Inspection on 07/06/07 for Dalemead

This inspection was carried out on 7th June 2007.

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 26/04/06

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 7th June 2007 10:30 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.V336075.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dalemead DS0000017362.V336075.R01.S.doc Version 5.2 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 020 8891 6697 anwar.dalemead@btinternet.com 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.V336075.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th April 2006 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.V336075.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection included a visit to the service by a Regulation Inspector on 7th June 2007. When we visited we spoke to the people who live and work at the home, visitors and the Manager. We also looked at records, observed what was going on and looked at the environment. As well as the visit we asked the Manager to complete a quality self assessment. We also wrote to the people who live at the home, their visitors, staff and other professionals to ask them what they thought about the home. Information from all these sources has been used to help form the judgements in this report. 18 people who live at Dalemead completed the surveys that we gave them. They all said that they were well cared for and had the support they needed. Most of them said that they liked the food and activities. 13 visitors returned surveys. They were all happy with the care given to their relatives and friends. They felt the staff were good at keeping in touch and they felt welcomed when the visited the home. Some of the things that people who live at Dalemead and their visitors and relatives said were: ‘The staff are very caring. I am very happy with the services offered at Dalemead.’ ‘I like it here and I wouldn’t get better anywhere else.’ ‘I think this home is the best place. The bosses are nice and will do anything for you.’ ‘I am well looked after and have nothing to be unhappy with.’ ‘I can’t remember anything ever happening that I was not happy with.’ ‘I am very lucky they found me and I found them.’ ‘It is reassuring to know that my mother is in good and efficient hands.’ ‘My mother is extremely happy, feels safe and secure.’ ‘Dalemead transformed my relative from a chronically unhappy, undernourished person into a cheerful and well looked after person.’ ‘My father has often said how kind the staff are and how good his care is.’ ‘We visit at different times of the day and always find our relative happy and content.’ ‘Excellent in all respects.’ ‘As far as I am concerned the care provided is excellent.’ ‘There is a pleasant and homely atmosphere.’ ‘We consider ourselves fortunate that our mother resides in Dalemead.’ 11 members of staff completed surveys. The staff said that they were well supported and the Manager was approachable and listened to their opinions. Some of the things which the staff said were: Dalemead DS0000017362.V336075.R01.S.doc Version 5.2 Page 6 ‘It is brilliant to work in such a home.’ ‘Dalemead is a very nice place to work. I find my workmates a very nice group of people who do the utmost for our residents.’ ‘I am very proud to be part of the team at Dalemead. It is a very friendly and happy environment to work in.’ 14 other professionals completed surveys. The professionals all felt that staff worked well with them and offered consistent support. One person said that they felt the home had improved in recent years. One person said, ‘I meet most of the residents in my role and in my opinion they all seem very happy and well cared for.’ One resident told us, ‘I am very happy living here. I have all I need. I have seen the home get better since I moved in here.’ What the service does well: What has improved since the last inspection? There have been lots of improvements to the standard of care over the past two years. Improvements since the last inspection include: Regular residents meetings have started. There are now signs and pictures on residents’ bedroom doors that they have chosen to help them identify which bedroom is theirs. A new senior member of staff has been appointed to oversee one of the units. Residents have chosen new names for the units they live in. All care staff now have regular individual supervision meetings with their manager. New organised activities are available. There is new information for residents and visitors about health care conditions, advocacy services and staff photographs on display to help people identify them. Dalemead DS0000017362.V336075.R01.S.doc Version 5.2 Page 7 The Manager has developed a training plan and audited all staff training. The senior member of staff on one unit has set up regular meetings to offer support to families. There have been some improvements to the way in which people’s care needs are recorded. There have been changes to the menu suggested by residents. The people who live at the home have more choices about their daily lives. There have been some improvements to the environment. What they could do better: 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. The summary of this inspection report can be made available in other formats on request. Dalemead DS0000017362.V336075.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dalemead DS0000017362.V336075.