Inspection on 26/04/05 for Dalemead

This inspection was carried out on 26th April 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Dalemead 07/06/07

Dalemead 26/04/06

Dalemead 12/10/05

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 Announced 26 April 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DALEMEAD G54-G04 S17362 Dalemead V216918 260405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Dalemead Address 10-12 Riverdale Gardens, East Twickenham, Middlesex, TW1 1QJ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8892 2161 020 8891 6697 Mr Anwar PHUL Mr Anwar PHUL Care Home 49 Category(ies) of 49 DE(E) registration, with number of places DALEMEAD G54-G04 S17362 Dalemead V216918 260405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 9th September 2004 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 G54-G04 S17362 Dalemead V216918 260405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 26th and 28th April 2005, and was announced. The inspection on the 28th was conducted by a Pharmacy Inspector, and their findings are detailed within Section 2- Health and Personal Care (Standard 9) of this report. The Manager was present throughout the inspection. The Inspection Team also met with service users and staff on duty and were made welcome by all. The atmosphere at the home was relaxed and peaceful and service users were seen pursuing a range of activities throughout the inspection. Interactions between staff and service users were positive and supportive. The Commission for Social Care Inspection routinely asks service users and their representatives to complete written questionnaires on the service prior to an announced inspection. No questionnaires have been returned on this occasion. Forty-four service users were residing at the home at the time of the inspection. What the service does well: The home provides a good range of information on the service through the Statement of Purpose, Service User Guide and assessment procedures. The Manager 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 Inspector observed positive interactions between visitors and staff. 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. The Activities Officer has consistently demonstrated a genuine enthusiasm and commitment to her role. She has introduced activity care plans for service users and undertakes work to meet individual and group needs. She has introduced new systems to help care staff initiate and support activity provision. DALEMEAD G54-G04 S17362 Dalemead V216918 260405 Stage 4.doc Version 1.30 Page 6 The Manager is committed to the home and has demonstrated a good awareness of the needs of the service. Staff reported that he is friendly and approachable and is willing to listen and implement ideas to improve the service. What has improved since the last inspection? What they could do better: The senior staff should continue to implement the changes that have been introduced and positive changes to practice should be encompassed by all units. The remaining Team Leader vacancy must be recruited to and all staff must be offered regular supervision and support from senior staff. Regular team meetings must be organised to allow for appropriate information sharing. The Manager should also consider supporting staff to share their expertise through in house training sessions, where appropriate. Individual training profiles for staff must be developed. The Manager must ensure that risk assessments are in place for all service users and are subject to regular review. Further improvements to the recording and storage of medication should be made. The Manager has developed a business plan which outlines his plans for the service. He has identified further areas of the building to be decorated and refurbished and plans to build a conservatory during the year. He has also implemented new quality monitoring systems and plans to use feedback from service users and their representatives to plan for further development of the service. DALEMEAD G54-G04 S17362 Dalemead V216918 260405 Stage 4.doc Version 1.30 Page 7 Fire doors throughout the home were wedged open. This presents a risk to service users and this practice must cease. The Manager should consider equipping doors with devices that hold them safely open to allow freedom of movement for service users. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DALEMEAD G54-G04 S17362 Dalemead V216918 260405 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection DALEMEAD G54-G04 S17362 Dalemead V216918 260405 Stage 4.doc Version 1.30 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 standard(s) 1, 3, 4 &5 Standard 6 is not applicable. All four standards assessed were met (3). 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. The Manager reported that only minor changes had been made since the last inspection of the service. 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 DALEMEAD G54-G04 S17362 Dalemead V216918 260405 Stage 4.doc Version 1.30 Page 10 needs, involving the service user, their representatives and any relevant professional input. 