Care Home: Sandhurst

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What the care home does well People living at Sandhurst say that they are made to feel “very welcome” from their very first day living at the home. Important information is obtained about people prior to agreeing to their moving to the home. This helps to reduce the risk of an inappropriate admission to the home and ensures that the team can meet people’s needs. There are good links with professionals, which helps to improve individuals’ health. Health and social care professionals tell us that there are “no problems” with the home and that “appropriate referrals are made for assessment”. People who live at the home say that the staff are "very attentive" and “know what they are doing” because they are well trained. Sandhurst DS0000022118.V376741.R01.S.doc Version 5.2 Their relatives are very satisfied with the care and also say that their relations are ‘happy, well fed and clean’. People living at the home told us they are treated as individuals. Professionals say that the people they support are well cared for. The home has an open feel. People living there say that they have the freedom to do what they want to, when they want to. At the same time, they are confident about the way staff protect their property for them. The also feel able to voice their concerns, if they have any, and know that these are taken seriously and looked into by the manager and provider. Families and friends say that they are encouraged to visit whenever they wish to. The people living at the home get support to keep in touch with their families and friends if they need to. There is a good choice of appetising and well-balanced meals at Sandhurst. People say that the choice is good and meals are “tasty”. Sandhurst is a comfortable place to live. People living there say that they are encouraged to see it as their own home and that it is always clean and well maintained. Staff feel well supported and are encouraged to do training so that they care for people properly. The manager and provider listen and consistently work towards improving the quality of life for people living in the home. What has improved since the last inspection? The nutritional needs of people living in the home are properly assessed and ensure that they receive the right types of food and drinks reducing the risk associated with choking or poor appetite. Peoples’ mental capacity has been assessed and the team is clear about whether a person is able to make decisions about their care and life at Sandhurst. The team have better knowledge of people’s needs in terms of occupation, interest and capabilities and are starting to use this information to make sure that activities are person centred and appropriate for each individual. Staff are having regular recorded supervision sessions, which is ensuring that they have the right skills, experience and knowledge to deliver the best care to people. What the care home could do better: SandhurstDS0000022118.V376741.R01.S.doc Version 5.2 Care plans could be made more person centred by including preferred daily routines for individuals. This would enable all staff to have a good understanding of how each person prefers their care and support to be delivered. Staff could further enhance individuals experience and choices during meals with a few simple changes, such as explaining what is planned and offering a choice beforehand, and having pictorial menus in visible places for people to see. The diversity of people should be taken into account with regard to the suitability of the environment. Best practice should be followed with regard to signage and painting of walls, doors and hand rails. Key inspection report CARE HOMES FOR OLDER PEOPLE Sandhurst 49/51 Abbotsham Road Bideford Devon EX39 3AQ Lead Inspector Susan Taylor Key Unannounced Inspection 2nd October 2009 10:30 DS0000022118.V376741.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Sandhurst DS0000022118.V376741.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Sandhurst DS0000022118.V376741.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sandhurst Address 49/51 Abbotsham Road Bideford Devon EX39 3AQ 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) 01237 477195 01237 470601 Mr Klaus-Jurgen Gunter Kothe Mrs Victoria Caroline Kothe Mr Richard James Phipps Care Home 23 Category(ies) of Dementia - over 65 years of age (23), Learning registration, with number disability over 65 years of age (23), Mental of places Disorder, excluding learning disability or dementia - over 65 years of age (23), Old age, not falling within any other category (23) Sandhurst DS0000022118.V376741.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 categories: Old age, not falling within any other category (Code OP) Dementia aged 65 years and over (Code DE(E)) Mental disorder aged 65 years and over, excluding learning disability or dementia (Code MD(E)) Learning disability aged 65 years and over (Code LD(E)) The maximum number of service users who can be accommodated is 23. 19th September 2008 2. Date of last inspection Brief Description of the Service: Sandhurst is a care home providing accommodation and personal care for up to 23 people, over the age of 65 years. It is registered to admit people who need care as result of Old Age, Dementia, a Learning Disability and/or a Mental Illness. The home is situated on the outskirts of Bideford. The 3-storey home consists of two adjoining houses, built in the Victorian era. The rooms are mainly single but some doubles are available. There is a lounge and a dining room on the ground floor. The 2nd floor (attic area) has room for 2 flatlets comprising of bedroom en suite and lounge. There are stair lifts between all three floors. The fees currently charged by this service are £295 to £391. Chiropody, toiletries, newspapers/magazines, personal items, clothing and hairdressing are additional variable costs which are not included in the fees. The last inspection report is displayed in hall. Sandhurst DS0000022118.V376741.