Care Home: 25 The Sandfield

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What the care home does well The service is planning for the future needs of the service users and is mindful of the likelihood of increased dependency and changing physical needs. The service users are treated with dignity and respect by a motivated and caring staff team who are well supported to undertake appropriate training. An experienced and qualified manager provides the staff team with leadership and direction. What has improved since the last inspection? The home have continued to improve and develop their person centred planning and attempts to fully involve, as far they are able, service users in all aspects of the planning of their care. New systems have been introduced to better audit the medication administration. What the care home could do better: The home needs to ensure that all medication errors are eliminated and that correct recording is maintained. The home needs to take action to address the quality of the kitchen fittings. CARE HOME ADULTS 18-65 25 The Sandfield 25 The Sandfield Northway Tewkesbury Glos GL20 8RU Lead Inspector Mr Simon Massey Key Unannounced Inspection 8th October 2007 10:00 25 The Sandfield DS0000016327.V334721.R01.S.doc Version 5.2 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 25 The Sandfield DS0000016327.V334721.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 25 The Sandfield DS0000016327.V334721.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 25 The Sandfield Address 25 The Sandfield Northway Tewkesbury Glos GL20 8RU 01684 275894 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) www.mencap.org.uk Royal Mencap Society Miss Lynne Beverley Wakefield Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 25 The Sandfield DS0000016327.V334721.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th February 2007 Brief Description of the Service: 25, The Sandfield is a detached property on a larger housing estate approximately two miles form the centre of Tewksbury. The home is close to local amenities and facilities. The home provides care and support to four adults with Learning Disabilities. The home is owned and maintained by New Era Housing Association and staffed and run by the Royal Mencap Society. The current fee for the home is £546.55. 25 The Sandfield DS0000016327.V334721.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Inspection was unannounced and took place on the 8th November 2007. The inspector met with the Manager, three service users and several members of the care staff. Records relating to care planning, medication, health and safety and staff training and recruitment were examined. An inspection of the environment was also carried out. A number of surveys were distributed and returned. What the service does well: 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 25 The Sandfield DS0000016327.V334721.R01.S.doc Version 5.2 Page 6 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 25 The Sandfield DS0000016327.V334721.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 25 The Sandfield DS0000016327.V334721.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose provides accurate and accessible information to service users and prospective admissions to the home. The admission procedure ensures that people’s needs and aspirations are assessed prior to prospective residents moving into the home. EVIDENCE: The home has produced a Statement of Purpose and Service User Guide. These provide information for prospective admissions and provide clear information about the care and ethos of the home. The home has an admissions procedure in place that meets the standard. This is a national policy and procedure provided by the Royal Mencap Society. The home has had no admissions for several years and it is therefore not possible to fully evaluate how it would be implemented in practice. The Manager is aware of the procedure to be followed and the need to complete full assessments prior to admission, to ensure that needs can be met within the home. 25 The Sandfield DS0000016327.V334721.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Detailed care plans ensure that the service users needs are documented and guidance is available to staff. The home takes action to encourage service users to make choices and supports them to take appropriate risks. Service users benefit from increased choice in relation to decisions about their daily lives EVIDENCE: A sample of care plans were seen, which were person centred with evidence of good recording and goals and objectives being appropriately reviewed and updated. Service users are involved as far as possible in the planning of their care. The plans are detailed and contain information and guidance to staff on the individual delivery of care that individuals identified needs require. 25 The Sandfield DS0000016327.V334721.R01.S.doc Version 5.2 Page 10 There was evidence of regular recording being undertaken and staff demonstrating their ability to anticipate needs, and a commitment to maintaining and, if possible, developing service user’s independence. The home has continued to improve and develop the person centred approach to care planning that was being implemented at the previous inspection visit in February 2007. Risk assessments were in place which were regularly reviewed and signed by staff to clarify they were aware of the information. The assessments are being used positively to promote welfare but ensure that people are protected from potential risks. The staff in the home are aware of the need to plan for future changing needs 25 The Sandfield DS0000016327.V334721.