Inspection on 12/10/05 for Dalemead

This inspection was carried out on 12th October 2005.

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

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

Other inspections for this house

Dalemead 07/06/07

Dalemead 26/04/06

Dalemead 26/04/05

Dalemead 09/09/04

Dalemead 29/04/04

Similar services:

Clovelly House Residential Home Ltd

Cherry Orchard Nursing Home

Coppermill Care Centre

Fountains Care Centre (The)

Eleanor Palmer Trust Home

Elmstead House

Bridgeside Lodge Care Centre

Charlotte House Mental Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Dalemead 10-12 Riverdale Gardens East Twickenham Middlesex TW1 2DA Lead Inspector Sandy Patrick Unannounced Inspection 09:00 12 October 2005 th 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 Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Dalemead Address 10-12 Riverdale Gardens East Twickenham Middlesex TW1 2DA Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8892 2161 02088916697 Mr Anwar Phul Mr Anwar Phul Care Home 49 Category(ies) of Dementia - over 65 years of age (49) registration, with number of places Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th April 2005 Brief Description of the Service: Dalemead is a privately run residential care home located in East Twickenham. The home is close to local shops, pubs, parks and other amenities. The home offers accommodation to 49 older people over the age of 65 who have dementia. The home was opened in 1942 and purchased by the current owner in 1989. The building consists of two Victorian properties linked together with a further extension. Accommodation is on three floors, all serviced by a passenger lift. There is a large and mature garden to the rear and a small car park at the front. The home is divided into four interconnecting units. All bedrooms have en suite facilities. The Registered Owner is also the Manager and has managed the home since 1978. The current scale of charges is £535.60 - £575.00 per week. Additional charges are made for hairdressing, private chiropody, toiletries, newspapers and magazines, escort duty and private transport. The Registered Person has produced a Service User Guide, which includes information on the aims and objectives of the service. Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 12th October 2005, and was unannounced. The Inspection Team consisted of a Regulation Inspector and a Pharmacy Inspector. The findings of the Pharmacy Inspector are recorded under Standard 9 of this report. The Manager was not working at the home on the day of the inspection, but met briefly with the Inspectors when he visited the home during the day. The Inspection Team met with the Deputy Manager, other staff on duty and service users throughout the day and was made welcome by all. The Deputy Manager reported that the home was fully occupied at the time of the inspection. The Inspectors saw service users pursuing a variety of activities throughout the day. Some staff had a good rapport with service users and treated them with respect and kindness. Some of the staff who spoke about service users to the Inspectors, clearly knew about individual needs and how these should be met. However, some other staff were observed and overheard being unkind and not showing due respect for individual needs, wishes and feelings. Some of the practices the Inspectors observed were not appropriate and service users have been put at risk. Service users who spoke with the Inspectors gave a mixture of views on the home. Some service users said that they were happy and well cared for. Whilst others gave examples of staff being unkind to them. These areas of concern were discussed during the feedback at the inspection and further information is detailed within this report. The Registered Person must take appropriate action to make sure that service users are treated with kindness and respect at all times. Cleaning products were not stored or labelled appropriately. Some cleaning products were stored in food containers in the same cupboards as food and drink. This is highly dangerous as many of the service users are confused and may not be able to identify the dangers of these cleaning products. This area of concern has been raised at previous inspections. An immediate requirement was made to store these products in labelled containers and locked facilities. Failure to meet this requirement endangers service users and may lead to enforcement action being taken by the CSCI. What the service does well: Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 6 The home provides a good range of information on the service through the Statement of Purpose, Service User Guide and assessment procedures. The Owner/Manager has worked at the home for many years and has a good knowledge of the service. He has good links with various care home associations, with health care professionals and other organisations and individuals to give a holistic approach to care and to keep updated on best possible practice. Families of service users are able to visit the home and be involved in the care of service users. The Chef has worked at the home for many years and has a good awareness of individual nutritional needs, likes and dislikes. The menu is varied and offers a choice of wholesome food. Service users reported that food was well prepared and tasty and staff reported that service users enjoy their meals. There is an excellent programme of planned activities offering service users choices, variety and opportunities to try new things. The Activities Officer is dedicated to her role and has introduced new activities for groups and individuals. A number of staff have worked at the home for many years and have spoken with the Inspectors about this. They have a good knowledge of individual needs and some staff demonstrated a genuine fondness for the people who they care for. What has improved since the last inspection? What they could do better: A large number of National Minimum Standards have not been met at this inspection and some of the areas of concern identified in this report are very Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 7 serious. Some of the concerns have been identified at previous inspections and should not be continuing. The Manager must make an action plan to address the areas of concern identified within this report. Failure to address these concerns within timescales may lead to regulatory enforcement action being taken by the CSCI. Further improvements around medication procedures and recording are required. Not