Inspection on 18/09/07 for Abbeyfield Dene Holm

This inspection was carried out on 18th September 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Abbeyfield Dene Holm 19/09/08

Abbeyfield Dene Holm 31/07/06

Abbeyfield Dene Holm 16/08/05

Abbeyfield Dene Holm 19/04/05

Abbeyfield Dene Holm 29/11/04

Abbeyfield Dene Holm 09/06/04

Abbeyfield Dene Holm 08/01/04

Abbeyfield Dene Holm 17/07/02

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Abbeyfield Dene Holm Dene Holm House Dene Holm Road Northfleet Gravesend Kent DA11 8JY Lead Inspector Mary Cochrane Key Unannounced Inspection 18th September 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Abbeyfield Dene Holm DS0000023933.V343991.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Abbeyfield Dene Holm DS0000023933.V343991.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbeyfield Dene Holm Address Dene Holm House Dene Holm Road Northfleet Gravesend Kent DA11 8JY 01474 567532 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) The Abbeyfield Kent Society Carol Ann Cooney Care Home 47 Category(ies) of Dementia - over 65 years of age (35), Old age, registration, with number not falling within any other category (12) of places Abbeyfield Dene Holm DS0000023933.V343991.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Care of one younger adult with a diagnosis of dementia is restricted to one service user whose date of birth is 19/06/1941. From time to time the home may admit service users whose assessed needs can be met and are under the age of sixty five (65) at the time of their admission. 31st July 2006 Date of last inspection Brief Description of the Service: Dene Holm is a large purpose built residential unit situated in Northfleet, on the outskirts of Gravesend. The home provides support to older people and people with dementia. The downstairs unit in the home is dedicated to supporting people with dementia. The building is accessible to wheelchair users with lift access to the first floor. Dene Holm has a team of staff covering a 24-hour rota. Current fees range from £346.29 to £550 per week. Information on the home’s services and the CSCI reports for prospective residents is detailed in the Statement of Purpose and Service User Guide. Abbeyfield Dene Holm DS0000023933.V343991.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Abbeyfields Dene Holm House is registered to provide care for 12 physically frail people and 35 people who have a diagnosis of dementia. At the time of the inspection there were 32 residents living at the home. The homes acting and deputy managers were on duty and both were available all day to assist in the inspection process. The residents and the staff were helpful and co-operative throughout the visit. In June 2007 a safeguarding adults alert was raised at the home. A multi – disciplinary meeting was held to discuss the issues and the action that needed to be taken. The home has worked actively with out-side agencies to improve the standard of care given to the residents. Visiting professionals have reported an improvement in care practises. At the time of writing the report the alert remained open. The following methods of inspection and information gathering were used: one-to-one discussion with residents and staff, observing interactions, care interventions and activities, reading and discussing individual support plans, risk assessments, selected policies, medication procedures, and training programmes. A tour of the building was undertaken and a mealtime was observed. The CSCI did receive a completed questionnaire from the home. Information from this will be used in the report. Questionnaires were sent to residents, relatives visiting professionals and staff. What the service does well: Prior to coming to live at Dene Holm House prospective residents and their relatives are given information, which will assist them to make an informed decision about whether the home is the right place for them. The manager makes sure the home can meet the needs of the people before they come and live there. The permanent care staff on duty were seen to interact with the residents in a respectful and caring way. They reported that they had developed good Abbeyfield Dene Holm DS0000023933.V343991.R01.S.doc Version 5.2 Page 6 relationships with the residents and are able to anticipate and meet their individual needs. Residents said they did have a choice about what they do and how they live their lives in. There was evidence to show that residents are given a choice, about what they eat, when they get up and go to bed. There was also a choice about decorating communal areas and bedrooms. Family and relatives are welcome at the home and reported that they feel involved. The food provided to the residents was seen to be nutritional, well cooked and well presented. Individual needs and wishes, likes and dislikes are known and alternatives provided. Special diets are catered for. In each of the units the staff have access to a kitchenette area where they can make drinks and snacks for the residents at any time. Any complaints made to the home are dealt with effectively. What has improved since the last inspection? What they could do better: Abbeyfield Dene Holm DS0000023933.V343991.R01.S.doc Version 5.2 Page 7 To ensure that all the following can take place there needs to be enough staff on duty at all times. They need to be able to have easy access to care plans and risk assessments so they can meet the individual needs of the residents. At the time of the visit a lot of agency staff were covering shifts. The service needs to employ more permanent staff to ensure consistency and continuity of care. The service needs to make sure that all the personal and health care needs of the residents have been identified and met and that risks are kept to a minimum at all times. There needs to be evidence in place to support this. The