Care Home: Sabrina House Residential Home

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What the care home does well What has improved since the last inspection? The home continues to maintain the building to a good standard with plans for further improvement over the next few months. The repairs to the bathroom on the first floor have been attended to, and although not fully used by the people living on the first floor the area is safe and in working order. What the care home could do better: The care plans should be in sufficient detail to inform staff of the actions needed to fully meet peoples assessed needs.When ever possible care plans should be developed, agreed and reviewed with the individual person and/or representative. Systems should be in place to record the health care needs of people to evidence that they are fully met. CARE HOMES FOR OLDER PEOPLE Sabrina House Residential Home 49 Longden Road Shrewsbury Shropshire SY3 7HW Lead Inspector Joy Hoelzel Unannounced Inspection 19th August 2008 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 Sabrina House Residential Home DS0000066417.V370295.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. Sabrina House Residential Home DS0000066417.V370295.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sabrina House Residential Home Address 49 Longden Road Shrewsbury Shropshire SY3 7HW 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) 01743 358929 Sabrina House Limited Margaret Elizabeth Fobister Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places Sabrina House Residential Home DS0000066417.V370295.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th September 2006 Brief Description of the Service: Sabrina House is a privately owned care home providing accommodation and personal care for thirteen older people. It is situated on Longden Road close to Shrewsbury town centre and local amenities. All bedrooms are single occupancy with two rooms benefiting from an en-suite facility. The communal areas are well furnished and comfortable and there is a small garden at the rear of the property. Information of the home and the provision of the service are available in the statement of purpose and service user guide, both documents are readily available. The service user guide does not include information on the current level of fees for the service. The reader may wish to obtain up to date information from the care service. Commission for Social Care Inspection reports for this service are available from the provider or can be obtained from www.csci.org.uk Sabrina House Residential Home DS0000066417.V370295.R01.S.doc Version 5.2 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. This unannounced inspection took place over five hours on Tuesday 19th August 2008. Twenty three of the thirty eight National Minimum Standards for Care Homes for Older People were inspected as they are viewed as key standards for services. Twelve people are currently living at the home and during the inspection were observed to be accessing all areas of the home. The registered manager and care manager were both at the home supported by three care staff and ancillary personnel. A look around the home took place, which included a number of bedrooms as well as communal areas. The care documents of a number of people using the service were viewed including care plans, daily records and risk assessments. Other documents seen included medication records, service records, some policies and procedures and staffing records. Discussions were held with people living and working at the home. Prior to an annual service review in June 2008, an Annual Quality Assurance Assessment (AQAA) document was posted to the home for completion. The AQAA is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for providers to share with us areas that they believe they are doing well. It is a legal requirement that the AQAA is completed and returned to us within a given timescale. The registered manager completed this document and returned it to us. We do an annual service review when there has been no major inspection of the service (we call this a key inspection) in the last 12 months. It does not involve a visit to the service but is a summary of new information given to us, or collected by us, since the last key inspection or annual service review. Sabrina House Residential Home DS0000066417.V370295.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The care plans should be in sufficient detail to inform staff of the actions needed to fully meet peoples assessed needs. Sabrina House Residential Home DS0000066417.V370295.R01.S.doc Version 5.2 Page 7 When ever possible care plans should be developed, agreed and reviewed with the individual person and/or representative. Systems should be in place to record the health care needs of people to evidence that they are fully met. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Sabrina House Residential Home DS0000066417.V370295.R01.S.doc Version 5.2 Page 8 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 Sabrina House Residential Home DS0000066417.V370295.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 1,3,6 Quality in this outcome area is good. Admissions are not made to the home until a full needs assessment has been undertaken. This tells the home all about them, what they hope for and want to achieve, and the support they need. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Details of what the service offers are available in two documents the statement of purpose and service user guide. Both are regularly updated to include the latest information. The service user guide has a section on the financial arrangements and fees but does not actually specify the level of fees charged. Sabrina House Residential Home DS0000066417.V370295.R01.S.doc Version 5.2 Page 10 The case file of the person who recently moved into the home was looked at to see if information had been sought regarding this persons needs prior to moving into the home. The manager discussed the admission process and stated that usually the care manager will visit the prospective service user in his or her own place of residence prior to offering a placement. In this instance the person was well known to the service, it was therefore unnecessary for a ‘home’ visit to be conducted. The person discussed the process and stated that their relative made all the arrangements, as they were unable to do so at the time. They went on to state a satisfaction with all aspects of the service but was anxious to go back to their own home in due course. Other case files looked at contained a pre admission assessment conducted by the home together with community assessments and information from previous placing authorities. The home does not offer an intermediate care service. Sabrina House Residential Home DS0000066417.V370295.