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported to pursue their interests and hobbies, and are able to access the local community independently or with minimal support. Service users are encouraged to eat healthily but their right to choose is respected by the staff team. EVIDENCE: Feedback in surveys to the inspector and conversations with service users demonstrated that a good range of activities are offered to the service users and that they are encouraged to be as active and involved in as many aspects of the home as possible. One person spoken to described their week’s activities and the choices they had made over some recent changes. The home is having to meet the increased physical needs of people but efforts are made by the staff to encourage activities and maintain service users lifestyles. 25 The Sandfield DS0000016327.V334721.R01.S.doc Version 5.2 Page 12 As evidenced at the previous inspection people are supported to undertake a choice of activities and every one has an individual weekly routine that they follow. Feedback from relatives was positive about the links they have with the home and the support that is provided to maintain contact. Service users were positive about the food, and the kitchen was well stocked with fresh and packaged food at the time of the visit. Service users are involved in planning the menus and doing the shopping if they choose. Peoples diet and weight are monitored and the team have involved a dietician in helping to support people to maintain their health through healthy eating. 25 The Sandfield DS0000016327.V334721.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s personal care and healthcare needs are met, promoting their dignity and wellbeing. Clear guidance and recording supports service users to receive their personal care in a way that promotes their privacy and dignity. Improved procedures in medication administration and auditing mean service users are better protected. EVIDENCE: There is evidence that the home monitor and support the meeting of health needs. The home have sought input and advice from outside professionals and provided staff training where appropriate. The home are aware of the need to monitor and assess increased needs. Where possible some adaptations have been made to the environment. The care plans detail the support that individuals require and also provide guidance to staff on how they would prefer this to be delivered. Individual files contain details of medical appointments and also information and correspondence from outside professionals. Staff record information following appointments into the individual files. 25 The Sandfield DS0000016327.V334721.R01.S.doc Version 5.2 Page 14 Positive feedback was received from outside professionals regarding liaison with the service and the seeking of advice and input. Staff have undertaken, or are booked onto, Dementia Care training and the team are also receiving input from the local Community Learning Disabilities Team on this area of need. The home have continued to make efforts to improve the medication administration and eradicate the occasional errors that had been identified at the previous inspection. The home have also had an inspection from the Commission’s Pharmacy Inspector and have implemented all the recommendations that were made. All medications were correctly stored and an appropriate auditing procedure is in place. One error was identified in the recording of medication administration and the Manager explained how this would be investigated and addressed. All staff must undertake training before they are authorised by the Manager to administer medication. Whilst the home provides a good to excellent service in respect to many parts of the Personal and Healthcare Standards, the overall rating is compromised by the errors in medication recording, which needs to be addressed. 25 The Sandfield DS0000016327.V334721.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a safe environment for service users in which they are respected and treated with dignity. There are satisfactory arrangements and procedures in place for the protection of service users. EVIDENCE: Evidence from recording, observation and interviews demonstrated that staff listen to the views and opinions of service users and make efforts to encourage choice. People appear confident in their interaction with staff and are able to make their feelings or opinions known. All staff have undertaken Adult Protection training, apart from the most recently employed. The home has a complaints procedure in place that is the policy of the National Mencap organisation. A record is also kept of when the Complaints Procedure is explained to the service users, something that is done on a regular basis. Service users are provided with a safe and secure environment in which they appear confident and relaxed. All service users have financial risk assessments in place and all personal monies are audited and regularly checked by the Manager. A sample of these were checked at this inspection and found to be correct. 25 The Sandfield DS0000016327.V334721.