Inspection on 17/04/07 for Sovereign House

This inspection was carried out on 17th April 2007.

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

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

Other inspections for this house

Sovereign House 18/05/09

Sovereign House 09/01/06

Sovereign House 29/09/05

Sovereign House 11/01/05

Sovereign House 21/06/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Sovereign House 30 Canterbury Road Herne Bay Kent CT6 5DJ Lead Inspector Kim Rogers Key Unannounced Inspection 10:15 17th April 2007 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sovereign House DS0000023564.V318682.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sovereign House DS0000023564.V318682.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sovereign House Address 30 Canterbury Road Herne Bay Kent CT6 5DJ 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) 01227 368796 01227 368796 Mr Hassan Ibrahim Louise Ibrahim Care Home 10 Category(ies) of Old age, not falling within any other category registration, with number (10) of places Sovereign House DS0000023564.V318682.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Date of last inspection 9th January 2006 Brief Description of the Service: Sovereign House is a detached property. It is situated only two minutes from the beach and high street. The home is registered to provide personal care and support to up to 10 older people. The home has eight en-suite single rooms and two rooms with adjoining bathrooms. Accommodation is situated on three floors and is well decorated and maintained. The home has a shaft lift. The home has a grassed front garden and a concreted rear garden with plants and shrubs. The home is owned by Mr and Mrs Ibrahim and they are the Registered Providers, Mrs Ibrahim is the Registered Manager. The fee for the home ranges between £303.25 and £495 For more information about the fee and what the fee includes please contact the Provider. Sovereign House DS0000023564.V318682.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was unannounced. The site visit was carried out over about 5 hours. Work was done before the site visit including surveying service users, care managers and relatives about the service. A review of notifications and the last report was also carried out. The requirement made at the last inspection has been met. The manager and staff assisted the inspector. The inspector spoke to service users individually and as a group and spoke to a relative visiting the home. The inspector had a look around and sampled various records. Service users said, ‘It is like the Ritz’ ‘I wouldn’t want to be anywhere else’ ‘Lovely food’ ‘They know my likes and dislikes’ ‘I cannot complain about anything’ ‘I was allowed to bring in my own furniture’ All 4 service users who returned a comment card said they feel safe and well cared for and have enough staff to meet their needs. Relatives said ‘It is an ideal place’ ‘They have been excellent, very friendly and attentive’ What the service does well: Relatives and service users said they had good information about the home before they made a decision about moving in. Trial visits are supported and terms and conditions clear. Detailed assessments are carried out to ensure the home can meet a persons needs. Service users said the home is always clean. This was apparent during the visit. The cleaner said she is given the time she needs to do a thorough job. The management is consistent and approachable. Staff are trained and are given support to develop their skills and use their initiative. Individual plans show short and long term goals. This has enabled some service users, who wanted to, to move back to their own homes. Sovereign House DS0000023564.V318682.R01.S.doc Version 5.2 Page 6 There are good systems in place to ensure safe medication practice. All rooms are personalised and single with en suite facilities. People can bring their own furniture into the home. What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Sovereign House DS0000023564.V318682.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sovereign House DS0000023564.V318682.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,6 Service users have the information they need to make a decision about moving in. Trial visits are supported and terms and conditions clear. Detailed assessments are carried out to ensure the home can meet a persons needs and some people have been supported to return to their own home. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Relatives and service users said they had good information about the home before they made a decision about moving in. Contracts in service user plans, detail terms and conditions of a person’s stay including the fee and what it includes. Service users or their representatives have signed and agreed contracts. The manager explains any extra charges to people. Sovereign House DS0000023564.V318682.R01.S.doc Version 5.2 Page 9 The manager said people can make trial visits for tea etc to help them make a decision. Some people have been supported to increase their independence and move back to their own homes. The manager said she meets prospective residents and carries out an initial assessment. This includes thinking about the compatibility with other residents. These detailed assessments were seen in individual plans sampled and include information about a person’s life, hobbies and interests. Assessments by care management were also present. This ensures that home has a good understanding of a person’s needs before they move in. Sovereign House DS0000023564.V318682.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Detailed individual plans ensure service users have the care and support they need. Medication practice is safe and health needs are well supported. Staff have values and respect people’s privacy and dignity. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person has an individual plan based on the initial assessment. Some were sampled and showed good detail of a person’s needs with short and long-term goals identified and recorded. All are reviewed regularly and include an assessment of potential risks. Staff have worked closely with professionals and service users to enable some service users to return to their own homes. Daily reports showed that staff are aware of and follow individual care plans. An issue was noted regarding the way night reports are written by a night staff. This was discussed with the manager who agreed to address it. Sovereign House DS0000023564.V318682.R01.S.doc Version 5.2 Page 11 Staff and the manager spoke with knowledge and understanding of service users needs. Health needs are assessed and supported with the home working closely with health professionals. The manager supported a service user to attend a healthcare appointment during the visit. Monitoring of health and other needs is good. Staff were observed following health professionals advice, daily reports showed this also. Personal care needs are recorded. Some service users said they prefer a shower to a bath and this is supported. All said the baths are suitable and staff assist with respect for privacy and dignity. Staff were observed showing care and respect for service users. Relatives confirmed this and also said the home keeps them informed and staff are available when needed. Medication administration was observed and aspects of medication practice checked including storage, records and staff competency. There are good systems for checking medication in and out of the home, records are well recorded and storage is safe. The manager and deputy showed good awareness of medication systems when questioned. The deputy manager has attended a one-day course and completed a distancelearning course raging the safe handling of medication although this was some time ago. The manager agreed to introduce as system of competency assessments for staff to check ongoing competency around medication. Sovereign House DS0000023564.V318682.