Inspection on 06/09/07 for Daken House

This inspection was carried out on 6th September 2007.

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

Daken House 15/09/06

Daken House 13/12/05

Daken House 22/08/05

Daken House 28/01/05

Daken House 01/07/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Daken House 240 Romford Road Forest Gate London E7 9HZ Lead Inspector Ms Harina Morzeria Unannounced Inspection 6th 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 Daken House DS0000007355.V340114.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. Daken House DS0000007355.V340114.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Daken House Address 240 Romford Road Forest Gate London E7 9HZ 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) 020 8221 2444 020 8221 2555 dkhumalo@lmkendon.co.uk LM Kendon Settlement Mrs Diana Khumalo Care Home 43 Category(ies) of Dementia (24), Old age, not falling within any registration, with number other category (19) of places Daken House DS0000007355.V340114.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 43 BEDS ELDERLY MENTALLY ILL PERSONS - NURSING MINIMUM STAFFING NOTICE Date of last inspection 15th September 2006 Brief Description of the Service: Daken House is a 43 bedded, purpose built nursing home. Daken House is owned by a charitable organisation, LM Kendon Settlement. The home primarily provides nursing care for people with dementia, living in the Borough of Newham. Permanent and respite (short term) accommodation is available. The home is divided into three separate units located on three floors. Strevens Unit on the ground floor has 9 bedrooms, The Reeves Suite situated on the first floor has 19 beds and The Glyde Suite on the second floor has 15 beds. Each unit has its own lounge, kitchen and dining area. Additional quiet lounges are available and there is a large activities/meeting room on the ground floor. Residents have access to their own hairdressing room within the building. A conservatory and range of patio areas with outdoor seating is also available. Daken House is situated on the Romford Road, in Forest Gate. Buses 25 and 86 run along this road to provide links to Stratford and Ilford. The nearest station is Forest Gate, British Rail Station. A small car park is available for visitors. A range of culturally diverse shops, services and amenities are situated on the Romford Road, Woodgrange Road and Upton Lane. The current statement of purpose and service user guide is available in the home and a copy can be obtained from the manager. At the time of this inspection the fees ranged from £591.00 to £629.00 per week and there are additional charges for services such as hairdressing, private chiropody, some outings and newspapers. Daken House DS0000007355.V340114.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection undertaken by the lead inspector on 6th September 2007. During the visit the inspector was able to speak to residents, visiting relatives and staff members. The files of four residents were viewed and case tracked, together with the viewing of medication administration records (MAR), staff rotas, training schedules, activity programmes, maintenance records, accident records, fire safety records, menus, complaints records, staff recruitment processes and files. Evidence has also been taken from the Annual Quality Assurance Assessment (AQAA) which had been returned to the Commission prior to the site visit. The community psychiatric nurse was also spoken to. The London Boroughs of Newham, Redbridge, Haringey and Tower hamlets Commissioning Units were contacted by telephone who fund people who use this service, inviting their comments on the service that they are commissioning. The inspector discussed equality and diversity issues with the manager who was able to demonstrate a good understanding of the many issues relevant to these areas. The home employ staff from various ethnic minority backgrounds who can understand and meet the needs of residents from different cultures, for example, the provision of appropriate meals, enabling residents to meet their religious needs and providing care in a person centred way taking in to account people’s cultural identity. What the service does well: As part of the inspection the CPN was visiting the home and was spoken to. He commented positively on his involvement with the home and expressed no concerns about the care being provided; and that any instructions given were well received and actioned accordingly. Other health professionals such as GPs, dentists, RGNs, Senior Liasion nurses have all stated that the “home provide a high standard of care to the residents.” Visiting times are flexible and people are made to feel welcome in the home so that residents are able to maintain contact with their family and friends. The service completes comprehensive pre-admission assessments, to ensure they can meet the needs of residents. Trial visits are offered to all prospective residents, to ensure residents have information on the services and facilities provided at the home. All residents can be assured, that at the time of their death, staff would treat them and their family with care, sensitivity and respect. The home has an equal opportunities policy to ensure residents or staff members are not discriminated against on the grounds of race, culture, age, sexuality or gender. Daken House DS0000007355.V340114.R01.S.doc Version 5.2 Page 6 The service has robust recruitment procedures ensuring the safety of residents. The service has a permanent staff team and little use is made of agency staff, which ensures a consistent service being