CARE HOMES FOR OLDER PEOPLE
Dale Park 221 Meols Cop Road Southport Merseyside PR8 6JU Lead Inspector
Mr Mike Perry Key Unannounced Inspection 09:30 26th July 2007 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 Park DS0000017278.V340943.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 Park DS0000017278.V340943.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Dale Park Address 221 Meols Cop Road Southport Merseyside PR8 6JU 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) 01704 501780 01704 501782 www.schealthcare.co.uk Southern Cross Healthcare Services Limited Mr John Melvyn Price Care Home 54 Category(ies) of Dementia (54) registration, with number of places Dale Park DS0000017278.V340943.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 54 DE Date of last inspection Brief Description of the Service: Dale Park is a purpose built home providing nursing care for 46 older residents with mental health needs related to dementia [the home is registered for 54 but shared rooms are used for single use]. The home is owned privately by Southern Cross Health Care and the Responsible Person is Mr Phillip Scott. The Registered manager is Mr John Price. The home is situated in Southport close to a retail park and with access to a bus route for the town centre. There are shops close by and a pub. Dale Park is divided over 2 floors and 4 units. Each floor has 2 lounges and 2 dining rooms. The first floor is accessible by a passenger lift and stairs. Two bedrooms have ensuite facilities. The home is equipped with manual handling aids and grab rails to promote independence. There is a car park to the rear of the home and there is an enclosed garden. The current Fees for the service are £506.50 to £587 weekly. Dale Park DS0000017278.V340943.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was a ‘key’ inspection for the service and covered the core Standards the home is expected to achieve. The inspection took place over a period of 12 hours over 2 days. The inspector met with the majority of residents and spoke with a number of residents and a number of relatives who were visiting the home. The inspector also spoke with members of care staff on a one to one basis and the registered manager. The inspector carried out a two hour observation on the first day of the inspection using a specialist tool for dementia care which highlights levels of staff interaction, resident well being and engagement with surroundings of the residents observed. The findings are used in parts of the report. Resident surveys were also given out and 12 of these were returned. They were mainly filled in by relatives due the level of communication of some residents. Comments are used in the report. One comment was received from a GP who visits the home. A tour of the premises was carried out and this covered all areas of the home including the resident’s rooms [not all bedrooms were seen]. Records were examined and these included three of the resident’s care plans, staff files, staff training records and health and safety records. What the service does well:
The home has a useful range of information guides available such as the ‘Service Users Guide’, which describes the facilities and services in the home. These are displayed in the entrance to the home. The manager or senior nurse in the home carry out assessments prior to residents coming into the home so that the home is better able to make a judgment as to whether needs can be met. The assessments seen were very comprehensive and included assessments from health and social care professionals also involved with the residents care Care plans are very well written and detail the health and personal care needs of residents in a clear manner. Care plans are evaluated / reviewed on a
Dale Park DS0000017278.V340943.R01.S.doc Version 5.2 Page 6 regular basis. Relatives spoken to have some involvement with the care plans and, depending on choice, had contributed information and views. Staff interviewed were keen to highlight the importance of good communication with relatives. There are reviews held every 3 months to keep relatives involved in the care. The staff in the home are careful to refer residents for health care reviews and this was evident from the regular visits by the GP as well as other health care professionals clearly recorded in the care files. One resident with a pressure sore was being monitored effectively with regular liaison with the tissue viability nurse. The wound care records were excellent as they gave a clear outline of the progress of the wound and the effectiveness of the treatment and care. Observation of residents evidenced a good standard of personal care for residents. Residents seen were clean and tidy. Relatives reported that personal care standards are maintained. One commented: ‘They keep my mother warm, clean and well fed. I could not ask for anything else. My mother has been in Dale Park for a number of years and I have never had any concerns about her care and welfare. I think they are very good under difficult circumstances. I am totally satisfied’. There is a lot of physical care in terms of assisting residents to the toilet, to mobilise and to feed and this care was carried out appropriately with staff using aids and adaptations available to them. The pace of the care was relaxed. At times residents became agitated and staff were seen to be skilled at intervening at these times and acting to