Inspection on 05/10/09 for Devonshire House

This is the latest available inspection report for this service, carried out on 5th October 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report Care homes for older people Name: Address: Devonshire House Devonshire House Care Home The Green West Auckland County Durham DL14 9HW     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: Jim Lamb     Date: 0 5 1 0 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 Older People Page 2 of 27 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) 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 Older People Page 3 of 27 Information about the care home Name of care home: Address: Devonshire House Devonshire House Care Home The Green West Auckland County Durham DL14 9HW 01388833795 01388832208 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Devonshire House Care Ltd care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 25 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 - Code OP, maximum number of places: 25 Physical Disability - Code PD, maximum number of places: 25 Date of last inspection Brief description of the care home Devonshire House is a converted large Edwardian House located in West Auckland. The home was originally opened in 1986 by a sole provider. However other members of the same family have recently become involved in the ownership of the home and have formed Devonshire House Care Ltd. There are 21 single and 2 double rooms located on three floors. These are accessible by means of a ramp and a lift. The home provides accommodation for mainly older persons who require either twenty-four hour general Care Homes for Older People Page 4 of 27 Over 65 25 0 0 25 Brief description of the care home nursing or residential care. There is a varied and active recreational programme for those who wish to participate. The fees charged are between 436:50p and 614: 25p per week. This does not include the free nursing care element. The cost of hairdressing or toiletries is not included. Care Homes for Older People Page 5 of 27 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 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: We have reviewed our practice when making requirements,to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The quality rating for this service is 2 stars. This means that the people who use the service experience good quality outcomes. How the inspection was carried out. Before the visit we looked at information we have received since the last visit, how the service dealt with any complaints and concerns since the last visit, any changes to how the home is run, the providers view of how well they care for people, and the views of Care Homes for Older People Page 6 of 27 people who use the service and their relatives, staff and other professionals. During the visit we talked with people who use the service, relatives, staff, the manager, and visitors, looked at information about the people who use the service and how well their needs are met, looked at other records which must be kept, checked that staff had the knowledge, skills and training to meet the needs of the people they care for, looked around the building/parts of the building to make sure it was clean, safe and comfortable,and checked what improvements had been made since the last visit. We told the manager/provider what we found. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: To aid service users with memory problems, memory orientation boards should be displayed and this will enable them to become more aware of their surroundings and daily events. Professional advice should be sought about the design, signage and colour schemes to be used for residential homes that cater for people with dementia. Care Homes for Older People Page 8 of 27 The staff must have all their mandatory training updated every three years by a qualified trainer/organisation. This will ensure that they retain the necessary skills needed to promote the service users welfare and ensure health and safety measures are being upheld. The refurbishment of the lounge areas will provide service users with a more highly attractive place to live. 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 9 of 27 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 10 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users are provided with enough information about the service to enable them to make an informed choice about whether this is where they want to live. Evidence: People who come to stay here are given an information pack, called a Service Users Guide, which includes useful information about what they can expect from the service. Everyone is encouraged to come and have a look around the home before making a decision. In this way people have good information to make a decision about whether to move to this home. There are clear records to show that the needs of the service users were assessed before they moved in so that the home knows whether those needs can be met here. Care managers of the Social Services Department carry out most assessments and Care Homes for Older People Page 11 of 27 Evidence: these are provided to the home. The manager also carries out assessments of prospective new service users, to make sure that the home can meet their individual needs. The assessments also include brief details of peoples spiritual and social care needs so that the home can plan to support them in these areas. All are provided with a contract that clearly explains the homes terms and conditions, and the fees to be paid. Care Homes for Older People Page 12 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning system is clear enough to ensure that staff have the information they need to meet the assessed needs of the service users. Evidence: A comprehensive range of assessments is completed to identify each service users current health, personal and social care needs. This information is used to devise and update individual care plans. Service users are involved in planning their care and have a key worker who monitors and helps to update care plans. A sample of four service user care plans were examined. These addressed physical health, personal hygiene, continence, memory and cognition, skin integrity, communication, social and spiritual needs. The recording was detailed, specific and personalised to the persons