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience GOOD quality outcomes. This was a key inspection of Sandhurst Residential Home under the ‘Inspecting for better lives’ arrangements. We were at the home with people for 11.5 hours. We looked at key standards covering: choice of home; individual needs and choices; lifestyle; personal and healthcare support; concerns, complaints and protection; environment; staffing and conduct and management of the home. We looked at records, policies and procedures in the office. A tour of the home took place. We met 9 people that live at Sandhurst and observed how staff looked after them. We met 6 staff, the manager and one of the registered providers. We sent surveys to 15 people living in the home and received 8 back. We sent surveys to 3 GPs and 4 other healthcare professionals and received 0 back. We also sent surveys to 10 staff and received 5 back. We spoke to 3 health and social care professionals. The comments from all these people, the results of surveys and our observations are in the report. In September 2009, the fees ranged between £295 and £391 per week for personal care. Additional charges are made for chiropody, hairdressing, newspapers and toiletries and these vary. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk. What the service does well: People living at Sandhurst say that they are made to feel “very welcome” from their very first day living at the home. Important information is obtained about people prior to agreeing to their moving to the home. This helps to reduce the risk of an inappropriate admission to the home and ensures that the team can meet people’s needs. There are good links with professionals, which helps to improve individuals’ health. Health and social care professionals tell us that there are “no problems” with the home and that “appropriate referrals are made for assessment”. People who live at the home say that the staff are very attentive and “know what they are doing” because they are well trained. Sandhurst DS0000022118.V376741.R01.S.doc Version 5.2 Page 6 Their relatives are very satisfied with the care and also say that their relations are ‘happy, well fed and clean’. People living at the home told us they are treated as individuals. Professionals say that the people they support are well cared for. The home has an open feel. People living there say that they have the freedom to do what they want to, when they want to. At the same time, they are confident about the way staff protect their property for them. The also feel able to voice their concerns, if they have any, and know that these are taken seriously and looked into by the manager and provider. Families and friends say that they are encouraged to visit whenever they wish to. The people living at the home get support to keep in touch with their families and friends if they need to. There is a good choice of appetising and well-balanced meals at Sandhurst. People say that the choice is good and meals are “tasty”. Sandhurst is a comfortable place to live. People living there say that they are encouraged to see it as their own home and that it is always clean and well maintained. Staff feel well supported and are encouraged to do training so that they care for people properly. The manager and provider listen and consistently work towards improving the quality of life for people living in the home. What has improved since the last inspection? What they could do better: Sandhurst DS0000022118.V376741.R01.S.doc Version 5.2 Page 7 Care plans could be made more person centred by including preferred daily routines for individuals. This would enable all staff to have a good understanding of how each person prefers their care and support to be delivered. Staff could further enhance individuals experience and choices during meals with a few simple changes, such as explaining what is planned and offering a choice beforehand, and having pictorial menus in visible places for people to see. The diversity of people should be taken into account with regard to the suitability of the environment. Best practice should be followed with regard to signage and painting of walls, doors and hand rails. 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 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. Sandhurst DS0000022118.V376741.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 Sandhurst DS0000022118.V376741.