storage of medication, practises and procedures need to be reviewed to make sure that the residents receive their medication safely and on time. The home needs to provide more stimulating activities and leisure pursuits for the residents in and out-side the home. More opportunities and choices should be provided so that life style expectations are met. Staff training needs to continue as planned. Staff training at the home should be up-to date and on going. More staff require specialist training especially in dementia, and managing behaviours. The society need to continue to up-grade and re-furbish the environment to ensure that it is a pleasant and safe place for people to live. The recruitment procedures need to be tightened up to make sure the residents are protected. The acting manager of the home is doing a good job but there needs to be a permanent manager in post who is solely dedicated to Dene Holm and the residents and staff. The home needs to further develop its quality assurance systems to ensure that it is meeting its aims and objectives and that it is improving the service for the residents. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Abbeyfield Dene Holm DS0000023933.V343991.R01.S.doc Version 5.2 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 Abbeyfield Dene Holm DS0000023933.V343991.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users receive sufficient information to enable them to make an informed choice about living at the home. A competent person will undertake a full assessment of their needs prior to them coming to the home. This home does not offer the facility of intermediate care EVIDENCE: The statement of purpose and service users guide contains all the necessary information to assist residents their representatives to make an informed decision as to whether the home is suitable and able to meet their needs. Abbeyfield Dene Holm DS0000023933.V343991.R01.S.doc Version 5.2 Page 10 They are clearly written and easy to read and understand. One resident had a copy in her room, which she said that she found useful. Due to the safeguarding adults alert in June ’07 the home agreed not to admit any further residents until the situation was resolved. At the time of writing the report the alert remained open. Pre-admission assessments of the 2 residents to arrive at the home prior to this date were looked at. These contained all the necessary information and were of a good standard. Information is gathered from residents, care managers and relatives. The assessments explore all the relevant areas of care including communication and behavioural needs. A copy of the joint assessment is obtained for all people who are under the local social services care management team. All the information is brought together to decide whether or not the home will be able to meet the assessed needs. The manager now needs to make sure that the assessment is used as starting point for developing a plan of care. A member of staff who has the necessary skills and training to do the task effectively and thoroughly assesses any prospective residents. Abbeyfield Dene Holm DS0000023933.V343991.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8,9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents still cannot be sure that all their needs will be identified and met and that all risks are minimised. Action still needs to be taken to ensure that the homes medication policies and procedures fully protect the safety of residents. EVIDENCE: A sample of care plans was looked at during the visit and shortfalls were identified in different areas of the care planning system. Some of the plans are of a reasonable standard and contained the information and guidance for staff to meet the needs of the residents. However others were not up-dated to reflect the changing needs of the people living at the home .For example one resident was observed being lifted in a hoist by 2 people. There was nothing in the care plan to show why he was been hoisted. The last review indicated he Abbeyfield Dene Holm DS0000023933.V343991.R01.S.doc Version 5.2 Page 12 was mobile. No assessment had been undertaken to show why the decision to use a hoist had been made and who made it. Another resident had been identified as experiencing falls there was no risk assessment in place to direct staff on how to keep the person as safe as possible. During a night shift a resident had been identified as having sores. Although this information had been passed on verbally to senior staff there was no evidence of this in the care plan or risk assessment of the action taken by care staff. It was later discovered that the resident did not have sores but there was nothing written down. Most of the plans seen gave good guidance on how to deliver personal care to the residents and some highlighted what residents could do for themselves and the areas where they needed support and intervention. However staff are not using this information. All the care plans are kept in the downstairs office, which means that staff cannot access them easily. At present care needs are met in a fragmented and task orientated way. Daily records do not give a clear picture about how residents spent their time and do not relate to the individual care plans. It was evidence that staff do rely more on reporting significant events verbally and in the communication book than recording them in the daily notes. This demonstrates that care plans and risk assessments are not being used as a daily working tool by the staff and residents. The home does need to develop a more person centred approach to care. The acting manager is still reviewing the recording of daily records and how information is shared and recorded. Staff need accurate and precise information and guidance on how to manage and meet the all the needs of residents and manage risks effectively. The acting and