CARE HOMES FOR OLDER PEOPLE
Darna House Groby Road Altrincham Cheshire WA14 2BQ Lead Inspector
Elizabeth Holt Key Unannounced Inspection 24th May 2006 11:00 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 Darna House DS0000006707.V293075.R01.S.doc Version 5.1 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. Darna House DS0000006707.V293075.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Darna House Address Groby Road Altrincham Cheshire WA14 2BQ 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) 0161 928 4342 0161 929 1914 Mr Simon Porritt Tracy Lynn Lidster Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Darna House DS0000006707.V293075.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. All service users shall be aged 60 years or over and require nursing care. Staffing levels as specified in the Notice issued under Section 25(3) of the Registered Homes Act and dated 2nd May 2000 shall be maintained. 21st March 2006 Date of last inspection Brief Description of the Service: Darna House is a care home providing nursing care and accommodation for 20 residents. The home is a detached Victorian house situated on a tree-lined road in Altrincham. Bedrooms are on three floors with access to these by stair lifts. Accommodation is provided in both double and single bedrooms. The home is in close proximity to Altrincham town centre. The grounds include a large garden area. There is ease of access to public transport, the motorway, local shops and parks. The current fees are £583.00 per week. This includes all care, food and laundry. The only normal extra is hairdressing. If other extras arose, they would be agreed in advance. Darna House DS0000006707.V293075.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on the 24th May 2006. All the core National Minimum Standards (NMS) were reviewed during this inspection. Information was gathered as part of the inspection process, which included a questionnaire completed by the manager, which gave information about the residents, the staff and the building. Time was spent talking to the residents and visiting relatives, the manager and the staff team about the day-to-day life in the home and to establish what the home was like for the residents living there. A tour of the premises was undertaken and examination of documents and care files for individual residents. Ten resident/relatives questionnaires were left to be forwarded to the Commission. Three responses were received at the time of this report being written. The Commission for Social Care inspection had not received any complaints or concerns about the home since the last visit. What the service does well:
The home continues to provide a relaxing, homely atmosphere and the residents were generally settled and appeared content in the home. A tour of the bedrooms showed that residents were encouraged to bring in their own pieces of furniture and personal belongings. Residents and relatives said they were treated with respect and their rights were respected. The manager and the staff team showed sensitivity towards the individual needs of the residents accommodated. The home has an open visiting policy and residents stated that their visitors were made welcome in the home. The standard of cleanliness throughout the home was high. One relative said, “the home is always kept clean and tidy”. The manager and the staff commented that residents are encouraged to make choices and have some control over their daily lives where possible. This was reinforced by relatives spoken to. The homemade lunch appeared appetising, the kitchen was clean and the home had adequate stocks of food including fresh fruit and vegetables. Staff were seen to assist residents sensitively at mealtime.
Darna House DS0000006707.V293075.R01.S.doc Version 5.1 Page 6 The staffing levels at the home were adequate to care for the residents and residents commented that the staff were kind and respectful. The manager had a good knowledge of the residents’ care needs. Residents and relatives spoke favourably about the trips out and a monthly programme of events was displayed. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection.
