Care Home: Sandbanks Care Home

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What the care home does well The home continues to provide a pleasant environment for its residents with personalised bedrooms, and a variety of communal areas to use. The gardens provide a safe area for people to walk, with handrails and areas to sit. People using the service and families said "staff have been very helpful and are always available to talk", "I have been very happy with the care my relative has received" "I am more than satisfied with the care" and "the staff are excellent". Staff felt that the home provided person centred care planning, staff training and good activities. Those responding to the surveys, and staff spoken to, were positive about the training, induction and support. What has improved since the last inspection? The home is making use of technology, such as sensor pads, to help improve safety. The care plans have continued to improve and provide easily accessible information for the residents and staff. Good monitoring systems are in place to ensure that all of the documentation is regularly checked. What the care home could do better: There were no requirements at this inspection as the areas where improvements could be made to the environment, the replacement of the cupboards in the three kitchenettes and the hall carpets, were already being addressed. CARE HOMES FOR OLDER PEOPLE Sandbanks Care Home Southville Road Bedfont Middlesex TW14 8AP Lead Inspector Ms Jane Collisson Key Unannounced Inspection 24th August 2008 09:25 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 Sandbanks Care Home DS0000032618.V370582.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. Sandbanks Care Home DS0000032618.V370582.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sandbanks Care Home Address Southville Road Bedfont Middlesex TW14 8AP 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) 0208 890 4872 0208 890 1160 paula.bilbie@hounslow.gov.uk London Borough of Hounslow Miss Paula Carol Bilbie Care Home 34 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Sandbanks Care Home DS0000032618.V370582.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is: 34 7th June 2007 2. Date of last inspection Brief Description of the Service: Sandbanks is a purpose built home for 34 older people. Owned and managed by the London Borough of Hounslow, it is situated in a residential area of Bedfont, with local shops and buses within half a mile. There is adequate parking for staff and visitors, both in front of the home and in the nearby road. Two units, Swallows and Lapwings, provide fifteen beds for people with dementia, both situated on the ground floor. On the first floor is the Magpies unit with ten beds for older people who may be frail because of illness, disability or age. The Community Rehabilitation Unit, with eight beds, is on the first floor. This provides Intermediate Care, for up to six weeks, for people who have been in hospital, or at home, and require support to enable them to continue to live at home. A physiotherapist and an occupational therapist, employed by the Primary Care Trust, support the people using the service. Each unit has a pleasantly furnished lounge, kitchenette and dining area. Thirty two of the bedrooms are single and there is one double room. All of the rooms are over 12 sq. metres and each has a wash hand basin. There are four bathrooms, including a shower room and baths with equipment for people with disabilities, and nine toilets situated throughout the home. The communal facilities include a large lounge, suitable for entertainments, functions and meetings. There is a large entrance hall with seating, and a room for visitors, residents and staff to use to make drinks. The well-furnished conservatory is used as the smoking area. The home has an extensive garden, Sandbanks Care Home DS0000032618.V370582.R01.S.doc Version 5.2 Page 5 with a pond and seating. Part of the garden has been separated to provide an area for people from the dementia units to use safely and securely. The Registered Manager has the title of Resource Centre Manager, as she is also responsible for the day centre located on the same site. There is a Deputy Manager, four Team Leaders and a team of day and night support workers and auxiliary staff, an administrator and an activities organiser. The fees are £650 per week. Sandbanks Care Home DS0000032618.V370582.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. We commenced this unannounced inspection on Sunday 24th August 2008 from 9.25am to 5.00pm. The Registered Manager was on leave. We were assisted by the Senior support worker in the morning and the Deputy Manager during the afternoon. A tour of all of the units and communal areas was made. There was a relaxed atmosphere and some residents were still having their breakfast. There were fourteen people in the dementia units, including one person on respite, five people in the Community Rehabilitation Unit and nine people in the older person’s unit. Seven care staff were on duty, in addition to the Senior support worker. During the inspection, we met five families visiting their relatives. The lunch time meal, which was a Sunday roast, was observed. The second visit of the inspection was made on the 27th August from 2.30pm to 4.15pm to complete the inspection and meet with the administrator. Because the first visit was at a weekend, the physiotherapy and occupational therapist were not working. The physiotherapist was met briefly on the second visit. He is shortly leaving his post but a new physiotherapist and a permanent occupational therapist have been appointed. The Activities Organiser was on holiday but a bingo session was being