Inspection on 31/01/07 for Dale Mount Residential Home

This inspection was carried out on 31st January 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 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 03/11/05

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 Unannounced Inspection 31st January 2007 09:30 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.V328858.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. Dale Mount Residential Home DS0000023934.V328858.R01.S.doc Version 5.2 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.V328858.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Dale Mount is one of two care homes on the same site who have the same registered manager and are 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, however there is no lift, and service users who become less mobile may have to find other suitable accommodation if a room on the ground floor is not available. 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 the Kentish Village, Southfleet. Public Transport is nearby as is the A2 providing links to Gravesend and Blue water. The home is currently operating without a registered manager. The fees range from £ 417 to £510 per week. Dale Mount Residential Home DS0000023934.V328858.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key Inspection at Dale Mount took place on 31st January 2007, between 9.30m and 1pm the link inspector was Sally Hall On the day of the inspection the Inspector agreed and explained the inspection process with the Registered Manager. Staff, service users and visitors were spoken with and a tour of premises was undertaken. However as an inspection of the other care home on site had taken place two days earlier a sample of care plans, written policies and procedures and records kept within the home had already been examined. The focus of the inspection was to assess Dale Mount in accordance with the National Minimum Standards for Older People. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. The home was ask to complete a pre–inspection questionnaire, the evidence from this was used along with the information gathered from the homes survey of service users, friends/families and other professionals that are involved with the service users at the home. What the service does well: What has improved since the last inspection? The laundry flooring has been replaced so that it is now easy to keep clean. The patio area is now flat and therefore not a risk to service users. The manager has now been registered and has almost completed her R.M.A. Dale Mount Residential Home DS0000023934.V328858.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Dale Mount Residential Home DS0000023934.V328858.R01.S.doc Version 5.2 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.V328858.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and there families are given the information they need to make an informed choice about the home. They can feel confident that the assessment undertaken prior to admission and the 28-day trial period will ensure their needs can be met before a permanent placement is offered. EVIDENCE: A Statement of Purpose and Service User’s Guide are given out to all prospective service users and/ or their families. The information in the documents is as required and is reviewed annually. All perspective service users are visited and an assessment is undertaken. In files sampled it was evident that several different types of assessment are undertaken. This gives a comprehensive picture of the service users needs, it Dale Mount Residential Home DS0000023934.V328858.R01.S.doc Version 5.2 Page 9 is started before the service users is admitted and completed fully during the 28days trial period. The home does not provide intermediate care. Dale Mount Residential Home DS0000023934.V328858.R01.S.doc Version 5.2 Page 10 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can be confident that their health and care needs will be provided in a way that preserves dignity, however documentation needs to be improved. The home has a robust medication procedure that is comprehensively monitored weekly by the manager to protect service users. EVIDENCE: The service users files sampled show that service users are being assessed. These assessments cover a wide range of service user needs and include for example cognitive assessment, communication and nutrition. The information from these is then used to formulate care plans. However some of the care plans are not as individual as they could be. Part of the plans are prepopulated and staff only have to enter the service users name. For example in one section pertaining to continence, it was not possible to tell if the service users concerned had a problem maintaining continence. The information could Dale Mount Residential Home DS0000023934.V328858.R01.S.doc Version 5.2 Page 11 be found in the assessment but staff should not have to look through assessments to find out what is normal for this service user. There was no evidence that service users and or families had been involved in the formation of the plans. The plans are reviewed but outcomes are not recorded. All these issues were discussed with the manager. The daily log does not cross reference with the care plans. Again it was evident that staff are fulfilling the service users’needs but they are not recording this sufficiently well. The staff at the home call in the GP when the service users are not well. Such visits are recorded in the daily log, however follow up information regarding outcomes of treatment such as antibiotics are not recorded. Service users are also visited at the home by chiropodists, opticians and dentists. This can be arranged by the home or privately by the service user or family. The home weighs the service users on a regular basis, and the records are kept in the service users’ file. If nutritional needs are identified then a detailed