all staff treat service users with respect and kindness and these staff must be appropriately trained, supervised and monitored. Food in some of the kitchens throughout the home was not stored or labelled appropriately. Service users were not offered choices at meal times. The staff support of service users at mealtimes was inappropriate and was at times dangerous. The storage of toiletries would suggest that service users share some of these. This is unacceptable and service users must have their own toiletries. Some areas of the building would benefit from renewal and redecoration. The hot water from some outlets is not thermostatically controlled and service users are at risk from scalding. Fire resistant doors are wedged open, which prevents them closing in event of a fire. Cleaning products are stored in unlabelled containers and are not locked away. Staff files indicate that criminal records checks have not been made on all staff. Staff files did not all contain written references. There was limited evidence of staff training. There was limited evidence of staff supervision and regular staff meetings. 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. Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 8 DETAILS OF Inspector FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 5 Prospective service users are provided with information about the service and are able to visit and spend time at the home prior to admission. There is an appropriate procedure for the assessment of service users, which incorporates their needs and opinions. EVIDENCE: The Registered Person has produced a comprehensive Statement of Purpose and Service User Guide for the home. These include the required information, including a copy of the home’s aims and objectives and the complaints procedure. Copies of these documents and the latest inspection report are available in the main foyer. There is an appropriate procedure for assessment. All potential service users are invited to spend a day at the home, sharing a meal and activities with other service users. The Manager or senior staff conduct an assessment of needs, involving the service user, their representatives and any relevant professional input. Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 10 Copies of pre admission assessments were seen within service user files seen. Assessments were comprehensive and included information on personal preferences, likes and dislikes, personal and medical needs, communication, social needs, night time support and orientation. Information from assessments was appropriately transferred to service user plans. There was evidence of consultation with service users and their families. Service users are admitted on a six week trial stay. At the end of this period a review meeting is held, where the service user, their representatives, the home and local authority make a decision about whether the home can meet the needs of the service user. Evidence of six week and annual review meetings were seen within service user files examined. Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Individual needs are recorded within service user plans. These are regularly reviewed. There is evidence that health care needs are monitored and met. There are insufficient records relating to personal care. The home has arrangements for the ordering, storage and recording of medication and has access to a pharmacist for advice. Omissions in the written procedures and in recording, and items brought in by relatives were found that might affect the health and welfare of service uses. Some of the practices observed were inappropriate and, in some cases, dangerous and abusive. Staff on duty failed to recognise that their behaviour was inappropriate and the Inspector is concerned this behaviour is custom and practice. From the observations made and conversations with service users, it is clear that not all staff treat service users with respect or sensitivity. EVIDENCE: Individual service user plans are in place for all service users. The Inspector looked at nine of these in different units. Team Leaders in two units have introduced new information into care plans and have encouraged staff in these units to contribute to care planning. Two of the units do not have a Team Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 12 Leader and although the care plans in these units are detailed and contain relevant information, the staff in these units have not been involved with their development and review and this may be the reason why they lack understanding of individual needs. Service user plans include information on promoting independence and choice. Not all service user plans had been signed by the service user or their representative and should be. Risk assessments are in place for all service users. These have been subject to regular review. However assessments of risk for two service users who smoke must be reviewed following a recent incident. The Team Leaders told the Inspector that they worked closely with health care professionals who support service users. All service users are registered with local GPs, who visit the home as required. One Team Leader spoke about the support a service user had received from the palliative care team and how these nurses had worked closely with staff at the home. The Team Leader reported that staff had a good understanding of how best to support this service user and worked well with their family to provide continued support and care at the home. The Team Leaders had a good knowledge of the service users’ personal and health care needs and how these could be met. Service user plans at the home are hand written and staff do not access computers as part of their everyday work. One of the Team Leaders told the Inspector that they felt they would be using computers more in their work and they would like to receive training in this area. Computerising areas of care planning and other records at the home would provide some benefits and mean reviews and updating information would be easier. However, the staff must be appropriately trained so that they can be involved with this process. All medications administered by staff along with the records relating to receipt, storage, administration and disposal of medication were examined. The person in charge and two members of staff were interviewed, policies and procedures reviewed and medication not supplied in the monitored dosages system was counted and compared to the amount that should be in stock to ensure medication had been administered as