CARE HOMES FOR OLDER PEOPLE
Darnall View 37 Halsall Avenue Darnall Sheffield South Yorkshire S9 4JA Lead Inspector
Shirley Samuels Key Unannounced Inspection 10:45 19 September 2006
th 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 Darnall View DS0000002954.V302027.R01.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. Darnall View DS0000002954.V302027.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Darnall View Address 37 Halsall Avenue Darnall Sheffield South Yorkshire S9 4JA 0114 243 3323 0114 243 3323 none 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) None Fisherbell Limited Vacant Care Home 23 Category(ies) of Dementia - over 65 years of age (23) registration, with number of places Darnall View DS0000002954.V302027.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The service may admit persons between the age of 60 and 65 years of age. 15th December 2005 Date of last inspection Brief Description of the Service: Darnall View provides care for up to 23 male and female service users living with dementia. The building has two stories with bedrooms on both floors. The main lounge and dining area is situated on the ground floor and the majority of the service users spend their day in these areas. The first floor has an area where a small group of service users can have their meals and lounge if they wish. The home is situated in a residential area with access to public transport and about 4 miles from the city centre. The current fee is £345.00, this fee is the same for all service users. There are additional charges for hairdressing, chiropody, some activities and toiletries. A statement of purpose and a service user guide was available, these however needed to be updated. Darnall View DS0000002954.V302027.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, carried out from 10:45am- 5:15pm. The inspector spoke with three service users; four relatives’ two members of staff the manager and the responsible individual. Observations were made of the interaction between service users and staff. A selection of records were examined including care plans, staff records and training records. An inspection of the building was also made. The manager completed a pre inspection questionnaire, which included information about the establishment, policies and procedures, service users, staffing and professional visitors to the home. The home has been extended to accommodate up to 23 service users. The home was full at the time of the inspection. The manager said there was one person on the waiting list. The inspector would like to thank the service users, staff and the managers for their support to the inspection process. What the service does well:
Service users were assessed prior to moving into the home. Each service user had a care plan which in the main detailed their health and social care needs. The medication system met the standards and protected service users from, harm. Service users were in the main treated with respect and their right to privacy was upheld. Regular activities took place in the home, small groups and individuals went out of the home for walks and to the shops. Service users were able to maintain contact with family and friends. Relatives spoken to said they were always made to feel welcome when they visited. Due to the level of dementia some service users found it difficult to make choices. Observations were made of staff encouraging service users to make choices and using distraction techniques to defuse situations where service users were demonstrating agitation. A relative said in their opinion the food provided was good and there was always a choice. Since the last inspection the home has had one complaint, which was made to the Commission for Social Care Inspection. The complaint related to one service users behaviour affecting the quality of life for the other service users living at the home. Service users were protected from abuse and further adult protection training was planned for the staff. The premises were safe, clean and well maintained. The majority of the information required was included in the staff files. The home has a stable staff team and manager. The responsible individual visits the home regularly, monitors and reports on the conduct of the home. Service users monies, which Darnall View DS0000002954.V302027.R01.S.doc Version 5.2 Page 6 were kept in the office, were stored appropriately and the records were accurate. Staff understood their responsibilities regarding health and safety. 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. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Darnall View DS0000002954.V302027.R01.S.doc Version 5.2 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 Darnall View DS0000002954.V302027.R01.S.doc Version 5.2 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 & 5. Standard 6 does not apply to this service. Quality in this outcome area was good. This judgement has been made using available evidence, including a visit to the home. A statement of purpose and service user guide was in place and each service user had a contract or placement agreement for those who were self funding. Individuals thinking of moving into the home and their relatives or able to visit prior to admission. This allowed potential service users to meet staff and existing service users. Each service user file contained an assessment, which had been completed prior to admission to the home. This ensured that staff had the information to assist them, in making a judgement about the care they could provide. EVIDENCE: The service user guide and statement of purpose was available on display in the home. Some of the relatives spoken to said they had been provided with some written information about the home others said they could not recall.
Darnall View DS0000002954.V302027.R01.S.doc Version 5.2 Page 9 The statement of purpose and service users guide seen, lacked information to reflect the change in category of service user. Three service user files were checked. Two contained the contract of care or service agreement. For the third service user the manager said the contract had been sent to the relative to be signed. All service users and the relatives spoken to said they were able to visit the home prior to admission. Darnall View DS0000002954.V302027.R01.S.doc Version 5.2 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, 10 &11. Quality in this outcome area was adequate. This judgement has been made using available evidence, including a visit to the home. Service users needs were in the main set out in a plan of care and their health care need were fully met. The medication system protected service users and met the required standards for administration and storage. Service users were in the main treated with respect and their right to privacy upheld. Service users and their relatives were assured that at the time of a service users death they would be treated sensitivity and with respect. EVIDENCE: Three service user files were checked. Each service user had a care plan, which identified their needs. They did not in the main detail the action required by staff. Care plans were not reviewed monthly as required and their was no evidence to show who had contributed to the care plan. Records of care provided were generally sufficient but was often repetitive in its content. Records were kept of visits from health care professionals. Relatives were satisfied with the health care provision and that treatment was obtained when needed.