record of what the service user eats and drinks are kept by staff. A service users said that District Nurses visit to the home at least twice a week. Two district nurses responded to the survey sent. Both agreed that the home informs the surgery if a service user is at risk and their input is required. They also stated that service users are treated with respect and dignity. A daughter of one of the service users who rang spoke about the conduct of the home. She confirmed that in her opinion service users are well care for and treated with respect and dignity at all times. She was more than happy that her mother is at the home. Service users spoken to said that staff treat them with respect. One said that the staff are friendly and have lots of patience. She said she was treated with respect and dignity at all times. Observation of the staff interacting with the service users also confirmed that staff approach to service users is respectful. Staff follow robust procedures when administering, ordering and storing medication. The manager does a comprehensive audit of medication weekly to ensure all service users are given the medication as prescribed. Dale Mount Residential Home DS0000023934.V328858.R01.S.doc Version 5.2 Page 12 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): 12,13,14,15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service users cannot be confident that they will be offered a programme of activities throughout the week, or have trips out available regularly. There are no restrictions on visiting. Service user can be confident that they will be offered a choice of home cooked nutritious meals. EVIDENCE: Activities take place just two afternoons per week, with some entertainers coming in approximately four times a year. There is no activity programme although the activity co-ordinator does cater for a range of activities to suit most interests. A recommendation has been made to review the way that activities in the home are recorded as the present system compromises confidentiality/data protection. A requirement of more activity time for service users is essential to ensure all service users have access to a form of motivation several times during the week. A trip out to the coast in the summer was enjoyed by service users and remembered by one particularly for Dale Mount Residential Home DS0000023934.V328858.R01.S.doc Version 5.2 Page 13 the fish and chip meal she enjoyed. More could be done to ensure service users have the opportunity to access the community. Staff were seen promoting service user independence, for example a service user is encourage to stand and take a few steps, the service user had been non weight bearing. The cook is changing the menu, the service users are offered a choice at each meal time, including the main meal. The service users said that the food is nice and second helpings are available. The staff record what meal service users have chosen individually and have a nutritional chart showing how much is eaten and drunk if a risk has been identified. Service users are weighed weekly. Mainly fresh ingredients are used and most dishes are home cooked. The food is all cooked at the larger home Dale Lodge and transferred to the home in a heated trolley. Staff were heard offering choices to the service users prior to the diner time meal. When a service user did not like either choice the staff rang the kitchen to ask for alternatives, eventually she chose something she liked. Dale Mount Residential Home DS0000023934.V328858.R01.S.doc Version 5.2 Page 14 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): 16,18. Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. There are robust policies and procedures regarding complaints and adult protection. However all staff must undertake the adult protection training every three years. EVIDENCE: The home’s complaint procedure varies depending on where this is located. It is recommended that this be reviewed and the copy containing all the time scales be the one used throughout the home. There are no complaints recorded, and staff said that if service users or families express concern they address the problem immediately. Staff questioned had a very good understating of there role regarding identify potential abuse and reporting it. The home has the local authority adult protection protocol to hand, as well as a their policy. Not all staff however has completed the adult abuse awareness training, it is a requirement for all staff to undertake this training every three years. Dale Mount Residential Home DS0000023934.V328858.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Service users can be confident that the standard of cleanliness throughout the communal areas is maintained at a high level. EVIDENCE: The home is kept very clean, is homely and comfortable. Individual bedrooms were spacious, bright and airy. The home has one main lounge, which is used for the viewing of television and a separate dining room. Communal areas in the home benefited from good natural light. The home has a separate laundry room, the flooring has been replaced and is kept clean. The rest of the room is in need of redecoration as paint is peeling in several areas. The area cannot be cleaned adequately and the sink unit was unclean and in need of repair or replacement. The sink unit door surface has been compromised and therefore cannot be cleaned effectively. Both bathrooms in the home now have hoists which makes them both accessible to all service users. Ongoing issues remain regarding the need for a passenger lift, The Statement of Purpose has been Dale Mount Residential Home DS0000023934.V328858.R01.S.doc Version 5.2 Page 16 changed to ensure service users admitted to Dale Mount know that if they are on the first floor and can not manage the stairs they may have to look for other accommodation, unless they can be cared for on the ground floor. One shared room does