Inspection on 30/06/05 for Autumn Care

This inspection was carried out on 30th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 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

Autumn Care 18/03/09

Autumn Care 17/03/08

Autumn Care 26/11/07

Autumn Care 24/08/06

Autumn Care 13/10/05

Autumn Care 16/12/04

Autumn Care 30/06/04

Autumn Care 18/03/04

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Dudsbury Manor 41 Dudsbury Road Ferndown Dorset BH22 8RB Lead Inspector Jo Palmer Unannounced 30 June 2005 10.45 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 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. Dudsbury Manor D55 S26795 Dudsbury Manor V228977 300605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Dudsbury Manor Address 41 Dudsbury Road, Ferndown, Dorset, BH22 8RB Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01202 573746 Mr John Henry Hughes Mrs Susan Linda Hughes Mrs Debra Eve Barbara Dacey Care Home 14 Category(ies) of OP - 14 registration, with number of places Dudsbury Manor D55 S26795 Dudsbury Manor V228977 300605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 16 December 2004 Brief Description of the Service: Dudsbury Manor is registered with the Commission for Social Care Inspection to accommodate a maximum of 14 older people. Mr & Mrs Hughes own the home and Ms Dacey is the registered manager. The premises are located in a residential area a short drive from the centre of Ferndown. Local amenities including shops and a pub are available within walking distance. A bus service is avaialble nearby. The home is a converted and extended family The bedrooms are located on the ground and first floors. There are 10 single rooms. 8 of which have en-suites, and two shared rooms. Both shared and two of the singles are on the ground floor. A stairlift provides access between floors. A communal dining room and lounge is on the ground floor. The gardens of the home are well maintained and there is outside seating to the rear of the home. Dudsbury Manor D55 S26795 Dudsbury Manor V228977 300605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection on 30 June lasted for four and half hours. On arrival, two carers were present one of whom was preparing the midday meal. The manager, Ms Dacey arrived at 11.30am having been out on an appointment. The purpose of the inspection was to assess progress in meeting the requirements and recommendations of the last inspection and assess outcomes for residents against some of the National Minimum Standards. This inspection identified that none of the previous requirements or recommendations have been addressed. Following any inspection, the registered persons are expected to submit an action plan detailing how requirements would be addressed to evidence that the home will comply with the regulation, after the last inspection, Mr & Mrs Hughes and Ms Dacey declined to submit an action plan. The inspector spoke with four residents, one relative, two care assistants, and the manager, toured the premises and examined relevant records. East Dorset Public Health Services carried out an inspection of the home under the Food Safety (General Food Hygiene) Regulations 1995 and the Health and Safety at Work Act 1974 in April this year. Several requirements were made and the officer from Public Health indicated in telephone discussion with the inspector that some progress has been made in addressing these requirements. There are still matters outstanding that require attention and that will be monitored by the Public Health Service. What the service does well: Although many concerns have been raised as a result of this inspection, discussion with residents and a visitor confirmed that they feel they are treated with respect and their privacy and dignity is promoted. Residents also confirmed that the provision of food was good although they could not always remember what they were having. Records and menus demonstrated a varied diet is provided offering a choice of menu; and the midday meal was observed in the dining room where residents were able to enjoy each other’s company. The home provides sufficient room for residents in their bedrooms and in communal areas and the standard of décor is satisfactory. The home has sufficient natural light and ventilation and was maintained at a reasonable temperature for the time of year. Furniture is generally, but not always, well maintained. Residents are able to maintain contact with their friends and families who are able to visit without restriction. Dudsbury Manor D55 S26795 Dudsbury Manor V228977 300605 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Many concerns have been raised as a result of this inspection, the registered persons must address issues raised as requirements as a matter of urgency to ensure that standards are improved and regulations are not breached. Before deciding to move to Dudsbury Manor, residents must be provided with up to date information and must undergo a thorough assessment of their needs and have confirmation that the home is able to meet these needs. Residents must be consulted and their views acted upon in determining their required and preferred care intervention in order that they can be confident that their needs can be met by the home or that it is the most appropriate place for them to live. All residents must be