provided to residents. Staff qualifications evidenced that the service has a ratio above 90 of NVQ qualified staff. What has improved since the last inspection? What they could do better: The manager and staff team continue to work hard to provide a good level of service for the residents and to meet each person’s needs, however, as stated, more needs to be done to improve the quality of life for people living with dementia. The manager needs to ensure that care staff are engaged in enabling residents living with dementia to participate in useful and stimulating activities. The manager needs to ensure that care staff are aware of the importance of communicating with residents when undertaking any tasks such as feeding, provision of personal care and activities. The manager needs to ensure that the home is free from offensive odours and further improvements in the environment are made as highlighted in this report. The manager must ensure that there are at all times enough staff available to meet the needs of people using the service, with more staff being available at peak times of activity and that the staff are appropriately trained to meet the needs of people living with dementia. Effective quality assurance and monitoring systems must be in place and include stakeholders in the community, to ensure their views are sought on how the home is achieving goals for residents. The home have identified a number of areas where they “could do better” in the AQAA which they will need to action. It was suggested to the manager that she uses the Key Lines of Regulatory Assessment (KLORA) to assist the service to identify and evidence the excellent quality of the service provided. Daken House DS0000007355.V340114.R01.S.doc Version 5.2 Page 7 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. Daken House DS0000007355.V340114.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 Daken House DS0000007355.V340114.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, 2, 3, 4, 5 and 6 (Standard 6 does not apply to this service) People who use this service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. Prospective residents and relatives are given information on the service which is contained in the Statement of Purpose. Prospective permanent residents can be sure that his/her needs will be assessed prior to making a decision to move into the home. Prospective residents and/or their relatives can visit the home prior to a decision being made that this is a suitable service to meet their needs. EVIDENCE: The home has a Statement of Purpose and Service User Guide in place. The Statement includes details of the organisation and management, the aims and objectives of the home. The Service User Guide includes details of the physical environment and the home’s complaints procedure. All residents are provided with a statement of terms and conditions, which includes fees payable and Daken House DS0000007355.V340114.R01.S.doc Version 5.2 Page 10 what they cover, accommodation provided and the care and services which the home offers. Residents files evidenced that prior to admission, assessments are undertaken by placing authorities and Daken House. Hospital reports are also produced if residents are discharged directly from hospital. ‘Getting to know you’ forms are also produced to detail the individual’s background, preferences and interests. Assessments also cover needs associated with medication, mobility, continence, social and leisure needs. The home has an admissions procedure. This states that prospective residents will be given the opportunity of visiting the home prior to making any decision to move in or not. Residents are admitted initially on a six week trial basis, after which a placement review meeting will be held when permanency decisions are made. Through observation and discussion there was evidence that the home is able to meet the collective and individual needs of residents . Staff demonstrated a good understanding of individual residents ’ needs and were seen to support them in a sensitive manner. Daken House DS0000007355.V340114.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): 7,8,9,10 People who use this service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. The health and personal care needs of the residents are met. Residents can be sure that they will be treated with respect and that their right to privacy is upheld and that at the time of their death, staff will treat them and their family with care, sensitivity and respect. EVIDENCE: The files of four residents were viewed during the inspection together with related documentation. The residents ’ plan sets out in detail the action which needs to be taken by care staff to ensure that all aspects of their health, personal and social care needs are met. Care plans were reviewed on a monthly basis and residents’ files evidenced daily monitoring by trained nurses and care assistants. Daken House DS0000007355.V340114.R01.S.doc Version 5.2 Page 12 Residents are supported to take risks as part of an independent lifestyle. Risk assessments have been developed for all residents and specific risk assessments were produced. Residents benefit from the consistent monitoring of their physical, psychological and emotional needs. Residents benefit from home visits from a dentist, chiropodist and relevant health professionals. Residents files evidenced that their weight is recorded regularly. An up to date care plan was in place to treat one service user’s ulcerated legs. This had included photographic evidence to monitor the progress. Nurses within the home have been trained to undertake various clinical