CARE HOMES FOR OLDER PEOPLE
The Sandford Nursing and Residential Home Watling Street South Church Stretton Shropshire SY6 7BG Lead Inspector
Pat Scott Key Unannounced Inspection 2nd August 2007 11:00 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 DS0000022271.V336375.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. DS0000022271.V336375.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Sandford Nursing and Residential Home Address Watling Street South Church Stretton Shropshire SY6 7BG 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) 01694 723290 01694 723290 Jubilee Care Ltd Mrs Tracy Jane Smith Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places DS0000022271.V336375.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The home may accommodate a maximum of 35 Older Persons of which 25 may be Older Persons requiring nursing care. The home must comply with the following minimum staffing requirements for nursing clients:0800-1400 1 RGN 4 Care Assistants 1400 - 2130 1 RGN 4 Care Assistants 2130 - 0800 1 RGN 2 Care Assistants These are minimum levels required every day, including weekends and do not take account of extra staff needed when more heavily dependent service users are in residence. These minimum levels are for service user care only. Date of last inspection 4th July 2006 Brief Description of the Service: The Sandford Care Home is situated close to the town centre of Church Stretton, which has all local amenities. The accommodation is provided in one building, on three floors accessed via a shaft lift. Communal facilities are all situated on the ground floor. There is easy access to gardens and the home has car-parking facilities. The home is owned by Jubilee Care Ltd, is managed under the direction of the Responsible Individual, Heather Stanford and the Registered Manager is Tracy Smith who is fully qualified with many years experience. The home makes their services known to prospective service users in: The Statement of Purpose, Service User Guide and web site which also contain their contact e mail address. The inspection report is mentioned in the statement of purpose and summarised in the service user guide. It is also on display in the entrance hall. Fees are reviewed annually and range from £450 - £675. The only additional charges to service users are for toiletries, hairdressing and newspapers. This is clearly laid out in the terms and conditions. DS0000022271.V336375.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A range of evidence was used to make judgements about this service. This includes: information from the provider in the annual quality assurance assessment, staff records kept in the home, medication records, discussion with people who use the service, discussions with the staff team, discussion with the manager, tour of the premises, previous inspection reports, quality assurance processes, Fire Authority reports, Environmental Health Office reports, observation of care experienced by people using the service. What the service does well:
Discussion with the manager and service users showed that admission to the home is personal and well managed. Prospective service users and their families are treated as individuals and with dignity and respect for the life changing decisions they need to make. The manager responds to individual needs for information, reassurance and support. Personal support is responsive to the varied and individual needs and preferences of the service users. The delivery of personal care is individual, flexible and reliable. Staff respect privacy and dignity and are sensitive to changing needs. Service users are supported and helped to be independent and can take responsibility for their personal care needs if able. The ethos of the home is that it welcomes complaints and suggestions about the service, uses these positively and learns from them. Service users say that they are extremely satisfied with the service, feel safe and cared for. All Staff working at the service know the importance of taking the views of service users seriously, and of listening to and responding to raised issues. A relative survey returned stated that: “We as a family have no complaints about the care given. We feel he (the relative) is very well looked after in all aspects”. Service users stated they have confidence in the staff that care for them. The manager ensures that all staff receive relevant training that is focussed on delivering improved outcomes for people using the service. The service puts a high level of importance on training and staff survey results show that they are supported through training to meet the individual needs of people in their care. The management have a clear vision for improvement in the home based on the service’s values and priorities. Equality and diversity issues are given priority by staff who are aware of the varying strands this involves. Areas that service users found most impressive about the home include: they have the
DS0000022271.V336375.R01.S.doc Version 5.2 Page 6 confidence that they will be cared for well; the caring attitude of staff who are professional and pleasant; everybody is treated as a different individual; a happy, bright atmosphere. 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. DS0000022271.V336375.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 DS0000022271.V336375.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standard 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Written records for the admission of new people to the service demonstrate that the process is personalised and that consideration has been given to all aspects of care. EVIDENCE: The service maintains pre-admission and admission records. The records were seen of two new service users admitted. The assessments were personalised and addressed physical health, social care and spiritual needs of the individual. The manager keeps copies of the assessment summary and care plans of those carried out through care management arrangements. Service users spoken with confirmed that they or their family had been consulted about their care needs before coming to live at the home. Trial periods are flexible to meet the preferences of the service user which allows them to keep control of their admission process.
DS0000022271.V336375.R01.S.doc Version 5.2 Page 9 The service intends to improve further by seeking post-admission views of service users as to the quality of the admission process. DS0000022271.V336375.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standards 7,8,9,10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users’ care needs and risk assessments are set out in their individual plans of care which ensures that all care needs have been addressed and will be fully met. The manager understands the need to comply with safe medication systems and staff practice ensures that the home’s procedures are complied with and that service users health matters are safely addressed. The actions of staff and their approach to care ensures that service users are treated with respect and their right to privacy is upheld. DS0000022271.V336375.R01.S.doc Version 5.2 Page 11 EVIDENCE: Three care plans were examined. All had care plans derived from the initial assessments. Each plan had a recorded monthly evaluation of the elements of care. They provide detail in how care is to be delivered by staff. The plans demonstrate contact with healthcare professionals such as district nurse, GP and dietician. Service users spoken with stated that support is flexible as they spoke of the various bed/rising times which are accommodated and always delivered in a way that respects their privacy. One person stated that: “I am very happy with the care that staff give me.” In May 2007 a quality survey conducted with outside contacts found that the staff always appear to know what they are doing when looking after service users. Service users all appeared well groomed with their hair, nails and clothes looking clean. No issues were identified in discussions regarding approach of staff or being assisted with intimate tasks. The service accepts responsibility for administering medication to service users via the monitored dosage system. The service has suitable storage facilities for all types of medicines. Written records for receipt and disposal are maintained and the medication reviews regularly take place at the GP surgery. The management has identified the need to develop a medication management audit tool to ensure that practice complies with procedures. DS0000022271.V336375.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standards 12,13,14,15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are provided with social activity and can keep in contact with family and friends. Social, cultural and recreational activities meet service user’s expectations through assessment, consultation and choice. Service users receive a healthy diet according to their assessed requirement and preference. EVIDENCE: The assessment process demonstrates that social/leisure pursuits are addressed prior to admission in a personalised way for the individual. Once living at the home, social activities are provided and the service shows that this is based on service user consultation through their interaction with the activity co-ordinator. A dedicated input of 23.5 hrs per week is provided for activities by the co-ordinator which provides for all tastes of leisure and hobbies in group or single formats. Photographs were on display of events. Newspapers, magazines and books were seen around the home with some people doing crosswords/quizzes, reading quietly or listening to music.
