Care Home: The Sands

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What the care home does well The manager is registered with us so he has passed the fit person process. He has been managing the home for some time so knows people well. People have the support they need to keep in contact with family and friends. The home is clean and well maintained. People have access to all areas. People have the support they need to remain healthy and well. People are having support to take more control of their medication. People have the opportunity to take part in a range of community based activities. Staff have a sound induction and have access to a range of mandatory training courses. What has improved since the last inspection? The assessment tool that staff use to assess peoples needs has been improved by the company. This means that more detailed information can be sought about a persons needs and personal goals. The manager can then make a decision about whether the home can meet the persons needs or not. Service users have been involved in developing their care plans. Staff are talking to people about their personal goals for the future. Personal goals are being recorded and supported. The rota has been changed to support evening activities. Staff have had training in autism and Makaton, a sign language. What the care home could do better: Parts of the home need updating and improving. The manager is aware of this and the AQAA shows that there are plans to purchase new sofas, redecorate some areas and have the flat roof repaired. Key inspection report Care homes for adults (18-65 years) Name: Address: The Sands 40 Lower Sands Dymchurch Kent TN29 0NF     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: Kim Rogers     Date: 0 3 1 2 2 0 0 9 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 25 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 25 Information about the care home Name of care home: Address: The Sands 40 Lower Sands Dymchurch Kent TN29 0NF 01303875095 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: the.sands@craegmoor.co.uk Lothlorien Community Ltd care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 3. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home The Sands is registered to provide care for up to three people who have a learning disability. The home is a chalet style detached bungalow, similar to other properties in a private residential road within walking distance of Dymchurch. The accommodation is provided on two floors. All bedrooms are single. There is a small garden to the front of the property and a large well maintained garden to the rear of the home. Limited parking is available off road and some parking is Care Homes for Adults (18-65 years) Page 4 of 25 Over 65 0 3 Brief description of the care home available in the road. Dymchurch has a selection of shops, cafes, churches and entertainment. There is a local bus service. The reported fees are about £973.81 - £1646.71 per week. Please contact the provider for further details. Care Homes for Adults (18-65 years) Page 5 of 25 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 was a key inspection of the service which included a short unannounced visit to the home. We assessed the key Minimum Standards. The last key inspection of this service was 15.10.07 . We carried out an Annual Service Review on 26.08.08. Copies of these reports are available from the Provider or can be viewed on our website. We spoke to the people who use the service. We spoke to staff and sampled some records. We made observations and had a look around the home. After the visit we spoke to the manager by phone. We looked at the Annual Quality Assurance Assessment or AQAA. The manager completed this and it gives information about how the home has improved, what could be better and how they intend to improve further. We looked at any notifications from the home about accidents and incidents. We looked Care Homes for Adults (18-65 years) Page 6 of 25 at other information we have about the home including things like comments and complaints. We sent surveys to the people who use the service and other stakeholders. People told us what they think about the home. We received 3 surveys back from service users and 4 from staff. All made positive comments about the service. Service users said in surveys that the staff listen and treat them well and that the home is always clean and smells fresh. Service users said they feel safe. One person said I am happy where I live. The staff are supportive. Staff said that they have the training and support they need and that they feel they have enough staff to meet peoples needs. Staff said, There is good communication. The manager is very, very supportive and helpful to staff and service users. The environment could be improved, especially the sleep in room. The AQAA shows that there are plans to improve the environment. Care Homes for Adults (18-65 years) Page 7 of 25 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 25 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 25 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. There is information available about the home to help people decide about moving in. People know an assessment will be carried out before they move in. Evidence: There is information available about the home. This information is written with pictures, photographs and symbols. This means that the information is meaningful to people who may be thinking about moving in. The provider company is in the process of improving the assessment tool so that it meets the Minimum Standard. This means that prospective service users will have their aspirations as well as their needs assessed in more detail before they move in so the manager can be sure the home can meet their needs. The AQAA shows that people can have trial stays and visits so they can see what it is like to live at The Sands. Nobody has moved in since the last inspection. In surveys received everybody said that they were asked about moving in and that that they had enough information about the home. Care Homes for Adults (18-65 years) Page 10 of 25 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. Service users know that their needs and goals will be supported. Risks are assessed and managed and people have the support they need to make choices and decisions. Evidence: Each person has a care plan that details the support they need. We sampled one care plan in detail. Since the last inspection service users have been involved in developing their care plans. People have been talking to their key workers about their aspirations and goals for the future. Staff told us about peoples needs and this corresponds with what is recorded in care plans. Risks are identified and assessed with strategies in place to reduce risks to people without restricting them. Plans are reviewed regularly so staff know if they are offering the right support or not. Staff record the review of plans with the daily notes they write. The manager agreed that recording the reviews in one place would be better than having to read through daily notes to find the information. Care Homes for Adults (18-65 years) Page 11 of 25 Evidence: There is information in plans about how people prefer to communicate. Staff have attended training in how to use alternative forms of communication and the AQAA shows there is more training planned. The AQAA shows that they plan to be better at supporting communication and have ideas on how to do this. We observed staff communicating respectfully and effectively with service users. Care Homes for Adults (18-65 years) Page 12 of 25 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. People have opportunities to take part in leisure activities. Relationships are supported and people are involved in the running of the home including planning and preparing meals. Evidence: People have the opportunity to take part in a range of activities in the community and when at home. Some people attend sessions at a local community centre. There are a range of sessions on offer and this is run by the company who run the home. In surveys, people told us they can choose how to spend their days. Each person has a weekly planner showing what they will be doing. On the day of the visit, one person was staying with family, one person was attending a day care session and another was home planning to go to the bank and shops. The AQAA shows they are planning