held on the second visit to the home. We sent surveys to the people living in the home and to the staff. Twenty one people replied, some having been assisted by their relatives or staff to complete the forms. Ten staff returned their forms. People were generally very positive about the care and support that they or their relatives receive, particularly those who had been in the home for a long time. People said that the “home is excellent”, the staff “are very good” and “all care is carried out with the person’s needs taken into consideration”. None of the people currently living in the home had any cultural needs to meet in relation to their diet. People who are diabetic and vegetarian are accommodated. The cook said that meals, such as Asian food, can be prepared if necessary. Care plans record people’s preferences in regard to cultural needs and whether or not people wish to have any special requirements provided. We found that the religious needs of people are met by the provision of communion on a weekly basis and church services once a month. A number of the staff on duty were from an agency but all of those we spoke to had previously worked in the home. The home has not been successful recently at recruiting staff but further efforts are to be made with an “open Sandbanks Care Home DS0000032618.V370582.R01.S.doc Version 5.2 Page 7 day” and the attendance at a job fair. Staff said that they did have some concerns about the high level of agency staff and how this affected the care in the home. We looked at a variety of records, including care planning files, medication, complaints and maintenance. The home completed the Commission for Social Care Inspection’s Annual Quality Assurance Assessment very comprehensively and accurately. This gave details of the home and how it functions, together with numerical information about the residents, staff, training and documentation. We examined at this inspection all of the key National Minimum Standards. There were no requirements at the previous inspection and none at this. What the service does well: What has improved since the last inspection? What they could do better: There were no requirements at this inspection as the areas where improvements could be made to the environment, the replacement of the cupboards in the three kitchenettes and the hall carpets, were already being addressed. Sandbanks Care Home DS0000032618.V370582.R01.S.doc Version 5.2 Page 8 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. Sandbanks Care Home DS0000032618.V370582.R01.S.doc Version 5.2 Page 9 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 Sandbanks Care Home DS0000032618.V370582.R01.S.doc Version 5.2 Page 10 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, 5, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Community Rehabilitation Unit is providing a service to help people to regain their independence and to return to their homes. People are provided with the information to help them to make a decision about living in the home. Full assessments demonstrate that the home is suitable to meet the needs of the people admitted. EVIDENCE: The home has up-to-date documentation to support people to make a decision about the home. Copies of the Statement of Purpose and Service Users Guide were provided and have detailed information about the management of the home and its various services. The Service Users Guide provides, in larger print, clear information on the facilities and services available in the home, which includes the complaints procedure. There is a CD of the Service Users Guide available for those that Sandbanks Care Home DS0000032618.V370582.R01.S.doc Version 5.2 Page 11 may require an audio version. Signed copies of the terms and conditions were seen in the files examined. We examined eight files from all four units which included the assessments received from Social Services or the hospital prior to admission. The care plans showed how the needs of the people being admitted could be met. People said that they had been able to visit prior to admission and one family said that “all of their questions were fully answered” and they were able to speak to relatives and their families about living in the home. The home’s units can meet a variety of different needs. The ground floor facilities are available for people with dementia and staff have received the training to support the needs of the people with this diagnosis. The general unit supports people with physical disabilities and those who are frail. The home has been able to manage, with the help of specialist nursing support, people with terminal care which has enabled them to remain in the home. The Annual Quality Assurance Assessment explained that the home is to apply for accreditation from the Royal National Institute for the Blind’s “Visibly Better Residential Services” to support those with impaired vision and the folder for this was seen on the inspection. Changes were being made to the Community Rehabilitation Unit (CRU) during the last inspection and it was relocated to the first floor. A treatment room has been created on the ground floor and has the equipment required to assist the staff to undertake the specialist support for rehabilitation. We did not meet with the professional staff in the Community Rehabilitation Unit on the first visit to the home, but saw in the files the information for ensuring that the people in the unit have the support they need. These included goals for their stay, which is for a maximum of six weeks. We spoke to people in the unit and they were happy with the services the home provides, including the food and their rooms. One person said that the stay had enabled them “to get their strength