CARE HOMES FOR OLDER PEOPLE
Darsdale Chelveston Road Raunds Northants NN9 6DA Lead Inspector
Irene Miller Unannounced Inspection 6th September 2006 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 Darsdale DS0000012760.V310525.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. Darsdale DS0000012760.V310525.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Darsdale Address Chelveston Road Raunds Northants NN9 6DA 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) 01933 622457 01933 389399 Northamptonshire Association for the Blind Mrs Valerie Margaret Grant Care Home 30 Category(ies) of Sensory impairment (3), Sensory Impairment registration, with number over 65 years of age (27) of places Darsdale DS0000012760.V310525.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The number of service users between 55 years and 65 years is limited to three. 22nd November 2005 Date of last inspection Brief Description of the Service: Darsdale is a residential care home providing personal care for 30 older people over the age of 65 years. The home is registered for service users who have a diagnosis of sensory impairment. Northamptonshire Association for the Blind is a charitable organisation that owns Darsdale Home for the Blind. The home is set in large and pleasant grounds on the outskirts of the small town of Raunds.There are bedrooms on both the ground and first floors of the building. A lift provides access to the first floor bedrooms. All Residents have accommodation provided in single rooms and twenty four of the rooms have en-suite facilities. Weekly fees range from £331.60 to £345.00 Darsdale DS0000012760.V310525.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for Service Users and their views of the service provided. This inspection was a ‘Key Inspection’ that focused on the key standards under the National Minimum Standards and the Care Standards Act 2000 for homes providing care for older people. Prior to the inspection taking place the Commission for Social Care Inspection sent out to the home a pre-inspection questionnaire and comment cards for completion by residents, visitors/relatives and healthcare professionals that are involved with residents healthcare needs. The pre-inspection questionnaire was returned to the Commission for Social Care Inspection along feedback cards from eleven residents, one visitor, and five general practitioners. The pre inspection questioner provided information on the management systems and the feedback cards received outlined the general satisfaction of those who live at the home and those who visit residents on a personal and professional capacity. The primary method of inspection used was ‘case tracking’ that involved selecting three residents and tracking the care they receive through review of their individual care plans (that sets out how the home aims to meet their personal, healthcare, social and spiritual needs). Policies, procedures and records in relation to staff recruitment, complaints, medication and general maintenance and upkeep of the home were viewed. Discussion took place with the homes management, residents and staff, and general observations of care practices were made. The Registered Manager Valerie Grant was not available on the day of this unannounced inspection taking place, however the Deputy Manager Susan Henderson was available throughout the inspection. The inspector spent two and a half hours planning the areas to focus on at this inspection, based upon information gained from reviewing the homes service history, the last two inspection reports and information from the pre inspection data collection systems. The inspection took place over a period of approximately six hours
Darsdale DS0000012760.V310525.R01.S.doc Version 5.2 Page 6 What the service does well:
The care plans were detailed and provided information for staff to follow to ensure that the resident’s need could be fully met. The management and staff work well with the District Nurse in providing care for residents who are at risk of developing pressure ulcers due to failing health and limited mobility. Staff training in the storage and administration of medication is to a high standard. Residents expressed satisfaction on living at the home, one resident said that they missed living by the coast saying ‘if only you could pick the home up and put it beside the seaside it would be perfect’, one resident said that they spend a lot of time in the garden, that they liked being outdoors and that the staff walk in the garden with them, another residents said that they enjoyed a cigarette and that the staff ensure that this is accommodated for them. Comments from residents received about via the comment cards were ‘the people here are very kind and caring, I am happy living here’, ‘it’s a pleasure living at Darsdale’, ‘I’m happy living at the home’. Residents said that they enjoyed the musical entertainers that visit the home, and the church services that take place fortnightly. Minutes of residents meetings demonstrated that residents have the opportunity to raise any concerns or complaints that they may have about the service. The Commission for Social Care Inspection had received one concern about the home since that last inspection visit, and were satisfied that the concern was dealt with appropriately by the home. Cross infection policies and procedures were in place with additional control measures in place such as the use of soluble laundry bags and hand sanitisers that were available within the bathrooms, toilets, and the laundry room. The bedrooms viewed were pleasantly decorated, well lit and personalised to the resident’s individual tastes. Within the bedroom of one of the residents who was at a high risk of falling, there was a floor pressure pad and a sound activated devise in place to alert the staff of when the resident was mobile during the night. These measures had been put into place to ensure that staff assistance was available and ensure the safety of the resident. There is a good staff supervision system in place each senior member of staff has a small group of staff for which they take on the responsibility of carrying out 1-1 supervisions and reviewing the care plans with the resident’s keyworkers.