issued with a copy of the home’s Terms and Conditions outlining their contractual rights and protection in the home. Following initial assessment, a care plan must be written that directs staff to meet the assessed needs of individual residents, assessments and care plans must be continuously reviewed taking into consideration the residents health and welfare needs and their views on how they want their care to be delivered. Where residents have specific needs in relation to mobility, continence, nutrition etc, a competent person must assess these and advice and guidance on best practice must be followed. Medication management systems require review in order to protect the interests and health of residents. How the home supports residents to exercise choice was not evident as care records do not show their involvement or detail their personal interests or preferences in relation to their social, cultural or recreational needs. Ms Dacey confirmed that no complaints had been received, there is no up to date complaints procedure available to assure people that their concerns and complaints will be taken seriously. There is no evidence of consultation with residents and no indication that they are able to make their own choices and decisions, it is therefore not evident that their legal rights are protected. Adult protection procedures are in place although these are out of date not demonstrating that any allegations can be effectively managed. The home’s environment is generally satisfactory although has not been assessed to ensure the correct aids, adaptations and equipment is provided to meet the needs of residents and there are not effective measures in place to ensure against the spread of infection. Dudsbury Manor D55 S26795 Dudsbury Manor V228977 300605 Stage 4.doc Version 1.30 Page 7 Staffing numbers were poor on the day of inspection although in the absence of a written rota and of comprehensive residents assessments to identify the level of need, it is difficult to assess whether usual staff provision is adequate. Staff are not recruited in a manner that is safe or protects residents as there is no recent record of their recent work history, references or other required information. The registered providers do not effectively manage the home and have not provided the registered manager with the necessary tools to do so. The registered manager does not have a job description, does not have an up to date copy of the National Minimum Standards or Care Homes Regulations 2001 and does not have sufficient management time to effectively run the home’s administration. The registered providers do not report on the conduct of the home each month thereby not demonstrating that they have a sense of the performance of the staff, the manger or whether resident’s needs are being met. Staff supervision takes place but records do not demonstrate that their roles and responsibilities are defined or that there is a positive management culture. There is no facsimile in the home as required under regulation 16. As well as the issues raised here regarding the required actions necessary of the registered providers to ensure they comply with legal requirements, several recommendations of good practice have been made. To aid orientation for residents, staff should ensure that clocks around the home reflect the correct time and are maintained in working order. There should also be sufficient hot water for residents to take a bath at any time of the day and the registered providers should arrange for an assessment of the premises to enable adequate aids and adaptations to be provided to aid mobility around the home. Furniture must be maintained in a good state of repair and replaced or repaired as required and any room that does not have an external window must have mechanical extractor fans in working order. 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. Dudsbury Manor D55 S26795 Dudsbury Manor V228977 300605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Dudsbury Manor D55 S26795 Dudsbury Manor V228977 300605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3 and 4. Standard 6 is not applicable. Prospective residents do not have sufficient or correct information to make an informed choice about whether to move to Dudsbury Manor and Terms and Conditions of Residency information is incorrect. Therefore, residents have no contractual rights or protection in the home. The assessment process is insufficient and does not enable the home to thoroughly assess a persons needs or establish whether those needs can be met at Dudsbury Manor. The systems for resident consultation are poor with little evidence that resident’s views are sought or acted upon. EVIDENCE: A recommendation made at the inspection dated 30 June 2004 has not been addressed regarding information available to resident. The Service User Guide and Statement of Purpose do not contain up to date information to inform residents about the care and services available at the home, the recommendation is now repeated as a requirement. Dudsbury Manor D55 S26795 Dudsbury Manor V228977 300605 Stage 4.doc Version 1.30 Page 10 A recommendation of the 30th June 2004 inspection was also made in respect of the home’s contract with residents. This has not been addressed, one of the two files examined held a contract, and one did not. The