back”, and the good food provided had helped with this. The physiotherapist was met on the second visit. There has been good continuity as he has been working in the home for more than three years. However, he was shortly to leave the service but was to hand over to a new physiotherapist. The occupational therapist has been part of the community team and is also to be replaced by a new staff member. One of the senior staff is responsible for the care staff in the unit, but was on leave. Sandbanks Care Home DS0000032618.V370582.R01.S.doc Version 5.2 Page 12 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, 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are in place and written in an easy to follow style. The health needs of the people living in the home are met by a variety of community services. Staff competency with medication administration is regularly checked. Staff were seen to be treating people appropriately. EVIDENCE: In the Annual Quality Assurance Assessment, the home explained that the Person Centred Care Planning is used in the service “to ensure that all aspects of an individual’s chosen lifestyle are incorporated into the care they receive and in a manner which affords them as many choices as possible as to how their care is delivered”. We examined a sample of eight care plans, with some from each of the four units. In addition to basic information regarding each person, and a photograph, we found the care plans provided information on all of their needs. We found the care plans, which show the identified needs, how they are to be met and by whom, to be clear and easy to follow. Regular reviews are Sandbanks Care Home DS0000032618.V370582.R01.S.doc Version 5.2 Page 13 made, on a monthly basis, and are signed by the residents wherever this is possible. Six monthly reviews are also held and we saw a file which records when these take place and if a reviewing officer attends. Regular monitoring takes place to ensure that these reviews are held. Cultural and religious needs are recorded and whether or not the person wishes to follow them. We found the health needs of people are met through the community services. People are registered with various general practitioners’ practices in the area. The district nurses visit the home twice weekly and we saw notes written by them in relation to the residents’ support. A 28-day Monitored Dosage System in used in three of the units. We examined the medication in two of these and found it to be in order. In the Community Rehabilitation Unit medication is kept in its original containers and people are assessed for self-medicating as they will usually need to do this when returning home. Where someone may need assistance to regain their confidence, staff will administer the medication. An assessment is carried out and samples were seen. The people who self-medicate have a locked space in their rooms in which to store their medication. We saw that staff are tested each year for their competency in giving medication. Regular audits are also carried out. There is a record in each file of the person responsible for giving medication on the shift and a monitoring check. Five medication errors have been recorded since the last inspection and the Commission for Social Care Inspection was notified where appropriate. We checked the medication in three units and found, when checking a sample, that there was one error in the stock figure brought forward. The medication, which was “as and when”, had not been used. The Deputy Manager was asked to check the stock and to find out where the error had been made, which was done. The remainder of the check was satisfactory. There were three insulin dependent diabetic people in the home. Two are selfmedicating and one has assistance from the staff who have been trained by the district nurses. The home also had a kit to support people with low blood sugar to avoid hypoglycaemia. Blood sugar levels are checked regularly. The training record showed that fourteen staff have been trained in insulin administration. We saw that people’s preferences are included in the care plans, such as same gender care and likes and dislikes. We saw evidence that, where a person had made a choice against medical advice, this had been discussed with the person, and their family, and recorded. People spoken to during the course of the inspection were positive about the way in which they are treated by staff. One relative said that their relative is “treated with respect and empathy”. Sandbanks Care Home DS0000032618.V370582.R01.S.doc Version 5.2 Page 14 There was a good rapport noted between the staff and the residents, and a pleasant atmosphere. Arrangements, which might be needed in the event of someone’s terminal illness or death, are included in the care plans. In a number of the care plans, information on peoples’ wishes with regard to their funeral arrangements was seen. Where people are unable to state their own wishes, the families have been involved in completing the records. The home has been able to keep people in the home who are terminally ill. Staff have identified the need to have palliative care training and this was being requested. Approximately half of the staff have had bereavement training. The home states in its Annual Quality Assurance Assessment that “we have excellent relationships with other health professionals such as the Macmillan Nurses and Palliative Care Team to ensure the service user along with their family/friends and the staff, are supported and comforted, and that their wishes in regard to their care up to and following death are met”. Sandbanks Care Home DS0000032618.V370582.R01.S.doc Version 5.2 Page 15 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. A