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. The home offers a service to people with a variety of needs, including sensory impairment, mental health needs and dementia. There is an ongoing training programme for staff. Service user plans are based on initial assessments and give detailed guidance for staff on how to meet specialist needs. The Manager reported that the home works closely with health care professionals to ensure a holistic approach to care. DALEMEAD G54-G04 S17362 Dalemead V216918 260405 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9 &10 Two standards were met (3). Two standards had minor shortfalls (2). Service users needs are appropriately recorded and regularly reviewed. Work is taking place to improve the quality of written information and guidance, and to promote better welfare for service users. Personal and health care needs are appropriately recorded and monitored. The home has arrangements for the ordering, storage and recording of medication and has access to a pharmacist for advice. The health and welfare of service users may be adversely affected by omissions in the written procedures, errors in recording and the keeping of out of date medication. EVIDENCE: Individual service user plans are in place for all service users. The Inspector examined eight of these. Service user plans reflected assessed needs. Plans were well designed and information was clearly presented. Newly introduced sections were seen in some service user plans. These included new daily routines, extended health monitoring and personal histories, (which included people and information important to the service user). Plans included service user preferences and wishes and there was an emphasis on promoting choice. Service user plans were subject to recorded monthly review. Plans had been DALEMEAD G54-G04 S17362 Dalemead V216918 260405 Stage 4.doc Version 1.30 Page 12 signed by the keyworker and a representative for the service user. information on service users was stored securely. All Daily observation notes are made and are kept on file. The Manager reported that keyworkers are being encouraged to contribute to these and that care planning training had been arranged for these staff. Assessments of risk had been incorporated into most, but not all service user plans seen. There was no assessment of risk relating to one service user who smoked. Assessments relating to mobility and manual handling were absent from two service user plans seen. Where in place, these had been subject to recorded review. Assessments of risk must be in place for all service users. All service users are registered with local GPs and other health care professionals as required. The Manager reported a good working relationship with health care professionals. Evidence of input from district nurses was seen. Medical consultation and liaison were recorded in service user plans. Plans contained guidance from health care professionals. Accidents and incidents are appropriately recorded. Service users are able to choose what time they rise and retire and where and when they wish to take their meals. Service users make their own arrangements for purchasing toiletries. Each service user is allocated a keyworker who gives them individual support and has input into the service user plan. Personal care needs are detailed in service user plans. A hairdresser visits the home twice a week. One of the Team Leaders spoke to the Inspector about new practices they had introduced to promote better health and welfare for service users. They reported that they had offered advice for staff to better understand how to monitor and meet health needs. Evidence of new systems in relation to this was seen. All medications administered by staff along with the records relating to receipt, storage, administration and disposal of medication were examined. The person in charge, two members of staff and one service user were interviewed, policies and procedures reviewed and administration of medication on one unit observed. From these observations and discussions no procedure was seen for the supply of medication to service users on leave from the home, the administration of medication procedure did not describe in detail the step by step process, the storage of medication policy did not describe the arrangements for items requiring cold storage. Six service users had missing entries on the administration record indicating administration/non-administration of medication. One item was found that had expired. The item was no longer DALEMEAD G54-G04 S17362 Dalemead V216918 260405 Stage 4.doc Version 1.30 Page 13 prescribed and was not in use. One item with a short expiry date once opened was not labelled with the date when opened. The item was still in date according to the date of dispensing. These issues may result in staff not being aware of the correct procedures in the home and service users may not receive the correct medication. One service user said that they were not sure about what medication they were taking and no patient information leaflets for the medication were seen on the day. Three controlled drugs were found that were not stored in the controlled drug cupboard. All other records had been completed accurately and provided evidence that all medication had been administered correctly, changes were clearly identified, and medication was stored and administered safely. Refer to Requirements 1 & 2 and Good Practice Recommendation 1. DALEMEAD G54-G04 S17362 Dalemead V216918 260405 Stage 4.doc Version 1.30 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 Three standards were met (3). One standard was exceeded (4). 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. Service users are offered choices about their daily lives, activities and food. There is a balanced and varied menu offering a range of wholesome and well prepared food. EVIDENCE: The home employs a full time Activities Officer, who develops an activities care plan on each individual service user. These identify individual and group needs. These plans are subject to monthly review. The Activities Officer developed a planned programme of activities designed to meet identified needs. The programme includes allocated time for individual support. The Activities Officer also co-ordinates activity provision by care staff. Participation in activities is recorded and these records are used for monitoring and reviewing the plan of activities. Each month a new programme is produced. The home also employs someone who runs an exercise class and DALEMEAD G54-G04 S17362 Dalemead V216918 260405 Stage 4.doc Version 1.30 Page 15 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. Each day, the Activity Co-ordinator offers hand massage and nail painting to service users. 