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 7,8,9,10 Quality in this outcome area is good. People’s health, personal and social care needs are met, staff are very knowledgeable of an individuals specific needs. However the care plan does not always support or record the care that is being delivered. The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All people living at the home have a plan of care that is based on the information gained prior to and at the point of admission. There was little evidence in the selection viewed that people or their representatives/relatives are involved in the planning and review process. The manager stated that people and their representatives are consulted on all aspects on care at the Sabrina House Residential Home DS0000066417.V370295.R01.S.doc Version 5.2 Page 12 point of admission and then at very regular intervals. This however is not recorded. Three plans were selected for inspection and generally contained the information required to ensure staff have the specific details for successfully meeting a persons needs. Staff were able to give a very detailed account of the differing care needs of individuals but this information was not fully recorded in the care plan. For example one person was being closely monitored for a loss of weight that had been identified. Staff had liaised with the general practitioner and a plan of action had been made. The care plan had not been updated to include this information. The staff were able to state that they were monitoring this persons daily nutritional intake but there was no recording to support this. Other case files included good concise accounts of people’s life history and includes significant life events. This ensures that staff have background information and can then offer a person centred approach to care. Where a risk has been identified an assessment of the risk and the action needed to reduce it has been completed. One case file contained a detailed assessment of the action needed when a person occasionally experiences a period of instability. This ensures that staff have the information for effectively managing the situation. Not all people living at the home commented on their experiences of home life, those who did stated that they were very happy and satisfied with the care they were receiving. The home operates a twenty eight day prescribing regime for the administration of medication using a monitored dosage system with the additional use of boxes and bottles of medicines. The care staff dispense the medications, no one is currently self administering their medication. The Medication Administration Record appears to be fully completed, and no gaps in the recording sheet were seen in the selection viewed. A member of staff demonstrated a good knowledge of the procedures and discussed the recent changes to the supplying pharmacy. Observation of staff working practice and during the tour of the premises evidences that the privacy and dignity of people is upheld at all times. Staff were very respectful when speaking with residents and it was obvious that very good relationships hade been developed and maintained. People were very relaxed and appeared comfortable. Sabrina House Residential Home DS0000066417.V370295.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 12,13,14,15 Quality in this outcome area is excellent. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care staff arrange and facilitate leisure and recreational facilities both inside the home and in the local community. Staff stated that most activities are arranged during the afternoons as this suits most people. People are asked each day what they would like to do. During the morning of this inspection three people were in the lounge and were watching the television. Other people stayed in their own rooms preparing for the day. Many people spoken with stated that they enjoyed Sabrina House Residential Home DS0000066417.V370295.R01.S.doc Version 5.2 Page 14 watching the television and listening to the radio in their rooms. They joined in with the afternoon activity if they so wished. The statement of purpose includes information on outings and therapeutic activities. The home offers an open house policy with people able to visit at times suitable to the resident. People spoken with said they were fully satisfied with the current arrangements. The main front door is kept locked at all times for security reasons, staff answer the door and allow entry. On exiting the door is opened by a domestic type lock. No doors inside the building are locked, people have free access to all areas. Should people wish to access the advocacy services for advice or help, information is freely available in the information file located at the entrance to the home. During the tour of the premises most bedrooms had been personalised and contained the photographs, pictures and trinkets belonging to the person. All rooms were very different and individual to the occupant. Meals are prepared by the catering staff and served in the dining room, although people can have their meal in other areas if they wish. But generally they use the dining room as opportunity to get together. The dining room was prepared in advance of the midday meal. People spoken with stated that the meals were highly satisfactory, with one person confirming that they can have their meal when and where they wish. Snacks and drinks are available throughout the twenty four hour period. Sabrina House Residential Home DS0000066417.V370295.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): OP 16,18 Quality in this outcome area is good. The complaints procedure is supplied to everyone living at the home and is displayed in a number of areas within the service. It has an open culture that allows residents to express their views and concerns in a safe and understanding environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Details of how to make a complaint are included in the statement of purpose and service user guide. A copy of the procedures is included in the information file at the entrance to the home. The manager confirmed that no concerns, complaints or safeguarding referrals have been made. We, the commission, have received no concerns directly during the past twelve months. People living at the home stated that if they had any concerns or worries about home life then they would have no hesitation but to speak with a member of staff. They felt confident that it would be resolved quickly. One person stated Sabrina House Residential Home DS0000066417.V370295.R01.S.doc Version 5.2 Page 16 that it was very doubtful that they would have any concerns, as they were highly satisfied with all aspects. Staff confirmed that they have seen the policies and procedures for safeguarding and discussed the action they would take if they had any suspicions of any wrong doings. The home offers a facility for residents to deposit personal monies for safekeeping; records relating to this have been maintained and fully receipted. Sabrina House Residential Home DS0000066417.V370295.