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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’s needs are well known and met. EVIDENCE: We looked at 3 care files to establish whether the care delivered was based on detailed assessment of people’s needs. Assessments had been done before the person had moved into the home or immediately at the point of admission. This included the person’s needs in terms of disability and medical background. Additional information gathered included a person’s preferences about bedtime routines and meals, significant relationships and social interests. Where appropriate the individual’s advocate had also been involved in the process. Relatives responding on behalf of their relation in a survey wrote comments that tell us that manager ‘is always approachable and welcoming’ and that the Sandhurst DS0000022118.V376741.R01.S.doc Version 5.2 Page 10 team always ‘keep family informed of any problems and maintain a happy and relaxed atmosphere’. Hazards had been identified for each person and the level of risk was clear with regard to issues such as tissue viability, falls, manual handling, mental health, behaviour and continence. Assessments had been regularly reviewed. We looked at the file of an individual with dementia whose care plan stated that they were at risk of malnutrition because they needed assistance to eat at mealtimes to ensure that their nutritional intake was sufficient. A detailed assessment had been completed and regularly reviewed. From this we were able to conclude that the person’s nutritional state had greatly improved and they had gained weight, which staff told us the individual needed to do. The manager verified that he had completed Mental Capacity Act training in 2009. As a result of the knowledge gained, he had reviewed the mental capacity assessments for all of the people living in the home. We looked at 3 of these whilst case tracking people’s care. 1 person had been assessed as lacking capacity. Whilst there was some information about this across the person’s care plan, there was no clear guidance as to who is responsible for making decisions on the person’s behalf in their best interests. For example, one individual who we case tracked has dementia is unable to make decisions about their healthcare needs. Detailed guidance about how each person’s best interests will be considered should be available for staff to follow and this will ensure that care is person centred and does not deprive in individual of their liberties without proper consultation and agreement. Sandhurst does not provide intermediate care therefore no judgement is made regarding standard 6. Sandhurst DS0000022118.V376741.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, & 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals’ personal, social and health care needs are well met. EVIDENCE: 8 people using the service returned surveys. 100 of people tell us that the staff listen and act on their wishes. Similarly, their responses show that 100 are satisfied with the medical support they receive. They also tell us that they are treated well. A relative wrote that their relation’s experiences of care at Sandhurst are ‘excellent’. Sandhurst DS0000022118.V376741.R01.S.doc Version 5.2 Page 12 5 surveys were returned by staff working in the home. Their responses tell us that they always or usually have information about peoples needs. Communication is said to be always sufficient. We looked at 3 care plans for the people who we case tracked. These were gave a good picture of the person’s needs and had been regularly reviewed. For example, a care plan written for a person with dementia stated that one of the aims of care was to promote the person’s abilities and independence. We observed good practice at mealtimes with the person who was gently prompted and enabled to eat all of the meal, which they would otherwise have not done. The risk assessment for this person highlighted that a reason for their admission was that they had been malnourished. Staff also understood that this person might be at risk of choking. Records demonstrated that the person’s weight was regularly monitored and showed that the individual was steadily gaining weight, which was a planned goal of care for the individual. We tracked the care of a person who was at risk of developing pressure sores. We looked at the individual’s care file and read that community nursing staff had regularly assessed the person using the ‘Medley’ tool to determine the level of risk of potential pressure damage the person might experience. The information highlighted that the person was very high risk as their health had deteriorated. Measures had been put in place to prevent pressure damage and we saw that the person was sitting on a pressure relieving cushion and had a pressure relieving mattress on their bed. One area where we felt the information was less robust was in recording individuals’ personal preferences, routines and social activities. This has started to be addressed with the introduction of ‘personal profiles’ that family are asked to complete. We discussed this as part of our feedback following the inspection, and said that plans could be made more person centred by including preferred daily routines for individuals. This would enable all staff to have a good understanding of how each person prefers their care and support to be delivered. A social care professional said that there is “always good communication [about people’s needs and changes to care] and the manager works in partnership with us”. Similarly, a healthcare professional that was visiting the home told us that communication is “very good”. For example, they had recommended that a person’s arm be elevated on a pillow every day to reduce swelling and promote healing of a wound that they were dressing. The healthcare professional said that they had observed this being done every time they visited. The person’s comfort was improved because the wound was nearly healed and swelling to the surrounding area had been greatly reduced. In daily records for all 3 of the people we tracked, we saw that other healthcare professionals such as the tissue viability nurse specialists, speech Sandhurst DS0000022118.V376741.R01.S.doc Version 5.2 Page 13 therapists and occupational therapists had been regularly contacted for advice