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. Information on the activity programme is clearly posted on notice boards throughout the home. The Inspector observed service users participating in a range of different activities. The Activities Officer and a small number of service users discussed their plans for the VE Day celebrations with the Inspector. A display of memorabilia, photographs and personal accounts had been arranged in the main entrance hall. An indoor ‘street party’ was arranged for the anniversary of VE Day. Service users spoke about their experiences and memories and said that they were looking forward to the party. Since the last inspection, 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. Throughout the inspection the Inspector observed positive interactions between staff and service users and people pursuing a variety of activities. Service users were offered choices by staff about what they wanted to do and the choice of music within communal areas. The Activities Officer spent some of the day supporting service users with flower arranging. Another group of service users were being supported to draw and knit in a craft group. There is a flexible visitors procedure. The Deputy Manager spoke about the importance of ensuring families feel able to contribute to the care of their relatives and that this is supported. The Inspector saw a number of service users receive visitors. There was a good rapport between staff and visitors. Service users’ choices and preferences are recorded in service user plans. Service users are able to bring their own belongings and furniture on admission, in agreement with the Manager. There are boards of information available for service users and their visitors in communal areas. Service users DALEMEAD G54-G04 S17362 Dalemead V216918 260405 Stage 4.doc Version 1.30 Page 16 are able to access all communal areas. Service users are able to rise, retire and eat at a time of their choice. 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. The Inspector saw that service users were appropriately supported during lunch time and staff were heard asking service users about their enjoyment of the food. Service users reported that food was well prepared and tasty. The Deputy Manager told the Inspector that the Chef had an excellent understanding of individual needs and preferences and spoke directly with service users about menu choices. DALEMEAD G54-G04 S17362 Dalemead V216918 260405 Stage 4.doc Version 1.30 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17 & 18 All three standards were met (3). There is an appropriate complaints procedure which is accessible to service users and their representatives. Service users legal rights are supported. There are appropriate procedures in place to promote protection of vulnerable adults. 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 since the last inspection. The Manager reported that all service users are registered to vote. The Activities Officer approached service users to ask them if they need assistance in obtaining postal votes or getting to polling stations for the general election held shortly after the inspection visit. The Manager reported that all service users had representatives external to the home. There is currently no advocacy service supporting service users at the home. It would be beneficial for an advocacy service to support service users as a group and as individuals and the Manager should considering obtaining further information on local services. The home has adopted the London Borough of Richmond Protection of Vulnerable Adults procedure and has its own procedures on abuse and whistle blowing. The Manager reported that all staff had undertaken relevant training DALEMEAD G54-G04 S17362 Dalemead V216918 260405 Stage 4.doc Version 1.30 Page 18 or were due to undertake this. The Inspector saw evidence that criminal record checks were made on staff prior to employment. Refer to Good Practice Recommendation 2. DALEMEAD G54-G04 S17362 Dalemead V216918 260405 Stage 4.doc Version 1.30 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 standard(s) 19, 20, 21, 22, 23, 24, 25 & 26 All standards are met (3). 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 and procedures are in place to ensure cleanliness and infection control. EVIDENCE: DALEMEAD G54-G04 S17362 Dalemead V216918 260405 Stage 4.doc Version 1.30 Page 20 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 passenger lift. All rooms are equipped with a call alarm system. The home is appropriately lit, ventilated and heated throughout. Since the last inspection some communal and private areas had been redecorated. This included the refurbishment of one bathroom and the purchase of a new hoist. One of the lounges has been rearranged to promote better use of space. The home is attractively decorated throughout and there are plans to decorate and refurbish further areas over the coming year. The Registered Person also plans to build a conservatory. Fresh flowers, photographs and pictures throughout the home add to the general ambience. The home was clean and odour free throughout on the day of the inspection. There are appropriate procedures for the laundering of clothes, infection control and disposal of clinical waste. DALEMEAD G54-G04 S17362 Dalemead V216918 260405 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30 Two standards were met (3). Two standards had minor shortfalls (2). Service users are supported by a team of carers, but lack of senior support in some areas of the home