range of regular activities are offered. There is a commitment to supporting residents to be as independent as possible and maintain their skills. The menu is varied and people say they enjoy the meals. EVIDENCE: An Activities Organiser is employed for three days a week. She was on leave so was not met during this inspection. Because of the temporary stays of some of the residents, and the dementia of nearly half of the residents, the feedback on activities was limited. However, there was information in the surveys to say that people find the activities to be sufficient, although some people said they did not wish, or found it difficult, to join in because of their health. There were no specific activities on the first day of the inspection, but a bingo session was held on the second visit. There was some concern among staff about the staffing levels and we were concerned that there could be difficulties in providing individual activities in the units, particularly when one-to-one activities can be desirable for people with dementia. Sandbanks Care Home DS0000032618.V370582.R01.S.doc Version 5.2 Page 16 All of the lounges have large, flat screen televisions for people to watch. People also have their own televisions if they wish. A small number of people have newspapers. A small “shop” is provided by a volunteer, on a weekly basis, so that residents can buy sweets, toiletries, stamps and other small items. Staff said that people are able to enjoy activities such as baking. A person replying to the surveys said that dominoes, skittles, sing-a-longs and cooking are enjoyed. One person said that they enjoyed the quizzes. A training course to enable to the staff to facilitate chair exercises has been requested. Entertainers come to the home regularly and outings take place. People are able to have their families and friends to visit at any time. Five families were seen on the first day of the inspection. They have the space to see their relatives in private. They were seen to use the drink making facilities available to relatives and residents. All of the people spoken to were positive about the home and those who had several years’ experience of the home said that it was “excellent” and they “couldn’t fault it”. One person confirmed that their relative was able to follow their religious beliefs on a regular basis. We saw that people were able to make choices, within the limitations of their disabilities. Those on the first floor, being more able to make decisions, were seen to go to their rooms or to various parts of the home as they wished. Those in the dementia unit are less able to choose but were seen to be encouraged to carry out small tasks. We observed the lunch being served. Vegetables are served in individual dishes so that people can choose how much they wish to have. Meals are served in the dining area in each unit and the tables were seen to be nicely laid. We saw a Sunday lunch of roast pork, Yorkshire puddings, roast and boiled potatoes, beans and carrots. A vegetable slice was available as an alternative or for the vegetarian residents. Salads were also available. A large print menu was displayed on each of the tables. People said that the food served that day was “very good” and everyone spoken to said that they enjoyed their lunch. A peach flan and cream was served, with peaches and cream for the diabetic residents. The majority of the feedback in the surveys was that people “always” or “usually” liked the meals, although one person said they were not always to their taste and their family sometimes brings food in. One person said the meals could be “more adventurous”. Comments are regularly kept on the meals provided and these are reported upon. There is no set menu for the evenings and people are asked what they would like and these may be cooked items or sandwiches. Fruit is supplied twice a week. The cook said that, although the rising cost of food was affecting the budget, she had tried to maintain the standards. Sandbanks Care Home DS0000032618.V370582.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. There are robust complaints and safeguarding adults’ guidance in place. People are aware of how to make a complaint. Staff are trained in safeguarding adults’ procedures. EVIDENCE: There has been one complaint recorded since the last inspection in June 2007, which was satisfactorily resolved. Eight compliments were also recorded. There is information about the complaints procedure in the Service Users Guide and in the Statement of Purpose. People spoken to and replying to the surveys said that they were aware of how to make a complaint. One person said that they had never had to make a formal complaint, but said that any minor problems are sorted out satisfactorily. In its Annual Quality Assurance Assessment, the home says that it has taken notice of the Charter Mark visit feedback to review the complaints and monitoring form. It will also promote the use of the suggestion box as it provides anonymity for those who do not wish to “make a fuss”. Staff said that they had training in safeguarding adults’ procedures and understood them. There have been no safeguarding adults meetings held in respect of the home. However, where any possible concerns have arisen, the Sandbanks Care Home DS0000032618.V370582.R01.S.doc Version 5.2 Page 18 home has asked the advice of the London Borough of Hounslow’s safeguarding adults department. Those issues did not require a safeguarding adults investigation and were resolved within the home. The Commission for Social Care Inspection has been kept informed of any issues through the Regulation 37 notices. Sandbanks Care Home DS0000032618.V370582.