Darsdale DS0000012760.V310525.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better:
Two written references must be obtained in respect of persons working at the home in line with Schedule 2 of the Care Standards Act 2000 (regulation 19) From three staff recruitment files viewed, two did not contain two written references. Accidents such as falls could be more closely investigated through using a person centred risk assessment approach to identifying the source of any health or environmental conditions that may cause heightened states of confusion or disorientation for residents and contribute to falls episodes. Please contact the provider for advice of actions taken in response to this
Darsdale DS0000012760.V310525.R01.S.doc Version 5.2 Page 8 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Darsdale DS0000012760.V310525.R01.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 Darsdale DS0000012760.V310525.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (standard 6 is not applicable) Quality in this outcome area is good. Information about the home and the services provided is made available to all prospective residents, this enables prospective residents to make an informed choice about whether the home will meet their needs and lifestyles. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Pre assessments are conducted for each prospective resident to ensure that the home can fully meet their needs, the assessments are carried out by the Registered Manager and Deputy Manager and also involve the local placing authority. Written contracts of the terms and conditions of residency are in place that are available on tape or brail if required. Darsdale DS0000012760.V310525.R01.S.doc Version 5.2 Page 11 The home is flexible with the admission procedure; prospective residents are encouraged to visit the home prior to moving in, however the home recognises that for some people this may be traumatic, therefore each admission is tailored to the individuals needs. A sample check of the assessments alongside the care plans confirmed that relevant information had been transferred to the care plans to inform staff of the needs of the new resident, and any associated risks that the move my bring on, such as disorientation for residents who have dual sensory loss. Darsdale DS0000012760.V310525.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good. The care plans and risk assessments contained detailed information on the health and personal care needs of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The information contained within the residents care plans viewed informed the reader of the residents preferred methods of communication, daily routines, dietary preferences and the level of personal and healthcare required. Residents who were receiving treatment for pressure ulcers and residents, who were at risk of developing pressure area ulcers, had detailed pressure area care treatment and prevention plans in place. The management and staff work closely with the District Nurse in providing pressure area care and records seen demonstrated that there was good monitoring, observation and recording systems in place, and pressure relieving equipment was seen to be in use.
Darsdale DS0000012760.V310525.R01.S.doc Version 5.2 Page 13 Feedback from the comment cards returned from Healthcare professionals that visit the home was good comments such as ‘one of the best in the area, clean, good communication and excellent care. Staff training records demonstrated that pressure area care training was available for staff. Food and fluid monitoring and turn charts were in place for a resident being cared for in bed. On examination the records were consistent ensuring that the needs of the resident in this area of their care was being met. The medication storage and administration records were viewed and seen to be in good order. Staff training is provided from the dispensing pharmacy this is in the form of a workbook manual that covers all aspects of medication management On speaking with residents they said that their rights to privacy and choice was respected. Residents were observed spending time within their own private rooms, within the communal lounge and in the garden, a number of residents were listening to music and enjoyed a sing a long session together. Staff were observed assisting residents with visual impairment around the home and were observed to treat the residents with respect. Darsdale