Care Home: Sandown Nursing Home

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What the care home does well There is a good pre-admission process in place that staff followed to ensure that the home is able to meet people`s needs prior to admission. The service is warm and homely and there is an ongoing programme to refurbish and upgrade the home. The furnishing was of good standard and appropriate to the service users` needs. Equipment was available to support and maintain the service users` independence as able. The service users told us that the meals at the home were good and choices were available to them. There is registered manager with responsibility for the day-to-day management of the service is supported by a business manager. What the care home could do better: Further development of care plans and risk assessments for new service users is needed to ensure that care is always provided in a consistent manner. Arrangement must be in place to ensure that people receive their prescribed medicines at all times. The manager must ensure that staff practices always promote autonomy and respect when providing personal assistance/ support. Random inspection report Care homes for older people Name: Address: Sandown Nursing Home 28 Grove Road Sandown Isle Of Wight PO36 9BE two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Anita Tengnah Date: 1 0 0 5 2 0 1 0 Information about the care home Name of care home: Address: Sandown Nursing Home 28 Grove Road Sandown Isle Of Wight PO36 9BE 01983402946 01983407975 admin@sandownnursinghome.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Miss Belinda Jane Davies,Mr Richard Henry Davies,Mrs Elizabeth Davies Name of registered manager (if applicable) Jingle Campos Santos Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Conditions of registration: The maximum number of service users to be accommodated is 39. The registered person may provide the following category/ies of service only: Care home with nursing (N) only - to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home Sandown Nursing Home is registered with the Care Quality Commission to provide care and nursing to thirty nine people in the older persons category. The home is a large Care Homes for Older People Page 2 of 11 care home 39 Over 65 39 0 Brief description of the care home Victorian residence that has been adapted and extended across the years to meet the needs of the individuals accommodated, with rooms provided on two floors and accessible via a passenger lift. The home is located in Sandown and is within walking distance of the main town, its facilities and amenities, including the local railway station and a bus service. Information about the rate of fees charged should be sought from the service. Care Homes for Older People Page 3 of 11 What we found: An unannounced inspection visit was undertaken over one day on 10 May 2010 as part of our monitoring process and lasted four and a half hours. We sent out the Annual Quality Assurance Assessment (AQAA ) to the registered person at the service. This is one of the means of collecting data from the service. We also sent out service users and staff surveys to the home to seek their views of the service provision. During the visit we spoke to a number of the service users and the staff. We looked at the environment, the service users records and care plans and some staff records as maintained at the service and we observed care practices. The inspection took into account the homes (AQAA), which arrived when we asked for it and was completed satisfactorily. The AQAA is a self assessment tool that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We have also looked at any other information that we have received since the last inspection. As part of our visit we looked at the pre-admission assessment process that the home has in place and the records of two service users who have been admitted since the last inspection. These showed that assessments were completed prior to admission. Details of the persons needs were recorded and the manager discussed that this information is used to develop the care plans. Although the service users did not visit the service prior to admission due to their poor state of health/ frailty, the manager said that their family are always offered the chance to look round the home that they often did visit and information about the service is shared with them. The care plans for three service users were looked at. The care plans were developed following long term needs assessments. Two of the care plans contained good details of the assessed needs and action plans were in place to show how these would be met. These included assistance with personal care, moving and handling, skin integrity, safety and bed rails as required. There was evidence that external agencies were consulted at regular intervals for one of the service users who was receiving their feeds through a tube. One of the new people recently admitted had a detailed assessment completed, however there was a lack of care plans to show how their immediate care needs would be met. Care plans for personal care, skin integrity/ pressure ulcer care were not available as required. This was discussed at the time of the visit and the manager was putting in place an action plan such as an interim care plan for this person to include pressure ulcer assessment and treatment. The manager stated that associated document in the pre assessment record would be used. This would ensure that care needs are met appropriately and in a consistent manner while care plans continue to be developed. The record for a service user was identified as requiring thickened fluids stage 1-2 and a pureed diet due to swallowing difficulties. The care plans showed that they were receiving a semi soft diet and this was brought to the attention of the manager and should be reviewed. There was no Speech And Language Therapist (SALT) assessment available and the manager said that she would be making a referral to the team. Care Homes for Older People Page 4 of 11 The manager stated that the home was developing a fall risk assessment tool for people identified as having a history of falls. This would help identify the level of risk and action plan put in place. The record for one service user with a pressure ulcer showed that an assessment was completed and details of treatment were recorded in their wound care plan and included wound evaluation. Pressure relieving equipment were available for the prevention and management of pressure risks. We looked at the process for the ordering, receiving and general management of service users medication. Medication was stored in a locked and secure medicine trolley, in a locked room and where a medical refrigerator was also housed. Controlled medicines were stored safely and recorded from