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

Also see our care home review for Dale Mount Residential Home for more information

This inspection was carried out on 5th May 2005.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Dale mount provides a welcoming and homely environment. It is decorated and furnished to a reasonable standard, is clean bright and airy. Service users benefit from the continuity of permanent members of staff.

What has improved since the last inspection?

Each service users care plans should be in sufficient detail to provide clear guidance to staff on the actions to be taken to meet all aspects of their health and welfare needs. The home is also to review its night care staff composition to ensure adequate numbers of staff are employed to meet the needs of residents.

What the care home could do better:

The home urgently requires a registered manager. The home must ensure that adequate and competent staffs are provided on every shift, 24 hours per day. Urgent progress needs to be made in regards to staff training and supervision as staff are lacking in basic knowledge around health care issues such as diabetes and pressure care areas. The home care must utilise health careprofessionals to meet resident`s individual needs, such as a diabetic nurse. The recruitment and selection procedure must be more comprehensive and robust to meet regulatory framework to ensure the protection of service users.

CARE HOMES FOR OLDER PEOPLE Dale Mount Residential Home Dale Road Southfleet Gravesend Kent DA13 9NX Lead Inspector Harbinder Ghir Unannounced 05 May 2005 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dale Mount Residential Home H56-H06 S23934 Dale Mount V230607 050505 Stage 4.doc Version 1.30 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 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 CRH Care Home 13 Category(ies) of Dementia - over 65 (13) registration, with number of places Dale Mount Residential Home H56-H06 S23934 Dale Mount V230607 050505 Stage 4.doc Version 1.30 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 Date of last inspection 26 November 2004 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 home is currently operating without a registered manager. Dale Mount Residential Home H56-H06 S23934 Dale Mount V230607 050505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, the first in the year running from April 1st 2005 to March 2006. The visit lasted from 10.00am to 3.00pm. The home is currently running to full capacity with no vacancies. On the day of the inspection 2 care staff, acting manager, group manager and the manager from sister home Dale lodge were spoken to. Residents and relatives were also spoken with, some records were examined and parts of the premises were inspected. What the service does well: What has improved since the last inspection? What they could do better: The home urgently requires a registered manager. The home must ensure that adequate and competent staffs are provided on every shift, 24 hours per day. Urgent progress needs to be made in regards to staff training and supervision as staff are lacking in basic knowledge around health care issues such as diabetes and pressure care areas. The home care must utilise health care Dale Mount Residential Home H56-H06 S23934 Dale Mount V230607 050505 Stage 4.doc Version 1.30 Page 6 professionals to meet resident’s individual needs, such as a diabetic nurse. The recruitment and selection procedure must be more comprehensive and robust to meet regulatory framework to ensure the protection of service users. 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 H56-H06 S23934 Dale Mount V230607 050505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Dale Mount Residential Home H56-H06 S23934 Dale Mount V230607 050505 Stage 4.doc Version 1.30 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 standard(s) Not inspected. EVIDENCE: Dale Mount Residential Home H56-H06 S23934 Dale Mount V230607 050505 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9 Limited progress has been made to ensure that health care needs of residents are met. These shortfalls have a potential to place residents at risk. Medication at the home is managed well. EVIDENCE: Individual plans of care are available but information in relation to aspects of health, personal and social care needs is generalised, brief and basic. Care plans identified risks but lacked detailed information on preventative measures. Plans are not being followed, are not up to date and had not been reviewed regularly. In regards to plans not being followed this was particularly evident of one resident who was diabetic. The plan consistently highlighted the resident’s need to eat and drink regularly due to his diabetes. However, case recording indicated the resident had failed to eat on one occasion and was left to sleep, which resulted in poor health and low sugar levels. Discussion with two members of care staff indicated lack of training on diabetes, lacking knowledge on the basics of a diabetic diet and the risks associated with diabetes. Residents are at serious risk of not having their