Inspection on 04/06/07 for Dalling House

This inspection was carried out on 4th June 2007.

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

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

Other inspections for this house

Dalling House 12/12/06

Dalling House 14/02/06

Dalling House 29/06/05

Dalling House 13/02/05

Dalling House 12/10/04

Dalling House 27/02/04

Dalling House 06/01/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Dalling House Croft Road Crowborough East Sussex TN6 1HA Lead Inspector Jenny McGookin Key Unannounced Inspection 4th June 2007 09:30 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 Dalling House DS0000021085.V336870.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. Dalling House DS0000021085.V336870.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dalling House Address Croft Road Crowborough East Sussex TN6 1HA Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (If applicable) Name of acting manager (if applicable) Type of registration No. of places registered (if applicable) 01892 662917 Aspenglade Limited Mrs Moya Reynard Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Dalling House DS0000021085.V336870.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users to be accommodated is twenty one (21). Service users must be older people aged sixty-five (65) years or over on admission. 12th December 2006 Date of last inspection Brief Description of the Service: Dalling House is close to Crowborough town centre, within walking distance of shops, churches and buses. The home is registered for 21 older people. Seventeen single and two double bedrooms, many with en suite facilities, are situated on three floors and are served by a passenger lift. There is a through dining room and lounge with a sun room that looks out onto a well- maintained rear garden, with a water feature. Information about the service, including the Statement of Purpose, Service User’s Guide and CSCI reports is made available to prospective service users or their relatives, on request, as part of the admission process. The range of weekly fees is £380.00 - £475.00. Additional charges, not included in the fees, include hairdressing, chiropody and newspapers. There is no e-mail address for the home. Dalling House DS0000021085.V336870.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is based on an unannounced site visit, which was used to inform this year’s key inspection process; to check progress with matters raised from the last inspection (December 2006,) given all the timeframes had run their course; and to review findings on the day-to day running of the home. Special attention was given to this home’s capacity to care for residents with special needs. The inspection process took seven and three quarter hours. It involved meetings with four residents over lunch (and a meeting with one other individually), two visiting relatives and a number of staff representing a range of functions of the home - the acting manager; the deputy manager; the head of care, and a carer. It also took into account feedback from a recent quality assurance questionnaire carried out by the home. The inspection also involved an examination of records, and the selection of two residents’ case files, to track their care. Interactions between the staff and residents were observed throughout the day. Seven bedrooms, selected at random, were checked for compliance with the National Minimum Standards on this occasion, along with some communal areas. What the service does well: The location of this home is judged generally suitable for its existing registered purpose, convenient for visitors and a generally satisfactory level of compliance with the National Minimum Standards is being maintained throughout. All areas of the building inspected were reasonably well maintained and odour free, accepting some facilities were undergoing refurbishment, with more in prospect. Records indicate that the health and personal care needs of the residents are generally adequately provided for. There is input from a range of healthcare professionals and some evidence of equipment and adaptations throughout the home. There appear to be sufficient management and staffing resources in place to keep people safe. The meals tend to be traditional English. There is a choice of meals and the standard of catering was judged satisfactory. This home is generally viewed positively by those using its services. Residents are consulted and are afforded choices on a day to day basis. Dalling House DS0000021085.V336870.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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 Dalling House DS0000021085.V336870.R01.S.doc Version 5.2 Page 7 be made available in other formats on request. Dalling House DS0000021085.V336870.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 Dalling House DS0000021085.V336870.