practices. This includes catheter care, blood tests and tissue viability. The home is also supported by weekly visits from the nursing home liaison nurse. The liaison nurse assists with phlebotomy, urine checks, wound care, training in clinical techniques and general medical advice. The home also has additional links with the local specialist incontinence nurse. Regular meetings are held with the Primary Care Trust and Daken House are part of the Nursing Homes Project. The aim of this Project is to support nursing homes through training, to reduce hospital referrals. Daken House are kept up-to-date on best practice through the regular networking meetings with GP’s, district nurses and mental health teams. The home aim to keep in contact with their local community. The home has developed a comprehensive medication folder with various policies, including medication administration, security and disposal of medication. Medication is stored in locked trolleys, in a designated locked staff office. Medication is only administered by qualified nursing staff. Regular medication reviews are held. Medication administration records were examined by the inspector and these were found to be accurately maintained. However, a packet of surplus medication was found in the medication trolley on the ground floor unit which was brought to the deputy manager’s attention and this was rectified by her. The home evidenced through documentation and discussion that residents are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. Wishes relating to death and dying have been included on the admission form. A suction machine has also been provided to assist in end-of-life care. The management team provide support and training for staff and there are opportunities to express anxieties and share emotional stress in this area of work. Feedback from one professional states that, “End of life care is well done in this home. The preferred place of care is the tool which they have been using with our help and it has produced good results.” A relative spoken to stated, “the staff look after her really well, I am really happy with the care my wife receives.” Daken House DS0000007355.V340114.R01.S.doc Version 5.2 Page 13 A feedback form received states that “the nurse in charge at the home keeps me fully informed, she is treated very well and has no complaints.” Daken House DS0000007355.V340114.R01.S.doc Version 5.2 Page 14 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): 12, 13, 14 and 15 People who use this service experience adequate quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. More needs to be done by staff to support residents to live valued and fulfilling lives. Appropriate social and leisure activities are provided however improvements are needed in this area. The meals in the home are well presented and nutritionally balanced. They offer both choice and variety to the residents. EVIDENCE: Whilst looking around the home it was apparent that the routines of daily living and activities are generally flexible. Residents can choose when to get up in the mornings and breakfast is served at times that are suited to meet the needs of individual residents Daken House DS0000007355.V340114.R01.S.doc Version 5.2 Page 15 Residents are encouraged to receive visitors at any reasonable time and some residents are able to maintain links with the local community. Some residents attend a day centre. There is a part time activities co-ordinator who works hard to organise and deliver activities to suit the needs of a diverse group of residents. There is an activities room on the ground floor, which is also used as a training room for staff. Generally, the activities co-ordinator is aware of the interests of individual residents and records are maintained of the activity and those participating. On the day of the inspection, the inspector noted that in the morning residents were seen watching TV or resting in their bedrooms and little interaction between staff and residents was seen. This was also noted by a monitoring officer present in the home on the day of the inspection. However, during the afternoon when the activities coordinator arrived the residents were encouraged to participate in some activities. A number of them were taken to the downstairs unit to celebrate another resident’s birthday. However, more needs to be done in this area. It is essential that care staff recognise that activities within a care home are not solely the responsibility of the activities co-ordinator. It is important that care staff are also engaged in enabling residents living with dementia to participate in useful and stimulating activities as well as retain daily living skills such as washing, dressing and choosing clothes. It would be beneficial if some resources were left in the lounges so that residents are able to “dip in and dip out” as necessary. Lack of a stimulating environment can have a direct impact on a resident’s behaviour. The National Minimum Standards for care homes for older people requires, that residents’ interests are recorded and they are given opportunities for stimulation through leisure and recreational activities in and outside the home which suit their needs, preferences and capacities, particular consideration is given to people with dementia and other cognitive impairments. Hence, the management and staff are required to ensure that the staff are actively involved in communicating with and encouraging residents to participate in small group, focused activities due to the residents’ short concentration span. More use could be made of the small lounges and quiet areas available