Inspection on 10/09/09 for Dovedale Court Nursing and Residential Home

This is the latest available inspection report for this service, carried out on 10th September 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.

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

Dovedale Court Nursing and... 04/10/06

Dovedale Court Nursing and... 12/12/05

Dovedale Court Nursing and... 27/07/05

Dovedale Court Nursing and... 01/11/04

Dovedale Court Nursing and... 24/05/04

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Heathlands

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Ravenhurst

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Inspirations

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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 Dovedale Court Nursing and Residential Home Holyhead Road Wednesbury West Midlands WS10 7PZ Lead Inspector Mandy Beck Key Unannounced Inspection 10th September 2009 09:00 DS0000004846.V377635.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Dovedale Court Nursing and Residential Home DS0000004846.V377635.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Dovedale Court Nursing and Residential Home DS0000004846.V377635.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dovedale Court Nursing and Residential Home Address Holyhead Road Wednesbury West Midlands WS10 7PZ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0121 502 6444 0121 502 0655 www.schealthcare.co.uk Southern Cross Healthcare Services Ltd Lisa Ann Geddes Care Home 76 Category(ies) of Dementia (43), Old age, not falling within any registration, with number other category (33) of places Dovedale Court Nursing and Residential Home DS0000004846.V377635.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home 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) 33 Dementia (DE) 43 The maximum number of service users who can be accommodated is: 76 19th October 2008 2. Date of last inspection Brief Description of the Service: Dovedale Court is a purpose built two-storey building, registered to accommodate thirty-three people requiring nursing care on the ground floor, and forty-three people requiring personal care who have dementia, on the first floor. The first floor is now separated and provides two units for people with dementia. The first floor is accessed by two passenger shaft lifts. There is a spacious reception area at the front of the building where the Manager, administration offices and visitors room are situated. All bedrooms are single with en-suite facilities. Lounges and separate dining rooms and all facilities are provided on both floors to meet the needs of service users. The home is situated close to Wednesbury town centre and has easy access to public transport. The home also has good parking provision to the front of the premises with enclosed gardens to the rear and side of the building. Ancillary services of catering, cleaning, laundry and maintenance are provided in-house. Fees for this home range from £492 - £580 per week. The reader may wish to contact the service to make sure that the fees are the most up to date. Dovedale Court Nursing and Residential Home DS0000004846.V377635.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that people who use this service experience good quality outcomes. We looked at all the information that we have received, or asked for, since the last key inspection. This included: • The annual quality assurance assessment (AQAA) that was sent to us by the home. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the home. • Information we have about how the home has managed any complaints. • What the home has told us about things that have happened in the home, these are called “notifications” and are a legal requirement. • The previous key inspection and the results of any other visits that we have made to the service in the last 12 months. • Relevant information from other organisations • We also spent time talking to the people who use the service and to the staff who support them. • We looked at the care of four people who use this service in depth. This is part of our case tracking process and helps us make judgements about the home’s abilities to meet people’s needs. What the service does well: People living in the home told us “I like the charm of the staff and the home is always clean and fresh”, “they provide me with everything you need and nice food daily. People are happy to help”. Each person choosing to live at Dovedale court will be visited at home by the manager and they can be confident their needs will be assessed in full before they move in. People have access to the doctor and other community services as they need them. Meals are nutritious and a well balanced diet is offered. People told us “the food is lovely, there is always a good choice”. Complaints are listened to and acted upon by the home. People we spoke to told us “I have never had to complain about anything”, “I have made a few comments and they have always been dealt with”. Dovedale Court Nursing and Residential Home DS0000004846.V377635.R01.S.doc Version 5.2 Page 6 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. Dovedale Court Nursing and Residential Home DS0000004846.V377635.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dovedale Court Nursing and Residential Home DS0000004846.V377635.R01.S.doc Version 5.3 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given all of the information they will need in order to make a choice about living in this home. They can feel confident their needs will be assessed in full prior to admission. EVIDENCE: The home has both a Statement of Purpose and Service User Guide that give people all of the information they will need to know about the service the home provides. It includes the range of fees people are expected to pay and the additional extras that will not be included in the weekly fee. Before people agree to move into the home the manager will spend time with them completing an assessment of their needs. This is done to make sure the home is able to meet people’s needs and that it will be the right place for Dovedale Court Nursing and Residential Home DS0000004846.V377635.R01.S.doc Version 5.3 Page 9 them. We looked at the needs assessments of four people during