Inspection on 26/04/06 for Dalemead

This inspection was carried out on 26th April 2006.

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 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 12/10/05

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 10:00 26th April 2006 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.V289521.R01.S.doc Version 5.1 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.V289521.R01.S.doc Version 5.1 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.V289521.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th October 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 £555.00 - £600.00 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.V289521.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visits took place over three days, 25th, 26th and 27th April 2006, and was unannounced. The Inspection Team consisted of two Regulation Inspectors and a Pharmacist Inspector. The report of the Pharmacist Inspector is contained within Section 2 of this report. The Inspectors were made welcome at the home. They met with residents, some visitors and staff on duty. The Inspectors spent time on each unit at the home, observing activities and lunch and speaking with residents and staff. The Inspectors also examined key documentation, including care plans, medication records, staff records and health and safety checks. The Manager has sent additional information to the CSCI and this formed some of the evidence for this inspection report. As part of the Inspection the CSCI sent questionnaires about the service to health care professionals, care managers and other professionals involved with the home. Questionnaires were also given to some service users on the day of the inspection and the Manager was given questionnaires to distribute to relatives, friends and advocates. Six residents returned questionnaires. They said that they were satisfied in most areas of their care, saying that they liked the food, activities and cleanliness of the home. Some residents said that staff were not always available or did not always act on what they said. Fourteen relatives and friends returned questionnaires. The majority of comments about the home were very positive. All visitors said that they were made welcome, although one person said that some staff were friendlier than others. One person said that they did not know how to complain if they were unhappy. Many of the relatives commented on the good cleanliness of the home. One person said that they felt things had really improved at the home over the last year. The majority of people said that staff were friendly and attentive and that they knew the needs of residents. One person said that they felt the staff had learned the personal preferences and ethnic needs of a resident quickly and well. One person commented that the home did not use agency staff and that this was really positive for the continuity of care. A number of people commented that the food was good. Some of the comments people wrote were, ‘I know my mother is happy here’, ‘the staff have a genuine interest in the welfare of residents’, ‘the staff show great kindness and understanding’, ‘the Manager and Deputy Manager are very aware of everything that goes on – I cannot speak highly enough of them’, ‘there is not a big turn over of staff’, ‘the management is very good’, when my relative returned home from hospital and needed extra care the staff were wonderful’, ‘I am delighted that my mother feels at home at Dalemead’. Dalemead DS0000017362.V289521.R01.S.doc Version 5.1 Page 6 Some of the relatives and visitors made suggestions for improvements. These included making better use of the garden, having the TV on less in the lounges when there was no organised activity, making afternoon tea less rushed and more pleasant for residents and some staff being friendlier and more helpful. Some people said that they were worried about the support at nighttime and when managers were not in the home. Thirteen professionals who work with the home returned questionnaires and two professionals rang the CSCI and spoke with the Lead Inspector. These included doctors, district nurses, care managers, activity providers and other health care professionals. All those who completed questionnaires said that the home communicated effectively and worked in partnership with them. The majority felt staff demonstrated a good understanding of residents’ needs and that they followed specialist advice. Several of the professionals said that they felt standards had improved at the home. Many of the professionals praised the work of team leaders. Some professionals commented on the caring attitude of some staff, food and the cleanliness of the building. One person spoke about how good the senior staff and activities officer were, saying that they had ‘made a difference to residents’ lives’. One person suggested better training for staff to help residents who were feeling ‘low’. One person suggested more input from Occupational Therapists at the home. One of the professionals who spoke to the Inspector said that they felt the Manager was not present at the home often enough and that when he was absent standards were not maintained. A high number of concerns were raised at the last inspection of the service in October 2005. Some of these were about the way in which staff supported residents and some were about serious health and safety risks. The Inspector felt that this was partly due to a lack of staff support, supervision and training. The Inspectors visited the home again in December 2005 to check compliance with some of the requirements made at the last inspection. There is not a separate report for this visit but a letter was sent to the Manager. The Manager was also invited to meet with the CSCI to speak about how he was going to address the requirements. Since this time there has been considerable work to improve standards. The hard work of the Manager and staff is noted and the benefits for residents were seen at this inspection. Work to improve standards must continue and the staff must be committed to