not have a curtain between the beds; it does have a curtain around the sink however. Dale Mount Residential Home DS0000023934.V328858.R01.S.doc Version 5.2 Page 17 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): 27,28,29,30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users can be confident the robust recruitment procedures protect them. The care of service users is enhanced because the staffing levels are sufficient and reviewed to ensure they meet the service users needs. Whilst the home provides its staff with a good range of training, service users cannot be fully confident that all of the staff have received all of the training that they are required to undertake. EVIDENCE: Staff files indicate a robust recruitment procedure, with all the required documentation and checks being available. The newly recruited staff completed an induction programme, which meets the NTO workforce training targets. The home has two members of staff on morning and afternoon. Two carers are allocated to the night shift one of which is waking staff. There are service user vacancies at the home and staffing levels are to be reviewed the manager indicated when the home is full again. The staff training matrix shows that there have been a large number of courses undertaken since the last Dale Mount Residential Home DS0000023934.V328858.R01.S.doc Version 5.2 Page 18 inspection. whilst this is to be commended it is important that all staff undertake all the required training. Staff are encouraged and supported to undertake NVQ’s in care at Level 2 and 3. Currently the home has achieved the 50 target of staff with an NVQ. Dale Mount Residential Home DS0000023934.V328858.R01.S.doc Version 5.2 Page 19 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, 33,35,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from an experienced manager who understands the complexities of dementia. Service users would benefit from staff who have regular formal supervision and are all fully trained in health and safety related courses. Service users do benefit from living in a home that is safe and regularly monitored. EVIDENCE: Dale Mount Residential Home DS0000023934.V328858.R01.S.doc Version 5.2 Page 20 The registered manager is also registered for the same home on the same site Dale Lodge. This registration was only allowed if both homes have their own assistant manager. The assistant manager of this home has now left and a replacement is being advertised for. The manager is about to complete her R.M.A. She has previously completed and NVQ Level 4 award in Management, NVQ Level 3 in Care (promoting independence) and VRQ level 2 in Dementia Care. The manager and some staff at the home have also completed NCFE Level 2 certificates in safe handling of medication. The completed Pre inspection questionnaire confirmed that all the maintenance certificates have been obtained and continue to be in date. There is a system in place for staff to report any maintenance issues. The fire log is kept up to date with checks happening with in the home as recommended, for example weekly sounding of the fire alarms. The manager checks the temperature of the rooms and water form sinks etc., She records the rooms chosen at random each month. There is a COSHH file available. Staff training in health and safety is now being arranged; however not all staff have had all the required training to date. Staff are not yet having supervision on a regular basis at least six times per year. The staff at the home respond well to the wants of the service users. Having dementia, service users find it hard to be part of meetings where issues could be discussed, but they can respond on an individual level in some cases and this is encouraged. For example, the menus have been negotiated in this way. The routine of the day appeared flexible, with staff responding to the needs of the service user. Dale Mount Residential Home DS0000023934.V328858.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 2 X 3 Dale Mount Residential Home DS0000023934.V328858.R01.S.doc Version 5.2 Page 22 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 A service user plan of care generated from a comprehensive assessment (see Standard 3) is drawn up with each service user/family and provides the basis for the care to be delivered. That these are individual to that service user and the daily log records how staff have met the care provision as detailed in the care plan. Timescale for action 01/04/07 2 OP8 3 OP12 4. OP26 13, 14, 16 Staff are recognising when a 01/03/07 service users need medical attention, however the outcomes of the treatment etc. need to be also recorded in the daily log as a follow up. 16(n) An activity programme is 01/03/07 required for service users, there also needs to be more staff time made available for the provision of activities through the week. 13, 23 The laundry require surfaces that 01/03/07 can be cleaned, areas of flaking paint and the damaged doors to the sink unit compromise this. The sink should be kept clean at all times. DS0000023934.V328858.R01.S.doc Version 5.2 Page 23 Dale Mount Residential Home 5. 6. OP36 OP38 18(2)(a) 25, schedule 4.1 Regular formal staff supervision is carried out six times per year. The registered manager ensures so far as is reasonably practicable the health, safety and welfare of service users and staff. Continue providing the necessary training so that all staff have all the required training by :- 01/04/07 01/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP13 Good Practice Recommendations Service users are enabled to have trips out, accessing the local community etc. Dale Mount Residential Home DS0000023934.V328858.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Dale Mount Residential Home DS0000023934.V328858.R01.S.doc Version 5.2 Page 25 - 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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