Care Home: Sampford Care Home

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What the care home does well People being considered for a move to the home are properly assessed, so that a suitable decision can be made about whether their needs can be met. The home has its own assessment format which covers all relevant areas and enables an initial care plan to be devised. The service also obtains relevant assessment and history information from other agencies. Suitable efforts are made to provide a varied programme of activities likely to meet the differing needs of people living at the home. One staff member has a lead role for this, whilst others also try to carry out activities with residents whenever they have time to do so. The opportunities offered cover both group and individual sessions, so that activities can be tailored to what each person prefers. The programme also includes entertainment coming into the home and opportunities for people to go on outings elsewhere.There is a strong focus on training, so that people living at the home benefit from the support of skilled and knowledgeable staff. Nurses specialise in various areas of expertise that help to deliver quality care to people using the service. The home is also well above the minimum targets for care staff who have National Vocational Qualifications (NVQs) in care. There are a wide range of systems for quality assurance. These measure all aspects of service delivery. They also ensure that people living in the home and their relatives get regular chances to give their views. All the various sources of evidence contribute to a detailed service development plan. This clearly recognises the key issues for the home and shows that steps are being taken to address them. People living in the home told us that they receive good care. They said that staff are friendly and helpful. They also described the food as "excellent". Staff working in the home also gave us positive comments. They said that there is a good atmosphere amongst the team. They feel that they receive good training and support, which enables them to work effectively with the people living in the home. What has improved since the last inspection? This is the first inspection of Sampford Care Home since it was sold to Majesticare in 2007. The service was re-registered at that point. This is therefore considered to be the first inspection of a `new` service. The report of the previous inspection in May 2007 was seen by the new owners when they completed purchase of the home shortly afterwards. They have addressed most of the requirements and recommendations which it contained, although they were not accountable for these. What the care home could do better: Some improvements have already been made and more are planned during 2008, however the premises are in need of major improvements, so that people living in the home benefit from a better quality environment. The long term plan is for a complete rebuilding on the site. In the interim, there are also plans to improve the current accommodation so that people living there have better facilities until the new premises are available. It must be clear that support to people living in the service with all their health needs is appropriate. We found examples of deficits in records and in need of review. Examples include instructions to carry out certain observations, with no accompanying record to evidence that this is happening. One set of records has no current care guidance on issues previously identified as important forthe individual. Some records relating to support with medication are incomplete or appear to contain incorrect and out of date information. All information about support to people living in the service who are at risk from falls needs to show a full process for risk assessment and management. Where a decision has been made to use bed rails, we saw that there are appropriate risk assessments and evidence of consent. However, one person who has falls from bed is supported by a mat on the floor, rather than bed rails. Their records do not show why this decision has been taken. The service is in the process of moving all records about people living in the home over to the Majesticare format. The examples we saw showed that records in this format are more likely to provide good evidence of up-to-date care guidance for all of an individual`s assessed needs. The plan is to move all records to the same format so that everyone living in the home benefits from a consistent approach. CARE HOMES FOR OLDER PEOPLE Sampford Care Home 27 Shurnhold Bath Road Melksham Wiltshire SN12 8DD Lead Inspector Tim Goadby Unannounced Inspection 5th & 12th December 2007 09:35 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 Sampford Care Home DS0000070152.V356092.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. Sampford Care Home DS0000070152.V356092.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sampford Care Home Address 27 Shurnhold Bath Road Melksham Wiltshire SN12 8DD 01225 709271 01225 702285 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) Majestic 3 Limited Andrea Cole Care Home 70 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (30), Old age, of places not falling within any other category (40), Physical disability (1) Sampford Care Home DS0000070152.V356092.