timescale for action 20/07/08 2. YA9 3. YA20 4. YA34 15(1)(2)(a)(b)(c)(d) The registered person must take the necessary action to ensure that care plans provide clear guidance on how to meet people’s care needs effectively, to promote the health and welfare of people accessing the service. 13(4)(a)(b)(c) The registered person 20/07/08 must take the necessary measures to ensure that risk assessments are functional to promote the safety and independence of people using the service. 13(2) The registered person 10/07/08 must review the medication system and practices to ensure the health and welfare of people receiving assistance with their medication and to make sure that they have their medication as prescribed by their doctor. 19(1)(a)(b)(i) The registered person 20/07/08 DS0000067055.V364892.R01.S.doc Version 5.2 Page 32 Sandylee House 5. YA24 23(2)(j) 6. YA24 23(4)(a)(i) 7. YA24 13(4)(a) must take the necessary action to ensure that staff recruitment practices promote the safety of people living in the service. The registered person 15/07/08 must take the necessary actions to ensure that hot water is available throughout the home to promote the health, safety and comfort of people who use the service. The registered person 20/07/08 must take the necessary measures to ensure that fire doors operate effectively to ensure the health and safety of people using the service. The registered person 20/07/08 must ensure that the necessary measures are taken to promote the health and safety of people living in the home. 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 YA1 Good Practice Recommendations To ensure that the Service User Guide provides relevant information relating to the service and provisions available within the home in a format that is user friendly and functional. To ensure that people are subject to a needs assessment (pre admission assessment) to guarantee that the service has the capacity to meet peoples needs prior to being admitted to the home. DS0000067055.V364892.R01.S.doc Version 5.2 Page 33 2. YA2 Sandylee House 3. 4. 5. 6. 7. 8. 9. YA6 YA7 YA14 YA16 YA16 YA17 YA22 10. 11. 12. 13. 14. 15. 16. 17. 18. YA23 YA24 YA24 YA24 YA26 YA26 YA27 YA35 YA35 To evidence service user involvement and/or their representative with plans of care and reviews so that they have their say in how their care is delivered. To ensure that the home practices and procedures aid people to make decisions in areas affecting their lifestyle to promote their rights and independence. Staffing levels should be reviewed to ensure that sufficient hours are provided to assist people with their chosen social activities. Peoples preferred form of addressed should be identified, recorded and used to respect the individual’s choice and rights. To review the need of having a television rota, to ensure that people have freedom of movement and choice within their home. To ensure that there is a suitable system in place to enable people to have a choice of meals to reflect their likes and dislikes. To ensure that people living in the home have access to a clear and effective complaints procedure, that all complaints are recorded and also identify what action have been taken to resolve the problem so that people who use the service are assured that their complaints will be listened to and acted upon. The homes financial procedure should be reviewed to safeguard people’s financial affairs. To ensure that wardrobes are secured to the walls to ensure the health and safety of people using the service. Consideration should be given in redecorating the bedroom where holes were identified in the wall to make these rooms feel better maintained and attractive. Privacy screening should be provided at the window in the bathroom to promote the privacy and dignity pf people living at the service. To provide a lockable facility for personal finances so that people living at the service are confident that their money is stored safely. To provide a headboard in the identified bedroom, to ensure the comfort of the person occupying this room. To ensure that people living in the home have access to the toilet on the ground floor to increase convenience and choice of facilities. To provide moving and handling training to increase safety of the staff and people who use the service. Staff to evidence completion of induction so that people who use the service are assured that staff know how to care for them. DS0000067055.V364892.R01.S.doc Version 5.2 Page 34 Sandylee House 19. YA39 20. YA39 To ensure that an effective, functional quality assurance system is in operation to ensure positive outcomes for people living in the home and that the service is being run to their best interests. To ensure that the future completion of the Annual Quality Assurance Assessment provides more detailed evidence of how quality standard are monitored and maintained to make sure that the service is being run in the best interests of the people who use it. Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Sandylee House DS0000067055.V364892.R01.S.doc Version 5.2 Page 36 - 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!