Darna House DS0000006707.V293075.R01.S.doc Version 5.1 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Darna House DS0000006707.V293075.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Darna House DS0000006707.V293075.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this area outcome is adequate. This judgement has been made using evidence made available and following a visit to the home. Information should be readily available to prospective service users and their families regarding the home and the service provided to help them make an informed choice. In general prospective residents’ care needs are assessed before they move into the home, however the shortfall in information provided could lead to a resident’s needs not being met. EVIDENCE: Since the last inspection the home have updated the Statement of Purpose and the Service Users Guide. The Service Users Guide should be made readily available to prospective residents. Procedures are available to ensure that the needs of prospective residents are fully assessed before they are admitted to the home however the documentation for one resident who was recently admitted was not well
Darna House DS0000006707.V293075.R01.S.doc Version 5.1 Page 10 detailed which could lead to the residents’ heath and social care needs not being fully met. The manager stated these procedures would be reviewed when the new format was implemented the week following the inspection. There was little evidence to suggest that the assessment involved the prospective resident and his/her representative. The home does not provide intermediate care therefore this standard was not relevant. Darna House DS0000006707.V293075.R01.S.doc Version 5.1 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. 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. Care plans were available for each resident however some shortfalls in the recording had the potential to put residents at risk. Policies and procedures were in place to deal with medication. EVIDENCE: A sample of care plans was examined. The manager stated that the new care planning system was due to be implemented the following week, however staff were currently required to write sufficient and accurate detail in the care plans to ensure all aspects of the residents’ care needs are met. Individual risk assessments must be completed. Moving and handling risk assessments were not fully completed; risk assessments must be extended to include falls, nutrition, and pressure relief for all residents. The daily progress report noted that a resident had a “large bruise to the back of her right hand”, an accident report had been completed however the staff had made the assumption the resident had fallen down the small stairs. A discussion with the manager highlighted the need for detailed recording of action taken by the
Darna House DS0000006707.V293075.R01.S.doc Version 5.1 Page 12 manager who stated she had questioned all staff about this incident and for appropriate recording of the accident. Again, the risk assessments for this resident were poorly recorded. Some of the problems recorded in the care plans were “medical” rather than based on the nursing problem. A discussion highlighted that staff may require an update in care planning and the development of risk assessments. Shortfalls were noted in the recording of the social needs of the residents however the new documentation would include this information. A number of the residents were noted to have unclean, lengthy fingernails which should be included as part of the daily care as necessary. Medication administration record charts (MAR) were examined and it was pleasing to see these had been appropriately signed for. A list of staff signatures was available for the Registered Nurses responsible for administering medication. From observations made during the inspection and discussions with staff members it appeared the staff treated the residents with respect and dignity. Darna House DS0000006707.V293075.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Some activities were provided and residents were able to maintain contact with family and friends. Residents were encouraged to exercise choice and control over their lives and the residents liked the food provided. EVIDENCE: An open visiting policy was available and residents commented that their visitors were made welcome. Visitors could enjoy the company of their relative in the privacy of their own bedroom or in the lounge. A visitor confirmed this and said he was always made to feel welcome. One relative reported that she and her husband had accompanied her mother on a summer trip, which they had thoroughly enjoyed, and the monthly treat was “excellent”. One resident had received Holy Communion from the local minister and she felt the home addressed her religious needs. At the time of this inspection all residents who could not use the stairs remained in their bedrooms due to the stair lift being out of order. It was pleasing to see this was being repaired before the inspection was completed. Darna House DS0000006707.V293075.R01.S.doc Version 5.1 Page 14 From conversations with residents it appeared they could exercise choice and control over their lives. Residents’ bedrooms showed they were encouraged to bring personal possessions into the home. The menus had been developed in line with the resident’s likes and dislikes. On the day of the inspection the main meal of the day lunch looked appetising. Concern was raised that residents were served their desert at the same time as their main course and therefore the custard would have been cold. Staff were generally seen to assist residents who required assistance at mealtimes in an appropriate way, however one care worker was not clear about ensuring the resident received a main course prior to her desert. The manager dealt with this at the time and ensured the resident received the appropriate meal. Darna House DS0000006707.V293075.R01.S.doc Version 5.1 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and relatives had a clear complaints procedure to follow. Not all staff had received training in Adult Protection therefore residents may be at risk. EVIDENCE: The home had a complaints procedure, which was also included in the Service User Guide. The home held a record of complaints however none had been recorded since the last inspection. The manager herself had not undertaken Adult Protection training however she had planned to do this. Care staff spoken to confirmed this training had been informative and they were aware of the course of action to take in the event of an allegation of abuse. Trafford’s Multi-Agency Policy was available however the staff should have available the details of who to contact for adult protection referrals. Darna House DS0000006707.V293075.R01.S.doc Version 5.1 Page 16 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 and 26 Quality in this area is good. This judgement has been made using available evidence including a visit to the service. The home was clean, comfortable and homely. EVIDENCE: The home provides a clean, homely environment. A tour of the premises was made which included communal areas, bathrooms, toilets and residents’ bedrooms. A number of bedrooms require a coat of paint however a programme of redecoration was in place. Plans were made to install a sluicing disinfector. A requirement made at the last inspection to remove the cord from the sash window in bedroom 6 had not yet been addressed however the manager stated this was to be resolved. Darna House DS0000006707.V293075.R01.S.doc Version 5.1 Page 17 The manager said that the programme of providing adjustable height beds was in progress. A requirement was made for the Commission to be provided with an action plan of how this is being addressed with timescales. Darna House DS0000006707.V293075.R01.S.doc Version 5.1 Page 18 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, 28, 29 and 30 Quality in this area outcome is good. This judgement has been made using available evidence including a visit to this service. The number and deployment of staff appeared in general sufficient to meet the residents’ assessed needs. Recruitment and selection procedures were satisfactory to safeguard and protect the residents. EVIDENCE: At the time of the inspection the home accommodated 13 residents plus one in hospital. The home employs 13 care staff, 5 of these staff members have achieved NVQ level 2 and the manager stated she did encourage the staff to undertake Level 2 training. A sample of staff files were examined. It was seen that Protection of Vulnerable Adult and Criminal Records Bureau Disclosure checks had been undertaken and that staff had a contract of employment. There were no records of a structured induction programme held on file however the manager planned to use a new format and had not employed any permanent new recruits since the last inspection. Staff files did not contain copies of the training certificates staff had undertaken. It is recommended that an individual training and development plan is available for each staff member.