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Majestic 3 Limited may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission are within the following category: Old age, not falling within any other category - code OP. Mental disorder, excluding learning disability or dementia, 65 years and over - code MD(E). Physical disability, aged 50 years and over - code PD. The maximum number of service users who can be accommodated is: 70. However no more than 40 service users requiring nursing or personal care may be accommodated at the home, until the 30 bedded unit is refurbished and made fit for use. 2. Date of last inspection Brief Description of the Service: Sampford Care Home is registered to care for up to 70 older people, including those with needs relating to their mental health. Following its sale in June 2007 the home is now operated by Majesticare Ltd, a company which has a number of care homes in various locations throughout England. The home is on the outskirts of Melksham. It is set in its own grounds, with off road parking at the front and views over open fields at the side and back. There are two linked buildings on the site, only one of which is currently used for accommodation. Future plans include a complete redevelopment of the site. All people living at the home have individual bedrooms. These are found on both floors of the building. There are also a number of bathrooms on each floor. Communal lounges are available both upstairs and downstairs, there is a dedicated dining space on the ground floor lounge. More information about the service can be obtained from the home. Copies of inspection reports can be accessed via the Commission’s website at www.csci.org.uk. Sampford Care Home DS0000070152.V356092.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was completed in December 2007. The process included a review of what we know about the service since it was last inspected in May 2007. The main change during this period was the completion of the sale of the home by its former owners to Majesticare Ltd, which took place in June 2007. Before this inspection we asked the home to complete an Annual Quality Assurance Assessment (the AQAA). This document gives us various information about a registered service. It also requires each service to audit its own performance and identify any areas for improvement. We carried out two visits to the home. The first of these was unannounced. The second took place by appointment, to meet with the home’s new manager, conclude the inspection process and give initial feedback. A total of just under eight hours were spent in the home over the two visits. During the visits we met people using the service, staff and management; looked at a sample of records, including case tracking of some people living in the home; looked at arrangements for medication; and toured the premises. The judgements made in this report are based on all of the evidence gathered, including the visits to the home. What the service does well: People being considered for a move to the home are properly assessed, so that a suitable decision can be made about whether their needs can be met. The home has its own assessment format which covers all relevant areas and enables an initial care plan to be devised. The service also obtains relevant assessment and history information from other agencies. Suitable efforts are made to provide a varied programme of activities likely to meet the differing needs of people living at the home. One staff member has a lead role for this, whilst others also try to carry out activities with residents whenever they have time to do so. The opportunities offered cover both group and individual sessions, so that activities can be tailored to what each person prefers. The programme also includes entertainment coming into the home and opportunities for people to go on outings elsewhere. Sampford Care Home DS0000070152.V356092.R01.S.doc Version 5.2 Page 6 There is a strong focus on training, so that people living at the home benefit from the support of skilled and knowledgeable staff. Nurses specialise in various areas of expertise that help to deliver quality care to people using the service. The home is also well above the minimum targets for care staff who have National Vocational Qualifications (NVQs) in care. There are a wide range of systems for quality assurance. These measure all aspects of service delivery. They also ensure that people living in the home and their relatives get regular chances to give their views. All the various sources of evidence contribute to a detailed service development plan. This clearly recognises the key issues for the home and shows that steps are being taken to address them. People living in the home told us that they receive good care. They said that staff are friendly and helpful. They also described the food as “excellent”. Staff working in the home also gave us positive comments. They said that there is a good atmosphere amongst the team. They feel that they receive good training and support, which enables them to work effectively with the people living in the home. What has improved since the last inspection? What they could do better: Some improvements have already been made and more are planned during 2008, however the premises are in need of major improvements, so that people living in the home benefit from a better quality environment. The long term plan is for a complete rebuilding on the site. In the interim, there are also plans to improve the current accommodation so that people living there have better facilities until the new premises are available. It must be clear that support to people living in the service with all their health needs is appropriate. We found examples of deficits in records and in need of review. Examples include instructions to carry out certain observations, with no accompanying record to evidence that this is happening. One set of records has no current care guidance on issues previously identified as important for Sampford Care Home DS0000070152.V356092.R01.S.doc Version 5.2 Page 7 the individual. Some records relating to support with medication are incomplete or appear to contain incorrect and out of date information. All information about support to people living in the service who are at risk from falls needs to show a full process for risk assessment and management. Where a decision has been made to use bed rails, we saw that there are appropriate risk assessments and evidence of consent. However, one person who has falls from bed is supported by a mat on the floor, rather than bed rails. Their records do not show why this decision has been taken. The service is in the process of moving all records about people living in the home over to the Majesticare format. The examples we saw showed that records in this format are more likely to provide good evidence of up-to-date care guidance for all of an individual’s assessed needs. The plan is to move all records to the same format so that everyone living in the home benefits from a consistent approach. 