Inspection on 07/02/06 for Sarum House

This inspection was carried out on 7th February 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sarum House 24/02/09

Sarum House 31/01/08

Sarum House 18/09/07

Sarum House 06/03/07

Sarum House 22/06/05

Sarum House 13/12/04

Sarum House 19/05/04

Sarum House 16/01/03

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 Sarum House Beehive Corner Old Sarum Salisbury Wiltshire SP4 6BL Lead Inspector Alyson Fairweather Unannounced Inspection 7th February 2006 2:00 Sarum House DS0000032418.V285661.R01.S.doc Version 5.1 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 Sarum House DS0000032418.V285661.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Sarum House DS0000032418.V285661.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Sarum House Address Beehive Corner Old Sarum Salisbury Wiltshire SP4 6BL 01722 335283 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) Wiltshire County Council Leonard William Clarke Care Home 10 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (2), Physical disability (2) of places Sarum House DS0000032418.V285661.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 22nd June 2005 Brief Description of the Service: Sarum House provides personal care and accommodation for ten people with a learning disability. The home is operated by Wiltshire County Council, and is on the outskirts of Salisbury. A nearby park and ride scheme offers regular bus journeys into the city, and Sarum House also has its own transport. The home is an older property, although good efforts have been made to maintain and enhance it. There are two floors for service user accommodation, and all residents have single bedrooms. The home has no lift, making the upper floor unsuitable for anyone with a physical disability. Baths, showers and toilets for general use are on both floors. Communal areas include a ground floor games room. Day care facilities, which several service users attend, are adjacent to Sarum House. Sarum House DS0000032418.V285661.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one afternoon and evening in February. There were nine people at home and one in hospital. Several residents, the manager and members of staff were spoken to, and all ten residents responded to our questionnaire. The management structure of the home has changed, and the new manager, Mr Len Clarke, has recently been registered with the Commission for Social Care (CSCI). The inspector walked round the premises and examined several records, including care plans, medication, risk assessments and staff training files. Staff and residents spent time with the inspector over supper and in one of their lounges What the service does well: What has improved since the last inspection? A great deal of work had been done on residents’ care plans. They contained a wealth of information about speople’s likes and dislikes and how their needs could best be met, as well as detailed information about their physical and mental health, their activities, their family contacts and any personal care needs. These care plans are reviewed on a regular basis and signed by the keyworker and the resident. Sarum House DS0000032418.V285661.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Sarum House DS0000032418.V285661.R01.S.doc Version 5.1 Page 7 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 Sarum House DS0000032418.V285661.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Prospective residents have enough information to make a choice about whether they would like to stay in the home. Their needs, hopes and goals are assessed and recorded before they move in to the home so that staff know how best to support them. EVIDENCE: The home has a statement of purpose and a service user guide which give details of the service offered, the staffing and management arrangements and the scale of fees. The service has recently changed, and these documents have been amended to reflect the fact that no respite care is to be offered in the home. They will also be changed to reflect the change in management structure. Although there have been no permanent residents admitted recently, an up to date community care assessment would be requested from the referring community care team. Information relating to mobility, domestic skills, accessing the community, personal care needs, communication and daytime and recreational activities would form part of this assessment. Family members, where appropriate, would also be a source of information, and staff would visit the resident or family prior to a place being offered. Sarum House DS0000032418.V285661.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 7 Care plans reflect the needs and personal goals of residents, which means that staff are able to support them in the way they wish. People make decisions about their lives with assistance where needed. EVIDENCE: A great deal of work has been done to improve residents’ care plans. Each person has a support plan which includes details of any personal care needs, medical and physical health, mobility and communication skills. The support plans also highlight people’s likes and dislikes, and what activities they like to pursue. Each need for support has a different care plan, and these are closely linked to risk assessments. Care plans are reviewed on a regular basis, and amended as necessary. The files containing the care plans held a lot of information which was out of date as well as current details, and it has been recommended that only current information should be kept on residents’ care plans, and any older material which is not relevant to their current care should be archived. Service users are supported to make decisions about their own lives with guidance from the staff. Some are able to manage their own finances, and Sarum House DS0000032418.V285661.R01.S.doc Version 5.1 Page 10 some have family involvement. Some residents choose to go to day services while others do not. Where restrictions are in place, for example to limit self harm or harm to others, this is clearly recorded and guidelines are drawn up for staff to follow. Sarum House DS0000032418.V285661.R01.