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who are thinking about moving to the home have enough information to help them make their choice. The staff make sure they gather information about individual needs so that they can decide whether the home is suitable for that person. EVIDENCE: There is a Statement of Purpose and a good clear guide to the home for residents. Copies of these are given to all potential residents and are available in each of the home’s lounges. The Manager has designed a new information leaflet to accompany these documents. Since the last inspection senior staff have gathered information and leaflets on advocacy services, dementia and other areas of interest for residents and Dalemead DS0000017362.V336075.R01.S.doc Version 5.2 Page 10 visitors. They have displayed these in the home’s entrance hall along with a comment box. There is a board displaying photographs of staff for each unit. This is designed to help residents and their visitors identify the people who are supporting them. One visitor told us about how difficult it had been choosing a home for their relative. They said that they would like to see information from the families who had chosen the home available to potential residents and their families. They felt that this would be useful and supportive and help people to make their decision about care for their relatives. The Manager said that he was considering asking families who did not choose Dalemead for their reasons why as this would help to look at ways the service could improve. There is a contract for everybody living at the home. The Manager has recently updated the contract to incorporate changes in legislation. Contracts are reviewed at least annually. People who let us know about their experiences said that they had enough information to help them decide about moving to the home. They said that they were able to visit. One person said: ‘My brother recommended this place after looking at many others.’ The Manager or senior staff make assessments of need and visit potential residents in their own home or hospital. They have started to invite keyworkers to these visits so that they can get to know the person and so that the person and their family have a named member of staff they know that they can contact. The assessments include information from the person themselves, their families and other professionals if needed. The home also receives referrals and information from social workers. Once someone moves to the home the staff continue to assess their needs over a six week period. At the end of this period the person, their representatives and the Manager meet to decide whether they wish to and can continue to be cared for at the home. One of the visitors who met with us said, ‘new residents always get lots of staff time and attention’. Dalemead DS0000017362.V336075.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The care needs of people living at the home are recorded. Records of these have begun to improve but further work is needed in some areas to make sure people have more choice about their own care. People’s health and personal care needs are met. Medication is generally well managed but further improvements are needed in some areas to make sure everyone is safe. EVIDENCE: Each person has a care plan which outlines their needs. There have been improvements to some of these. The improvements include reviewing the layout and design, involving the people the care plans are written about in their development and making sure the care plans focus on the individual needs. The improvements are positive and the staff now need to ensure changes are made to all care plans. The majority of care plans are not accessible to the people that they are about and they need to be. Dalemead DS0000017362.V336075.R01.S.doc Version 5.2 Page 12 Some of the terms used in care plans need to be changed. These include referring to toileting, references to people being aggressive and in one care plan the person was referred to as a ‘ real darling’. Risk assessments are in place for some people. Sometimes different areas of risk were recorded on the same assessment. Not all of these had not been made in agreement with the person they are about or their families. For example some people have bed rails designed to keep them safe at night. The home must have a record to show that they have agreed to the use of these as they restrict the person’s freedom. The medical professionals who contacted us said that the staff worked well in partnership with them. They felt that the staff made good observations of health needs and made contact with them as needed. Some of the comments that they made were: ‘I believe that the staff provide excellent care in a challenging environment.’ ‘The staff have a caring attitude and treat the residents with great respect and dignity.’ ‘The staff are very sensible towards medical health issues.’ ‘The staff prepare people for treatment in a comfortable and suitable place.’ There is an appropriate medication procedure. Staff have had training about medication. People are supported to manage their own medication if this is what they wish to do and they are able. One area of the home has trialled a monitored dosage system of storage and administration. This has worked well and the new system is going to be introduced for all medication in the home. The system is a more secure and easier to use way of managing people’s medication. The information on different medications used is good. Medication administration records are accurate. Medication is stored securely and in most cases safely. However, one bottle of topical medication was not stored in the fridge and should have been. It should also have been labelled with the date of opening and some denture cleaning tablets were not appropriately labelled. There was a record of staff signatures in one unit but not in all areas of the home. One person felt that their relative could not always understand staff and there was sometimes communication difficulties. The Manager said that he is liaising with a local college to offer training and support for staff whose first language is not English. He hopes that this will improve communication. People who contacted us said that they felt person care needs were met. Some of the things which they said were: Dalemead DS0000017362.V336075.R01.S.doc Version 5.2 Page 13 ‘The hairdresser is excellent.’ ‘My mother gets the medical attention she needs we are very pleased with the standard of care.’ ‘My mother is always treated with respect. Staff are friendly and caring and my mother is always well dressed and physically cared for.’ ‘Staff are caring and understand my relative’s complex needs. They treat her with respect and help her with aspects of her daily life.’ ‘My mother has always taken a pride in her appearance and staff respect this by painting her nails, styling her hair and making sure she is dressed appropriately.’ One visitor felt that more care should be taken with choosing clothes as their relative was not always dressed in coordinating outfits, or sometimes fastenings were missing. Some people were seated in wheelchairs throughout the day, including at mealtimes. There was no care plan in place stating that this was their choice and there was no care plan relating to skin care and pressure areas for one of these people. Staff receiving training about end of life care and dying and death. The staff work closely with other health care professionals and the palliative care team when people need support in this area. Dalemead DS0000017362.V336075.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. People living at the home have excellent opportunities to participate in group or individual activities. They are able to see their visitors when they want to and visitors are made to feel welcome. People are able to make choices about their everyday lives and these are respected. There is a good choice of freshly prepared food. EVIDENCE: There is a planned programme of activities which is continuously being reviewed and new activities provided to meet the wishes and demands of the residents. There is an Activities Coordinator and she plans and facilitates most of the activities. These are well advertised and she promotes the different activities each day making sure everyone knows what is going on and has the option to join in. She has developed an activities care plan for each person and keeps this under review. The plan considers individual needs and looks at ways that these can be met. She spends some of her time supporting individuals and small groups. Dalemead DS0000017362.V336075.R01.S.doc Version 5.2 Page 15 She organises trips to the local shops and parks as part of the weekly programme of events. There are regular activities in each area of the home, and people are encouraged to visit other communal lounges to meet different people and to see different parts of the home. There is a programme of special events and visiting entertainers. These include a regular visit from a local farm, musicians and singers. Special dates and events, such as Easter, St George’s Day and bank holidays are celebrated with a variety of activities and often themed competitions. There are also regular visiting activity providers, including an arts and craft person, a keep fit person and someone who brings their pet dog for people who wish to stroke and spend time with. Earlier in the year the home held an arts exhibition. People who live at the home were encouraged to display their art and craft work for other residents and visitors. Photographs of this event were on display. One resident spoke with pride about the day and the items that they had worked hard to produce and then been able to show to others. There is a range of resources on each unit for people to use when there is no organised activities. These include craft materials and games. The Activities Officer chose the resource items for each unit according to the needs and wishes of the people living there. Some of the things that people said about activities were ‘The activities are very well organised and interesting.’ ‘The Activities Coordinator is enthusiastic and committed.’ ‘The staff understand my mother’s cultural background and help her celebrate this within the home.’ Some of the professionals who help provide regular activities at the home contacted us. They said that they felt the home offered good support and a variety of activities. There are photographic displays of activities around the home. These show residents enjoying special events and visits from a local farm and entertainers. Visitors are welcome at any time and those who contacted us said that staff stayed in regular contact and always made them feel welcome when they visited. Some relatives said that they could continue to be involved with offering care when they wished to. Some of the things that they said were: ‘When I have taken my relative to hospital, the care staff provide me with lunch on my return if I have not eaten.’ ‘The staff keep us informed and written and verbal communication is always good.’ ‘We are always made Dalemead DS0000017362.V336075.R01.S.doc Version 5.2 Page 16 welcome, regardless of the time of day. The staff are always chatty and friendly and offer us food and drink and the opportunity to eat with our relative if we wish.’ ‘We were informed immediately when my mother had an accident. We are kept up to date with any changes. The staff telephone us to discuss any issues and arrange meetings if needed.’ ‘My mother enjoys spending time with her family and this is supported by staff. The staff chat about family members and remind my mother when people are visiting.’ The atmosphere throughout the home was friendly and relaxed. There was music playing. Staff were chatting to residents, people appeared content and comfortable and mealtimes were not rushed. Over the past two years senior staff have offered support and training so that the staff have a better understanding of allowing people freedom of choice. During this inspection visit the staff were observed being polite and informative to residents and allowing them to make their own decisions about what they wanted to do and where they wanted to go. People were given choices about what they wanted and amounts of food at mealtimes and were able to see the food choices before they were served onto their plates. People were able to help themselves to condiments and the staff asked them about their enjoyment of their meal. The improvements in these areas are noted and the staff should continue to work towards a more person centred approach looking at how they can offer more individual choices, such as better choice about when they can bathe, people being able to help themselves to vegetables and drinks at mealtimes and people being offered an alternative to wearing an apron when they are eating. There are fresh flowers in each unit. The staff on one unit said that one of the people living there always made the flower arrangements. Other residents are supported to take part in daily activities such as laying the tables or drying up cups and saucers if they want. Care plans included information on people’s cultural and religious needs. Local churches visit the home and hold a service and offer Holy Communion for those who wish to take part. The Activities Coordinator has started facilitating regular residents’ meetings. Minutes of these are displayed in large print in the lounges and copies given to all those who attended. Following a recent residents’ meeting changes were made to the menu which had been suggested by the group. One unit has started to produce a newsletter for residents and their families. The Team Leader on this unit has offered a regular opportunity for families to Dalemead DS0000017362.V336075.R01.S.doc Version 5.2 Page 17 meet with him to discuss their individual needs and any concerns that they have. The menu is displayed and people are given choices about the meals that they would each morning. The staff said that the chef was very flexible. The Activities Officer organises regular food tasting sessions, where she offers people new and different types of food to try. Recent sessions have included fruit smoothies, different cheeses and different types of melon. Popular foods are included in future menus. One person said, ‘there is limited choice for diabetics and insufficient fresh fruit.’ Fresh fruit is available in fruit bowls throughout the home for people to help themselves. The senior staff said that staff offer fruit at mealtimes and offer to peel fruit if needed. They should make sure that everyone is being offered this and should ask people if there is any different type of fruit that they would like. Two of the comments from people living at the home about food were: ‘I never leave anything’ and ‘the food is excellent.’ Dalemead DS0000017362.V336075.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 & 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People living at the home are protected by appropriate procedures. EVIDENCE: There is a suitable complaints procedure which is issued to all residents and their families and is discussed at their six-week review. Copies of the procedure are available throughout the home. There is a record of all complaints and concerns. One person who contacted us said, ‘When we raised a concern it was resolved within 24 hours.’ The senior staff were contacting local advocacy services to ask them how they could provide support for people living at the home. One idea is that they attend residents’ meetings and another is that they meet with people individually. The home uses the local authority vulnerable adults protection procedure and has its own procedures on abuse and whistle blowing. The staff are aware of these and have had relevant training. Dalemead DS0000017362.V336075.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People live in a safe and well maintained environment. EVIDENCE: The home is divided into four separate units each with its own lounge, bathrooms, kitchen and dining areas. All bedrooms have en suite toilets. There is a large, attractive and well kept garden. Some of the bedrooms and bathrooms have been redecorated and upgraded since the last inspection. One of the bathrooms was being converted into a shower room. The people living at the home have chosen signs and pictures to be displayed on their doors which help them to identify which bedroom is theirs. The people Dalemead DS0000017362.V336075.R01.S.doc Version 5.2 Page 20 living on each unit have renamed their units. The staff took suggestions from individuals and then all the residents from each unit decided on the final name. The new names have a botanical theme. One unit has been named Orchids. The team leader for this unit said that relatives and visitors had bought orchids to be displayed in individual rooms and communal areas throughout the unit. Residents in one unit have requested bigger dining tables and the Manager plans to purchase these to meet their needs. The communal area in another unit is due to be changed to make it more homely and to provide different areas for relaxation. New furniture and flooring will be purchased for this room. Considerations should be given to replacing and rearranging the furniture in other communal rooms. The chairs in some lounges do not match and are placed around the walls. Consideration should be given to making these rooms more homely. The senior staff said that they had been looking at information on supporting people with dementia to get ideas about how to improve the environment. One of the senior staff has created a maintenance and cleaning check list for staff to help them identify environmental needs. The home employs cleaning staff and was clean throughout on the day of the visit. Some of the things people said about the home were: ‘The home is very clean and fresh.’ ‘The staff keep my mother’s room tidy and this is important to her.’ ‘We have good up to date equipment to do our jobs.’ Dalemead DS0000017362.V336075.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People living at the home are supported by a competent staff team. The staff receive the training and support to help them in their work. EVIDENCE: A new team leader has been appointed to oversee one of the units. All units now have an allocated team leader who supports staff and residents within that unit. The senior staff team is now complete and senior staff who spoke with us said that the team was very supportive of one another, sharing ideas and helping to solve problems. They meet regularly and contribute their ideas to the running of the home. Some of the things people said about the staff were: ‘The care staff are very understanding to each person’s needs.’ ‘The staff are kind to me.’ ‘The care staff at Dalemead do a fantastic job and I could not wish for better care for my mother.’ ‘The staff make residents feel at home.’ ‘We would like the staff to know how much they are appreciated by our mother and us.’ One person said that they would like there to be more staff on duty at night. One person said that it would be useful to have more staff available at mealtimes to help residents who found it difficult to eat without support. Dalemead DS0000017362.V336075.R01.S.doc Version 5.2 Page 22 The staff are supported to undertake NVQ awards and over half of them had achieved at least Level 2. Other staff were undertaking the qualification at the time of the inspection. The staff who we had contact with described thorough recruitment procedures. They said that they had good support and good training. We looked at staff recruitment records for the newest members of staff. These were complete and showed that thorough checks had been made before the staff were employed. The Manager has developed a training plan and profile for each member of staff. This identifies their personal training needs. All training is appropriately recorded and records indicate that staff have had key training in manual handling, food hygiene, first aid, medication, abuse awareness and other safety areas. There is a good audit of training and information about when staff need to update their training and knowledge. The Manager is looking at providing computer training for the staff, particularly senior staff. This would be beneficial and help them with the development of care plans and other paperwork they need to complete. The Manager told us that all care staff now have regular supervision meetings with their line manager. He plans for non-care staff to also have these meetings. Regular team meetings are held and minutes taken. The staff who contacted us said that they were able to contribute their ideas and that they were listened to. Some of the things the staff said were: ‘I have always received very good support and advice from my team leader.’ ‘I work in at atmosphere which is beneficial to the residents and staff alike. I feel we are a very happy team.’ ‘The home has a nice family atmosphere.’ ‘Very impressive quality of supervision and very structured.’ ‘My team leader is very supportive.’ ‘The senior staff listen, support and have a good approach to problems.’ ‘Very good team leader, very supportive and good supervision.’ ‘I have regular supervision and can approach management at any time.’ Dalemead DS0000017362.V336075.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 43, 35, 36 & 38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The people live in a home which is well managed. The Manager has been committed to improving the quality of the service and involving residents, staff and other stakeholders in this. EVIDENCE: The Manager has worked at the home for 29 years. He is a Registered Nurse and Social Worker and has undertaken the Registered Managers Award. He knows the service well and is knowledgeable about individual residents and staff. He has shown a commitment to improving the home and working towards meeting requirements made at previous inspections. Dalemead DS0000017362.V336075.R01.S.doc Version 5.2 Page 24 The Manager meets regularly with the team of senior staff. They discuss the National Minimum Standards and how the home is meeting these. The senior staff said that the Manager invites them to make suggestions and be critical so that they are all working towards the improvement of standards at the home. Some of the things people said about the Manager were: ‘The Manager is someone very supportive, helping staff moral. He is flexible, easy going and positive.’ ‘The Manager’s door is always open should we ever need to speak to him.’ ‘The Manager is a good listener and consults us.’ ‘The Manager and management team provides excellent support.’ ‘The Manager is excellent at feeding back information and listening to staff suggestions and acting on these.’ The Manager has asked residents, families and other stakeholders to complete questionnaires about the service to help monitor the quality of the service. He was in the process of collating these and was going to complete a report and action plan from his findings. The Manager develops a business plan annually. In this he lays out the home’s achievements and plans for the coming year. He has created an action plan based on the National Minimum Standards and the wishes and views of the people using the service. 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. Shortly before the inspection visit, the home had an environmental health inspection. The Manager was able to demonstrate how recommendations from the Environmental Health Officer were met or were being met. There was also a recent inspection by the Fire Officer. The findings of this were satisfactory. The staff make regular checks on health and safety around the home and record these. The temperatures of the fridges in each unit are checked daily. In one unit records indicated that a fridge was running at a high temperature. This should be checked and appropriate action taken to make sure food is stored at a safe temperature. Dalemead DS0000017362.V336075.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 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 3 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 3 3 3 X 3 Dalemead DS0000017362.V336075.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No 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 15 Requirement Timescale for action The Registered Person must 31/08/07 make sure risk assessments are clearly recorded and include agreements from the resident or their family. The Registered Person must 31/08/07 make sure people’s consent to remaining in wheelchairs is recorded and that care plans regarding this and care of skin and pressure areas are in place. The Registered Person must 31/07/07 make sure medication is safely managed including correct storage and labelling. 2. OP7 12 15 3. OP9 13 Dalemead DS0000017362.V336075.R01.S.doc Version 5.2 Page 27 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 OP1 Good Practice Recommendations Consider using comments from residents and their families to improve the information available to people who are considering moving to the home. The Registered Person should consider supporting staff to undertake IT training so that computerised care planning and other records can be used. The Registered Person should: Complete work to make all care plans person centred. Make sure information in care plans is clear and there is no negative or inappropriate terminology. 4. 5. 6. OP9 OP10 OP15 There should be a record of all staff signatures. The staff should make sure people are always dressed appropriately and their clothes are well maintained. The staff should make sure everybody is getting the fresh fruit they want and is being offered help to prepare this if need be. Consideration should be given to creating more menu choices for diabetics. The Registered Person should consider replacing chairs which do not match in communal lounges and rearranging furniture to make the environment more homely. Fridges storing food must be maintained at a safe temperature. 2. OP7 3. OP7 7. 8. OP15 OP19 9. OP38 Dalemead DS0000017362.V336075.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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