this inspection and found that each one had been completed and provided a sound basis for staff to be able to plan care for people. People choosing to live here are given ample opportunity to sample the service before they agree to move in. We were told that people are encouraged to spend time in the home on trial visits. One person told us “I had been to several places but chose this one”. The home does not provide intermediate care facilities at this time. Dovedale Court Nursing and Residential Home DS0000004846.V377635.R01.S.doc Version 5.3 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home do have their health care needs monitored but more attention could be paid to people’s changing needs. The home needs to improve the medication systems it has in place so that people have their medication as is has been prescribed. EVIDENCE: All people living at the home have their own individual plan of care. This plan details how the nursing and care staff will meet their needs. In all five of the care files seen there were risk assessments in place that looked at the risk of malnutrition, falls, moving and handling and pressure sore development. The nursing staff make sure that people are assessed for the use of bed rails and their associated risks. In most cases where a risk had been identified a management or care plan had been drawn up showing how the risk was to be managed. Dovedale Court Nursing and Residential Home DS0000004846.V377635.R01.S.doc Version 5.3 Page 11 In two people’s care records we saw no care plans in place. This means that staff will have very little guidance in meeting those people’s needs. We had also been told that these two people were, on occasion, quite challenging for staff to care for. We saw in the daily records that staff had written “hit care staff with walking stick” and “hit another member of staff with walking stick”. Staff confirmed that they knew how to look after them and gave good examples of what they would do to manage this type of behaviour. The home must make sure that when people are admitted, even for short stays that care plans are in place to give guidance to staff and assurance to people that their needs can be met. We looked at pressure area care in the home. We found most people had the equipment they needed. We also noted that one person had been visited by the Tissue Viability nurse in May 2009 and specialised equipment had been recommended. Generally care plans for the reduction of pressure and pressure sores were detailed. We did find in one person’s files some inconsistencies the home will need to address. The person had developed a pressure sore; it was unclear from reading the notes exactly when this happened. The care plan said that the sore needed to be dressed on alternate days this was dated 01 September 2009 but the first recorded dressing of the sore was dated 04 September 2009. Staff were able to tell us about the turn charts the home uses, we looked at this persons turn charts and found that there was no recording of any pressure sore development in the comment section of these charts as we would expect. The pressure sore risk assessment had not been updated to reflect the person’s change in condition. None of the care staff we spoke to knew about this person’s pressure sore. If staff are unaware of a person’s condition they are unlikely to be able to care for it. All people living in the home have regular contact with their own Doctors and are able to access other specialist community health services such as chiropody, dentists and the opticians. We have identified problems with one doctor during this inspection. The home has told they are not happy with the service they are receiving. We saw evidence in people’s care records that staff have asked for the doctor to visit people when they are ill but the doctor has refused and sent the home a prescription to the home without seeing the person. We discussed this with the manager at the time of this inspection; we have recommended the home consider making their views known to the local Primary Care Trust who may be able to investigate this matter further to improve the service for the people living in the home. The home keeps records of all hearing and sight tests and ensures that service users have the appropriate aids such as glasses and hearing aids. We looked at the medication systems in place for people. At present the home supports every person living there with medication. There are good systems in place for ordering and returning medicines. There are improvements needed to the recording systems and the way in which medication is administered. For example we have recommended that two people sign the Medication Dovedale Court Nursing and Residential Home DS0000004846.V377635.R01.S.doc Version 5.3 Page 12 Administration Record (MAR) when they handwrite entries on to them. This will help reduce the risk of errors in transcribing occurring. Staff are not accurately recording the amount of medication that is being received into the home on the MAR. This makes auditing medication difficult and the home cannot fully demonstrate that people have received their medication as it had been prescribed. For example we looked at one person’s MAR for pain relief, staff had recorded that 14 tablets had been received; they had signed the MAR sheet a total of 15 times, this indicates that staff have given this medication this many times. We checked the box of pain medicine and found that there were still 4 tablets inside. This suggests that the person was not receiving their pain relief as it had been prescribed. We also looked at the homes recording of fridge temperatures and treatment room temperatures. We did this it make sure the home is storing medication as per manufacturers instructions. The home must make sure that the temperature in the first floor treatment room is kept below 25oC or below. All other recordings were completed appropriately. We spoke to some of the people living in the home during this inspection. They told us “staff here are very good”. We asked if staff paid particular attention to their dignity and need for privacy. They said, “Oh most definitely they are very caring”. We saw staff talking to people in a polite manner and when they were giving assistance to people