prescribed to protect the health and welfare of residents. From these observations and discussions no procedure was seen for the supply of medication to service users on leave from the home. There was a policy for action following a medication error. The person in charge said that there was no formal system of reporting these incidents. One resident had two missing entries on the administration record indicating administration/nonDalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 13 administration of medication. It was clear from the medication container that the medication had been given correctly. Two items with a short expiry once opened were not labelled with the date when opened. From the dose administered the containers would be finished before they reached the expiry period. Two items were found on one unit staff said had been brought in by relatives. Staff said they had not administered these items although no record of these items was made on the administration record. No record was made regarding confirmation with a GP that the items could be used. The amount of medication in stock agreed with the amount that should be in stock for all items although in seven instances it was difficult to check as the quantity of medication left carried over from one week to the next was not recorded on the administration record. One controlled drug that is administered by the district nurse is stored in the home. No record is made in the register for this item. The fridge temperature had not been recorded regularly on two units. The pharmacist identified that the fridge temperatures should be recorded on the last advisory visit. This had not been followed. The communication books on each unit identified changes in residents’ conditions and actions taken in response to advice from health professionals. All other records had been completed accurately and provided evidence that all medication had been administered correctly unless otherwise recorded, changes to medication clearly identified, and medication was stored and administered safely in order to protect the health and welfare of residents. Records of baths are in place for some service users but not others. Records indicated that some service users had long gaps between baths. This may be an error in recording. It is important that all service users are offered regular baths and that records are accurate and up to date. Throughout the day the Inspection Team witnessed a variety of staff approaches. Some staff worked well with service users, offering them choices, initiating conversations and generally attending to needs. However, a small number of staff were seen to behave inappropriately. These staff did not appear to realise that their behaviour was inappropriate. This is a serious concern and all staff need to be able to recognise what constitutes bad practice and abuse. During lunch in one unit, staff attending to service users did not speak to any service users except in response to questions asked or to tell service users off. For much of the lunchtime, service users were left unattended in the dining room, with the staff coming to the room for practical tasks. The two staff Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 14 members serving lunch did not offer any choices regarding food, portion size or condiments to any of the service users. They plated up food and handed it to service users without comment. One service user was told not to use a spoon to eat their dinner. Another service user was told to sit down when they stood up to see what the food on the serving trolley was. Another service user was told that they were not allowed mayonnaise with their dinner as it did not go with their meal. Service users were not offered choices about drinks during mealtimes and were all given the same. Gravy was poured by staff on meals without asking service users about their personal preferences. During the meal a CD of music was playing. When this music finished one staff member turned the CD on again without asking service users if they wanted to listen to the same music again. These practices are institutionalised and unacceptable. Service users were not treated as individuals and the staff behaved in a routine which showed no regard or interest in the service users or the food that they were serving. One service user was at the hairdressers when lunch was served. The staff served this person’s soup and drink even though they were not there. These were left on the dining table and for the service user who returned to the dining room twenty minutes later. This practice is unacceptable and food must not be pre served and left to go cold. Two service users in two different units were left in wheelchairs to eat their lunch. Service users must be given the opportunity to sit in normal chairs if they wish. If service users chose to remain in their wheelchairs or there is a medical reason for this, then this must be recorded and repsected. At one point during the meal a service user said to a member of staff that they had not had their morning cup of tea. The staff member put a finger to her lips, told the service user to be quiet and pointed to the Inspector. This behaviour is completely unacceptable. Service users have the right to make comments such as these to anyone they chose. Staff must not tell service users to be quiet and must not ask service users to modify their behaviour or comments to hide information from the Inspector. The Inspector has serious concerns about the support given to a service user to eat their meal. The service user was left alone to drink their soup and then eat their meal. However, periodically a staff member walked over to the service user and took their soup cup or cutlery and started to force feed the service user. They did this on several occasions each time walking up and walking away without speaking to the service user. The service user appeared to be managing sufficiently on their own and the reason for this intrusive, inappropriate and dangerous behaviour by staff was unclear. If a service user requires assistance with eating and drinking then this must be fully recorded within their care plan. Staff supporting service users must sit with them for the duration of their meal and must offer them choices and speak with them whilst supporting them. Staff assigned to these duties must be appropriately Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 15 trained to do so and must not force feed service users with large mouthfuls. The practice observed was abusive. However the staff member and other