Inspection on 09/05/05 for Dallington House

This inspection was carried out on 9th May 2005.

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 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

Dallington House 29/01/09

Dallington House 11/02/08

Dallington House 22/02/07

Dallington House 25/11/05

Dallington House 22/08/05

Dallington House 23/02/05

Dallington House 13/12/04

Dallington House 09/06/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Byars Care Home

St Marys Nursing Home

Jubilee Villa Care Home

Bramble Lodge

Parkmanor Residential Home

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

CARE HOMES FOR OLDER PEOPLE Dallington House 228 Leicester Road Enderby Leicestershire LE9 5BF Lead Inspector Keith Williamson Unannounced 9 May 2005 at 9.00 am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dallington House C51 S1786 Dallington House V220465 0905005.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Dallington House Address 228 Leicester Road Enderby Leicestershire LE5 1TA 0116 2750280 0116 2750280 None Mr Harshavadan Dave Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Harshavadan Dave Care Home 16 Category(ies) of LD(E) Learning Disabilities over 65 - 8 registration, with number OP Old Age - 16 of places LD Learning Disability - 8 Dallington House C51 S1786 Dallington House V220465 0905005.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Minimum age of admission in category LD is 55 years. No person to be admitted to the home in the categories LD (E) or LD when 8 persons in the total of these categories/combined categories are already accommodated within the home. To be able to admit the person of category MD (E) identified in correspondence from the previous registration authority dated 09/05/01. To be able to continue to provide care to two service users, as identified in correspondence with the National Care Standards Commission dated the 13th of January 2004, who fall within category MD (E) and who were living in the home prior to the 1st of April 2002. To admit a named person into the home. Date of last inspection 23/02/05 Brief Description of the Service: Dallington House is situated on the Leicester Road in Enderby adjacent to the “Foxhunter” roundabout. Positioned in a mainly residential area the home provides accommodation for 16 Older people, including 8 places for residents with learning difficulties aged 55 years and older. The home has two floors and has access to the upper floor via a stair lift. All communal, lounge and dining space is situated to the ground floor, with the bedrooms being evenly distributed between both floors in the home. The home is well situated on the main bus route into Leicester and is close to the train station at Narborough, where the nearest local shopping is also situated. Dallington House C51 S1786 Dallington House V220465 0905005.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over one day, commenced at 9.00 am and was completed that day by one Inspector. An opportunity was taken to view the care plans and other records in the home. Three Residents were spoken with on this visit, however, none made comments applicable to the Inspection visit; three staff were also spoken with. Nine questionnaires were returned to the Inspector both prior to and during the Inspection process, of those nine one person commented they were unsure of sufficient staff being on duty. The owner (and manager) assisted with the Inspection, spending time with the Inspector discussing the management of the home. Overall the Inspector recognised improvements throughout the home, with fifteen of the thirty requirements from the last inspection being improved. What the service does well: What has improved since the last inspection? What they could do better: Dallington House C51 S1786 Dallington House V220465 0905005.doc Version 1.30 Page 6 There were a number of outstanding requirements from the last Inspection, which still need to be dealt with at this time. Relatives could be more involved in the care planning process as no Residents expressed any interest in the care planning process. Generally the paper work is poor, not well organised, and periodic reviews and amendments are not planned into the general day-to-day running of the home. Meal choices are poor, with little provision for nutritional input into the present menu and meal system. 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. Dallington House C51 S1786 Dallington House V220465 0905005.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Dallington House C51 S1786 Dallington House V220465 0905005.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 & 6. The admission process is followed consistently for all planned admissions. EVIDENCE: Pre admission assessments were seen on all Resident files seen on the day, this indicates that Residents are appropriately screened prior to moving into the home. All of these files included the information necessary to compile individual plans of care, which were also viewed as part of the Inspection process. Evidence of ongoing assessment is also in place. The home does not currently offer a service under Standard 6. Dallington House C51 S1786 Dallington House V220465 0905005.