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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 1, 2, 3, 4, 5, 6 Prospective residents and their representatives have most of the information needed to decide whether this home will meet their needs Residents have their needs assessed and a contract which clearly tells them about the service they will receive. EVIDENCE: This home has a Statement of Purpose, Service User Guide and contract, each of which usefully describes the facilities, services and principles of care. Some amendments will be required to improve or obtain full compliance with all the elements of this standard. These have been reported back to the home separately. Dalling House DS0000021085.V336870.R01.S.doc Version 5.2 Page 10 No other languages or format are said to be currently warranted. But given the poor recall of some individuals, when asked about this (in conversation during this site visit and in feedback questionnaires distributed by the home), an admission checklist is recommended to evidence the issue of these documents, to ensure people have all the information available to make informed choices. Feedback on the day of this inspection confirmed that the decision to apply to this home was generally made by third parties (such as relatives, funding authorities or, in one case, a previous employer) and influenced by its locality (i.e. close to where the resident, or relatives lived), than by any public information produced by the home itself. The residents spoken to on this visit were, however, generally very satisfied with the choice of home made. The home has its own preadmission assessments, and takes assessments from other health and social care needs into account. Less clear, however, was this home’s capacity or authority to meet any attendant physical or mental health needs, which may historically have placed some admissions outside its registration category. It is accepted that the acting manager has been reassessing and reviewing some individuals to put this right, and, although this process is by no means complete, this has in three cases so far led to their transfer into more appropriate settings. Prospective residents or their representative are invited to visit the home, before moving in, though only one relative could recall doing so. Each prospective resident is offered a trial stay of four weeks before their admission is confirmed by contract. See section on “Environment” for a description of equipment and adaptations, and section on “Health and Personal Care” for a description of services provided. Intermediate Care This home does not provide intermediate care. Should it do so, all the elements of National Minimum Standard 6 will apply. Dalling House DS0000021085.V336870.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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 7, 8, 9, 10 The health and personal care, which each resident receives, are based on ongoing assessments of their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Three residents’ files were selected for case tracking on this occasion. The format of each resident’s care plan is clearly designed to address their personal and healthcare needs, and to some extent their social care needs (though this aspect would benefit by further development). And in each case they are usefully underpinned by a range of assessments (e.g. moving and handling, pressure sores), and monitoring charts (e.g. food intake and weight) thereon. Each care plan is clearly designed to identify the practical action required by staff. However, some of the instructions in the plans of action would have universal application, and would not single out one resident’s needs from Dalling House DS0000021085.V336870.R01.S.doc Version 5.2 Page 12 another’s. There were some risk assessments, though this aspect should be further developed to identify risks and the controls that need to be in place in respect of individuals, their activities and environments. Daily reports are made by each shift, and input from healthcare professionals (district nurses, chiropodists and community psychiatric nurses) is being recorded. The home is currently served by four GP practices, which means residents have some element of choice. A key worker system is helping to ensure daily records are being maintained by each shift, but they are not being summarised monthly. This is recommended practice, to help inform the care plan reviews. There was better evidence of care plans being formally reviewed (matter raised for attention at the last inspection, and instigated as from January 2007) and records clearly identified who participated in each case. This is judged a promising start, though it was too soon to judge the longer term effectiveness of this system. When asked, only one of the residents showed any recognition of the formal care planning process, though a recent feedback exercise has confirmed that there is a generally sound level of satisfaction with the care provided by the staff at this home. Observed interactions were judged appropriately familiar and respectful, and this is said to be representative. The home does not use the Royal Pharmaceutical Society Guidance on the administration and storage of medication (this is strongly recommended, for reference purposes), but has access to a copy of the British National Formulary. It has a medication trolley, which was judged in good order, and is kept properly secured. An examination of current medication administration records indicated compliance with required standards for record keeping. There were no apparent gaps or anomalies. The home benefits by periodic inspections by a pharmacist from the East Sussex Primary Care Trust, to ensure practice conforms to safe practice standards. And this has been underpinned by staff training events. One resident is reported to manage his own medication satisfactorily, though his storage facility should be better secured. Although there are two double rooms, all the other bedrooms in this home are currently being used for single occupancy, which means personal care and treatments can generally be given in privacy. Dalling House DS0000021085.V336870.