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Inspection on 22/07/08 for Darlington Court Care Home

Also see our care home review for Darlington Court Care Home for more information

This inspection was carried out on 22nd July 2008.

CSCI found this care home to be providing an Adequate service.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents are provided with good medical and health care support. Trained nurses routinely monitor residents` needs and ensure they receive the medical treatment they require.The care home has developed good policies and practices for the administration of medication. This means that residents receive the medication they require safely. The care home has developed good policies and practices with regard to visiting. This means residents are encouraged to maintain contact with family and friends according to their own wishes. The care home has developed good policies and practices with regard to handling complaints. This means that residents and their relatives can be confident that they can speak to the manager or senior staff about any concerns they have. They will be listened to and their concerns will be investigated. Action will be taken to put right any identified shortfalls in the care or service provided. The environment has been maintained to a good standard. This means residents living conditions are comfortable, clean and safe.

What has improved since the last inspection?

Improvements have been made to care practices. This means that residents are offered drinks regularly and throughout the day. Improvements have been made to the recording of allegations of abuse. Such have been routinely recorded and reported to the local authority so that they may be investigated them.

What the care home could do better:

The manager must ensure the needs of all prospective residents are assessed before admission. This will mean that the home will be able to demonstrate it can meet the needs of new residents.Information gathered from such assessments must be used to draw up individual care plans. This will mean that staff will know what the needs of new residents are and what they are expected to do to meet them. Individual care plans must be updated when the outcome of any investigation into allegations of abuse are known. This will mean that staff will know what to do to protect vulnerable residents. Staffing levels must be reviewed regularly and improved when necessary. This should take place following the review of the care needs of individual residents. This will mean staffing levels are sufficient to meet the current care needs of residents. Arrangements must be made to set up a system for the regular supervision of staff employed at the care home. this will mean that staff receive the support and guidance they need to carry out their work.

CARE HOMES FOR OLDER PEOPLE Darlington Court Care Home The Leas off Station Road Rustington West Sussex BN16 3SE Lead Inspector David Bannier Unannounced Inspection 22nd July 2008 09:00 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 Darlington Court Care Home DS0000024133.V367393.R03.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. Darlington Court Care Home DS0000024133.V367393.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Darlington Court Care Home Address The Leas off Station Road Rustington West Sussex BN16 3SE 01903 850232 01903 775595 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) manager.burroughs@careuk.com Care UK Community Partnerships Ltd Care Home 61 Category(ies) of Dementia (6), Dementia - over 65 years of age registration, with number (61), Old age, not falling within any other of places category (61), Physical disability (6), Physical disability over 65 years of age (61) Darlington Court Care Home DS0000024133.V367393.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - N 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 Dementia DE aged 50 years and over 2. Physical disability PD aged 50 years and over. The maximum number of service users to be accommodated is 61. Date of last inspection 24th April 2006 Brief Description of the Service: Darlington Court is a care home registered to provide nursing care and accommodation for up to sixty residents in the categories listed above. The accommodation is laid out in two units to care for the categories of residents separately. Residents who have dementia are accommodated on the unit on the ground floor. Residents who are elderly frail or who have physical disabilities are accommodated on the unit on the first floor. The home is located in Rustington and it is situated on a residential cul-de-sac close to a main road and the local railways station. Darlington Court consists of a two-storey purpose built building with kitchen and laundry facilities. The majority of the homes bedrooms are single and all of the rooms have en-suite facilities. Each unit also includes a lounge and dining area to cater for the residents who live there. A vertical passenger lift provides access to each floor. The premises have been well-maintained and has accessible gardens for residents to enjoy. The range of fees charged by the home is £432 to £800 per week. Chiropody, Darlington Court Care Home DS0000024133.V367393.R03.S.doc Version 5.2 Page 5 hairdressing and incidentals such as newspapers and toiletries are not included. The registered provider is Care UK Community Partnerships Ltd The registered provider has identified Mrs Anne Edwards as the responsible individual and is responsible for supervising the management of the care home. The registered provider has appointed a manager who has yet to submit an application to register with us. Darlington Court Care Home DS0000024133.V367393.R03.