deputy manager are being proactive in ensuring the health care needs of the residents are met. They are liaising closely with the PCT and specialist nurses. They have re-established a good relationship with the district nursing team who offers advice, input and assistance when necessary. Any concerns about tissue viability are assessed so that appropriate treatment and intervention is commenced as soon as possible. The home now also has regular contact with the community matron. The older peoples mental team is involved with some residents and there is also access to the local falls clinic. Each resident is registered with a local G.P. and any area of concern related to health is referred to the G.P. The residents have regular appointments with opticians, a chiropodist and dentists. The management of the service needs to make sure that all the health needs of the residents have been identified and met at all times. They need to ensure that all the care staff are aware of the needs and the action they have to take. This needs to be clearly and accurately documented. Abbeyfield Dene Holm DS0000023933.V343991.R01.S.doc Version 5.2 Page 13 The home uses the Monitored Dosage System (MDS) to administer medication. All staff who administer medication have received training. A list of staff competent to administer medication is kept. Sample signatures are also available. MDS were cross-referenced with MAR sheets and at the time of the visit these tallied. Control drugs are stored and administered according to procedures. The medication has been moved to a new storage area because of temperature control difficulties. On the day of the visit it was seen that on several occasions the temperature was still too high. The cupboards were medication is stored are not suitable and not in line with the Royal Pharmaceutical Guidelines. The medication trolley is also overloaded, and it is difficult for staff to find the individuals medication. There is only one drug trolley for both floors. On the day of the visit the morning drug round had taken 3 hours. (There had been a fire alarm in the middle of it). Staff reported that the giving out medication takes a very long time. This means that residents are receiving medication at the wrong time and not at regular intervals. It also means the senior member of staff is unavailable. The home needs to review the practises and procedures on the administration and storage of medication. Protocols and guidelines need to be developed for the individual residents who receive medication ‘when needed’. This will ensure that all medication is given safely and for specific reasons. It will also ensure a consistent approach by staff. There also needs to be robust risk assessments in place for any resident who is self medicating. Through observation and from talking to the residents and staff there was evidence to show that privacy and dignity is up-held in certain aspects of care Residents are well dressed in clothing appropriate for the season and appeared well kept. Permanent staff were observed assisting the residents in a caring and supportive manner and were seen treating them with respect and understanding. Some members of staff were observed demonstrating good body language and communication skills when interacting with the residents. Members of staff spoken to confirmed an understanding and commitment to this aspect of care. However it was observed that agency staff on duty had little knowledge of the needs of individual residents. They performed tasks without communicating effectively or explaining what they were going to do. On one of the units were all the residents are female 2 male members of staff were on duty. This would compromise the privacy and dignity of the people living at the home. There was some evidence available that individuals are involved in some decision making about what happens in the home. One person also said that he was able to choose the colours for his bedroom walls and carpet. Abbeyfield Dene Holm DS0000023933.V343991.R01.S.doc Version 5.2 Page 14 Abbeyfield Dene Holm DS0000023933.V343991.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does not provide the residents with opportunities and facilities that enable them to maintain an appropriate and fulfilling lifestyle in and outside the home. Family links are encouraged and maintained wherever possible. The home provides nutritious and varied meals for the residents. EVIDENCE: Due to the low numbers of staff on duty and the high dependency of some of the residents it is very difficult for staff to organise and undertake activities and leisure pursuits. Some residents did report that they would like to do more others said that they are happy sitting in the lounge. At the present time the service is not providing a person centred approach to care. Abbeyfield Dene Holm DS0000023933.V343991.R01.S.doc Version 5.2 Page 16 On the day of the visit the majority of the residents on the ground floor sat in the lounge in front of the television. No one was given the opportunity to do anything else. There was more activity on the 1st floor. Residents, staff and relatives reported that service users do enjoy partaking in activities when they are provided. The home does have the some visits from out-side entertainers. The home did have 2 occupational therapy students on a 12-week placement until June ’07. There was a gap until the 17th September when 2 more students have started. They are now getting to know the residents and will be introducing group and individual activities. The manager needs to look at ways of implementing more structure and organisation to daily activities to ensure that all the needs of the residents are met. The home needs to ensure that daily activities are planned in advance following consultation with residents. This will allow both residents and staff to be prepared. It will also offer guidance