changing the way that they work so that residents are kept safe and have their individual needs met. The Manager must make sure that there is work for continuous improvements and monitoring of quality outcomes not just in response to inspection report requirements. What the service does well: Dalemead DS0000017362.V289521.R01.S.doc Version 5.1 Page 7 The Statement of Purpose and Service User Guide give a good overview of the home and information for service users and their visitors (including recent inspection reports) is readily available at the home. There is an excellent range of individual and group activities and the Activities Officer has a very good knowledge of individual needs. Residents families are supported to be involved in the continued care of their relative if they wish to. The Cook knows the likes and dislikes of residents well and there is a wide range of freshly prepared food. The senior staff have worked hard to improve standards and to support staff to have a better understanding of how to meet residents’ needs. What has improved since the last inspection? What they could do better: The improvements at the home have been noted and these must continue. Since the last inspection there has been more management input and support. This level of support must be maintained to make sure that standards do not slip. Some staff at the home have been resistant to changes. It is important that they recognise why changes need to be made and why it is important for residents to have individual care and support. The Manager and senior team must continue to work closely with staff to help them to understand this. Dalemead DS0000017362.V289521.R01.S.doc Version 5.1 Page 8 The Manager needs to look at how some staff can be supported to change the way they work and any negative attitudes they have. Further work should take place to make care plans focus more on strengths and social needs. Some further improvements in medication are needed. Some further improvements to the environment are needed, in particular work to help residents orientate themselves. Further training is needed for some staff. All staff must have regular supervision and take part ion team 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.V289521.R01.S.doc Version 5.1 Page 9 DETAILS OF Inspector FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dalemead DS0000017362.V289521.R01.S.doc Version 5.1 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5 Quality in the Choice of Home Section is good. This judgement has been based on information received from the home and seen during a visit to the service. People wishing to move to the home are given information about the service and are able to visit and spend time at the home prior to admission. An assessment of needs is made for all residents. EVIDENCE: There is a suitable Statement of Purpose and Service User Guide for the home. These contain 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 residents are invited to spend a day at the home, sharing a meal and activities with other residents. The Manager or senior staff make an assessment of needs, involving the resident, their family and any relevant professional input. Dalemead DS0000017362.V289521.R01.S.doc Version 5.1 Page 11 Copies of assessments were seen. Assessments were comprehensive included information on personal preferences, likes and dislikes, personal medical needs, communication, social needs, night time support orientation. Residents and their families are consulted throughout assessment. and and and the Residents move to the home on a six week trial stay. After six weeks a review meeting is held, where the resident, their representatives, the home and local authority make a decision about whether the home can meet the needs of the resident. Evidence of six week and annual review meetings were seen. Contracts of care are in place for residents who are self funding. Copies of these are held at the home. Three of the residents who returned questionnaires said that they had received a contract, two said that they could not remember and one said that they had not. The Manager should make sure that contracts are in place for all residents and that they have copies of these. Dalemead DS0000017362.V289521.R01.S.doc Version 5.1 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in the Health & Personal Care Section has improved and is mostly good. This judgement is based on observations, speaking to residents and staff and information from health care professionals. Care plans are in place for all residents. Further work to improve these, to involve care staff in their development and to look at ways to promote a person centred approach should take place. The health care needs of residents are met and are recorded. Health care professionals working with residents are happy with the staff knowledge and support. The support of residents with their personal care and at mealtimes has improved and staff now have a better understanding of how to meet their needs. The overall quality of the medication standard is adequate. There were some inaccuracies in record keeping. These did not put the health or welfare of residents at risk. Dalemead DS0000017362.V289521.R01.S.doc Version 5.1 Page 13 EVIDENCE: Each resident has a care plan. Copies of these are held on the units and in the main office. Over the past year Team Leaders have introduced some new information to these care plans and have improved recording in some. Care plans give clear information on meeting some needs and focus on maintaining independence and choice. Care plans tend to focus on personal, health and medical needs and maintaining personal safety. The information on these is comprehensive. The information on social needs, personal histories and interests is limited. The Activities Officer has recorded her own information on these needs. However, only limited information is actually recorded in the care plan. Further information on social needs should be held within the main care plan. The care plans are written and mainly used by senior staff. The care staff do not tend to record