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 Residents are offered a healthy diet and enjoy their meals and mealtimes. EVIDENCE: The food provided in the home was of a good quality, and people can have snacks if they want to. A good supply of fruit and vegetables was available and healthy eating options were encouraged. Breakfast is often toast or cereal, although cooked food would be available for those who wanted it. A packed lunch can be made available for those people who attend day services. A wide variety of eating routines are catered for. Some of the residents who live in more independent surroundings have their own kitchen and take responsibility for their own supper. Those residents who required support with their meals were seen to be given time and encouragement to eat. Staff were obviously aware of people’s likes and dislikes. Supper time was a very happy meal, with the service users, the inspector and staff members all chatting together. It was noticeable that staff did not sit at the table and eat with the residents. At many of the other Wiltshire County Council’s services this is done as a matter of routine, and residents seem to enjoy the family feeling which this gives. It is also clear from joining some of these other services at supper time Sarum House DS0000032418.V285661.R01.S.doc Version 5.1 Page 12 that this is often a time where staff and residents can exchange chat on a more informal and relaxed basis. It is therefore recommended that staff on duty in Sarum House in the evening should consider joining the residents for supper. Sarum House DS0000032418.V285661.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Residents receive personal support in the way they require, and their physical and emotional needs were being met. People are encouraged and supported to control and administer their own medication, although adding stock control of PRN medication to the home’s policies and procedures would mean a safer system. EVIDENCE: Support plans were in place to help staff when giving personal care. One resident had a detailed bathing plan in place, and another had one for continence care. Bedtime is flexible, with resident usually being home by 11 pm, although this can be extended by agreement. All residents are registered with a GP and there is input from other health professionals as required, with appointments being recorded in the care plan. One resident uses a wheeled walking frame, and another resident is currently in hospital. His mental health needs have been well documented, and staff make visits to this resident in hospital. The home has a policy in place for all medication, and all staff have medication training when they first start work. A pharmacist comes in to do this and staff have a workbook which must be completed, with staff being tested before they start to administer medication. Staff administer medication to most service Sarum House DS0000032418.V285661.R01.S.doc Version 5.1 Page 14 users but one person self medicates and is supported to do so by staff. There is a comprehensive book-in system and medication administration records are used. These are signed whenever medication is given to a resident. Guidelines are also in place for PRM medication, although it was noted that one box of medication had no start date evidenced, making it difficult to make an accurate audit. A requirement has been made that this must be done for all boxes, and it is recommended that a running total should be recorded for all medication not kept in blister packs. Sarum House DS0000032418.V285661.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 Each service user has a copy of the home’s complaints procedure, and have their views listened to and acted on. EVIDENCE: There is a complaints procedure which outlines the steps to take if there are any complaints. This also gives details of how service users and families can contact the Commission for Social Care Inspection (CSCI). Residents are also given a postcard with these details on them, as well as how to contact their care manager. The complaints information is available in a picture format. Two service users spoken to in the in the more independent unit were aware of who talk to if they had any complaints, and were sure that the manager would listen to them and take any action necessary. Sarum House DS0000032418.V285661.