and direction to ensure that the activities take place and are not just something that happens on the spur of the moment. Visitors are welcome within the home at all reasonable times and no restrictions are imposed. Residents are able to receive their visitors in the privacy of their own rooms or in the quiet communal area. Some staff were observed offering choice in a way that was appropriate to each resident’s understanding. It was reported that routines such as getting up, going to bed and mealtimes are flexible. The home does need to be able to evidence how residents make choices in their daily lives. The more able residents at the home felt that they were able to have choice in regards to their day-to-day lives. Individuals’ wishes to maintain personal relationships are respected. The residents are encouraged to bring their own personal possessions into the home. One resident said ‘’the staff will do anything for you”. The menu appears varied and nutritious. Residents are offered a choice of meals on a daily basis and records were available to demonstrate this. Alternatives are recorded. Specialist diets are provided. Residents can eat in the dining rooms or in the privacy of their own room. Meal times are relaxed and unhurried with residents being able to take their time to enjoy the food. Staff were observed assisting residents to eat in a respectful way. Drinks and snacks are available throughout the day. Abbeyfield Dene Holm DS0000023933.V343991.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives can be confident that their concerns and complaints will be listened to and acted on. There are systems in place, which protect residents from abuse. EVIDENCE: The home has a complaints procedure, which meets the national minimum standards. The complaints procedure is available within the home and some of the residents and staff are aware of how to make a complaint. Since the last inspection the home has received 2 complaints and have dealt with them according to homes policies and procedures. They have also used the complaints and its outcome to improve practises within the home. Complaints are taken seriously and acted on. A safe guarding adults was raised at the home in June 2007. A meeting has taken place with the service and the involved agencies. The service has been pro-active in dealing with the alert and has made changes to ensure the safety and well being of all the residents. Improvement plans and action plans have been developed and at the time of the visit are being implemented and actioned. The home has improved its practises. The majority of staff have Abbeyfield Dene Holm DS0000023933.V343991.R01.S.doc Version 5.2 Page 18 received up-to date training in safe guarding adults and were able to explain how they would protect the people living at the home. Abbeyfield Dene Holm DS0000023933.V343991.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,22,24,25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service is working hard to provide the residents with a home that is clean, comfortable, and well maintained. EVIDENCE: Since the last inspection there have been environmental improvements within the home and the work is on going. The service does need to show that they have a planned programme with timescales to improve and up-grade the building and out-side areas. Some bedrooms have been refurbished and re-decorated. New flooring has been laid in the downstairs hallway. The carpet in the “Pocahontas” lounge has not yet been replaced and remains very stained. The chairs in the lounge remain around the walls and very close together. The overall impression was Abbeyfield Dene Holm DS0000023933.V343991.R01.S.doc Version 5.2 Page 20 that the room was crowded. There was little room for tables for residents to place their drinks or for staff to assist residents when they needed help to mobilise. This was evidenced when a resident need a hoist and 2 carers to take him from the lounge area to his room. The acting manager did report that there are plans to extend the lounge with a conservatory area. The upstairs areas have lot more space, as they are not fully occupied. Residents are a lot more comfortable in these areas and were able to mobilise more safely. The home has now found suitable storage space for wheel chairs, hoists and other equipment. All the equipment seen at the visit appeared clean and maintenance checks have been carried out. Lifting aids were being used without a proper assessment being made by suitable qualified person. This will put residents and staff at risk. The acting manager reported that tiles had been replaced in the in the 1st floor sluice room the bathroom in ‘Dickens’ and the kitchen in ‘Pocahontas’. The grouting and sealant in the kitchen still needs replacing. The fencing around the garden has now been replaced and the area is now secure. There is an attractive garden, which the residents can use. The service needs to make sure that all out-side areas are safe for residents to use. It has been reported in relatives meetings and in a recent OT report that some areas of the garden require levelling, as they are a potential trip hazard. There are areas on the patio, which are a potential risk to residents. Risk assessments need to be in place to evidence how the risk will be managed and minimised. The deputy manager did say that no one goes out into the garden unless a staff member accompanies them. New beds are on order to replace the remaining hospital beds used at the home. The radiators now have covers to protect residents. There are the facilities available in all the appropriate areas for hand washing and the home has the appropriate facilities for the disposal of clinical waste. Soiled laundry is transported correctly in red bags and washed at the appropriate temperatures. There had been complaints about the laundry facilities. Residents were losing clothes and garments were getting muddled up. The home now has a full time laundry person and residents reported that things have improved. Areas in the laundry area do still need up grading. The floor was cracked and worn in several places. There are policies and procedures in place to protect the residents from the spread of infection. Abbeyfield Dene Holm DS0000023933.V343991.