Care Home: Sandhills

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What the care home does well Admissions were found to be thorough and care was taken to ensure people were welcomed into a relaxed and happy environment. A new communications profile will add significantly to the information carers require to ensure needs are known and can be met. There was excellent evidence about the importance placed on providing people with choices and to ensuring individual needs and wishes were met. The Leisure companion to provide an extra element of support and enjoyment was seen to be working well. The staff team were seen to be skilled, well motivated and experienced in working with people who live at the home. They knew people`s needs very well and were able to respond when needed. What has improved since the last inspection? XX What the care home could do better: XX Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Sandhills Lower Road Stalbridge Sturminster Newton Dorset DT10 2NJ two star good service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Peter Still Date: 0 9 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Internet address www.cqc.org.uk Information about the care home Name of care home: Address: Sandhills Lower Road Stalbridge Sturminster Newton Dorset DT10 2NJ 01963362247 01305252001 sandhills@drh.uk.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Dorset Residential Homes care home 10 Number of places (if applicable): Under 65 Over 65 10 0 learning disability Additional conditions: The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability - (Code LD) The maximum number of service users who can be accommodated is 10. Date of last inspection A bit about the care home Sandhills is located on the outskirts of Stalbridge in North Dorset, and is a registered care home providing nursing and personal care for up to 10 people with learning disabilities. One of the bedrooms is made available for short stay/ respite accommodation. The home is managed by Dorset Residential Homes, a registered charitable trust that operates a number of care services across Dorset. The home is a detached property that has been extended and converted to meet the needs of service users. The communal areas comprise a lounge, separate dining room, conservatory and kitchen. There is small office on the first floor for staff. Detailed information about the services provided at Sandhills can be found in the homes Statement of Purpose / Service User Guide. Weekly fees were between one thousand and fifteen pounds and one thousand, two hundred and three pounds. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home This was a key, unannounced inspection. The last inspection was undertaken on 25th October 2006. Prior to the inspection, we reviewed information the Commission had received since the last inspection. We also sent out surveys to: people who live at the home, staff and professionals. The manager was not working at the home on the day of the inspection and we were supported by her senior staff, who were open and very helpful in supporting the process. The manager came to the home towards the end of the inspection to see if any points needed her support and this was helpful too. We examined a number of files including care plans, risk assessments and files relating to the maintenance of the building. We spoke with a number of people who live at the home and were given help to communicate with other people. We observed staff as they worked and we also made a tour of the building to consider the environment. What the care home does well What has got better from the last inspection What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Peter Still 33 Greycoat Street London SW1P 2QF 02079792000 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . A carefully planned and comprehensive admission policy, ensures people are admitted on the basis of a thorough assessment and that their needs can be met. People who live at the home are protected by having a written contract of residency. Evidence: We reviewed the statement of purpose and service user guide for the home and three files to consider the admission process. One new person had been admitted since the last inspection and their experience had been positive. The Home ensures a carefully planned admission, which includes documentation about the home in easy to read format, visits and consideration of assessment information. People will often have a weeks trial at the home before any decision is made. Each file reviewed, contained a written contract, the file for one person did not have an index, which made it a little difficult to find information but other files did. Information provided showed that care is taken to ensure a smooth transition for people moving to the home, which includes family members and others important to the person. The manager and her staff create a warm and welcoming environment and all people living at the home are involved. Documentation shows that pre admission information is built into the care plan for the individual. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who live at the home have their needs comprehensively recorded. A system was in place to help staff ensure people can make decisions and choices in their lives. Risk assessments are undertaken to keep people safe and to support those risks, which can improve peoples quality of life. Evidence: We were shown the communication passport for one person receiving respite care. The document had been produced by another service and it was considered to be excellent in its layout and content. Staff spoken with talked about its value, which contained key information within an easy to understand format. The booklet goes with the person, wherever needed such as for a respite stay or to a hospital. It was considered that a carer reading the information would immediately understand key needs of the individual. We were told that Sandhills was actively pursuing the same sort of key information booklet and will adopt many of the principals. We considered that it was good practice that Sandhills was willing to consider helpful tools developed by others. The booklet Sandhills uses is called my communication profile. We looked at a file, which contained valuable information for example Makaton signs the person can use. The document was interspersed with pictures, which gave a good understanding of the individual. Each individual has a chart called Choices and essential needs to aid my life and support. This enables staff to monitor choices people make each day so that they can Evidence: be analysed and used to help with the development of further choice. It also shows how much input staff need to give, with the aim of reducing this where possible. Choices include: What time to have dinner; to have some quiet time; when to go out; hand face/ nail care; skittles. The manager had made a key statement within her Annual Quality Assurance Assessment concerning the aim of the home to: promote a positive emotional environment, a sense of well-being within a safe environment, key workers listening to and actioning individual choices. We observed that staff were promoting these aims with great commitment during the inspection. One support plan we reviewed had been updated in the middle of January this year and was therefore considered up to date and was detailed concerning the persons needs. The home was in the process of transferring care plan documentation to a new and more detailed system called the 24 hour clock. This will provide the care plan information throughout the day and will provide easy reference to changing needs at different times of the day. Evidence from residents meetings showed that people living at the home were consulted about the running of the home and have a say in what they like to do. Activity records also demonstrated this. We examined risk assessments and found them to be comprehensive and up to date. One assessment had been reviewed at the end of the previous month. One assessment reviewed concerning a significant personal healthcare need was both comprehensive and clear in its detail. All confidential documentation was seen to be kept locked away. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living and Sandhills enjoy an active lifestyle and are supported to do the things they wish to, which includes involvement in the local community and support to maintain good relationships with family and friends and companions. Staff promote and support individual choice and the rights of people in all aspects of their lives to enhance their quality of life. People are supported and benefit from a healthy diet, which includes choice. Evidence: Most people who live at Sandhills spend time during the day at a local education centre and evidence was seen, which shows good communication between the centre and Sandhills. Staff were observed to constantly offer a range of activity, which was also documented and talked about. One record showed that an individual wanted to go out for skittles on their birthday and had made it clear they wished all at the home to go too. The home is located close to local amenities, which people enjoy. We spoke with a Leisure Companion who works with three people on a rotational basis, to provide one to one companionship. This Companion said they thoroughly enjoy their work and the benefits they see for people are rewarding; they had good feedback on their work and are well supported by staff at the home; an individual had chosen to go shopping in Yeovil on the day of inspection. A reflexologist also visits every two weeks. Evidence: It was clear that staff have a commitment to ensuring lifestyle, including activity is a part of everyday life and centred on what each individual wants. We observed two people receiving quality one to one time with staff during a part of the inspection. The manager reported in her Annual Quality Assurance Assessment that she intends to develop tactile activities within Sandhills over the next twelve months, which we consider to be a beneficial objective. We spoke with one individual who said I get on with all staff and talked enthusiastically about a holiday in France. Another talked about attending three groups for the blind, which they enjoy. The Annual Quality Assurance Assessment gave evidence about staff working to improve individual emotional connection and communication. This was considered during the inspection and it was observed that all staff communicated easily and with confidence. They knew peoples individual needs well and were able to understand emotions. It was noted that the manager intends to undertake further work to improve Individual Communication Profiles and also to send out regular news letters to families. One person spoken with said they enjoy meals at the home. The home uses a four week, seasonal menu cycle and this will vary, dependent on what is fresh, available and on what people wish to eat. Some people are involved in shopping for food. If people change their minds about the meal produced, they are supported to look for other choices. One member of staff spoken with said they had received food hygiene training. Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living at Sandhills will know that staff work hard to meet individual needs and preferences. The healthcare needs of people are monitored and good access to local health care agencies meets their physical and emotional needs. The medication policies and practice at the home protects people. Evidence: We conducted much of the inspection from a central position within the home and were able to observe staff for much of the day as they worked with people. Interaction was observed to be relaxed and happy. Individuals, who have complex needs, were seen to be content and comfortable with staff. Staff were working very well together as a team - they were knowledgeable and effective in meeting peoples needs in the way they wished and required. Two medication records were viewed for individuals and found to be accurate and up to date. Records were well set out and a double signature used to give evidence that the administration of medication had been checked by a second person. The system was well organised and the medication cupboard was secured safely. It was noted that at the time of inspection, no individuals looked after their own medication. The home receives a pharmacy audit from the local company that provide medication. People have an individual medical Profile and there were reports of annual health checks. The minutes of one recent staff meeting reviewed, gave detail about a reduction in medication for one person, which had caused a change leading to the need of a revised Evidence: risk assessment. This gave evidence of good communication, promotion of support and choice to improve quality of life. It also showed review of medication and risk assessment. It was noted that one member of staff had attended training about Death & Dying and the manager intends to cascade this training. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Staff know how to act if a concern is raised and will listen to people who live at Sandhills and the policies and procedures protects them. Evidence: No complaints have been received since the last inspection. Two people spoken with said they had no complaints and were happy with the care they receive. Two staff we spoke with about adult protection and whistle blowing were clear about the proper steps they would take if they had a concern. One member of staff said that they receive training concerning adult protection at their induction, which included Whistle Blowing. They also said the manager reinforces this training at staff meetings. The home maintains policy and procedures, which includes Whistle Blowing. Points of issue are raised at residents meetings. It was noted that the manager intends to review adult protection training for her staff team during the next eight months. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living at Sandhills are provided with a good and homely environment, which is maintained and meets their needs. Evidence: We found Sandhills to be homely and with a positive and relaxing atmosphere. Key workers support individuals with choice and taste concerning their bedrooms. The home has a pleasant conservatory, the lounge and dining area was homely and the kitchen well equipped. Outside, the home benefits from a large garden with plenty of different places to enjoy, which includes a pergola and gazebo. We spoke with a domestic cleaner who had just started work at the home and once she had completed her work, we found the home clean and tidy. A review of sample records showed that the home was keeping up to date with required maintenance records such as fire and equipment. The fridge and freezer checks were also seen to be up to date. Since the last inspection, three bedrooms had been re-modelled to meet needs of individuals, including major alterations to the en-suite bedroom. During our tour of the building we saw two carpets with stains and were told these were already listed for renewal. During the inspection we saw a local builder at the home planning maintenance work, which showed that the manager ensures maintenance issues are responded to. The weather was cold during the inspection and we considered, later in the morning, that a number of rooms were too cold. We were told that the heating had gone off and should be back on soon. However the heating did not come on and at the point we decided to ask for action, we found that staff had been proactive. We were told there had been previous problems with the heating system. Staff knew the procedure and steps to take in relation to an urgent matter. Staff had alerted the providers head Evidence: office and had called out an emergency heating engineer. Before we left the home, the engineer had established a fault and how to solve it and had also carried out temporary work to ensure the system would function. A member of staff from the providers office had also brought out emergency heaters, one of which was put to use. We considered that staff had taken good steps and the home was warm before we left. It was also noted that further emergency heating provided by an external company could have been provided if necessary. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who live at Sandhills benefit from an experienced and committed staff team who know and respond to individual needs. People living at Sandhills are supported by staff who are carefully recruited and receive training. Regular supervision supports staff with the people they work with. Evidence: We observed staff to be skilled and experienced. The home always has senior staff working to ensure effective support is provided; there were eight shift leaders. The manager is qualified and very experienced. Seven members of staff were qualified nurses. It was considered that bearing in mind the high level of need of some people living at Sandhills, that the home had a good mix of staff and experience to support them. One individual, who was smiling said: I know how to wind them up (Staff), I get on with all staff, sometimes they say they have to do something with another resident but most of the time if I need something they are quick to help me - there is nothing that could make things better. One member of staff spoken with said: We all get on well together as a staff team. We reviewed two staff files and found evidence of a good recruitment process, which included references and national staffing checks. We reviewed staff supervision notes, which showed regular supervision. The manager holds a staff supervision list to ensure supervision is undertaken when necessary. Staff spoken with confirmed they had regular and supportive supervision. We examined staff meeting minutes, which we found to be well recorded including key detail. One matter concerned a bedroom door and an implication of a fire risk. Another Evidence: point showed the manager had considered some weakness in consistency at staff hand-over and the need for prompts and reminders. Actively looking at issues such as this demonstrate that the manager takes proactive steps when needed. The October 2008 minutes recorded detail about Sandhills relinquishing the N, nursing registration category and how this was felt to be positive in that it provided more flexibility in the way staff are used. Staff we spoke with confirmed they were happy with the change. When the home had the nursing registration category, this required qualified nursing staff to always be on duty, with the consequence that frequently agency nurses had to be used, who often did not know the people living at Sandhills or their specific needs, leading to a lack of continuity. The new staffing approach was working well and staff moral had improved due to reassurance and continuity now provided to the people who live at the home. Responses from surveys we had sent to staff were positive, however there was concern from a number of staff about the amount of paperwork and how this had an impact on time spent with individuals. We considered this issue and talked with three staff about it. They confirmed it was an issue, though they could see that it was necessary, in moving practice forward. A major issue was the task of transferring the current documentation to a a new system. Two staff said they had raised this in their survey but that they could now, see the light at the end of the tunnel and so felt more comfortable about it. However, we did observe staff spending a great deal of time concentrating on record keeping, which is clearly an important. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who live at Sandhills benefit from an experienced manager who shows clear direction and leadership to her staff team. Individuals can be confident that staff understand the importance of choice and for people to be listened to so that improvements can be made that enhance quality of life. Policies and procedures are in place, which safeguard peoples rights and best interests. Evidence: The manager was not present during most of this inspection. We found good evidence to show that the manager is experienced and provides good leadership. Proactive steps had been taken to improve practice at the home such as the Communication Passport, which staff enthusiastically talked to us about. It was clear from staff meeting minutes and the Annual Quality Assurance Assessment that staff at the home promote choice and the rights of individuals, concentrating on the needs of the individual and by creating care plans that enhance quality of life, following the wishes of people living at Sandhills. We examined the cash record held for one individual and found the cash held to be short by 20 pence. This was discussed and it was established that the money was held in the safe and ready to be placed with the cash for the individual. The recording practice appeared to be in good order. Evidence: The main care file for individuals contained all key information but we found the files heavy and somewhat cumbersome; it may be helpful to consider an archiving system. One member of staff spoken with said they had been working on the filing system and that it was improving. During the inspection we observed staff working on this task and we do not see any need to make a recommendation in this report, since staff and the manager were clearly aware of issues and actively responding to them. The home has robust policies and procedures, which were reviewed and Sandhills is supported by the provider, Dorset Residential Homes in their work, which includes monthly unannounced visits. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. - 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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