Inspection on 13/10/09 for The Dales Nursing Home

This is the latest available inspection report for this service, carried out on 13th 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

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE The Dales Nursing Home 19-20 Howell Road Exeter Devon EX4 4LG Lead Inspector Teresa Anderson Key Unannounced Inspection 13th October 2009 10:00 DS0000072320.V377950.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. The Dales Nursing Home DS0000072320.V377950.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 The Dales Nursing Home DS0000072320.V377950.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Dales Nursing Home Address 19-20 Howell Road Exeter Devon EX4 4LG 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) 01392 221266 Chartbeach Limited Mrs Marie Brown Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places The Dales Nursing Home DS0000072320.V377950.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 either gender whose primary needs on admission to the home are within the following category: 2. Old age, not falling within any othe category (Code OP) The maximum number of service users who may be accommodated is 31. 3rd October 2008 Date of last inspection Brief Description of the Service: The Dales Nursing Home is situated in central Exeter approximately one mile away from the centre. It is located in a residential area away from the main thoroughfare of traffic. Bus stop and shops are within easy walking distance and there is a train station is in the city centre. The home has its own small car park at the rear of the home. Parking on the roads outside is restricted by resident’s permits. The Home is registered to care for 31 older people with general nursing needs. The building itself is of an older character and comprises two former dwellings converted into one. Communal areas are on the ground floor and bedrooms are spread over the three floors. There are 25 single rooms and 3 shared rooms. There is lift access to all floors, which have level access throughout. There are two communal sitting rooms and a dining room. There are wellmaintained gardens to the front and rear of the property. The cost of care is ranges from £522.00 - £650.00 per week at the time of inspection. Additional costs, not covered in the fees, include chiropody, hairdressing and personal items such as toiletries and newspapers. Previous inspection reports are available on request. The Dales Nursing Home DS0000072320.V377950.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 two star. This means the people who use this service experience good quality outcomes. This inspection was undertaken as part of the normal programme of inspection. Prior to the visit to the home we (the commission) asked the management to complete an Annual Quality Assurance Assessment (AQAA). This gives us general information about the home, together with the management’s assessment of what they do well and what they plan to improve upon. We sent surveys asking for feedback and comments to 8 people living here, to 5 staff working here and to health professionals who visit the home. We received 5 surveys from people living here, 3 from staff and 1 from a healthcare professional. Their comments and feedback have been used to help us to form judgements about this home. We visited the home on one day, starting at approximately 10.00am and finishing at approximately 7.30pm. We looked closely at the care, services and accommodation offered to three people living here as a way of judging the overall standard of care provided, and as a way of understanding the experiences of people living here. We looked at records relating to how people’s needs are assessed, care planning, medicines, training and staff recruitment. We spoke with people living here and with some visitors to the home. We also spoke with staff working here and with the manager and the owner. We looked around the home, at the majority of bedrooms and at all the communal and service areas of the home. What the service does well: This is nursing home that is well managed, yet relaxed and friendly. The home is clean and odour free throughout. Before coming to live here the manager (who is a registered nurse) carries out assessments of peoples needs. This helps to ensure that the home, and staff working here, can meet people’s needs. From this a plan of care is formulated by a nurse to direct staff as to how their needs should be met. These plans are reviewed regularly to ensure that the care delivered is the most appropriate. People say they are well cared for and that staff make sure that their medical needs are attended to by calling the doctor when needed. We also saw that people see specialist health care professionals and have preventative The Dales Nursing Home DS0000072320.V377950.R01.S.doc Version 5.2 Page 6 healthcare including being treated by a dentist and chiropodist. We saw that people’s medicines are managed safely and that people get the medicines they are prescribed. No one living at this home has a pressure sore. People enjoy a varied diet cooked for them by someone who has a good knowledge of their specialist dietary requirements. People get the support they need to eat from carers. This results in people maintaining or increasing their weight. The dining rooms have recently been joined and staff anticipate that this will help mealtimes to be more sociable occasions. People are listened to, and tell us that staff usually or always act upon what they say, and they take any grumbles, suggestions and/or complaints seriously. Staff are described as