Inspection on 17/12/09 for Vitalise Sandpipers Centre

This inspection was carried out on 17th December 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Vitalise Sandpipers Centre 20/03/07

Vitalise Sandpipers Centre 09/03/06

Vitalise Sandpipers Centre 31/08/05

Vitalise Sandpipers Centre 16/02/05

Vitalise Sandpipers Centre 29/06/04

Vitalise Sandpipers Centre 11/01/04

Similar services:

Ruskin Lodge

Dystlegh Grange

The Good Companions

Springfield Cottage

Cuerden Grange Rest Home

Cornmill Nursing Home

Sue Ryder Care Birchley Hall

Wyncourt

Extracts from inspection reports are licensed from CQC, this page was updated on 14/03/2010.

Key inspection report CARE HOME ADULTS 18-65 Vitalise Sandpipers Centre The Fairway Southport Merseyside PR9 0LA Lead Inspector Mrs Claire Lee Key Unannounced Inspection 17 and 18th December 2009 09:00 th Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Vitalise Sandpipers Centre Address The Fairway Southport Merseyside PR9 0LA 01704 538388 01704 549764 sandpipers@vitalise.org.uk www.vitalise.org.uk Vitalise 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) Mr Darren Andrew Holloran Care Home 38 Category(ies) of Dementia (38), Physical disability (38) registration, with number of places Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing- Code N To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia- Code DE Physical disability- Code PD The maximum number of people who can be accommodated is: 38 Date of last inspection Brief Description of the Service: The centre is a 38-bedded centre run by Vitalise. Vitalise is a national charity providing planned holiday breaks for guests (people who use the service) with physical disabilities and visually impairement. It also offers planned breaks for carers (for the purpose of this report the term carer refers to a family member or friend who has accompanied a guest to the centre). Vitalise has five accessible centres in the United Kingdom. The centre is located in Southport close to the town centre and with easy access to public transport and the beach. The centre also overlooks the marine lake. The centre is situated over the ground and first floor, the upper floor is accessible by stairs, a covered walkway and spacious passenger lift. The centre has a balconied sun terrace, 2 lounges, dining room, bar and other recreational space with comfortable chairs on each floor. There are 30 single rooms and 4 double rooms. All bedrooms have an ensuite facility. The centre has an excellent standard of equipment and environmental adaptations suitable for guests with disabilities, however staff do ensure maximum independence is promoted for the guests. The centre continues to provide care to guests who have nursing needs and at the same time provides a relaxed holiday break with a full range of social activities and events within very pleasant, comfortable accommodation. The fee rate for accommodation at the centre ranges from £550.00 to £1,100 a week. Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. An unannounced visit to the centre took place as part of the inspection of the service. It was carried out over two days for a duration of approximately fifteen hours. One of the Commission’s pharmacy inspector’s accompanied the lead inspector to look at how medicines are administered and managed at the centre. This was in light of a number of medicine errors that have recently occurred. Thirty four guests were staying at the centre at this time. The term guest is used in this report as this is what people staying there like to be known as. During the time spent at the home different areas were looked at and a number of care, staff and health and safety records were checked to see what care and support the guests received. Discussion took place with six guests, twelve staff, a relative, a volunteer and the manager. The centre has a volunteer service and the volunteers provide companionship for the guests and some personal support. During the inspection three guests were case tracked (their care files were looked at and they were asked for their views of the centre). Other guests also took part in the inspection and all the key and other standards were assessed during the visit. Reference to them is made in this report. To find out more about the care provided at the home survey forms called Have Your Say About... were distributed to a number of guests and staff prior to the inspection. A number of comments included in this report are taken from surveys received and also interviews which took place during the site visit. Comments received were positive regarding the staff, the facilities and the overall management. An AQAA (annual quality assurance assessment) was completed by the manager. The AQAA comprises of two self questionnaires that look at the outcomes for people. The self assessment provides information as to how the manager and staff are meeting the needs of the current residents and a data set that gives basic facts and figures about the home, including staff numbers and training. The AQAA was completed to a good standard and some information from it has been recorded in this report. Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 6 What the service does well: Feedback from the guests regarding the centre was positive and the following comments were made: “It is a good place for a holiday” “I enjoy coming here” “The trips are great” “Staff always nice to be with” Staff were seen to be friendly, efficient and patient in their approach when helping the guests. Staff interviewed described the importance of providing a good holiday for the guests and were knowledgeable regarding the guests’ needs and how to help maintain their independence. They were seen to help guests get ready for the trips and also chatting in small groups or one to one with those guests who wished to remain at the centre. There was a pleasant relaxed atmosphere. A number of guests require a high level of nursing care and the centre is well equipped to provide this support. Bedrooms have special beds, mattresses and over head tracking to assist with transferring the guests safely. All bathrooms are equipped with bath aids and the corridors are spacious for wheelchair use. A GP service is arranged at the centre each Monday, which the guests found reassuring and they can also see a doctor ‘out of hours’. This helps the guests to relax knowing that