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. Sampford Care Home DS0000070152.V356092.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 Sampford Care Home DS0000070152.V356092.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): 1, 2 & 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective users of the service have their needs assessed and have suitable information to make a choice about the home. People using the service have written contracts with terms and conditions of their residence in the home. Standard 6 is not applicable to this service. EVIDENCE: Information about the service, including its Statement of Purpose and Service User Guide, has been updated to reflect the change of ownership to Majesticare Ltd. Copies of the amended documents have been sent for printing and should be available from the home shortly. Sampford Care Home DS0000070152.V356092.R01.S.doc Version 5.2 Page 10 The service is also working through the process of ensuring that all people living in the home have updated contracts and terms and conditions of residence. The company’s format includes details about the obligations of all parties, what is covered by fees and what is subject to additional charges. Items not covered by the main fee for care and accommodation include chiropody, hairdressing, newspapers, toiletries, postage and stationery. People who were admitted since Majesticare bought the home have the relevant documents. People who were living at the home before the sale are gradually transferring on to the new contracts. We saw care records for three people recently admitted to the home. They show that there is a full assessment of needs. This is used to produce initial care plans, which are then reviewed and developed more fully over time. Assessment information is also obtained from other sources. For instance, a person may have a community care assessment which has been completed by the local authority. Or people who have been discharged from hospital have a summary report of their history and needs at that point. Daily records show that, on the day a new person is admitted to the home, a full entry is made about the individual and their needs. Sampford Care Home DS0000070152.V356092.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): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service have their abilities, needs and goals reflected in their individual plans. People using the service are supported to address most of their personal and health care needs effectively. Some improvements are needed in some care records to show that all aspects of health care are appropriate. People using the service are protected by the home’s procedures for the handling of medicines. People using the service have their privacy and dignity respected. EVIDENCE: There were 28 people living at Sampford Care Home when we visited. We checked sets of records for six of these people. Sampford Care Home DS0000070152.V356092.R01.S.doc Version 5.2 Page 12 All records relating to people using the service are being transferred to the format preferred by Majesticare. This process has already been completed in most cases. A full audit is planned for February 2008. The new format enables all relevant information to be recorded. Assessments are completed on topics such as nutrition, mobility, pressure areas, continence and dependency level. Where support needs are identified, care plans and risk assessments are then completed. These are kept under regular review. All of the records we checked had been reviewed within the previous month. In most cases all assessed needs have plans in place. Guidance is clearly set out, with explanations of how and why to give support. The involvement and consent of people using the service, or their representatives, is shown. Daily records include detailed notes about any relevant issues and show that identified concerns are followed up. Care plans include guidance on support with a wide range of needs. These include physical health areas, such as pressure area care. They also include emotional and psychological support, such as helping people who are prone to anxiety or distress. Health records include details of any contact with medical professionals. Some deficits were noted in the sampled records. In particular, one file which has not yet transferred to the new format had various gaps. Some plans for areas of care had been discontinued without clarity about why this had happened, or suitable information being included about a new approach for key areas such as continence and epilepsy. Two service users with diabetes had guidance within their care plans stating that certain areas, such as vision or condition of feet, must be checked by staff at regular intervals – in some cases daily. There was no accompanying evidence that this was happening. It was not clear if there had been a decision that these checks were not required, or if they were being omitted. We saw some people having difficulty with aids they need to help them with everyday living. One was unable to operate their hearing aid and told us that they didn’t have batteries for it. Another had his glasses on incorrectly so that they were pinching the nose and making it appear red and sore. This person has a health condition which increases the risk of skin damage. We checked systems for medication. Any medicines which need to be refrigerated are kept in a special lockable fridge for this purpose, which is in the nursing office. For all other medicines, suitable