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, 20, 21, 22, 24, 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home continues to be well maintained, with comfortable communal areas, outdoor facilities and personalised private spaces. There is a selection of communal areas both inside and outside of the home, this means that people using the service have a choice of place to sit quietly, meet with family and friends or be actively engaged with other people who use the service. Suitable equipment is available for bathing and showering safely. The home is clean and hygienic. EVIDENCE: We found that the home is pleasantly furnished, in a homely style, and is well maintained, clean and comfortable. All of the bedrooms we saw were personalised and furnished in an individual style. People who were able to comment said that they were happy with their rooms. They are large enough to accommodate more than one comfortable chair if the person wishes to entertain their visitors in their room. However, there are also a variety of Sandbanks Care Home DS0000032618.V370582.R01.S.doc Version 5.2 Page 20 other areas and visitors were seen to make good use of these, particularly when there were a larger number of visitors. The Deputy Manager said that the three kitchenettes are to be refurbished. The fourth one has been replaced in the last year and is designed to help people with dementia to be able to use it. We noticed that the carpets in the corridors were in need of replacement as areas were fraying. This work has already been agreed and new carpets were to be provided in the corridors and staircases within a few weeks. A conservatory is provided for residents who smoke, although we were informed that none of the current residents do so. One family were making use of the garden on the day of the inspection. The home has four bathrooms and nine toilets. These are located throughout the home and some are near to the larger communal facilities. The equipment available includes a shower room and assisted baths. The home also makes use of equipment such as an inflatable cushion to help to move people who may fall and sensor mats for people who may get up in the night and need assistance. We found the home to be very clean on both of the visits of this inspection. People were asked in the surveys about the cleanliness of the home and responded positively. We saw the laundry and the person who undertakes the majority of this work for the residents. She confirmed that equipment was all in working order. The laundry room was clean and tidy. We also found the kitchen to be clean and in good order. Staff said that they have time at weekends to undertake deep cleaning as they do not have to cook for the day centre, a task they undertake from Monday to Friday. The home’s cook has a National Vocational Qualification Level 2 in catering. Sandbanks Care Home DS0000032618.V370582.R01.S.doc Version 5.2 Page 21 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): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service ensures that all staff receive relevant training that is targeted and focused on improving outcomes for residents. Staff report satisfaction with the level of training and the programme shows that staff have the opportunity to undertake relevant courses. There is an excellent level of National Vocational Qualifications training. EVIDENCE: There are currently three staff covering the two units for the fifteen people with dementia. There are two staff in the Community Rehabilitation Unit and two staff in the mornings and evenings in the fourth unit, with single staff cover during the afternoon. Three staff are on waking night duty. Approximately half of the staff on duty were agency staff. The London Borough of Hounslow now only uses one agency for continuity. We found that the agency staff on duty were familiar with the residents as they had all worked in the home before. However, there was concern raised by permanent staff about the high number of agency staff. In the Annual Quality Assurance Assessment, the home explains that the uptake from interview to starting in post is disappointing. The home has been unsuccessful in recruiting staff on two occasions. There are to be stalls at a job fair and an “open day” for the London Borough of Hounslow’s homes for older people. Sandbanks Care Home DS0000032618.V370582.R01.S.doc Version 5.2 Page 22 There are two staff in the home who are manual handling trainers and provide the training for staff. The Deputy Manager also undertakes some of the training courses. Dementia training has been provided by the Alzheimer’s Society and the home was looking for more advanced training. A comprehensive list of the training undertaken, together with the renewal dates, was provided. Staff were all up-to-date with the basic training courses of moving and handling, infection control, first aid, food hygiene, safeguarding adults, whistle blowing and fire training. Twelve of the staff have the 4-day first aid training. In addition, medication competency training is carried out regularly and the documentation on this was seen. Other courses attended by most of the staff include customer care, challenging behaviour, fire warden training and dementia awareness. The Deputy Manager provided us with a training development plan which included the updates people require, and requests for advanced dementia and “end of life” training. Only one new staff member is in post and was working through the induction training, which follows the Skills for Care programme. We checked a sample of forms which the home keeps as the records are held at the London Borough of Hounslow’s human resources department. They have permission to hold “pro forma” information and a sample