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The pace of life at the home suits service users who are supported to make choices about their lives. People are supported to keep in contact with friends and family and access community facilities. Food is good and wholesome although not everyone knows what’s on the menu. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People spoken to said they have enough to do. Surveys showed that most people think there is enough to do some of the time. Likes and dislikes are recorded in individual plans. Service users were observed enjoying magazines, puzzles and newspapers. The atmosphere was relaxed and happy. People are supported to access the community. Individual interests and hobbies are recorded in service user plans. The manager said she would consult further with service users about social activity preferences to see if any improvement could be made. Sovereign House DS0000023564.V318682.R01.S.doc Version 5.2 Page 13 Religious needs are met and visitors are able to come and go without restriction. One visitor said he visits two to three times a week unannounced with no problems. Relatives said they are welcomed into the home and kept informed about their relative. People were observed making choices and decisions, which were listened to and respected by staff. The mealtime was observed with hot lunch being served in the dining room or in people’s rooms. The mealtime was relaxed with people given the time and support they need. A service user said ‘they know what I like and don’t like’ and ‘lovely food’ All 4 comment cards said the food is good. A care staff is assigned to the cooking each day, the kitchen is suitable and there are plans to possibly improve the kitchen in the future. There is a second kitchen on the second floor which service users have access to if they wish. Nutrition is monitored and recorded. A staff member was heard telling a service user what was on the menu that day although when asked some service users did not know what was for dinner. This was discussed with the manager who agreed to consult people about the best way to display the menu. Sovereign House DS0000023564.V318682.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People know their complaints will be listened to and acted on. Service users are safeguarded from harm. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints policy and procedure, which is included in the information given to all service users. The procedure is also displayed on the wall in the ground floor hallway. Service users and relatives said they know who to complaint to if they had any problems or issues. The manager said she gives her contact number to all next of kin so can be reached anytime. The home has a policy to safeguard adults and most staff have completed units about adult protection as part of their NVQ qualification. The manager said that adult protection refresher training is planned. There is a whistle blowing policy to support staff in raising concerns. Sovereign House DS0000023564.V318682.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 The standard and cleanliness of the environment within the home is very good providing people with an attractive, safe and homely place to live. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users surveyed all said the home is always clean, as did relatives. The inspector had a look around during the visit and all areas of the home were very clean. The inspector spoke to the cleaner who works five days a week. The cleaner said she is given the time she needs to do a thorough job. Bedrooms are personalised and one service user said she was able to bring her own furniture to the home. Sovereign House DS0000023564.V318682.R01.S.doc Version 5.2 Page 16 Everyone spoken to said they are happy with their rooms. All rooms are single and have en suite facilities with other toilets, bathroom and shower room nearby. A shaft lift accesses the first floor. There are adaptations to maintain and maximise independence like assisted baths, walk in shower, ramps and easy turn taps. There is a small purpose built laundry. The laundry floor and finishes are impermeable and walls easily cleaned. The washing machines have the specified programming ability to meet disinfection standards. Radiators are covered for safety reasons. Sovereign House DS0000023564.V318682.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 There are enough staff who are suitably trained to meet service users needs. The manager plans to assess staff competency regularly to ensure this continues. Recruitment checks are robust protecting service users. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users said there are enough staff on duty to meet their needs and give them assistance when they need it. Relatives said they feel there are enough staff who have the right skills. Nearly 100 of staff have a National Vocational Qualification. The manager and deputy are assessors and have supported staff to achieve the award. Training is planned around service users needs. Competency assessments have been introduced and the manager plans to develop the range of topics that the assessments cover. The induction has been improved with the introduction of work booklets to test staff’s knowledge and understanding. Staff were observed supporting service users with care, patience and understanding. Sovereign House DS0000023564.V318682.R01.S.doc Version 5.2 Page 18 The manager was observed allowing staff autonomy to make decisions leading to a confident motivated staff team. The manager carries out recruitment checks before a person starts work at the home. This includes references and a Criminal records bureau check. Sovereign House DS0000023564.V318682.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 The home is well managed and run in the best interests of service users. Health and safety of all is protected and service user’s finances safeguarded. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The management of the home has been consistent since the last inspection. Service users and relatives were complimentary about the management of the service. One relative said ‘they are straight on the phone ..and keep me informed.’ Sovereign House DS0000023564.V318682.R01.S.doc Version 5.2 Page 20 The manager has the skills and a qualification required to manage the home and is near to completing a foundation degree in health and social care. The manager was observed to be approachable and supportive. The home is kept in a secure manner. The manager as far as reasonably practicable ensures compliance with relevant legislation to ensure that the health, safety and welfare of service users and staff is promoted and protected. The pre inspection questionnaire showed that the required checks of the premises and equipment are carried out. Staff attend health and safety training and have attended safe moving and handling training as required at the last inspection. Incidents and accidents are recorded and reported appropriately. The manager monitors the service, carrying out audits of practice and records. Questionnaires are sent to people who use the service, their relatives, care managers and other stakeholders. Results have been analysed, published and a development plan produced. The manager manages some people’s personal allowance. Individual records are kept with receipts to safeguard service users and the home. Sovereign House DS0000023564.V318682.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 4 Sovereign House DS0000023564.V318682.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP15 OP7 Good Practice Recommendations Consult with service users about displaying the menu in a suitable format so people know what’s on offer for dinner, tea etc. Ensure night reports are signed and recorded appropriately. Sovereign House DS0000023564.V318682.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Sovereign House DS0000023564.V318682.R01.S.doc Version 5.2 Page 24 - 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. 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