storage is provided on both floors of the home. Sampford Care Home DS0000070152.V356092.R01.S.doc Version 5.2 Page 13 Trolleys are used for medication rounds. These are chained to walls in locked rooms when not in use. Other medicines are stored in locked cupboards. Additional storage and recording controls are in place for some medicines, as required by law. All medication administration record charts that we checked are maintained appropriately. Alterations to prescriptions are noted down clearly and signed for by two staff. In one case, instructions from a GP about the various reductions to one prescribed dose over several weeks are clearly set out by a letter which the doctor has provided. People living at Sampford Care Home rarely retain any of their own medicines, although they may do so if they are assessed as capable. When we visited, one person was keeping their own inhaler. They have a suitable risk assessment and guidance, with evidence of their consent. The situation is reviewed every six months, with the involvement of the person’s GP. One person’s care plan relating to anxiety refers to possible use of a prescribed drug as an intervention to help manage this. However, the person’s current medication records no longer show the drug in question as being prescribed for them, and staff said that it has been discontinued. Another service user is prescribed a medicine ‘as required’ to assist in the management of pain. Records show that they have not taken it for several months. Staff told us that the individual is able to report their own pain and request the medicine if they feel they need it. However, the person’s care plan for medication does not include any information about this issue. We observed several examples of staff interacting with people living in the home during our two visits. On all of these occasions staff treated the people using the service with appropriate dignity and respect. All personal care was carried out in privacy. Sampford Care Home DS0000070152.V356092.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service are provided with a developing range of activities and opportunities, to help fulfil their recreational interests. People using the service are able to maintain and develop appropriate relationships with family and friends. People using the service are supported to exercise choice and control in all aspects of their daily lives. People using the service are offered healthy, nutritious and enjoyable meals, in line with individual needs and preferences. EVIDENCE: An activities co-ordinator is employed for 30 hours per week. A range of activities are provided daily, including gentle exercise, ball games, quizzes, art classes and walks in the garden. Sampford Care Home DS0000070152.V356092.R01.S.doc Version 5.2 Page 15 Group sessions are alternated between the two floors of the home. Usually around seven or eight people attend these. One to one sessions are provided for those people not wishing to participate in group activities, or no longer able to do so due to their health. These can be tailored directly to the wishes of the person. Examples include offering nail care, help with writing letters or doing crosswords and art or craft activities. Other staff also told us that they try and spend time with service users whenever they can. They may help them with activities such as knitting, or simply take time to sit and chat. Church services are held at the home once a month. Ministers of various religious faiths may visit, depending on the wishes of people using the service. Entertainment is also provided. Over the Christmas period a full schedule is planned, including a pantomime, a carol service and a party. Other events are marked throughout the year, such as pancake day and Easter. Plans for 2008 include an event to tie in with the summer Olympic games. It is hoped this will involve local schools; and relatives of people living at the home. Outings are provided for those people who are able to undertake them. Trips have included visits to Wilton House and to a garden centre. A local community bus can be hired to support people to go on shopping trips. People living at Sampford Care Home also enjoy reading, watching TV and receiving visitors. A record is kept of all activities offered and who attended. Some people using the service told us that they find time at the home can drag. The home has plans to extend its input to all its residents by completing social care plans for each individual, as one of its development targets in 2008. People using the service are able to maintain links with family and friends. The visitors book shows that there are regular visits taking place throughout the day. We saw a number of people visiting those living at the home, during both of our inspection visits. People living at the home are able to receive guests in their own rooms, or to make use of communal lounges if they prefer. Visitors sometimes have a meal with the person they are visiting. Records are kept of any social contacts for people living at the home. People using the service choose where they prefer to spend their time. We met several who enjoy spending their days in the privacy of their own rooms. People have various items in their rooms which help to occupy them, such as books, television, stereos and personal computers. Sampford Care Home DS0000070152.V356092.R01.S.doc Version 5.2 Page 16 Other people who we met like spending time in either of the home’s lounges. However, fewer people seem to do this. Some people told us that they don’t go to the lounges, simply because there is no-one else there to talk to. The home does not provide a separate dining room. People can eat in one of the communal rooms or in their bedroom. The comments made about the food were very positive. Two service users told us that they think the meals at Sampford Care Home are “excellent” and were very complimentary about the home’s new chef. Choice is available at each meal. The home is also able to cater for a range of special dietary requirements. People with chewing or swallowing difficulties can have pureed meals. Specialist requirements such as diabetes or food allergies can be taken into account. Many of the people living at the home require staff support at mealtimes. This is given in accordance with their needs. The home is also able to offer care to people with more serious physical health needs, who may need to receive nutrition via specialist feeding equipment. Nutritional risk assessments are in place, supported by a care plan if someone is considered to be at risk. Sampford Care Home DS0000070152.V356092.