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The inspection has followed the Inspecting for Better Lives methodology and is called a key inspection as it assesses those standards determined by the Commission as key standards. This inspection will also determine the frequency of inspections hereafter. The registered provider returned an Annual Quality Assurance Assessment (AQAA) prior to the inspection. Some residents and staff were sent surveys by the Commission entitled “Have Your Say.” These are designed to enable residents and staff to give their opinions about how the care home is being run. The information received from these documents will be referred to in the report. We visited the care home on Tuesday 22nd July 2008. As this was an unannounced inspection we gave the manager and provider no notification of our intention to visit. We spoke to some residents and observed care practices. We also spoke to the friend of a resident who was visiting the home at the same time. This helped us to form an opinion of what it is like to live in this care home. We also spoke to some staff on duty in order to gain a sense of how it is like to work at the care home. We also viewed some of the accommodation and examined some records. The visit lasted approximately six and a half hours. The manager was present and kindly assisted us with our enquiries. What the service does well: Residents are provided with good medical and health care support. Trained nurses routinely monitor residents’ needs and ensure they receive the medical treatment they require. Darlington Court Care Home DS0000024133.V367393.R03.S.doc Version 5.2 Page 7 The care home has developed good policies and practices for the administration of medication. This means that residents receive the medication they require safely. The care home has developed good policies and practices with regard to visiting. This means residents are encouraged to maintain contact with family and friends according to their own wishes. The care home has developed good policies and practices with regard to handling complaints. This means that residents and their relatives can be confident that they can speak to the manager or senior staff about any concerns they have. They will be listened to and their concerns will be investigated. Action will be taken to put right any identified shortfalls in the care or service provided. The environment has been maintained to a good standard. This means residents living conditions are comfortable, clean and safe. What has improved since the last inspection? What they could do better: The manager must ensure the needs of all prospective residents are assessed before admission. This will mean that the home will be able to demonstrate it can meet the needs of new residents. Darlington Court Care Home DS0000024133.V367393.R03.S.doc Version 5.2 Page 8 Information gathered from such assessments must be used to draw up individual care plans. This will mean that staff will know what the needs of new residents are and what they are expected to do to meet them. Individual care plans must be updated when the outcome of any investigation into allegations of abuse are known. This will mean that staff will know what to do to protect vulnerable residents. Staffing levels must be reviewed regularly and improved when necessary. This should take place following the review of the care needs of individual residents. This will mean staffing levels are sufficient to meet the current care needs of residents. Arrangements must be made to set up a system for the regular supervision of staff employed at the care home. this will mean that staff receive the support and guidance they need to carry out their work. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Darlington Court Care Home DS0000024133.V367393.R03.S.doc Version 5.2 Page 9 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 Darlington Court Care Home DS0000024133.V367393.R03.S.doc Version 5.2 Page 10 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): 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care needs of all prospective residents have not been assessed before they move in. This means the care home cannot demonstrate they are able to meet the needs of identified residents. We found no evidence that intermediate care is being provided at Darlington Court. EVIDENCE: During our last visit to Darlington Court we found evidence that staff at the home are not carrying out a full assessment of residents needs prior to admission. Darlington Court Care Home DS0000024133.V367393.R03.S.doc Version 5.2 Page 11 We identified the names of six residents for case tracking purposes. We looked in depth at the care records of four residents. We discussed the assessments of two residents who had recently been admitted. The records of one resident identified that the purpose of the admission was to provide rehabilitation. We were informed that the term used for this service is “slow stream rehabilitation”. Eleven beds have been identified at Darlington Court to provide this service. When we looked at the pre assessment form for this resident we found no information about their needs with regard to the level of rehabilitation they required. The assessment, which had been carried out, identified the needs of the resident in terms of their residential and nursing care requirements only. We asked to see the pre-admission assessment of a second resident who had also recently been admitted. The manager informed us that such an assessment had not been carried out. We were informed that the resident had been admitted to a bed funded by the Primary Care Trust (PCT). We were also informed that the care home does not routinely conduct pre assessments on residents funded in this way. We discussed the provider’s pre admission assessment policy. This stated that the purpose of the policy is “To ensure that a pre admission assessment is completed comprehensively for all service users so that they can be appropriately placed and that their needs can be met.” The manager was unable to explain why the policy had not been followed in this case. We received surveys completed by staff who work at the care home. Two surveys confirmed that staff are usually given up to date information about the needs of people they support or care for. Three surveys confirmed that staff are never given such information. One person commented, “We never find out when service users have infectious diseases such as MRSA and C Diff until they have been here for a while. When we have admissions we aren’t told all the correct details i.e. if a service user is weight bearing or not. Sometimes we will be transferring them for weeks until we find out they mustn’t be.” We spoke to staff on duty who were able to demonstrate they understood the needs of identified residents. They also told us they have not always had sufficient information about the needs of newly admitted residents. This means staff do not know what is expected of them in order to meet residents’ needs. Information supplied by the manager prior to our visit confirmed that “We have standard company policies and procedures which we follow to ensure all service users are pre assessed in order that we can meet their needs appropriately.” Darlington Court Care Home DS0000024133.V367393.R03.