health care needs met as they had in respect of the situation described above. This has now resulted in an adult protection investigation. However, care staffs are making Dale Mount Residential Home H56-H06 S23934 Dale Mount V230607 050505 Stage 4.doc Version 1.30 Page 10 detailed daily entries into case records, which are consistent with their observations. The practice of administering medication prescribed to individuals was observed. Medication was overall managed well. Medication and records are stored and locked away in a medication cupboard. Records seen, but one were recorded appropriately. Dale Mount Residential Home H56-H06 S23934 Dale Mount V230607 050505 Stage 4.doc Version 1.30 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 standard(s) 13, 15 The meals in this home are good offering both choice and variety. However, there are serious concerns relating to how and if the special dietary needs of some residents are being met. Family relationships are promoted and encouraged by the home. EVIDENCE: The home offers a choice of two hot meals at lunchtime, and a choice for breakfast and teatime. Residents are asked to choose their lunchtime meal in the morning. One resident spoken to informed that the meals are not bad and felt that the portions were not big enough and were not filling. The food diary was seen which indicated the choices offered each day. No individual food records were found to indicate resident’s dietary intake in order to monitor their nutritional intake. No special dietary menus were seen in regards to diabetics or how a residents diet is managed in regards to their health care needs. It was recommended that this is done urgently for those with special dietary needs to prevent any serious healthcare risks. Resident’s family and friends can visit at any time. Relatives were seen to visit various times throughout the day during the inspection. Dale Mount Residential Home H56-H06 S23934 Dale Mount V230607 050505 Stage 4.doc Version 1.30 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Not Inspected EVIDENCE: Dale Mount Residential Home H56-H06 S23934 Dale Mount V230607 050505 Stage 4.doc Version 1.30 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 23, 24, 25, 26 The home is well furnished and decorated. The home was clean and warm. Individual independence and safety would be greatly enhanced if the home had a passenger lift in place. EVIDENCE: The home was well presented, homely and clean. No odours were detected at the home. Individual bedrooms were spacious, bright and airy. Rooms were adequately furnished, and had sufficient space to accommodate the required furniture. The home has one main lounge, which is used for the viewing of television and a dining room. Communal areas in the home benefited from good natural light. However, the suitability of electrical goods within the main lounge needs to be reviewed and maintained, as the TV screen in the lounge was yellow. The home has a separate laundry room, which does not have a sluice facility. The floor was not impermeable and could not be readily cleaned. The patio area to the rear of the property was uneven with some parts of the paving coming away. The first floor bathroom was not assisted leaving 13 residents to share one assisted bath on the ground floor in the home. On going Dale Mount Residential Home H56-H06 S23934 Dale Mount V230607 050505 Stage 4.doc Version 1.30 Page 14 issues remain regarding the need for a passenger lift. Personal safety of residents at high risk of falls is an ongoing concern. One relative spoken to highlighted the urgent need for a lift. Dale Mount Residential Home H56-H06 S23934 Dale Mount V230607 050505 Stage 4.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 30 The procedures for the recruitment of staff must be more robust and comprehensive to ensure the protection of residents. The arrangements for staff training needs urgent reviewing to ensure residents are not placed at risk. EVIDENCE: The home has two members of staff on AM and PM. It currently employs 8 permanent members of care staff. 2 carers are allocated to the night shift one of which is waking staff. The home is in the process of reviewing this shift, as this is not sufficient to meet the needs of the residents. It was evident that two members of staff were over stretched during the day whilst performing their daily duties. If a member of staff were tied up it would only leave the other member of staff to attend to the needs of 13 residents. Staffs are lacking basic training around the resident’s current health care needs. Training on diabetes and pressure care areas was identified as urgent. When speaking to staff they were unaware of what a diabetic diet was, the risks associated and how to manage diabetes. They had received no formal training and no formal resources such as a diabetic nurse were utilised. Three staff files were seen one of which indicated regular supervision and yearly appraisals. The new recruit completed a good induction programme. One file viewed was that of the last appointed manager. No references were found on file. Another staff file included two very poor