one contract that had been issued on 15 June 2005 referred to the home’s registration under the 1984 Registered Homes Act and referred to the previous registering authority. This was a poor photocopy, part of which was illegible. The registered persons should read and consider the guidance by the Office of Fair Trading, ‘Fairer Contracts for Care Home Residents’. Two resident care files were examined, one contained a form of assessment carried out the day prior to admission, basic detail was held identifying the resident’s needs, there was no record of from where the information was obtained. The second care file held an assessment sheet dated the day after the person moved to Dudsbury Manor resulting in this person being admitted to the home without any acknowledgement or recognition of their needs, this basic post admission assessment, identified that the person had a diagnosis of dementia. There was no evidence of the resident’s involvement or consultation in the assessment process or their agreement with the outcome. Dudsbury Manor D55 S26795 Dudsbury Manor V228977 300605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 There is no comprehensive or reliable care planning system in place to effectively provide staff with the information they need to satisfactorily meet resident’s personal care and welfare needs. Resident’s health needs are met however through visits to doctors and other health professionals as required. The systems for the administration of medication are poor and potentially place service users at risk. Residents feel they are treated with respect and their privacy and dignity is promoted. EVIDENCE: There was no evidence of continuous assessment or review of resident’s health and welfare needs, no evidence of resident consultation and no record of where care planning information had been obtained. Care plans did not evidence the resident’s agreement with the outcome or method of planned care delivery. Care plans examined provide very little detail regarding how care is to be delivered or why. For example, one care file identified on the admission Dudsbury Manor D55 S26795 Dudsbury Manor V228977 300605 Stage 4.doc Version 1.30 Page 12 assessment that the person had no continence needs, the care plan informed staff to ‘assist with toileting’; daily records for this resident indicated in one entry that the resident was ‘assisted to toilet and pad changed’. This practice does not demonstrate knowledge by staff of the resident’s needs and could be a contributing factor in the resident’s distress and agitation that was also documented at this time. This resident and one other had a documented diagnosis of a dementia type illness; Dudsbury Manor is not registered to accommodate persons in this category. Several clocks around the home had stopped and were showing the wrong time, which does not promote resident’s independence or aid those with degrees of confusion and disorientation. There is little or no evidence in service users’ records that needs are assessed in relation to nutrition, mobility, skin care, continence, mental health or that preferences of specific social, cultural or religious needs are understood and catered for. Care plans do not provide sufficient information to adequately direct the caregiver for example; one entry reads ‘needs supervision and assistance with personal care’. This is not measurable, does not detail any considerations for the resident’s personal preferences regarding how, when or by whom personal care should be given. Examination of medication stocks and records evidenced some errors in the management of drugs in the home. Some medication records had been signed indicating that the medication had been given to the resident although it was evident by the numbers of tablets remaining in some of the medication packs that it had not been given. A tub of cream seen in a resident’s room was prescribed for someone else who was no longer at the home. The Commission’s pharmacy inspector visited the home prior to the last inspection and made two recommendations, these have not been addressed and are repeated in this report. Ms Dacey confirmed that she has made amendments to the home’s medication policy that were approved by the pharmacy inspector although the amended policy is not being used in the home. Residents spoken with confirmed that hey are treated respectfully by staff, staff interaction with residents was observed an noted to be respectful and one relative spoken with commented on how respectful the staff were of her relatives wishes. One set of care records also demonstrated a high regard for the person with the instruction to staff to respect this person’s dignity when bathing. Dudsbury Manor D55 S26795 Dudsbury Manor V228977 300605 Stage 4.doc Version 1.30 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 Support from the home in enabling residents to exercise choice was not measurable as written assessments and care plans did not indicate their involvement or detail their social, cultural or recreational interests. Residents maintain contact with their friends and families who are able to visit freely. A good, varied diet is provided offering a choice of menu; meals are taken in the dining room enabling residents to enjoy each other’s company. EVIDENCE: Daily care records demonstrated the visits by friends and families