on the units to engage with residents in meaningful activities. Through checking individual files the inspector noted that staff were aware of the life histories of the residents and had organised an orchestra to come and play at the home as one of the residents was in an orchestra. Another resident was a florist and activities/books were provided for her around this, which is good practice but a consistent approach by all staff needs to be made on a daily basis to engage with the residents. The inspector was able to observe meals being served on two units. Some of the residents needed either supervision by staff or assistance with eating. Staff assisted residents with feeding where needed, however the inspector noted that the staff did not communicate with residents whilst assisting them. Meal times should be pleasant, social occasions when communication forms an important part of the process. Daken House DS0000007355.V340114.R01.S.doc Version 5.2 Page 16 The manager and staff need to discuss the importance of communicating with residents when undertaking any tasks such as feeding, provision of personal care and activities. Residents receive three daily meals, drinks and snacks are available throughout the day. Choices are offered at each mealtime. African/Caribbean and Asian options are available, alongside a traditional British meal. Specific dietary needs are catered for, meal times are flexible and residents are able to eat in their own room if they wished. A large percentage of residents’ feedback received states that they have a choice of food. A typical comment received is “very nice food, I like it very much.” However, one resident states that he would like to have a cooked breakfast every day and would prefer various salads during lunchtime. The inspector recommends that care staff try to ascertain who this person is in order to ensure that he receives meals he prefers. The taking of meals should be an enjoyable experience for all residents, and the manager’s attention is drawn to the Commission’s report Highlight of the day that is about food and nutrition within care homes. Daken House DS0000007355.V340114.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 People who use this service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. Residents and their relatives and friends can be confident that their complaints will be listened to, taken seriously and acted upon by the manager. Residents are protected from abuse by the policies, procedures and practices within the home. EVIDENCE: The home has a written complaints policy and procedure and the complaints log inspected indicated the number of complaints received and included details of investigation, action taken to resolve them and the outcome for the complainant. The manager also maintains a register of issues and concerns, which enables her to address any expressions of concern or dissatisfaction with any element of the service without delay. Complaints and concerns made to the manager are always taken seriously and she actively addresses all concerns and aims to resolve these to the satisfaction of the complainant. There is an in house training programme for staff in safeguarding adults and recognising and reporting abuse. Those staff spoken to during the inspection Daken House DS0000007355.V340114.R01.S.doc Version 5.2 Page 18 were aware of the action to be taken if they had concerns about the safety and welfare of residents. Staff were also aware of the whistle blowing policy. Daken House DS0000007355.V340114.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, 21, 22, 23, 24, 25 and 26 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to the service. The home is clean and spacious with access to indoor and outdoor facilities, however further effort needs to be made to make it free from offensive odour. There are sufficient and suitable toilets and bathrooms for the number of residents. The atmosphere in the home is welcoming. Each resident has their own bedroom and they are encouraged to personalise them with their own possessions. The signage and décor throughout the home must be more reflective of the needs of people living with dementia. EVIDENCE: Daken House is divided into three separate units located on three floors. Strevens Unit on the ground floor has nine bedrooms, the Reeves Suite Daken House DS0000007355.V340114.R01.S.doc Version 5.2 Page 20 situated on the first floor has 19 beds and the Glyde Suite on the second floor has 15 beds. Each unit has its own lounge, kitchen and dining area. Additional quiet lounges are available and there is a large activities/meeting room on the ground floor. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in privacy or in their own rooms. A tour of the whole home was undertaken at the start of the inspection, and some areas were visited again later during the day. Although the home was clean and tidy there was an offensive odour apparent upon entering the different units, which must be addressed by the management team as a matter of priority. This issue was also raised in the feedback received from contracts officers. Some bedrooms were seen either by invitation of the resident, or with permission, whilst others were seen because the doors were open or being cleaned. Generally there were no offensive odours in the home and the home was clean and tidy. The standard of the furnishings and fittings is generally being maintained to a good standard. There is an ongoing refurbishment programme for the home with plans to replace the carpets in bedrooms and living areas as well as obtaining new furniture. Residents have access to their own