Inspection on 14/12/05 for Dane House

This inspection was carried out on 14th December 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Dane House 16/07/07

Dane House 29/05/06

Dane House 18/07/05

Dane House 06/12/04

Dane House 01/06/04

Similar services:

The Shelley

Thorndene

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

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

CARE HOMES FOR OLDER PEOPLE Dane House 52 Dyke Road Avenue Brighton East Sussex BN1 5LE Lead Inspector Debbie Calveley Unannounced Inspection 14th December 2005 10:00 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 Dane House DS0000013976.V254600.R01.S.doc Version 5.0 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. Dane House DS0000013976.V254600.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Dane House Address 52 Dyke Road Avenue Brighton East Sussex BN1 5LE Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01273-564851 01273-507161 Tamaris Healthcare (England) Ltd (wholly owned subsidiary of Four Seasons Health Care) Mrs Tracey Fiona Davis Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25), Physical disability (5) of places Dane House DS0000013976.V254600.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. That the maximum number of service users to be accommodated is twenty-five (25). That service users are sixty-five (65) years or over on admission. That service users may also have a physical disability. That a maximum of five (5) service users may have a physical disability and be aged between forty-five (45) years and sixty-five (65) years on admission. 18th July 2005 Date of last inspection Brief Description of the Service: Dane House is a converted family house situated in a residential area of Hove. The home is registered to provide nursing care for twenty-five service users in the category of old age. A variation to the category has enabled the home to provide care for up to five service users with a physical disability. Dane House is a large detached property, with a conservatory to the rear of the house leading to a pleasant rear garden with a pond and good quality garden furniture. The accomodation offered consists of nineteen single bedrooms, ten with ensuite facilities and three double bedrooms, two with ensuite bathrooms. There are ample communal bathrooms with adaptions for the disabled. The lounge area is large with comfortable furniture which leads into a conservatory currently being used as a dining area. There are other quiet areas on the ground floor with comfortable chairs which can be used by the residents. Dane House DS0000013976.V254600.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 14 December 2005. It commenced at 10.00 am and was conducted over six hours. There were seventeen residents living in the home on this day. The methodology of the inspection included a tour of the building, inspection of documentation and records, the delivery of care for eight residents and informal interviews with eight residents, two relatives and four members of staff. The inspector would like to take this opportunity to thank the staff and residents for their welcome and for their views of life in Dane House. What the service does well: What has improved since the last inspection? All residents now have a contract/terms and conditions on admission to the home. All the residents are within the registration category of the home. Dane House DS0000013976.V254600.R01.S.doc Version 5.0 Page 6 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. Dane House DS0000013976.V254600.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Dane House DS0000013976.V254600.R01.S.doc Version 5.0 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 the following standard(s): 1, 2, 3, 4 and 5. The Statement of Purpose and Service Users Guide give prospective residents the information required, enabling them to make an informed choice about where they live. Visits to the home by prospective residents and their family prior to admission are encouraged so they can meet staff and fellow residents before making a decision. A contract/statement of terms and conditions is now given to all residents on admission, which confirms the facilities offered and care agreed. Residents have been admitted to the home without a full and detailed pre admission assessment, thus not ensuring the home can meet their needs. EVIDENCE: The Statement of Purpose and Service Users Guide give prospective residents the information required enabling them to make an informed choice about where they live. Two of the residents spoken with were aware of the Service Users guide and found it informative. Dane House DS0000013976.V254600.R01.S.doc Version 5.0 Page 9 A new contract of terms and conditions under the ownership of Four Seasons is now in place for all residents. Two residents confirmed that they had a contract. A senior member of the staff completes a pre-admission assessment using the homes assessment tool Four assessments were seen fully completed, three were incomplete and did not give much detail about the reasons for the admission and what care was needed, and one resident did not have one at all. It was confirmed by three residents that their family were involved in the preadmission assessment. One relative said that he had been informed that it was taking place but could not be there. The assessment is undertaken at the residents’ place of residence, and input from other relevant professionals is sought when and as required. Four of the eight residents spoken with said they remembered visiting the home before admission, which had made them feel they had the choice. One resident said that it had helped her “make her choice by visiting other homes in the area, one resident said he had chosen the home because of its location and another resident said that they had visited the home and had liked the atmosphere. Another said that his family had chosen it for him and they live close by. Dane House DS0000013976.V254600.