Enter and view: SAGE

Healthwatch Barnet carried out an announced Enter and View visit to SAGE Care Home on 13 December 2016. SAGE is a 60-bed nursing and residential care home in Golders Green that follows Orthodox Jewish traditions and provides care for a mixture of residential, nursing and dementia residents. At the time of the visit, 57 residents were living in the home. 

The report found that the home had made significant improvements following previous concerns raised by the Care Quality Commission (CQC). Staff and management described a period of substantial change involving restructuring, revised procedures, stronger leadership and support from external specialists. Healthwatch concluded that these changes had improved staff stability, consistency of care and the overall environment for residents. 

The home was found to be clean, well maintained and undergoing a phased refurbishment programme. Bedrooms were generally pleasant and personalised with residents’ possessions, and the grounds were attractive and accessible. However, inspectors noted that some communal lounges were underused, some rooms contained inappropriate storage, and one bathroom was being used to store wheelchairs, reducing its usability.

Care planning had been extensively reviewed since the appointment of the current manager in March 2016. The home had worked with Bradford University’s Dementia Advisory Group to improve dementia care planning, and care plans were reviewed monthly with input from relatives. Most residents and relatives interviewed reported that they understood and were involved in care planning. End-of-life care planning was also well established and involved both families and hospice services where appropriate. 

The management of residents’ health and wellbeing was viewed positively. The home employed physiotherapists, received regular visits from GPs, opticians and chiropodists, and had access to specialist services including tissue viability nurses. Residents’ weights and nutritional status were monitored regularly, and hydration support was in place where needed. Relatives and residents spoke highly of the quality of healthcare support available. 

Staffing levels were robust, with nurses, carers, lounge staff, domestic staff and activity coordinators available across the home. Many staff had worked at SAGE for over a decade, providing continuity and stability. The use of agency staff had been significantly reduced under the current management team, and staff morale appeared positive. Some residents also benefited from privately funded one-to-one carers in addition to the care provided by the home.

Training arrangements were comprehensive and covered clinical skills, dignity, care planning, safeguarding, nutrition, mental capacity, DoLS and specialised nursing procedures. Staff received supervision every two months and annual appraisals. Nevertheless, some staff felt they would benefit from spending more one-to-one time with residents, and Healthwatch recommended monitoring how well staff understood and applied training, particularly e-learning. 

The home offered a wide range of activities, including outings, music sessions, exercise classes, arts and crafts, flower arranging, baking and celebrations of Jewish festivals. Residents also had access to transport for community outings. Some relatives suggested that additional activities suitable for people with visual impairments would improve inclusivity. 

Food was prepared on site according to kosher standards and was generally praised by residents and relatives. Menus operated on a four-week cycle and special diets were accommodated. However, Healthwatch suggested improving menu choice by offering more varied alternatives and introducing pictorial menus to help residents make informed choices. Inspectors also noted concerns about food hygiene practices in the kitchen, particularly regarding the use of protective clothing.

Feedback from residents and relatives was overwhelmingly positive. Most felt listened to, involved in decision-making and satisfied with the care provided. Seven of the eight relative questionnaires returned stated that they would recommend the home to others. 

Overall, Healthwatch concluded that SAGE had successfully transformed itself from a service that had previously been criticised into one providing good-quality and stable care. The report highlighted strong leadership, effective teamwork and improved systems as key factors in this progress. 

Recommendations included ensuring future refurbishments are dementia-friendly and informed by residents and relatives, improving storage arrangements, providing more activities for residents with visual impairments, increasing menu choices, introducing pictorial menus, maintaining food hygiene standards and strengthening monitoring of staff competency following training. The home accepted the recommendations and outlined actions to address each area.