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service are protected by the arrangements for responding to any concerns about their welfare. EVIDENCE: A complaints policy and procedure is in place. The policy is openly displayed in the home. Information is also included in the pack sent out to prospective admissions to the home. A record of complaints is maintained. This includes information about any action taken and the outcomes. Recent issues raised with the home have been relatively minor. The home is working to ensure that all such concerns are logged, so that any themes can be identified, and potential issues can be addressed at an early stage. One service user told us that they had to raise a concern. They were happy with the response received when they did so. Procedures are also in place for safeguarding vulnerable adults, with information about the home links to Wiltshire’s multi-agency process for adult protection. All staff have received training in abuse awareness and are due for a further refresher. The home’s new manager is planning to attend more detailed training during 2008. Sampford Care Home DS0000070152.V356092.R01.S.doc Version 5.2 Page 18 The company has a policy for ‘whistle blowing’, which enables staff to raise any concerns they may have about practice. This has recently been reviewed and a new version issued. Some service users may present particular challenges, associated with their mental health needs. The records we saw relating to such issues have clear guidance in place about how to support the individual. There is input from other appropriate specialists, such as members of community teams giving support to people with learning disability or mental health needs. Sampford Care Home DS0000070152.V356092.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The building currently used to accommodate people is reasonably well maintained. Suitable steps have been taken to make initial improvements and there are longer term plans to improve the overall standard of accommodation. EVIDENCE: Sampford Care Home is made up of two buildings linked by a corridor. One building has not been used to accommodate people for several years. It is now in a very poor state of repair. The building is damp and badly damaged in various areas. Some ceilings have come down. The laundry facility and maintenance office are still in this building. It has also become a general storage area. Sampford Care Home DS0000070152.V356092.R01.S.doc Version 5.2 Page 20 The new owners have plans for complete redevelopment of the site. Their current plan is to demolish and rebuild. This will be done in two stages, subject to the necessary planning approval. Majesticare has consulted with local commissioners about likely future service demand. The completed new service, which they hope to have fully available by December 2009, should offer a total of around 40 beds for people with a mix of health care needs. The building currently used to accommodate people is reasonably well maintained. Bedrooms are decorated when required, so that service users’ own rooms are of a good standard. Areas such as bathrooms and corridors are less well decorated in parts. There are plans to redecorate a number of these, using more neutral colours. There are plans for further improvements, so that people living at the home benefit from these over the period leading up to completion of a new property. Accommodation is on both floors. There is a passenger lift between these, although it is quite small. The service is considering also providing a stair lift so that some people can get between floors more easily. All people using the service have individual bedrooms, although none of them have en-suite facilities. We visited several rooms during this inspection. They have been personalised by their occupants, with items including furniture, ornaments, pictures and photographs, and home entertainment equipment such as televisions, stereos and personal computers. Each floor has a lounge but no separate dining room. The possibility of creating a dining area on the ground floor is being looked into. Bathroom and toilet facilities are provided on both floors. Some changes have been made to these since the previous inspection. More are planned. A bathroom downstairs is to be converted to a ‘wet room’ style shower facility. Some furniture and equipment has been replaced. For instance, a number of new beds have been purchased. More changes are planned. We saw that a number of chairs are in poor condition, with damaged upholstery which spoils their appearance and also makes them hard to keep clean. The home arranged an overall assessment of the premises and equipment by an occupational therapist in September 2007, to advise on possible improvements that will aid people living there. There are various areas for staff. A nursing office and an administrative office are on the ground floor. The registered manager has an office upstairs, which Sampford Care Home DS0000070152.V356092.R01.S.doc Version 5.2 Page 21 is also going to move downstairs, to be more accessible to people visiting the home. A room was being converted for this purpose during our visits. Sampford Care Home also has a large garden at the rear, with views over open countryside. Some work has taken place to