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Residents would benefit from a more comprehensive care planning system that guides staff in all aspects of personal and health care and that all risks are identified and planned for. The medication management at this home has improved since the last inspection. Further improvement in practice is necessary to attain an acceptable standard. EVIDENCE: The system of care planning has been reviewed and all the documentation concerning the resident has now been amalgamated in to one folder and kept in the locked clinical room. The feedback from staff is that if they need to access the care file they have to search for the trained nurse to open the room, this sometimes causes delays and inconvenience. Different methods of maintaining the confidentiality of resident’s sensitive information whilst ensuring care staff have access to the daily needs/changes of residents were discussed. It necessary for the present system to be reviewed. Dane House DS0000013976.V254600.R01.S.doc Version 5.0 Page 11 Eight care plans were viewed and it was evident that some needs had been identified and planned for. However, some were incomplete, not regularly reviewed and there was no evidence to show that all residents or their representatives are involved in compiling and reviewing the plans. It was noted that the positive outcomes observed at this time are still dependent upon staff knowledge and memories rather than full and detailed recording. One resident did not think he was consulted about his care plan, another said she was “happy with the care she got, and would tell them if she wasn’t”. One resident admitted in June 2005 did not have a pre-admission, an admission profile or social profile completed, this meant that her formulated care plans were incomplete and that it would not be possible to monitor her needs accurately. An immediate requirement was made at the time of inspection in respect of this. The clinical room was found clean and tidy, the cupboards and fridge were also clean and found to be well stocked and not over crowded. On viewing the medication administration charts some gaps for residents were identified, which were discussed with the manager. The completion of the majority of charts were found to be improved from the previous inspection. Verbal orders need to signed and dated by the staff member receiving the instructions so any queries can be tracked. One residents’ medication had been stopped, but there was no clear record of the reasons for this, which would be beneficial for monitoring for any side effects of withdrawal. Throughout the inspection it was observed that residents were treated with dignity and respect. A resident remarked that he “was fed, staff were friendly and respectful and take time to talk to him”, one resident said “ I have been here just a short while, but they are looking after me very well, they are polite and friendly”. One comment from a resident was “they do not understand old people and what they want”, this resident was given a comment card and a service users guide to allow the resident to share the concern with the manager. Dane House DS0000013976.V254600.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Residents would benefit from a daily programme of activities based on their preferences. Visitors are welcome to the home at all reasonable times to ensure residents maintain links with family and friends. Residents are encouraged to exercise choice over their daily lives. Meals are creative and nutritious offering both choice and variety. EVIDENCE: There is evidence of an activity programme, which is displayed in communal areas of the home. A residents’ granddaughter was providing a singing recital during the afternoon of the inspection, which the majority of residents attended and enjoyed. The feedback from residents regarding activities provided was again mixed and it is felt that gathering feedback from residents regarding past hobbies and interests would be beneficial. There are quite a high percentage of male residents and again it was these that felt that there was little to occupy them. Three residents said that they did not attend the activities and that it was their choice. They said they preferred to stay in their room, to watch television or read. Dane House DS0000013976.V254600.R01.S.doc Version 5.0 Page 13 One resident said that he spent most of his time reading and felt that the exercise class and beauty sessions were not for him. It was confirmed by talking to residents that the routines of daily living have a degree of flexibility; residents can request meals at a different time if they are going out and in their preference for getting up and for going to bed. There is open visiting and two relatives said they were welcomed to the home, whenever they visited. Residents are able to handle their own finances if they wish to, and if they are able. In every bedroom there is a lockable facility to safeguard valuables. Furniture and other belongings are welcomed by the home if the resident wishes to bring them with them. Certain rooms have been personalised. The chef personally visits all residents with the following days choices. The menus demonstrated choice and variety and were indicated a well balanced diet. The menus rotate on a four weekly basis and change according to the seasons. Fresh fruit is readily available. The midday meal offered on the day of the inspection was chicken and mushroom pie with vegetables and potatoes or chicken curry served with rice and popodums, a vegetarian/vegan alternative was also served. A resident who is a vegan said that the chef does consult him regularly regarding meals and felt that he does a very good job. The majority of residents said the choice was good and the food was always tasty. One resident remarked that “ the food is good, but I do not always know what I have ordered, but it is a pleasant surprise when it arrives”. Three residents spoken with said they prefer to eat in their rooms, as they enjoy their privacy, but the food is always hot and tasty”. The dining area has moved from the lounge into the conservatory, it is pleasantly furnished with good quality furniture and fabrics. There is natural light, but also blinds to reduce the glare of the sun and radiators positioned for heat in the winter months and fans for the summer. The tables are positioned to create a congenial atmosphere. There were eleven residents eating in this area and those that required assistance were seen to be assisted with respect and dignity. Records are held detailing daily food choices for each resident. Dane House DS0000013976.V254600.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18. The home has a positive approach to the management of complaints and residents and relatives are confident that appropriate action is taken. Arrangements for protecting residents are satisfactory, protecting them from possible risk or abuse. EVIDENCE: There is a policy and procedure is in place for dealing with complaints and this is also outlined in the Statement of Purpose and Service Users Guide. The manager is aware of the timescales set down for dealing with complaints and a complaints register is available. There is one complaint being investigated at the present time. The Adult Protection policy in the home was found to be up to date and staff interviewed were knowledgeable about the systems in place to protect vulnerable residents. There is evidence of on-going training for all staff in Adult Protection. Dane House DS0000013976.V254600.