information within these and in one unit the care plan for one resident could not be located when requested by the Inspector. The care plan should be a tool for staff to help them understand the needs of the people they are caring for. The Manager said that he has started to work with staff so that they can be more involved in the development and review of care plans. Further work in this area should take place so that staff routinely use the care plans. Although some information within the care plans is well recorded. There is potential to improve these documents and use them to help create a more person centred approach to care. The care plans tend to focus on problems and should include more information on individual strengths. Although care plans focus on maintaining independence in meeting personal and health needs, the staff should also consider different ways in which residents can express their choices and independence in other areas and take risks. The Manager should consider ways to involve staff in looking at how they can promote person centred planning. Care plans are regularly reviewed. Recording of baths and monitoring of health needs had improved in care plans. All residents have an allocated keyworker. But the keyworking system is not used to its full potential. Keyworkers who spoke to the Inspectors said that they made sure personal care needs were met for the residents they cared for. The role of the keyworker could be used more effectively to promote individual care. The Manager should look at ways to support a more effective keyworking system. Some of the terminology used in care plans and communication books was negative and some information was unclear. The staff should be aware that Dalemead DS0000017362.V289521.R01.S.doc Version 5.1 Page 14 negative terminology is inappropriate. They should also make sure information is clear and easy to understand. At the last inspection one of the Team Leaders said that they would like IT training and access to computers so that care plans could be computerised. They have not yet had the opportunity to do this. Computerising care plans would make updating information easier. The Manager should consider ways to support staff to develop their IT skills and provide a computer which staff can access. The home employs a hairdresser who visits twice a week. She has worked at the home for over twenty years and knows the residents well. The Inspectors met with service users who were seeing the hairdresser. The atmosphere was lively and the residents clearly enjoyed the service. The hairdresser said that she felt the residents were well cared for at the home and all their personal care needs were met. All residents are registered with local GPs and other health care professionals as required. The senior staff work closely with these professionals. One service user showed the Inspector a new electric wheelchair they had recently been given. The staff said that an Occupational Therapist was coming to work with the service user and staff to make sure they knew how to use this equipment. All six of the residents who completed questionnaires said that they received the care and support they needed and that their medical needs were met. Three residents said that staff were not always available when needed and did not always listen to what they said. Since the last inspection there has been work to help staff have a better understanding of how to support residents to make choices. The Inspectors saw evidence that some staff had taken this on board and were listening to what residents said and wanted. However, Inspectors also saw that some staff still followed set routines and did not necessarily let residents make choices. The work to support staff to understand why this is important must continue. Six medical professionals completed questionnaires about the home. All of them said that the staff communicated well with them and demonstrated a clear understanding of the health needs of service users. They all felt that specialist advice was listened to and acted upon. One doctor wrote that there had been recent improvements to the service. A number of surveys said that they felt the senior staff were very good and their communication was excellent. Training in dementia was recently organised for all staff. One of the team leaders said that the training provider had worked with senior staff to prepare training which would be suitable for the staff and relevant for the work that Dalemead DS0000017362.V289521.R01.S.doc Version 5.1 Page 15 they did with residents. This is very positive and further training to look at different areas of dementia care would be useful to improve staff understanding, skills and knowledge further. At the last inspection there were serious concerns about the way in which some residents were supported at mealtimes. Since the inspection, team leaders have organised and led training for all staff on supporting residents with eating and drinking. The team leaders said that the training had been successful. The Inspectors noted significant improvements in this area, with staff offering more choice, supporting residents in an appropriate way and communicating clearly with them The home has arrangements for the safe storage, recording, administration and disposal of medication. The recording and auditing of medication has improved since the previous inspection by a Pharmacist Inspector. Medication is given correctly and residents are given a choice of when to have their medication. All staff giving medication have received training. The reason medication is not given to residents needs to be recorded more accurately. The fridge temperature needs to be monitored and recorded accurately. All records relating to receipt, storage, administration and disposal of current medication were examined. The Manager, and three staff member were interviewed. A sample of the current medication in stock was compared to the current records and medication not supplied in the monitored dosage system was counted and compared to the records. This was to check that medication was being given