staff on duty did not appear to recognise that there was anything wrong with this practice. This is a serious concern and the Manager must take action to ensure that service users are appropriately supported during meal times. Staff serving meals wore plastic aprons and gloves. Although the Inspector recognises the need to protect clothing, there is no reason for staff to wear plastic gloves whilst serving food. The staff serving food should obviously make sure their hands are clean and follow safe hygienic practices. The staff should not need to handle the food directly and should be using serving utensils. Wearing plastic gloves to serve food creates an institutionalised feel and is inappropriate. The Inspector observed two members of staff in another unit sitting with service users and chatting with each other for a considerable period of time. Neither member of staff spoke with the service users around them and, again, they did not appear to realise that this behaviour is unacceptable. One service user told the Inspector that members of staff had told them off for not putting their continence aids in the bin. Another service user told the Inspector that staff had been rude to them in the past. Two members of staff were overheard discussing the health and personal care needs of one service user in front of other service users. One service user who was walking to their room after lunch was told to go back to the lounge by staff on duty. The service user was then left in a seat in the lounge. The staff member did not have any form of conversation with the service user, did not ask them why they were going to their room and did not explain why they felt that the service user should return to the lounge instead of going to their own room. Service users have the right to move around the home freely. Any restrictions on this must be agreed by a multidisciplinary review and must be documented within care plans. Staff on duty are responsible for effectively communicating so that service users understand this. If there are no agreed restrictions then service users must not be prevented from going to their room if they please. One service user tried to have a conversation with a staff member who was in one of the units’ kitchens. The staff member argued with the service user and then laughed at what the service user was saying. They told the service user to, ‘give me some peace’. Following this another staff member who had not been involved in the conversation walked up to the kitchen shut the door so that the service user could not continue their conversation and walked away again without comment. This kind of treatment of service users is totally unacceptable. If staff are too busy to speak with service users at any given time then they must make this clear by being polite and informative. Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 16 There is a payphone available to service users on the ground floor. However, no chair is placed beside this. A box of toiletries, including hairbrushes, was stored in the kitchen of one unit. Bars of soap were seen on the side of a bath in one unit. Bottles of bubble bath were stored in two communal bathrooms. None of these items were labelled and their storage implies that these are used as communal toiletries. This issue has been raised at previous inspections. Communal toiletries must not be used. Service users must possess their own supply of toiletries which are either stored in their rooms or labelled to avoid being used by others. Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 – 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 There is a dedicated Activities Coordinator who organises and manages a full and varied programme of activities. Activities are designed to meet the needs of individuals and groups. The Activities Officer has consistently developed the service that she offers. There is a flexible visitors procedure and families are able to be involved with the care of their relatives if they wish. Not all service users are offered choices with regards to their daily lives. There is a balanced and varied menu offering a range of wholesome and well prepared food. Food on units was not stored appropriately. EVIDENCE: The home employs an Activities Officer who develops individual activity care plans for all service users. She reviews these monthly and records all activity participation. There is a full and varied activity programme which is changing and adapting to meet the needs of service users. The staff on duty all spoke highly of the Activities Officer and senior staff said that she was ‘invaluable’ and ‘excellent’. She is enthusiastic and has consistently demonstrated a Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 18 genuine commitment to her role. At this inspection she spoke about new ideas and things that she had tried at the home. What makes the activities particularly good at Dalemead is the attention to individual needs. The Activity Officer makes an effort to meet everybody’s needs to some extent. This includes spending time with each service user within the home and also taking those who wish out to local cafes, parks and shopping. The home also employs someone who runs an exercise class and another person who runs a craft and needlework class, both are held weekly. Other activities include games, quizzes, reminiscence, walks to local places of interest, small group shopping, music, poetry and craft work. The Activity Officer has undertaken specialist training for her role and reported that she keeps her training updated and is involved in national groups designed to inform and support Activity Officers. The Activities Officer has undertaken work with some families to produce service user ‘life histories’ to enhance service user plans. The activities programme allows time with each service user every week to pursue an activity of their choice. On the day of the inspection the Activities Officer spent time with each service user on one unit. Some service users participated in art and craft, others did a short quiz and with one service user the Activities Officer arranged a list of DVDs which she planned to hire for this service user to watch. Every day the Activities Officer offers nail and hand care to a group of service users and appointments can be booked so that everybody has an opportunity for this each week should they wish. In addition to this individual approach group activities are organised. These include activities for the whole house and for each unit. There is a clear programme of activities which