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26. The home provides a comfortable, clean and safe environment for those living there and visiting. Residents are enabled and encouraged to personalise their room, and rooms are homely and reflect the resident’s personalities and interests. There is specialist equipment in the home for residents’ use to maximise their independence. EVIDENCE: Dane House provides a comfortable, safe and well-maintained environment for the residents. The carpets however in some bedrooms are badly stained even though they have been deep cleaned, which impacts on the overall impression of the room. The residents are encouraged and enabled to personalise their rooms with furniture and pictures, and this was evident during the visit. All personal items are listed in the individual care plans. Dane House DS0000013976.V254600.R01.S.doc Version 5.0 Page 16 Residents are offered the opportunity of having a lock and key for their bedroom, risk assessments are in place for this. All residents have a lockable facility for the storage of personal items and valuables. Three residents said it gives them some degree of independence to be able to keep some papers in their room and deal with their own correspondence. There is an ongoing maintenance programme and the home was found well decorated and maintained. The home provides adequate communal rooms that are well used. The lounge area was found warm, comfortable and homely. The conservatory was both clean and comfortable and is at present used as the dining room. The garden and patio areas have both wheelchair access and seating. There are toilet, washing and bathing facilities to meet the needs of the residents, including showers and assisted baths. Specialised equipment to encourage independence is provided e.g. handrails in bathrooms, hoists, wheelchairs and lifts to all areas of the home. The corridors are wide enough for self-propelling wheelchairs. The lighting in the home is of domestic quality and there are above bed lights as well as the main ceiling lights. Water temperatures are controlled and monitored monthly and a record kept. Random temperatures were taken and were of the recommended level. Polices and procedures for infection control are in place and are updated regularly. The home was clean and free from offensive odours on the day of the inspection. One resident said,” everyone is very nice and the place is kept clean”. Good practice by staff was observed during the day and there were gloves and aprons freely available in the home. The laundry room is small and the floor is not impermeable and there is no hand washing facility for staff to use. Dane House DS0000013976.V254600.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 29. The staffing levels in place on the day of the unannounced inspection were adequate to meet the assessed needs of the residents. The recruitment practice is robust and provides sufficient safeguards for the protection of residents. EVIDENCE: The morning shift consisted of one trained nurse and three carers; the staffing levels were seen to be sufficient for the needs of the residents at this time. The staffing levels need to be flexible according to the changing needs and numbers of the residents. Five staff recruitment files were viewed and contained all the relevant information required by the standard. Criminal Record Bureau and P.O.V.A checks were in place as were the necessary two references and employment history; trained nurses had verification of their PIN numbers and expiry dates. Overseas nurses files evidenced the necessary work permits and health checks. Dane House DS0000013976.V254600.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Residents benefit from a manager who is experienced and confident enabling her to run the home efficiently and effectively, including providing support to staff. The ethos of the home is open and some improvements to staff and resident’s consultation have been made to improve communication. All aspects of resident’s health, safety and welfare were found protected and promoted. EVIDENCE: The manager is suitably qualified and experienced to run the home. She takes responsibility for the day-to-day running of the home and is supernumery to the care staff; she is also on call for any emergencies. All the residents are aware of the manager and her role as she maintains a visible presence in the home. Dane House DS0000013976.V254600.R01.S.doc Version 5.0 Page 19 There are systems in place to safeguard residents financial interests; with policies and procedures in place for staff to follow in respect of gifts and rewards from residents and their families. Formal staff supervision is provided in accordance with the standards and is recorded and kept in the staff files. Staff training in moving and handling, infection control, COSHH, first aid, fire safety and food hygiene are undertaken and recorded, and all staff are receiving further training in nutrition, specific diseases such as motor neurone and diabetes and prevention of adult abuse. Documents relating to safe working practices and Health and Safety were available and found to be satisfactory as were accident records. Weekly testing of the call bell system and water delivery temperatures are undertaken and recorded to ensure residents health and safety are protected. Dane House DS0000013976.V254600.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 1 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 2 3 3 STAFFING Standard No Score 27 3 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Dane House DS0000013976.V254600.R01.S.doc Version 5.0 Page 21 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 OP4OP3 Regulation 14(1)(a) Requirement That all residents have a preadmission assessment completed in full before admission to the home to ensure the home is able to meet the needs of the prospective resident. (Previous timescale of 30/09/05 not met.) That a comprehensive plan of care is generated from a comprehensive assessment is drawn up for/with each service user, and it is reviewed at least once a month.(Previous timescale of 30/09/05 not met.) That all documentation in respect of residents health needs are kept up to date, reviewed regularly and assessable to all staff as per schedule 3. Medication administration record charts must reflect current medication profile and must be a true and accurate record. That changes to orders of medication are signed, dated and recorded.(Previous timescale of 18/06/05 not met.) That an activity programme is devised to ensure all service DS0000013976.V254600.R01.S.doc Timescale for action 15/12/05 2 OP7 15(2)(b) (c)12(1) 01/04/06 3 OP7OP8 13(1)(b) 17(1)(a) 01/04/06 4 OP9 13(2) 14/12/06 5 OP12 16(2)23 (2)12(4) 01/04/06 Dane House Version 5.0 Page 22 6 7 OP24 OP26 16(c) 16(2)(j) users social needs are met. (Previous timescale of 30/09/05 not met.) That the badly stained carpets in bedrooms are replaced. That the laundry facilities are reviewed and the floor covering be impermeable. 01/04/06 01/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Dane House DS0000013976.V254600.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 Dane House DS0000013976.V254600.R01.S.doc Version 5.0 Page 24 - 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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