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 12, 13, 14, 15 Residents are able to choose their life style, social activity and keep in contact with family and friends. Residents receive a healthy, varied diet according to their assessed requirement and choice. EVIDENCE: Records and feedback confirm that there is usually an event planned for each day, and residents all said they were generally content with their lifestyles there. The home has its own dedicated activities co-ordinator and there is a weekly programme on display. Examples of activities include: Bingo, skittles, sing-a longs, card games, arts and crafts, conversation sessions, as well as therapies such as hand massages, music sessions (involving the playing instruments, dancing, exercises and relaxation), manicures and hairdressing. Dalling House DS0000021085.V336870.R01.S.doc Version 5.2 Page 14 There are table-top gardening sessions (planting seeds and potting up – tomato plants, runner beans and sunflower seeds), which representatives from the Prince’s Trust came in to prepare a plot in the garden for. There are Pat-aDog sessions and the home has its own DVD player, video cassette player etc. Although one outing was not well attended, residents have requested more, and the home is hoping to build up sufficient funds for its own minibus. Residents can choose when to go to bed or get up, and what to do during the day, but tend in practice to have their own fairly set routines. They were observed being supported to make choices and decisions during the day of this inspection. The home has open visiting arrangements and this was confirmed by residents, relatives and feedback, though visitors are requested to avoid mealtimes where possible. There is a communal pay phone in entrance hall, but this is not a particularly private arrangement. However, there is a mobile handset in the office, which can be taken to residents for use in the privacy of their own bedrooms. There is no charge for this though small donations are accepted. Residents can arrange for the installation of private telephone lines in their bedrooms, but this and call bills would be at their own expense. Two or three have done so. The home is situated on a steep gradient from a fairly busy road just over a third of a mile from Crowborough High Street. Crowborough train station is about a mile and a half away. A bus stop is within walking distance linking it to Tunbridge Wells (11-12 miles away) with all the community and transport links that implies. Records confirmed that dietary needs and preferences are properly identified as part of the home’s assessment processes and observed thereon. Food is delivered fresh on a weekly basis from a range of local retailers and prepared on site. The acting manager said that when a resident has a birthday s/he gets to choose the menu for that day. They always have a choice of menu, and they have menu cards (on display). A group of residents were for lunch on this site visit and the selected lunchtime meal options were judged tasty. The meals (traditional English fare) were judged well prepared and presented and the residents clearly enjoyed what they had selected. The pace of the meal was unhurried. Staff were observed attending residents in a respectful way. Dalling House DS0000021085.V336870.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 16, 18 Residents have access to a complaints procedure There are systems in place to help ensure residents are protected from abuse. EVIDENCE: This home’s complaints procedure is summarised in the home’s Statement of Purpose, and further detailed in its Service User Guide (which has been recently redistributed). The acting manager reports that no complaints have been registered, which would ordinarily be judged unrealistic in a close knit communal setting such as this, particularly given the recent disruptions caused by some individuals with mental health problems. The home’s own feedback exercise indicates that very few residents are familiar with its complaints process, and this will require attention. Families and friends tend to be relied on to provide advocacy for individual residents. Information on independent advocacy services is, therefore, strongly recommended, to help ensure residents’ legal rights are protected The last inspection (December 2006) found that the home had procedures to address abuse, and to enable staff to whistle-blow without fear of Dalling House DS0000021085.V336870.R01.S.doc Version 5.2 Page 16 recrimination, though both required further attention to make them fully compliant with the National Minimum Standards. The acting manager said this matter has been addressed and has been underpinned by training for staff, and this was confirmed by records and in interviews with individual members of staff. Staff confirmed their commitment to report any incidences of abuse, should they occur. Less clear was evidence of relevant funding authorities’ multi disciplinary protocols, designed to obtain timely and co-ordinated responses, should instances of abuse occur. Dalling House DS0000021085.V336870.