and support. One person spoken to confirmed that staff knocked on their door, provided care in the privacy of their room and treated them with respect and kindness. The person said that all the staff “treat you nicely’’. The home uses a monitored dosage system. Senior staff are responsible for stock taking. Records of ordered drugs and a register of controlled drugs were seen and tallied with those being stored. The system was easy to audit and we tracked how medication is managed for 3 people. Records accurately reflected medication having been given as prescribed by the GP. All medication was kept in a secure place. We observed medication being given to individual’s concerned after lunch and at the evening meal. This was done safely and records were completed appropriately after each person had taken their medication. Other care staff we spoke to said that medicines are only given by staff trained to do this. We examined a random selection of four staff files, two of which were for longer serving employees that had certificates demonstrating this. Therefore, medicines are managed safely for people that need help to take them. Sandhurst DS0000022118.V376741.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals’ social and diverse needs are reasonably well met, but could be improved to include more choices in everyday life. EVIDENCE: Relatives responding in a survey told us that there is ‘good humour is always apparent to visitors and relatives’ at Sandhurst. One person living in the home said “family are always made welcome and visit regularly”. We had a discussion with a group of 5 people about their life at the home, their accommodation, the food and their care. We observed that some more Sandhurst DS0000022118.V376741.R01.S.doc Version 5.2 Page 15 mobile people walked around the home and had particular areas where they liked to sit and watch the life of the home go by. Information sent to us by the manager explained that the programme of activities was altered as a result of listening to the people. People we spoke to told us “we all like playing bingo and have great prizes”. Information on activities planned in October was on the notice board in the entrance hall. One person said “XXX had a birthday yesterday and we had a cake and party for her”. We saw the person’s birthday cards and flowers were also on display on the mantle piece. We met another person who said “I like my own company and don’t want to mix with other people”. Whilst staff respected this person’s choice, we observed that they regularly visited the individual to check whether they were ok and needed anything. This tells us that people are valued as individuals and how they choose to live their life is respected. Information sent to us by the provider verified that 100 of the people living at Sandhurst are of Christian faith - ‘individual religious needs are catered for through the local community for residents to visit a place of worship or to attend the homes in house service depending on their religion’. People’s religious and spiritual preferences were recorded in their care files. Autumn harvest celebrations included a service conducted by a local minister. During the afternoon, we observed this taking place in the lounge and people taking part appeared to enjoy this. Games and quizzes, one-to-one activities and group sessions, sensory and musical events were planned. Since the last inspection, the manager has started to introduce a more person centred approach to activities by assessing people using the POOL assessment. This has enabled the team to establish the type of activities that are most appropriate for an individual with dementia, which ensures that they are fulfilled and stimulated during the day. Staff said that they are more aware of what is appropriate for this person and we observed them using reminiscence techniques to engage with the individual about the person’s interest in flower arranging. Records demonstrated that the person’s level of engagement had increased gradually over the course of months since they moved into the home. As a result of this, the individual was mentally stimulated and assessed as being more settled living at the home. We spent time in the lounge and dining room observing how staffs interact with people. We saw staff engaging with people with genuine warmth and respect. People appeared to respond to this and enjoyed the attention. We noticed that the clock had stopped and was showing the wrong time, which would disorientate people. The manager had also noticed this and quickly rectified it by changing the batteries in the clock. In surveys 8 people tell us that they get ‘fresh vegetables, cakes, puddings’, which are ‘home cooked’. Their responses told us that the food and menus at Sandhurst DS0000022118.V376741.R01.S.doc Version 5.2 Page 16 the home is ‘always’ good. We spoke to 5 people all of whom were looking forward to lunch, but could not recall if they had been asked what they would like. Staff said that they told people what was being served for lunch, but their experience and choices during the lunchtime meal could be improved with a few simple changes, such as offering a choice of juices, explaining what was planned for lunch, having pictorial menus in visible places for people to see as a prompt. We saw that people were offered extra helpings. The catering staff explained that they have written details of individuals’ likes and dislikes and can plan menus around these. We were told that special diets such as low fat/sugar had been made for people with diabetes for example. We looked at the file of an individual with dementia whose care plan stated that they were at risk of malnutrition. This person needed assistance to eat at mealtimes to ensure that their nutritional intake was sufficient. A detailed assessment had been completed and had been regularly reviewed. There was a detailed care plan about this, which we observed being followed at lunchtime. We saw the carer sitting next to the individual engaging the person in conversation and prompting them to eat their meal, which they did independently. Sandhurst DS0000022118.V376741.