but indicate only limited social care. There was no indication of social or recreational activities; care records do not indicate the resident’s participation in decisionmaking processes. Menus examined demonstrated that there was a varied diet provided, the carer on duty who was cooking for the day confirmed that residents are told what is on the day’s menu and if they do not like it or want something different, an alternative would be prepared. Supper menu’s are provided by individual choice and a variety of light cold or cooked dishes are prepared. Residents confirmed that the provision of meals was good. Dudsbury Manor D55 S26795 Dudsbury Manor V228977 300605 Stage 4.doc Version 1.30 Page 14 East Dorset Public Health Services carried out an inspection of the home under the Food Safety (General Food Hygiene) Regulations 1995 in April this year, several requirements were made regarding the home’s kitchen, personal hygiene, hazard analysis and cleaning schedule. Discussion with the officer from Public Health indicated that some progress has been made in addressing these requirements. Dudsbury Manor D55 S26795 Dudsbury Manor V228977 300605 Stage 4.doc Version 1.30 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17 & 18 Complainants are not directed through a written procedure detailing how their concerns will be addressed, therefore, they cannot be confident that their complaints will be listened to or taken seriously. Resident’s rights are overlooked by a lack of consultation about the care they receive with the supposition therefore that they are unable to make decisions for themselves. Procedures for responding to suspicions of abuse are not held in accordance with up to date local authority guidance; therefore, any allegations of abuse cannot be managed effectively. EVIDENCE: The home’s complaints procedure is contained in the Service User Guide and resident’s contracts (see also section of report headed ‘Choice of Home’). The complaints procedure is out of date and refers complainants to the previous registering authority, a relative spoken with confirmed that a copy of the complaints procedure had not been provided. There is no record in resident’s care files detailing their advocacy arrangements, legal representation or ability to make decisions for themselves. (See also requirement under standards 3, 7 and 14 regarding consultation) The home has a copy of the local authority guidance ‘No Secrets’ which informs staff how to report incidents or allegations of abuse. This document is the 2001 issue, which has since been up dated to provide details of the appropriate people to contact in such circumstances. Dudsbury Manor does not have the up to date version of the policy. Dudsbury Manor D55 S26795 Dudsbury Manor V228977 300605 Stage 4.doc Version 1.30 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 21, 22, 23, 24, 25 and 26 Bedrooms, bathrooms toilets and communal areas provide sufficient room for residents and a satisfactory standard of décor. Furniture is generally, but not always, well maintained. The atmosphere in the home was, in the main, satisfactory with sufficient light, ventilation and at a suitable temperature for the time of year. No consideration has been given to ensuring the home provides the necessary aids, adaptations and disability equipment to meet resident’s needs. Facilities for staff to ensure against the spread of infection are not in accordance with recommended best practice. Dudsbury Manor D55 S26795 Dudsbury Manor V228977 300605 Stage 4.doc Version 1.30 Page 17 EVIDENCE: The home was visibly clean during this visit although strong odours in some rooms indicated a need for deeper cleaning to be carried out. In one bathroom that does not have an external window, the extractor fan was not working. In this bathroom too, there was no hot water. Ms Dacey stated that the hot water takes a long time to come through, Ms Dacey also confirmed that hot water temperatures are regulated to prevent accidental scalding, this was not checked during this inspection. The home was a reasonable temperature and was otherwise, well ventilated. All areas of the home are pleasantly decorated. Some furnishings require attention, namely, an armchair in one resident’s room did not have a seat cushion, a plastic covered pressure relief cushion was in its place. This room was vacant, therefore, the pressure relieving cushion was not in place to meet a specific resident’s needs. One room had a chest of drawers that was broken. Ms Dacey confirmed that a recommendation of previous inspections had not been addressed, the premises has not been assessed by a suitably competent person to establish the extent of the disability equipment needed to meet the needs of the residents. Infection control procedures are in place although there is no provision of satisfactory hand washing facilities for staff including anti-bacterial soap and disposable towels. The home’s washing machine does not have a sluicing programme; Ms Dacey confirmed that some residents have faecal incontinence. All bed linen and clothing is washed on the premises. East Dorset Public Health Services carried out an inspection of the home under the Health and Safety at Work Act 1974 in April this year, several requirements were made regarding the home’s health and safety management, risk assessments, maintenance