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 19, 20, 21, 22, 23, 24, 25, 26 Residents live in a generally safe, well-maintained and comfortable environment. EVIDENCE: All areas of the home inspected were found to be comfortable and (with the exception of one or two toilet facilities) reasonably clean - accepting some refurbishment was in process, with more in prospect. The home was adequately lit and centrally heated at comfortable temperatures. The furniture tends to be domestic in style and there were homely touches throughout. All bedrooms and communal areas have accessible call bells, although some call points in bathrooms had been temporarily disabled while refurbishment work is being carried out. Dalling House DS0000021085.V336870.R01.S.doc Version 5.2 Page 18 There are limited garden facilities as such at the front. And the forecourt there is largely reserved for car parking. A steep gradient onto a relatively busy road at the front should be risk assessed for use with wheelchairs and mobility aids. The small enclosed garden at the back provides a pleasant enough area to go into or sit in. There is a patio area provided with garden furniture and there are attractive focal points and landscaping, but most of the garden would be inaccessible because of a deep terrace. The home has a “No Smoking” policy. Smokers would need to smoke outside. There is a shaft passenger lift up to the first floor, and all areas likely to be accessed by residents within the home itself are otherwise step-free. Residents have access to their own wheelchairs, Zimmer frames and other mobility equipment. There is some equipment and adaptation available in this home such as two hoists, plate guards and grab rails - though not consistently (e.g. on both sides of corridors or outside approaches). One communal bath seat tends not to be used at all because residents do not feel sufficiently secure on it. And other examples of disabled access are detailed through this section of the report. There have been no overall periodic audits by specialists such as OTs etc. This input is strongly recommended to ensure the home continues to meets the needs of residents, who are likely to be mobility impaired by reason of their age. Residents have a choice of communal areas, and furnishings tend to be domestic in character. See section on Daily Life and Social Activities for details on telephones. Two bedrooms are registered as double rooms, but all the others designated as single rooms. This effectively means that almost all the residents have access to the privacy of single bedrooms. Seven bedrooms were selected for assessment against the National Minimum Standards on this occasion. They did not all have all the furniture or fittings prescribed by the National Minimum Standard – in some cases for want of useable floor space. And non-provision is not being properly justified by properly documented risk assessment or consultation. The acting manager should look for opportunities to replace obvious institutional commodes with more discreet models, to accord the residents with more dignity. One resident’s insistence on wedging her door open should be risk assessed and alternative provision made. Dalling House DS0000021085.V336870.R01.S.doc Version 5.2 Page 19 This home has a communal WC on all three floors and bathroom facilities on both upper floors i.e. reasonably accessible to all the bedrooms and communal areas. With the exception of two bedrooms (which share a WC/ bathroom facility), all bedrooms have their own en-suite WC facilities and some also have en-suite baths. Some of these facilities were judged in need of updating or deep cleaning. And one cistern handle was found to be difficult to operate. There are two baths, with a swing-out bath seat. Unfortunately there are currently no shower facilities, other than shower attachments on baths. This should be reconsidered as it effectively means that residents do not have much choice. Continence appears to be managed adequately at this home. There were no unpleasant odours. See schedule for matters raised for attention. Dalling House DS0000021085.V336870.R01.S.doc Version 5.2 Page 20 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 adequate This judgement has been made using available evidence including a visit to this service. 