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 19,26 Quality in this outcome area is good. The home provides a physical environment that is appropriate to the specific needs of the people who currently live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Sabrina House is a small care home providing a good standard of accommodation and is suitable for the current service user group. The home does not have a planned programme for the redecoration and refurbishment of the home but work is carried out when required. The communal areas are well furnished, comfortable and homely in character. Sabrina House Residential Home DS0000066417.V370295.R01.S.doc Version 5.2 Page 18 During the tour of the premises, the bedrooms appeared to be comfortable with an assortment of furniture either provided by the home or the persons own, so each bedroom was very different and personal to the occupant. People stated that they were very satisfied with their accommodation. The manager and care manager discussed the plan for upgrading the bathroom situated on the ground floor with the possibility of installing a shower facility. The garden at the rear of the premises is accessible and therefore can be used by people if they wish to do so. All areas of the home were very clean and hygienic. Sabrina House Residential Home DS0000066417.V370295.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 27,28,29,30 Quality in this outcome area is excellent. The service is proactive rather than reactive in its staffing, recruitment and training, with planning for the potential needs of people who may use the service in the future. The result of this is a diverse staff team that has a balance of all the skills, knowledge and experience to meet people’s needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing levels are maintained at three care staff during the day reducing to 2 care staff at night. On call arrangements are available in the event of any emergencies. A duty rota is maintained on a weekly basis to identify the people in the home at any one time. General observations of staff working practice and home life, discussions with people living and working at the home suggests that the staffing complement is satisfactory for the needs of the current resident population. One person commented – Sabrina House Residential Home DS0000066417.V370295.R01.S.doc Version 5.2 Page 20 • The staff are marvellous, will do anything for you, no waiting when I ring the bell they come immediately The statement of purpose details the qualifications held by the current workforce and indicates that of the fourteen permanent staff twelve have gained accreditation at National Vocational Qualification level 2 and above. Staff stated that there are many opportunities for training not only in the mandatory topics but also in specialist areas. All staff have had dementia awareness training and one person has attended a workshop for the deprivation of liberty safeguards and Mental Capacity Act. Two staff personnel files were selected for inspection and indicated that suitable recruitment procedures are in place. Each file contained references, criminal record bureau disclosures and confirmation of identity. The manager demonstrated a good sound knowledge of the recruitment procedures and the importance of employing the ‘right’ person for the job. Residents are offered the opportunity to meet with prospective employees prior to interview and offering a position within the home. Sabrina House Residential Home DS0000066417.V370295.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 31,33,35,38 Quality in this outcome area is good. The management team have a clear understanding of the key principles and focus of the service, based on organisational values and priorities. They work to continuously improve services. There is a strong ethos of being open and transparent in all areas of running of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The management team consists of the registered manager Ms Margaret Fobister and the care manager Ms Ann Gahan. Both ladies have the required Sabrina House Residential Home DS0000066417.V370295.R01.S.doc Version 5.2 Page 22 management qualifications to successfully manage the home. There are very clear lines of accountability for the care and administrative provision. Ms Fobister and Ms Gahan were very knowledgeable regarding the aims and objectives of the service and the care needs of the people living at the home. People living and working at the home offered positive comments about the style of management and expressed a satisfaction with the service. Quality assurance and monitoring of the service continues with satisfaction surveys distributed periodically to residents and visitors. Staff meetings are arranged every three months offering the chance to discuss any issues formally. The manager stated that there are numerous opportunities for residents to make comment on how they find living at the home, and visitors are welcome to speak with staff whenever they feel a need. The service user guide contains a satisfaction questionnaire, covering various aspects of how they perceive life at the home. The home offers a facility for residents to deposit personal monies for safekeeping; records relating to this have been maintained and fully receipted. Weekly, monthly and annual testing of the equipment and premises are conducted with records kept and available for inspection. The maintenance person has the responsibility for overseeing all aspects of the health and safety for the premises. Sabrina House Residential Home DS0000066417.V370295.R01.S.doc Version 5.2 Page 23 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 2 X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 4 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 Sabrina House Residential Home DS0000066417.V370295.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? N0 STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 3 Refer to Standard OP1 OP7 OP8 Good Practice Recommendations The service user guide should include information on the current level of fees. When ever possible care plans should be developed, agreed and reviewed with the individual person and/or representative The care plans should contain sufficient information to ensure that staff have full details of the assessed and ongoing health care needs. Sabrina House Residential Home DS0000066417.V370295.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Sabrina House Residential Home DS0000066417.V370295.R01.S.doc Version 5.2 Page 26 - 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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