Care Home: Sandmar

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What the care home does well A great deal of work had been done on residents` care plans and risk assessments. They contained a wealth of information about people`s likes and dislikes and how their needs could best be met, as well as detailed information about their physical and mental health, their activities, their family contacts and any personal care needs. These care plans are reviewed on a regular basis and signed by the keyworker and the resident. One healthcare professional who wrote to us said: "We have been impressed with the improvement in Sandmar over the years. Staff always consider the needs of individuals living in the home, and always act to meet them appropriately". One resident said: "They look after me very well". Another said: "I only have to ask for something and it is done right away". What has improved since the last inspection? This is the home`s first inspection under their new registration. Previously, we had asked them to make some changes regarding the property, and we found that this had been done. We also asked them to make sure that all staff had infection control training, and they had done this. What the care home could do better: The medication procedures in place were good, but staff were not always recording the dates of when medication was opened. They also needed to develop contingency plans in case of residents using medication to self-harm. The manager has been asked to make sure these matters are attended to. The premises were mainly in good order, although the building itself is quite old. There were a couple of areas which needed improvement, and these included the flooring in the laundry, and the maintenance of the dining room floor. The provider has been asked to put new, non slip flooring in the laundry, and re-varnish the dining room floor. The smoking room windows need attention, and the bathroom tiles need re-grouting. Areas where dust gathers, like behind washing machines and in extractor fans need to be regularly cleaned. The home has a complaints procedure in place, and staff have good communication with residents and can usually pick up any concerns they may have about the service. However, there was no formal record of any complaint being made, although we are aware that at least one complaint has been made. The manager has been asked to make sure that he logs the details of any concern or complaint and keeps records of the outcome of these. Key inspection report Care homes for adults (18-65 years) Name: Address: Sandmar 18 Wingfield Road Trowbridge Wilts BA149EB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Alyson Fairweather     Date: This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Adults (18-65 years) Page 2 of 34 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 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 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. 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 Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Sandmar 18 Wingfield Road Trowbridge Wilts BA149EB 01225775060 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): JJ & S (Chippenham) Ltd Name of registered manager (if applicable) Mr Jitendra Kumar Singh Tirbhowan Type of registration: Number of places registered: care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is 18. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Mental Disorder (Code MD) Date of last inspection Brief description of the care home Sandmar is a privately owned care home which offers accommodation and personal care for up to eighteen people with a past or present mental health disorder. It is a large semi-detached Victorian property on the outskirts of Trowbridge. The home has 12 bedrooms for service users, 6 single bedrooms are over 10 sq. m. and 6 double bedrooms are over 16 sq.m. All bedrooms are used as single rooms at present. There are also two large lounges, one of which incorporates a games room, a sun lounge and a dining room. Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 18 Brief description of the care home Residents are not usually permitted to use the kitchen, as staff prepare all the meals. However, tea making facilities are available in individuals bedrooms, subject to risk assessment. Public transport is available nearby, although the home is within walking distance of the local amenities of the town centre. There is a large garden to the front of the house and a paved courtyard to the rear. Smoking is permitted in the sun lounge at the rear of the property. Fees vary from £400 to £500 per week at Sandmar. Care Homes for Adults (18-65 years) Page 5 of 34 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 peterchart Poor Adequate Good Excellent How we did our inspection: This inspection visit took place over one day in November 2009. We had previously received an Annual Quality Assurance Assessment (known as the AQAA) from the home. This was their own assessment of how they are performing. It gave us information about what has happened during the last year. We looked at the AQAA and reviewed all the other information that we have received about the home since the last inspection. This helped us to decide what we should focus on during our visit. We received written feedback from six residents, three staff members and one professional healthcare worker. We also looked at various files and documents, including care plans, risk assessments, health and safety records, medication records, staff training files, and the staff recruitment procedures. Several service users and staff members were spoken to, as well as the homes manager and deputy manager. Care Homes for Adults (18-65 years) Page 6 of 34 Various documents and files were examined, including care plans, risk assessments, health and safety procedures, staff training files and medication records. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: 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. Care Homes for Adults (18-65 years) Page 8 of 34 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 Care Homes for Adults (18-65 years) Page 9 of 34 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. Prospective clients and families are given information leaflets so that they can choose whether or not they wish to use the service. All residents have their individual needs assessed before they arrive, so that staff know how best to support them. Evidence: The home has a comprehensive Statement of Purpose and Service User Guide which give an overview of the service which will be provided. This has recently been updated, and a copy is given to every potential resident. It gives details of the organisations complaints procedure. Of the six residents who wrote to us most said they had been asked if you wanted to move to the home and that they had received enough information before they moved in. One person said: From the very first day of moving in I have enjoyed living at Sandmar. I remember thinking I would be happy here, and I still am. Another said: I have been kept informed about Sandmar both before and since moving in. It is recommended that the Statement of Purpose is amended to include details of the new management arrangements, i.e. that the organisation is now a limited company. There should also be reference to the fact that residents are not encouraged to enter the kitchen unaccompanied. Care Homes for Adults (18-65 years) Page 10 of 34 Evidence: All residents are referred to Sandmar by staff of other mental health services, for example the Community Mental Health Team (CMHT). This referral includes a detailed application form, risk assessments where present and a copy of the most recent Personal Recovery Plan, which gives details of how the potential resident can best be supported with their mental health needs. The homes manager then conducts a referral interview, at which stage residents are able to say what they feel their needs and goals are, and to assess whether the home might be able to help with these. Potential residents make several visits to the home, and can spend time getting to know staff and other residents. This allows further assessment of their needs to take place. Care Homes for Adults (18-65 years) Page 11 of 34 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. Care plans reflect the needs and personal goals of residents. People are encouraged to make choices and decisions about their own lives, and are supported to take risks as part of an independent lifestyle. Evidence: A great deal of work has been done by staff in relation to compiling care plans for residents. Each plan now has an index page which quickly shows where to find specific care plans. Care plans are made up of two sections, one of short term goals and one of long term dependency assessments. They include information on communication, accommodation, mental and physical well-being, health and social activities, as well as individual Personal Recovery Plans. Care plans have been reviewed regularly, but this is also done when the situation has changed, and are usually signed by the resident. A system of daily records is in place, and peoples likes and dislikes are recorded. When we asked staff if they are given up-to-date information about the needs of the people they support or care for in the care plan, everyone said that they did. Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: We noted that two residents had no photographic ID on file. They had both chosen not to do this. We discussed the matter with the manager, asking how this fitted with the homes missing person procedure. That is, if a person went missing, how would they be able to describe them to the police. We also informed him that the law governing care homes says that photographic ID must always be in place for residents living there. We have therefore asked him to make sure that this is made available from now on. On the files we looked at, we also saw that the Personal Recovery Plans which were completed by peoples CMHT worker had a section about Advance Directives. This means usually that people can,while they are well, give instructions about what kind of treatment they would like when they are unwell, or who should be contacted at that time. Unfortunately this part of the form had not been completed in the files we looked at. In discussion with the manager, it was agreed that it would be useful for the home to have this information, and that they would introduce it to their own care planning documents. Residents are supported to make decisions about their own lives with guidance from the staff. They are encouraged to manage their own finances wherever possible, although some have official financial appointees, and some have family involvement. Where restrictions are in place, for example to limit self harm or harm to others, this is clearly recorded and guidelines are drawn up for staff to follow. There is a no alcohol policy in the house, although some people like to go out to the local pub occasionally. There is also a designated space for smoking. Risk assessments were on file for all residents, and these are reviewed regularly. They were clearly linked to peoples care plans, and included things like personal care, the risk of falls and the risk of someone harming themselves or other people. Risk assessments completed at CPA meetings are also on file. In discussion with the staff, it was clear that they were aware of the ways in which residents could be at risk, and were taking measures to avoid these. Some residents have been known to smoke in their bedrooms, and staff were said to discuss this frequently with them, pointing out the potential risks. A risk assessment had been introduced for these residents, and is reviewed with them on a regular basis. Under the regulations governing care homes, there are several things which providers must do. This includes notifying the Care Quality Commission of anything which affects the wellbeing of residents. This includes any hospital admissions, any serious accidents, any medication errors, and any acts of aggression. Whilst looking at accident and incident records, we saw that there had been several which we had not Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: been told about. The manager has been asked to ensure that this is done in future, and we agreed to send a copy of our guidance to them. Care Homes for Adults (18-65 years) Page 14 of 34 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. Social and leisure activities are varied and tailored to individual need, with residents choosing what they wish to do, although staff support time for activities is limited. Residents can have as much or as little contact with family and friends, and are encouraged and supported by staff. Some restrictions are placed on their movements within the home, specifically in the kitchen, but these are regularly monitored and discussed. Evidence: Residents activities were varied, but staff told us that some had dropped off, and that the arts and crafts sessions were due to start up this winter. An activities programme previously started by the homes administrator had slow interest. Public transport is easily accessible, although not all residents choose to use it. Residents are informed of events and leisure activities that are available locally. Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: In the home, people play card games and pool, and two residents were seen to be enjoying playing scrabble with the manager while we were there. A table tennis board and a Wii games console have also been purchased, so people can play golf or bowling. It is also planned to by an exercise game for the Wii. Some residents show no interest in taking part in group activities and group outings. Many have their own daily routine and dont tend to want to break their routine to try new act ivies. Staff carry out monthly one-to-one meetings with residents to find out the type of activities they would like to get involved with and when they would like to do it, enabling a structured set of activities that are in demand to be devised. One person has joined the local library, where they are able to borrow DVDs and books and someone has been buying books over the internet, with the help of a member of staff. One person has enjoyed planting bulbs in the garden, and over the summer there were barbecues in the garden, as well as a day trip to Weston-super-Mare. We saw that there was a record of someones interest in cooking their own meal or helping staff to cook the main meal. As noted below, residents do not go into the kitchen unaccompanied. There was no evidence that this had been followed up, although staff told us that they had encouraged it. It is recommended that discussions with people about their interests are recorded, so that staff can evidence their efforts and note when and why people change their minds. Residents can entertain family or friends either in the privacy of their own bedrooms or in the communal areas available. Staff encourage and support links between residents and their families, although the frequency of contact varies depending on individual circumstances. Some people have relatives to visit or meet them in town. Various friendships have developed between residents, The home operates on the basis that residents are not allowed to enter the kitchen. All residents have a kettle and cold drinks available in their room, and are asked on a regular basis if they would like to have access to the kitchen. We looked at minutes of the last residents meeting and saw that this was the case; they say that they do not. Staff had agreed previously that it would be a way of encouraging independence in residents if they were supported in developing their domestic skills, provided that a risk assessment was in place for all of them. It is recommended that the registered person ensures that the fact that residents do not have access to the kitchen is regularly reviewed with them, and records are kept of these discussions. We also suggest this information is clearly identified in the homes Statement of Purpose, so that people know about this limitation from the start. Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: Some residents do their own laundry, although staff still mainly take responsibility for this. Most residents take part in household chores, with some looking after their own room. One resident was seen to have asked for a key so that the bedroom door could be locked when they were out, and this was done immediately by the management. Others have chosen not to have this, and it is recorded in their care plans where this is the case. The food provided is of a good quality, with roast meat and accompaniments being offered twice a week. The fridge and freezer contained a variety of foodstuff, including meat, fish, vegetables, salad, cheese, yoghurts, tomatoes, apples and bananas and bread. Diabetic meals are also catered for. Lunch on the day of our visit was liver and onions with potatoes, carrots and cabbage. One resident said that the food was: Very good. I usually enjoy whatever they make. CQC recently received a complaint where insufficient food was raised as a concern, including no food after tea time at 5 pm. We asked the manager for a copy of the menus, and we saw that there was a supper dish included after 7 pm. We spoke to several residents and staff and they all confirmed that supper was offered every day, although occasionally someone would decline. Care Homes for Adults (18-65 years) Page 17 of 34 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. Residents personal support needs are recorded in care plans so that they can receive this support in the way they wish, and their physical and emotional health needs are met. People are supported to self-medicate where possible, and are protected by the homes medication policies and procedures, although some work needs to be done with regard to preventing potential self-harm by medication. Evidence: All residents are registered with a General Practitioner (GP) whilst living at Sandmar, and all other medical professionals are seen as and when required. This varies according to the needs of individuals. The home has good links with local mental health teams, and can call for support if any crisis periods arise. All residents attend mental health reviews on a regular basis, and care plans can be amended at this time. Although Sandmar caters for people with mental health needs, one or two residents have had physical problems which have necessitated having personal care support from staff. Staff have sought advice from the