make this more accessible to people living at the home. However, plans for any further development have been put on hold until the expected major building works take place. The home was clean and hygienic to a reasonable degree, given the condition of some areas. We saw cleaners at work on both of our visits, using appropriate equipment. Each bedroom has a cleaning schedule form, which is kept on the back of the door. Staff make a note of when each required task has been completed. A ‘deep clean’ of the kitchen was completed recently. In response to a requirement of the last inspection, the service has a policy relating to the cleaning of re-useable medical equipment. Staff receive training on hygiene and infection control as part of the in-house programme. Sampford Care Home DS0000070152.V356092.R01.S.doc Version 5.2 Page 22 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): 32, 33, 34 & 35 Quality in this outcome area is good, and excellent in the area of qualifications for care staff. This judgement has been made using available evidence including a visit to this service. People using the service have their needs supported by suitable numbers of appropriately trained staff. People using the service are protected by effective practices in staff recruitment. Care is needed to ensure that all records are available for inspection. EVIDENCE: The home benefits from stability and continuity in the staff team. Some carers have worked at the home for many years and have a good understanding of the care needs of its residents. Staff working at the home under its previous ownership have retained employment with Majesticare. Staffing levels have been increased slightly by the new owners. The home has recruited extra carers to allow for additional cover when there are absences, due to issues such as holidays and sickness. This enables the home to cover the rota from within its own staff team, and avoid the use of agencies. Sampford Care Home DS0000070152.V356092.R01.S.doc Version 5.2 Page 23 For each daytime shift two nurses are on duty, each overseeing care on one floor. Carers work on both floors to support them. There are usually a total of five carers on early shifts and four in the afternoon and evening. Night time cover is provided by waking staff. There are one qualified nurse and three carers on duty for these hours. There are 13 ancillary staff, including catering, cleaning, laundry and maintenance. These posts are now overseen by a newly created post of house manager. This role has been taken up by the home’s administrator, who also continues to perform other duties. We spoke with staff who confirmed that they receive various training, from induction onwards. A number of areas are covered in-house, with DVDs which staff watch and then have to answer questions about afterwards. These sessions take place every week. Care staff have the opportunity to gain National Vocational Qualifications (NVQs) at Level 2 or above. The home is well above the minimum 50 target for care staff with such a qualification. Several staff have also gained the award at Level 3. We checked recruitment records for three recently appointed staff. These showed that all the required checks are completed before new employees begin working at the home. In one of the three files one written reference could not be located during our visit. However, the recruitment checklist showed that the home had chased this up when it was delayed, and recorded it as received before the staff member began at the home. All staff records are being transferred into a new format, which should reduce the possibility of key documents being mislaid. All recruitment is carried out through the home, including the interviewing of candidates and the processing of checks once people have been offered a post. Sampford Care Home DS0000070152.V356092.R01.S.doc Version 5.2 Page 24 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): 32, 33, 35 & 38 Quality in this outcome area is good, and is excellent in the area of quality assurance. This judgement has been made using available evidence including a visit to this service. The registered manager is suitably qualified and experienced, so that people using the service benefit from a well run home. There are thorough systems for quality assurance, including mechanisms for obtaining the views of people using the service and their supporters. Support for people using the service with their money is suitable and safe. People using the service have their welfare protected by most of the systems for upholding health and safety. Some improvements are needed in record keeping, to show that all individual approaches are appropriate. EVIDENCE: Sampford Care Home DS0000070152.V356092.R01.S.doc Version 5.2 Page 25 The registered manager of Sampford Care Home is Mrs Andrea Cole. She was appointed in June 2007, around the same time that Majesticare purchased the home. She was registered as manager in December 2007. Mrs Cole is a qualified nurse who has also completed a National Vocational Qualification (NVQ) in management at Level 4. Mrs Cole is line managed by one of Majesticare’s operations managers, who oversees this and four other homes in the group. The operations manager visits Sampford Care Home at least once a month, and carries out the checks and reports required within Care Homes Regulations. Majesticare also have a director of nursing, who is able to provide appropriate professional support and advice. Within the home, the registered manager is supported by a senior nursing colleague, who is also responsible for overseeing the care of people living in the home. The new house manager oversees ancillary staff, so that the registered manager can concentrate more exclusively on care issues. There are a number of systems which contribute to quality assurance. Majesticare have an annual plan for each of their homes which sets out the areas to be checked on every month. Some of these occur more than once