of equipment and manual handling. Discussion with the officer from Public Health indicated that while progress has been made in addressing requirements, there are still matters outstanding that require attention. Dudsbury Manor D55 S26795 Dudsbury Manor V228977 300605 Stage 4.doc Version 1.30 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 The needs of residents are not sufficiently assessed to judge whether there are adequate numbers of staff on duty to meet those needs. Limited progress has been made in ensuring that staff are safely recruited or equipped with the skills necessary to meet assessed need. EVIDENCE: On arrival at the home for this inspection, two care staff were on duty, a third carer had reported sick. One carer was preparing the midday meal leaving one for meeting resident’s needs. The manager was unavailable due to unavoidable personal circumstances. One of the carers confirmed that she had tried to get a third person to come on duty; no one was available. The carer confirmed that there was no recourse to the registered providers in these circumstances to enquire after additional staff. Ms Dacey arrived part way through the inspection. There is no written duty rota identifying who should be in the home at any given time. Ms Dacey confirmed that five care staff are currently doing their NVQ level 2 training and are due to finish in September 2005. Staff spoken with demonstrated an understanding of residents basic care needs although some behaviours noted in care records did not demonstrate that appropriate action was taken in respect of them. For example, one care record held many entries detailing periods of aggressive type behaviour and agitation, ‘shouting’, ‘wants to go home’ and ‘confused and very unsteady..’ There was no record Dudsbury Manor D55 S26795 Dudsbury Manor V228977 300605 Stage 4.doc Version 1.30 Page 19 demonstrating appropriate action taken in relation to these behaviours that demonstrated how well staff understood the resident’s needs or were able to competently manage them. Ms Dacey confirmed that staff have recently been on infection control, medication management, and care skills courses. The file for one new member of staff was examined. This member of staff had been previously employed by the home and the old documentation was held. There were no up to date references, no up to date c.v (history of employment) and no Criminal Records Bureau check. Ms Dacey presented a copy of the home’s induction programme that has recently been devised by Mrs Hughes, one of the registered providers. This programme serves as an adequate ‘in house’ induction/introduction to the home, it does not comply with the requirements of the National Training Organisation occupational standards for care. There is no induction programme or foundation training provided that meets with Skills for Care (formerly TOPSS) specifications. There are five units in the induction standards: Unit 1 Understand the principles of care Unit 2 Understand the organisation and the role of the worker Unit 3 Understand the experiences and the particular needs of the service user groups Unit 4 Maintain safety at work Unit 5 Understand the effects of the service setting on providing services. There are a further five units in the foundation standards: Unit 1 Understand how to apply the value base of care Unit 2 Communicate effectively Unit 3 Develop as a worker Unit 4 Recognise and respond to abuse and neglect Unit 5 Understand the experiences and particular needs of the individuals using the service. The registered persons are advised to look at the Skills for Care web site at www.skillsforcare.org.uk or telephone 0113 2451716 for information on available training and funding opportunities. Dudsbury Manor D55 S26795 Dudsbury Manor V228977 300605 Stage 4.doc Version 1.30 Page 20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36 and 37. There is no clear management accountability in the home resulting in some management practices not promoting or safeguarding the health, safety and welfare of residents. Staff are supervised regularly although there is no indication that roles and responsibilities are defined or that staff or residents benefit from a positive management culture. The systems for service user consultation in this home are developing although there is little evidence that service user views are sought or acted upon. EVIDENCE: Ms Dacey, registered manager is currently undertaking an NVQ level 4 management in care award, however, it was evident that there is minimal support from the registered providers. Ms Dacey is not provided with management time, the home did not have a written duty rota for staff (see standard 27 under section headed ‘Staffing’) and Ms Dacey confirmed that Dudsbury Manor D55 S26795 Dudsbury Manor V228977 300605 Stage 4.doc Version 1.30 Page 21 when she is on duty, she is working as one of the care staff numbers. Ms Dacey does not have a written job description. There was no evidence that the registered providers visit the home at least monthly and prepare a written report in accordance with regulation 26 on the conduct of the home. Ms Dacey had an out of date version of the National Minimum Standards and Care homes Regulations. In speaking with care staff, it was evident that, as on the day of inspection, when they are short of staff