Care Home: The Sandford Nursing and Residential Home

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What the care home does well The manager and staff put people at the centre of their care, treatment and support by enabling them to make decisions. The assessment process allows people to express their views as far as they are able to, including those acting on their behalf. People receive a service from a provider who take steps to prevent abuse and does not tolerate any abusive practice should it occur. People can be confident they will be offered a choice of meals that they will enjoy and meets their dietary needs. People can be assured that robust recruitment procedures are in place to ensure suitable staff are employed. The manager demonstrates a positive approach to seeking the views of residents and their relatives. She makes sure people are kept informed of developments and changes within the home and seeks their views as to whether they are suitable or not. The information in the manager`s self assessment (AQAA) provided us with reliable information about the service and matched our assessment that the home is well managed and seeks to continually review and develop the service it provides. Comments we received include: `Everyone is so helpful and friendly to all of us and we receive wonderful care and consideration`. `Always made to feel welcome with a cup of tea`. `Staff have helped me to progress after my stroke`. What has improved since the last inspection? There is now a dedicated member of staff to carry out supervision of staff including induction and appraisals. A second activity organiser has been appointed which has improved the range of activities on offer. The provider has continued to update the fixtures, fittings, furnishings and fabric of the home to improve the quality of the environment for people who live there. A relative told us that the regular carers were `Excellent`. Another person said `The staff are wonderful I cannot praise them enough`. People could tell us who their key worker is by name. What the care home could do better: The management of this service has a good awareness and understanding of what they want to achieve and how to do this including involving people who use the service. Care plans need to centre on people as an individual and take into account resident preferences and diversity.Recording of the rationale for use of bed rails could be more detailed. This should include documenting the person centered aspect of the safety management including discussion had with other parties in the multi-disciplinary team. Recording regular checking of the integral bed rails and any maintenance required. Training should be implemented for all staff who use them during their work. Daily records should give an indication of how the person has spent their day giving consideration to the general well being and emotional/social support of the person receiving care. Key inspection report Care homes for older people Name: Address: The Sandford Nursing and Residential Home Watling Street South Church Stretton Shropshire SY6 7BG     The quality rating for this care home is:   three star excellent 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: Pat Scott     Date: 0 8 0 4 2 0 1 0 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 Older People Page 2 of 24 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: The Sandford Nursing and Residential Home Watling Street South Church Stretton Shropshire SY6 7BG 01694723290 01694723290 accounts@jubileecare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Jubilee Care Ltd care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 35 The registered person may provide the following category of service only: Care Home with Nursing (Code N) 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) 35 Date of last inspection Brief description of the care home The Sandford Care Home is situated close to the town centre of Church Stretton, which has all local amenities. The accommodation is provided in one building, on three floors accessed via a shaft lift. Communal facilities are all situated on the ground floor. There is easy access to gardens and the home has car-parking facilities. 0 Over 65 35 Care Homes for Older People Page 4 of 24 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This is a key inspection for The Sandford. This inspection site visit provided an opportunity to find out how peoples developing care needs are being met, together with the services plans for improvement. This report draws on information received from the home in their Annual Quality Assurance Assessment, which is a self-assessment process that requires care services to record how well care outcomes for the people living in their service are being met as well as providing a range of statistical information about the service. We also looked at information we have about how the service has managed any complaints and responded to safeguarding referrals. We reviewed what the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. Care Homes for Older People Page 5 of 24 We reviewed the previous key inspection outcomes of 2/8/2007 and Annual Service Reviews of 18/7/2008 and 23/7/2009. We gathered relevant information from other organizations such as the Environmental Health Office (EHO), Health and Safety Executive (HSE) and the Fire Safety Officer (FSO). We spoke with 3 people about their experience of care and reviewed care plans. One Regulatory Inspector carried out this inspection over 3 hours Care Homes for Older People Page 6 of 24 What the care home does well: What has improved since the last inspection? What they could do better: The management of this service has a good awareness and understanding of what they want to achieve and how to do this including involving people who use the service. Care plans need to centre on people as an individual and take into account resident preferences and diversity. Care Homes for Older People Page 7 of 24 Recording of the rationale for use of bed rails could be more detailed. This should include documenting the person centered aspect of the safety management including discussion had with other parties in the multi-disciplinary team. Recording regular checking of the integral bed rails and any maintenance required. Training should be implemented for all staff who use them during their work. Daily records should give an indication of how the person has spent their day giving consideration to the general well being and emotional/social support of the person receiving care. 