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28,29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The people living at the home are at risk by insufficient numbers of staff on duty. The permanent staff have a good understanding of the residents and positive relationships have been formed. Staff training needs to be further developed to ensure that all the needs of the residents are met. Recruitment practises are generally sound but areas do need tightening up to ensure the service users are fully protected. EVIDENCE: A relative reported, “ There does not seem to be enough staff around. Sometimes there is no-one in the lounge”. A resident said, “ Sometimes they are so busy you don’t like to bother them”. Another person reported ‘ the staff are caring and patient there is just not enough of them” Abbeyfield Dene Holm DS0000023933.V343991.R01.S.doc Version 5.2 Page 22 From looking at the duty rota, talking to staff, residents, relatives and from observation on the day of the visit it was evident that there was not enough staff on duty to meet all the needs of the residents. From observations and talking, there was evidence to show that the staff were stretched to meet just the basic needs of the service users. For the afternoon shift there is often only one member of staff on each of the units on the first floor, this leaves vulnerable residents unattended for periods of time. On day of the visit 2 agency staff and 1 permanent member staffed Pocahontas. The agency staff needed support and guidance to assist residents. A senior staff was also on duty but her time was predominately taken up with doing the medication round. The home is using a lot of agency staff while trying to recruit permanent staff to work at the home. The home needs to make sure that it has enough staff on duty with the necessary qualities skills and knowledge to meet the needs of the residents. Staff did report that the home has improved greatly over the past months. They said the acting and deputy manager where ‘working flat out’ to make things better. Staff and visiting professionals reported that the atmosphere and staff moral has also improved since the acting manager came and the deputy was appointed. 50 of the staff have now achieved NVQ level 2 or above. Staff said that the amount of training available has increased over the past few months and they were able to demonstrate their knowledge on different aspects of care. The mangement do need to develop ways to check staff competencies after they have received training. There are still gaps in mandatory training.The staff also need to receive more specialist training to ensure that they have the skills knowledge and capabilities to care effectively, positively and safely for the residents at the home.The manager is aware of this shortfall. The staff reported that they now feel valued by the management and they said that they are listened to and any ideas or concerns are acted on. The home does have regular staff meetings. Recruitment practises on the whole are thorough. References are sought and safety checks obtained before staff are employed. Staff received a contract following a probationary period and all staff receive terms and conditions of employment. The acting manager ensures that audits are undertaken on the staff files to ensure that all the necessary information is in place. It needs to be ensured that a full employment history is obtained and that any gaps are explored. Evidence of this needs to be kept on file. There also needs to an up to date picture on staff files. Abbeyfield Dene Holm DS0000023933.V343991.R01.S.doc Version 5.2 Page 23 At the time of the visit it was observed that a member of staff who had only started at the home the day before was working with residents unsupervised. This was discussed the acting manager a the time of the inspection and immediate steps were taken to rectify the situation. Abbeyfield Dene Holm DS0000023933.V343991.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is well managed but need a dedicated manager in post to ensure stability and consistency. Further development of the homes quality assurance will help residents to air their views and will help the home to measure its success in meeting their aims and objectives. Residents can be assured that their monies will be kept safe. The home protects the safety of residents and staff. Abbeyfield Dene Holm DS0000023933.V343991.R01.S.doc Version 5.2 Page 25 EVIDENCE: The management of Dene Holm House has been through a period of upheaval and change since June of this year. The home now has an acting manager in post from one of the societies other care home. Her position is a temporary measure. A permanent deputy manager has been appointed. They have both worked very hard over the past months and have made progress in meeting the national minimum standards and have been addressing the identified shortfalls in the home. They both realise there is still a lot of work to do. They reported that they have received support and guidance from the external management of the society. The organisation does need to make sure that a permanent manager is in post as soon as possible to provide stability, consistency and continuity for the residents and the staff. A staff member commented that, ‘the acting manager is supportive and I feel that I can go and talk to her.” The home has started to implement a quality assurance programme as required on the last report. Questionnaires have been circulated to residents and