comfort and validate the residents feelings. NVQ training is ongoing and the home is now aiming for 85 of care staff to be NVQ trained. Overall the training in the home is good evidencing that care staff have the knowledge base to carry out care. Three staff files were inspected and the standards for the recruitment of staff are good. All files contained necessary details including POVA [Protection of Vulnerable Adult] and Criminal Records Bureau [CRB] checks. The home has very good systems in place for monitoring and improving quality. There is an annual external independent quality audit conducted as well as various ongoing internal auditing processes undertaken by the company and staff in- house. There is a ‘Friends and Family’ forum held on a regular basis where relatives can have some input into the running of the home. Southern Cross also carries out a service user satisfaction survey. Dale Park DS0000017278.V340943.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better:
The care planning is very good but there is a recommendation that there should be a better link between the care staff documentation and the care plan, which is held n a separate file. A copy of the ‘care plan index’ placed in the personal care file would help with this. Activity to engage residents in their surroundings should be more consistently planned. There needs to be particular attention paid to making the best use of available facilities such as the snoozelen room and the garden area. The one to one work that the activities person gets involved in is very good and there needs to be more of this. Meal times should be given further consideration so that they are planned with maximum staff availability and input so that residents needs a consistently met and mealtimes are given prominence. The external areas of the home including the garden need to be properly maintained so that residents can benefit and improve there quality of life. Dale Park DS0000017278.V340943.R01.S.doc Version 5.2 Page 8 Staffing in the home is generally consistent and does meet care needs but this should be maintained at all times particularly given the highly demanding nature of the care needs of people with dementia. Training in the home is good. It is recommended that the induction programme is fully audited against the skills for care induction standards to ensure compliance. 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 Park DS0000017278.V340943.R01.S.doc Version 5.2 Page 9 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 Park DS0000017278.V340943.R01.S.doc Version 5.2 Page 10 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): 1,3 [standard 6 N/A] Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are assessed and admitted to the home appropriately so that their care needs can be met by the staff. EVIDENCE: The home has a useful range of information guides available such as the ‘Service Users Guide’, which describes the facilities and services in the home. These are displayed in the entrance to the home. Relatives spoken to say that they had been given copies of this document which had helped in both choosing the home and also assisted in the settling in period. There is an up-to-date copy of CSCI’s inspection report available in the entrance as well as the results of service user satisfaction surveys, which are displayed on the wall. There is a copy of the Service User Guide in each of the resident’s bedrooms. Dale Park DS0000017278.V340943.R01.S.doc Version 5.2 Page 11 The manager or senior nurse in the home carry out assessments prior to residents coming into the home so that the home is better able to make a judgment as to whether needs can be met. The assessments seen were very comprehensive and included assessments from health and social care professionals also involved with the residents care. The assessments also include a ‘draft care plan’ which outlines the residents more immediate assessed needs so that care is planned from admission. Further assessments are carried out once the resident is admitted and from these a more comprehensive care plan is devised. The assessments include all routine daily living activities such personal care as well as more specific assessments covering risk, nutrition, pressure area care, and mental assessments. The social assessments display evidence that relatives are involved in the care from an early stage. The manager aim is for more relatives to get involved in the care assessments and planning of residents and this will be achieved through the ‘friends and family support group’ that is run on a regular basis. Dale Park DS0000017278.V340943.R01.S.doc Version 5.2 Page 12 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): All key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care planning system in the home is of a very good standard and involves relatives in the daily care of residents. Residents are referred for and receive appropriate health and personal care so that well-being is promoted. EVIDENCE: Individual care plans were available for each resident. 3 care plans were reviewed and these were very well written and detailed the health and personal care needs of residents in a clear manner. The files are so arranged that each care need has any supporting care documentation along side for easy reference. Care plans are evaluated / reviewed on a regular basis. The evaluations were a clear note of progress made against the goals set on the care plan. Relatives spoken to have some involvement with the care plans and, depending on choice, had contributed information and views. There is a ‘client review’ form, which outlines reviews with relatives. Relatives found these useful and said
