Care Home: Sanstone Resource Centre

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What the care home does well People told us that they were happy with the care provided at Sanstone Resource Centre, they told us that: "Yes I am very happy with Sanstone," "they look after us here", "They go out of their way to make residents and visitors feel at home and make sure that everyone is comfortable. They always put residents first." People have their needs assessed before they come to live at the home. This information helps people make an informed choice as to whether the home will be suitable for them. When people have their needs assessed this gives increased confidence that staff will be aware of their needs and therefore will be able to meet them. People are encouraged to visit the home prior to them deciding to come and live there. People receive good standards of care and support that meets their needs and choices. Health care needs are met. A relative told us: "She is well looked after, they bend over backwards to help." People told us that the food is "very nice" and a choice is always available". Knowledgeable and friendly staff provide care at the home. Staff, are committed to caring for the people at the home. People living at the home told us: "Staff lovely and very friendly". The home has robust staff recruitment and selection processes, which minimises the risk of unsuitable people working at the home and protects people who live there. What has improved since the last inspection? The service has care plans which take into account individual needs, preferences, likes/dislikes. We have however identified that further improvements are needed in care planning. There have been many changes to the staff working at the home with previous Sanstone Resource Centre staff moving to work in other homes. We feel that although this transition has been difficult there will now be greater staff stability until the closure of the home. What the care home could do better: Sanstone Resource CentreDS0000071310.V377267.R01.S.docVersion 5.2There is a need for consistent management at the home. The ongoing changes in the management of the home in the last year have shown the need for an effective leader to enable the home to now go forward and address the five requirements and seven recommendations that we have made as a result of this inspection. Care plans need to be comprehensive and reflect all people`s needs, choices and capabilities. A detailed plan of care will provide staff with information not only about people`s needs but give them instructions on how they should be met. The Acting Manager has already identified that improvements are needed with the management of medicines. We have given the home three requirements and five recommendations (detailed at the back of this report) to further improve the management of medicines at the home. The service has identified a need to develop an individual plan for people to maintain/regain their independence. We agree that this needs to be undertaken as soon as possible particularly for those people moving towards more independent living and should be identified within their care/support plan. Key inspection report CARE HOMES FOR OLDER PEOPLE Sanstone Resource Centre Sanstone Road Bloxwich Walsall West Midlands WS3 3SJ Lead Inspector Amanda Hennessy Key Unannounced Inspection 26th August 2009 08:30 DS0000071310.V377267.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. Sanstone Resource Centre DS0000071310.V377267.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 Sanstone Resource Centre DS0000071310.V377267.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sanstone Resource Centre Address Sanstone Road Bloxwich Walsall West Midlands WS3 3SJ 01922 710 572 01922 710 572 joy.sumner@housing21.co.uk www.housing21.co.uk Housing 21 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) Vacant Care Home 38 Category(ies) of Dementia (10), Old age, not falling within any registration, with number other category (38) of places Sanstone Resource Centre DS0000071310.V377267.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 Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 10 2. Old age not falling within any other category (OP) 38 The maximum number of service users to be accommodated 38. Date of last inspection 9th September 2008 Brief Description of the Service: Sanstone Resource centre provides care for up to thirty eight older people; up to ten people may also have dementia. A separate day care facility is included in the same building. The home has been identified for closure by January 2011, as part of the modernisation of Housing 21 services in Walsall. All bedrooms are single occupancy and are located on both floors. Bathrooms and toilets are appropriately situated around the home with adaptations to assist people. A passenger lift is available to assist people move between the floors. There are several lounges throughout the building. The building is in mature and pleasant grounds. The home is just a short distance from the main road into Bloxwich and a main bus a route. Adequate car parking is available. The service user guide seen identified that fees charged are up to £432 per week for permanent care and £108.10 per week for respite care. The fee information given applied at the time of the inspection; persons may wish to obtain more up to date information from the service. Sanstone Resource Centre DS0000071310.V377267.