they did so sensitively and did not rush people. Dovedale Court Nursing and Residential Home DS0000004846.V377635.R01.S.doc Version 5.3 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by the home to lead active lives and to maintain contact with their families and friends. EVIDENCE: One person commented about the home’s activities “we could have more things to do such as films on the telly war films and comedies”. We were told that following a recent coffee morning people had been reminiscing about old films they liked to watch and the home is currently trying to buy these films for them. The activity coordinator told us there are regularly planned activities which included coffee mornings, bingo and playing dominoes. We looked at the way the home supports people with their daily routines. We were told by staff the daily routine for people is rather rigid and people do tend to spend a lot of time in the dining room. We looked at the times meals are provided and found that there is only a gap of two and half hours between the end of breakfast and lunch being served. Staff said “we take them to Dovedale Court Nursing and Residential Home DS0000004846.V377635.R01.S.doc Version 5.3 Page 14 breakfast and then help them back into the lounge this is about 10.30 am at 11.50 am we start the toileting and take people back to the dining room for dinner”. Tea is served about 5pm and people can have supper before they go to bed. We have asked the home to look again at the times meals are served and to consult with people living in the home to see if they are happy with the current arrangement. We were told by staff that people have allocated bathing days but rather than this being based upon people’s individual choice, it is based upon the room number they occupy. For instance when new people move into the home, their bathing day will already be determined by the room they occupy. We spoke to the home manager about these comments; she told us “people do have a choice about when they are bathed. Each person is bathed or showered on admission but bathing should not be done based upon room numbers and should always be based upon people’s preferences”. The home will need to explore this further with care staff to make sure that people are offered a choice based upon their own wishes as the manager has told us. The home has an open visiting policy and people are encouraged to have visitors when they choose. People have the opportunity to see their visitors in the comfort of their own rooms or in one of the many lounges throughout the home. On this particular day it was very sunny and people had chosen to sit out in the garden with their visitors. Meal times appeared to be a relaxing occasion. Staff were busy trying to give out meals to everyone so that people did not have to wait too long for them. The dining rooms were pleasantly decorated and seemed to be nice place for people to eat their meals. We observed people being assisted to eat their meals by staff and noted that this was done discreetly and in a sensitive manner. People do have a choice about where they want to eat their meal as we observed a small number of people having their meal in their bedroom. The Nutmeg system for nutrition is still in use. This involves menu planning and making sure the meals are nutritious and do not exceed recommended levels of salt, fat or sugar. The manager is able to put the details of a planned meal into the computer that works out if the meal planned is good enough for service users to eat and enables her to make changes where needed. The home is able to cater for specialised diets. People told us “I like the food here”. Dovedale Court Nursing and Residential Home DS0000004846.V377635.R01.S.doc Version 5.3 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home can feel confident their views will be listened to and acted upon. The home will take appropriate steps in making sure that vulnerable people are protected from harm. EVIDENCE: The home has a complaints policy that is available to all people. A copy of the complaints policy is in the service user guide and in each person’s bedroom. Since the last inspection in November 2007 there have been 11 complaints recorded. The manager told us that she is always there to talk through any concerns that people have and will always act upon them. Those people who answered our surveys told us “I would always speak to the nurse in charge” and “I know who to speak to I needed to make a complaint. I wouldn’t hesitate the manager and the staff always try and smooth things out for us”. The home has policies in place for dealing with allegations of abuse and keeping people safe from harm. We call this safeguarding vulnerable adults. We spoke to staff about this. All of the staff we spoke to were able to tell us what different types of abuse there were and how they would recognise the signs of abuse. Generally most of the staff knew who to refer to if an allegation was made to them or they had witnessed an act of abuse. The Dovedale Court Nursing and Residential Home DS0000004846.V377635.R01.S.doc Version 5.3 Page 16 manager of the home understands what is expected of her in relation to reporting of incidents and allegations to the safeguarding team. Since our last inspection the home has been subject to an investigation by the local authority in relation to the care of one person in the home. This investigation resulted in a suspension of admissions to the home for a short time. The home has worked with the local authority to improve their practices and record keeping in order to safeguard the people living in the home. We have found throughout this inspection that although there are still some shortfalls in the homes documentation, the care and attention people receive has improved. We also talked to staff about their knowledge of the Mental Capacity Act 2005 and the deprivation of liberty safeguards. We did this because we wanted to know if staff were aware of what the implications for practice this legislation has. Staff need to be able to understand what a deprivation of liberty is so that they can take action to prevent it from happening or to take steps to protect the people in their care. Staff told us they had not had any training in this and were not aware of what it