references one of which advised against the applicant seeking care work. The home needs to undertake all necessary recruitment checks and ensure references are of good quality to Dale Mount Residential Home H56-H06 S23934 Dale Mount V230607 050505 Stage 4.doc Version 1.30 Page 16 ensure the protection of residents. Criminal Records Bureau checks could not be viewed as they were locked away. Dale Mount Residential Home H56-H06 S23934 Dale Mount V230607 050505 Stage 4.doc Version 1.30 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32 There is no leadership; guidance and direction to staff to ensure residents receive consistent quality care. This had resulted in practices that do not promote and safeguard the health, safety and welfare of people using the service. EVIDENCE: There is no registered manager and this has been the case since July 2003. There has been a high turn over of acting managers in the last two years, the last acting manager left the home in March 2005. The group manager for the company stated that a senior carer was currently receiving training to act as manager. Concerns were raised on how much managerial time is allocated to the new acting manager as well as performing hands on care. Concerns were also raised as to the amount of managerial experience the new candidate has. The group manager informed that the intention is for the acting manager to be Dale Mount Residential Home H56-H06 S23934 Dale Mount V230607 050505 Stage 4.doc Version 1.30 Page 18 enrolled on a manager’s course. An application for registration has not yet been received. Dale Mount Residential Home H56-H06 S23934 Dale Mount V230607 050505 Stage 4.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 2 14 x 15 1 COMPLAINTS AND PROTECTION 3 1 x x 3 2 2 1 STAFFING Standard No Score 27 1 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 1 1 x x x x x x Dale Mount Residential Home H56-H06 S23934 Dale Mount V230607 050505 Stage 4.doc Version 1.30 Page 20 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 27 Regulation 18 (1) (a) Requirement Th registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. In that appropriate numbers of of staff are on duty at all times to meet the needs of service users. The registered person shall not employ a person to work at the care home unless the employers is satisfied on reasonable grounds as to the authenicity of the referencs referred to in paragraph 5 of Schedule 2 in respect of that person, and has confirmed in writing to the registered person that he is so satisfied. In that the home seeks two good reference for newly recruited members of staff. The registered person shall ensure that the care home is conducte so as to promote and Timescale for action 05/08/05 2. 29 19 (4)(c) 05/08/05 3. 30 12 (1) (a) (b) 18 (c) 05.08.05 Dale Mount Residential Home H56-H06 S23934 Dale Mount V230607 050505 Stage 4.doc Version 1.30 Page 21 make proper provision for the health and welfare of service users and to make proper provision for the care and, where appropriate, treatment, education and supervision of service users. The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that the persons employed by the registere perosn to work at the care home training appropriate to the work they are to perform. In that staff comprehensive training in diabetas and pressure care areas. That a training matrix is devised, adhered to and kept upto date for all staff. 4. 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 7&8 Good Practice Recommendations It is strongly recommended that Care Plans are more comprehensive and daily records are recorded in detail, and daily individual records of nutrional intake are also recorded in detail, and that care plans are kept under review. It is strongly recommended that comprehensive risk assessments are undertaken with particular attention to preventative measures and ways of minimising risk. It is strongly recommended that special individual dietary needs a adequately catered for within the home. It is recommended that a programme of routine maintenance checks are undertaken. It is recommended bathing facilities within the home are increased to meet residents personal hygiene needs. It is strongly recommended that home has a sluice facility H56-H06 S23934 Dale Mount V230607 050505 Stage 4.doc Version 1.30 Page 22 2. 3. 4. 5. 6. 7 15 19 21 26 Dale Mount Residential Home 7. 8. 26 31 to minimise the risk of infection. It is strongly recommended that the laundry floor is replaced for it to be impermeable and wall finishes are readily cleanable. It is strongly recommended that the home appoints a full time registered manager. Dale Mount Residential Home H56-H06 S23934 Dale Mount V230607 050505 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection The Oast, Hermitage Court Hermitage Lane Maidstone Kent 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. Extracts may not be used or reproduced without the express permission of CSCI Dale Mount Residential Home H56-H06 S23934 Dale Mount V230607 050505 Stage 4.doc Version 1.30 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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