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 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced Key Inspection was carried out by two inspectors on one day from 8.30 a.m. – 7.00 pm, neither the home nor the provider knew that we would be visiting. There were thirty-four people living at the home at the time of our visit. The National Minimum Standards for Older People were used as the reference for the inspection. Information for the report was gathered from a number of sources: a questionnaireAnnual Quality Assurance Assessment (AQAA) was completed by the previous Acting Manager of the service and was sent to us before the inspection; We looked around most of the home including peoples rooms, bathrooms, toilets and communal rooms. Records about the safety of equipment and the building were also checked. Fourteen written surveys were returned directly to us from people living in the home and their relatives, these survey forms are known as have your say about Sanstone, to enable people to tell us about their experiences of life at the home. We had discussions with the Acting Manager, care staff and people who live in the home and their relatives, to gain their views of what it is like to live at the home. We looked at how the service has responded to concerns, how it protects people from abuse and how staff are recruited and trained. We also looked at the number of staff available to care for people who live in the home. Four people who live in the home were case tracked, this process involves establishing peoples experiences of living in the care home by meeting or observing them, discussing their care with staff, looking at their care records and focusing on outcomes of the care that they receive. Tracking peoples care helps us to understand the experience of people who use the service. As part of this process we also looked at peoples medicines, how they are ordered and records of their administration. Sanstone Resource Centre DS0000071310.V377267.R01.S.doc Version 5.2 Page 6 What the service does well: People told us that they were happy with the care provided at Sanstone Resource Centre, they told us that: “Yes I am very happy with Sanstone,” “they look after us here”, “They go out of their way to make residents and visitors feel at home and make sure that everyone is comfortable. They always put residents first.” People have their needs assessed before they come to live at the home. This information helps people make an informed choice as to whether the home will be suitable for them. When people have their needs assessed this gives increased confidence that staff will be aware of their needs and therefore will be able to meet them. People are encouraged to visit the home prior to them deciding to come and live there. People receive good standards of care and support that meets their needs and choices. Health care needs are met. A relative told us: “She is well looked after, they bend over backwards to help.” People told us that the food is “very nice” and a choice is always available”. Knowledgeable and friendly staff provide care at the home. Staff, are committed to caring for the people at the home. People living at the home told us: “Staff lovely and very friendly”. The home has robust staff recruitment and selection processes, which minimises the risk of unsuitable people working at the home and protects people who live there. What has improved since the last inspection? What they could do better: Sanstone Resource Centre DS0000071310.V377267.R01.S.doc Version 5.2 Page 7 There is a need for consistent management at the home. The ongoing changes in the management of the home in the last year have shown the need for an effective leader to enable the home to now go forward and address the five requirements and seven recommendations that we have made as a result of this inspection. Care plans need to be comprehensive and reflect all people’s needs, choices and capabilities. A detailed plan of care will provide staff with information not only about people’s needs but give them instructions on how they should be met. The Acting Manager has already identified that improvements are needed with the management of medicines. We have given the home three requirements and five recommendations (detailed at the back of this report) to further improve the management of medicines at the home. The service has identified a need to develop an individual plan for people to maintain/regain their independence. We agree that this needs to be undertaken as soon as possible particularly for those people moving towards more independent living and should be identified within their care/support plan. 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. Sanstone Resource Centre DS0000071310.V377267.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 Sanstone Resource Centre DS0000071310.V377267.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): 1, 3 and 6. 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 have their needs assessed and required information about the home to enable them to make the decision that the home is suitable for them. EVIDENCE: The home provides required information about services they offer within the service user guide and statement of purpose. The service user guide is available in every bedroom to enable people to refer to it when they need to. We were told that the service user guide is also available in large print and Braille on request. The Acting Manager told us that she is currently updating the service user guide to reflect the recent management changes, so people can have an accurate picture of what they can expect from the service. Sanstone Resource Centre DS0000071310.V377267.R01.S.doc Version 5.2 Page 10 People have an assessment of their needs which is usually undertaken by a senior member of staff. We looked at these assessments and found them to contain sufficient information about people’s needs choices and capabilities. The assessment of needs then forms the basis of the person’s plan of care, giving staff information about their care needs. We found that when people come in either for “emergency” respite care or for “interim “ care the person’s assessment is undertaken by a social worker. The service provides short term “interim and respite care”. Interim and respite care is usually short term either until the person is able to return home or is waiting for alternative long term accommodation. We have been told that the home will only accommodate people for short stay until permanent places for them to live can be found prior to the closure of the home. Sanstone Resource Centre DS0000071310.V377267.