Dale Park DS0000017278.V340943.R01.S.doc Version 5.2 Page 13 that staff were particularly good at keeping them updated regarding changes in care. Staff interviewed were keen to highlight the importance of good communication with relatives. There are reviews held every 3 months for some relatives. Staffs interviewed were aware of the care needs of these residents. Care staff discussed the personal care files that they maintain which record the daily routine care of residents. Some care staff reported little time to access the care plans due to pressure of daily work with residents. There is however a ‘care plan index’ for each resident which highlights the main care needs and there was some discussion as to the value of including this in the personal care file for easy reference for care staff. The staff in the home are careful to refer residents for health care reviews and this was evident from the regular visits by the GP as well as other health care professionals clearly recorded in the care files. One visiting GP was pleased with the way the home monitored resident’s health needs and made appropriate referrals for any support needed. One care file evidenced a recent referral for one resident regarding a skin complaint and this had been well documented. One resident with a pressure sore was being monitored effectively with regular liaison with the tissue viability nurse. The wound care records were excellent as they gave a clear outline of the progress of the wound and the effectiveness of the treatment and care. Medications for residents are safely administered. One resident reviewed did not always comply with medications and would refuse. This was a particular problem because of a diabetic condition that required regular insulin injections. The medication records indicated that the insulin was always given and the nurse discussed how this would be around meal times but was open to some flexibility due the nature of compliance. This was recorded in the care notes. Observation of residents evidenced a good standard of personal care for residents. Care staff complete daily records of care interventions such as washing and dressing. Residents seen were clean and tidy. Relatives reported that personal care standards are maintained. One commented: ‘They keep my mother warm, clean and well fed. I could not ask for anything else. My mother has been in Dale Park for a number of years and I have never had any concerns about her care and welfare. I think they are very good under difficult circumstances. I am totally satisfied’. Dale Park DS0000017278.V340943.R01.S.doc Version 5.2 Page 14 It was noted that the home have reduced resident numbers at present and therefore slightly higher staffing ratios than would be the norm. During the 2hour observation of care it was noted that staff were very patient and the pace of the care given was appropriate for residents. Dale Park DS0000017278.V340943.R01.S.doc Version 5.2 Page 15 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): All key standards. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The social care in the home is provided with emphasis on people’s individuality so that friends and family feel involved in the home and the care but this needs to be more consistently maintained in some key areas so that residents can experience increased engagement and improved well-being. EVIDENCE: As part of the inspection a two hour observational study was undertaken in one of the lounge areas so that care could be assessed in terms of the daily interactions of residents with their surroundings and how this effected how well they feel. The study evidenced some good practice by care staff who were observed to patient and supportive of residents throughout the period. There is a lot of physical care in terms of assisting residents to the toilet, to mobilise and to feed and this care was carried out appropriately with staff using aids and adaptations available to them. For example some residents were assisted with a hoist and during dinnertime one resident had an adapted plate to help him eat [although this possibly needs reviewing and was discussed at the time]. The pace of the care was relaxed. At times residents became agitated and staff
Dale Park DS0000017278.V340943.R01.S.doc Version 5.2 Page 16 were seen to be skilled at intervening at these times and acting to comfort and validate the residents feelings. In terms of engagement with the environment and surroundings the residents observed varied in their responses. Care staff [two in total] were engaged in physical care tasks for the most part and when not receiving direct care residents were observed to be withdrawn or asleep. The only stimulus in the room was the television which was continually on but none of the residents were engaged with this. The activities person came into the room half way through the observation and the difference in terms of resident’s engagement and observed feelings of well being were marked. The activities person was very skilled at working on a one to one basis with residents and used touch and eye contact as well as verbal prompts to engage residents and enable them to participate in their