kind, loving, gentle and very caring. They are employed in sufficient numbers to meet peoples’ needs. There is always a nurse on duty and she is supported by 7 carers in the morning, between 4 and 6 in the afternoon and 2 at night. Staff are recruited using robust methods to ensure they are suitable to work with vulnerable people and are encouraged to undertake training. What has improved since the last inspection? What they could do better: The following requirements were made as a result of this inspection. The home are legally obliged to address these standards of care. The management arrangements do not include systems that robust enough to ensure that the care planned by nurses or specialist health care professionals is being implemented by all staff. This means that people might be being put at risk. In addition the quality of social life experienced by some people living here is not as good as it could be. This relates to people with mental health problems or people who are less able. Although people are safe from abuse, the manager has yet to become fully up to date with the Mental Capacity Act to ensure that systems for acting in people’s best interests are robust. We also made some recommendations. These are not legally enforceable and relate to good practice. The Dales Nursing Home DS0000072320.V377950.R01.S.doc Version 5.2 Page 7 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. The Dales Nursing Home DS0000072320.V377950.R01.S.doc Version 5.3 Page 8 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 The Dales Nursing Home DS0000072320.V377950.R01.S.doc Version 5.3 Page 9 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): 1 and 3. People using the service experience good quality outcomes in this area. People’s needs are thoroughly assessed before a decision is made to admit each person living here, meaning that people’s needs can be met. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We looked at the assessments of two people recently admitted to the home. We saw, and people confirm, that the manager visits people before admission so that she can meet with them and find out about their needs. Information about people’s care needs is recorded in enough depth and detail to ensure that an accurate picture of that person’s needs is obtained. In addition, the manager gathers information from families and from other professionals such as social workers and nurses. This combined information gives the home a The Dales Nursing Home DS0000072320.V377950.R01.S.doc Version 5.3 Page 10 good idea about peoples’ abilities, usual routines, and needs, so that they can decide if the home can care for them and meet their needs. We saw that the home has a written guide explaining the services provided. People told us they had enough information about the home before moving in. The Dales Nursing Home DS0000072320.V377950.R01.S.doc Version 5.3 Page 11 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. Improvements to the way people’s care is planned and delivered means that people’s health, welfare and medication needs are met in a person centred and respectful way. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: In surveys people told us that they always or usually receive the care and support they need and that they always get the medical support they need. When we spoke with people living here during our visit, we were told that they are pleased with the care and support they receive. We looked at three care plans to see how people’s care is planned. We found that each person has a plan which instructs staff about what that person’s The Dales Nursing Home DS0000072320.V377950.R01.S.doc Version 5.3 Page 12 needs are and what the risks to their health and welfare are. We saw that accredited tools are used to make these assessments and that the recommendations these tools make are followed. These include tools for assessing people’s risk of developing pressure sores, becoming dehydrated and becoming malnourished. We saw that when a risk is identified that a plan as to how this risk is to be managed is put into place. We saw that care plans are reviewed regularly and as needed. Nurses working here carry out reviews of the care planned and delivered, to determine if the plan of care is working and to make any changes to the plan which are needed. We saw that nurses are using the information available to them in order to made decisions about people’s care. For example the care plan of one person states that they are at risk of developing pressure sores and of malnutrition. A management plan has been put into place to address these risks, and this plan has been reviewed. The nurse has recorded and explained why some actions are to continue and why some are to change. No one living at this care home has a pressure sore and all the records we saw show that people are maintaining their weight. We saw that people who need help to go to the toilet are given this and that those people who need to be changed because they are incontinent are frequently attended to. One person told us even though they are in their 90’s that they have never ‘had an accident’ because staff help them to go to the toilet. We spoke with staff about care plans and they show that they have a good knowledge of people’s needs and of how these needs are to be met. One carer told us in depth about the actions to be taken to address someone’s swallowing difficulty whilst supporting them to eat so that they remain safe. However, we observed another carer not putting this plan of action fully into practice. They used a desert spoon instead of a teaspoon, although the amount