DS0000012760.V310525.R01.S.doc Version 5.2 Page 14 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 is good. The lifestyle in the home meets the resident’s needs and expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Individual preferences in relation to daily living activities were recorded within the residents care plans. On speaking with residents all expressed satisfaction on living at the home, one resident said that they missed living by the coast saying ‘if only you could pick the home up and put it beside the seaside it would be perfect’, one resident said that they spend a lot of time in the garden, that they liked being outdoors and that the staff walk in the garden with them, another residents said that they enjoyed a cigarette and that the staff ensure that this is accommodated. Comments from residents received about via the comment cards were ‘the people here are very kind and caring, I am happy living here’, ‘it’s a pleasure living at Darsdale’, ‘I’m happy living at the home’. Darsdale DS0000012760.V310525.R01.S.doc Version 5.2 Page 15 Residents said that they enjoyed the musical entertainers that visit the home, and the church services that take place fortnightly. Some residents attend a day centre twice a week, and residents spoken with that attend the centre said that they enjoyed their time spent there. On the residents and visitors notice board located in the main lobby of the home there was a list of planned weekly activities, staff said that the residents really enjoyed singing and this was evident on the afternoon of the inspection when a group of residents were observed listening and singing along to some old musical favourites. Individual choice is exercised in where residents choose were to take their meals To aid with orientation for residents who are visually impaired the home endeavours to ensure that routines and eating arrangements are consistent. The lunchtime meal on the day of inspection was Chicken with Stuffing, Mashed potatoes and mixed vegetables, followed by sponge and custard Residents said that overall they were pleased with the food available, one residents said that they would like more cooked meats such as Ham on the menu and Bovril, the resident said that they had raised this with the Registered Manager. Records of residents meetings demonstrated that meals are discussed on the agenda and that individual preferences are taken into consideration when reviewing the homes menus. Comments in relation to meal times received via the resident’s feedback cards were ‘In the hot weather we had stew and dumplings’, ‘there could be more choice at mealtimes’, ‘staff need to be quieter in the dining room’. The residents comments were discussed with the Deputy Manager who informed the inspector that acting upon the requests of residents the menus had been reviewed and the home was on week two of a new 4 week menu plan. Staff and residents were visited within the dining room during the lunchtime sitting. The dining room was clean and pleasant, and the staff were observed serving the meal and assisting residents without creating excessive noise. However it was noted that the high ceiling, vinyl flooring and the use if horizontal blinds in place of curtains, has the impact of sounds not being absorbed within this environment and the slightest sounds within the room amplified. Darsdale DS0000012760.V310525.R01.S.doc Version 5.2 Page 16 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 is good. Residents can be assured that any complaints that they may have will be listened to taken seriously and acted upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All residents are given a copy of the homes statement of purpose that explains how the home will respond to any complaints, and there was a copy of the complaints procedure displayed within the entrance to the home, that was in large print. Minutes of residents meetings demonstrated that residents have the opportunity to raise any concerns or complaints that they may have about the service. The complaints log was viewed and no complaints had been received at the home since the last inspection visit. The Commission for Social Care Inspection had received one concern about the home since that last inspection visit, and were satisfied that the concern was dealt with appropriately by the home. Residents said that they would know who to speak to if they wished to express any concerns or complaints about the service at the home.
