Inspection on 03/11/05 for Dale Mount Residential Home

This inspection was carried out on 3rd November 2005.

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 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

Dale Mount Residential Home 31/01/07

Dale Mount Residential Home 05/05/05

Dale Mount Residential Home 26/11/04

Dale Mount Residential Home 26/07/04

Dale Mount Residential Home 06/02/04

Similar services:

Deepdene Care Centre

Ferndale Residential Care Home

David Gresham House

Elizabeth House

Elvy Court Nursing Home

Fontenay Nursing Home

Clairmont Residential Home

Cornford House

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

CARE HOMES FOR OLDER PEOPLE Dale Mount Residential Home Dale Road Southfleet Gravesend Kent DA13 9NX Lead Inspector Sally Hall Announced Inspection 3rd November 2005 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 Dale Mount Residential Home DS0000023934.V251820.R01.S.doc Version 5.0 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. Dale Mount Residential Home DS0000023934.V251820.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Dale Mount Residential Home Address Dale Road Southfleet Gravesend Kent DA13 9NX 01474 832461 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) Nicholas James Care Homes Ltd Care Home 13 Category(ies) of Dementia - over 65 years of age (13) registration, with number of places Dale Mount Residential Home DS0000023934.V251820.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registration includes 3 Service Users who are physical frail whose date of births are: 04/07/1920, 06/05/1913 and 14/05/1913 5th May 2005 Date of last inspection Brief Description of the Service: Dale Mount is one of a group of care homes managed by Nicholas James Care Homes Limited. The home offers 24-hour care to 13 people over the age of 65 years, who have a diagnosis of dementia. The accommodation is split between 2 floors. All rooms are spacious, airy and bright. They all have hand basins, TV points and a call system. The home is close to local services and facilities within Kentish Village, South fleet. Public Transport is nearby, as is the A2 providing links to Gravesend and Blue water. The manager is responsible for the the two homes on this site, however both homes have their own deputy manager in post. Dale Mount Residential Home DS0000023934.V251820.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection at Dale Mount took place on 3rd November 2005 starting at 10.ooam and being completed at 3.30pm. The Inspector agreed and explained the inspection process with the Manager. Time was spent reading documentation, including a sample of written policies and procedures, reviewing care plans and records kept within the home. A partial tour of the premises was also undertaken. The focus of the inspection was to assess Dale Mount in accordance with the National Minimum Standards for Older People. The inspector used the information presented by the manager in the pre-inspection questionnaire. However, the home had not sent out the questionnaires from the Commission for Social Care Inspection for service users, relatives and other involved parties to complete, so it is not possible to use that feedback in this report. This information will be followed up with the home at a later date and if appropriate will be used in the next report. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. What the service does well: What has improved since the last inspection? The home has introduced new assessment and care planning documentation, this is much more detailed than before and gives a clear picture of the service users’ needs and the action staff need to take to meet these needs. It also clearly identifies the risks that maybe involved and how these should be minimised. The home’s second bathroom has been refurbished and has a hoist to assist service users who need help getting in and out of the bath. The laundry has a washing machine with a sluice facility and the home is using the ‘red sack’ system to improve infection control. Dale Mount Residential Home DS0000023934.V251820.R01.S.doc Version 5.0 Page 6 What they could do better: 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. Dale Mount Residential Home DS0000023934.V251820.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dale Mount Residential Home DS0000023934.V251820.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3-6 The admissions procedure ensures that only service users whose needs can be met are admitted to the home. The service users benefit from staff who are trained to care for people with dementia. EVIDENCE: The manager visits prospective service users, whether that is at their home or in hospital. This is when she completes her initial assessment to ascertain if the service user’s needs can be met by the home. The new pre-admissions assessment that has been devised gives all the information required when fully completed. These are used for all new admissions. The home has been actively encouraging the staff to undertake the required training NVQ’s in care and courses on understanding dementia, so that all staff have the skills and knowledge to provide for the care needs of the service users. Residents and families are encouraged to visit the home prior to admission and are admitted to the home on a temporary basis for 4 weeks. Intermediate care is not provided at the home. Dale Mount Residential Home DS0000023934.V251820.R01.S.doc Version 5.0 Page 9 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 the following standard(s): 7,8,10,11. The care planning system is clear and provides staff with the information they need to meet residents’ needs. The service users’ health care needs are identified and met; however documentation needs to be more detailed. The staff preserve the service users’ dignity and respect their wishes regarding their funeral arrangements. EVIDENCE: The individual plans of care are now based on comprehensive assessments. This has enabled service users’ needs to be identified, with staff action to meet those needs being detailed. It was noted however, that these new formats have there roots in nursing care, but this has been recognised and changes are being made to ensure they reflect residential dementia care. Those daily reports viewed in service user files were repetitive and did not reflect a true picture of the care staff are providing. They did not show details of the social interaction or activities provided. This was discussed with the manager and staff, as more detailed records of the care provision are required. The time that events happen and details of the care