as directed. All the medication in stock agreed with the list of medications on the administration records. The administration records had all been completed. Where an error on the records had been detected appropriate action was taken to find out what had happened. Staff were all aware of the procedure for checking and handling medication. Most medication is given from a monitored dosage container. Staff are able to check if medication has been given or not. When medication is not supplied in the MDS there is a clear audit trail to check whether medication has been given correctly. The amount of medication currently in stock agreed with the records. This indicated that medication had been given to the resident as prescribed unless otherwise recorded. When medication is not given as prescribed the reason was clearly recorded except in three instances. The reason the medication had not been given was recorded as “other” with no explanation what this meant. The staff described why the medication had not been given. Dalemead DS0000017362.V289521.R01.S.doc Version 5.1 Page 16 All medication was stored securely and in the correct conditions. From the records and talking with staff the fridge temperature is not monitored and recorded properly. The temperature was within the correct range on the day of the visit. The home has access to a pharmacist for advice. The last visit had been in January 2006. A record was made of the visit and the recommendations in the report had been acted on by the home. The pharmacist has trained staff giving medication in safe medication management. Dalemead DS0000017362.V289521.R01.S.doc Version 5.1 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 In general the quality in the Daily Life and Social Activities Section is good to excellent. This judgement is based on observations, discussions with residents, staff and visitors and information from questionnaires. The activities at Dalemead are excellent and residents have their needs met through individual and group activities. The Activities Coordinator has an impressive knowledge of individual needs and residents are happy with the support they get in this area. Residents are supported to stay in contact with families and friends. Visitors are welcome at any time. The home values the importance of family contact and allows family members to continue to be involved with caring for their relative if they wish. Residents are supported to celebrate their culture. Their religious needs are generally met through visiting clergy and activities. Residents are supported to try new foods and to look at different cultures through their activities. Food at the home is freshly prepared, varied and enjoyed by most residents. Choices are available but this is not always made clear to the residents. Dalemead DS0000017362.V289521.R01.S.doc Version 5.1 Page 18 EVIDENCE: The home employs a full time Activities Coordinator. She has detailed activity care plans for each resident and has developed a programme of activities which meets individual and group needs. The Activities Coordinator is appropriately qualified and experienced and continues to attend relevant training. Each day group activities are organised in different units. The Activities Coordinator also spends time with individual residents chatting, taking them to the shops, with nail care and helping them to do different activities of their choices. Her enthusiasm and dedication to the role is obvious and she is very skilled at involving all residents and focusing on their skills and interests. The Inspectors spent some time watching her run an activity session involving residents from a number of units. The activity was physically and mentally stimulating and all those participating were clearly enjoying this very much. Support was given to residents who had hearing impairments and those who found it more difficult to understand what was going on. The Inspectors also saw the Activities Coordinator spending time with individual residents. A wide variety of activities is organised and these are attractively advertised on notice boards is a weekly exercise group and an arts and craft session run by visiting activity providers. The Activities Coordinator has an excellent knowledge of individual needs and was heard organising to supply residents with videos, music, books and other things of interest. Residents who spoke with the Inspectors said that they were encouraged and supported to do things they wanted to do. For example one resident said that they liked gardening and were able to do this. Another resident said that the Activities Coordinator took them to local shops every week. A number of the residents said that they enjoyed a recent visit from a local farm who bought animals for them to see, stroke and hold. Photographs of this event showed that it was very popular. All the residents who completed questionnaires and those who spoke with Inspectors said that they were happy with activities. Several of the relatives and other professionals who contacted the CSCI also said how good they thought the activities were. Some of the activities have been designed to celebrate cultural needs. Most of the residents are British and have enjoyed recent celebrations for the Queen’s birthday and Easter. The Activities Coordinator is aware of individual needs and addresses the cultural needs of those residents who are not British. The Activities Coordinator said that the Manager was very supportive of her work and was providing transport for a number of trips over the summer, including a trip to Kew Gardens and one to Richmond. Each unit has a box of activity resources, for reminiscence, quizzes, crafts and music, which are Dalemead DS0000017362.V289521.R01.S.doc Version 5.1 Page 19 available for residents and staff to access at any time. Photographs of various activities are on display throughout the home. Visitors are welcome at the home at any time and throughout the inspection the Inspectors saw and met with a number of visitors. Several of the visitors said that they were able to continue to care for their relatives