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The resident’s health and personal care needs are set out in an individual plan of care. However, they have not always been drawn up from information taken from assessments of residents needs before they are admitted. Care plans have been reviewed regularly. However, the manager has not ensured the outcome of recent safeguarding adult investigations has been used to up date the individual care plans of identified residents. Residents’ health care needs have been met. Residents are protected by the home’s policies and practices for administering medicines. EVIDENCE: Darlington Court Care Home DS0000024133.V367393.R03.S.doc Version 5.2 Page 13 Care records have been maintained on the home’s computer system. All staff have access to residents’ records. The home’s computer has been fitted with a security system. This means that staff can only access information they need to do the work expected of them. As we have found that pre admission assessments have not been carried out on all residents, the manager was unable to demonstrate that care plans have been drawn up from the information gathered when residents’ needs were assessed. Records that we saw included information about each resident’s physical needs such as communication, eating and drinking, elimination, personal hygiene, pressure area and wound care, and mobility. They also include information about each resident’s medical history, their current diagnosis and medication requirements. Care plans also include clear instructions to staff so they know what is expected of them in order to meet the identified needs of residents. The care planning system includes risk assessments for skin condition, nutrition, mental health and manual handling. It also records visits to each resident by doctors and other health care professionals together with any treatment prescribed. We were informed that the manager reviews care plans every month. The records seen also provided evidence that this does take place. This means that care plans should reflect residents’ current care needs. We were recently informed of two events that affected the wellbeing of residents. The manager also saw fit to notify the local authority under local safeguarding adults procedures. It was agreed that it would be appropriate for the manager to conduct an investigation into one of these incidents. The manager was able to demonstrate that this had taken place. However, the manager was unable to confirm that they had reviewed and amended the resident’s care plans in light of these findings. This means that staff do not have up date information about the actions they should take to ensure the resident’s needs are met and the resident is safe. The manager informed us they were aware of the shortcomings of care plans and had been in discussion with their line manager to agree an action plan to make the necessary improvements. We spoke to several residents who confirmed they are satisfied with the care provided. We also noted that residents had been well cared for. One resident told us, “The staff are very good – I am very happy here.” We also spoke to the friend of a resident who was visiting. They were able to confirm they are satisfied with the care and attention afforded to residents. We saw staff provided care in a manner that ensured their dignity and privacy has been maintained. Staff were courteous when speaking to residents and ensured doors were closed when personal care was being provided. Information supplied by the manager prior to our visit confirmed that, Darlington Court Care Home DS0000024133.V367393.R03.S.doc Version 5.2 Page 14 “Individual care plans are in place and are evaluated monthly. From our pre admission assessment, we are able to provide on admission appropriate equipment in line with Service Users needs such as pressure relieving equipment, nutritional assessments, moving and handling equipment.” Appropriate systems have been put in place for the recording, storing, handling, and disposal of medication. Medication is stored safely and securely. There was no evidence of medication being stock piled. Medication record sheets were seen. They had been maintained in a satisfactory manner and were up to date. Staff training records confirmed that all staff who are responsible for administering medication have received training in this area. We were also shown how staff administer medication. A trained nurse informed us that they take the medication trolley either to the dining room or to the resident’s bedroom before medication is administered directly to the resident. this residents are given the correct medication in accordance with the prescribed dosage and We also observed medication being given to residents over breakfast. This confirmed what the trained nurse told us. Information supplied by the manager prior to our visit confirmed that the home conducts, “Monthly audits of medication administration procedure.” Darlington Court Care Home DS0000024133.V367393.R03.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13. 