27, 28, 29, 30 Staff in the home now have the basic training and are in generally sufficient numbers to fill the aims of the home and meet the initial presenting needs of residents. But training investments will need to be more pre-emptive of emerging needs. EVIDENCE: Staffing rotas for the three-week period (14 May to 3 June) generally confirmed the staffing arrangements as described by the acting manager, specifically: From 8am till 2pm there should be three staff giving direct care, and from 28pm there should be two. This represents a reduction on the arrangement as found at the last inspection. At night (8pm till 8am) there should be two waking staff. This arrangement includes the manager’s deputy, and can include direct interventions by the acting manager. There is a pre-determined on-call arrangement, to keep people safe. Dalling House DS0000021085.V336870.R01.S.doc Version 5.2 Page 21 There is a cook on site from 9am till 2pm and ancillary staff to do domestic work (three hour shifts in the morning or afternoon) and an activities coordinator who works 3-4 hour shifts and can provide extra help. Feedback from residents and relatives confirmed that they were generally very satisfied with the care given, and that staff generally had time to chat with them. But there are three residents who require two staff to assist them with daily / night time tasks, which effectively means neither would be available to attend to any of the others for those periods, without the intervention of the manager, ancillary staff or on-call personnel. Feedback indicates that staffing is sometimes too stretched e.g. when individuals go sick. Since the last inspection, the acting manager has done a lot work to remedy gaps in the home’s recruitment documentation, to ensure the process is more demonstrably compliant with required practice standards, so as to safeguard the residents. This process was not complete, so there were still isolated gaps. The acting manager has also introduced training events in key matters such as medication, food hygiene, moving and handling, 1st aid (appointed person), and adult protection. But there now needs to be a rolling cycle of training to ensure staff competence is systematically updated, in line with best practice standards, and the level of NVQ accreditation (33 ) is still significantly below targets for the sector. It is accepted that one or two staff expect to be registered for NVQ training. Four residents are reported to have communication difficulties, and at least five have mental health problems – all of which indicates the need for specialist training, to ensure the home has the capacity to care for them. Dalling House DS0000021085.V336870.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 31, 32, 33, 34, 35, 36, 37, 38 The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a qualified, competent manager. EVIDENCE: Mrs Reynard has been the acting manager for this home since 6 November, having previously run her own domiciliary care agency, and also worked as the Registered Manager of two residential care homes and as a deputy manager in two others. Dalling House DS0000021085.V336870.R01.S.doc Version 5.2 Page 23 Mrs Reynard obtained SRN qualification in 1969, and the Advanced Management in Care award in 1996. And she is currently undergoing NVQ4 training with a view to obtaining her Registered managers Award, and has maintained investments in a range of mandatory training courses. Feedback indicates Mrs Reynard has made a positive impact on the staff and residents already. But she has yet to submit an application for registration by the Commission, and will be assessed in due course. There are clear lines of accountability within the home and within Aspenglade as an organisation. Team working and flexibility have been identified as key strengths in this staff group. Feedback during the site visit and from the home’s own recent quality assurance survey confirm a generally sound level of satisfaction with the care given by staff. There was good evidence of residents’ participation in decisions about their own daily routines. Aspenglade has yet to produce a business development plan for this home, and there was no timeframe for this. The challenge will be to conspicuously include the views of all stakeholders if it is to properly measure the home’s success in meeting its aims, objectives and statement of purpose. Notwithstanding findings in respect of the management ethos in this home (see above), there was as yet still insufficient evidence of formal documented staff supervision meetings, to comply with all the elements and frequency of this standard. This matter was raised for attention at the last inspection and will require attention as a priority. Nor was there good evidence of regular staff group meetings. Gaps in policies and procedures were reported to have been addressed, but there was no system for certifying that staff had read or agreed to comply with their provisions – all of which could combine to create variable practice. The arrangements for safekeeping and accounting for residents’ money and valuables appeared diligent, though there needs to be appropriate lockable facilities in each bedroom. One resident has been keeping medication in a portable cash tin, which is not judged secure. All the property maintenance records seen were up to date and well maintained. There were some risk assessments in place but their scope was not extensive (i.e. in respect of each individual, their activities and their environments), and there needs to be better evidence of their regular review, to ensure the health and safety of residents and residents are being properly safeguarded. This will become especially important if the home intends to provide specialist care. Dalling House DS0000021085.V336870.R01.S.doc Version 5.2 Page 24 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 