Darna House DS0000006707.V293075.R01.S.doc Version 5.1 Page 19 The manager used the telephone checking system for the personal identification numbers of the Registered Nurses with the Nursing and Midwifery Council. It appeared that any further Nursing and Midwifery Council checks were not carried out following their appointment. A discussion highlighted that good practice would involve re checking that the Registered Nursing staff who are employed by the home remain on the register. Darna House DS0000006707.V293075.R01.S.doc Version 5.1 Page 20 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements have been made in some areas of management practices, for example staff supervision. A questionnaire is available to monitor the views of the people using the service. The health, safety and welfare of the residents and staff were promoted by the home. EVIDENCE: The manager demonstrated that she knew each resident well and had a detailed knowledge of his or her care needs. The manager was studying towards the NVQ Level 4 Management course and hopes to complete this by March 2007. Darna House DS0000006707.V293075.R01.S.doc Version 5.1 Page 21 A questionnaire was available to seek the views of residents/relatives of the home however this had not been sent out in the last 12 months. It is recommended that a quality audit is also sent out to visiting professionals. The manager worked along side the staff to provide a baseline for the formal supervision of the staff. It was pleasing to see that the new form had been in use since March 2006 however some further development of the process was needed. All the residents at the home were supported by their families to manage their personal finances. Extra money was required for hairdressing only. At the time of this inspection. Residents commented that they were happy with the financial arrangements provided. Information was provided by the manager in a pre-inspection questionnaire. This record showed that the required health and safety checks were being carried out. Fire safety checks were being carried out regularly. Staff had attended a fire drill in April 2006. The Food standards inspection was carried out in February 2006. The requirements made had been addressed which involved attending a course on “Safer food better business”. The cook held a certificate in Intermediate Food Hygiene. Darna House DS0000006707.V293075.R01.S.doc Version 5.1 Page 22 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 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Darna House DS0000006707.V293075.R01.S.doc Version 5.1 Page 23 Yes 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 OP3 Regulation 14(1)(b) Requirement The needs of the residents must be fully assessed before admission to the home. A full audit of all the care plans and risk assessments to ensure that each resident has an individual plan of care that accurately details the action required by staff to ensure the health, social and personal care needs of the residents accommodated are met. Timescale for action 30/06/06 2. OP7 13 31/07/06 3. OP7 15(1) Where possible the service user’s 30/06/06 plan must be drawn up with the involvement of the service user, or representative. (The previous timescale of the 30/05/06 had not been met) The resident’s fingernails must be maintained and kept clean. Evidence must be available that all staff have received Protection of Vulnerable Adult training. The Adult Protection Procedure 4. 5. OP8 OP18 12 13 30/06/06 31/07/06 Darna House DS0000006707.V293075.R01.S.doc Version 5.1 Page 24 must be accessible for staff and contain the information relevant for making referrals to the appropriate local authority. 6. OP19 16 An action plan must be provided to the Commission to show how the programme of providing adjustable height beds for the residents is progressing. A programme of redecoration and renewal must be maintained and work identified undertaken. 31/07/06 5. OP19 23(2) 31/07/06 6. OP38 26 The registered person must 03/07/06 provide a written report on a monthly basis to the Commission on the conduct of the care home. (The previous timescale of the 30/05/06 had not been met). 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 OP28 Good Practice Recommendations It is recommended that the Personal identification numbers for the registered nursing staff are checked with the Nursing and Midwifery councils monthly “Fitness to Practice“ list. It is recommended that each staff member have a training and development plan. It is recommended that a quality assurance system be used to provide an audit to report on the quality of the service provided. 2. 3. OP30 OP33 Darna House DS0000006707.V293075.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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