hairdressing room within the building. A conservatory and a range of patio areas with outdoor seating is also available. Security is maintained through door codes and CCTV cameras are restricted to entrance areas and do not intrude on the daily life of residents . The premises were generally found to be clean, appropriately lit, ventilated and heated. All lounges had orientation boards that detailed the date, staff on duty, meal choices and activities. Major refurbishment and extension work to increase the number of beds from forty three to fifty, is now complete and the home are waiting for the Commission’s Registration team to register the additional rooms. Redecoration of the home is ongoing and will be incorporated in the overall refurbishment plan. The Registered Manager explained that the work will ensure the comfort of residents is taken into account at all times. The residents have sufficient lavatories and washing facilities. There is a choice of bathing facilities; adapted bathrooms and hoists are available. Sluices are located separately from residents toilets and bathing facilities and a designated laundry is provided. The new rooms incorporate en-suite facilities. Residents have specialist equipment to maximise their independence. Evidence was seen that consent forms are in place for the use of cot sides. Sufficient manual handling equipment and other specialist equipment for residents is provided. This has included specialist pressure relieving beds, belts and sliding sheets. Hand washing facilities are prominently sited and staff were observed to be practising an adequate standard of hand hygiene. Daken House DS0000007355.V340114.R01.S.doc Version 5.2 Page 21 However, the home can further enhance the quality of life for people living with dementia by giving consideration to utilising the existing design and layout of the units to meet the specialist needs of people living with dementia. For example, through the use of visual cues such as colour and signage. Containers with suitable materials could be located around the units so that those residents who can walk can touch and feel things. The use of calming equipment such as lighting or a small aquarium could be used. Staff must be aware of the factors such as noise. On the day of the inspection, the inspector noted that some residents were quite noisy which was upsetting some other people. Feedback received from residents also states that there is a lot of noise in the units. The inspector recommends that staff use the other small communal areas for small group activities with these people, which will be beneficial for all concerned. There were a few appropriate pictures in the corridors, lounges or dining rooms. The manager must give consideration to ensuring that there are items of interest for residents throughout the home. Pictures of the East End of London can be obtained from the local library and these can also be used as points of discussion with residents living with dementia. Boards with different materials stuck to them can be displayed on the walls, and this will aid to the enjoyment of residents who are walking along the corridors as they can touch different types of material. The placing of magazines and ornaments at a level that can be reached by residents will also aid in activities for residents. The physical environment has an enormous impact on how the strengths and skills of people living with dementia are supported or not. Changes mentioned above if implemented can help to support people living with dementia, and help to maximise independence and minimise confusion. Therefore, since the service is registered for the provision of care to people living with dementia, and this is viewed as a specialist service the organisation must consider improvements to the environment as follows: Using changes in colour in different areas to help with orientation Having toilet seats that are a different colour to the rest of the room to help with identification, and this includes the en suites. Using pictorial signs as well as written signs and ensuring these are at the right height to help with identifying different rooms and areas Providing freedom to walk about in areas that are interesting and that have pictures and sitting areas, together with times when staff will take residents, especially those who are prone to “walking” into a garden that is safe and is planted with plants and flowers that have colour and smells. Garden mobiles can also be beneficial to residents as these will provide points of interest and movement. Improved lighting to all units as older people often have failing eyesight. Daken House DS0000007355.V340114.R01.S.doc Version 5.2 Page 22 Daken House DS0000007355.V340114.R01.S.doc Version 5.2 Page 23 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 People who use this service experience adequate quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. Residents benefit from a stable, well-supported, culturally diverse staff team to meet the individual needs of the residents, however staffing levels must be kept under continous review. The needs of people using this service are currently met by the numbers and skill mix of staff but all staff must receive full dementia training. Residents are supported and protected by the home’s recruitment policy and practices. EVIDENCE: The home has a relatively stable and diverse staff team, who are occasionally supported by bank staff. Residents were consistent in their praise for the home and had no complaints. Residents commented, “they are qualified nurses and caring staff” “the staff listen and help as well”. A relative was