Inspection on 14/10/08 for Sapling

This inspection was carried out on 14th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sapling 30/10/07

Sapling 13/06/06

Sapling 02/11/05

Sapling 27/06/05

Sapling 25/10/04

Sapling 06/05/04

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Sapling 372 Chessington Road West Ewell Surrey KT19 9EG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lesley Garrett     Date: 1 4 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Sapling 372 Chessington Road West Ewell Surrey KT19 9EG 02083936731 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Charlie Yong Huat Puah Type of registration: Number of places registered: Emas Ltd care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 4. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home Sapling is registered to provide accommodation and care to four older service users with a learning disability. The home is a purpose built bungalow and accommodation consists of a lounge area, a dining room, conservatory, laundry room, bathroom with shower, toilets and four single bedrooms with their own toilet and hand basin. The home has a large garden to the rear of the property which is private, secure and accessible to service users, and private parking is available. The registered provider is Mr. Puah of Emas Limited. Care Homes for Older People Page 4 of 28 Over 65 0 4 Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection of the care home was an unannounced Key Inspection. Mrs L Garrett, Regulation Inspector, carried out the inspection and the registered manager represented the service. The inspector arrived at the service at 11:00 and was in the home for three and a half hours. It was a thorough look at how well the home is doing. It took into account information provided by the home and any information that CSCI has received about the service since the last inspection in October 2007. It was not possible to hold full conversations with the people who use the service therefore observations of these people took place during the time we were in the home. Interactions with staff were observed and the responses from the people who use the service was also observed. The home supplied CSCI with an AQAA (Annual Care Homes for Older People Page 6 of 28 Quality Assurance Assessment). This document was used to assist with the inspection. The inspector looked at how well the service was meeting the key national minimum standards and complying with the regulations and has in this report made judgments about the standard of the service. Documents sampled during the inspection included the homes care plans, daily records and risk assessments, medication procedures, staff files, some training records, and the homes safeguarding and complaints policies and procedures. From the evidence seen by the inspector and comments received, the inspector considers that the home would be able to provide a service to meet the needs of individuals who have diverse religious, racial or cultural needs. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 28 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who wish to use the service only move into the home following an assessment of their needs and are satisfied that their needs can be met. Evidence: The manager stated that the home has not had an admission for over a year. The preadmission assessment for the person last admitted to home was sampled. This assessment was found to be thorough taking into account their health and social care needs. The manager does his own assessment and prospective residents can visit the home in advance to look at the facilities and spend some time with existing people who use the service. Overnight stays can also be arranged.The manager also said that part of the assessment process also includes the psychologist, occupational and physiotherapists, and the care manager. Care Homes for Older People Page 11 of 28 Evidence: The home does not offer intermediate care. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans in the home reflect the care needs of people using the service and contained evidence that health care professional advice are sought and acted upon. Evidence: All of the individual care plans were sampled. These were found to contain all of the necessary information that allows staff to care adequately for the people in their care. All the risk assessments had been completed and had been signed, dated and agreed by the people using the service or their representative. The manger had begun to make these plans more person centered since the last inspection and they include a biography about each person including their likes and dislikes and their social activities. All care plans now contained a manual handling assessment and falls risk assessment. The home has very close links with local health services which benefits people using the service. The care plans sampled showed a variety of interventions, carefully documented, in relation to visits and treatments. Guidelines drawn up by health Care Homes for Older People Page 13 of 28 Evidence: professionals were on file and were being followed by staff. One individual is being attended by the district nurse and these notes were contained within the care plans and clear for staff to read and understand. Health action plans are also in place. The manager takes overall responsibility for ordering and collecting medication from the local pharmacy. Only those staff who have had training can administer the medications and an external specialist trainer is used for this training together with the local pharmacy. The storage arrangements were secure and and the home does not hold any controlled drugs (CDs), therefore, does not have a CD cupboard. During the course of the inspection staff were observed interacting with the people using the service and spending time in the lounge talking and assisting them when needed. Personal care is delivered in private and people who use the service wear their own clothes and were dressed individually on the day of inspection. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The structured activities at the home are fairly limited but meet the needs of the people who currently use the service. Evidence: The activity plans showed a number of day-time activities for the people who use the service including Us-in-a-Bus and a visiting music therapy session. The home keeps a separate log for the people who use the service detailing what activity they have attended on a particular day and this was examined and found to be regularly updated. The activities at the home continue to be fairly limited but the manager said they are regularly assessed to ensure the people using the service have enough mental stimulation. On the day of the inspection staff were observed throughout the day talking and interacting with each individual. One member of staff also assisted with a book for one person. Another individual was happy to help the staff in the kitchen drying the crockery. The home has an adapted minibus and a people carrier. These are used to take the people using the service out. Shopping trips into Epsom have been arranged, visits to Care Homes for Older People Page 15 of 28 Evidence: Epsom Downs and going into town for a coffee. The manager also said that they all went on holiday this year to Butlins and this was really enjoyed. People who use the service are encouraged to keep up family and friendship links and visits are allowed at reasonable times. In addition to the individuals own bedrooms, visitors could also be seen in the dining room or the conservatory when these are not in use. People who use the service are given opportunities to make choices. On the day of inspection staff were seen to talk appropriately to the individual about going into the dining room for lunch. The staff also demonstrated a good knowledge of likes and dislikes of the people and this is all documented in their care plans. None of the people using the service can manage their own financial affairs. Where there are no relatives willing or able to do this, the manager has made arrangements with social services and the Court of Protection to assist them. People who use the service can bring personal possessions with them when they move into the home and all four rooms visited were very personalised and comfortable. There is a documented menu in place, based on the likes and dislikes of the people living there. There is also a separate note kept when other meals, not on the planned menu, have been substituted. Menus continue to be shown to a dietitian for approval especially when there are changes made. The environmental health officer visited three months ago and made no requirements or recommendations. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident that their complaints are listened to and that they are protected from abuse. Evidence: There is a complaints policy in place and a user-friendly version for the people using the service. The manager said there have been no complaints to the home or to CSCI since the last inspection and the complaints book was checked. The address for the South East regional CSCI office has changed, so this will need to be altered in the policy and the policies contained within the individual care plans. There is an in-house safeguarding adults policy which makes it clear that all suspected incidents of abuse must be reported to social services and the police where appropriate. During the last inspection in October 2007 the inspector saw a copy of the local authoritys safeguarding adults procedures. The manager could not find this copy and thought that a member of staff may have taken in home to read. We told the manager that there is now a 2008 copy available on the internet and he assured us that he would down load a copy and place it in all of his homes. Staff were aware of the procedures when asked and training records confirmed that staff had received training. The manager said that he provides safeguarding adults training every two years but that only one member of staff has received training this year but that he would organise for all the staff to receive the training before the end of the year. Care Homes for Older People Page 17 of 28 Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home enables people who use the service to live in a safe, well-maintained and comfortable environment. Evidence: Sapling provides a very homely environment for the people using the service with good quality furnishings and fittings. The conservatory provides an extra space for people, which is comfortable and bright. Bedrooms are personalised and comfortable and one particular person using the service has the benefit of an electric bed which was purchased recently as the persons condition had changed. The home does not have radiator covers but the manager has a risk assessment in place which is monitored regularly. The home is clean and odour free throughout. The laundry was clean and tidy and the door is kept locked. Staff all attend a course on infection control provided by an external training provider and there is an infection control policy in place. The hazardous substances cupboard is now kept locked. On the day of inspection one member of staff was observed walking along the hall wearing the apron that he had worn to prepare lunch . The manager stated that he would speak with the member of staff to ensure that this apron would not be worn when attending to any of the people using the service. Gloves and aprons were readily available for use by staff. A different Care Homes for Older People Page 19 of 28 Evidence: colour disposable apron should be available for use when staff are working in the kitchen. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained and in sufficient numbers to support the people using the service. Recruitment practices at the home protect the people living there. Evidence: The home had a relaxed atmosphere and staff were observed to undertake their tasks in a quiet and orderly manner. We observed staff interactions with people using the service all of which were professional and supportive. The staff in the home during the day were relaxed and calm with the people using the service.The staff rotas were seen and the manager said that the staffing levels remained the same with two carers on during the morning shift, two in the afternoon and one carer at night. The manager said that he is always on call and can be called at any time if assistance is required.The dependency level of one particular person using the service had recently deteriorated. The manager said he would review the night time arrangements if the staff needed to use a hoist during the night. All staff working at the home have either achieved their national vocational qualification (NVQ) or are registered nurses. There is one new member of staff without the NVQ but they will commence their course following the induction period the manager told us. Care Homes for Older People Page 21 of 28 Evidence: Two recruitment folders were sampled and they contained all the information required to safely employ staff. The manager has reviewed all the recruitment folders since the last inspection. One recruitment folder did not contain the reference from their previous employer. The member of staff stated that the person had now sold the business and thought that it was not necessary to get their reference. The manager said that he will try to obtain that reference and place it in the member of staff employment folder. The manager told us following the inspection that this reference had been applied for. The manager stated that he arranges training regularly with a training provider. Staff files sampled demonstrated this takes place as certificates were in place. Staff spoken to on the day said that the home does have regular training sessions which included manual handling. On the day of the inspection we observed two members of staff moving a person who uses the service with a lift that is not recommended. We explained to the members of staff and manager present that another way of moving that particular person will need to be found. The manager said that this person had recently deteriorated and now needed a hoist to move them. A hoist was ordered that day and the manager said that he will rent a hoist until the permanent one is delivered. Other training available to the staff is infection control, food hygeine and some staff had completed a dementia course. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements at the home have improved since the previous inspection which will benefit the people who use the service. Evidence: Since the last inspection the registered provider for the home has now completed his application and has been successful in registering with the Commission to be the manager. He also manages a sister home but this is just a little way down the same road. He said that he divides his time quite easily between the two homes as they are both very small. A folder is kept containing the homes evidence for quality monitoring such as monthly health and safety checks and the annual legionella checks. Meetings are held monthly for the people who use the service and there are regular reviews of their care. The manager showed us that he is about to send surveys to the relatives or representatives, advocates and health care professionals that are involved with the Care Homes for Older People Page 23 of 28 Evidence: people who use the service. He has never sent surveys out before so this is the first time. He will then draw up an action plan to follow up any negative comments that may arise from the survey. None of the people who use the service are able to manage their own finances. All people are clients of the local authority and, in the absence of anyone willing and able to manage their finances, the owner said the local authority has asked him to do this via the Court of Protection. The owner said during the last inspection that where he does have responsibility for a persons finances the books are checked periodically by an auditor from the Court of Protection. Since October of last year he also had his accountant independently audit these records. These records were not available on the day of inspection as they were with the accountant for auditing. Fire training has taken place regularly and the smoke alarms are tested. The records for the training were current but the smoke alarms had not been tested for two months according to the records. The person responsible for this was present and the manager spoke to them during this visit. The home has no smoke alarms and a discussion took place about seeking advice from the fire authority about current legislation. Following the inspection the manager rang and also wrote to say that he had spoken with the fire authority and they had also looked at the regulations and due tom the layout of the building a fire alarm is not necessary. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 19 Two references must be obtained when employing new staff one of which must be from the previous employer This ensures that people who use the service are protected by the home recruitment policy. 14/11/2008 2 30 13 Manual handling training to be repeated for those members of staff that were witnessed moving an individual and using a manual handling technique that is not recommended. This ensures that all people who use the service are protected from injury due to poor manual handling techniques. 14/11/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. Care Homes for Older People Page 26 of 28 No. Refer to Standard Good Practice Recommendations 1 16 It is recommended that the address of CSCI be changed to the current one on the complaints policy that is available to the people who use the service. It is recommended that the home purchase aprons that are disposable and for use only in the kitchen for preparation of food. 2 26 Care Homes for Older People Page 27 of 28 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!