surroundings. Although working one to one other residents nearby were also seen to be engaged and listening and watching. The quality of this level of interaction is not consistent however. The activities person is employed full time but with a care home of up to 54 residents with dementia her time is insufficient to provide the level of planned intervention necessary to make a real difference on a daily basis. Both care staff and relatives reported that the activities person spends very limited time in the activity described above so that for long periods residents can be left not engaged and either withdrawn or asleep. This was observed on units throughout the inspection. The home [on the evidence of this visit] have improved in that the day areas are now generally staffed but in terms of quality regarding general socialisation there still needs to be some work to improve opportunity in this area so that residents are more likely to experience positive feelings of well being. The activities person was able to evidence diverse work in terms of the creation of a snoozelen [area providing opportunity for resident to engage and relax using light and music] in one of the bedrooms. There is also a similar room that has been created for general use. Again, however, the usage of both of these areas was reported to be limited. For example the resident only used the facility in her room once a week or fortnightly. Similarly the snoozelen room was reported to be used only occasionally. Staff reported that if the key was made more generally available this area could be better used. It would appear from the inspection that the staff have the ability and knowledge to carry out some very good work in dementia care but with minimum staffing and the level of physical care needed they do not always have the level of input needed. One staff member summed it up ‘ it’s a very good home but the residents need to do more. They still sit around a lot and rarely get out’. Dale Park DS0000017278.V340943.R01.S.doc Version 5.2 Page 17 Relatives reported a high level of satisfaction with the care and felt involved on a daily basis. One reported, ‘staff are marvellous. I feel the home has improved. They are open to comments and suggestions. We have ‘family and friends meetings’ and have speakers at these. John [manager] has a ‘surgery’ every Wednesday for family and supporters but we can see him any time’. Other comments were just as favourable. Most felt that the areas that could be improved on were getting out more and access to the garden areas. Meal times were observed. The staff have worked at trying to make this time more relaxed and interactive for residents. The level of disability observed was high so that many of the residents require feeding by staff and others varying levels of assistance. Generally the meal time observed was well paced and residents were assisted by staff to maintain their diet. With only two staff to assist in the dining room [on one unit] there were inevitable short cuts in care however. For example one carer had to feed two residents at the same time and a meal was put out and could have gone cold until the nurse in charge finished giving out medicines and assisted. There was some discussion with the manager about how further improvements could be made. The obvious immediate improvement could be the arranging of medication times to be either before or after meals so that the nurse can have a more direct involvement with meal times. [This will depend on any specific actions of individual medications]. Staff were aware of residents likes and dislikes. There were some orientation aids available for residents [see ‘environment’] but it was noted that none of the units had a menu board advertising the daily meal which may assist some residents to further engage in the meal time experience. The chef discussed the new computerised menu planning system [NUTMEG], which assists in planning a balanced diet for residents so that more healthy options can be planned. With some residents on specialised diets the home can evidence good attention to the diverse needs of residents with respect to diet planning. Dale Park DS0000017278.V340943.R01.S.doc Version 5.2 Page 18 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): Key standards. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good complaints process and the home has responded appropriately to concerns raised so that residents are protected. EVIDENCE: Staff have undergone some training in protection of vulnerable adults and abuse awareness and there is more of this planned. Staff spoken to were able to relate examples of good care practice and understand and report poor practice. Residents are therefore protected. The complaints file evidenced 2 complaints over the last year. One looked at in detail concerned the loss of jewellery and glasses. This was investigated by the manager and letters sent within time scales. Relatives were aware of the complaints process and this is clearly displayed in the homes information guides, which are readily available. Relatives reported that managers are available to listen to concerns and both staff and visitors felt that managers would act on concerns raised. Dale Park DS0000017278.V340943.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is comfortable in that bedrooms and day areas continue to be maintained with respect to good practice in dementia care. There remains some work needed externally so that residents can benefit from access to well maintained outdoor areas EVIDENCE: Since the last inspection there has been work completed on refurbishment and decorating of the home. The home presents as warm, clean and welcoming with comfortable lounge and bedrooms. There was no evidence of unpleasant odours. There is much evidence of good practice in trying to create an environment for the diversity of need that people with dementia present with. For example there are colour-coded doors for bedrooms and toilets and bathrooms and there is good usage of signs to orientate residents [although this can still be developed further]. Bedrooms all have names and photographs and are well