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users benefit from a home that is well maintained and decorated and provides a comfortable homely environment, though hygiene could be compromised until the repairs in the kitchen area are undertaken. EVIDENCE: The requirements made at the last inspection in respect of the kitchen have not yet been actioned and have therefore been repeated. There is a need for action to be taken in respect of the kitchen radiator, which has very flaky paint, and also the work surface in front of the sink, which is badly chipped. Both these shortfalls are potential health hazards and require urgent attention. As observed in the previous inspection the fitted kitchen is approaching the time when it will need replacing or updating, as many of the doors are worn and some cupboards are not very accessible to service users. The front of the house has been cleared and improved with a new parking area installed and the home have employed some part time gardening help to 25 The Sandfield DS0000016327.V334721.R01.S.doc Version 5.2 Page 17 maintain the appearance of the property. The home is generally well maintained and, apart form the kitchen area, is kept in a good state of repair. The home was very clean and hygienic throughout on the day of the inspection. The concerns identified around the laundry facilities have been addressed through ensuring better observation of infection control procedures by the staff team. The home provides a very homely and comfortable environment for the service users. The Manager explained how they were aware that the environment needs to be carefully monitored to ensure that any adaptations or possible alterations that are required to meet future increased physical care needs are identified. Some adaptations have been made to the property to better meet identified needs. The downstairs bathroom was being updated and better equipped to meet the increased needs of the occupant of the downstairs room. 25 The Sandfield DS0000016327.V334721.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Needs are met by a motivated and competent staff team who work well as team and relate well to the service users. EVIDENCE: Feed back from questionnaires and interviews with service users provided evidence that the staff are competent and professional and relate well to the service users. Staff are receiving regular supervision and those spoken to said they were well supported by the Manager and able to discuss any ideas or concerns that they may have about any aspects of the care provided. The majority of the staff are qualified to at least NVQ level 2 and all were up to date with training in fire safety, food handling, health and safety and medication administration. The home has regular staff meetings and staff said they worked well as a team with good communication and support being in place. Staff were observed communicating with service users and interacting in a positive manner. A selection of recruitment files were examined and these contained all the required documentation and evidence that correct recruitment procedure are carried out. 25 The Sandfield DS0000016327.V334721.R01.S.doc Version 5.2 Page 19 There was evidence that all staff are involved in the care planning process with individual service users and are committed to providing care based on choice and meeting individual needs. 25 The Sandfield DS0000016327.V334721.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good management of the service promotes the safety and wellbeing of the people living in the home. Various systems are in place, which help to monitor and improve the quality of the service. There are a range of measures in operation which help to protect service users’ health and safety. EVIDENCE: The Manager has the required qualifications and experience to competently run the home. There is evidence that they work to continuously improve the service and provide an increased quality of life for residents. There is an ethos of being open and transparent in the running of the home. The Manager provides leadership and direction to the staff team and supports the training that is undertaken. Record keeping is maintained to a good standard and there is evidence that the manager works cooperatively and positively with the Provider to develop and improve the quality of care provided and promoted. The Manager is open about the areas of the service they wish to improve and the actions they are planning. 25 The Sandfield DS0000016327.V334721.R01.S.doc Version 5.2 Page 21 The manager has been pro-active in challenging poor practice and promoting a professional approach to meeting the needs of the service users living at the home. All records relating to health and safety were up to date and all checks had been completed and recorded. A monthly audit of health and safety is undertaken and recorded. The Manager is regularly supervised by their line manager, and there are agreed targets and objectives that are worked to. 25 The Sandfield DS0000016327.V334721.R01.S.doc Version 5.2 Page 22 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 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 x 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X 3 X X 3 x 25 The Sandfield DS0000016327.V334721.R01.S.doc Version 5.2 Page 23 YES 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. Standard Regulation 1. YA20 13(2)&17(1) Requirement The home must complete accurate records of medicines administered within the home The home must address the issues identified in the report relating to the kitchen radiator and the damaged kitchen worktop. Requirement not met (Previous timescale30/04/07). Timescale for action 08/11/07 2. YA24 23(2)(b) 31/12/07 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 25 The Sandfield DS0000016327.V334721.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection 4th Floor Colston 33 33 Colston Avenue Bristol BS1 4UA 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 25 The Sandfield DS0000016327.V334721.R01.S.doc Version 5.2 Page 25 - 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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