the random sample that we looked at. The manager confirmed that the registered nurses were responsible for the service users medicines. We talked to a staff member about disposal of a medicines and this was managed and recorded appropriately as per the homes procedures. A sample of the medication administration record (MAR) charts was looked at and this showed that staff were recording medicines as administered. We discussed with the staff about a written protocol for service users who are prescribed medication on an as needed (PRN) basis only and how staff would know when this should be given. This is to ensure that people receive their medication when they require them and do not receive medicine when not needed and to ensure consistency. The manager said that this would be developed. One service user was noted not to have received one of their medication for four days as the staff stated they had run out of stock. Clear procedures need to be in place for checking and ordering medicines to ensure that people receive their prescribed medicines at all times and they are not put at risk. The home was using a bulk system for some medicines that included pain killers and aperients and creams protocol for the management of bulk medicines needs to be developed and creams/ ointments dispensed must contain the names of the service users and the date that they are dispensed/opened. We found that some of the creams/ ointments in the service users bedrooms did not contain these information and pose an infection control risk. We sent out some service users and staffs surveys when we undertook a review of the service in March 2010. We received a good response and this showed that people were satisfied with the care that they are receiving. Some of the comments included: Provides nursing care. We appreciate the care and attention that our relative is receiving at Sandown. Very good at caring for the patients and liaising with the family. Another comment was that the staffing is good and caring and with excellent lounge. They tell us that the home is clean and fresh and they know who to speak to informally if they are not happy. Most of them said that they knew how to make a formal complaint. One of the service users we spoke to said that they have the choice to remain in their rooms or in bed as they chose. Another person was receiving short term respite care at the service and was complimentary about the care that she was receiving. Care Homes for Older People Page 5 of 11 The meals at the home were well managed and people we spoke to were complimentary about the food provided. They told us that they were supported to choose from the daily menu and they were able to opt for something different from the menu and this would be provided. The lunchtime meal was seen and this looked well presented, balanced and nutritious. Hot and cold drinks were available to the service users throughout the day. Staff were available to offer support with meals as required and meals were not rushed. We observed that one of the staff did not offer appropriate support when helping two service users with their meals. This meant that by the time the second person would receive their lunch it would be cold and this had been left exposed. This was brought to the attention of the manager as action was required to ensure that people are supported appropriately at all times and staff promote their dignity and choice. The home has a planned activity programme in place that included weekly songs and music from external entertainers. The staff arranged slide shows, bingo, board games, musical entertainments and reminiscence slide shows. The home maintains good links with the local community and staff from the Alzheimers society carried out sensory activity such as planting sunflower and sweet peas. A monthly church service was also available from the local Parish Church. The provider told us that they are looking at developing more 1:1 activities as this was highlighted in their recent survey. Most of the service users are accommodated in single bedrooms. One of the shared room was being used for single occupancy at the time of the visit. The staff were observed knocking on bedroom doors and waiting to be given permission to enter before going in. The home was warm clean and it was evident that there is an ongoing programme of refurbishment. The providers were at the home on the day of our visit and planning to renovate some parts of the service including new carpets. The furnishing was of good standard and appropriate to the service users needs. There is a system in place for the management of the service users personal allowances. The homes administrator maintained good records/ receipts of all transactions that are undertaken on behalf of the service users. Personal allowance are maintained in a residents account. Invoices are raised for items that are not included in the fees such as chiropody, hairdressing, personal shopping and sent to the nominated persons responsible for payments. The service users personal allowance that were maintained at the service were all pooled together and the home must ensure that these are maintained individually. The manager confirmed that this will be addressed. The service has a registered manager who is responsible for the day- to day management of the service. It was evident from interactions observed that the staff and the service users had developed good relationships with each other. The registered providers attend the home at least on a weekly basis and the staff reported that they are very supportive. The AQAA states that with the introduction of deprivation of Liberty (DOL) legislation, the service was in the process of providing training for all the staff and updating their policies to guide practice. Care Homes for Older People Page 6 of 11 What the care home does well: 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 set out on page 2. Care Homes for Older People Page 7 of 11 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 11 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, 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 9 13 The registered person must 30/06/2010 ensure that arrangements are in place for the handling, safe administration of medicines in the care home. These must include creams and ointments. To ensure that people receive their prescribed medicines as prescribed and safely at all times. 2 10 12 The registered person must 15/06/2010 ensure that the staff respect the choice and dignity of the service users when providing support to them. To ensure that people receive support in an appropriate manner at all times. Care Homes for Older People Page 9 of 11 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 Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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