has had an impact on service delivery. The units which are directly overseen by Team Leaders are better managed. There is an appropriate programme of training for staff, although this is not clearly evidenced. There is a programme to support staff to achieve NVQ qualifications. Procedures for recruitment and selection of staff are designed to safeguard service users. EVIDENCE: All staff are issued with an employee handbook that details the main personnel policies and procedures, and the roles and responsibilities of staff. The Manager is supported by a Deputy Manager and two Team Leaders, one of whom was recently appointed. There is one Team Leader vacancy. The Team Leaders oversee the work of one unit each. Paperwork and general procedures within the units overseen by the Team Leaders tend to be better managed. One Team Leader who was recently recruited spoke at length about the work that they had undertaken in their unit. Considerable improvements to the service had been made and the Team Leader felt that staff worked more efficiently with this direct support from senior staff. Service user plans within units managed by Team Leaders were generally more in depth and contained required information. Staff working in units without a Team Leader do not receive regular individual supervision or attend team meetings. The third DALEMEAD G54-G04 S17362 Dalemead V216918 260405 Stage 4.doc Version 1.30 Page 22 Team Leader post has been vacant for some time and the staff within the effected units would greatly benefit from the direct management of a Team Leader. The requirement made at the last inspection to recruit to these vacant Team Leader posts has been partly met. The Manager recognises the importance of recruiting to the remaining vacancy but has reported difficulties in finding suitable staff. The staff team at Dalemead is relatively stable with some long serving employees working there for other twenty years. This consistency of support is a positive force in the home and has been complimented by more recently employed members of staff bringing new ideas and practices. Staff throughout the home who spoke with the Inspector reported that the Manager was supportive and receptive to new ideas. Eight new staff have been employed since the last inspection, including one Team Leader and a full time maintenance worker. Six staff have left employment. The service does not employ agency staff. There is a programme to support staff to obtain NVQ qualifications. The Manager reported that twelve staff have achieved NVQ Level 2 or above and three more staff were due to complete their qualifications later in the year. The Deputy Manager is an NVQ Assessor and the Manager reported that he hopes that the two Team Leaders will undertake their Assessors course during the year. The Manager accesses a range of local training and is a member of various care home organisations who offer support and learning opportunities. The Manager reported that all staff are qualified in basic first aid. Records indicate that recent training for staff has included first aid, food hygiene, manual handling, abuse, dementia, COSHH and fire safety. The Manager reported that planned training includes further manual handling and food hygiene, also health and safety, mental health in later life and report writing. Induction training for staff includes use of an approved workbook and evaluation of knowledge and performance. The Manager showed the Inspector a training audit. However, individual training profiles are not in place for staff. The Manager reported that he plans to undertake work in this area. It is important that individual training needs and achievements are evidenced and information is available for inspection. One of the Team Leaders spoke to the Inspector about small informal training sessions which they had given to their staff team. This led to a discussion around the benefits of in house training from senior staff. This was also discussed with the Manager. Consideration should be given to establishing a more formal forum for staff to offer their expertise and experiences to others. This type of training would work alongside the external training sessions. DALEMEAD G54-G04 S17362 Dalemead V216918 260405 Stage 4.doc Version 1.30 Page 23 There are appropriate procedures for the recruitment and selection of staff. The files relating to the recruitment of the three most recently employed members of staff were examined. These contained the correct information and evidenced pre employment checks. Files did not contain a recent photograph and these must be obtained. Refer to Requirement 3 & 4 and Good Practice Recommendations 3 & 4. DALEMEAD G54-G04 S17362 Dalemead V216918 260405 Stage 4.doc Version 1.30 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, 36, 37 & 38 Six standards have been met (3). Two standards had minor shortfalls (2). 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. There is an appropriate system for quality monitoring. Not all staff participate in regular formal supervision or team meetings. There are a range of practices and procedures in place to ensure health and safety, although one practice presents a risk to health and safety. 