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals’ views are listened to and acted upon EVIDENCE: The home have a stated complaints procedure and copies of this are posted throughout the home and are included in the homes information that is given to all people admitted to the home. 100 (8) of people responding in a survey verified that they knew how to complain and who to speak to if they were unhappy. Since the last inspection 2 complaints have been made to the Care Quality Commission regarding this home. The provider was asked to investigate both complaints. These were not substantiated and the provider sent us detailed reports demonstrating that a thorough investigation had taken place and also supporting the outcome. The staff having training in the Protection of vulnerable adults and those Sandhurst DS0000022118.V376741.R01.S.doc Version 5.2 Page 18 spoken to during the inspection were aware of who they should report any concerns they may have in relation to possible abuse. 100 (8) of people responding in a survey felt that the staff always treated them well and listened to them. The home had a written policy and procedure for dealing with suspected allegations of abuse. We spent some time observing interactions between staff and people living at Sandhurst. Staff engaged with people continuously at the right speed and demonstrated genuine warmth and attention, which people appeared to respond to and enjoy. The registered manager told us that they had taken steps to safeguard an individual. A visiting social care professional told us that the manager had “acted promptly and appropriately” and had ensured that decisions made about the individual concerned were in their best interests. As a result of this, the individual was undergoing assessment and independent advocates were due to visit the person. Therefore, the manager has put into practice the knowledge he gained during training about the Mental Capacity Act and Deprivation of Liberty Safeguards and has protected the person from a potentially abusive situation. The home holds small amounts of cash for individuals. We checked a sample of these. There were records of all transactions and the amounts counted were correct. The service user guide is transparent about extra charges that are levied to people living in the home. These include chiropody, daily newspapers and periodicals, travel expenses incurred by hospital appointments and private telephone connection and telephone calls and line charges. Recruitment practice is robust and ensures that people are cared for by properly vetted staff. Sandhurst DS0000022118.V376741.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements continue to ensure that the home is clean, well maintained and safe and that furniture provided for people is of an acceptable standard. EVIDENCE: Information sent to the Commission verified that equipment is regularly serviced, that staff strive to keep the home clean, tidy and odour free and that each time a new person moves in if appropriate the bedroom to be occupied is decorated. Sandhurst DS0000022118.V376741.R01.S.doc Version 5.2 Page 20 We carried out a tour of the home and looked a 3 people’s bedrooms. We also looked at maintenance records spoke with 4 people using the service, the Registered Manager, Provider and staff. We also considered the results contained in the surveys we received and read 3 peoples care records. 100 percent of people (8) in a survey commented that the home is always clean. Information sent to the Commission verified that a cleaning rota was put in place after the last inspection. We found that all areas of the home, with exception of 1 bedroom and a bathroom were clean and odour free. We discussed this with the manager who said that “bathrooms are supposed to be cleaned by the staff after use” and said they would “put a system in place to ensure this is always done”. We found that the communal areas are well furnished and provide a homely environment for people to enjoy. Since the last inspection, rooms have been decorated including the dining room which has had tongue and grove cladding fitted. Maintenance records demonstrated that routine maintenance and renewal of the fabric and decoration of the home is done. We read contractors certificates that showed equipment is regularly maintained. We found that call bells are accessible in every room and that there are stair lifts to assist people when needed, in addition we saw grab rails and other equipment to assist people. We observed that hoists are used by staff when moving the position of people that are immobile or have difficulty weight bearing. We did an in-depth observation of the suitability of the environment for people with dementia. Much of the paintwork was cream and hand rails were cream. We did not see any specialist adaptations that would enable people with dementia orientate them to particular rooms like the bathroom, their own bedroom or to discourage entry to unsafe areas. We observed 1 person wandering in and out of the lounge. We discussed this with the