Dale Park DS0000017278.V340943.R01.S.doc Version 5.2 Page 20 personalised. On one unit there are themed photographs. The general ambiance is well maintained and relaxing. Visitors were pleased with the facilities and remarked that ‘everywhere is always clean and tidy’. Each unit visited had the TV on with none of the residents engaged in this. The continual invasive noise made it difficult to interact and talk with relatives and residents in some instances. There is no radio facility although piped music is available. The home has been developed with the needs of the residents in terms of new shower facilities so that there is a choice of bathing. Nursing aids such as specialised chairs and recliners have also been provided. Externally there are signs of some poor maintenance. The garden area is in need of attention with long grass and flowerbeds in need of attention. This area is now accessible from one of the day areas but is underused [reports from staff and visitors]. The remaining gardens could be better developed and currently as not used at all. The fencing is in poor condition in parts and needs attention. There is no gardener employed at present and the maintenance person struggles to maintain such a large home both internally and externally The manager reported that relative feedback is that some windows are in need of attention as the double glazing panels are displaying internal condensation [this was evident from observation]. There is an ongoing development plan for the home and the manager was in the process of updating this. The comments in this report need to be borne in mind. Dale Park DS0000017278.V340943.R01.S.doc Version 5.2 Page 21 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): Key standards. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are recruited and trained appropriately so that resident needs can be met but the overall quality of care could be better maintained by developing staff for activity input as well as a person to work on the garden. EVIDENCE: For 36 residents in the home there were 2 trained nurses and 8 care staff on duty and these figures are generally consistent from reviewing the duty rota. It was noted that on two occasions in the recent past [12th and 15th July] the home has operated with less than these numbers and on one of these occasions staff reported that only 2 care staff were left to manage 15 residents. Comments have been made in the report about the high level of dependency of the residents and staffing numbers are very important to maintain a level of care. The manager explained that it is difficult to cover shifts at short notice if staff go sick but the present company policy regarding accessing agency staff does not help at these times. The need to ensure staffing numbers was a requirement during the last inspection and although this has generally improved there must be continued vigilance in this area. The manager and activities person are additional to these numbers. There is also an administrator. There has been no use of agency cover so that continuity of care is more likely to be provided in meeting resident’s needs.
Dale Park DS0000017278.V340943.R01.S.doc Version 5.2 Page 22 The quality of the care could be enhanced by the provision of more hours for activity input [see social care section] and the maintaining of the garden could be improved by specific staff hours for this purpose [see environment]. Staff observed displayed very good communication skills when dealing with residents who are confused and did not seem rushed in any aspect of care. There is a reduced level of residents at present and staff felt that generally they had a little more time at present. All staff spoken to at the time of the inspection felt that a good standard of care is maintained and this was echoed by relative interviews who described staff as ‘marvellous’ and ‘the staff are excellent at caring for residents. They treat them with respect and that bit extra…… as part of a family. I am very happy with the care my mother receives especially after she had a stroke recently’. Staffs training files were seen. The home has a good induction programme for new staff and staff spoken to had found this beneficial. Some induction records had been signed of over a period of 2 weeks which seems rather quick, especially for those staff new to caring [as one record seen evidenced]. There was some discussion wit the manager and it would be a recommendation that the induction checklist is audited against the skills for care common induction standards to ensure that all areas are covered. The skill mix of trained nurses in the home lacks nursing staff with a mental nurse qualification in sufficient numbers. Some general nursing staff