Darsdale DS0000012760.V310525.R01.S.doc Version 5.2 Page 17 Staff training records demonstrated that training is provided on the protection of vulnerable adults. Darsdale DS0000012760.V310525.R01.S.doc Version 5.2 Page 18 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 is good. Residents live in a well-maintained and homely environment This judgement has been made using available evidence including a visit to this service. EVIDENCE: The furnishings within the home were clean and homely. The building and upkeep maintenance records viewed were seen to be in good order. However it was noted that within the communal lounge there was an excessive amount of dead flies within the covers of the fluorescent strip lighting and on the roof of the lean to conservatory that required attention. The carpet within the main lounge was frayed where there had been a join, this was brought to the attention of the Deputy Manager who was aware of this
Darsdale DS0000012760.V310525.R01.S.doc Version 5.2 Page 19 and confirmed that the carpet was due for renewal, the homes management need to be attended to this as a high priority as it could present a tripping hazard if left unattended Cross infection policies and procedures were in place with additional control measures in place such as the use of soluble laundry bags and hand sanitisers that were available within the bathrooms, toilets, and the laundry room. The bathrooms and lavatories were clean and bright, with grab rails in strong contrasting colours to the bathroom furniture, to make them more visible. There was specialist equipment available to include assisted baths that are under a maintenance contract. The bedrooms viewed were pleasantly decorated, well lit and personalised to the resident’s individual tastes. Within the bedroom of one of the residents who was at a high risk of falling, there was a floor pressure pad and a sound activated devise in place to alert the staff of when the resident was mobile during the night. These measures had been put into place to ensure that staff assistance was available and ensure the safety of the resident. Several of the resident’s rooms had telephones and clocks that were suitable for the visually impaired. Darsdale DS0000012760.V310525.R01.S.doc Version 5.2 Page 20 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 is good. Residents are cared for by a trained staff team, however recruitment procedures need to be more thorough to provide better protection for Residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the inspection there was sufficient staff available to meet the current needs of residents, staff were observed spending time sitting and socialising with the residents. Three staff recruitment files were viewed and the recruitment documentation, containing evidence that Criminal Records Clearance (CRB) and Protection of Vulnerable Adults (POVA 1st). However there were inconsistencies in obtaining two written references, as required in Schedule 2 of the Care Standards Act 2000. From three staff recruitment files viewed one had obtained three references, one had a written reference and a telephone reference, and another had obtained one written reference, however this reference did not identify who had supplied the reference and was not dated. There was some evidence within one of the staff files that a referee had been requested on more than one occasion to supply the home with a written reference for the staff member.
Darsdale DS0000012760.V310525.R01.S.doc Version 5.2 Page 21 The home has achieved the target set by the National Minimum Standards that at least 50 of the staff are trained to National Vocational Qualification level 2. Training records evidenced that staff receive mandatory induction training on moving and handling, food hygiene, fire procedure, health and safety, first aid, protection of vulnerable adults, control of substances hazardous to health and infection control. In addition to mandatory training, there is vocational training to meet the needs of the residents, such as medication, dual sensory impairment, communication skills, Parkinson’s and palliative care. Through viewing the care plans and talking with residents and staff it is apparent that there are residents living at the home who have short term memory loss, and dementia who require emotional support, and dementia care training has been provided. Darsdale DS0000012760.V310525.R01.S.doc Version 5.2 Page 22 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 is good. The management and administration at the home promotes the health safety and welfare of residents and staff, however the shortfalls in obtaining references for new employees could place the residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans that were viewed during the inspection were well maintained, up to date and accurate. However the risk assessments could benefit from some additional information to be included, from the accident records viewed one resident had experienced several falls, many of the falls had occurred during the early weeks of the residents admission into the home, and it was
Darsdale DS0000012760.V310525.R01.S.doc Version 5.2 Page 23 assumed that the falls had been due to disorientation with the new surroundings or sensory losses. There was information recorded within the residents care plan that indicated that the resident suffered from recurrent infections and that when infection is present this resulted in the resident becoming confused and disorientated. A risk assessment had not been implemented acting upon the information available to identify this infection trigger to instruct the staff on how the infections could be managed or eliminated, and hence protect the resident from injury due to falls as much as reasonably practicable. Residents meetings provide a forum for residents to express their views. Money held on behalf of residents was stored securely and systems were in place to ensure that all transactions were consistently recorded, a sample check was made and the accounts were in good order. Confidential records in relation to residents and staff were stored appropriately. There was a good staff supervision system in place each senior member of staff has a small group of staff for which they take on the responsibility of carrying out 1-1 supervisions and reviewing the care plans with the resident’s keyworkers. Staff expressed satisfaction at working at the home and of the support provided from the homes management. The registered manager is suitably qualified, competent and experienced to manage the home, and is supported by a deputy manager who has achieved the National Vocational Qualification level 4 and registered managers award. Darsdale DS0000012760.V310525.R01.S.doc Version 5.2 Page 24 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 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 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Darsdale DS0000012760.V310525.R01.S.doc Version 5.2 Page 25 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 OP29 Regulation 19 (Schedule 2) Requirement Two written references must be obtained for all new employees, prior to commencing employment. Timescale for action 31/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Darsdale DS0000012760.V310525.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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