Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Dallington House 228 Leicester Road Enderby Leicestershire LE19 2BF The quality rating for this care home is:
two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kim Cowley
Date: 2 9 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home
Name of care home: Address: Dallington House 228 Leicester Road Enderby Leicestershire LE19 2BF 01162750280 01162750280 hdave@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Harshavadan Dave,Mrs Rashmi Dave Name of registered manager (if applicable) Mr Harshavadan Dave Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 16 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Learning disability - Code LD Dementia Code DE Date of last inspection Brief description of the care home Dallington House is a detached residential property situated on the Leicester Road in Enderby. It is on the main bus route into Leicester, and the train station and local shopping centre at Narborough are nearby, Care Homes for Older People
Page 4 of 27 care home 16 Over 65 0 0 16 16 16 0 Brief description of the care home The service provides care for 16 older people, some of whom have dementia, and includes eight places for residents with learning difficulties aged 55 years and older. Accommodation is on two floors and with access to the first floor via a stair lift. There is a large lounge on the ground floor, which overlooks the garden. This leads to a dining room and a small conservatory. Bedrooms are on the ground and first floors. Fees are based on local authority rates. Further information about the home is available from the Owner/Manager. Care Homes for Older People Page 5 of 27 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was a key inspection that included a visit to the home and inspection planning. Prior to the visit, we (throughout the report the use of we indicates the Commission for Social Care Inspection) spent half a day reviewing information relating to the home. During the course of the inspection, which lasted five hours, we checked the key standards as identified in the National Minimum Standards. This was achieved through a method called case tracking. Case tracking means we looked at the care provided to three residents living at the home by meeting them; talking with the staff who support Care Homes for Older People
Page 6 of 27 their care; checking records relating to their health and welfare; and viewing their personal accommodation as well as communal living areas. Other issues relating to the running of the home, including health and safety and management issues, were examined. We also talked to two other residents, one visitor, the Owner/Manager, and two care assistants. What the care home does well: What has improved since the last inspection? Risk assessments have been re-written and improved and are now reviewed at least once a month. Those we sampled were detailed and contained the information staff needed to keep residents safe. Recording in the accident book has also improved and a falls prevention policy has been introduced which helps staff to reduce the amount of falls in the home. All staff had first aid training in September 2008. The Manager and Deputy have attended courses on safeguarding and the Deprivation of Liberty Act. This will help to ensure they have up-to-date information about their safeguarding responsibilities. Each staff member now has an Employees Individual Training Record. This documents the training they have completed and identifies any future training needs. As the home now admits residents with dementia all staff have completed a course in Dementia Care. This will help them to care effectively for the residents with mental Care Homes for Older People Page 8 of 27 health needs. Changes have been made to the home to make it more suitable for residents with dementia. Corridors and toilets have been redecorated in bright colours that are intended to make it easier for those with dementia to find their way around. In addition pictorial signs have been put on the doors of some of the rooms to indicate what they are used for. External doors have been fitted with alarms to alert staff if a resident wanders. The lounge has also been refurbished and new carpets laid in the entrance hall, on the stairs, and in the corridors and landings. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. Residents needs are assessed prior to admission to ensure the home is suitable for them. This judgement has been made using available evidence including a visit to this service. (Standard 3 was inspected.) Evidence: People who are interested in coming to live in the home are assessed by the Manager or Deputy to ensure their needs can be met. We looked at the assessments belonging to the residents we case tracked. All were sufficiently detailed and contained the information staff needed to make a judgement about the suitability of the home for the person in question, including their ethnicity
Care Homes for Older People Page 11 of 27 Evidence: and cultural background. Since the last inspection the homes registration has changed, and residents with dementia are now admitted. Assessments showed peoples mental health needs are given full consideration, and expert advice sought where necessary before a place is offered. This makes it more likely that the placement will be a success. Standard 6 was not inspected, as this home does not provide intermediate care. Care Homes for Older People Page 12 of 27 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. Staff in the home, and in the wider community, meet residents health and personal care needs. This judgement has been made using available evidence including a visit to this service. (Standards 7, 8, 9, and 10 were inspected.) Evidence: We looked at care plans and saw they were person centred which means they focused on residents individual needs, taking into account their views on how these should be met. This helps to ensure the care provided is flexible and fits in with their lifestyles. The plans covered the health, personal and social needs of the person in question, and their likes, dislikes, and preferred routines. Care plans showed that residents health needs are promptly met and GPs, District Nurses, and other health and social care professionals are involved where necessary.