on the spoon was quite small. They also gave this person a drink which was quite fluid and not of a ‘runny honey’ or ‘custard’ consistency as instructed by the specialist Speech and Language Therapist. As is good practice, appropriate referrals are made to specialist health care professionals. Records show that people see their GP when needed and people told us this happens in a very timely way. Records show that they are also referred to the psychiatrist, dentist, chiropodist, optician and audiologist when needed. Records also show that people are supported to attend specialist out patient clinics when required. Feedback from a healthcare professional told us that staff usually seek advice and act upon it. We spoke with three relatives during out visit to the home. All told us how good the care at this home is. They say that staff attend quickly to people and that people who are not mentally able get as good care as those who can speak up for themselves. One visitor told us that when people become upset or distressed that staff always respond to them and try to help them. The Dales Nursing Home DS0000072320.V377950.R01.S.doc Version 5.3 Page 13 We observed some practices and looked at some equipment used by the home during our visit to see how people’s moving and handling needs are met. We were told that the home has hoists for staff to use. We were also told that the decision about which one to use is based on which hoist is available. We observed the hoist being used on the ground floor. We saw a member of staff had to use poor moving and handling techniques in order to move the hoist that one person was in. We also saw that the same hoist was used for a very tall person whose head nearly touched the top of the hoist, meaning they could be hurt. We saw in care plans that staff do not have instructions about the size of sling to use as they should do. We also saw two members of staff using an underarm lift to help someone to move up in the chair, which is not good practice. We talked to the manager about this. The manager and owner tell us that they have already identified some of these issues. They are not satisfied with the training given and have already made arrangements to change the trainer. In addition staff from another of the owner’s homes are going to provide training and look at the assessment and use of moving and handling equipment. We looked at the pressure relieving equipment used in the home. We saw that there are a lot of air mattresses, which are recommended for people who are identified as being at high risk of developing pressure sores. Some of this equipment is quite old and staff cannot adjust the air pressure in the mattress as they should be able to do according to each person’s weight. We asked one person who was lying on an older type mattress if they were comfortable. They told us that they were. The manager reports that this problem has already been identified and that 4 replacement units have been ordered. It is important to note that no one living in this home has a pressure sore. We looked at the way that people’s medicines are managed. We saw that there are good systems in place for ordering, storing and returning medicines. We looked at records and found that staff always sign when a medicine has been given, and that this includes signing for prescribed creams. We saw that hand written entries are checked and signed by two nurses, as is good practice. We looked at the way controlled drugs are stored and found these are stored safely and in line with the Royal Pharmaceutical guidelines. We counted some medicines to see if they match the amount recorded. We found that these are generally in order. However, one person has more tablets than records show they should have. Staff explain that on this occasion, they have not added the amount of tablets in stock to the amount of tablets received. We also checked to see if medicines needed refrigeration are kept appropriately. We found they are stored in a dedicated fridge which is kept in a locked room. The fridge temperature is checked but not recorded. The thermometer used does not measure the minimum and maximum temperatures that the fridge has been running at as it should. The Dales Nursing Home DS0000072320.V377950.R01.S.doc Version 5.3 Page 14 We wanted to know if people are treated with respect and with dignity. In surveys one person commented that staff always treat them with respect. A visitor told us that the person they visit, and other people, always wear well cared for and matching clothes. They say that the person they visit is helped to match their shoes and jewellery to their outfits, and this is a way of helping this person to maintain their dignity. We saw that people were taken to the bathroom or toilet to receive their personal care in private as is good practice. We saw some staff speaking softly and discreetly with people living here. They knelt down so that they could make eye contact with them and responded to them. We saw other staff not attending discreetly to people and not responding to them when they called out, which is not good practice. Although not recorded, staff were able to tell us which people prefer to have a female or male carer. They say that there is always a male and female carers on duty to ensure that those who have a preference have this met. However, it is not clear how this decision is made for those people who have dementia and cannot speak. The Dales Nursing Home DS0000072320.V377950.R01.S.doc Version 5.3 Page 15 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 and 15. People using the service experience adequate