2 2 3 1 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 2 2 2 2 3 2 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 2 3 2 2 2 Dalling House DS0000021085.V336870.R01.S.doc Version 5.2 Page 25 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 OP1 Regulation 4 (1) & Schedule 1 Requirement It is required that the statement of purpose be reviewed and amended, in accordance with Schedule 1. (Previous timescales of 31/05/2006 and 31/03/07not met). The home’s Service User Guide will require attention to obtain full compliance with all the elements of this standard It is required that the home is able to demonstrate that it has the capacity and authority to meet the assessed needs (including specialist needs) of service users. This process is incomplete. (Previous timescale of 31/03/2007). Work must continue to ensure personnel files properly evidence all the elements listed in Schedule 2, to ensure residents are in safe hands The acting manager must submit an action plan to obtain the requisite of staff trained to NVQ2 or equivalent, to ensure residents are in safe hands DS0000021085.V336870.R01.S.doc Timescale for action 30/06/07 2 OP1 4(1)(c)5( 1) 14 (1) (a) 30/06/07 3 OP4 31/07/07 4 OP29 7, 9, 19& Schedule 2 18 31/07/07 5 OP28 30/06/07 Dalling House Version 5.2 Page 26 6. OP36 18 (2) It is required that all care staff have the requisite level and frequency of formal documented supervision sessions be introduced for all care staff. (Previous timescales of 01/04/05, 31/08/05 & 31/05/06 not met). It is required that all parts of the home, to which service users have access are risk assessed to ensure they are free from hazards to their safety, including door wedges. Original timeframe 31/12/06) 31/07/07 7. OP38 13 (4) (a) 31/07/07 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 The home could usefully include in its admission procedure a checklist to certify the issue of a Statement of Purpose, Service User Guide; and whether other languages or formats were warranted. The home’s Terms and Conditions of Residence Agreement should be amended to obtain full compliance with all the elements of this standard Care plans should more clearly single out each resident’s needs from another’s. And they should more actively: • pursue the residents’ emotional needs • offer specialist interventions e.g. to individuals with mental health needs • establish any unmet needs. These elements should be attended to ensure a more holistic approach. Medication. The home should have ready access to the Royal Pharmaceutical Society Guidance on the administration and storage of medication. And one resident’s storage facility should be better Dalling House DS0000021085.V336870.R01.S.doc Version 5.2 Page 27 2 3 OP2 OP7 4 OP9 secured. 5 6 OP17 OP18 Where residents lack capacity, the home should facilitate their access to available advocacy services The home should obtain copies of all funding authorities’ multi-disciplinary adult protection protocols, to ensure a timely and co-ordinated approach, should any instance of abuse ever occur. Building. The following matters are raised for attention: • The safety of the gradient up to front entrance from busy road should be risk assessed for use by wheelchairs or mobility aids • Access to rear garden should be assessed re restriction by level change • A Loop system is recommended in TV rooms for use with hearing aids • Bathroom and WC facilities o The suitability of bath seats should be reviewed; o Some WCs (communal and en-suite) should be deep cleaned; o The home should discontinue use of bar soap and fabric towels in communal facilities o The home should consider installing a shower so that residents have a choice • Bedrooms – the home should discontinue the practice of wedging open of doors (consider installation of Dorguards linked to fire alarm system). • The acting manager needs to assess bedroom provision against NMS and to be able to justify non-provision by properly documented risk assessments or consultation • Lockable facilities – portable cash tins would need to be secured against hard surface); • One en-suite cistern did not appear to be efficient. • The acting manager is asked to submit a copy of the latest EHO report and any action plan this generated • The acting manager is asked to confirm whether the home’s washing machine has a sluice or disinfecting cycle There should be a staff training and development programme in place, which meets the National Training organisation (NTO) workforce training targets, and ensures staff fulfil the aims of the home and can meet the changing needs of residents Aspenglade should produce a business development plan for this home. The challenge will be to conspicuously include the views of all stakeholders if it is to properly measure the home’s success in meeting its aims, DS0000021085.V336870.R01.S.doc Version 5.2 Page 28 7 OP19 8 OP30 9 OP33 Dalling House objectives and statement of purpose. Dalling House DS0000021085.V336870.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. Extracts may not be used or reproduced without the express permission of CSCI Dalling House DS0000021085.V336870.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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