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Overall service users live in a homely and comfortable environment, although changes in the bedroom door locks would make it safer for them. The home is clean and hygienic. EVIDENCE: The home is an older property, although good efforts have been made to maintain and enhance it. Several areas of the home had been improved since the last inspection, and the home was clean and hygienic. The work which was meant to have been done replacing the locks on residents’ bedroom doors had not been done, although work is in progress. There are plans in the near future to further use four more bedrooms on the upper floor, and the work must be completed before any new resident can be admitted. There are longer term plans for the re-provision of learning disability services, and this would mean that several purpose built bungalows would be used for small groups of residents. Sarum House DS0000032418.V285661.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 35 Service users are supported by competent and qualified staff, although staff have not been trained to meet the needs of all service users. EVIDENCE: All new staff receive induction training, and have also started using the Learning Disability Award Framework (LDAF) to assist their training, which means that the needs of service users with learning disabilities will be more fully understood. An induction pack is also being developed for bank staff. There are currently two staff who have NVQ Level 3, one who is undertaking NVQ Level 3, and one who is about to begin. All staff have mandatory training which includes medication, manual handling, first aid, food hygiene, basic health and safety and risk assessment. Whilst examining care plans, and in discussion with the manager, it was clear that at least one resident with a learning disability also have a serious mental health problem. Although guidelines are in place for managing certain challenging behaviours, there has been no training available for staff in dual diagnosis. As this would clearly benefit both service users and staff, the manager has been asked to ensure that appropriate training is sought and offered to care staff. Sarum House DS0000032418.V285661.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 and 42 Service users benefit from a well run home. The health, safety and welfare of residents are not promoted and protected. EVIDENCE: The home’s manager, Mr Len Clarke, has recently been registered by CSCI. He has worked at Sarum House for some years, and was deputy manager for a period before his successful appointment. He has a City & Guilds certificate in Learning Support for People with Learning Disability, and has started the Registered Manager’s Award, which he hopes to complete as soon as possible. He has recently had training in risk assessment, health & safety, the Effective Witness and the Protection of Vulnerable Adults. During the inspection, residents were observed to talk freely to him, and he was seen to be encouraging and positive. The home has good fire safety policies and procedures in place. Water temperatures are tested on a weekly basis, and all staff have had food hygiene training, with food temperatures being recorded on a daily basis. One staff member takes responsibility for fire safety procedures, and the fire bell and Sarum House DS0000032418.V285661.R01.S.doc Version 5.1 Page 19 emergency lighting are tested regularly. Fire extinguishers are checked annually by an outside contractor, and Wiltshire County Council conduct an external Fire Safety Audit. Fire drills are held on a quarterly basis, with the names of both staff and residents who take part being recorded. During a tour of the premises, it was noted that materials which should have been stored in a locked cupboard under Control of Substances Hazardous to Health Regulations (COSHH) were lying loose in the kitchen and a shower room. The manager has been asked to ensure that this matter is dealt with and that all such materials are kept locked up in future. Sarum House DS0000032418.V285661.R01.S.doc Version 5.1 Page 20 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 3 2 3 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 3 23 X ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X X x LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X X X X 2 X Sarum House DS0000032418.V285661.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? YES 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. 2. Standard YA20 Regulation 13 (2) Requirement Timescale for action 07/02/06 YA24 13(4) (c) The start date must be evidenced on all boxes of PRN medication. 07/04/06 Bedroom door locks must be easily openable from the inside without the use of a key and of a type that cannot prevent the door from being opened from the outside. Where locks are of a cylinder type the snib should be removed. Comment: This requirement has been carried over from previous inspections. See Standard 24 All staff must receive specific training relating to the mental health issues of people with learning disability. All hazardous materials must be kept in a locked cupboard at all times. 3. YA35 4. YA42 18 (1) (c) (i) 13 (4) (a) 07/05/06 07/02/06 Sarum House DS0000032418.V285661.R01.S.doc Version 5.1 Page 22 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. 3. Refer to Standard YA6 YA17 YA20 Good Practice Recommendations Only current information should be kept on residents’ care plans, and any older material which is not relevant to their current care should be archived Staff on duty in the evening should consider joining the residents for supper. A running total should be recorded for all medication not kept in blister packs. 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