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Currently, residents are not provided with activities that satisfy their recreational interests and needs. The manager is in the process of appointing an activity coordinator. Residents maintain contact with family and friends as they wish. Residents are helped to exercise choice and control over their lives. Residents receive a wholesome appealing balanced diet in pleasing surroundings. EVIDENCE: The manager informed us that the care home is in the process of recruiting to the post of activity coordinator, who will be responsible for planning and Darlington Court Care Home DS0000024133.V367393.R03.S.doc Version 5.2 Page 16 organising activities and outings for residents to enjoy. The manager also informed us, as a result there is no activity programme in place at present. The manager showed us around the premises. We noted that lounges have been equipped with televisions and video recorders for residents to enjoy. There were also some board games, some books and equipment to be used in reminiscence sessions. However, there was no evidence of organised activities during our visit. We examined care records and found they included information with regard to residents’ leisure interests and hobbies. Information supplied by the manager prior to the inspection confirmed that improvements planned to take place over the next 12 months include, “To develop a plan of activities; to employ an Active Living Co-ordinator; to increase involvement in local community by supporting local charities, holding events in the Home etc.” We saw several residents were entertaining visitors. As the weather was pleasant and warm several visitors were taking residents out for a walk in the garden. Residents told us they are able to have visitors as often as they choose. A visitor also confirmed that they are made very welcome. Information supplied by the manager before our visit confirmed that the care home has, “Open visiting policy of the Home; encouragement to see visitors in private; visitors are greeted with a smile and welcomed to the Home.” The main meal is taken at approximately 12.30 each day. Food is cooked in a central kitchen and transported in hot trolleys to the dining room of each unit. The meal is served out to residents by care staff. We noted that the dining rooms were attractively presented. Each table had been laid with linen tables clothes, cutlery, condiments and sprays of fresh flowers. Each dining room has a small kitchenette where staff, residents or visitors can prepare hot and cold drinks. During our visit we saw the meal being eaten by residents. It consisted of a choice of either fish pie or cheese and onion bake. We noted the meal was presented in an appealing manner to encourage and stimulate residents’ appetite. We saw residents were enjoying the meal provided. However, residents told us the food can sometimes be unappealing and very bland to the taste. We spoke to the manager about this who informed us they were aware of the need make improvements. The manager informed us they had recently been in discussion with the catering staff and had worked with them to draw up menus, which had not been available before. We were given copies of menus that indicated that residents are provided with a varied, nutritious and wholesome diet. We spoke to the cook who informed us of the special diets they are currently providing for. This includes diabetic food, liquidised and finger foods for residents who have difficulty eating. Darlington Court Care Home DS0000024133.V367393.R03.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager has ensured any complaints made by residents their relatives or friends will be listened to, taken seriously and acted upon. The registered manager has ensured residents are protected from abuse or neglect. EVIDENCE: We saw that the home’s complaint procedure was displayed in each of the units within the care home. Residents we spoke informed us that they would speak to the person in charge if they were unhappy. We looked through the record of complaints the manager has received. This indicated that complaints have been dealt with appropriately and in accordance with the home’s own complaint procedure. Information supplied by the manager prior to our visit confirmed that all complaints received have been resolved to the satisfaction of the person making the complaint within agreed timescales. This information also Darlington Court Care Home DS0000024133.V367393.R03.S.doc Version 5.2 Page 18 confirmed that what Darlington Court does well is, “ A company complaints procedure is on display in the Home; we have an open attitude and ensure availability of senior staff to encourage complaints and suggestions to be made; we take prompt action in response to complaints.” We looked through records of training that all staff have undertaken. This indicated that all staff have been provided training in identifying all forms of abuse and reporting any allegations made. We spoke to staff who were on duty. They were able to confirm they have received appropriate training to ensure vulnerable residents are protected. We have been made aware of recent instances when the manager has needed to alert the local authority of possible allegations of abuse under local safeguarding adults procedures. The manager and the registered provider collaborated fully with this process. Information provided by the manager prior to our visit confirmed that all staff have undertaken appropriate training. It was also confirmed that policies and procedures have been drawn up that staff are expected to follow, which have been designed to protect vulnerable residents from abuse and neglect. The manager has also identified the following as areas that the care home does well, “ We deal with all safeguarding vulnerable adult alerts quickly and effectively; we protect service users from abuse; we have ensured all staff have undertaken POVA (Protection of Vulnerable Adults) training.” Darlington Court Care Home DS0000024133.V367393.R03.