meant. The manager told us that the organisation is currently in the process of preparing training for all its staff and this is due to begin during October. The home does use bed rails for some people in order to keep them safe whilst in bed. We looked at the risk assessment for their use and found them to be up to date and reviewed regularly by the staff. This means that people would not be restrained inappropriately. We looked at recruitment practices and found the home is taking steps to prevent unsuitable people from working with vulnerable adults. This includes required checks against the Protection of Vulnerable Adults list (PoVA) and a Criminal Records Bureau disclosure (CRB). Dovedale Court Nursing and Residential Home DS0000004846.V377635.R01.S.doc Version 5.3 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience good 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 well maintained and clean environment EVIDENCE: The home was found to be homely, clean, tidy and decorated and maintained to an acceptable standard. Since our last inspection there have been new carpets throughout the home and the redecoration of the home is ongoing. There is some signage around the home to tell people the location of bathrooms and toilets, although not all bedrooms had names or numbers on to help people find their bedroom. The first floor has been completed redecorated since our last visit. It feels much more relaxing and homely. The are directional signs for people to guide them around the home. Each person has a choice of which colour they would Dovedale Court Nursing and Residential Home DS0000004846.V377635.R01.S.doc Version 5.3 Page 18 like the door to their bedroom painted. The manager also told us “people can decorate their rooms how they want, it is their home”. Bedrooms we saw were personalised to people’s own tastes. There are enough small lounges for people to be able to choose where they want to spend the day. Each of the lounges has been decorated and the inclusion of giant murals on the wall make a pleasant addition. Staff told us the garden mural in particular on the first floor is a big talking point for people and can be used as part of reminiscence talks and other activities. The manager told us “the first floor felt a little bit outdated so we have redecorated and it seems to be very popular now”. Dining rooms are pleasantly decorated and tables are laid ready for people to sit and eat their meals. Bathing facilities have also been redecorated and these too have benefited from the addition of giant murals. Most of the bathrooms now have an “underwater” theme to them but do feel quite relaxing and make the room feels a lot lest clinical in appearance. There is plenty of seating in both gardens for people to make the most of. We have already pointed out on the day of this visit the weather was quite hot and it was nice to see people making the most of the garden. We saw people enjoying the sun and eating choc ices and having a cold drink. One lady told us “oh this is lovely can’t ask for much more can you”. Staff have had training in infection control and throughout the home each toilet and bathroom had hand washing facilities with liquid soap and paper towels. Staff also said they had access to plastic aprons and gloves when they needed to assist people with personal care. There is alcohol hand rub throughout the home for people to use. All of these measures will help reduce the risk of cross infection to the people living here. Dovedale Court Nursing and Residential Home DS0000004846.V377635.R01.S.doc Version 5.3 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are appropriate numbers of staff on duty to meet people’s needs. Staff are trained and have the knowledge and understanding to meet people’s needs. EVIDENCE: The home has a skill mix of both trained nurses and care workers on duty to meet people’s needs. In addition to the care staff there are housekeeping, kitchen, laundry and maintenance workers all working hard to keep the home running smoothly? One person said “The staff are wonderful there is never anything that is too much trouble”. We spoke to staff during this inspection who told us, if they could change anything it would be to have more staff on duty. They said “sometimes even when we are short staffed it is not covered, we try to pick up the shifts so that this doesn’t happen”. Another staff member told us “I really like working here; there is a very good staff team we get on very well and support each other, like covering shifts when we are short”. At present the home appears to have sufficient staff on duty to help meet people’s needs. Although we have identified care is rather “task based” and not based upon people’s individual choices. The home is aware of the need to review staffing levels as people’s needs change. Dovedale Court Nursing and Residential Home DS0000004846.V377635.R01.S.doc Version 5.3 Page 20 The home supports all care staff through training in National Vocational Qualifications. Staff we spoke to confirmed that they had completed both their level 2 and 3 NVQ training in Health and Social Care. This means that staff have the knowledge and understanding to be able to meet the people’s needs who live in the home. In addition to this training the home has also trained member of staff to be “trained trainers” in moving and handling, tissue viability and continence care. We looked at the recruitment processes in the home. We saw the staff files of four people. All of them contained the required information and security checks such as previously mentioned Protection of Vulnerable Adults (PoVA)first, and CRB’s. This means the home has systems in place to prevent unsuitable people from working with vulnerable adults. All new staff spend a week being trained before starting work, so that they are equipped to care for people. When they do start they are supported by senior care staff. Staff are supported to undertake further training. All staff we spoke to us told us that they have regular ongoing training. We observed staff interacting positively with people in the living at the home, they were highly dependent and had very limited communication staff were seen to provide reassurance by stroking peoples hands and gave people drinks and assistance