and in Ms Dacey’s absence, they do not have recourse to the registered providers. One person spoken with confirmed that she has not received any written information about the home and does not have a copy of the home’s complaints procedure. Ms Dacey confirmed that Mrs Hughes, one of the registered providers has reviewed and re-written some of the home’s policies and procedures and staff training material, examination of these evidenced that they have not been written in accordance with current best practice or in line with current legal requirements. Ms Dacey confirmed that a notice has been given to all families of residents in the home, this notice details the home’s commitment to reviewing resident’s social and personal care needs on a three monthly basis. The notice informs families that they will be invited to a meeting to discuss their relative’s care. Ms Dacey confirmed that one such meeting has so far taken place and it is hoped that all families will be met with by August 2005. The purpose of the meeting is to discuss the resident’s needs and request that the family sign the care documentation to confirm that they have read and agreed with it. Whilst it is recognised that the family’s contribution can be valuable, it is also necessary to remember that residents care records are confidential and that some residents may not wish their families to see them. It is also necessary not to make the assumption that residents cannot make decisions for themselves. Regulation 24 supported by Standard 33 require the registered person to establish a system for reviewing and improving the quality of care in the home and to supply residents (and the Commission) with a copy of the report of the reviews carried out, the system for review must provide for consultation with residents and their carers. Previous to this inspection, Ms Dacey was carrying out regular staff supervision; the records seen in relation to this basically met the accepted standard. Since this time, Ms Hughes has revised the recording format for supervision; the new format was examined and noted to not to cover the topics that would be expected. The new format directs the supervisor and member of staff to discuss employment issues and working conditions rather than the philosophy of care in the home, all aspects of practice and training and development needs. Dudsbury Manor D55 S26795 Dudsbury Manor V228977 300605 Stage 4.doc Version 1.30 Page 22 Records are held securely in the home although many require attention, up dating and review as identified in other areas of this report where requirements are made. Dudsbury Manor D55 S26795 Dudsbury Manor V228977 300605 Stage 4.doc Version 1.30 Page 23 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 1 1 1 1 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION x x 2 1 3 2 2 1 STAFFING Standard No Score 27 1 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 2 1 1 1 1 x x 1 1 x Dudsbury Manor D55 S26795 Dudsbury Manor V228977 300605 Stage 4.doc Version 1.30 Page 24 No Are there any outstanding requirements from the last inspection? 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 1 Regulation 4&5 Requirement Timescale for action 1.09.05 2. 2 5 3. 3 14 The registered persons must supply a copy of the Service User Guide to each service user; this must contain a summary of the homes Statement of Purpose, complaints procedure and the latest inspection report and must hold up to date informaiton about the current circumstances of the home. Service users must be issued 1.09.05 with an up to date contract detailing the terms and conditions of their stay in the home. The contract must be legible and written in a format that is easily understood. Accommodation must not be 1.09.05 provided to persons at the care home until their needs have been assessed; assessments must be comprehensive and provide sufficient detail to enable staff at the home to understand the needs to be met. Persons with mental health needs must not be accommodated. Assessments and care planning must evidence service user consultation and their involvement in the process. Version 1.30 Dudsbury Manor D55 S26795 Dudsbury Manor V228977 300605 Stage 4.doc Page 25 4. 3 14 5. 7 15 6. 8 15 7. 9 13 8. 12 & 14 16 The registered persons must write to service users following pre-admission assessment to confirm that, based on the findings of the assessment, the home is able to meet their needs. Previous timescale for action 28.02.05) Care plans must provide for staff detailed instruction for action that is required in order that assessed needs can be met. Action stated must be time specific and measurable. Care plans must evidence consultation with the service user, their representatives and any other health professionals where appropriate. Mobility needs, continence and nutritional needs must be assessed by competent persons and advice on best practice obtained to formulate a detailed care needs that provides instruction to staff on how needs are to be met. The medicines policy must be updated to include advice given by the Commissions pharmacy inspector and must be avaialble for staff reference. The home must have a clear audit trail for medicines through accurate recording. items prescribed for one resident must not be used for others. The registered persons must consult service users about their social interests and make arrangements for them to engage in local, social and community activities. They must be consulted about the programme of activities arranged by the home and provide facilities for recreation that meet their needs. D55 S26795 Dudsbury Manor V228977 300605 Stage 4.doc 1.09.05 1.10.05 1.10.05 1.09.05 1.09.05 Dudsbury Manor Version 1.30 Page 26 9. 