requirements. The plans demonstrated care and support to be provided by staff and what the person can do independently. There were also good examples of plans that showed how risks to the person are managed or minimised. These should be signed by the service user or their representative, this will ensure that everyone is aware of the risks identified. Care Homes for Older People Page 13 of 27 Evidence: Service users said they always receive the care and support they need, and that the staff always treated them with respect and maintained their privacy and dignity. One service user said, This is a lovely place, the staff are very good to me. My family live in the village and i am able to see them most days. Another said, My daughter visits often, i have no complaints at all, and i like the staff very much they are all very kind and helpful. Service users have a choice of local GP practices, and the residential side of the home has support from a District Nurse. There are arrangements for an optician, dentist and podiatrist to make home visits. Service users also receive input, if required from mental health care professionals, physiotherapist and occupational therapists. All contact with health care professionals is well recorded. Service users have their moving and handling, nutrition, continence, and pressure sore risk needs assessed. Falls assessments are also completed. There were some good examples of care plans linked to specific health care needs and medical conditions. Where identified these incorporated appropriate aids and equipment used. All staff who administer medication undertake relevant training, only qualified nursing staff manage the medication systems. A sample of medication charts was examined. These were appropriately recorded and have service users photographs for identification purposes. The staff team were reminded that all handwritten entries in the medication charts must have two staff signatures. All personal care and medical examination/treatment is carried out in private. Service users confirmed that staff treated them with respect and personal care is always carried out in a dignified manner. Care Homes for Older People Page 14 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users are offered a good quality lifestyle, which includes varied social contact and activities. Evidence: Each person has an assessment of their social needs that gives details of his/her background, lifestyle, routines and interests. The information is used to implement individual social care plans. One service user continues to attend a local day centre three days per week. Wherever possible staff support individual needs and requests for one-to-one activities and outings. The home has a well thought out activities programme, and service users are supported and encouraged to participate. The proprietor said that she will ensure that fixed orientation boards will be purchased, and memory lane boxs will be introduced for each service user. She also intends to create a new optic-light relaxation area for service users to use and enjoy. The home has an open visiting policy. Visitors are welcomed and can take refreshments and meals. Service users choose whom they wish to see and where to receive visitors. Contact with friends and family is supported through visits, telephone Care Homes for Older People Page 15 of 27 Evidence: calls and letters/cards. Two visitors said they are always kept up to date with important issues affecting their relative. Some service users continue to manage their financial affairs. Where this is not possible they are assisted by relatives/representatives. The homes management does not take responsibility for finances, other than holding cash for personal. Service users nutritional needs are assessed and care planned where necessary, and weights are monitored. Special diets are catered for. These currently include low fat, diabetic and soft diets. Blended food is served separately. Independent eating is encouraged, with use of aids if needed. There are plans to purchase food moulds, and this will enhance the presentation of the food for those who require soft/blended diets. The current menus showed that there is a choice of meals available. Menus are displayed. The inspector observed lunch. The tables were nicely set, placemats and full range of condiments. Hot and cold drinks were available. The meal was served at a leisurely pace, and staff were on hand to offer discreet help if needed. Service users told the inspector the food is good. They confirmed choice of meals is offered. The service users said that the meals were very good and they confirmed that they were always offered a choice. Care Homes for Older People Page 16 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints management is effective, and this results in the service users being protected from harm and abuse. Evidence: Information about complaints is displayed on notice boards around the home and in the homes Statement of Purpose and Service Users Guide. The people spoken to by the inspector confirmed they were aware of how to raise any concerns or complaints. Although nobody spoken to had any cause for complaint, all expressed confidence that any complaints they might have would be taken seriously. Service users and families views are obtained through regular contact and an open door policy. Service users / Family Meetings are held, (but these need to be more frequent) which provide an additional forum to discuss any concerns or potential difficulties. Staff meetings are also held. One person spoken to said, Ive never had to make a complaint, but if there is a problem I speak to the staff or the manager. Another person said, If anything is wrong they always get it sorted out for me. The organisations policy and procedure documents relating to adult protection provide information and guidance to staff. A copy of Durham & Darlington Adult Protection Care Homes for Older People Page 17 of 27 Evidence: Committees Inter-Agency Adult Protection Policy & Procedures on abuse and the protection of vulnerable adults is available in the home. The home also has a copy of the Department of Healths NO SECRETS. The manager said that additional staff training about abuse and the protection of vulnerable adults is arranged for all staff. Care Homes for Older People Page 18 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable and safe environment for those living there. Evidence: The home was clean, well decorated and well maintained. The grounds were attractive, tidy, safe, and accessible. The home has an appropriate amount of sitting, recreational and dining space. There are enough rooms for a variety of activities to take place. The manager should ensure that appropriate signs are fixed on toilet doors, bathrooms, dining and lounge areas. This will enhance and promote the orientation for people with memory problems. The management team plan to contact Stirling university who will provide appropriate information about environmental design, and colour schemes suitable for this client group. Service users can see visitors in private in their own rooms. Furnishings and fittings were domestic in design and in good condition,(New furniture and soft furnishings should be considered for the lounge areas). The proprietor said that she plans to refurbish the bathroom on the ground floor. The proprietor is considering creating a small independent specialist unit on the Care Homes for Older People Page 19 of 27 Evidence: second floor of the home for four service users with learning disabilities. The unit will have a four bedrooms, lounge/diner, small kitchen and laundry facilities. All doors have privacy locks and room sizes meet the required standards. There is space on either side of beds when necessary, to enable access for carers and specialist equipment. The rooms were centrally heated and the heating level could be controlled within each bedroom. Radiators and pipes were guarded. There was emergency lighting throughout the home. The kitchen was clean and well organised. Water is stored at over 60C. Valves at water outlets ensure water is provided close to 43C to prevent scalding. The manager said that water temperatures are checked and recorded. The laundry facilities are very well organised. The washing machines have the specified programme to meet disinfection standards. Care Homes for Older People Page 20 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a good match of well-qualified staff, who are appropriately recruited and supervised. Evidence: The personnel records of three staff were examined. All three had completed application forms, the dates of employment were clear, making it easy to follow a clear employment audit trail. The manager also completes an audit check list and this ensures that all the necessary checks have been completed prior to commencing employment. All had the required two work references, (crb) criminal record bureau check, documentary evidence of identity, induction and training and development information. The manager confirmed that, if there are any concerns about the content of a CRB disclosure, these are discussed with the proprietor. All staff have an annual training matrix drawn up, this covers all mandatory training needs, and other core training needs, such as Dementia Awareness and Adult Protection. Individual staff members have his or her individual training needs analysis Care Homes for Older People Page 21 of 27 Evidence: on their personal file. These have recently been revised to cover developmental as well as mandatory and core training. The manager must ensure that all staff receive 3 yearly mandatory training updates by a person/organisation qualified to provide this training. More than 80 of staff have completed NVQ level 2/3, and because of the additional learning disability category, this training is now linked to LADAF, this ensures that staff have the knowledge of the disabilities and specific conditions of the service users. Care Homes for Older People Page 22 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is supported by the organisation in providing good leadership throughout the home, with staff demonstrating an awareness of their roles and responsibilities. Evidence: The registered manager has the required qualifications and experience to run the home. There is a range of quality systems in the home. There is an annual survey of the views of the service users and their families. The findings are collated and an action plan drawn up to address any areas of concern. There are meetings held with both the service user groups and with the staff group. These are minuted and action points listed. The manager said that she intends to have more frequent relative/service user meeting. In the past these have been very informal, and minutes were not always kept.She will ensure that all future meeting are Care Homes for Older People Page 23 of 27 Evidence: recorded. Both individual and central supervision records were studied. These records show that not all staff are receiving bi-monthly pattern of supervision, The manager agreed that these had lapsed, but said that she will make sure that all supervision is back on track immediately. All staff receive annual health and safety training and infection control training. This is good practice. Checks of the fire log book showed that all the required checks and tests of equipment and systems take place at the proper intervals, as does fire safety training. The homes accident book is kept up to date and information is fully recorded. Each accident is reviewed after 24 hours to check the outcomes of the accident and any treatment given. There is a monthly audit of accidents, and a detailed audit of all falls. Servicing and maintenance records are comprehensive and well maintained. Care Homes for Older People Page 24 of 27 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 25 of 27 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 1 12 provide fixed orientation boards that dipict the date, season, the names and photographs of staff on duty. This will assist service users with memory problems to become more aware of and the names of the staff on duty, and more orientated in their surroundings. 2 19 Consider refurbishing the lounge areas and renewing lounge chairs. This will enhance the appearance of the communal areas within the home. 3 30 The Manager must ensure that all staff receive statutory training updates every three years by a qualified person /organisation. This will ensure that service users continue to be cared for by properly trained and skilled staff. Care Homes for Older People Page 26 of 27 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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