provided is now recorded. Records viewed indicated that residents were able to have access to appropriate health care professionals as and when required. All service users Dale Mount Residential Home DS0000023934.V251820.R01.S.doc Version 5.0 Page 10 have their own GP, often keeping the doctor they previously had at home when possible. Regular visits by the chiropodist, optician and dentist were recorded in the service users’ individual files. The medication administration, recording and storage was not audited during this inspection. During the inspection staff were seen preserving the dignity of service users and they treated them with courtesy and respect. Some staff were seen offering choices and showed that they had a good understanding of the communicational difficulties and needs of service users with dementia. The funeral wishes of the service user or their family were recorded in the files sampled. The manager confirmed that they endeavour to offer a home for life. Although the home is not a nursing home, with the support of the GP and district nurses they would look after service users who become terminally ill. However, this would only happen with full agreement of the family, care management and the health care professionals. Dale Mount Residential Home DS0000023934.V251820.R01.S.doc Version 5.0 Page 11 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 the following standard(s): 12, 14,15. Activities and stimulation for service users are now being introduced back into the home on a regular basis. The meals in this home are good and offer both choice and variety, the home also caters for special diets. EVIDENCE: Service users are now being offered a programme of activities; on the day of the inspection a new activity co-ordinator arranged several different activities, having started by finding out about the past lives of the service users and their interests. This helped her formulate a programme of activities that the service users are likely to be interested in. The staff continue to provide sing-a-longs and bingo for the service users but the activity co-ordinator will do more by way of games and crafts. She will be in the home two afternoons a week to start with. The home also has outside entertainers coming in from time to time. Relatives were welcome to visit at any reasonable time. There is not a designated visitor’s room within the home, so for privacy the service user can take visitors to their bedrooms. Some evidence of staff offering service users choice was observed during the inspection process but there was little documentary evidence to show that this is promoted in the home via daily reports etc. This was also true of the Dale Mount Residential Home DS0000023934.V251820.R01.S.doc Version 5.0 Page 12 promotion of independence, it is part of the plans of care, however staff do not record what they have encouraged service users to do for themselves. Several service users spoken with said they enjoyed the meals provided. The menus showed a good choice at lunchtime, the menus for the four weeks are on the notice board in the home and the daily choices are also written up on the board each day. The home provides special diets for service users when required. They also liaise with the dietician if they want advice on special diets. The home keeps a record of the meals served and within the daily record the amount service users have eaten and drunk. The closeness of the meals times is a concern, as many service users do not have supper. This means service users have a period of more than twelve hours between teatime and when they eat again at breakfast. The home is to look at gradually moving the current meal times to reduce this gap. Dale Mount Residential Home DS0000023934.V251820.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 16-18. The way complaints issues are monitored after the initial complaint is raised could leave service users at risk. The home needs to review the adult protection protocols and whistle blowing policy and to protect service users further the staff need to have the appropriate training. EVIDENCE: The complaints procedure was seen, the time scales were reviewed during the inspection to ensure they are realistic. No documentation could be found relating to the complaints that the manager was aware of prior to her taking on the post. The manager has now devised a form were complaints can be recorded and their progress tracked. These will be kept in a file with any compliments received. The manager explained that although the service users have dementia she always ensures that they receive a voting form. These give service users the opportunity to visit the polling station or have a postal vote. The home has a copy of the local authority protocols, however they now need to adjust their own policy/procedure to match this document. A number of staff at the home required adult protection training, the manager confirmed that this was being addressed. Dale Mount Residential Home DS0000023934.V251820.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 21,22,26 The possibility of cross infection could put staff and service users at risk due to the laundry not being effectively cleaned. EVIDENCE: The home now has a sluice machine and the red sack system is in place so that staff do not have to handle foul linen any more than is necessary. However, the laundry was found in an unclean state and the carpeted flooring is not acceptable. The floor must be a non slip material and be washable. A full tour of the building did not take place but issues raised in the last report were followed up. The home has refurbished the bathroom and evidence was seen that a hoist is being installed in that bathroom within days of the inspection taking place. Work has taken place in the garden to ensure that the patio area is safe for service users to walk on. Although much improved there are still areas that are uneven and suggestions were made for how the worst of these could be dealt with. Dale Mount Residential Home DS0000023934.V251820.R01.S.doc Version 5.0 Page 15 Dale Mount Residential Home DS0000023934.V251820.