16 22 10. 11. 17 18 12 13 12. 26 13 13. 27 18 14. 27 & 37 17 15. 28 18 16. 29 18 Service users and their representatives must be provided with an revised copy of the homes complaints procedure that details to who a complaint will be made, how it will be responded to and by when and how the complainant will be informed of the outcome. A record must be held identifying each residents representation and advocacy arrangements. Up to date information must be available for staff reference detailing the procedure to be followed should any incident of abuse be suspected or alleged. To prevent the spread of infection, staff must be provided with suitable hand washing facilities including anti-bacterial soap and disposable towels. Where feacally incontinent service users are accommodated, a sluicing facility must be provided. The registered persons must ensure that there are sufficient numbers of staff on duty to meet service users assessed needs. A written duty rota must be available demonstrating what persons are on duty and a record of whether the rota was actually worked. The registered persons must ensure that staff are able to demonstrate skills learnt in respect of service users care and written records. Where service users present specific health or welfare needs, records must indicate action taken to manage this. The registered persons must demonstrate that all persons employed at the home are fit to be so. Up do date documentation D55 S26795 Dudsbury Manor V228977 300605 Stage 4.doc 1.09.05 1.09.05 1.09.05 1.10.05 1.09.05 1.09.05 1.09.05 1.10.05 Dudsbury Manor Version 1.30 Page 27 17. 30 18 18. 31 9 19. 32 26 20. 33 24 must be held including proof of persons identification, employment history and qualifications, and two references, one which must be from the most recent employer. The registered persons must ensure that all staff are trained to a level that demonstrates their competence to do their jobs. Care Staff must receive induction and foundation training within the specified time-scales that conforms with National Occupational Standards for care staff. The registered manager must have a written job description clearly defining her duties, responsibilities and lines of accountability. The registered manager must have sufficient time to carry out necessary administrative and management duties. The registered manager must have an up to date copy of the National minimum standards and Care Homes Regulations 2001). The registered provider must inspect the home, at least once each month and interveiw, with their consent and in private, such of the service users, their representatives and persons working at the homeas is necessary to form an opinion of the standard of care provided. The inspection must also include aninspection of the premises, its record of events and any complaints. A report of the visit must be made avaialble to the registered manager and to the Commission. The registered person must establish a system for reviewing and improving the quality of care D55 S26795 Dudsbury Manor V228977 300605 Stage 4.doc 1.09.05 1.09.05 1.09.05 1.09.05 Dudsbury Manor Version 1.30 Page 28 21. 36 18 22. 37 17 23. 31 16 in the home and to supply residents (and the Commission) with a copy of the report of the reviews carried out, the system for review must provide for consultation with residents and their carers. The registered persons must 1.10.05 establish a system for staff superivion that includes discussion about the philosophy of care in the home, all aspects of practice and training and development needs. All records must be maintained 1.09.05 as identified in schedules 3 and 4 of the Care Homes Regulations 2001. A facsimile (fax) should be 1.09.05 provided to aid communication. 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. 3. Refer to Standard 7 21 22 Good Practice Recommendations Clocks must be checked regularly to ensure they are showing the correct time in order to promote service users independence and aid orientation. There should be sufficient hot water for resdients to take a bath at any time of the day. The registered persons should demonstrate that an assessment of the premises has been undertaken by a suitably qualified person in order to establish the extent of the disability equipment and any aids and adaptations required to meet the service users needs. All furnishings must be maintained appropriately and be suitable for their purpose. Furnishings must be provided in accordancce with the homes advertising in its own service user guide. In rooms that do not have external windows, extrator fans for the purpose of vantilation, must be maintained in working order. D55 S26795 Dudsbury Manor V228977 300605 Stage 4.doc Version 1.30 Page 29 4. 24 5. 25 Dudsbury Manor Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI Dudsbury Manor D55 S26795 Dudsbury Manor V228977 300605 Stage 4.doc Version 1.30 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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