quality outcomes in this area. Continued attention to the way that people with different abilities have their social needs met means this area of care continues to improve. People enjoy and benefit from the food served which meets their dietary and nutritional needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The information given to us in the AQAA and our discussions with the manager tell us that the management team are aware that improvements in the area of meeting people’s social needs are needed. Some arrangements have been made to achieve this. These have included the appointment of an activities coordinator, the input of a more established activities co-ordinator from the The Dales Nursing Home DS0000072320.V377950.R01.S.doc Version 5.3 Page 16 owners other home, and the implementation of a more structured activities programme In surveys the majority of people told us that there are usually or sometimes activities they can join in with. When we visited the home we looked at what type of things people are supported to do. Most people have a television and/or a radio in their bedroom. Some people told us that they like to watch television, listen to the radio or read in their bedrooms. We saw staff helping them to select the channel they wanted to watch, and one person told us the staff have tuned the radio to their favourite station so that they can listen to it. The home has a library and one person told us they really appreciate being able to use this. Another person told us they like their own company, reading the paper and watching what is happening. Other people spend their days in the communal lounge where there is a television. We saw that a few people were watching this, but the majority of people did not. The home also has a budgerigar and the owners have a dog which they bring to the home. We saw people responding to the dog by smiling and calling for her to come to them. The manager told us in the AQAA that the visiting dogs (Pets for Therapy) also visit the home. We saw that people who are able to chat with staff do so and that these people got a lot of attention. We observed that people who sit quietly or who are unable to ask for company tend to not get any company from staff unless they are being supported to receive care, such as eating. The duty rota shows that the home has a part time activities co-ordinator who arranges social events and activities. The home had its first garden party this summer and musical entertainment and exercise sessions are arranged. We saw in records that the activities co-ordinator arranges quizzes and spends time chatting with people. We looked at records to see how people with mental health needs have their social needs and interests planned and met. We saw in one care plan that some information has been collected about this person’s previous interests and activities. Records show that they have joined in with a quiz and the exercise to movement sessions, been in the garden and had their nails cut. These activities do not link to this person’s previous interests that are recorded. When we spoke with this person, because of their cognitive disability, we could not determine if they like these activities or if their social needs are met. They did tell us that they would like to go out. Staff say that this person is at risk of falls and their care plan explains that this person is not safe on the road and is therefore not allowed out. However, there is not a plan of care to address their desire to go out of the home, escorted by staff. Care records of other people with mental health needs that we looked at do not contain a plan of care as to how their needs for social contact are to be addressed. The AQAA tells us that there are 13 people living at the home who have mental health needs. The Dales Nursing Home DS0000072320.V377950.R01.S.doc Version 5.3 Page 17 We asked people if they enjoy the food served at the home. Everyone we asked said they did. We observed people who cannot communicate their views verbally eating their lunch indicating that they enjoy the food. In surveys the majority of people told us they always or usually enjoy the food served. We saw in records that people are offered a choice for breakfast, lunch and tea and that the home runs a 4 week menu meaning that meals are repeated every four weeks. Staff told us that they know what people like to eat and what they don’t like as the majority came to live here when they could give the staff this information. We saw in the kitchen that the cook keeps a list of what people like and don’t like to eat. Two of the three people we case tracked could tell the staff about their food preferences, and one could not. We would expect that as staff got to know this person’s preferences from their reactions to the food offered, that they would record this so that only the food this person showed they liked would be offered. This has not happened. We saw that people were given the support they need to eat and that some people had specialist equipment, such as a plate guard to stop food slipping off the plate, to help them to be more independent. Other people who would have benefited from this equipment did not have it. We saw that one person took a long time to eat their meal. The length of time taken would have resulted in the last part of this meal being cold as equipment to keep the meal warm was not used. People normally eat their lunch in the dining rooms. However, these rooms have been knocked into one to make it a more congenial and social setting and is currently being decorated. We spoke with the cook about meeting the needs