to increase the range of activities on offer. Care Homes for Adults (18-65 years) Page 13 of 25 Evidence: Staff said that everyone is involved in the day at day running of the home like the housework and cooking. People can access the kitchen and other areas so have control over their environment. People are involved in planning and preparing the meals. Nutritional needs are recorded as well as needs relating to eating and drinking. These needs are monitored so any changes can be picked up and acted on. People have the support they need to keep in touch with family and friends. Relatives details are recorded and visits to and from family are supported. Care Homes for Adults (18-65 years) Page 14 of 25 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. People know their personal care and health needs will be supported. Medication practice is safe protecting service users. Evidence: The support people need with their personal care is recorded in individual care plans. Additional information has been added so staff have more detail about how people prefer to be supported. Health needs are recorded so staff know what support people need to remain healthy. There are guidelines for staff to follow about individual health needs. Staff monitor peoples weight and nutrition so they can act if anything changes. People have support to attend health appointments. People have booklets in their care plans about being healthy with an action plan of what support people need to remain well and healthy. Staff have training related to peoples health needs. Medication is stored safely in the office and in some individual rooms giving more privacy and some control to service users. A service user told us they are happy about having their medication safely in their room. Staff said that they have training in how Care Homes for Adults (18-65 years) Page 15 of 25 Evidence: to administer medication safely. Staff then have a yearly competency assessment by the manager which includes an observation. Staff could tell us about correct medication procedures. Care Homes for Adults (18-65 years) Page 16 of 25 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. People know who to complain to and are confident their complaints will be acted on. People are protected from harm and abuse. Evidence: There is a written complaints procedure displayed in the home. This is also produced with text, photographs and symbols. The AQAA shows that there have been no complaints about the service since the last inspection. The Commission has received no complaints about the service since the last inspection. People meet up regularly to talk about things like activities and menus. Staff said this also gives opportunity for people to raise any concerns or complaints. Service users told us in surveys that they know who to talk to if they have a complaint. There is a safeguarding vulnerable adults and whistle blowing policy and procedure. Staff said that they attend training in safeguarding vulnerable adults so are aware of the procedures. Staff were able to tell us about the procedures they would follow if they suspected abuse. The policies and procedures are displayed in the office for staff to refer to. Care Homes for Adults (18-65 years) Page 17 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and generally well maintained. Evidence: The home has adequate furniture and fittings and some parts are in the process of being redecorated. The AQAA shows that more redecoration is planned and they also plan to buy new sofas. There is a lounge diner and kitchen and each bedroom is single. There are enough bathrooms and showers that meet peoples needs. Service users have support to take part in keeping the house clean. The home was clean and smelled fresh on the day of our visit. People told us in surveys that the home is always clean and smells fresh. There is a garden to the front and rear of the house. There is an office and staff sleep in room. One staff member said in a survey that the environment could be improved especially the sleep in room. There has been a leak from the flat roof above which has stained the ceiling in this room. The flat roof is being repaired. Care Homes for Adults (18-65 years) Page 18 of 25 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. There are enough staff to meet service users needs. Staff have access to mandatory and other training. Recruitment checks are carried out before people start working at the home. Evidence: There is usually two staff on duty with the manager also working shifts with staff. Staff said the rota is planned around service users appointments and activities and that extra staff come in when needed. In surveys from staff, all four said they think there is enough staff. There is a stable staff team who know service users well. The team leader spoke with understanding and knowledge about peoples needs. One staff survey said, there is good communication between staff. In surveys, service users said that staff are very supportive and that they treat them well and listen. Staff have access to mandatory training courses. Staff told us they are up to date with their mandatory training and the manager confirmed this. Staff said they have training in subjects related to peoples needs including autism and sign language. Staff told us that they have the training and support they need. The induction of new staff meets the Minimum Standard. Recruitment checks are carried out before a person starts working at the home. Staff Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: told us in surveys that they had recruitment checks and an induction. Staff have the opportunity to attend staff meetings and have one to one meetings or supervision with a line manager. This means that staff get some coaching, mentoring and support. Care Homes for Adults (18-65 years) Page 20 of 25 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. The home is well managed and has an experienced manager in post. There are quality assurance systems in place and peoples health and safety is protected. Evidence: The manager has been managing The Sands for about two years. The manager is registered with us so he has passed the fit person process. The manager has had several years experience in working with people with a learning disability. The manager completed the AQAA. This was well completed and gives us the information we need about how they intend to improve outcomes for people at The Sands. The AQAA shows that equality and diversity needs are understood and supported. It shows that the manager has identified barriers to improvement and has ideas of how to overcome these barriers so the home continues to improve. All four staff surveyed said they get enough support from the manager, they can attend staff meetings and they get the training they need. One staff said the manager is very, very supportive and helpful to staff and service users. Staff said the manager works shifts alongside them and takes turns in covering sleep in shifts. Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: There are quality assurance systems in place. The company carries out audits of the service including a financial audit and health and safety audit. The manager completes weekly and monthly returns for head office which are monitored. Surveys are sent out to stakeholders by head office to gain peoples views about the service and service users meetings are held so people get to air their views. The manager said the manager of another company home or the area manager makes monthly visits to the home. These visits monitor practice and reports are completed that show that service users and staff are spoken to. The manager said he has formal supervision meetings on a regular basis to talk about the service issues, training needs and to get support and coaching. The manager said the area manager is accessible when he needs advice. The AQAA shows that health and safety checks are carried out on the premises and equipment. Staff attend training related to health and safety including food safety and first aid. Regular fire drills are held and fire equipment is checked regularly. Care Homes for Adults (18-65 years) Page 22 of 25 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 23 of 25 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 Adults (18-65 years) Page 24 of 25 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. 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