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 11. Residents are well looked after in respect of their health, personal care and medication needs. The final wishes of Residents are not appropriately dealt with, so does not wholly support the Residents spiritual needs. EVIDENCE: Care plans reflect Residents current needs and include contact with health care professionals. Residents are given an opportunity to sign their care plan, though little interest in this is shown by the Residents in the home. A relative indicated that they would be interested in the compiling and review of their relatives care plans, but had not recently been given the opportunity to do so. There are a number of outstanding issues from the last Inspection that require to be actioned with this report. Medication is administered more appropriately; however greater clarity is required for staff dispensing “prn” or “as required” medication and accurate instruction must be provided for staff. No evidence was apparent of the final wishes of Residents, and this should be amended, and care plans changed accordingly. Dallington House C51 S1786 Dallington House V220465 0905005.doc Version 1.30 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 15. Social care and activities are offered regularly to the group, this provides some opportunity for the Residents to join in Social Care. The choice of meals on offer remains restricted. EVIDENCE: Residents are offered a number of social pastimes in line with the abilities of the group. Staff were seen to dedicate specific time for activities in the home. Residents are encouraged to keep up their community contact, and a number of Residents still attend day centres in Leicester and Hinckley this is good for the Residents concerned and keeps up their social contacts, visiting is unrestricted. Meals on offer in the home include a choice, but this continues to be limited as no cook is employed and the care staff perform all catering as well as care and domestic tasks, so giving a limited time to providing a full meal choice to the Residents in the home. Dallington House C51 S1786 Dallington House V220465 0905005.doc Version 1.30 Page 11 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Residents do not have their complaints recorded appropriately, and therefore cannot be assured that complaints are dealt with appropriately or seriously. EVIDENCE: A number of files were viewed and details of a verbal complaint were not recorded into the Complaints records, therefore there was no outcome to indicate if the complaint had been resolved. Dallington House C51 S1786 Dallington House V220465 0905005.doc Version 1.30 Page 12 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22 and 24. The home is maintained to a fair standard. Adequate communal space is provided in the home for residents’ comfort. The home is clean, hygienic and has a homely environment. EVIDENCE: A brief tour of the home was conducted to view the outstanding requirements from the last inspection. The maintenance plan has now been updated, but has yet to have the full details of all the proposed improvements to the environment of the home. The patio to the garden has yet to be levelled and should, if the dates are adhered to, ensure a safer environment for Residents to enjoy the warmer weather. The repairs required to the shower to the ground floor shower have now been completed and this area is once again in use, however the shower unit to the first floor shower/bathroom have not yet been completed. Dallington House C51 S1786 Dallington House V220465 0905005.doc Version 1.30 Page 13 The bath hoist to the first floor is also out of order and again must be repaired promptly to ensure Resident safety and choice. Personal possessions were noted in all Residents bedrooms on the day of the Inspection, however it was also noticed the clocks in bedrooms if working, did not tell the actual time. Dallington House C51 S1786 Dallington House V220465 0905005.doc Version 1.30 Page 14 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 29. Staff in the home are of a good skill mix, some being trained professionals, giving Residents the benefit of an experienced workforce. Staff recruitment records in the home are not of a sufficient accuracy to ensure safety of Residents in the home. EVIDENCE: Staffing levels at the time of the Inspection were adequate to meet the needs of the Residents in the home, however the staff “multi task” and have to attend all of the tasks in the home, these include domestic and catering duties. Of the staff files viewed evidence of a detailed induction programme was seen to be in place, foundation training was also seen to be in place. Of the staff files in the home, not all have the appropriate proofs of identification required prior to commencing employment. Two references are in place in most staff files, though gaps in employment history are not followed up and explained; overall this does not provide a safe environment for Residents. Dallington House C51 S1786 Dallington House V220465 0905005.doc Version 1.30 Page 15 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38 Residents’ rights and safety are not safeguarded by policies and procedures. EVIDENCE: A number of policies were viewed within the Inspection process none of which had been reviewed recently. Some temperature monitoring records for hot and cold areas in the kitchen and hot water were also viewed these were upto-date. The Manager has attempted to ensure the safety of Residents by obtaining the appropriate Control of Substances Hazardous to Health data sheets for use within the home however has been unsuccessful in doing so and continues to place both Residents and staff in danger by this omission. Dallington House C51 S1786 Dallington House