of people who need specialist diets. She told us that she knows who has a diabetic diet and who needs their food to be pureed or softened because they have problems swallowing. She says these are the only specialist diets that are needed at the moment. She showed us a list she refers to to determine if the foods she serves are classed as soft or not according to the Speech and Language Therapist’s (SALT) guidelines. She also told us that if she is not sure that she phones SALT to find out. Visitors we spoke with told us it is easy to visit the home and that they are always made welcome. One person told us they are always offered refreshments and another told us they are kept up to date with changes and developments. We saw staff helping one family to move to another part of the lounge so that they could sit and chat comfortably without disturbing others. The Dales Nursing Home DS0000072320.V377950.R01.S.doc Version 5.3 Page 18 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. People have their comments and complaints listened to and acted upon and are safeguarded from abuse. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: In surveys people told us that there is always someone to speak with informally if they are not happy and that staff always or usually listen and act on what they say. When we spoke with people they told us they have no complaints or that if they want something changed or done differently that they only have to ask. Many people told us that the manager and deputy are always available and listen to them. The home reports they have received 4 complaints since the last inspection. We looked at the records relating to these and found that these related to receiving a meal they had not requested or a meal that was not up to the usual standards of quality, and one was about a member of staff. Records show that these complaints were addressed and that the people who made the complaints were satisfied with the outcome. The commission have not received any complaints about this service. The Dales Nursing Home DS0000072320.V377950.R01.S.doc Version 5.3 Page 19 We asked staff to tell us about their understanding of abuse. They were able to tell us about obvious forms of abuse as well as more subtle forms of abuse such as being rough with or unkind to someone. They told us that if they suspected or saw this that they would report this to the manager or the owner. They told us they believe that this information would be taken seriously. We asked the manager and the owner what they would do if abuse were reported to them. The manager’s response was not in line with the multi agency safeguarding guidance. The owner responded that an alert would be made to the safeguarding team, as it should be. The manager explained that she has not had experience of using these procedures and, when asked, told us she has not received training from the local adult social services department. She has however arranged this training. People who live here told us that they feel safe and well cared for. They say that staff are kind, gentle and very caring. We looked in care plans to see if people had been assessed under the Mental Capacity Act as they should be. We found one assessment relating to the decision to use a bedrail and this is good practice. However, no other assessments of capacity in relation to decision making have been made, although a number of people living here have dementia and other mental health conditions. We have asked the manager to consider whether it would be appropriate to make a Deprivation of Liberty referral for one person living here. We have been made aware that actions have been taken in relation to this issue. The Dales Nursing Home DS0000072320.V377950.R01.S.doc Version 5.3 Page 20 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, 22 and 26 People using the service experience good quality outcomes in this area. The improvements to the home’s general environment and to infection control procedures are having positive effects for people living here. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Since the last inspection parts of the home have been refurbished, redecorated and improved. The programme of re carpeting the communal areas has started and will continue once building work is complete. The two small dining rooms which were described as dark have now been joined to make one larger dining room, and is currently being decorated. Staff anticipate this will improve the overall atmosphere and sociability of meal times. In addition a large and wheelchair friendly shower room has been created as prioritised by the owners The Dales Nursing Home DS0000072320.V377950.R01.S.doc Version 5.3 Page 21 at the last inspection and new garden furniture has been bought for people to sit out on. In surveys people say the home is usually clean and fresh. There were no unpleasant odours in the home even though the information given to us by the manager tells us that the majority of people living here are incontinent. Since the last inspection the manager has joined the local Infection Control forum where good practice is shared, and has continued with the programme of training for staff. We observed staff using gloves to carry out personal care tasks and removing these before moving onto the next task. We saw that gloves, liquid soap, hand towels and alcohol gel rub are available throughout the home, as is good practice. We also noticed that some bins can only be operated by hand (not by foot as they should be) and that there are no gloves kept in the sluice. We saw the laundry was reasonably tidy and clean. Staff told us