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered provider has ensured residents live in a safe, well-maintained environment. The registered provider has ensured the home is clean and hygienic. EVIDENCE: We looked at the private accommodation of several residents along with the communal areas, including the dining room and the lounge of each unit. These areas were clean, decorated and furnished in a comfortable manner that met the needs of the residents accommodated. Bedrooms have also been appropriately decorated. Residents have been encouraged to bring personal Darlington Court Care Home DS0000024133.V367393.R03.S.doc Version 5.2 Page 20 effects and small items of furniture in order to make bedrooms as individual as possible. We spoke to some residents who told us the home was a comfortable place to live. They also confirmed they were satisfied with the accommodation provided. As we walked around the premises the manager informed us that a programme of redecoration and refurbishment had recently started in order to freshen up the accommodation. We noted that some communal accommodation and several bedrooms had been redecorated, re carpeted and refurbished. Information supplied by the manager prior to our visit also confirmed the improvements undertaken over the last twelve months have included, “Re furbished and upgraded the dining rooms on both Units including new flooring; new carpets laid in some bedrooms; new carpet laid in the foyer; new pictures on the walls. This information also informed us that improvements planned over the next twelve months will be to, “Continue with refurbishment plan and upgrade environment.” We also visited the kitchen area, the laundry, and several bathrooms. We noted that these areas have been maintained to a satisfactory state of cleanliness. We discussed the importance of ensuring the laundry area is kept clean and hygienic to reduce the risk of cross infection. We noted that a system was in place to ensure dirty and clean laundry is kept separate. Information supplied by the manager prior to our visit confirmed that policies and procedures are in place for staff to follow to ensure the risk of cross infections is reduced. It also confirmed the premises has been visited by the Fire Officer and Environmental Health officer to ensure it is safe and meets requirements in terms of fire safety and health and safety regulations. Equipment such as gas installations, electrical wiring and equipment have been regularly checked and maintained to ensure they are safe to use. Darlington Court Care Home DS0000024133.V367393.R03.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered provider has not reviewed staffing levels to ensure there are sufficient staff on duty to meet the needs of current residents. It is not clear if the registered provider has ensured residents are in safe hands at all times. Residents are supported and protected by the home’s recruitment policy and practices. The registered provider has ensured all staff have received appropriate training. EVIDENCE: During our last visit to Darlington Court we found evidence that staff rotas in the unit accommodating residents with physical frailties are not changed when the care needs of residents accommodated are higher than normal. Staff Darlington Court Care Home DS0000024133.V367393.R03.S.doc Version 5.2 Page 22 members who are off sick are not always replaced leaving the shift short of staff, which has an impact on the level of care that is provided. During this visit we were given copies of staff rotas to look through. The staff rota showed that each unit is staffed separately each day and night. There is one trained nurse on each unit from 8am to 8pm each day and also from 8pm to 8am each night. There are usually at least four care assistants from 8am to 8pm each day on each unit where residents who are considered elderly are accommodated. From 8pm to 8am each night there are two waking care assistants on each unit. In addition housekeeping staff are on duty to cook meals, carry out laundry duties and to clean the premises. There have been occasions, recently when care staffing levels have been less than this, sometimes falling to three care staff particularly during the afternoon and early evening. During the night there has sometimes been one waking care assistant. We looked through staff rotas for the past four weeks and noted that this has occurred as a result of annual leave and sick leave. Where it has not been possible to cover shifts with existing members of staff agency staff have been used. However, there have also been occasions when the manager has been unable provide cover for these shifts. We spoke to several residents who confirmed they were satisfied with the care provided. They also told us that the staff working in the care home are very good. They were very kind and attentive, and had the appropriate knowledge and skills to ensure their needs are met. We observed breakfast and the main meal being taken in the unit accommodating residents who have dementia. We were informed that the staff team had been reduced by one for the morning shift; this was due to a member of the team having to take sick leave at short notice. Whilst we saw no evidence of poor care practices we did note that, during the meal, all staff including the trained nurse were busy helping residents to eat their meal. This meant there was no one available to attend to residents who did not need help with eating their food. Two surveys returned by staff confirmed that there are usually enough staff to meet the individual needs of residents, whilst three surveys confirmed that there were never enough staff. One person commented, “We are always working short staffed which takes its toll on everybody, staff and residents.” Another person commented, “We only have enough time for basic care,” whilst another member of staff told us, “We are always short staffed.” After looking through a selection of residents’ care records and talking to them we found evidence that the current nursing and care needs of residents are high. This means that it is essential that staffing levels are maintained to ensure the safety and wellbeing of residents. Darlington Court Care Home DS0000024133.V367393.R03.S.doc Version 5.2 Page 23 We saw the recruitment records of two members of staff who have started working at the care home since our last visit. These records demonstrated that the registered providers have obtained appropriate checks for these staff, including criminal records checks (CRB) and other documentation to confirm their identity. Surveys returned by staff confirmed their employer had carried out appropriate checks and had obtained references before they started work at the care home. Information supplied by the manager prior to our visit also confirmed that the care home has, “Robust