extremely happy stating, “the place is marvellous, all the staff are marvellous, nothing can be improved here”. There is a wide diversity in the staff team and its composition reflects the culture and gender of people using the service. People using the service consistently report that their needs are being met by the staff team. Daken House DS0000007355.V340114.R01.S.doc Version 5.2 Page 24 There is one qualified nurse and two support staff on each unit at the present time, however, this ratio will be reviewed when the number of residents accommodated in the home is increased. The home also employ cooks and domestic staff to carry out ancillary duties. On the day of the inspection, the inspector was concerned to note that the staff were not seen to interact with residents and many residents were seen watching television either in the lounges or in their bedrooms. This was also particularly noticeable during mealtimes when residents were simply “fed” by staff with little communication taking place. The manager is aware that in order to provide a good quality of care it is essential that staff have sufficient time to give 1:1 attention to the residents, to be with residents talking to them and participate in daily living activities or to take residents out of the home for walks or other communal activities. There are no ratios required by the Commission as staffing levels must always be sufficient to meet the current assessed needs of all of the residents. There are many residents who are quite mobile and would benefit from visits to facilities outside of the home, and there are many residents who would benefit from more staff interaction. At all times there must be enough staff available to meet the needs of people using the service, with more staff being available at peak times of activity. Generally staff are undertaking training, with new staff attending induction programmes, on going training is also being provided by the home. They also have access to Social Services and Primary Care Trust training. The home liaison nurse also assists with teaching staff clinical and care practices. Staff files showed that they have done training in essential areas such as health and safety, adult protection, dementia awareness, assisted movement, fire safety, manual handling, infection control, complaints handling, equality and diversity, food hygiene, bereavement and loss, administering medication. The home is registered to provide care to people with dementia but only the managers have completed the ‘Training Skills in Dementia Care’, course. All other staff have completed basic dementia awareness training. This issue was discussed with the manager, as all staff must be trained and competent to deliver the care required by the particular group of residents they look after. The manager is required to ensure that all staff working in the home undertake the full training in dementia care, in order to ensure that they are able to understand and meet the needs of residents suffering from dementia. The majority of staff have achieved NVQ level 2 and/or 3 qualifications and this continues with staff who have yet to achieve this qualification. The manager was aware of the Mental Capacity Act 2005 and is organising training for the staff on a rolling basis. Residents and relatives spoke highly of many of the staff and nurses. A relative told the inspector “they are qualified nurses and caring staff.” Another relative commented, “she is treated very well and has no complaints”. Daken House DS0000007355.V340114.R01.S.doc Version 5.2 Page 25 Staff recruitment processes are robust and in accordance with Regulation and in line with the organisation’s recruitment policies. Recruitment was checked by examining the personnel files for two newly appointed staff as well as for two other staff. This was found to be in good order with necessary references, Criminal records Bureau (CRB) disclosure, and application forms duly completed. Daken House DS0000007355.V340114.R01.S.doc Version 5.2 Page 26 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, 36 and 38 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager of the home is experienced and well-qualified and residents benefit from this. Effective quality assurance and quality monitoring systems must be in place in order to ensure the home is run in residents’ best interests. Residents financial interests are safeguarded by the policy and procedures of the home. The staff team work together to make sure that residents are safe and secure whilst living at Daken House. Staff are appropriately supervised. Residents’ rights and best interests are safeguarded by the home’s recordkeeping policies and procedures. Residents’ and staffs’ health, safety and welfare are promoted and protected. Daken House DS0000007355.V340114.R01.S.doc Version 5.2 Page 27 EVIDENCE: The registered manager has been in post since October 2005, is a registered nurse and has the appropriate clinical and management qualifications. During the inspection the manager was able to demonstrate a clear understanding of the key principles and focus of the service and works continuously to improve services for the residents. The manager evidenced a person centred approach to care and all staff spoken to, spoke positively about the support they receive from the manager and nursing staff. Plans to develop the service were discussed and a formalised plan is in place indicating future plans for the home. At the time of inspection, the inspector was able to see the new rooms already constructed which are yet to be approved by the Commission’s Central Registration team. The home