is advertised on notice boards in each unit. Service users are encouraged to participate in inter-unit competitions to earn points and prizes for their units if they wish. The notice boards are bright and informative. Special events are organised on a regular basis and since the last inspection there has been a VE Day party, a summer barbeque, a cream tea party and monthly visits from entertainers. The Activities Officer told the Inspector that two trips to see the Christmas lights and a Christmas party were being organised. A group of entertainers is coming to the home to perform a pantomime. Service users will also be supported to go Christmas shopping in Richmond individually or in small groups. The Activities Officer said that service users are encouraged to contribute their ideas for activities. Bi monthly newsletters have been created to inform Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 19 service users and their relatives of activities and to encourage participation and choices. The Activities Officer said that one new activity which had been a success was food tasting, where a specific food type (she gave the example of different types of melon) is sampled by service users. The Activities Officer said that she worked really closely with the cook who provided food for this and other events and was willing to add new ideas to the menu if service users wanted this following their food sampling. The Activities Officer told the Inspector that she was pleased that more and more staff were becoming involved in activity provision, assisting her and also supporting service users when she was not there. The Activities Officer has purchased equipment for each unit so that care staff can initiate a range of activities with service users. She reported that the contents of the boxes has been matched to the known likes of service users within the units and she regularly added to these. A small number of service users access local day centres. Church services are held at the home every fortnight. During the afternoon of the inspection a large group of service users were flower arranging and making collages of garden photographs and pictures. The atmosphere within the group was fun and one of enjoyment. Service users in this group appeared happy and fulfilled. There were many different conversations and service users were laughing and sharing jokes. The work of the Activities Officer and the provision of activities at Dalemead is of a very high standard. The measure of success can be seen in the way that service users react when they are with the Activities Officer and when they are included in these activities. The Activities Officer and those who have assisted her should be proud of their achievements and dedication to individual support. Although the Activities Officer said that staff were becoming more involved in activity provision, the Inspector saw that in some units service users were not being supported by staff. In one unit service users were watching the television and wanted the channel changed. None of them knew where the remote control was. The Inspector located it on a window sill and saw that the battery casing was broken. The Registered Person should make sure that service users can reach the remote controls for equipment and that they are in full working order. The hairdresser visits the home on a regular basis and was working on the day of the inspection. Many of the service users told the Inspector that they liked having their hair done and felt she did a good job. Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 20 There is a flexible visitors procedure and families are encouraged remain involved in the care of their relatives if they want to. On the day of the inspection, visitors were welcomed to the home and were able to spend time with service users in private. Staff were polite to visitors and many clearly had a good rapport with relatives. There is a varied and wholesome menu which offers choices for service users. Main meals are prepared by catering staff. Breakfast, snacks and drinks are prepared by staff within the units. Service users were seen to take breakfast throughout the morning at a time of their choice. On the day of the inspection none of the service users who spoke to the Inspector knew what they were having for lunch or what time this would be served. There is a small handwritten menu on display, but this is not accessible to many of the service users. The Registered Person should consider ways to better advertise the menu choices and inform service users. The Lead Inspector was seated in one of the dining rooms during the midday meal. Some of the concerns about the manner in which food was served and service users were supported is discussed in the previous section of this report. Service users were not offered choices and meals were served in an uncaring way. Mealtimes and food are often very important to service users and staff should recognise this. Two of the service users on the unit where the Inspector was have soft food. The cook had prepared all elements of their meals separately and this is how they had been delivered to the unit. Staff on the unit mixed the pureed potato, vegetables and meat together before serving. This practice is unacceptable and must cease. There are small kitchenettes on each unit. Some food is stored in these for breakfasts, drinks and snacks. The kitchens on two units were inspected. In one unit the ice box in the fridge contained two packets of unlabelled samosas and two unlabelled mugs of frozen liquid. There were jugs of squash in the fridge which had also not been labelled. Bowls of butter and jam covered in cling film were stored in a broken bread bin. These were not labelled. A plastic bag containing some mouldy food which had become liquidy and was unrecognisable was stored in the fridge and removed by the Inspector. In another unit the fridge was in need of defrosting and had become frozen in places. There was a carton of frozen apple juice in the ice box and an unlabelled bowl of brown liquid in the fridge. Bowls of butter was also stored in the kitchen. Cereal had been decanted into ice cream tubs. These were not labelled. All food and drinks must be labelled with what they are and the date of opening. Old food must be removed and must not be given to service users. Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 21 Fridges should be regularly defrosted and cleaned. Open butter and jam should be stored in the fridges. The home has previously experienced problems with pest infestations and staff should make sure food is stored appropriately to reduce the risks of further infestations. Ice boxes in fridges must not be used to freeze food. Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 22 Complaints and Protection The intended outcomes for Standards 16 – 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 There is an appropriate complaints procedure which is accessible to service users and their representatives. Service users are at risk from staff who do not recognise abuse and from insufficient recruitment checks. EVIDENCE: The home has an appropriate complaints procedures, detailing time sales and information on how to contact the Commission for Social Care Inspection. There have been no complaints to the home since the last inspection. However, a complaint was made to the Inspector during the inspection visit. Details of this complaint were given to the Manager to investigate. He undertook a thorough investigation and fed back to the complainant and Commission for Social Care Inspection. The home has adopted the London Borough of Richmond Protection of Vulnerable Adults procedure and has its own procedures on abuse and whistle blowing. Not all staff have been trained in protection of vulnerable adults and must be. The Inspector observed some practices which could be seen as abusive during the course of the Inspection. The staff involved did not appear to recognise that what they were doing was wrong. Nor did other staff on duty. This is a serious concern and service users are at risk. Staff recruitment files did not evidence thorough pre employment checks on staff and service users are placed at risk. Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 23 Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 24 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): 19, 20, 21, 22, 23, 24, 25 & 26 In general, the building is well maintained, welcoming, homely, attractive and meets the needs of the service. Private and communal areas are spacious and meet the needs of service users. The building is kept clean. EVIDENCE: Accommodation is provided in two adjoining converted houses and an extension. The home has an extensive, attractive and mature garden, which is accessible. There is a small car park at the front; however roadside parking is limited to permit holders. The home is divided into four units on three floors. Each unit has its own kitchenette, lounge and dining area and bathroom. The largest unit accommodates sixteen service users. All bedrooms are for single occupancy and have en suite facilities. Service users are able to bring their own furniture and belongings to their rooms. All bedrooms are equipped with television aerial points. Service users are able to have their own telephone line if they wish. The Inspector saw that bedrooms were personalised and reflected individual tastes. Corridors are equipped with grab rails and there is a Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 25 passenger lift. All rooms are equipped with a call alarm system. The home is appropriately lit, ventilated and heated throughout. There is a rolling programme of maintenance and redecoration and at the time of the inspection the outside of house was being painted. Other areas of maintenance should also be attended to. These include the replacement of worn and stained carpets. In one bathroom the taps were difficult to turn on and sprayed out of the sink. In one kitchenette drawer handles and cabinets were broken. The Deputy Manager said that regular checks on maintenance and health and safety did not take place and that management relied on staff notifying them of problems. The Registered Person should consider making regular recorded checks themselves as areas of maintenance may be missed by staff and serious health and safety concerns were identified which regular checks may have avoided. Some of the chairs in communal lounges do not match and it would improve the appearance of these areas if chairs matched or were covered to match each other. Work to improve the environment had taken place in one lounge. A new fish tank had been purchased and was about to be set up by the Activities Officer and other staff. The home has an attractive and well maintained garden. Only a small number of bedroom doors in the home are labelled with service users’ names. Most of the doors, including bathrooms and WCs are not labelled and are just numbered. This can be confusing to service users who may not be able to orientate themselves or locate their own bedrooms. Consideration should be given to asking service users how they wish to identify their bedrooms. Labels do not necessarily have to be name plates but could be a symbol or picture which is meaningful to the service user. The home was clean throughout on the day of the inspection and there are appropriate procedures for laundering clothes. However, cleaning products were not stored safely. Refer to Standard 29 of this report. Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 26 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 The home is well staffed, although the Team Leader vacancy has had a negative impact on the way in which some staff are supported. Recruitment procedures do not allow for sufficient checks to be made on staff prior to their employment. Some staff do not receive training, support and supervision to undertake their role and service users are put at risk of harm and abuse. EVIDENCE: There are two Team Leaders who oversee two of the home’s four units. There has been a third Team Leader vacancy for a long time. There is considerable differences between the two units managed by Team Leaders and the two that are not. Examples of poor practice were seen in the units without a manager and paperwork and systems in these units need improving in some areas. The Manager has reported that he is unable to find a suitable candidate for this managerial post. However, failure to recruit to this position has had a detrimental effect on the home and the staff working in these units are not receiving the supervision and support that they need, which in turn has put service users at risk. The home is otherwise fully staffed. Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 27 The Manager has produced a list of training achieved by staff. However, there was limited evidence of training in staff files. No individual training profiles had been developed and only a small number of certificates from training were seen. All staff must undertake training in protection of vulnerable adults, food hygiene, basic first aid and administration of medication. All staff must also receive training in dementia. Other training needs identified at this inspection included care planning and eating and drinking. The Manager must undertake a full training audit looking at individual training needs. There must be a programme of planned training and training achieved must be evidenced. One of the Team Leaders spoke about a range of training she had undertaken and some training undertaken by staff in the unit. The staff who spoke to the Inspector spoke highly of the Manager and said that they were supported. This is positive. However, there has been limited formal supervision at the home and no evidence of supervision in many of the staff files examined. There have been no staff meetings at the home since July 2004 and no senior staff meetings since April 2004. Without regular staff meetings and supervision staff do not get the information and support they need to effectively do their job. These meetings must be reinstated on a regular basis. Nine staff files were examined. One staff file for the newest member of staff could not be located. None of the staff files examined were complete. Two files had no references. Only two files had two written references, and none of these were from previous employers. In one of these one reference said that the referee had only known the staff member for a few months. In one file one of the references was from someone who lived at the same address as the member of staff. Only three of the files had photographs. Three of the files did not contain criminal record checks. Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 36 & 38 The Manager is appropriately experienced and qualified and has consistently demonstrated a good knowledge of the service. The management approach is open, positive and inclusive. Inadequate steps have been taken to make sure that service users are safe and poor practices place service users at considerable risk. EVIDENCE: The Manager is also the Owner. He has worked at the home for many years, including prior to his purchase of Dalemead. He demonstrated an in-depth knowledge of the home and the needs of the service. The Manager is a qualified nurse and social worker and has the Registered Managers Award. Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 29 Staff at the home reported that the Manager was open and supportive and welcomed new ideas and innovations. During the course of the inspection, information on a number of accidents and incidents was seen. These included a high number of falls and an attack on a member of staff. These incidents had not been reported to the CSCI and must be in accordance with Regulation 37. There are no regular recorded checks on health and safety. The Deputy Manager reported that the management team relied on staff informing them of concerns. This is insufficient and serious concerns relating to health and safety were identified. First aid supplies had not been checked and were inadequate in some units. Fire doors throughout the home were wedged open. This included doors into kitchens and dining rooms. The Inspector recognises that the heavy closed doors restrict movement of service users. However, devices to hold doors safely open should be purchased so that service users are not at risk. The current practice of wedging open fire doors means that a fire could spread through the home putting everybody at risk. This has been discussed at previous inspections and the Manager is well aware of the risks. Further fire safety training should be organised for staff so that they understand the risks of preventing fire resistant doors from closing. The last recorded fire drill was in December 2004. More regular fire drills must be organised. Not all hot water outlets have been equipped with thermostatic values to reduce the risk of scalding. All outlets used by service users must be appropriately equipped. This has been discussed with the Manager at previous inspections and he understands why this is important. The delay in equipping all outlets puts service users at risk. The last check on water delivery temperatures was made in November 2004. Checks must be made on a more regular basis. Cleaning products were stored in unlabelled containers and were not locked away. In the kitchenette in two units COSHH products were found in various cupboards and on the floor. In one kitchen washing powder was stored in a tub labelled ‘strawberry ice cream’ next to similar tubs containing biscuits, tea bags and cereal. A bottle of unlabelled blue liquid was stored next to bottles of cordial. During the course of the inspection one service user, who was confused, spent time alone in this kitchen area. There is a serious risk to the well being of service users. This risk could be easily prevented. The inability of staff to recognise the dangers of this is seriously concerning. An immediate requirement was made to lock away all COSHH products and to make sure that they are labelled. The Manager wrote to tell the Inspector that this Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 30 requirement had been met. This situation will be monitored and failure to comply with this requirement in the future may lead to enforcement action being taken. Staff should also undertake relevant training to make sure they understand that these inadequate health and safety practices could endanger the lives of service users. Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 31 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 1 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 X X X X X 2 Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 32 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 13(4) (6) Requirement Timescale for action The Registered Person must 30/11/05 review and update assessments of risk following related incidents. The Registered make sure: Person must 2 OP9 13(2) 1. That there is a procedure 01/12/05 covering the supply of medication to service users on leave from the home and a formal reporting system for medication errors. 1st December 2005. 1. That the administration/nonadministration of all medication, including items brought in by relatives, is recorded accurately. 14th November 2005. 2. That the use of medication brought in by relatives is Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 33 checked with the GP before they are used and the confirmation is recorded. 14th November 2005. 3. That the fridge temperature on each unit is recorded regularly. 14th November 2005. 