and the Inspectors saw that staff supported this and that family input was valued. Visitors said that they felt the staff were kind and supportive and said that they were always made welcome at the home. All the relatives who completed questionnaires on the service said that they were made welcome and were kept informed about the care of residents. The Manager has recently asked relatives to complete his own quality questionnaire and was completing a report of the findings. He said that he plans to act on comments made by relatives about changes which they would like to see introduced. Residents are supported to make use of the local community if they wish and some residents regularly visit local shops. Some residents access local day centres. Regular church services are held at the home. Since the last inspection there has been improvements to the control residents have over their own lives. Over recent years the Manager has introduced new procedures, including providing individual medicine cabinets and improvements to activities which have allowed residents more choice and control. Since the last inspection staff have been supported to have a better understanding that residents should be able to make choices and take risks. At the last inspection some staff were observed telling residents where to go and where to sit, but at this inspection residents were afforded more freedom of choice. This is mainly due to the support from the Manager and senior staff and training. However, some staff still find it difficult to allow residents freedom of choice and work a in a more institutionalised way. It is important that all staff recognise and value the right of residents to make choices and to take risks. Work to promote a person centred approach and further staff training and support is needed. The cook has worked at the home for many years and has an excellent knowledge of individual needs, likes and dislikes. She spoke to the Inspectors about menu planning and how she hopes to involve residents more in making changes to the menu. She said that she has recently tried new dishes and has seen how successful these have been with residents. The cook said that she tries to use seasonal and fresh produce. The kitchen and store rooms are well maintained and are stocked with a wide range of food. The cook spoke about planned improvements to the storage areas which are due to take place over the next few months. Food stored in kitchenettes within the units was stored and labelled appropriately. This is an improvement and staff appear to have a better understanding of why this is important. Dalemead DS0000017362.V289521.R01.S.doc Version 5.1 Page 20 Menus at the home are varied and include a range of hot and cold food. Most of the food is traditional British dishes, which is what the residents have said they prefer. However, some new food and food from different parts of the world have been introduced to the menu. Since the last inspection, information for residents on menus has been improved. Some residents told Inspectors that they were able to request different dishes from the main menu if they wished to. However, the choices available to residents were not altogether clear on the menu. The menus on display lacked some detail, for example the menu on the days of the inspection did not specify what type of soup was being served. Some residents did not know what they were having for lunch on the day of the inspection. The Manager should consider ways to develop the menu so that residents to make it more accessible, give clearer and more detailed information and to clearly show what choices are available. The Inspectors observed the support given to residents at lunchtime. There was significant improvements since the last inspection and staff were supportive, offered choices and gave encouragement so that the experience was more pleasurable for residents. Some of the staff supporting residents to eat were still offering large mouthfuls of food and they should be aware that this can be distressing and unpleasant for the people who they are helping. Residents who spoke with the Inspectors and those completing questionnaires said that they liked the food at the home. Dalemead DS0000017362.V289521.R01.S.doc Version 5.1 Page 21 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 The quality in the Complaints and Protection Section is mostly good. There is an appropriate complaints procedure which is available to residents and their visitors. There are appropriate procedures covering abuse and whistle blowing and all staff have recently attended relevant training. EVIDENCE: There is a suitable complaints procedure, which gives information on timescales for investigating complaints and how to contact the Commission for Social Care Inspection. There have been no complaints made to the home in the past year. The CSCI received one complaint about the service which was referred to the Manager to investigate. The Manager took appropriate action to investigate this and report back his findings. The home has adopted the London Borough of Richmond protection of vulnerable adults procedure. The home has its own procedures on abuse and whistle blowing. Since the last inspection all staff have undertaken training in the protection of vulnerable adults. Some staff who spoke to the Inspectors raised concerns about practices. These included other staff not following health and safety procedures and allegations that residents were not given choices about changes to their life. It is important that all staff are aware of their responsibilities under the whistle blowing procedure and report any such incidents to the Manager to investigate. Dalemead DS0000017362.V289521.R01.S.doc Version 5.1 Page 22 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 The quality of the Environment Section is mostly good. The building is suitable to meet the needs of residents but there are some decorative and health and safety needs. The layout and design of some areas could be confusing for residents who may find it difficult to orientate themselves. EVIDENCE: Dalemead is a converted house on three floors. The home has a large and attractive 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 Dalemead DS0000017362.V289521.R01.S.doc Version 5.1 Page 23 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. The home has a programme of decoration and repair and is generally well maintained. There are areas of wear and tear and some areas which are in fairly urgent need of decoration. Some decoration work was taking place at the time of the inspection. Two kitchenettes have been refurbished since the last inspection. The chairs in some of the communal areas do not match and the Manager should give consideration to providing new furniture. Some light fittings were damaged and broken and these must be repaired. Some of the corridors and doors to bedrooms and bathrooms look similar and have no means of identification. 