they have sufficient washers and dryers to cope with the laundry. People told us they wear their own clothes and that their clothes seldom go missing when sent to the laundry. The owner reports that the home has 3 hoists and 1 stand aid to help with moving and handling. There are some older pressure relieving air mattresses which are more difficult to control (see Health and Personal Care) and some small equipment such as heated plates and plate guards are not always made available for people who need them. We talked to staff and they told us that they have training about what to do in case of fire and fire drills. However, we found that one emergency fire escape door was partially obstructed by a chair, which was addressed by the owner. The Dales Nursing Home DS0000072320.V377950.R01.S.doc Version 5.3 Page 22 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 and 30. People using the service experience good quality outcomes in this area. People living here are cared for by well trained and competent staff who are recruited using robust practices so that people are safe. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: In surveys people told us that staff are usually available when needed and the majority of people told us that staff usually listen and act on what they say. Comments about staff included ‘they treat me with dignity and respect’, ‘staff show loving care to residents’ and ‘very friendly and always try to solve any issues in a timely and effective way’. During the inspection people living and visiting here told us that staff are really good, kind and helpful. We observed staff interacting with people, for example helping them to eat, responding to requests for attention and preparing to provide personal care. As we have said in the Health and Personal care section of this report we saw variable skills. We discussed this with the manager who had already identified this and we saw records that she is addressing this in formal supervision. The Dales Nursing Home DS0000072320.V377950.R01.S.doc Version 5.3 Page 23 We saw that there is always a nurse on duty during the day and night and that there are usually 7 carers on duty until 2pm. 5 carers from 2pm to 4pm and then there are 6 carers on duty until 8pm. At night there are 2 carers working with the nurse. In addition there are two housekeepers on duty most week days, a cook and kitchen assistant and a maintenance man on 2 days. The AQAA tells us that 9 of the 22 care staff have a National Vocational Qualification (NVQ) in care, and that staff receive induction training recommended by Skills for Care. The owner reports that a number of staff are currently undertaking NVQ training, and he anticipates that more than 50 of staff will have this qualification. Staff told us that they are given training relevant to their role and which helps them to understand and meet the needs of the people they care for. This has included some specialist training. However, we were told that staff had to keep leaving a training event as they had not been freed up for this training and also had to attend to caring duties. We looked at the recruitment files for three people who work at this home. Pre-employment checks, including references and police checks had been taken up prior to employment. This helps to ensure that only individuals who are suitable to work with vulnerable adults are recruited. The Dales Nursing Home DS0000072320.V377950.R01.S.doc Version 5.3 Page 24 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, 36 and 38. People using the service experience good quality outcomes in this area. People benefit from the open and efficient management style and from being involved in the running of the home which is safe. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The manager of this home is Marie Brown. Mrs Brown has been in post for 5 years. She is a Registered Nurse and is due to complete the Leadership and Management Award by the end of this year. Mrs Brown tells us that she keeps up to date with best practice and changes by attending training courses and by reading professional journals. She has recently established a formal link with The Dales Nursing Home DS0000072320.V377950.R01.S.doc Version 5.3 Page 25 the Infection Control department of the local Primary Care Trust as a way of improving and maintaining infection control standards in the home. The information given to us in the AQAA was not as comprehensive as it should be. We discussed this with the manager and owner and reminded them of the guidance available to them for completing this important document. We noted that previous requirements made by the commission had not been fully acknowledge or addressed in this document. We also noted that equality and diversity are not well addressed. We talked to the manager and owner about this and they agreed that further training in this area might be beneficial. Although the AQAA lacked information, we found during our discussions with the manager and owner that they had already identified many of the shortcomings we identified during this inspection. For example, they have made arrangements for, or are already, addressing the shortcomings in relation to moving and handling, staff’s varying skills in planning and reviewing care, staff always treating people with dignity and training generally. The manager also recognises that she needs to carry out more supervision of staff practice following training, and in relation to ensuring care plans are being put into practice by staff. The management team have developed a formal quality assurance system. This involves sending surveys