Care Homes for Older People Page 13 of 27 Evidence: Although care plans were of a good standard, it was difficult to find key information due to residents files being disorganised. It is recommended they are sorted out. Information that is no longer relevant could be archived and what remains put in some order and indexed. This will make it easier for staff to access the information they need. Since the last inspection risk assessments have been re-written and improved and are now reviewed at least once a month. Those we sampled were detailed and contained the information staff needed to keep residents safe. At the last inspection we also asked for recording in the accident book to be improved so that a clear account was given of what occurred, and what action staff took. This has been done and recording in the accident book is now of a good standard. In addition a falls prevention policy has been introduced which helps staff to reduce the amount of falls in the home. We looked at medication storage facilities and records. In general, medication is securely stored, although improved facilities are required if and when controlled drugs are kept in the home. Advice should be sought from the homes pharmacist about this matter. Medication records were examined and appeared accurate, although when staff use the code O, when medication is not given, they need to say why it was not given, for example not required in the case of PRN medication. During the inspection staff were observed caring for residents in a discreet and respectful manner. Relationships between staff and residents appeared warm and friendly, and all residents interviewed praised the staff team. One resident said, The staff are always polite and they never tell us what to do. Care Homes for Older People Page 14 of 27 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. Residents social and cultural needs are identified and met. This judgement has been made using available evidence including a visit to this service. (Standards 12, 13, 14, and 15 were inspected.) Evidence: The home has a friendly atmosphere and the residents appear to get on well and to have formed friendship groups. Some activities are provided for residents. These include armchair exercise classes, floor games, bingo, and karaoke. Once a month outside entertainers come into the home and put on a show for the residents. In discussions residents said they liked socialising with each other and the staff. Some residents go out on occasions to day centres, with relatives, and on shopping trips with the Manager. A few residents do not go out at all due to their frailty. One resident said she liked the garden. She told us, When the weathers nice I go out in the garden and walk around. The Manager brings in DVDs for one resident who likes to watch them in his room.
Care Homes for Older People Page 15 of 27 Evidence: Menus showed that a wholesome and varied diet is provided and there are choices at every meal. Staff are aware of residents likes and dislikes, and of any particular dietary requirements they have. This information is also recorded in residents care plans. The food served is mainly English, with some Asian vegetarian meals. The latter are prepared in the home, or bought in from a local restaurant. All the residents we talked to said they liked the food. One commented, I have toast and marmalade for my breakfast. For dinner we have pies and stew and vegetables. Today weve got sausages and I like them. Care Homes for Older People Page 16 of 27 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. Residents and their representatives are encouraged to talk to staff about any concerns they might have. Staff know how to safeguard residents. This judgement has been made using available evidence including a visit to this service. (Standards 16 and 18 were inspected.) Evidence: The complaints procedure is on display in the home. This tells residents and their representatives what to do if there is anything they are unhappy about. Due to their disabilities some residents are not able to use this procedure. The Manager said staff would advocate for these residents and let others know if they appeared unhappy about any aspect of their care. All residents who were able to give their views said they would speak out if they had a complaint. One told us, If I was unhappy about something I would tell the staff or the Manager. Records showed there have been no complaints since the last inspection. Both Management and staff at the home are aware of their responsibilities to safeguard the residents they care for. There is a safeguarding policy in place which staff can refer to where necessary. All staff are trained to safeguard residents and
Care Homes for Older People Page 17 of 27 Evidence: discussions in staff meetings help to ensure they know what to do if they have concerns about their well-being. Since the last inspection the Manager and Deputy have attended courses on safeguarding and the Deprivation of Liberty Act. This will help to ensure they have up-to-date information about their safeguarding responsibilities. Care Homes for Older People Page 18 of 27 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. Residents live in an environment that is safe, comfortable, and well maintained. This judgement has been made using available evidence including a visit to this service. (Standards 19 and 26 were inspected.) Evidence: Dallington House is comfortable and homely. At its centre is a large lounge where residents tend to congregate during the day. It has a good range of easy chairs, so residents can chose where to sit, and looks out over the homes secluded gardens. Off this lounge are the dining room, and a small conservatory. We looked at three bedrooms, with their occupants permission, and all were personalised and well decorated. One resident told us, The televising (in the lounge) was new just before Christmas. Mr Dave bought it for us. Another said, I like my room. Its on the ground floor. Since the last inspection some changes have been made to the home to make it more suitable for residents with dementia. Corridors and toilets have been redecorated in bright colours that are intended to make it easier for those with dementia to find their way around. In addition pictorial signs have been put on the doors of some of the