described courses in dementia care they had a attended and more of this training should be facilitated. NVQ training is ongoing and the home is now aiming for 85 of care staff to be NVQ trained. The training matrix seen evidenced more recent training in adult protection / abuse awareness. Following a complaint raised at the beginning of the year the manager had made it a priority that care staff would undertake the companies training package on individualised care ‘as a matter of urgency’. Currently only a few staff have attended this however. Overall the training in the home is good evidencing that care staff have the knowledge base to carry out care. Three staff files were inspected and the standards for the recruitment of staff are good. All files contained necessary details including POVA [Protection of Vulnerable Adult] and Criminal Records Bureau [CRB] checks. Dale Park DS0000017278.V340943.R01.S.doc Version 5.2 Page 23 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): All key standards. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed in the best interests of residents and there is evidence of continued planning and change to meet best practice so that resident’s needs are better met. Dale Park DS0000017278.V340943.R01.S.doc Version 5.2 Page 24 EVIDENCE: The Registered Manager is Mr John Price who was appointed in December 2002 having worked at Dale Park as the Deputy prior to this appointment. Mr Price has many years experience working with the older resident group and has held previous managerial positions within the care profession. Mr Price is a qualified nurse RMN, SEN (Gen) and also has a social work management qualification [CSWM]. Overall staff interviewed felt generally supported and stated that the manager was approachable and helpful. The system of formal supervision in the home has commenced and has improved from last inspection in that there is more consistency with staff reporting that they have had sessions and found them useful and supportive. The home has very good systems in place for monitoring and improving quality. There is an annual external independent QA audit conducted as well as various ongoing internal auditing processes undertaken by the company and staff in-house [medication audit, care plan audit, Health and Safety Audit] and the results are discussed at staff meetings as well as management meetings. [Staff meetings were reported a infrequent and there should be more of these]. There is a ‘Friends and Family’ forum held on a regular basis where relatives can have some input into the running of the home. Southern Cross also carries out a service user satisfaction survey. None of the residents have the capacity to manage their own finances. The policy of the home is for relatives to manage this. The administrator manages personal allowances in house with input from relatives. Records are maintained and receipts kept for money spent. A finance manager from the company also completes a regular audit of the system. There are good systems in place for the ongoing management of health and safety in the home. Policies and procedures are continually reinforced with staff via the regular Health and safety meetings as well as dissemination of policies on a regular basis. Records seen, such as [fire, manual handling, gas], were all up-to-date. Dale Park DS0000017278.V340943.R01.S.doc Version 5.2 Page 25 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 4 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 3 X 3 Dale Park DS0000017278.V340943.R01.S.doc Version 5.2 Page 26 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. Standard Regulation Requirement Timescale for action 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 OP7 Good Practice Recommendations The care plan index contained in the main care file should be copied into the care staffs ‘personal care file’ so that there is a practical and easily accessed link to the main care plan for carers to read. Activities need to be more consistently planned so that residents are better engaged on a daily basis. Attention should be paid to: • • • 3 OP13 Introduction of more diverse environmental stimulus other than TV [radio for example]. More time spent on one to one work with residents. Better access to snoozelen facility. 2 OP12 Residents should be accessing garden areas more frequently and getting out of the home on a more routine
DS0000017278.V340943.R01.S.doc Version 5.2 Page 27 Dale Park 4 5 OP15 OP19 6 OP27 basis. Meal times should be reviewed with regard to comments in the report. The home should continue to be developed with attention being paid to external areas and the need to access garden space so that the quality of life for people in the home can be enhanced. Continued vigilance is needed to maintain minimum agreed staffing numbers at all times. The company policy on accessing agency support if required should be reviewed. Some additions to the staff team such as increased activity hours and a gardener would enhance care overall. 7 OP30 Nursing staff should be encouraged to attend clinical updates on dementia. The induction programme for staff should be audited against the skills for care induction standards. Dale Park DS0000017278.V340943.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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 Park DS0000017278.V340943.R01.S.doc Version 5.2 Page 29 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