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 Older People Page 8 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 24 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff conduct a full assessment of need which means that people are involved in and receive care, treatment and support that respects their rights to make or influence decisions. People are provided with good information about the home so that they can be clear about what the service offers, the facilities that are available, the cost, and how to raise any concerns. Evidence: The service has a statement of purpose and service user guide book in large print format. This provides good information so that people can understand the care, treatment and support choices available to them. The guidance also provides information to help other people acting on their behalf, to understand their care, treatment and support, including their right to make decisions about their care. Care Homes for Older People Page 10 of 24 Evidence: The assessment process addresses of the things that are important to people in relation to their care and these are established as part of the preadmission and admission process with the support required to meet these needs discussed to see if it can be provided. A person spoken with said that they were offered the opportunity to discuss their care and felt the staff tried very hard to involve them and keep them upto-date. A key principle for the service is to consult with and involve people living in the home and their relatives or carers in developing a plan of care that will successfully meet the their needs as far as possible whilst also trying to accommodate peoples choices. People we spoke with said that there was open door visiting and that staff made them very welcome each time they came into the home. Care Homes for Older People Page 11 of 24 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All people using the service have care plans that cover all needs so that support for health and well-being, advocacy and social activities is consistently provided. There are processes for all aspects of medicines management so that people receive their medication safely and as prescribed. Evidence: Three care plans were looked at in detail. The content showed that after a full assessment a care plan is formed. This is informative and up to date but not written in a person centred way. The plans recorded standard needs without reflecting peoples preferences and diversity. The manager stated that the service is aware of this aspect of care planning and are to review the way staff record in them to make them personable. Risks had been identified with the statement of how they were to be managed and reviewed. The service has taken fully into account peoples capacity to make their own choices regarding their care and also their right to take informed risks. However, basic Care Homes for Older People Page 12 of 24 Evidence: information for the safe and appropriate use of items such as bed rails is in place. We discussed with the manager the need to make the initial assessment/rationale undertaken to use them, more specific to the individual and those involved in their care. Records of frequent review, recording, training and checking of the rails could be improved. Although plans are regularly reviewed for their effectiveness and kept up to date in recognition of the changing needs of the person, the evaluation of care was brief and the daily records more so. Nutritional risk assessments are done to enable people to make healthy choices concerning diet and maintaining adequate nutrition. There is a record of the persons personal history and social information which gives a good indication of the social/emotional support a person will need. As a response to a request at a recent residents meeting a photograph of the persons keyworker is in the care plan. The home has a very good record of preventing pressure ulcers and treating wounds that are present on admission from hospital. Staff continue to receive training to meet the needs of people with complex needs who require high levels of nursing intervention. Clear records indicated that the procedures for medication are followed in practice, monitored and reviewed. Care Homes for Older People Page 13 of 24 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given opportunities to lead dignified, comfortable and fulfilling lives based on their individual preferences, abilities and choices. People are provided with a choice of meals that they enjoy and maintain their health. Evidence: The managers self assessment (AQAA) tells us of changes that have been made as a result of listening to people living at The Sandford and their relatives. Details of the activities and events taking place on a daily basis are displayed for people to see on a board and in a monthly newsletter. The activity program includes opportunities for relatives to join in with events. People told us the home was very welcoming. Friends and relatives are encouraged to visit any time of the day and are made to feel very welcome. There are regular opportunities for residents and relatives to give their views on how the home is run. Residents are encouraged to chair the meetings and develop the agenda. Each person living in the home has a plan of care that takes account of their individual interests, preferences and life history so activities can be matched to their Care Homes for Older People Page 14 of 24 Evidence: individual needs. People are offered a choice of meals each day. We could see from our discussions with people that individual arrangements are made for people who need special diets or have particular preferences. Care Homes for Older People Page 15 of 24 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they will be protected and their individual rights supported because there is an open and inclusive atmosphere in the home and staff work in their best interests. The procedures used in the home insure that peoples comments and complaints are listening to and acted on properly. Evidence: The service has systems in place to deal with comments and complaints and provides people with information about this in various formats including audio and large print. People we spoke with said that they would know who to complain to and would feel quite comfortable in doing so. Staff understand aspects of the safeguarding process relevant to their care setting and are regularly provided with training and updates in this area. The manager has taken on board the implications of the Mental Capacity Act and Deprivation of Liberty in making sure people act in the best interests of residents and involve them in decisions about their lives. This has included updating the documents available in each persons care plan and providing staff with training. Care Homes for Older People Page 16 of 24 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, 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. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe, clean home, which is kept under review by the manager and provider, so that the improvements under way will benefit the people who live there. People can be confident there are suitable systems in place to provide them with fresh clean laundry and prevent infections spreading. Evidence: The grounds are very well maintained. Rooms are personalised with a high standard of cleanliness seen. There has been an ongoing redecoration and refurbishment programme which is now complete and residents opinions were sought regarding the decoration. Staff take responsibility for ensuring people are living and working in a safe environment as they go about their work. A person commenting on the improvements being made to the home said it Seems to be improving all the time. All areas of the home we visited were fresh and clean. People are provided with freshly laundered clothing and bed linen that promotes their dignity. There are good systems in place to reduce the risk of infection. This includes staff, resident and visitor access to liquid soap and paper hand towels. Staff have access to Care Homes for Older People Page 17 of 24 Evidence: protective clothing and disposable gloves. Minutes of a recent resident meeting praised staff highly for the way they dealt with an infectious episode at the home. Care Homes for Older People Page 18 of 24 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a staff team have been selected for their suitability to work with vulnerable people and receive the training and supervision they need to respond to peoples diverse and changing needs. Evidence: People commented positively on the approach of staff. One person said the staff are Always pleasant and caring. Another said The staff are truly good and caring. I cannot praise them enough. They work very hard all the time. The recruitment records we reviewed showed us that the manager is receiving the required checks before staff are fully employed. There is a training plan in place to make sure staff receive the regular training they need to stay up to date. Staff are trained in specific areas, according to their role in the home, to enable them to support the needs of older people. Clinical training for the registered nurses to maintain their practice is supported. Observation of their practice showed they take a pride in their work. Care Homes for Older People Page 19 of 24 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident in the service provided at The Sandford because the home is well managed, their views are fully considered and the company systems for monitoring the quality and safety of the service are kept up to date. Evidence: The manager provides effective leadership and management of the home based on providing good outcomes for the people who live there and involving their relatives. A relative told us there is a genuine commitment from the manager to listen to what people say about the home, ideas are acted upon by taking them to the General Manager and people provided with feedback. There is a detailed quality assurance program in place that provides the manager and provider with a system of continued review and reflection on the standard of service provided. There are well established systems described in other areas of this report for obtaining the views and experiences of people who live, work and visit the home. Care Homes for Older People Page 20 of 24 Evidence: Residents and their relatives receive feed back from the surveys carried out via meetings or newsletters. The home has a good history of meeting the required standards and providing excellent outcomes for people. The manager who is a registered nurse and experienced manager keeps up to date with current nursing practice to ensure appropriate procedures are followed and any nursing intervention is based on evidence based practice. The self assessment (AQAA) the manager submitted was sent to us on time. The information provides a true reflection of the service and confirms what we found during our visit. It also shows us that the manager works to achieve excellent outcomes for the people living in the home and is open to new opportunities. There are clear systems in place to account for any money deposited and paid out on behalf of residents for example to the hairdresser or chiropodist. There is an annual appraisal system in place to review the work of each member of staff. Staff confirm that they receive regular supervision. The manager has a supervision schedule and says that she links discussions to each persons training and development plan. The training records we saw confirmed that staff receive the health & safety training they need to support safe working practices. These include food hygiene, fire safety, moving and handling and first aid training. Health and safety risk assessments covering the work of the home are in place and kept under review. Staff receive the training they need to work safely but need to have more awareness around risk assessing bed rails more thoroughly in a person centred way. Records of all accidents are maintained and reviewed by the manager to identify any emerging patterns or risks for individual people. The manager keeps us informed of events in the home, such as accidents and incidents. The range and frequency of notifications have not raised any concerns with us. The manager has provided dates of regular servicing of equipment and systems within the home. Care Homes for Older People Page 21 of 24 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 Older People Page 22 of 24 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 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 23 of 24 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). 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