continence advisor where necessary. Staff have supported all the district nurse, GP and hospital appointments needed. These have included appointments with the Pain Clinic, an eye specialist, Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: physiotherapist and hydrotherapy sessions. Dentists and opticians are seen as and when needed. The professional healthcare worker who wrote to us said: Management and staff are always aware of peoples health needs and make sure that appointments are kept. The home has good medication policies and procedures in place. Residents medications are reviewed annually with their psychiatrist or the GP. The Medication Administration Record (MAR) was checked and found to have been completed accurately, although some consistency is needed in how staff record when medication is not taken, as some staff score through and some leave it blank. Medication storage was found to be good, with all drugs kept in a locked cabinet. All staff completed medication training in 2007, and it is recommended that they have a refresher course. Some of the boxes in the cupboard were not dated when opened, which means it is not always easy to check how much medication should be in stock. The manager has been asked to make sure that this is done in future. It is also recommended that a regular medication audit takes place, and that this is recorded. One resident has, in the past, told staff that they have stored medication up, and were going to take it all at once. Staff at this time said that if they didnt want to take medication, they should say so at the time it was being administered. Unfortunately, if the resident has any ideas of overdosing on medication then they are unlikely to refuse it. The persons care plan clearly says that staff will administer their medication and will supervise them taking it. Staff must make sure that the medication care plan is followed, and this should be expanded so that all staff are aware of how to make sure medication is swallowed. Staff must negotiate a regular room search option with the resident if there is any suspicion of drug storing for the purposes of self-harm. The manager has been told that he must ensure that this is done. Care Homes for Adults (18-65 years) Page 19 of 34 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. Service users feel their views are listened to and acted on, although there was no formal method of storing complaints and their outcomes. The policies and procedures the home has in place try to ensure that residents are safeguarded from abuse and harm. Evidence: The home has a complaints procedure in place, and this is given to service users and their families along with the service user guide. All the residents who wrote to us said that they knew who to talk to if they werent happy and all said they knew how to make a complaint. Relatives have also told us that they knew what to do. One complaint was made recently to us, in relation to there not being enough food, and the fact that the building was cold. As the complainant preferred to remain anonymous, we asked the manager to show us evidence that people were provided with food in the evenings and that the building was heated at night. He did this, and we also checked it out when we visited. We found that a light supper was available for all residents, and that there is a thermostatic control which regulated the temperature of the building, whenever it dropped below a certain level. Unfortunately, the manager had not kept a record of this complaint. When we asked to see the folder where complaints were held, he said that because there were no complaints, there wasnt one. He also said that occasionally residents brought minor concerns to him. We have therefore asked him to make sure that a formal record of all Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: complaints is kept, and that the outcome of any complaint is stored alongside. Minor concerns should also be recorded. The home has copies of the Wiltshire and Swindon No Secrets document, as well as the organisational policy and procedure on responding to allegations of abuse. All staff members have received training in Safeguarding People, and all are encouraged to report any incidences of poor practice. A Whistle Blowing procedure is available for all staff, and risk assessments are in place for all residents. There have been no referrals to the local safeguarding teams. Care Homes for Adults (18-65 years) Page 21 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a reasonably comfortable environment, although some areas needed attention and they have restricted access to parts of the home. The home was mainly clean and hygienic throughout, although cleaning of hard to reach areas needed to improve. Evidence: Sandmar is a large semi-detached Victorian property on the outskirts of Trowbridge. Public transport is available nearby, and the home is within walking distance of the local amenities of the town centre. There is a large garden to the front of the house and a paved courtyard to the rear. There have been many environmental improvements. New carpets have been laid throughout the home, rooms have been decorated and some new furniture purchased. Residents bedrooms were homely and each contained individual personal items, such as stereos and TVs. One person had asked for, and been given, a key for their room. A separate room is provided for people who wish to smoke, although the perspex windows of this were stained and smeared. The cleaner reported that chemicals had been used to try to clean them but it hadnt worked. Further attempts should be made to clean these so that people can see out. The windowsill also needed re-covering. Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: The dining room floor was scraped and worn, although it was said that this had been varnished not too long ago. The manager has been asked to make sure that this floor is re-varnished or made good in some other way. A cleaner has recently been employed by the home, and this had had a beneficial effect on the staff team, freeing them up from cleaning duties. The home was clean and tidy on the day we visited. However, the grouting on the tiles of the downstairs bathroom needed to be cleaned or re-grouted. The laundry room contains two washers and two driers. There was a great deal of dust and fluff behind the machines. This must be cleaned out thoroughly and regularly in order to prevent the spread of any micro-organisms. The laundry is not laid with nonslip flooring, and as such, the floors could be dangerous in the event of spills. The manager has been asked to make sure that the floor in the laundry is laid with purpose made, non-slip material. The downstairs bathroom/shower room had been redecorated, and was clean and bright. However, the extractor fan was extremely dusty, and should be cleaned regularly. Of the six residents who wrote to us, five said that the home was always fresh and clean, and one said usually. One person told us that they helped with the cleaning, and others said they tried to look after their own rooms. However, the restrictions on residents using the laundry and the kitchen detract from having a homely feel to the premises. Care Homes for Adults (18-65 years) Page 23 of 34 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. Residents individual and joint needs are met by appropriately trained and qualified staff. They are supported and protected by the homes recruitment policy and practices. Residents are supported by staff who are supervised, but would benefit from this being more regular. Evidence: All staff have NVQ Level 2 and two people have NVQ Level 4. The deputy manager has completed an NVQ Level 3 in Care and an NVQ Level 4 in Management. Various observations were made of staff interactions with residents. All staff were seen to be patient and good humoured, taking time to talk with residents and encourage them to express their thoughts and opinions. The healthcare professional who wrote to us said: My client always gets on with the staff and management of the home. Training records showed that staff have had specific mental health training, and this has included issues such as bi-polar disorder, obsessive compulsive disorder, challenging behaviour, depression and schizophrenia. Recent training has included first aid, manual handling, safeguarding adults, Deprivation of Liberty and Schizophrenia and infection control. All staff, including the manager, have done food hygiene training. A new DVD has been purchased for staff use, entitled Dignity in Residential Care. Staff training in medication administration was done in 2007, and it is Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: recommended that they receive refresher training in this area. The home has introduced a training matrix which shows when various training will be held. There was no mention of manual handling or any mental health training on this matrix, and it is recommended that it is added. The matrix itself does not show when peoples training needs updated and should be amended to reflect this. Sandmars employment checks include Criminal Records Bureau (CRB) and checks against the Protection of Vulnerable Adults (POVA) register, two written references and a medical declaration. All potential staff complete an application form, and this is kept by the home. Several staff files contained no photographic ID, and we have asked the manager to make sure that this is done. It is no longer a legal requirement that passport and driving licence details are kept, and these should not be stored on personnel files. Sandmar staff have regular staff meetings and minutes are kept of these meetings. Staff supervision was being held, but some people did not have regular sessions and some people had none at all on file. The manager admitted that perhaps he had not recorded some of the meetings and put them on file. We have asked him to ensure that all staff members have regular supervision sessions with their line manager, and that records are made of these sessions. We recommend that all staff with responsibility for supervising staff should have training in supervision practice. A schedule of when supervision sessions are to be held should be drawn up. Care Homes for Adults (18-65 years) Page 25 of 34 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. Residents benefit from a well run home. Their views underpin the monitoring and review of care practice, and people feel that their views are listened to. The homes policies and procedures are good, and the arrangements for carrying out health and safety checks mean that residents live in a safe environment. Evidence: The manager/provider has been registered with CQC for some years, and also has another home in Wiltshire. He has appointed an administrator to support him with much of the day to day work in the home. This person has made great improvements to care planning and risk assessments, and ensures that the homes paperwork is kept up to date. He has completed his Registered Managers Award and is currently studying for his Mental Health Diploma. One person said: The home is always well run, and another said: Theres always a good atmosphere. The provider visits the home frequently, and the administrator and deputy manager see all residents on a daily basis. This helps when trying to find out what residents feel about the care offered and helps to foster good relationships. A quality assurance Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: questionnaire was done in November 2008, and sent to residents, families and other third parties. The feedback included one persons comment which said the activities were poor. Since then the manager has bought a table tennis set and a Wii console for people to play games. We asked the residents if carers listened and acted on what they say. Of the six residents who wrote to us, four said always and two said usually. Residents meetings were found to be difficult to hold because people chose not to meet together on a regular basis. This has been helped by the deputy manager meeting with people on an individual basis to speak to them about any thing they would like to do or any way in which the service can improve. One resident we spoke to said: I only have to ask for something and it is done right away. All staff have had food hygiene training and food temperatures are recorded on a daily basis. Central heating and gas checks