V220465 0905005.doc Version 1.30 Page 16 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 2 3 2 2 x 2 x 2 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x x x x x x x 2 2 Dallington House C51 S1786 Dallington House V220465 0905005.doc Version 1.30 Page 17 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15 Requirement The registered person must provide evidence of service user or relative involvement in the signing of care plans. The original timescale of 4th May was not met. The registered person must ensure all care plans have the appropriate risk assessments entered into them. The original timescale of 4th May was not met. The registered person must ensure any care plan developed from a Care Programme Approach worker is included in the main plan of care. The original timescale of 4th May was not met. The registered person must mention individual restrictions placed on service users in the home. The original timescale of 4th May was not met. The registered person must ensure safe working practices and arrange for the appropriate training and supervision for staff administering medication. Timescale for action 9th August 2005. 2. 7 15 9th August 2005. 3. 7 15 9th August 2005. 4. 7 15 9th August 2005. 5. 9 13(2) 9th August 2005. Dallington House C51 S1786 Dallington House V220465 0905005.doc Version 1.30 Page 18 6. 9 13(2) 7. 9 13(2) 8. 9 13(2) 9. 9 13(2) 10. 11 12 11. 15 16(2)i The original timescale of 4th May was not met. The registered person must ensure the precise dose; frequency and circumstances of administration of “prn” medications must be entered into individual service users medication regimes or care plans. The original timescale of 4th May was not met. The registered person must ensure that medication of a varying dose, is recorded appropriately when administered; and precise instructions to when and what amount of medication is to be given must be ascertained from the prescriber and entered into individual service users medication regimes or care plans. The original timescale of 4th May was not met. The registered person must ensure medication regimes are regularly reviewed by the service users’ prescriber. The original timescale of 4th May was not met. The registered person must ensure a policy for the administration is put in place, negotiated with the appropriate prescriber and shared with staff in the home. The original timescale of 4th May was not met. The registered person must ensure the final wishes of Residents are entered in the individual plans of care. The registered person must offer suitable menu choices to service users in the home. The original timescale of 4th May 9th August 2005. 9th August 2005. 9th August 2005. 9th August 2005. 9th August 2005. 9th August 2005. Dallington House C51 S1786 Dallington House V220465 0905005.doc Version 1.30 Page 19 was not met. 12. 13. 16 19 22 23(2) All complaints must be recorded appropriately, with all dates and the final outcome. The registered person must complete and detail the plan of routine maintenance for the home. The original timescale of 4th May was not met. The registered person must ensure the patio area and gardens to the rear of the home, must be made safe for service users. The original timescale of 4th May was not met. The wallpaper to the staircase and first floor landing requires to be replaced. The carpet to the staircase requires to be replaced. The ceilings to the first floor corridoors require to be repaired and painted. The registered person must ensure the shower unit is repaired, and anti slip flooring provided to bathroom 5. The original timescale of 4th May was not met. The first floor bathroom, bath panel requires to be replaced. The bath hoist to the first floor bathroom requires to be repaired. Some of the lounge and bedroom chairs require to be restained or replaced. The registered person must arrange for the carpet to the main lounge area to be replaced. The registered person must ensure the recruitment of staff ensures all gaps in employment and both references are 9th August 2005. 9th August 2005. 14. 19 23(2) 9th July 2005. 15. 16. 17. 18. 19 19 19 21 23 23 23 23 9th September 2005. 9th October 2005. 9th September 2005. 9th August 2005. 19. 20. 21. 22. 23. 21 22 24 26 29 23 23 23 13(3) 17 9th July 2005. 9th July 2005. 9th September 2005. 9th August 2005. 9th July 2005. Dallington House C51 S1786 Dallington House V220465 0905005.doc Version 1.30 Page 20 24. 37 24 25. 38 13(4) confirmed and followed up with the appropriate individual. The registered person must review, ammend and redate all policies and procedures periodically. The registered person must ensure that Control of Substances Hazardous to Health (coshh) data sheets are available in the home. The original timescale of 4th May was not met. 9th July 2005. 9th July 2005. 26. 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 27 Good Practice Recommendations The registered person must ensure the staffing levels meets the recommended level of the Department of Health Residential forum, to ensure service user safety in the home. Dallington House C51 S1786 Dallington House V220465 0905005.doc Version 1.30 Page 21 Commission for Social Care Inspection The Pavilions, 5 Smith Way Grove Park Enderby Leicestershire LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Dallington House C51 S1786 Dallington House V220465 0905005.doc Version 1.30 Page 22 - 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. 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