medical attention is at hand if they should need it. An important part of the centre is the social aspect and staff and volunteers go out of their way to ensure the guests enjoy their stay. Guests are able to choose which outings they wish to go on and there is also plenty going on at the centre in the evenings. The centre offers themed weeks, such as, Queen Week, Youth Week, Alzheimer’s Week, Christmas Shopping Week and New Year Week. Many of the guests choose to come for the same week each year as they like to meet up with friends. Families are made welcome at any time. The centre has its own transport with designated drivers for the outings. A shopping trip was arranged during the inspection and a party night was planned with a three course meal and entertainment for the evening. The centre was found to be spotlessly clean and well maintained. During January of each year the centre is closed for cleaning and maintenance and the staff attend their training at this time to ensure they work safely. NVQ (National Vocational Qualifications) in Care is ongoing for the staff as part of their development and learning. Recruitment files and training records seen were up to date to evidence the staffs’ learning programme. The decoration of the centre was found to be good and guests have full use of the communal areas. This includes a lounge/dining room and a smaller room Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 7 which can be used for quiet time. There is also a bar and swimming pool which is open to them. The quality of the service is subject to regular review by the staff at the centre and also by head office. This helps to ensure the centre is run in their best interest. Guests are encouraged to give their views of their stay and this was observed through direct communication and the use of satisfaction questionnaires which are handed out at the end of each week. A guest said, “You only have to ask and the staff will get things sorted for you.” There is a good management structure, which includes a deputy manager and duty managers to support the registered manager. Guests interviewed were complimentary regarding the management of the service. Comments included: “It is well run” “Darren (manager) is very organised” “It provides a break which is what I want” What has improved since the last inspection? What they could do better: There are concerns regarding the overall management of medicines in the centre. There have been a number of medicine errors prior to this inspection. Medicines must be signed for after people have taken them and not in advance. Signing in advance is unsafe and can lead to serious mistakes. Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 8 The arrangements for medicines handling training and assessing staff competence should be improved. This will help make sure staff have the necessary skills to handle medicines safely. Photographs of the guests should be on all their medicines records. This will help reduce the risk of mistakes when giving medicines. Changes have been made to the lunch time menu and this has resulted in guests not being offered a choice at this time. An alternative light meal should be introduced at this time, so that guests can choose what they would like to eat. There has been a mixed reaction from the guests to this change. Guests’ care plans should record in more detail the use of creams/ointments and pressure relief, so that staff are aware of how they are to monitor the guests’ pressure areas as part of their ongoing care provision. Volunteers carry out a degree of personal care for the guests and this must continue to be strictly monitored. The deputy manager stated that assessments are being introduced to assess the competency of the volunteers which is a good way of monitoring their practice. A number of care staff require formal supervision by the manager, as these sessions have not been conducted of late. This should be undertaken as part of their ongoing development and to support them in their job role. The Commission should be advised of the date when the moving and handling equipment is serviced. This is needed to ensure it is in safe working order. Vitalise has yet to develop a policy regarding the deprivation of liberty safeguards which have been introduced as part of the Mental Capacity Act 2005. Policies and protocols should be developed for staff to refer to. Staff should receive training in and understand the deprivation of liberty safeguards, and their implications for day to day practice and care planning. These have been introduced for people who lack capacity and need extra protection. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 9 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 10 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 Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Guests, carers and their families have sufficient information regarding the centre, so they know what the centre can offer. Care needs assessments are carried out so the guests know that their needs can be met during their stay. EVIDENCE: The centre provides short breaks for guests who have a wide range of disabilities and they can be accompanied by their carers. On average the centre provides a break for approximately 1600 guests a year. There was plenty of information available regarding the centre and what it has to offer the guests. This included Vitalise’s own glossy brochure and a Statement of Purpose and Service User Guide. These documents provided good detail so that the guests, carers and their families had sufficient information to decide whether to stay at the centre. They are printed in different formats, such as large print and with the use of pictures to help communicate the information. The Statement of Purpose and Service User Guide was displayed in guests’ bedrooms and satisfaction questionnaires reported that prospective guests found the information useful and relevant to their stay. Vitalise also has its own website, which details a full range of services available. Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 12 Prior to arrival at the centre guests are required to complete a booking form. This is used as an initial assessment of their health and social care needs. The AQAA reported that prospective guests can ‘liaise with the reservations department who can offer advice and support on the service and its facilities, as well as how to obtain funding.’ A guest confirmed that the booking system worked well and that there was always some one to answer any queries. Guests are asked to provide a medical certificate from the GP regarding their health and current medication. This provides information for the staff as part of the assessment and assists with assessing the general health of the guest. The booking form records information in respect of social support and also daily activities. For example, personal care, equipment to assist mobility, diet, communication, mental awareness, continence management and specialist care for wounds or skin conditions. Staff interviewed said that they had sufficient information to plan the care needed. Many of the guests return for several visits each year, however their health needs are reassessed to ensure staff deliver the correct level of support. A guest said, “I come back regularly and the staff are there to help me, they are very aware of what I can and can’t do.” Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standard 6,7,8 and 9 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Guests have a plan of care and they are consulted regarding how they wish to spend their time at the centre so they can maintain their chosen lifestyle. EVIDENCE: Guests attend the centre to enjoy a holiday. Staff interviewed were seen to respect the wishes of the guests with regard to how they wanted to spend their day. Guests were seen to be supported to maintain their independence in all areas of daily living. This included taking part in excursions, enjoying the freedom of the centre and knowing that staff were available to provide care and support according to need. A guest commented, “It is great to come here and just get on with the holiday.” Social activities are planned collectively or on a one to one basis depending on the guests’ needs and wishes. Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 14 Guests at the centre have a plan of care which is drawn up from the initial booking form. The AQAA reported that the personal care needs of the guests are met and that, ‘each service user (guest) is contacted during the week leading up to their break to discuss and develop their own care plan.’ As part of the care tacking process, three guest care files were looked at. The care plans seen recorded information relating to different areas. For example, personal care, communication, mobility, mental state, nutrition, sleep and social support. The plan of care is more of a statement of care as guests are only at the centre for a short time. Further detail regarding the plan of care is stated under Standard 19 of this report. Staff interviewed said they refer to the plan of care each day. They demonstrated a good knowledge of the guests’ individual needs and what the guests expect from them. Care documents recorded the equipment guests needed to ensure they could maintain their normal lifestyle and risk assessments were in place to identify risks that may affect a guest’s independence. For example, how to move a guest safely, excursions from the centre, tea and coffee making facilities in guests’ rooms and the use of bed rails to minimise the risk of a guest falling. Guests sign to say they are in agreement with their plan of care and how staff manage risks that affect their safety during their break. Limitations to freedom and choice may be imposed by the staff and this is done in the best interests of the guests. Thought and consideration is given to the fact the guests come to the centre for a holiday, however staff are aware that any risks to them must be identified and action taken to protect them. Guests interviewed said they had the care and support they needed and that they were able to enjoy the centre and all it had to offer. Comments included: “The staff are brilliant” “I have the help I need each day” “I have no worries about the care” Satisfaction surveys for the guests were given out during the inspection and the manager confirmed that they are distributed weekly. The information is collated at head office and the results of the surveys fed back to the staff at the centre. The surveys look at many areas, for example, the facilities, meals, information provided when booking a break, staffing and social arrangements. The results were very positive although some mixed comments were received regarding the change to the lunch time menu. This is reported under Standard 17 of the report. A guest said, “Having a questionnaire is a good idea and you can always talk to the girls as well.” Guest meetings are not arranged as the guests are only at the centre for a short time. A guest said the staff welcomed ideas and suggestions especially Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 15 around social arrangements. The centre has a number of polices and procedures which relate to respecting the guests’ individual needs and choices, This helps to ensure equality and diversity is understood and respected by the staff. Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 16 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: Standards 12,13,14,15,16 and 17 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Guests can choose how to spend their day thus maintaining their chosen lifestyle and to join in with a wide range of activities organised by the staff. Guests enjoy well balanced meals and meal times are seen as a social occasion where people can meet and get to know one another. EVIDENCE: Vitalise’s brochure states, ‘Vitalise believes that everyone deserves a hassle free, fun break with the freedom to spend your time however you wish.’ Social entertainment plays a major part in this and the centre continues to offer an excellent range of activities and outings so that guests can enjoy their time at the centre. Themed weeks are arranged throughout the year, for example, Youth Week, Queen Week, Alzheimer’s Week, Northern Week, Holistic Week, Christmas Shopping Week and New Year Week. Many of the guests return at different times of the year or choose to return for the same Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 17 themed week. Guests arrive with or without their carer therefore numbers present at the centre can fluctuate. This does however not affect the social arrangements and planned activities. Outings are arranged most days and this includes shopping trips and visits to local attractions, which are always popular. Staff and volunteers accompany the guests for the trips. The centre has its own transport with three adapted, easily accessible vehicles and designated drivers. Guests interviewed said how much they enjoyed going to different places and that this played an important part of their holiday. A trip to Birkenhead Market took place during the inspection and the staff try to arrange outings to suit individual requests and according to need. Not all the guests go out each day, some prefer to stay in with the staff and volunteers. A guest said, “It is entirely up to you if you want to go out.” The AQAA reported, ‘within the centre we offer guests a flexible routine enabling them to maintain their lifestyle as much as they choose.’ Staff and volunteers were seen spending time with those guests who wished to remain at the centre. They were talking, playing cards, listening to music and watching a film. The centre has four double rooms and couples can stay together. Staff welcome family and friends and they can be booked in for lunch or dinner if they so wish. There is plenty of entertainment at the centre and this includes, plasma TV, quiet lounge, DVDs, games area, bingo, karaoke, live music, film shows, internet access, swimming pool and quizzes. The AQAA reported, ‘we have introduced digital freeview TVs into all bedrooms.’ This enables guests to enjoy a number of channels according to their individual preference. A party night was taking place at the time of the inspection with a three course meal and a singer. The party nights are arranged each week and guests said they are fun. The lounge has a licenced bar and there is shop in the main reception that sells a range of items such as, clothing, postcards and jewellery. The hairdresser attends the centre each week and guests can also enjoy a massage. Guests made the following comments regarding what the centre offers: “It is good and we can go out when we want” “I enjoy shopping in Southport with the volunteers” “Lots of entertainment and trips out” “It is great” “First rate, trips are first class” “There is never any pressure to do anything” “The staff and volunteers really make the stay fab, they know we like to go out” “It is a shame when it ends but I will come back. I love meeting people” “I enjoy going out to different places” Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 18 “There are plenty of staff around to help and go out with me on the trips” The staff aim to give guests a good holiday in safe surroundings with their support. Guests interviewed said they were able to maintain their independence but the staff were there to help. A staff member said, “It is a happy and professional environment. It offers activities the guest may not usually get, trips, games nights and entertainment.” Guests are able to lock their bedroom door and they have a lockable facility for the safekeeping of valuables. All areas are accessible for guests who use a wheelchair and a guest said, “The centre is great for getting around.” Staff were seen to promote a flexible daily routine based on what the guests requested. Guests interviewed said they could get up and retire at a time to suit them and that staff supported them with this. As previously stated, guests can choose to take part in trips out or stay at the centre. Meals are served in the main dining room and the dining room tables were attractively laid for all meals. Menus were available for the guests and they enjoy a good choice of hot and cold meals at dinner and breakfast. Changes have been made to the lunch time menu in that guests are now offered soup and sandwiches rather than a lighter cooked meal. Vitalise have sent out satisfaction surveys to the guests regarding the meals and there has been mixed responses to the changes made to the lunch time menu. Some guests find the lunch menu limited and boring while others are happy with it. We did not receive any complaints regarding the changes made, however we would recommend that an alternative light meal be added to the menu. This would give guests a choice. The manager stated that a packed lunch of soup and sandwiches is prepared for guests who go out on the trips and that there had been a high degree of wastage when a cooked meal was served at midday for guests who remain at the centre. Guests interviewed said that snacks, fruit and hot and cold drinks were available through out the day and they had access to a drinks machine. The licenced bar is open at various times and staff receive bar training as part of their induction. Staff and volunteers can have their meals with the guests as part of their working day. Guests interviewed said they liked this arrangement. They said it promotes a friendly and relaxed feel to the centre. Guests made the following comments regarding the food: “It is very nice” “Really good choice in the evenings” “Always plenty to eat” “Staff and volunteers serve it very well” “Lovely meals, nicely cooked” “Meals are very good” Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 19 The kitchen was found to be well stocked and the catering manager had a list of the guests’ dietary requirements according to preference and medical conditions. Dietary needs had also been recorded in the guests’ care plans so that staff were aware of this information. The catering manager has worked at the centre for many years and continues to provide food hygiene training to the staff. This is required to ensure staff handle food safely. Food safety records were found to be up to date to ensure food was handled and cooked safely. Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18,19 and 20. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Medicines must be signed for after people have taken them and not in advance. Signing in advance is unsafe and can lead to serious mistakes. EVIDENCE: Guests were seen to receive personal support in a helpful and professional manner from the staff and volunteers. Dependencies on the guests fluctuate week by week and staff said they receive sufficient information to provide the necessary care and support the guests need. They said they gain this information from the care files, communicating with the guests and their carers and also the handovers that they take part in at each shift change. The AQAA reported that the guests receive care ‘within the boundaries of the centre’s policies and procedures, to match their individual needs.’ Guests interviewed said they received help with various activities according to their needs and wishes. For example help with washing and dressing, walking Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 21 and wheelchair use. They said this help was given in a polite manner. A physiotherapist now attends the centre to provide gentle exercises as part of providing specialist support and guests have the use of the swimming pool for relaxation and rehabilitation. To ensure good communication, the centre offers may aids such as large print documents and signs. A member of staff is able to perform sign language and hearing dogs and dogs for the blind are welcomed with the guests. Specialist beds are provided at the centre to ensure the safety and comfort of the guests. This was seen at the time of the inspection. As previously stated guests have a plan of care which outlines their health care needs. As their break is only for one or two weeks the staff do not have the time to develop a more detailed plan of care. The care plans are laid out as a statement of care with respect to activities such as, help with washing and dressing, continence management, sleep and diet. Care documents seen did not always record in detail how staff were treating guests who had vulnerable skin due to their medical condition or disability. The use of creams/ointments and pressure relief should be recorded fully so that staff are aware of how they are to monitor the guests’ pressure areas as part of their ongoing care provision. Discussion with the registered nurses confirmed that existing care documents would be reviewed to ensure this information was better recorded. They agreed that work was needed to improve them. Care plans had been completed for clinical conditions. For example, evidence was seen of a care plan which detailed the care needed for a person who required a special prescribed dietary regime. This was completed in good detail and gave staff the information needed to monitor their nutritional intake to keep them well. The moving and handling assessments are used as part of the plan of care. They identify the number of staff and equipment to be used to move a guest safely. Two care staff have a team leader role and they are responsible for supporting the other care staff in their work. Staff interviewed said this worked well. The centre has a nurses’ office that can be used for clinical treatments and a GP surgery is held at the centre every Monday. There is also an ‘on call’ service, so guests do not have to venture outside the centre if they wish to see a doctor. A guest said that having a doctor on call was reassuring. As part of the visit a pharmacist inspector looked at how medicines were being handled. We found medicines stock and records to be generally well organised and securely stored. We found the records of medicines received into the home, given to people and disposed of were usually clear, accurate and complete so accounting for them was simple and easy to do. Medicines were carefully checked into the home and any problems were identified quickly and prompt action was taken to obtain new supplies of medicines if the stock brought in by guests was not suitable for use. Good procedures and paperwork were in place for medicines taken out on trips that helped make sure they were handled safely. Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 22 We observed most of the morning medicines being given to people in the dining room whilst having their breakfast. However, we found best practice was not always being followed. Nursing staff signed the medicines records in advance of people taking them and sometimes the person giving the medicine was not always the person preparing and signing the record (this is called a runner). Nursing staff also said they would sometimes give medicines to care staff to give to guests. We had been told of recent mistakes that had resulted in medicines being given to the wrong people and clearly both of these practices could have contributed to this. We also found that if a person had more than one medicines record then a photograph was not on each record, due to the high turnover of guests we advised the registered manager that a photograph on each record would help reduce the risk of giving medicines to the wrong person. We looked at how controlled drugs (medicines that can be misused) were handled and found they were securely stored. We checked the controlled drug register and found some minor recording mistakes because not all entries had been correctly witnessed and dated. When we observed a controlled drug being prepared and given to a guest we saw it was signed as administered in advance of it being taken. This is not good practice because if the person did not take the medicine, for example, if they refused, then the records would not be accurate. We saw some evidence of audits (recorded checks) of the medicines. These were carried out weekly to help make sure stock was suitable for use, to help identify mistakes and to help make sure enough medicines were in stock for the week. We looked at how people were trained and assessed for competency in medicines handling. Following our last visit in May 2008 we recommended that the training be improved and that a formal assessment of staff competence be developed but we found no improvements in either of these areas. We again raised concerns that staff were not always following the correct procedures when giving and recording medicines due to inadequate training and unclear medicine handling policies. Formal training and competency assessment help make sure staff have the necessary skills to handle medicines safely. Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 People using the 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 are able to express their concerns by using an effective complaints procedure. Policies and procedures are in place to safeguard people who use the centre. EVIDENCE: Guests have access to a complaints procedure, a copy of which was seen in the Service User Guide. Complaints received are investigated by the manager and the operations manager responds in writing to the complainant. A complaint log is kept at the home and a print out of complaints was looked out for 2009. The log shows whether the complaint has been upheld and what action had been taken to resolve the issue. The AQAA reported that fifteen complaints had been received and five upheld. The AQAA also referred to the fact that the ratio of complaints is slightly up for the year however this must be looked at within the context of the number of guests who stay at the centre each year. Staff interviewed said that they strive to do their best for the guests and guests interviewed said they were pleased with the accommodation, the staff and the excursions. Policies and procedures are in place to help safeguard the guests. This includes Vitalise’s own policies and also Sefton’s local guidelines on reporting alleged incidents to help protect vulnerable adults. Staff interviewed were clear as to what abuse is and how it should be reported. Their training records evidenced training in safeguarding people. Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 24 Evidence was seen at the time of the inspection to support this when a guest wished to raise a concern. The AQAA reported four safeguarding referrals and the relevant agencies had been involved with any necessary investigations. There have been a number of alleged thefts at the centre over the last year, however the police have been unable to take any action as there is no known perpetrator. When guests arrive at the centre they are reminded to use the secure facilities to store their money and valuables and to remain vigilant at all times. Policies and procedures were in place to help protect the financial interests of the guests. Financial records were seen for monies held on behalf of the guests and these were up to date and accurate. With regards to the Mental Capacity Act 2005 there has been no staff training around the Deprivation of Liberty safeguards. These have been introduced for people who lack capacity and need extra protection. This ensures people are looked after safely. A good practice recommendation for this is stated under Standard 41 of this report. Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24,25,26,27,28,29 and 30 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Guests benefit from staying in a centre which is safe, well maintained, well equipped and clean. EVIDENCE: The AQAA reported, ‘we provide an environment that is appropriate to the diverse needs of our service users (guests) to ensure their preferred lifestyle is respected.’ The centre is purpose built and is situated near the sea front with easy access to the town centre. The centre is designed to provide maximum independence to the guests in a discrete homely environment. The furnishings, fittings, equipment are suitably adapted for the guests so that they can maintain their independence safely and in comfort. Guests interviewed said they liked the Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 26 centre as it was easy to get round and was kept very clean. This was found to be the case. A receptionist is on duty at the main entrance and next to the reception desk is a small shop for the guests to purchase items. Visitors are asked to sign in and out and an alarm system is operational at the front door to ensure the security of the building. There is a fish pond and a swimming pool on the ground floor. The centre is based over two floors. The upper floor accessible by stairs, a covered walkway and passenger lift. The corridors are spacious and hand rails are positioned throughout. Door handles are at the appropriate height for guests who use wheelchairs and signs are in large print to help guests find their way round. The centre was decorated for the festive period. Areas seen were warm and adequately ventilated to ensure the comfort of the guests. All bedrooms have height adjustable beds with overhead tracking for use of hoisting equipment and to aid the transfer of the guests safely. A nurse call systems is available in all rooms and the bedrooms are ensuite. Bedrooms seen were pleasantly decorated and had plenty of furniture and a secure facility for storing valuables. Bedrooms doors also lock to help promote privacy for the guests. Guests have access to equipment to ensure their independence including, special reclining chairs, cushions, shower trolleys, bath hoists, stand aids, nursing beds and mattresses. The bathrooms were clean and the hot water regulated to ensure it was delivered at a safe temperature for the guests. Guests have the uses of two communal rooms, one is used as a quiet room and the other is the lounge and dining room. This room also has a bar with plenty of comfortable arm chairs and coffee tables. There was plenty of room to accommodate wheelchairs for the guests to get around easily. A terrace overlooks the marine lake and the guests sit out here in warm weather. The grounds are accessible for everyone. The laundry room was organised and clean. Infection control procedures were in place and staff had access to glove, aprons, liquid soap and hand gel to minimise the risk of cross infection. A housekeeper is employed and oversees the cleanliness of the building with the domestic staff. Health and safety policies and procedures were in place for the ongoing protection of people in the centre. A number of comments were received regarding the accommodation: “Very good” “So clean” “Great to get around” “The bedroom is fine, good that it has a lock” Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 27 “Cannot fault it” Looking around the accommodation and discussion with the guests confirmed that the centre provides a wide range of up to date specialist equipment and adaptations to meet the individual needs of people who use the service. Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 28 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,32,33,34,35 and 36 People using the 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 guests are cared for by staff who are recruited safely and who are trained and skilled to provide the care and support they need. EVIDENCE: There were sufficient staff on duty to provide care and support to the thirty four guests at the centre. The staff are assisted by volunteers for some aspects of personal care. Staffing rotas were in place for the duty manager/supervisor, care team, nursing team, housekeeping team/reception, catering team and maintenance/drivers. Staff are line managed by their appropriate head of department, however there is no care manager currently employed. Vitalise are advertising this post and in the mean time a registered nurse who has worked at the centre for a long time is taking the lead for the clinical care. A staff member said the centre was very busy as they care for guests with varying dependencies and medical conditions. The registered manager was on duty at the time of the inspection with two registered nurses and six care staff. Other staff were also on duty from the Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 29 different teams to ensure the centre was managed effectively. Guests were pleased with the staffing arrangements, they said they could communicate well with everyone and that they had got to know the staff well at the centre. Their comments included: “First class” “The staff are absolutely first class, they do a wonderful job” “Very good people to be with” “Very busy” “They could do with more staff” Over the last two years nine new staff have been employed. Three staff files were looked at with regards to recruitment practices and this showed that new staff had been recruited safely to help ensure the protection of the guests. Checks carried out included police clearance, two written references from past employers and a full employment history. There was also evidence of an equal opportunities form, identification numbers for the registered nurses to enable them to practice and interview questions. New staff receive an induction over a six week period and this is conducted by the registered manager and the heads of department to ensure they are familiar with all areas of the centre. The inductions seen were detailed and provided relevant information relating to the person’s job role, working for Vitalise and various care practices. All staff attend an annual training programme in January of each year. The centre is closed for a set period of time for this and also for maintenance and renovation if needed. Staff said they receive regular updates for moving and handling, infection control, food hygiene, health and safety and first aid. Training record showed this and also staff attendance for courses such as, safeguarding adults, pressure areas care and dementia. A staff member said, “We all have to attend to ensure we are up to date with our training.” The training programme helps to ensure the staff have a balance of all the skills, knowledge and experience to meet the guests’ needs. Discussion took place with the manager regarding the content of the medicine training. Staff were not always following the correct procedures when giving and recording medicines due to inadequate medicine training and unclear medicine handling policies. Staff are supported to take NVQ (National Vocational Qualifications) in care and other areas, for example cleaning and support services. The AQAA reported that of the nineteen permanent staff, fourteen have achieved an NVQ at Level 2 or above in care. NVQ Level 4 in Management has been achieved by a deputy manager and duty manager. Plans for the future include NVQ in Management for all the managers. This demonstrates a commitment to their learning and development. Good communication was evident with the staff during the day of the inspection and the manager holds regular meetings with them. Meetings are Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 30 also held with the heads of department. Minutes of meetings held were looked at and these showed good attendance by the staff. A staff meeting was held at the time of the inspection and the staff said they were able to talk freely about any issue. Supervision is provided for the staff, however records for individual supervisions were not up to date for the registered nurses and the care staff. The manager stated that recent supervision sessions had not been held for them. These should be undertaken as part of their ongoing learning and development. This is of particular importance as there is no care manager at this time and also in light of the medicine errors that have occurred. Vitalise has a volunteer force and their recruitment is co coordinated by head office and also the deputy manager for the centre. A number of volunteers come from oversees and they are supported by Vitalise to improve their spoken and written English where needed. The deputy manager is advised when the volunteer is able to commence and checks include police clearance, references and a Certificate of Good Conduct. The volunteers receive an induction and training programme. This includes areas such as, use of wheelchairs, communication, certain medical conditions, handling the guests and assisting them with meals. The number of volunteers can fluctuate at the centre and ideally the aim is to have one volunteer per guest. The volunteers support guests with their social arrangements and some care following an induction and training at the centre. The use of volunteers for providing some personal care to the guests has been in place for a long period of time and the manager is aware that primarily the health care needs of the guests must be met by the permanent staff. The use of volunteers for this purpose must be strictly monitored. The deputy manager stated that assessments are being introduced to assess the competency of the volunteers which we believe is a good way of monitoring their practice. Guests interviewed said they were pleased the volunteers at the centre who accompany them with the trips out. Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 31 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37,38,39,40 and 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Medicines recording must be improved and given in accordance with the centre’s policy and procedure to ensure guests receive their medicines safely. EVIDENCE: The centre has a good sound management structure in place and heads of department support the registered manager, Mr Darren Holloran. These include a deputy manager and two duty managers. Mr Holloran has completed a Degree in Management and undertakes training with the staff in January of each year. Guests and staff praised his management style and said that his door was always ‘open’ if they wished to speak with him. As previously stated, the centre requires a care a manager and until this is filled, a registered nurse Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 32 has taken on this role. This is to provide Mr Holloran with clinical support