during the annual cycle. The home is also working through a complete audit of all areas of its operation, linked to the care home standards. For each section a checklist is kept of the various examples which can be produced to show compliance. These are then collected together as a portfolio of evidence. The registered manager is compiling this, which will then be checked by her line manager. Surveys are distributed to people using the service and their relatives on different topics at intervals of about three months. The feedback requested is on issues such as life in the home, activities, the admission process and care delivery. The responses received are then collated by the manager. The service has a detailed improvement plan which identifies areas to address in each of the outcome groups in care home standards. The most comprehensive plans fall within the ‘Environment’ section, recognising that this is the area in which most improvements are required. The improvement plan format sets out what needs to happen, the actions towards this, who is responsible and a target date for achievement. The improvement plan for Sampford Care Home includes completing the transfer of all documents to Majesticare formats; and producing social care plans for all people living at the home, based on their life histories. Sampford Care Home DS0000070152.V356092.R01.S.doc Version 5.2 Page 26 Some people living in the service wish to retain their own money. There is suitable storage in their own rooms for them to do this. However, most of the people living at Sampford Care Home have help in managing their money. We saw that there are appropriate systems to store this securely and to keep records of the balance for each individual. Only three staff have access to the moneys held. Records are made for all transactions, with the majority being signed for by two people. Receipts are retained for most expenditure. The systems are audited internally at least once every three months. We checked some sample records against the sums being held and found that these tallied. When moving into the home, people using the service or their relatives sign to indicate their consent, if they wish to make use of the arrangements for support with their money. Each individual indicates, from a list of options, what items their own money may be used for. There is also a facility to record which sums can be given to someone living at the home for them to keep at their own risk, which promotes a degree of independence for people not managing their own money. Health and safety is audited by an external company which Majesticare have contracted with. Their most recent inspection of Sampford Care Home led to a long list of recommendations. As a result, various tasks are being addressed. Fire exit doors are having old locks replaced with push handle opening devices, which will be simpler to operate in any emergency. Some bedrooms are being fitted with extra electrical sockets, so that there are fewer double plugs or trailing wires. New service and maintenance contracts have been set up for key areas such as gas safety and testing of portable electrical appliances. There are also regular weekly checks of various health and safety topics. We saw staff on duty using appropriate equipment, such as hoists with slings, to lift and transfer people living at the home. Staff took care to uphold privacy and dignity whilst carrying out such tasks. For instance, they intervened to adjust one person’s clothing so that it was appropriately positioned. Oxygen is used and kept in various rooms around the home. We saw that the required signage is in place wherever this is needed. A number of people living at Sampford Care Home have bed rails in place. We saw several appropriate examples in people’s records about risk assessments and evidence of consent for this. However, one person had a mat on the floor next to their bed, rather than bed rails. Records show that the person has falls from bed on to the mat. The individual’s care plan does not contain Sampford Care Home DS0000070152.V356092.R01.S.doc Version 5.2 Page 27 information about why this approach has been chosen instead of bed rails or some other intervention. Sampford Care Home DS0000070152.V356092.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 3 X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 X X 2 Sampford Care Home DS0000070152.V356092.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? N/A 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 OP8 Regulation 12-1 14 15 12-1,2,3 13-7,8 Requirement There must be evidence of suitable support for and monitoring of all identified health care needs. Timescale for action 31/01/08 2 OP38 The persons registered must 31/01/08 ensure that documented risk assessments are in place for any decisions relating to the use of a mat on the floor by a bed instead of using bed rails. 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 OP7 Good Practice Recommendations The service should complete its audit and review of all care plans, so that there is consistent quality of information about all people using the service. There should be clear guidance about any assistance people using the service require with sensory aids, such as DS0000070152.V356092.R01.S.doc Version 5.2 Page 30 2 OP8 Sampford Care Home glasses or hearing aids. 3 OP9 Medication records and care plans should be checked, to ensure that any information about prescribed medicines is cross-referenced correctly. Medicines prescribed to be given ‘as required’ should have clear guidance about the circumstances in which they may be administered. 4 OP9 Sampford Care Home DS0000070152.V356092.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Regional Office 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 Sampford Care Home DS0000070152.V356092.R01.S.doc Version 5.2 Page 32 - 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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