where needed. Dovedale Court Nursing and Residential Home DS0000004846.V377635.R01.S.doc Version 5.3 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and is run in the best interests of the people living there. People’s health and safety is promoted by the home. EVIDENCE: The home management has changed since our last key inspection. Lisa Geddes has been managing the home for 16 months. She told us “I am very much a hands on sort of a person, I like to get round the home and say hello to everybody, every day”, and “I want people to know that I am there to help them and will support them anyway I can”. Staff told us “Lisa is very good to talk to and if you have a problem she will try and sort it out for you she is Dovedale Court Nursing and Residential Home DS0000004846.V377635.R01.S.doc Version 5.3 Page 22 good like that”. People who answered our survey said “I think the manager is very good and tries to help us”. We have identified within the complaints and protection section of this report that staff were not aware of the Mental Capacity Act and the Deprivation of Liberty safeguards or their responsibilities under this legislation. We advise that all staff have training in this legislation so that they are aware of their responsibilities under the legislation. The manager has told us the organisation has already recognised this as an area for improvement and they will be providing training for their staff in the near future. The Home Manager completed the homes AQAA which was returned to us when we asked for it. The AQAA gave us adequate information about the service and developments that have been made although more information could have been included on current developments. The home has an identified quality plan. Until recently the Home Manager has been completing a monthly audit of the care environment, this has included medication, care plans, environment, staffing, kitchen and activities. All reports were completed and sent to head office and issues arising have been dealt with. In July this system was replaced by peer review. The manager explained that a visiting manager will come to the home and complete a thorough audit of the service. Suggestions are made and actions points agreed for improvement. The information from the most recent Southern Cross key outcome inspection tool” showed the home is performing very well but there were some improvements to be made to care planning. We have also found this to be the case during this inspection. We have seen that care plans need to be updated regularly in order to reflect the changing needs of the people living there. We have also highlighted shortfalls in the way medication is managed in the home. The home will need to make improvements if people are to be given medication as the doctor prescribed it. People are surveyed about their experiences and quality of service they receive, the last time this was done was November last year, relatives, and professionals were also included. This gives people the opportunity to raise any concerns or compliments they have about the service they receive. Secure facilities are available for the safe keeping of peoples personal money and valuables. Records are available for all transactions which detail the reason for the withdrawal, receipts are available as proof of purchases. All money is kept within a bank system and we were able to see that interest is added monthly to any balances. The home has computerized records of all training statistics which show that most of the staff have received all statutory training and when needed training is booked to address any gaps. The home also has trained trainers to deliver Dovedale Court Nursing and Residential Home DS0000004846.V377635.R01.S.doc Version 5.3 Page 23 training. We spoke to staff who told us the training is very good I think we get plenty and it keeps us up to date. The AQAA confirms that maintenance contracts for the building is up to date we also found that the home is in a good state of repair and equipment is in working order. All of the staff we spoke to confirmed they had had fire training, and a recent fire drill. Dovedale Court Nursing and Residential Home DS0000004846.V377635.R01.S.doc Version 5.3 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 2 X X 3 Dovedale Court Nursing and Residential Home DS0000004846.V377635.R01.S.doc Version 5.3 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement People’s care needs must be recorded in an individual care plan. This will make sure that staff are aware of people’s needs and have guidance to show them how to meet those needs. People’s care plans must be kept under regular review and amended when people’s needs change. This will mean that all staff are aware of the changing needs of the people they care for. The home must make sure that the temperature of the treatment room on the first floor is kept at 25oC or below. This will ensure that people’s medication is being stored as recommended by the manufacturer. Timescale for action 30/10/09 2 OP8 15 30/10/09 3 OP9 13(2) 15/10/09 Dovedale Court Nursing and Residential Home DS0000004846.V377635.R01.S.doc Version 5.3 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations Further work should be undertaken to ensure a person centred approach to care planning is undertaken based on individuals differing needs and involving the person. The home needs to develop an audit tool that will identify shortfalls in the homes medication systems and allow them to take action to put right any issues. That all MAR sheets are maintained without gaps, and that medication is signed for the point of administration or an appropriate code entered for non-administration That all handwritten entries or changes on MAR sheets are signed and witnessed by two staff The home should review the gaps between meals in consultation with the people living in the home. It is recommended that staff receive training around the Mental Capacity Act 2005 and their role, accountability and responsibility under the provision of this act. 2 OP9 3 OP9 4 5 6 OP9 OP15 OP18 Dovedale Court Nursing and Residential Home DS0000004846.V377635.R01.S.doc Version 5.3 Page 27 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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