relatives; the home is currently developing questionnaires for visiting professionals; a system of regular audits is being implemented. The information needs to be collated and the strengths and weaknesses of the home identified. From this information the home needs to improve the service it provides for the residents. This will ensure that the aims and objective and statement of purpose are being met. More work still needs to be undertaken on this system. The service told us that the resident’s monies are monitored monthly and the personnel department also undertakes audits. Personal monies are kept safely and a record is kept of incomings and outgoings. Staff reported that they now receive supervision. From looking at the documentation all staff are receiving formal supervision. There was evidence in place to show that that staff are having regular staff meeting. Policies are in place to strengthen safe practices. The home has informed us that all the relevant checks and inspection of equipment and system have been undertaken. An accident book is maintained. The acting manager informed us that all fire checks are done at the required intervals. Water temperatures are taken and comply with regulations. The Manager is aware of RIDDOR and reporting incidences to the Commission under Regulation 37. COSSH products are locked away safely. Environmental risk assessments are in place. Abbeyfield Dene Holm DS0000023933.V343991.R01.S.doc Version 5.2 Page 26 Abbeyfield Dene Holm DS0000023933.V343991.R01.S.doc Version 5.2 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 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 X 2 X 2 2 2 STAFFING Standard No Score 27 1 28 3 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 2 Abbeyfield Dene Holm DS0000023933.V343991.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES 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 Schedule 3 Requirement Residents plans to be up to date and regularly reviewed. Care actions/interventions to be in more detail and to show clear steps. All individual risk assessments to be completed where a risk has been identified. Risk assessments to show more detail. Working care plan and risk assessments to be available for care staff. The input of care staff and, where applicable, of residents and relatives, to be documented in the care plan. Daily records need to contain relevant information about the day of the residents and written in a format that is easy to follow. (Out-standing requirement from the previous inspection Time scale of 01/09/06 not met). Abbeyfield Dene Holm DS0000023933.V343991.R01.S.doc Version 5.2 Page 29 Timescale for action 31/12/07 2 OP9 13(2) The service needs to make sure that medication is stored safely and correctly. Medication needs to administered within reasonable limits of the prescribed times The manager needs to develop protocols and guidance for the individual residents who receive medication when needed. Assessments and competency checks need to be in place for residents that self-administer medication. (Out-standing requirement from the previous inspection Time scale of 01/09/06 not met). 31/10/07 3. OP12 16(2)(m) 4. OP19 23 (2)(o)(n) The service needs to consult and involve residents about their interests and make arrangements for them to enable them to engage in local, social and community activities All parts of the home to which residents have access are so far as reasonably practicable free from hazards for their safety. The garden paths and patio area needs to be made safe. (Outstanding requirement from the previous inspection Time scale of 01/09/06 not met). . The home needs to provide adequate furniture and equipment suitable to the needs of the residents. Hospital style beds must be used only when assessed as being necessary by a relevant health care professional. Where a resident requires the 31/10/07 31/12/07 5. OP22 16(2)(c) 13(4)(c) 31/12/07 Abbeyfield Dene Holm DS0000023933.V343991.R01.S.doc Version 5.2 Page 30 use of lifting aids, suitably qualified person needs to access the suitability of the equipment. (Out-standing requirement from the previous inspection Time scale of 01/09/06 not met). . 6. OP27 18 (1) (a) The home needs to make sure that it has enough staff on duty at all times with the necessary qualities skills and knowledge to meet the needs of all the residents. All staff need to be suitably qualified and competent to undertake their role effectively and safely. 31/10/07 7 OP30 18(1)(a) (c) 31/12/07 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 2 Refer to Standard OP8 OP10 Good Practice Recommendations The manager needs to ensure that there is accurate records kept to evidence all the healthcare needs of the residents The service needs to ensure that the privacy and dignity of the residents is promoted and respected at all times. Residents should have the choice of receiving care from a staff member of their own gender. The home needs to produce a renewal and maintenance programme with timescales in regard to both the interior and the exterior work of the property. The carpets and furniture in communal areas needs replacing. More space is need in the downstairs lounge to allow residents comfort and safety. The laundry floor finishes need to impermeable. The service needs to have a permanent manager in post DS0000023933.V343991.R01.S.doc Version 5.2 Page 31 3. OP19 4. OP20 5. 6. OP26 OP31 Abbeyfield Dene Holm 7. OP33 who has the necessary competencies, qualities and skills to manage the service effectively. Effective quality assurance and quality monitoring systems, based on seeking the views of relatives/representatives, are in place to measure success in meeting the aims, objectives and the statement of purpose of the home. Abbeyfield Dene Holm DS0000023933.V343991.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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