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. Since the last inspection senior staff have conducted and recorded a check on maintenance and health and safety around the home. Given the size of the home and some of the health and safety hazards the Inspectors noted (including broken light fittings, a condemned fire extinguisher) there should be more regular checks on the building. On the days of the inspection, the home was clean throughout. Dalemead DS0000017362.V289521.R01.S.doc Version 5.1 Page 24 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 quality in the Staffing Section is adequate to good. This judgement is based on observations made and evidence seen during the visit to the service. Staff are employed in sufficient numbers. Senior staff have worked together to look at how the quality of the service can be improved. Recruitment practices have improved and residents are protected by thorough checks on potential staff. Training for staff is improving and the Manager has looked at new ways of supporting staff through in house training. Further training and improvements to the way in which training is recorded are necessary. Some staff do not have a clear understanding of how to support residents in an individual way. Some staff have demonstrated inappropriate attitudes and these need to be addressed so that residents are safe and well cared for. EVIDENCE: There are enough staff to support residents to meet their daily needs. Since the last inspection a senior member of staff has been employed to oversee one of the units. The staff on this unit had been without senior support for some time and the employment of a new person been positive. Three of the units now have senior support workers. The Manager wants to employ another part time senior staff member to work in forth unit. Dalemead DS0000017362.V289521.R01.S.doc Version 5.1 Page 25 Since the last inspection the senior team have met more regularly and have worked together to look at how the service can be improved. The seniors have led in house training for staff and have introduced new systems and paperwork. This is positive and must continue. The Manager must make sure the senior team continue to meet regularly and take a lead in change and development. Since the last inspection two new members of staff have been recruited. The Manager demonstrated that appropriate checks had been made on these staff before they commenced work. In the past staff have been employed without thorough checks being made. This situation must not reoccur and the Manager is responsible for making thorough checks so that residents are not put at risk from unsuitable workers. The Manager has started to look at the training needs of staff and to complete staff training profiles. Two training profiles had been started at the time of the inspection. The Manager must make sure complete records of training for all staff are in place. The Manager has organised updated training in some areas for all staff. This has included protection of vulnerable adults training, manual handling and dementia training. Further training in dementia and around the other needs of residents is important and should be organised on a regular basis. The in house training by senior staff has been successful and has helped the staff to have a better understanding of some aspects of care. Further in house training should be organised to meet specific needs. In particular some staff find it difficult to adopt a person centred approach and this should be a key aspect of future training. The Manager has arranged for senior staff to undertake training in care planning, supervision and mentoring and for the Activities Officer to undertake further training in therapy, reminiscence and craftwork. Staff are supported to undertake NVQs. The Manager said that eleven of the twenty-six care assistances were qualified to NVQ Level 2 or were undertaking it. Four more staff were due to start this later in the year. Two members of staff are taking NVQ Level 3. One of the staff members who spoke to the Inspectors said that they felt sorry for the residents and another staff member said that they sometimes lost their temper. One staff member said that they felt it was unfair that residents could raise their voice at staff but that staff could not raise their voices or ‘defend themselves’. One staff member took one of the Inspectors into a resident’s bedroom to speak to them, without the resident’s permission. These attitudes are very worrying. Further work to make sure the staff understand their role and responsibilities must take place. It is never acceptable for staff to lose Dalemead DS0000017362.V289521.R01.S.doc Version 5.1 Page 26 their temper or raise their voice to residents. If the staff feel stressed by an aspect of their work they should be able to voice their concerns appropriately to a senior member of staff. Observations throughout the inspection visits showed that some staff members got on well with residents and made an effort to initiate and sustain conversations. However, some staff did not and either found it difficult or did not want to do this. This is an important aspect of their role and the Manager must work with staff to make sure they can support residents in this