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 G54-G04 S17362 Dalemead V216918 260405 Stage 4.doc Version 1.30 Page 25 Staff at the home reported that the Manager was open and supportive and welcomed new ideas and innovations. The Team Leaders and Activities Officer all spoke highly of the support that they received from the Manager and Deputy Manager. The Manager reported that he has recently issued relatives with questionnaires on the service as part of the Quality Assurance programme. He had not received any responses at the time of the inspection. In addition he reported that he has asked senior staff to conduct quality monitoring interviews with service users on a regular basis to gain their opinions on aspects of service delivery. The Inspector is eager to see the outcome of these new quality monitoring tools. The Manager has recently established regular senior team meetings. Minutes of these indicate that they are a useful forum for discussion about the service and also a way of imparting information about National Minimum Standards and the Care Homes Regulations. The Manager supervises senior staff on a regular basis and they reported that they felt well supported. Team Leaders organise meetings for staff within their units and individual supervision. However staff who work within units not overseen by a Team Leader do not attend regular meetings nor do they receive individual supervision. The Registered Person has developed a business plan for the coming year. This is realistic and outlines priorities for development and recognises achievements. There is evidence that a great deal of work has gone into improving areas of the service and to meeting requirements made at the last inspection. The Deputy Manager spoke positively about changes and developments to the service. The Business Plan outlines plans to refurbish areas of the building, build a conservatory, develop training opportunities and implement the quality assurance procedure further. Service users or their representatives maintain full control of their finances. The Manager reported that any expenditures, such as hairdressing, are paid for in arrears and the appropriate party is invoiced, Records required by Regulation were seen to be in place and were accurate. There was evidence of regular checks on health and safety, including gas safety, electrical wiring and appliances, fire safety, water safety and food storage temperatures. Regular fire drills are maintained and recorded. Over the past year hot water outlets have been equipped with thermostatic controls to reduce temperatures to a safe level. The Manager reported that all outlets used by service users are set to a safe temperature. The home was recently visited by the Environmental Health Officer and Fire Officer. Reports form these visits were seen and there was evidence that recommendations had been actioned. DALEMEAD G54-G04 S17362 Dalemead V216918 260405 Stage 4.doc Version 1.30 Page 26 Some fire doors throughout the home were wedged open. The Inspector acknowledges that service users need to be able to move freely around the home and that fire doors can be heavy and restrictive. However, doors should be held open safely with approved devices, which allow the door to close if the fire alarm is activated. DALEMEAD G54-G04 S17362 Dalemead V216918 260405 Stage 4.doc Version 1.30 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 3 3 2 3 2 DALEMEAD G54-G04 S17362 Dalemead V216918 260405 Stage 4.doc Version 1.30 Page 28 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 13(4) & 6) Requirement The Registered Person must ensure that assessments of risk are in place for all service users and are subject to regular review. The Registered Person must: 1. Ensure that the administration/nonadministration of all medication in the home is recorded accurately. 2. Ensure that procedures are in place covering the supply of medication to service users on leave from the home and that the storage and administration policy are up dated with the actual practice in the home. 01/07/05 Timescale for action 30/06/05 2. OP9 13(2) 29/04/05 3. Ensure that all items with a 01/06/05 short expiry date once opened are labelled with the date when opened. 4. Ensure that all medication that has expired and is no longer in use is disposed of appropriately. The Registered Person must 3. OP27 18(1)(a) 01/06/05 31/07/05 Page 29 DALEMEAD G54-G04 S17362 Dalemead V216918 260405 Stage 4.doc Version 1.30 recruit to the vacant Team Leader vacancy. Previous requirement made 09/09/04 The Registered Person must develop individual training profiles for the staff and must evidence training needs and achievements. The Registered Person must ensure that all staff receive regular formal supervision and particiapte in team meetings. The Registered Person must ensure that fire doors are not wedged open. Where necessary, doors should be equipped with approved devices which hold them safely open. Previous requirement made 09/09/04 4. OP30 18(1)(c) 19(1)(a), Schedule 2(4) Schedule 4 (6)(a) 12(5)(a) 18(2) 13(4) & (6) 31/07/05 5. OP36 31/07/05 6. OP38 31/05/05 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 OP9 Good Practice Recommendations 1. It is recommended that all controlled drugs be stored in a controlled drug cupboard that complies with the Misuse of Drugs Regulations 1973. 2. It is recommended that patient information leaflets on all medication prescribed in the home are available for service users and staff. The Registered Person should consider obtaining further information on local advocacy services to enable service users to better access these. The Registered Person should ensure that photographs of all staff are obtained for staff files. G54-G04 S17362 Dalemead V216918 260405 Stage 4.doc Version 1.30 Page 30 2. 3. OP18 OP29 DALEMEAD 4. OP30 This Recommendation will become a requirement if not met by the next inspection. The Registered Person should consider how best to support staff to share their expertise through in house training. DALEMEAD G54-G04 S17362 Dalemead V216918 260405 Stage 4.doc Version 1.30 Page 31 Commission for Social Care Inspection Ground Floor 41-47 Hartfield Road Wimbledon 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 G54-G04 S17362 Dalemead V216918 260405 Stage 4.doc Version 1.30 Page 32 - 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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