manager and recommended that further research about this should be done to ensure that environmental changes also take account of the needs of people with dementia. The home has guidance on infection control that is accessible to staff. Protective clothing was seen being used and we observed staff regularly washing their hands after caring for people. Additionally, all the staff carried alcohol gel on their person and told us that the infection control procedures had been reviewed as part of the ‘pandemic flu planning’ that is going on in the home. This demonstrates good practice and protects people living in the home from the risk of infection. Information sent to the Commission verified that all (25) staff has done infection control training. We looked at the laundry, which has external access only. We met the member of staff who was doing the laundry and saw that there is a good system in place that ensures clothes and linen and washed separately for infection control purposes. Similarly, we Sandhurst DS0000022118.V376741.R01.S.doc Version 5.2 Page 21 observed that linen and clothes are taken to the laundry in receptacles and clean clothing is returned to people the same day after being washed, dried and ironed. People looked well turned out in their own clothes, which were clean. Sandhurst DS0000022118.V376741.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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’s needs are being met by knowledgeable, skilled and caring staff. Recruitment practices protect people that live at Sandhurst. EVIDENCE: We spoke at length with 5 people about their care needs and whether these are met by the staff working in the home. People said that staff come “quickly” if they need help and we observed this to the case. They also made comments like “we get excellent care”. We examined duty rosters for September 2009. Five staff were on duty during the morning, three in the afternoon and four in the evening. Additionally, there was a cook and a domestic working until 2:30 p.m. In a survey 100 of staff responding (5) verified that there is always sufficient staff to meet the needs of people living in the home. We were at the home until the evening on the first day and then in the morning on the second day. There was a relaxed atmosphere and people were attended to promptly. We sat in the lounge for some time talking to people and during this time staff were frequently coming in to check on individuals, to change a person’s Sandhurst DS0000022118.V376741.R01.S.doc Version 5.2 Page 23 position or to help them have a drink. People that needed individual attention, particularly at lunchtime received this on a 1 to 1 basis. For example, we saw a carer sitting next to a person with dementia, giving them eye contact and engaging the person in conversation whilst prompting them to eat their meal, which they did independently and at their own pace. There is a diverse staff team at Sandhurst; the gender mix matches that of the people living there. Information sent to the Commission states that ‘staff retention is high’. We looked at 3 staff files of individual’s appointed since the last inspection. Relevant pre-employment checks, including references (CRB and POVA checks) had been taken up. Therefore, the recruitment procedures are robust and ensure that individuals’ are suitable to work with vulnerable adults. Training records showed that staff has training in all key areas of health and safety, as well as some specialist areas such as working with people with dementia and physical disabilities. We spoke to a group of 4 staff who verified that they are offered regular training updates, including opportunities to complete the NVQ (National Vocational Qualification) in care. We spoke to 2 new staff who verified that they had had a thorough induction that had prepared them well for caring for people. Staff made comments like “I absolutely love working at Sandhurst and really enjoy looking after people”. Information sent to us by the manager verified that this is consistent with Skills for Care Standards and lasts for at least 3 months. We looked at individual training portfolios, which contained certificates demonstrating that there is a learning and development culture in the home. Information sent to us by the manager tells us that 52 of staff (12) have an NVQ2 or above. Sandhurst DS0000022118.V376741.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sandhurst is a well run home that has consistently improved the quality of service people receive over the last few years. EVIDENCE: Since the last inspection, the Commission has registered the manager. He has completed the NVQ level 3 & 4 in care and the Registered Manager’s Award. Since being interviewed he had concentrated on developing his knowledge Sandhurst DS0000022118.V376741.R01.S.doc Version 5.2 Page 25 about the Mental Capacity Act and Deprivation of Liberty Safeguards, which he was recommended to do. As discussed under the Complaints and Protection section of this report, he has demonstrated his ability to put this knowledge into practice and took swift action to ensure that decisions being made for a person are in their best interests. He told us that he used the internet extensively, in particular the Commission’s professional website, to keep up to update thus ensuring that the care delivered is best practice. We spoke to 3 health and social care professionals in the course of the inspection. They all told us that the manager “works in partnership” and regularly “consults” them about all aspects of care and support. One professional said “XXX