as he is not a registered nurse. It was evident during the time spent at the centre that the manager works well with the staff and he makes time to meet with the guests each day. A guest said, “It is nice to see Darren on breakfast duty.” Guests arrive at the centre on the same day and it is evident that this is a very busy time for the staff on duty. The guests’ care needs are assessed at this time and their medicines checked in. We have again raised the question as to whether guests could arrive at the centre on different days to ease the workload for the staff. This will help to ensure the admission, assessment and care planning process is not rushed. To ensure standards are maintained guests are asked to complete a questionnaire regarding their stay. The percentage of satisfaction for the service was found to be good in all areas. The manager said he is keen to rectify any issues that may arise and to continually improve the service. Quality audits are also completed by head office and this incorporated the results from the questionnaires to ensure the centre is run in the guests’ best interests. Areas recorded included, complaints, hospitality, accident reporting, emergency procedures. Discussion with guests and a relative on the day of the inspection confirmed that the staff do their best to make the stay enjoyable. A guest made the following comment regarding the centre, “The most important thing is I am happy coming here and therefore my family are relaxed because I am.” Senior management complete a monthly visit to the home and prepare a formal report of their findings. This also helps to monitor standards at the centre and enables them to meet the staff and guests who are accommodated. The AQAA reported that the organisation has a five year strategic plan. The centre has a one year plan based on this which the managers work to as part of ensuring the centre continues to provide a good service for the guests, their carers and families. The AQAA gave details of maintenance checks and contracts for services and equipment for the service. A spot check evidenced in date contracts for the gas, electric and fire prevention. This is needed to ensure a safe environment for the guests to stay. A date for the servicing of the moving and handling equipment is taking place in January 2009 to ensure it is working safely and in accordance with current legislation. Staff receive fire training to ensure they know how to act in the event of a fire. Fire alarms were seen to be subject to a weekly test to ensure they were working effectively. Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 33 The AQAA reported on policies and procedures for safe working and health and safety. A number of these were seen and they had been subject to review to ensure they were up to date and in accordance with current legislation. There is however a concern that staff are not recording medicines in accordance with the centre’s policy. Records for administering medicines must be improved as we have again raised concerns that staff were not always following the correct procedures when giving and recording medicines due to inadequate training and unclear medicine handling policies. This has the potential to place the guests at risk. The manager must ensure policies and procedures in the centre are implemented to protect the guests. Vitalise has yet to develop a policy regarding the deprivation of liberty safeguards which have been introduced as part of the Mental Capacity Act 2005. Policies and protocols should be developed for staff to refer to. Staff should receive training in and understand the deprivation of liberty safeguards, and their implications for day to day practice and care planning. These have been introduced for people who lack capacity and need extra protection. Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 34 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 3 ENVIRONMENT Standard No Score 24 4 25 3 26 3 27 4 28 3 29 4 30 4 STAFFING Standard No Score 31 3 32 4 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 3 4 X LIFESTYLES Standard No Score 11 x 12 3 13 3 14 4 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 2 x 3 3 4 2 x 3 x Version 5.3 Page 35 Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13(2) Requirement Medicines must be signed for after people have taken them and not in advance. Signing in advance is unsafe and can lead to serious mistakes. Timescale for action 09/02/10 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA17 Good Practice Recommendations An alternative light meal should be introduced at lunch time so that guests can choose what they would like to eat. Guests’ care plans should record in more detail the use of creams/ointments and pressure relief so that staff are aware of how they are to monitor the guests’ pressure areas as part of their ongoing care provision. Discussion with the registered nurses confirmed that existing care documents would be reviewed to ensure this information was better recorded. 3. YA19 Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 36 4. YA20 The arrangements for medicines handling training and assessing staff competence should be improved. This will help make sure staff have the necessary skills to handle medicines safely. Photographs of the guests should be on all their medicines records. This will help reduce the risk of mistakes when giving medicines. 6. YA36 The use of volunteers for this purpose must be strictly monitored. The deputy manager stated that assessments are being introduced to assess the competency of the volunteers which we believe is a good way of monitoring their practice. Registered nurses and care staff should receive supervision of their job role as these sessions have not been conducted of late. This should be undertaken to ensure as part of their ongoing learning and development. 7. YA41 Policies and protocols should be developed for deprivation of liberty safeguarding for staff to refer to. Staff should receive training in regarding these and understand the implications for day to day practice and care planning. Vitalise Sandpipers Centre DS0000017270.V378901.R01.S.doc Version 5.3 Page 37 Care Quality Commission Care Quality Commission North West Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.northwest@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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