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 Service users’ care, social and emotional needs are promoted by the employment of caring and suitably trained staff. Service users are protected from potential abuse by the home’s robust staff recruitment procedures. EVIDENCE: The home’s present staffing numbers and skills mix are appropriate for the number and assessed needs of the service users. The manager was able to explain how these numbers are monitored and would be increased if the staff were not able to meet the service users’ needs. The home currently uses 280 care staff hours per week. The home shares the cooking staff with the other home on site. It has it’s own cleaning staff, they are currently recruiting into one of these posts. The maintenance work within the home is covered by a team which is employed by the organisation. The home has been pro-active regarding NVQ’s. Over half the home’s staff now have a NVQ level 2 qualification or above in care. Some staff are also doing an NVQ in dementia care. The staff are rewarded with an increase in pay once they have completed their award. The staff files were sampled and the required documentation was found to be in the files. These included the application forms, references and CRB checks etc. Dale Mount Residential Home DS0000023934.V251820.R01.S.doc Version 5.0 Page 17 The manager explained the induction that all staff receive to ensure that they know the layout the buildings, fire procedures, home’s policies etc. The manager also said that they have recently enrolled a number of staff on the formal induction required for all new staff. The intention is for most staff to go on this course even though they may have been working at the home for sometime. Dale Mount Residential Home DS0000023934.V251820.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38 Service users would benefit from staff who have regular supervision. The home’s record keeping, policies and procedures protect the service users’ rights and best interests. The service users are benefiting from the improvements in health and safety within the home, however attention needs to be paid to the staff training required in this standard. EVIDENCE: The current manager has the experience and is working towards the qualifications required. The manager has now demonstrated a clear focus on raising standards. The manager is the registered manager for the other home on the same site; now the deputy managers are now in post she needs to apply to become the registered manager at Dale Mount. Dale Mount Residential Home DS0000023934.V251820.R01.S.doc Version 5.0 Page 19 The home has a very positive and friendly atmosphere, with service users who appeared comfortable with their surroundings. Staff said that they felt they were part of one big family. Staff said they felt that service users benefited from the small size of the home, which they said feels homely. Service users who were able to express an opinion said that the staff were “very patient and kind”, “they always listen and do what they can to help”. Questionnaires have been formulated and the manager said that she intends to send them out soon. These will be for service users family/friends, she is formulating another for health professionals who visit the home. As most of the service users have dementia it is now almost impossible to get a true picture of the home’s performance directly from them. The home has all the required insurance cover in place evidence of this was seen. Records showed that all staff are starting to receive formal supervision. Documentation covers most of the topics needed to meet the criteria set out in this standard. The manager is aware of the frequency needed for staff supervision. Random sampling of records and discussion with the manager, indicated that most records required by regulation are being maintained. The home keeps all confidential information securely within the home and staff questioned were aware of who could have sight of the service users file. Various measures have been taken to promote safe working practices in the home. This includes for example, training staff in moving and handling, first aid, health/safety, infection control plus regular checks and monitoring of systems in the home. However, it was evident that not all staff are up to date with this training. Staff training is now being arranged, systems are needed to ensure that all the staffs’ training certificates remain in date and that all staff have covered all the required training. The manager is hoping to complete the moving and handling and adult protection training in the next six months for all staff. She hopes to complete all the other required training for all staff in the next year. The home now has a COSHH file available for staff to use in an emergency. The fire log is being completed, and most staff have now had fire training. The manager confirmed that the home has a building risk assessment. The maintenance certificates such as Gas, electric and LOLER were confirmed as being in place and current within the pre inspection questionnaire completed by the manager. Dale Mount Residential Home DS0000023934.V251820.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 X X 3 3 X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 2 3 2 Dale Mount Residential Home DS0000023934.V251820.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15, 13 Requirement Timescale for action 01/12/05 2 OP26 13, 23 3 OP38 25, schedule 4.1 A service user plan of care generated from a comprehensive assessment (see Standard 3) is drawn up with each service user and provides the basis for the care to be delivered. The all the care provided is recorded in the daily log and cross references with the plans. 01/01/06 The premises are kept clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of infection, in accordance with relevant legislation and published professional guidance. Replace the flooring in the laundry with impervious non slip flooring that can be cleaned. Also ensure that the laundry is keep in a clean state. The registered manager ensures so far as is reasonably 01/11/06 practicable the health, safety and welfare of service users and staff. Ensure that all staff receive the required training in time scales agreed in the report resulting in all training being completed at the latest by DS0000023934.V251820.R01.S.doc Version 5.0 Dale Mount Residential Home Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP18 Good Practice Recommendations The registered person ensures that service users are safeguarded from physical, financial or material, psychological or sexual abuse, neglect, discriminatory abuse or self harm, inhuman or degrading treatment, through deliberate intent, negligence or ignorance, in accordance with written policies which reflect recent changes in legislation and the local AP protocols. The manager applies to become registered for the home. That staff supervision continues on a regular basis. 2 3 OP31 OP36 Dale Mount Residential Home DS0000023934.V251820.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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