Darnall View DS0000002954.V302027.R01.S.doc Version 5.2 Page 11 Records were kept of all the medication in the home. The records of administration tallied with the medication checked. Controlled drugs were stored and recorded as required by the regulations and all staff responsible for the administration of medication was appropriately trained. Service users medication was reviewed regularly. Relatives spoken to said. The service and staff was “marvellous”, “10 out of 10”. The observations made on the day of the inspection were very positive except in one instance. Staff demonstrated sensitivity and patience. They were observed offering choices and using their skills and knowledge to defuse and distract service users who became distressed or agitated. There was however one example where a member of staff responded verbally inappropriately to one service user. The inspector challenged the staff member about this immediately and reported the incident to the manager. The three service users files checked contained information on the action to be taken on the death of the service. This ensured that service users wishes would be respected. Darnall View DS0000002954.V302027.R01.S.doc Version 5.2 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 & 15. Quality in this outcome area was good. This judgement has been made using available evidence, including a visit to the home. Social activities take place inside and outside of the home. Service users are encouraged to take part but are not required to. Contact with friends and family is encouraged, which ensured they are involved in the life of the service user. While many of the service users find it difficult to make choices staff were observed offering choices and encouraging service users to choose. EVIDENCE: There is an activity coordinator employed at the home. Activities provided include board games, bingo, and reminiscences sessions, trips outside of the home include trips to the local shops short walks in small groups or individually. Records were kept of the activities, which took place and the service users who took part. There were many visitors on the day of the inspection. They all said they were made welcome when they visited. The staff said they encouraged family involvement in the life of the service users. Darnall View DS0000002954.V302027.R01.S.doc Version 5.2 Page 13 Staff said they had access to service users care plans and some history. This allowed them to assist service users in making choices, which related to past preferences, particularly were service user dementia was at advanced level. Service users and relatives said the meals provided were good. The service users enjoyed the meal provided and there was very little waste. There were no service users who needed help with eating. Staff were observed encouraging service users to eat. The lunchtime meal was a little noisy due to some service users level of agitation. Staff were observed trying to create a calm and pleasant mealtime, by distraction and offering one service user an alternative place to sit. Care plans included details of special diets and the staff spoken to were able to identify these and appropriate meals were provided. Darnall View DS0000002954.V302027.R01.S.doc Version 5.2 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 & 18. Quality in this outcome area was adequate. This judgement has been made using available evidence, including a visit to the home. The home has a complaints procedure which was available to service users and relatives. This enabled them to voice any concerns that arise. Service users are protected from abuse and procedures are in place to ensure that allegations are responded to appropriately. EVIDENCE: Since the last inspection the home had received two complaints. One of which was made to the CSCI. The service provider investigated both complaints. This resulted in action being taken to reduce the risk to service users and to improve procedures regarding the assessment of service users prior to admission, clarity of other procedures within the home in addition to further training for staff on the care of people living with dementia. Records of complaints were kept but did not contain details of the complaint the investigation and the action taken and were not kept in sufficient detail. Staff were able to verbalise the action they would take following any allegation and training was ongoing. There have been no allegations of abuse. Darnall View DS0000002954.V302027.R01.S.doc Version 5.2 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 & 26. Quality in this outcome area was good. This judgement has been made using available evidence, including a visit to the home. The home is safe, well maintained, clean and hygienic. Service users have access to comfortable indoor and outdoor communal facilities, ensuring they live in a homely environment. Service users have the specialist equipment they require to maximise their independence. Bedrooms are safe and comfortable and service users are able to have their own possessions around them. EVIDENCE: Service users had access to all parts of the home. Two service users had a key to their bedroom all other bedrooms were locked during the day. The manager said this was to maintain privacy and dignity for all service users. While allowing service users to wonder freely around the home locking doors reduced the incidents of service users belongings being tampered with. Relatives
Darnall View DS0000002954.V302027.R01.S.doc Version 5.2 Page 16 spoken to said they understood why doors were locked and had no objection to this. During the afternoon some service were noted sitting in their bedroom. Temporary signs were posted on bedroom and other doors to help orientate the service user. The manager said that permanent more substantial signs were on order and would be fitted. Bathrooms and toilets were clean warm and well decorated but lacked a homely feel; there were no blinds or any form of dressing up to the windows. Service users said they liked their bedrooms; some bedrooms were more individualised than others. All the rooms were single with en suite facilities this provided all service users with their own private space. Darnall View DS0000002954.V302027.R01.S.doc Version 5.2 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, 28, 29 & 30. Quality in this outcome area was adequate. This judgement has been made using available evidence, including a visit to the home. Service users needs were in the main met by the number and skill mix of the staff, but were under review to ensure more effective deployment of staff. The recruitment procedures, in the main met the required standards and protected service users from harm. Staff were trained and