to users of this service and their relatives. A summary of the results has been produced and published for people to read. The owner reports that the feedback given has resulted in some changes. For example, there is now a senior member of nursing staff on duty at weekends to ensure that the standard of care delivered is consistent. This service does not manage people’s personal allowances. People spend their monies via the home’s petty cash system and their supporters are provided with invoices of monies spent. We looked at the way that this home ensures that people are safeguarded from injury. We found that staff receive training in health and safety, fire safety and moving and handling. Windows on the upper floors restricted openings to prevent accidents from falls. Radiators are covered and water temperatures are limited by thermostatic valves to prevent accidental scalding. Accidents are recorded and the manager looks for patterns or themes or for ways in which accidents or falls might be prevented in the future. The AQAA shows that maintenance of equipment and systems, such as water, gas and electrical systems, and equipment such as the passenger lift and hoists are upto-date. Staff say the manager is approachable, available and helpful. They say the management team try really hard and that this results in a strong team who work hard to ensure people get the care they need. They say there is a good communication system in the home meaning that they get good information The Dales Nursing Home DS0000072320.V377950.R01.S.doc Version 5.3 Page 26 about people and their needs. Staff also say they feel well supported and that the manager meets with them regularly to discuss how they are working. The Dales Nursing Home DS0000072320.V377950.R01.S.doc Version 5.3 Page 27 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 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x 2 x x x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 3 The Dales Nursing Home DS0000072320.V377950.R01.S.doc Version 5.3 Page 28 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. Standard 1. OP8 Regulation 12 Requirement There must be a system in place to ensure that all staff are following the instructions given by nurses and specialist health care professionals. This includes, but is not exclusive to, the instructions left by the speech and language therapist in relation to someone at risk of choking due to swallowing problems. This will help to ensure that people have their care needs met because the care planned by a nurse is the care delivered. The manager must continue to ensure that stimulating and meaningful activities are developed, and that people have opportunities to interact and be social. This is particularly relevant for those people with mental health needs. This will help to ensure that people of all abilities have a good quality of social life. The manager must be familiar with the procedures to be followed in relation to: DS0000072320.V377950.R01.S.doc Timescale for action 31/12/09 2. OP12 16 30/12/09 3. OP18 13 31/12/09 The Dales Nursing Home Version 5.3 Page 29 The Mental Capacity Act Deprivation of Liberty. This will help to ensure that people are safeguarded from abuse, from being restrained inappropriately and from having their liberty deprived, and will ensure that actions taken are always done so in their best interests. 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 OP9 Good Practice Recommendations All medicines in the home must be counted and recorded so that they are completely auditable. The temperature of the medicines fridge should be recorded using a minimum/maximum thermometer, so that staff can see if the fridge always runs at the most effective temperature. It should be ensured that all staff understand the issue of dignity, and that there is a system in place to monitor, and where necessary address, staff practices in relation to this. Further developments should be made to the way in which people with communication problems/mental health needs are supported to make choices. This includes, but is not exclusive to, making choices about what to eat. Consideration should be given to providing more people with equipment such as plate guards and heated plates to help people to remain as independent as possible. The home should have sufficient foot operated waste bins and gloves in appropriate places to ensure that good infection control practices can always be followed. Work should continue to ensure that at least 50 of carers obtain a National Vocational Qualification (NVQ) in care. In order to ensure the future good management of the home, the manager should continue and complete the leadership and management qualification as soon as DS0000072320.V377950.R01.S.doc Version 5.3 Page 30 2. 3. OP10 OP14 4. 5. 6. 7. OP22 OP26 OP28 OP31 The Dales Nursing Home 8. OP38 possible. We are told that this course involves training in Equality and Diversity which will help the manager to integrate all six strands of diversity (where applicable) into staff practice. The manager should also access the guidance provided by the commission in relation to completed the Annual Quality Assurance Assessment. The system for moving and handling people should ensure that the appropriate equipment is available and that people are moved and handled safely. The Dales Nursing Home DS0000072320.V377950.R01.S.doc Version 5.3 Page 31 Care Quality Commission Care Quality Commission South West 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. 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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