is always helpful and willing to help out in an emergency” with regard to placements. The provider and manager gave the Commission a reasonable picture of the current situation in the service, in a document entitled AQAA (Annual Quality Assurance Assessment). However, there were areas when more supporting evidence would have been useful to illustrate what the service has done in the last year, and/or explicitly how it is planning to improve. We discussed this with the provider and manager who explained that the original document that had been steadily completed over the course of the year had been lost due to a major computer failure. As a result, and in order that the document arrived within the timescale required, the AQAA had been completely quickly. Both the manager and provider said they were “very frustrated” about this because the lost version was very detailed. We read the results of a quality assurance survey, which sought the views of people living in the home and their relatives that was displayed on the ‘resident’s notice board’. This demonstrated that the service has enhanced the way it seeks the views of people and acts on their suggestions for improvement. Relatives responding on behalf of their relations in a survey wrote comments like ‘care given to mom is second to none’ and ‘residents appear happy, well fed and clean’. We looked at records showing how money is managed on behalf of 3 people that live in the home. All were accurate when cross checked with the balance kept for safekeeping. A best practice recommendation had been implemented ensuring that entries had two signatures to denote that transactions have been witnessed. We concluded that people’s money is well managed. We spoke to 4 staff during the inspection, all of whom said they regularly had 1:1 supervision sessions. The manager told us that they had delegated some of the supervisory management to the deputy manager. We looked at 3 staff files, all of which had a record of the supervision sessions that had taken place. In a survey 100 of staff responding (5) felt well supported. Sandhurst DS0000022118.V376741.R01.S.doc Version 5.2 Page 26 Regular supervision of staff is ensuring that staff always follow best practice. During the inspection the manager and provider suspended a member of staff so that concerns about the individual’s practice could be investigated. This demonstrated that disciplinary procedures are robustly followed and ensure that people are protected. Comprehensive Health & Safety policies and procedures were seen, including a poster displayed near to the office stating who was responsible for implementing and reviewing these. We toured the building and observed that cleaning materials were stored securely. Data sheets were in place and staff spoken to understand the risks and strategies to minimise those risks from chemicals used in the building mainly for cleaning and infection control purposes. We observed hand sanitizer being used by staff to minimise the risk of cross infection. Records of accidents were kept and showed that appropriate action had been taken. The fire log was examined and demonstrated that fire drills, had taken place regularly. Similarly, the fire alarm had also been regularly checked. People living in the home, relatives and staff told us that the alarm was checked “every week”. One person said “I feel very safe”. Hoist used to change people’s position had been check by an engineer twice in the last 12 months. We observed a person that we were case tracking having their position changed at lunchtime. Staff followed good manual handling practice and carefully explained to the person what they were doing to reassure them. The registered provider told us that they had obtained several quotes for a new kitchen to be installed and intend to totally refurbish it with stainless steel units as recommended by Food Safety Experts. Sandhurst DS0000022118.V376741.R01.S.doc Version 5.2 Page 27 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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 3 x x 2 x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 3 Sandhurst DS0000022118.V376741.R01.S.doc Version 5.2 Page 28 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 OP3 Good Practice Recommendations Detailed guidance about how each person’s best interests should be available for staff to follow. This will ensure that care is person centred and does not deprive in individual of their liberties without proper consultation and agreement. Individual’s preferred routines should be documented in detail to ensure that care is always person centred. This would enable all staff to have a good understanding of how each person prefers their care and support to be delivered. People’s experience and choices during meals could be further enhance with a few simple changes, such as explaining beforehand what is planned for lunch and offering a choice, and having pictorial menus in visible places for people to see. Future decoration and refurbishment should be done to DS0000022118.V376741.R01.S.doc Version 5.2 Page 29 2. OP7 2. OP15 3. OP22 Sandhurst best practice to ensure that the needs of people with dementia are taken account of. Resources such as Designing Interiors for People with Dementia ISBN 1-85769-179-2, University of Sterling. Tel:(01786) 467740 E mail: m.t.marshall@stir.ac.uk/dsdc should be used. Sandhurst DS0000022118.V376741.R01.S.doc Version 5.2 Page 30 Care Quality Commission Care Quality Commission South West Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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