experienced in the care and support of older people, and were developing their skills and knowledge further in the care of older people with dementia. EVIDENCE: Staff said they did not feel there was always enough staff on duty, but added that the management were reviewing the rota to ensure that the deployment of staff better met the needs of the service users. The sample rota checked and the number of care staff on duty on the day of the inspection showed that the staffing levels were not being maintained at all times. To reduce the impact on the service users and to assist the staff, it was evident that on these occasions the manager assisted with the direct care of service users and domestic duties around the home. Observation on the day of the inspection was that staff were attentive to service users. Activities were taking place and service user in the lounge were supervised at all times. Darnall View DS0000002954.V302027.R01.S.doc Version 5.2 Page 18 The manager said that eight of the eighteen care staff had completed the NVQ level 2 in care. Three staff files were checked they contain the majority of the information required by the regulations. There were however gaps in employment, which were not explained, and photograph of the employee was not in place on two of the three files. The manager said that since the last inspection staff have received training in food hygiene, dementia care NVQ level 2 and 3 in care, fire training, health and safety and moving and handling. Darnall View DS0000002954.V302027.R01.S.doc Version 5.2 Page 19 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 & 38. Quality in this outcome area was good. This judgement has been made using available evidence, including a visit to the home. The home is well managed; the manager is experienced and able to run the home responsibly. Regular visits by the responsible individual and the owner ensures that the conduct of the home is monitored. Arrangements are made to ensure that service users finances are managed in a satisfactory manner. The home is managed and monitored to ensure the health safety and welfare of service users, staff and visitors. Darnall View DS0000002954.V302027.R01.S.doc Version 5.2 Page 20 EVIDENCE: The manager is experienced and qualified to manage the home. He has successfully completed the Registered Managers Award and has experience in the care of people living with dementia. The manager is currently going though the process of becoming the registered manager for the home. The manager works closely with the responsible individual and the owners to ensure that the home is run in the best interest of the service users. The responsible person and the owner visit the home and have regular contact with service users, staff and relatives. The owner said that reports on the conduct of the home was completed, these were not available for inspection. Staff said they had confidence in the manager and felt they were able to influence the way the home was run. This meant that service users benefited from the leadership and management approach of the home. Relatives said they had contact with the responsible person and the manager. They were able to comment informally about the standard of care, they were able to raise concerns and give feedback and said in the main they were satisfied with the service provided. Written records and receipts were kept of financial transactions and there was safe storage for service users monies. The records showed that the staff had received health and safety training. Observations were made of appropriate moving and handling techniques and staff had access to equipment to carry out handling tasks safely. Accidents were recorded on individual accident forms and detailed in service users daily notes. There were some events, which resulted in service users being transferred to hospital, which had not been appropriately notified to the CSCI. Hazardous substances were safely stored. Certificates were provided to the CSCI to confirm the safety of the building, gas and electrical supplies and equipment. Darnall View DS0000002954.V302027.R01.S.doc Version 5.2 Page 21 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 2 3 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 x x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 2 Darnall View DS0000002954.V302027.R01.S.doc Version 5.2 Page 22 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 OP1 Regulation 5 Requirement A statement of purpose and a service user guide must be updated to take account of the variation in the service and this must be submitted to the CSCI. Previous timescale 30/1/06 not met. Service users care plans must include the action required by staff. Care plans must be reviewed monthly and include details of who has contributed. Service users must be treated with respect at all times. Staff must be made aware of appropriate and inappropriate verbal responses to service users. Records of complaints must be kept in sufficient detail. They must include details of the complaint, the investigation, findings and the action taken. All staff must receive adult protection training. Signs must be placed on doors as appropriate to the needs of the service users. Previous
DS0000002954.V302027.R01.S.doc Timescale for action 01/12/06 2. OP7 15 01/11/06 3. OP10 12 01/11/06 4. OP16 17 Schedule 4 18 23 01/11/06 5. 6. OP18 OP19 01/03/07 01/12/06 Darnall View Version 5.2 Page 23 timescale 30/1/06 not met. 7. OP27 18 There must be sufficient staff at all times to ensure that service users needs are met and to provide appropriate levels of supervision and activity. 01/11/06 8. OP29 18 9. 10. 11. OP29 OP30 OP31 19 Schedule 2 18 9 The recruitment procedures 01/11/06 must include checking gaps in employment and a photograph of the employee kept on file. There must be a recent 01/12/06 photograph on each staff file. 50 of care staff must be 01/03/07 trained to NVQ level 2 in care. The application to register the 01/11/06 manager for the home must be submitted to the CSCI. Previous timescale 30/01/06 not met. The monthly reports made by the responsible person or the owner of the home, on the conduct of the home. Must be available for inspection. The CSCI must be notified in writing of any accident or event, which results in a service user being transferred or admitted to hospital. 01/11/06 12. OP33 26 13. OP38 37 01/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP19 Good Practice Recommendations To create a more homely feel, Consideration should be given to the use of blinds or other form of dressing for the toilet and bathroom windows. Darnall View DS0000002954.V302027.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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