also plan to make every double room into a single rooms which will incorporate ensuite facilities. An on going refurbishment programme is in place. On the day of inspection the home was supported by a deputy manager who was in-fact working her last day at the home. Hence, at present this post is vacant, however, the inspector was informed that the vacancy had already been advertised to recruit to the post. Interviews and feedback forms received from staff related that they felt supported by management and they enjoyed working at the home. “we have regular staff meetings. The manager is “always giving support”. “The manager carries out daily rounds in each unit. She is informed of any changes or problems in the units.” Feedback from other professionals also highlighted that the management team provide a “very caring and dedicated service”. Residents benefit from a well supported staff team. Records evidenced that staff have regular supervision, supervision contracts have been produced and staff appraisals are in progress. Staff benefit from monthly staff meetings where a range of topics are discussed. These included care practices, procedures, complaints, training and development and Commission for Social Care Inspection updates. Residents have the opportunity to discuss their views and inform the quality of care at monthly consultation meetings. Visits required under Regulation 26 of the Care Home Regulations 2001 are being undertaken by the organisation, and Regulation 37 notifications are being sent to the Commission as necessary. However, an effective quality Daken House DS0000007355.V340114.R01.S.doc Version 5.2 Page 28 assurance and monitoring system must be in place. Although questionnaires for relatives were seen more needs to be done to ensure that the manager seeks the views of residents, staff, other stakeholders in the community, for example, GPs, chiropodists, voluntary organisation staff, visiting professionals and any other people who provide a service or monitor the home on how the home is achieving goals for the residents. The results of the survey must be published in a report which can then inform all planning and review of the service. A suggestion box is located in the front entrance area. Accidents and incidents records were examined and were appropriately maintained. Fire safety and water temperature records were also examined. The fire alarm is tested on a weekly basis and regular fire drills are held. The home informed the inspector that they follow advise given by the fire safety officer with regard to risk assessments and procedures to be followed in the event of a fire. The health and safety of residents is promoted by the home’s practices. Health and safety certificates were examined and were found to be up to date. Where necessary risk assessments are in place and staff work to the health and safety policy. The home has an efficient financial management system and records were accurately maintained. Records were generally found to be appropriately maintained. Residents’ information is confidentially stored in locked cabinets. Examination of residents’ records evidenced that files are audited by management and missing information is highlighted for necessary action. Daken House DS0000007355.V340114.R01.S.doc Version 5.2 Page 29 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 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 2 3 3 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 3 3 3 3 Daken House DS0000007355.V340114.R01.S.doc Version 5.2 Page 30 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 OP12 Regulation 16(m),(n) Requirement The registered person must ensure that care staff are engaged in enabling residents living with dementia to participate in useful and stimulating activities. The registered person must ensure that care staff are aware of the importance of communicating with residents when undertaking any tasks such as feeding, provision of personal care and activities. 3. OP26 16 (2) (k) The registered person must ensure that the home must is free from offensive odours. The registered person must ensure that, since the service is registered for the provision of care to people living with dementia (and this is viewed as a specialist service) the organisation consider improvements to the environment in order to meet their needs. DS0000007355.V340114.R01.S.doc Timescale for action 30/11/07 2. OP15 16 30/11/07 30/11/07 4 OP22 23 30/11/07 Daken House Version 5.2 Page 31 5 OP27 18 The registered person must ensure that, since the service is registered for the provision of care to people living with dementia (and this is viewed as a specialist service) there are at all times enough staff available to meet the needs of people using the service, with more staff being available at peak times of activity. 30/11/07 6 OP30 18 7 OP33 24 The registered person is required 30/11/07 to ensure that all staff working in the care home receive full and appropriate training in the care of people with dementia. The registered person is required 30/11/07 to ensure that an effective quality assurance and monitoring system is in place in order to review the quality of the service provided in the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Daken House DS0000007355.V340114.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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. Extracts may not be used or reproduced without the express permission of CSCI Daken House DS0000007355.V340114.R01.S.doc Version 5.2 Page 33 - 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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