way. Dalemead DS0000017362.V289521.R01.S.doc Version 5.1 Page 27 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, 33, 35, 36, 38 Quality in the Management Section is mostly good. The Manager is suitably experienced and qualified. The Manager has started to look at ways to measure quality outcomes to the service. There has been some improvements to health and safety practices but more regular checks on the building must take place to maintain good safety standards. There has been some improvements to the support of staff although more regular individual supervision and team meetings must take place. EVIDENCE: Dalemead DS0000017362.V289521.R01.S.doc Version 5.1 Page 28 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. Staff at the home reported that the Manager was open and supportive and welcomed new ideas and innovations. The Manager has started to look at ways of quality monitoring at the home. He has worked with senior staff to look at outcomes for service users in each of the National Minimum Standards areas. He has also contacted relatives and asked them to complete questionnaires about the service. The questionnaires ask for information on food, activities, care, cleanliness and staffing. He has received a number of responses and is preparing a report on these. A copy of the report and action plan to meet any identified needs should be forwarded to the Commission for Social Care Inspection. There has been improvements to the frequency of individual supervision and staff meetings. However, two staff who spoke to the Inspector said that they did not meet regularly or have individual supervision. The problems with the attitude of some staff must be addressed through supervision and to effectively change institutionalised practices communication through individual and team meetings is essential. The Manager must make sure all staff receive regular supervision with their line manager and that team meetings are organised so that information can be shared and the staff can contribute to change through appropriate forums. There has been considerable work to improve many aspects of the service since the last inspection and the Manager and staff are commended for their hard work. The Manager should continue to work closely with the senior team to look at continuous improvement of the service. The Manager has developed a suitable business plan which has been reviewed in line with CSCI inspection reports and internal quality monitoring. This flexibility and the Manager’s approach to change is positive and is an indication that he is looking at how to improve outcomes for residents. 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, There is evidence of regular checks on fire equipment, water temperatures and first aid supplies. However there has only been one recorded health and safety check of the building since the last inspection. During the inspection the Inspectors found several broken light fittings and a condemned fire extinguisher. More regular and thorough recorded checks should be in place. There has been improvements to the storage of COSHH products. Dalemead DS0000017362.V289521.R01.S.doc Version 5.1 Page 29 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X N/A 2 X 2 Dalemead DS0000017362.V289521.R01.S.doc Version 5.1 Page 30 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 OP9 Regulation 13(2) Requirement Timescale for action The Registered Person must 01/06/06 make sure the reason medication is not given to residents is recorded clearly. The Registered Person must make sure staff are trained in how to monitor and record the fridge temperature properly. 2. OP38 OP19 13(4)&(6) 23(2)(b) The Registered Person must 30/06/06 make sure health and safety is maintained and that decorative and repair needs are attended to. Regular and recorded health and safety checks must be made. The Registered Person must 31/08/06 make sure detailed training profiles are in place for all staff. Training needs of all staff must be met through formal and in house training. 3. OP30 18(1) Dalemead DS0000017362.V289521.R01.S.doc Version 5.1 Page 31 4. OP36 12(5)(a) 19 The Registered Person must 30/06/06 make sure staff do not behave inappropriately or have inappropriate attitudes towards residents. The Registered Person must 31/07/06 make sure all staff receive regular formal supervision and participate in team meetings. Previous timescale 31/12/05 requirement 31/07/05 & 5. OP36 12(5)(a)1 8(2) 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: 1. Make sure care plans include detailed information on social needs. 2. Consider ways to promote a more person centred approach to care planning and support of individuals. 3. Make sure information in care plans is clear and there is no negative terminology. 2. OP7 The Registered Person should: 1. Support staff to be more involved development and review of care plans. in the Dalemead DS0000017362.V289521.R01.S.doc Version 5.1 Page 32 2. Look at ways in which the keyworking system can be used more proactively to support individual care. 3. OP7 The Registered Person should consider supporting staff to undertake IT training so that computerised care planning and other records can be used. 4. OP15 The Registered Person should consider how menus can be further developed to make them more accessible and to give more information about choices available. The Registered Person should consider replacing chairs which do not match in communal lounges. 5. OP19 6. OP19 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. This work should be prioritised. 7. OP27 The Registered Person should employ a senior staff member to support the running of the 2nd floor unit. The Registered Person should support staff so that they have a good understanding and feel confident in conversing with residents socially and not just task based communication. 8. OP30 Dalemead DS0000017362.V289521.R01.S.doc Version 5.1 Page 33 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.V289521.R01.S.doc Version 5.1 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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