DS0000022271.V336375.R01.S.doc Version 5.2 Page 13 Reminiscence therapy is provided in liaison with the local library. Staff are trained in various activities such as Bee Active and hand and foot massage. All service users spoken with said they liked the food and it is always nicely cooked. Service users were seen enjoying their lunch in pleasant surroundings. Those requiring assistance with their meal were helped individually by staff in a sensitive and unhurried way. The quality surveys conducted by the service in May 2007 showed that service users had the opportunity to comment on the meal provision and the majority found this aspect of the service to be ‘excellent’ and ‘cannot fault it’. The Chef visits service users on a one to one basis and as a result the home has provided for a more diverse taste in meals, including themed events. Political and religious views are recorded within the care plans. Regular religious services are held at the home. DS0000022271.V336375.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standards 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure which is accessible so that people who use the service have information of how to make complaints about the home. Training is provided so that service users are protected from abuse and have their legal rights protected. EVIDENCE: Service users surveys stated they know whom to approach if they have a problem. All expressed confidence that issues would be dealt with. There is a high level of accessibility to the management at this home which ensures that concerns can be dealt with very quickly. The service has plans to improve the complaints procedure to include an audio format. There is a suggestion box in the foyer. Previous inspections have identified that staff receive full training on safeguarding adults. Files seen for new staff recorded that this training had been provided. DS0000022271.V336375.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standards 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home has improved, so that service users live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: All areas seen around the home are clean and rooms personalised and decorated according to the wishes of those service users occupying them. Communal areas and facilities have been improved with plans to modernise toilet and bathing facilities. The service is working towards reducing the number of shared rooms with three new rooms already in operation. Plans are also in place to change the kitchen facilities, treatment room and to complete the landscaping of the communal garden. Quiet areas have been provided around the home so that service users can sit and talk with their visitors in private.
DS0000022271.V336375.R01.S.doc Version 5.2 Page 16 The laundry service is well organised. Service user surveys returned commented that: “everywhere is clean and sweet smelling, as are our clothes which are taken into wash regularly”. DS0000022271.V336375.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standards 27,28,29,30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff in the home are being trained and are in sufficient numbers to fill the aims of the home and meet the changing needs of service users. EVIDENCE: Staff work to a keyworker system. Service users spoken with confirmed they knew the name of the staff member looking after them for the morning shift. Two new recruit files were examined. All checks required by Regulation were in place before the person commenced employment and inductions have taken place. The service has had the paperwork translated into Polish for those workers from this country. The management input is supernumerary to care staff numbers although the manager does directly supervise staff during their shift-work. Staffing rotas are in place and a board in the foyer displays the daily staffing compliment for the attention of anyone who wishes to view it. NVQ training is provided and the minimum ratio of 50 trained staff being at level 2 has been achieved. The service has four NVQ assessors and four staff qualified to NVQ level 3. Staff surveys confirmed they are provided with DS0000022271.V336375.R01.S.doc Version 5.2 Page 18 professional development training and all statutory updates which is recorded in staff files seen. The service users know the staff very well and observation showed that they provide a personal but professional service. DS0000022271.V336375.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standards 31,33,35,38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect and with effective quality assurance systems in place, service users are assured that the overall conduct of the home is being well managed. EVIDENCE: The organisation, Jubilee Care Ltd, is competent to provide the service and demonstrates the ability to continually improve the service to provide value for money. The management is aware of the running costs of the home which they have effectively used to provide better outcomes for service users, e.g. the injection of cash to fund the redecoration and refurbishment of the premises. The service is good at identifying any shortfalls and is keen to explore ways of improving the care provided.
DS0000022271.V336375.R01.S.doc Version 5.2 Page 20 Staff practice is very service user focussed and customer satisfaction is high on the agenda. This is evidenced by the commitment to conducting service user surveys and including service users ideas in management decisions. Staff and external stakeholders are also surveyed for their views of the service. Service users stated that they trust the staff and feel safe in the home. The manager demonstrated a commitment to the equality and diversity of service users by addressing needs arising out of age and disability. Good record keeping systems are in place. All records seen are written in a way that shows the service listens to the people who use it. What people say is heard, acted upon and reviewed and elements of the annual quality self assessment were seen to be in place. E.g. consultation with service users, reviewed policies, revised menus etc. DS0000022271.V336375.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 X 14 X 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 3 DS0000022271.V336375.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. Refer to Standard Good Practice Recommendations DS0000022271.V336375.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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
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