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, 9 and 10. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home have their needs identified and met. The management of peoples medicines needs to be reviewed to ensure that people have the medicine that they need and are prescribed for. EVIDENCE: Care needs are identified following an assessment of people’s needs this information is then transferred into their plan of care. The Acting Manager told us that she will be reviewing the care planning system to ensure that care plans fully reflect all people’s needs, choices and capabilities. Care plans were not always fully completed despite a member of staff signing to say that the care plan was complete. We found that not all people’s needs were identified within the care plan or contained accurate instructions for staff,examples of this included one person care plan which identified no problems with Sanstone Resource Centre DS0000071310.V377267.R01.S.doc Version 5.2 Page 12 continence yet other information that had been supplied to the service showed that they need to use continence aids, another person was susceptible to frequent urinary tract infections yet there was no record of this in their assessment or care plan. We did find that care plans did not always include changes to people’s needs including short term problems. For example, two people had urinary infections, although staff had arranged for the doctor to visit them quickly there was no record of a need for increased fluid intake in their plan of care. The Acting Manager assured us that this would be addressed with the new care planning system. We were told that care plans are all reviewed at least weekly by a manager, although it was evident that changes were not identified. Staff on each shift make a record of the persons day and their general health and at this point any changes to their needs should be identified. The service’s AQAA identified that it needs to develop individual plans for maintaining/regaining independence. We were unable to see any instructions within care plans how staff are assisting people with the transition to live more independently such as making drinks, preparation of meals or management of their medicines. There is currently a vacant post with Housing 21 to assist people with their “Life Skills” as the previous member of staff had recently left. Staff need to assist people to be more independent which should be identified within people’s plan of care. People have access to other health professionals depending on their needs such as doctors, district nurses, opticians and chiropodists. There are risk assessments to monitor peoples health for falls, pressure sores and poor nutrition which usually identified actions to minimise any risk to the person. We did find however that risk assessments were not always complete. We were also able to see that when there is any changes to the persons health, staff ensure that they are seen by their doctor. People told us: “I’m well looked after here, I couldn’t fault them,” and “they ring the doctor for me if I’m not well.” There are up to date policies and procedures in place for the storage and administration of medicines (including controlled medication) at the home. We were told that only trained care staff are responsible for the ordering and management of medicines at the service. A Deputy Manager has recently been given the responsibility for the overall management of medicines as the Acting Manager told us she had already identified improvements were needed. We found an inappropriate entry for the removal of controlled drugs from the home which was contrary to policies and procedures. We were concerned that despite other entries for the same person staff had not questioned the legitimacy of this entry which would have enabled an investigation to take place earlier. The Acting Manager told us that she would undertake a full investigation of this and a complete audit of all medicines in the home and Sanstone Resource Centre DS0000071310.V377267.R01.S.doc Version 5.2 Page 13 would tell us of the outcome of the investigation. We highlighted a number of things that need to be improved to ensure that people’s medicines are being safely stored and managed. We also found that all unused medication is returned at the end of each month, despite them then being reordered which is a waste of valuable NHS resources. Areas for improvement are identified within the recommendation and requirement section of this report. We also checked some of the balances of people’s medicines and found two people whose medicines we looked at was not correct; this means that it is not certain that these people had had all the medicines that they were prescribed for. The homes staff induction programme includes a section on treating people with respect. We observed staff to knock before entering bedrooms and toilets and interacted in a friendly and open way using people’s preferred name. Sanstone Resource Centre DS0000071310.V377267.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 and 15. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People would benefit from more things to do but have the opportunity to make choices about their life in the home and maintain relationships with friends and relatives. EVIDENCE: Peoples’ interests and choices are recorded within their care records. A ‘life history’ is requested and in most cases is available to staff, which gives a good insight to people’s life and preferences. People told us that they are able to get up and go to bed and spend the day as they wished. We have been told that the home’s activity programme is under review. The Acting Manager told us that staff have helped people register with “Ring and Ride” so they can go out if they are able to. People told us that they would like more things to do, they told us: “I’d like them to take us out, we spend all day every day in the home.” Staff told us that it has been difficult to arrange activities with both staff and residents moving in and out of the home in recent weeks. They told us “its Sanstone Resource Centre DS0000071310.V377267.R01.S.doc Version 5.2 Page 15 been difficult because we feel we are inferring but we have identified things for the residents to do.” Housing 21 previously had a member of staff who had assisted people prepare for their transfer to independent living, although this person has since left. It is disappointing that work with people towards more independence which will help them when they live in their own flat does not appear to have continued. Visitors are able to visit the home at any reasonable time in the day. We observed several visitors arriving and leaving during the day of the inspection. Relatives also told us: “We are made welcome.” A new relative told us; “Every single member of staff popped their head round the door and said hello and asked us if they could get us anything while we were waiting for mum to get here.” The home has communion on a monthly basis for people to attend if they wish to. The Home has a four-week rolling menu. There are at least three meal choices available at each mealtime. People using the service confirmed that they always have a choice offered and can have their meals in the dining room or if they prefer their own bedroom. People told us: “the food is very good here,” and “ the food is excellent.” We did sample the food served and it was all tasty. We did find that vegetables served from one trolley would have benefited from being a bit hotter, the Acting Manager told us that she would ensure that checks on the temperature of the food would be undertaken. Sanstone Resource Centre DS0000071310.V377267.R01.S.doc Version 5.2 Page 16 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 and 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. There are appropriate procedures in place to listen to people who live in the home and keep them safe. EVIDENCE: The home has a complaints policy and procedure. The complaints procedure in the Service User Guide and is also displayed in the home. We found that the home takes all concerns seriously. The home has had nine complaints in the last year. We looked at records of all complaints and found that they have all been investigated and required actions undertaken. We have received no complaints about the home in the last year. People we spoke with all told us that they know how to make a complaint, they told us: “”I’d tell my family and they would sort it out for me,” and “I would tell the staff.” Staff we spoke to said that they would highlight any concerns to whoever is in charge of the shift or the manager. It is positive that staff have all had safeguarding training or have training arranged for them shortly but all said Sanstone Resource Centre DS0000071310.V377267.R01.S.doc Version 5.2 Page 17 “I’d tell the senior as its not right, I always think about they could be my mum or dad.” There have been no safeguarding referrals in the last year. Sanstone Resource Centre DS0000071310.V377267.R01.S.doc Version 5.2 Page 18 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 and 26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is a clean and homely place to live despite some facilities being outdated. EVIDENCE: The home is homely and clean. Décor throughout the home is generally satisfactory although there are areas where the woodwork has been marked and damaged and some of the décor is dated. There are some small bedrooms with no ensuite facilties. The manager said that there is an ongoing maintenance and refurbishment plans despite plans to close the home in January 2011. A number of peoples’ bedrooms have been redecorated and carpets have been replaced. The home has large, pleasant and well maintained grounds. Sanstone Resource Centre DS0000071310.V377267.R01.S.doc Version 5.2 Page 19 The home has a number of lounges including a quiet lounge, smoking room, pool room. Lounges are comfortable and have domestic style furniture. The home does not have en-suite bedrooms but toilets and bathrooms are located close to people’s bedrooms and all have adaptations for dependent people. The home has a range of aids and adaptations to assist dependent people. There is a staff call system throughout the home, a small passenger lift, grabs rails and two hoists. All bedrooms in the home are single occupancy. We found bedrooms to be clean and tidy with personal pictures etc, although some are small. One person told us: “I’d like a larger room as I think the layout makes it difficult for me to watch my television.” The home is clean and free from odour. There are good arrangements with the provision of gloves, aprons, liquid soap and paper towels available throughout the home to minimise the risk of cross infection. Sanstone Resource Centre DS0000071310.V377267.R01.S.doc Version 5.2 Page 20 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): 27, 28, 29 and 30. 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. The home has knowledgeable staff who understand and meet peoples’ needs. Recruitment and selection processes protect people using the service. EVIDENCE: We found that generally the home is staffed with appropriate numbers and skill mix to meet people’s needs. People told us that: “they always come when I ring,” and “ I don’t need much help but they are always there when I need them.” One staff member told us: “I think that we need more staff at mealtimes.” We did observe some difficulties and would advise that there is a review of staff availability at mealtimes. Staff we met spoke positively about support and training they receive and were knowledgeable about peoples’ needs. We observed good interaction between staff and people living at the home. All staff that we spoke to told us that they had a care qualification (minimum of National Vocational Qualification level 2). The previous Acting Manager told Sanstone Resource Centre DS0000071310.V377267.R01.S.doc Version 5.2 Page 21 us all but one member of staff has a care qualification. This gives confidence that staff are knowledgeable and understand peoples’ care needs. People were complementary about the staff and told us: “they give us good care and listen to us,” and “the staff are very nice.” Staff recruitment and selection is completed to the required standard. All staff files seen contained appropriate checks such as criminal records checks and references which are obtained before staff start working at the home. We were told that new staff have, induction training that meets the “Skills for Care” standards. Records of staff induction were available. Sanstone Resource Centre DS0000071310.V377267.R01.S.doc Version 5.2 Page 22 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 and 38. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a need for consistent and effective leadership to enable the ongoing development of the home and the staff team. EVIDENCE: The home has had three managers since our last inspection. The current “Acting” manager is Nita Clements. Mrs Clements is an experienced home manager and told us that it is planned that she will be the manager until the homes closure in January 2011. Mrs Clements recognises the problems that exist as a result of staff changes, as staff have moved to new homes as part of Sanstone Resource Centre DS0000071310.V377267.R01.S.doc Version 5.2 Page 23 the re-provision of services owned by Housing 21 within Walsall Borough. Problems identified within this inspection particularly with care planning and medication could have been addressed sooner if there had been greater stability with the management of the home to recognise shortfalls earlier. Mrs Clements discussed her plans to improve services at Sanstone Resource Centre. The homes AQAA was sent to us when we asked for it. The AQAA gave us a reasonable picture of the home. The previous Acting Manger identified that improvements were difficult to identify as the management team had been there for such as short time. We found that due to the management changes in areas which were identified as needing development, no development had yet been made and other areas also required improvement. The home has a quality assurance programme. It is positive that other home managers from the Housing 21 organisation come in to audit practice based on the National Minimum Standards. Areas such as health and personal care, the environment and staffing are reviewed and when appropriate actions are identified for a development plan for the home. We were told that surveys are sent to all people who are discharged from the service, these surveys are returned directly to Housing 21 head office. Mrs Clements told us that she will be sending out surveys shortly, so that she can identify improvements that people feel are needed. The home does not act as appointee for people using the service. There are appropriate arrangements in place when people request it to keep small amounts of money for services such as hairdressing and chiropody. There is a record of all transactions and receipts are available to confirm the transactions. It was also positive to be told that daily checks on the contents of the safe are undertaken. Staff told us that they receive supervision, the Acting Manager said that she will ensure that staff supervision will be undertaken on a more regular basis. The home has an up to date health and safety policy for safe working practice with a range of risk assessments. Staff receive training and regular updates in all mandatory training. Maintenance contracts were randomly selected and were found to be up to date. Sanstone Resource Centre DS0000071310.V377267.R01.S.doc Version 5.2 Page 24 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 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 2 x 3 Sanstone Resource Centre DS0000071310.V377267.R01.S.doc Version 5.2 Page 25 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. 1. Standard OP7 Regulation 12(1), 15 Requirement Care plans must be sufficiently detailed to highlight all peoples’ needs including short term needs and how they should be met. There must be an appropriate record for the receipt, administration and disposal of medicines. There must be an appropriate signed and dated entry for the receipt, administration and disposal of controlled medication. A full investigation of the inappropriate entry for the removal of controlled medication must be undertaken and the Care Quality Commission notified of its outcome. There must be a registered manager who is competent and assessed as being a fit person to manage the home as identified by the Care Standards Act 2000 Section 11 (1). Timescale for action 26/10/09 2 OP9 13(2) 26/10/09 3 OP9 13(2) 27/09/09 4 OP9 13(2) 27/09/09 5 OP31 9 30/11/09 Sanstone Resource Centre DS0000071310.V377267.R01.S.doc Version 5.2 Page 26 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. 2. 3 4 5 6 7 Refer to Standard OP9 OP9 OP9 OP9 OP9 OP12 OP12 Good Practice Recommendations The amount of medicine given when a variable dose of medicine is prescribed should be identified. The temperature of the medication fridge should be between 2 and 8oC and should be checked at least daily. The temperature of the room where medicines are stored should be recorded at least daily. The practice of returning all unused medication at the end of each month to then reorder the same medication should stop to ensure more effective use of resources. Whenever appropriate any remaining medication should be recorded as carried forward to the next month. A key member of staff is identified to coordinate activities within the home. An activity programme is developed that reflects the needs choices and interest of people living at the home. Sanstone Resource Centre DS0000071310.V377267.R01.S.doc Version 5.2 Page 27 Care Quality Commission Care Quality Commission West Midlands Region 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). 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