are done annually, as well as portable electrical appliances. Unfortunately, a portable heater had been placed in the dining room, and when we looked at it, it had not been checked. This could potentially be very dangerous and we asked the manager to make sure it was removed immediately until it had been checked. We have reminded the manager that all portable appliances must be checked for safety before use The homes deputy manager is the designated fire officer, and he gives staff gives fire instructions three monthly. He is currently reviewing and updating the fire procedures and risk assessments. The hot water system has been re-adjusted to control the temperature of the water and radiators have been covered throughout the house. The stair lift has an annual servicing contract in place. A call bell system has been installed in the home and this is linked to staff pagers so they can respond quickly to any resident or colleague who needs them. This call system was checked, and it was answered by staff on duty within one minute. Care Homes for Adults (18-65 years) Page 27 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Adults (18-65 years) Page 28 of 34 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 Requirement 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 Requirement Timescale for action 1 6 17 All residents must have photographic ID on file. So that they can be easily identified in an emergency. 11/01/2010 2 9 37 CQC must be informed of anything which affects the well being of residents. This includes any hospital admission, any involvement with the police, any serious accidents, medication errors and any acts of aggression. So that any risks to residents are monitored and the home demonstrates how they manage these risks. 11/01/2010 3 20 13 All boxes of medication must 11/01/2010 be dated when opened. So that it is easy to check how much medication should be in stock. 4 20 13 Staff must make sure that peoples medication care 11/01/2010 Care Homes for Adults (18-65 years) Page 29 of 34 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 Requirement Timescale for action plan is followed, especially if someone is suspected of storing medication for the purposes of self harm. The care plans must be expanded to ensure that all staff are aware of how to make sure pills are swallowed. So that all residents safely take the medication prescribed to them. 5 22 17 A formal record of all complaints must be held. So that people can be sure their concerns are listened to and taken seriously, 6 24 23 The dining room floor must be re-varnished or made good in some other way. So that residents live in a homely environment. 7 30 16 The dust behind the washing 11/01/2010 machine and driers in the laundry room must be cleaned out thoroughly and regularly, as must extractor fans. So that there is less risk of spreading any microorganisms which might lead to cross-infection. 11/02/2010 11/01/2010 Care Homes for Adults (18-65 years) Page 30 of 34 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 Requirement Timescale for action 8 30 13 The floors in the laundry must be laid with purpose made, non-slip material. To avoid the risk of accidents. All staff files must include photographic ID. So that there is evidence of checks done when employing staff. 11/02/2010 9 34 17 11/02/2010 10 36 18 All staff members must have 11/02/2010 regular supervision sessions with their line manager, and records should be made of these sessions. So that staff have the opportunity to talk over their work practice and training needs 11 42 13 All portable appliances must 05/01/2010 be checked for safety before use. So that the potential risk of an electrical fire is minimised. 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 1 1 The Statement of Purpose should be amended to include details of the new management arrangements, specifically Page 31 of 34 Care Homes for Adults (18-65 years) 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 that the organisation is now a limited company. There should also be reference to the fact that residents are not encouraged to enter the kitchen unaccompanied. 2 3 6 9 The manager should consider introducing an Advance Directive section to the residents care plans. Where residents behaviour is aggressive, records should be kept of any discussions with them about how to manage their behaviours, and any potential consequences to them. Records should be kept of discussions with residents about their interests, for example cooking, and why the decisions were made not to pursue these interests. A regular medication audit should be done, and this should be recorded. Staff should receive refresher training in safe handling of medication. Staff should complete the Medication Administration Record in a consistent manner when medication is not taken. Staff should negotiate a regular room search option with any resident suspected of storing medication for self harm purposes. This should be recorded in the medication care plan. Minor concerns from residents should be recorded, as well as details of how they are resolved. Further attempts should be made to clean the perspex windows of the smoking room so that people can see out. The window sill should be re-covered. The stained grouting on the tiles of the downstairs bathroom should be cleaned or re-grouted. Passport and driving licence details should no longer be stored on personnel files. The training matrix should be amended to include manual handling and mental health training, and should show when peoples training needs updated. All staff should have refresher training in medication administration. All staff with responsibility for supervising staff should have training in supervision practice. A schedule of when Page 32 of 34 4 12 5 6 7 8 20 20 20 20 9 10 22 24 11 12 13 24 34 35 14 15 35 36 Care Homes for Adults (18-65 years) 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 supervision sessions are to be held should be drawn up. Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: 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. Care Homes for Adults (18-65 years) Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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