3 OP10 12(1) The Registered Person must 30/11/05 make sure that all service users are offered regular baths and that this is recorded. The Registered Person must 30/11/05 make sure toiletries are not used by more than one service user and that they are appropriately stored and labelled. The Registered Person must 30/11/05 make sure that service users are not left in their wheelchairs whilst they eat unless there is an agreed reason or they chose to remain in their chairs. This must be recorded. The Registered Person must 30/11/05 make sure that staff do not discuss confidential information about service users in front of others. The Registered Person must 30/11/05 provide a seat by the payphone. The Registered Person must 30/11/05 make sure that staff initiate and sustain conversations with service users and include them DS0000017362.V258099.R01.S.doc Version 5.0 Page 34 4 OP10 12 5 OP14 OP10 12 6 OP14 OP10 12 7 OP14OP10 12 8 OP14OP10 12 Dalemead in conversations as appropriate. 9 OP14OP10 12 The Registered Person must 30/11/05 make sure staff do not place restrictions on service users or order them around. Service users must not be told to modify their behaviour because of the presence of an Inspector. 10 OP15 OP14OP10 12 The Registered Person must 30/11/05 make sure that service users are offered choices at mealtimes. This includes choices about portion sizes, condiments, drinks and cutlery used. Staff must not force their choices and values on service users. The Registered Person must 30/11/05 make sure that food is not preserved to service users who are late for their meals. The Registered make sure that: Person must 31/12/05 11 OP15 OP14OP10 12 12 OP15 OP14OP10 12 13(4) (6) 18(c) 1. There is a clear record where service users require assistance with eating and drinking. 2. Staff supporting service users to eat and drink are trained to do so. 3. Staff supporting service users to eat and drink, sit next to them, speak to them about what they are doing, offer them choices and offer them small and manageable mouthfuls. Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 35 13 OP15 OP14OP10 OP15 12 The Registered Person must 30/11/05 make sure that staff do not wear plastic gloves to serve food. The Registered Person must 31/12/05 make sure service users know what the menu choices are and what time meals are served. The Registered Person must 30/11/05 make sure that pureed food is served in separate portions and food is not mixed together. The Registered make sure: Person must 30/11/05 14 12 16(2)(i) 15 OP15 12 16(2)(i) 16 OP15 16(2)(i) (g) 1. Food in units is stored and labelled appropriately. 2. Kitchens and fridges on units must be regularly checked, cleaned and defrosted. 3. Ice boxes in fridges must not be used to freeze food. 17 OP29OP18 13(4) (6) 19(1)(a) The Registered Person must 30/11/05 make sure that criminal record checks and at least two written references are received on all staff prior to employment. The Registered Person must 31/01/06 make sure that all staff are trained in the protection of vulnerable adults and are aware of what constitutes as abuse. The Registered Person must 31/12/05 Version 5.0 Page 36 18 OP30OP18 13(4) (6) 18(1) 19 Dalemead OP38 23(2) DS0000017362.V258099.R01.S.doc OP19 arrange for regular recorded checks on the environment to be made to identify maintenance and health and safety requirements. 18(1)(a) The Registered recruit to the Leader Person must 31/01/06 vacant Team vacancy. 20 OP27 Previous requirement timescale 31/07/05 21 OP28 18(1)(a) The Registered Person must 31/03/06 make sure that staff are supported to undertake NVQ qualifications. The Registered Person must 31/03/06 develop individual training profiles for the staff and must evidence training needs and achievements by 31st December 2005. Staff must underake training in areas identified. Previous requirement timescale 31/07/05 23 OP36 12(5)(a) 18(2) The Registered Person must 31/12/05 make sure all staff receive regular formal supervision and particiapte in team meetings. Previous requirement timescale 31/07/05 24 OP29 18 19 Sch 2 Sch 4 The Registered Person must 31/12/05 make sure all records are in place for staff, and are available for inspection. 22 OP30 18 19 Sch 2 Sch 4 Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 37 25 OP31 37 The Registered Person must 30/11/05 make sure the CSCI is notified of any accidents and incidents at the home. The Registered Person must 30/11/05 make sure that regular checks are made on first aid supplies. The Registered Person must 30/11/05 make sure regular fire drills take place and are recorded. Fire safety training must be organised for staff. The Registered Person must 30/11/05 ensure that fire doors are not wedged open. Where necessary, doors should be equipped with approved devices which hold them safely open. Previous requirement timescale 09/09/04 and 31/05/05 26 OP38 13(4) (6) 27 OP38 13(4) (6) 23(4)(e) 28 OP38 13(4) (6) 23(4)(c) 29 OP38 13(4) (6) The Registered Person must 31/01/06 make sure all hot water outlets used by service users are thermostatically controlled to a safe temperature. Regular checks must be made and recorded on all water outlets. The Registered Person must 30/11/05 make sure all COSHH products are labelled and locked away. Staff should receive training and information on why this is important. 30 OP38 13(4) (6) Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 38 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 Registered Person should consider supporting staff to undertake IT training so that computerised care planning and other records can be used. 1. It is recommended that the controlled drugs administered by the district nurse be recorded in the controlled drugs register. 2. It is recommended that all items with a short expiry date once opened be labelled with the date when opened 3. It is recommended that the quantity of medication carried over from one week to another be recorded on the administration record to make it easier to audit the use of medication 3 OP19 The Registered Person should consider replacing chairs which do not match in communal lounges. The Registered Person should arrange for service users to chose how they wish their room to be identified by name plates, pictures or other decorations to support better orientation throughout the home. 2 OP9 4 OP19 Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 39 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 Dalemead DS0000017362.V258099.R01.S.doc Version 5.0 Page 40 - 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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