recruitment procedures.” We looked at staff training records. They demonstrated that newly appointed staff undertake structured induction training. This includes providing an understanding of the principles of good care practices and covers the promoting of residents’ rights, independence, choice and dignity. Training records also provided evidence that confirmed staff have been provided with mandatory training such as identifying and reporting abuse, fire safety, health and safety, first aid, infection control and food hygiene. Staff surveys returned us confirmed induction training covered everything they needed to know to do the job when they started. They also confirmed they had been given training which is relevant to their role, helps them understand and meet the needs of residents and keeps them up to date with new ways of working. Information supplied to us by the manager before our visit confirmed that over 35 of staff have obtained the National Vocational Qualification (NVQ) in Care at Level 2 or above. Approximately 12 of staff are currently working towards the same qualification. This information also confirmed that what the care home does well is provide a “Staff training programme; full induction programme for new staff; In house NVQ training programme.” Darlington Court Care Home DS0000024133.V367393.R03.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The day-to-day running of this care home has been adversely affected by the turnover of managers in the past eighteen months. It is not clear from evidence seen if Darlington Court is being run in the best interests of residents accommodated. Residents’ financial interests are safeguarded. The health, safety and welfare of residents and staff are promoted and protected EVIDENCE: Darlington Court Care Home DS0000024133.V367393.R03.S.doc Version 5.2 Page 25 The registered provider has informed us that a new manager was appointed on 2nd July 2008 following the resignation of the previous manager. Following discussion with the manager, we were informed that they had tendered their resignation. Their last day of work was to be the day after our visit. The manager was unable to provide evidence to confirm there have been regular staff meetings or meetings with residents and their relatives. This means it is not clear if the care home is being run in the best interests of residents. There was no evidence that demonstrated that all staff receive regular support and supervision from the manager or from senior staff. Staff we spoke to informed us they had not had supervision in the past 18 months. Staff also told us they have not felt well supported. Staff on duty spoke highly of the manager, who has provided some direction and leadership to the staff team since their appointment. Three surveys returned by staff confirmed the manager regularly meets with them to give support and discuss how they are working. One survey confirmed they sometimes receive support form the manager. One member of staff commented, “We have a new manager, so far they have been keen in giving us support.” The staff we spoke with were clearly disappointed that the manager had chosen to leave after such a short time at the care home. We spoke to the manager about these matters. The manager informed us that they had carried out an initial assessment of the care home in order to identify for themselves areas that needed improvement. Whilst the manager has not had time to commence work on this, the manager informed us they have shared their assessment with the responsible individual. The manager also confirmed that identified areas for improvement reflect the same areas highlighted in this report. For example systems need to be set up to ensure all prospective residents needs are assessed before admission; care plans need to be improved to ensure they provide clear information about the current needs of residents and how they should be met; staffing levels should be reviewed in line with changing needs of residents; all staff should be supervised regularly to ensure they know what is expected of them. The manager informed us that there is provision for residents to deposit money and valuables for safekeeping. We looked at examples of the records kept of transactions undertaken on behalf of residents. They had been well maintained, were up to date and were accurate. The premises have been well maintained, ensuring a safe environment in which residents can live and staff can work. The registered provider has supplied information that indicates equipment such as boilers; other gas Darlington Court Care Home DS0000024133.V367393.R03.S.doc Version 5.2 Page 26 installations and electrical equipment have been regularly serviced and maintained. Residents have told us that they are satisfied with the accommodation and services provided. According to training records staff have been provided training in such subjects as fire safety training, moving and handling, food hygiene, infection control, health and safety. Darlington Court Care Home DS0000024133.V367393.R03.S.doc Version 5.2 Page 27 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 X X 2 X X 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Darlington Court Care Home DS0000024133.V367393.R03.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(1) Requirement People who are considering admission must have their needs assessed so that they will know the care home is able to meet them. Following reviews of residents’ needs, staffing levels must also be reviewed, to ensure there is sufficient staff on duty to meet their needs and protect their safety and wellbeing. A system for the regular supervision of all staff must be set up to ensure they get the support and guidance they require to carry out the work expected of them. Timescale for action 19/08/08 2. OP27 18(1) 19/08/08 3. OP36 18(2) 19/08/08 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 Darlington Court Care Home DS0000024133.V367393.R03.S.doc Version 5.2 Page 29 Darlington Court Care Home DS0000024133.V367393.R03.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone 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. 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