of these forms were examined and found to be in order. We found that there is a good level of National Vocational Qualifications training and twenty three of the twenty four care staff have National Vocational Qualifications Level 2, with three also having Level 3. The cook has Level 2 in catering and two domestic staff have National Vocational Qualifications Level 1. Sandbanks Care Home DS0000032618.V370582.R01.S.doc Version 5.2 Page 23 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): 31, 33, 35, 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is well managed by suitably qualified and experienced staff. People’s finances are safeguarding by good accounting systems. The health, safety and welfare of the residents are met by regular maintenance and systems checks. The AQAA contains excellent information that is fully supported by appropriate evidence. It includes an understanding of the importance of equality and diversity and evidence showing how they have listened to residents. Quality assurance systems are in place for checking a variety of systems. Record keeping is of a consistently high standard. EVIDENCE: The Registered Manager has several years’ experience of managing residential homes and has the Registered Managers Award qualification. The Deputy Manager also has the Registered Managers Award and NVQ Level 4 in Sandbanks Care Home DS0000032618.V370582.R01.S.doc Version 5.2 Page 24 management. He is also a National Vocational Qualification Assessor and Verifier. There has been a reorganisation within the Borough which had led to some staff being re-graded. A number of staff have left the home and these changes have led to some dissatisfaction among the staff. However, staff said that they enjoyed working in the home and with the residents. In the surveys they said felt sufficiently well trained and “worked well together as a team”, although one person said more “team building” would be a way in which the home could improve. The Deputy Manager showed us the regular audits which are undertaken. This system is used by the three London Borough of Hounslow older peoples’ homes and is being refined to provide the information required. An Action Plan was in place to show how improvements can be made. The checks included reviews and audits of medication. The Deputy Manager reported that the quality assurance systems are in the process of being reviewed with view to improving them. Regular and detailed Regulation 26 visits are made to the home. The home reports accident and incidents, under Regulation 37, as required. The Annual Quality Assurance Assessment records that regular meetings for the people and their representatives take place. Surveys are used for feedback. The home states that, following a Relatives/Representatives survey carried out in January 2008 visitors were not always aware who staff were. From this, staff are reminded, on handover, to wear their name badges. We saw that the majority of staff have had their annual appraisals this year and that regular supervision sessions are held. A plan has been develop of the training needs identified. All of the supervision and appraisal are recorded on charts so that the evidence is available to be seen. We checked a sample of fire records and found that they were in good order. A fire risk assessment has been completed and was due to be updated shortly after the inspection. An evaluation of the evacuation procedures was due to take place. Weekly fire drills are held and all of the staff in the home take part so that they are fully aware of the procedures. The maintenance records showed that small electrical appliance testing took place in December 2007. The last hot water testing took place in August 2008 and the lift was serviced in June 2008. Several of the policies and procedures, which are produced by the London Borough of Hounslow, were noted not to have been reviewed for some years. It is recommended that these are reviewed in the near future to ensure that they are in line with current legislation. We checked with the Administrator the systems in place for managing people’s money. In most cases, the families of the residents bring in sums of money Sandbanks Care Home DS0000032618.V370582.R01.S.doc Version 5.2 Page 25 for their personal requisites, such as hairdressing, newspapers, toiletries and outings. Only three people have their money managed by the London Borough of Hounslow. The accounts are regularly audited and checked against the sums kept in the Borough’s accounts. We saw samples of the records which are kept manually and on the computer system. These include receipts for money brought in and the receipts kept for the expenditure. A monthly receipt is provided to each person of his or her expenditure. The home has an account to pay for extra treats for the residents and some fund raising takes place. Sandbanks Care Home DS0000032618.V370582.R01.S.doc Version 5.2 Page 26 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 3 4 HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 3 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 4 3 3 3 X 4 X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 4 4 X 3 Sandbanks Care Home DS0000032618.V370582.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP36 Good Practice Recommendations That the Registered Providers demonstrate that reviews of all of the policies and procedures are undertaken to ensure that they are up-to-date and relevant. Sandbanks Care Home DS0000032618.V370582.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Sandbanks Care Home DS0000032618.V370582.R01.S.doc Version 5.2 Page 29 - 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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