Care Homes for Older People Page 19 of 27 Evidence: rooms to indicate what they are used for. External doors have been fitted with alarms to alert staff if a resident wanders. The lounge has also been refurbished and new carpets laid in the entrance hall, on the stairs, and in the corridors and landings. All the areas we inspected were warm, clean, tidy and fresh. During the inspection we saw that one resident had difficulty opening one of the lounge doors while simultaneously using her frame. We discussed this with the Manager who said he is planning to put an electronic closing device (which operates if the fire alarm goes off) on it so it can be left open when residents are in the lounge. This should be done as it will enable residents to move around the home more easily. Care Homes for Older People Page 20 of 27 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. An established staff team meets residents needs. Relationships between staff and residents are warm and caring. This judgement has been made using available evidence including a visit to this service. (Standards 27, 28, 29, and 30 were inspected.) Evidence: The staff team is small and established. Turnover is low and agency staff are not used, so residents benefit from continuity of care and get to know their carers well. All the residents interviewed praised the staff team and the following comments were made, The staff are nice and kind, and, The staff are always in a good mood. Three staff files were examined. All the required information was in place including satisfactory CRB/POVA checks and written references. This will help to ensure that residents are safeguarded. At the last inspection we asked for training records to be improved as they were out of date and incomplete. This has been done and each staff member now has an Employees Individual Training Record. This documents the training they have
Care Homes for Older People Page 21 of 27 Evidence: completed and identifies any future training needs. Since the last inspection all staff have completed a course in Dementia Care. This will help them to care effectively for the residents with mental health needs who are now being admitted to the home. All care staff now have NVQ (National Vocational Qualification) Level 2, or above, Whig gives them the skills to work in care. And senior carers have completed a range of courses covering subjects such as Person Centred Planning, Learning Disabilities, and the Mental Capacity Act. Staff have six monthly supervision sessions with the Deputy. This provides them with support and gives them the opportunity to reflect on their work and raise any concerns they might have. The home achieved Investors in People status in 2003. This was renewed in 2006, and is coming up for renewal again this year. Investors in People status is awarded to employers who provide a good working environment for their staff. Care Homes for Older People Page 22 of 27 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. Residents live in a home that is safe and well managed. This judgement has been made using available evidence including a visit to this service. (Standards 31, 33, 35, and 38 were inspected.) Evidence: The Manager, who is also one of the Owners, gets on well with everyone at Dallington House. Residents, staff and visitors told us they found him supportive and approachable. One resident said, I like Mr Dave very much. When he comes through he always speaks to me. He is well qualified and experienced in care, and continues to attend training courses with his staff team to keep his skills up to date. Residents views on the running of the home are collected in a number of ways. The Manager spends time chatting to residents to get their opinions of the service.
Care Homes for Older People Page 23 of 27 Evidence: Residents meetings are also held, and questionnaires sent out to residents relatives. These consultations help to ensure that the home is run in the best interests of residents. The home looks after small amounts of money for some residents who are not able to look after it themselves. Appropriate records are kept and these are double signed by staff. Other residents have their money looked after by their relatives or representatives. Arrangements are in place to promote and protect the health and safety of staff and residents. The Manager maintains a record of health and safety checks, and risk assessments are carried out to ensure compliance with health and safety regulations. At the last inspection we asked for first aid training to be reviewed to ensure there was at least one member of staff on duty for each shift who knew what to do if a resident had a fall or other accident. In response the Manager arranged for all staff to have first aid training and this was completed in September 2008. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 7 15 Risk assessments must be 11/03/2008 regularly reviewed and contain all the information staff need to care safely and effectively for residents. This will help to reduce risk in the home. Recording in the accident book must be improved so that a clear account is given of what occurred, and what action staff took. This will help to ensure that staff are responding appropriately when accidents occur. 11/02/2008 2 7 17(1)(a) 3 18 13(6) The home?s safeguarding 11/03/2008 policy needs to be updated, as at present it does not make clear the role of social services in safeguarding investigations. This will help to protect residents by ensuring that a multi agency approach is used if a concern is raised. All staff training must be recorded so it is clear that staff are competent to carry out their duties. 11/03/2008 4 30 18(1)(a) Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No. Refer to Standard Good Practice Recommendations 1 2 7 9 Residents files should be reorganised and indexed so it is easier for staff to find key information. When staff use the code O, to indicate that medication was not given, they need to say why it was not given, for example not required in the case of PRN medication. Advice should be sought from the pharmacist about the suitability of the homes medication storage facilities for the keeping of controlled drugs. An electronic closing device (which operates if the fire alarm goes off) should be fitted on the lounge door so it can be left open when residents are in the lounge. This will enable residents to move around the home more easily. 3 9 4 19 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
