CARE HOMES FOR OLDER PEOPLE
Darwin House Darwin Lane Sheffield South Yorkshire S10 5RG Lead Inspector
Janis Robinson Unannounced Inspection 18th January 2006 9:00 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 Darwin House DS0000002955.V263976.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Darwin House DS0000002955.V263976.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Darwin House Address Darwin Lane Sheffield South Yorkshire S10 5RG 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) 0114 230 1414 0114 230 7039 Darwin House Limited Mrs Christine Frudd Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Darwin House DS0000002955.V263976.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 30th June 2005 Brief Description of the Service: Darwin house is a home providing personal care for 25 older people. It is situated in a residential area of Sheffield. The facilities are on three floors accessed by a lift. Seventeen single and five double rooms are available. Each of the bedrooms is provided with en-suite toilet facilities, five rooms have ensuite showers. A variety of communal lounge space, and communal library room and dining room are provided. A central laundry and kitchen serve the home. Sufficient bathing facilities are available. The home has pleasant landscaped garden provided with seating. The home has a car park. Darwin House DS0000002955.V263976.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over 4.5 hours from 9.00 am to 1.30 pm. An inspection of the environment was undertaken. A proportion of records were checked, including care plans, complaints, menu, rotas, staff training, supervision and recruitment, health and safety and fire records. Interactions between staff and residents were observed. Six residents and the majority of staff were spoken with. Discussions with the homes manager took place. What the service does well:
The interactions observed between residents and staff appeared patient and respectful. Residents said staff were ‘wonderful’, ‘excellent’, and ‘very caring’. Staff displayed a strong sense of commitment to meeting resident’s needs. Trial visits took place, to enable prospective residents and their representatives to make informed choices. Staff undertook a range of training to keep them up to date and ensure they were able to meet residents’ needs. Access to specialists was available. Care plans were in place for all residents. These were well set out and easy to read. They set out all aspects of personal, social and health care needs and recorded the staff action required to ensure all identified needs were met. Residents’ health care was monitored and access to health specialists was available. Residents confirmed that staff were respectful towards them. Residents’ wishes relating to dying and death had been recorded, to ensure these were carried out. The routines at the home were flexible and residents were free to choose how to spend their day. A part-time activities worker was employed, and all residents said they enjoyed the activities provided. There was an open visiting policy, to encourage contact with relatives and friends. The menu was varied, a balanced diet was provided and choices were offered at mealtimes to respect resident’s preferences and maintain health. There was a complaints procedure and adult protection procedure in place, to promote residents safety. All of the residents said they had confidence in the homes manager and staff, who would listen to any concerns and take them seriously. The environment was well decorated, well maintained, clean and fresh smelling. Communal areas contained homely touches to provide a comfortable
Darwin House DS0000002955.V263976.R01.S.doc Version 5.0 Page 6 environment. Bedrooms contained personal belongings, which enabled residents to have some control over their personal space. Sufficient bathing facilities were provided to ensure residents personal care needs were met. Agreed levels of staff were being maintained. Health and safety procedures were identified and carried out, and systems were checked and serviced to maintain a safe environment. Some mandatory training took place, to equip staff with the essential skills needed. What has improved since the last inspection? What they could do better:
Some staff required training in adult protection procedures in order that they were aware of the procedures to follow if an allegation was made. Thorough recruitment procedures to ensure residents were safe had not been consistently adhered to. Staff recruitment files did not contain all of the required documentation. Gaps in employment history had not been explored. Staff supervision did not take place a minimum of 6 times each year, to ensure all staff received appropriate support and guidance. Updates in aspects of mandatory training were required to ensure staff had the essential skills required to carry out their duties. Staff had not participated in a practice fire drill at the required frequency. Insufficient staff were trained in first aid to ensure there was a qualified person on duty at all times.
Darwin House DS0000002955.V263976.R01.S.doc Version 5.0 Page 7 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. Darwin House DS0000002955.V263976.R01.S.doc Version 5.0 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 Darwin House DS0000002955.V263976.R01.S.doc Version 5.0 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): 4 and 5 Trial visits were encouraged to enable prospective residents to look around the home, meet residents, staff and give them the information needed to make informed choices. Staff undertook periodic training to keep them up to date and access to specialist services was arranged, in order that all assessed needs were met. The information available and actions taken ensured that standards were met. EVIDENCE: All of the residents said the home met their needs. One resident said ‘I am very well looked after’, and a further resident said ‘the staff are wonderful’. Residents confirmed that they had access to specialists at hospitals, and some health professionals, such as dentists and opticians, visited them in the home, so that all of their health care needs were met. Residents confirmed that they had been able to look around the home, stay for a meal and meet residents and staff, who provided them with the information they needed before choosing to move in.
Darwin House DS0000002955.V263976.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Each resident had a care plan, to give staff the information needed to ensure all care needs were met. Health care was monitored, assessed and met. Medication systems were safely managed. Staff respected residents privacy and appeared respectful towards residents. Each care plan contained a section on death and dying, to ensure residents wishes were sought and carried out. EVIDENCE: Care plans contained the full range of information required. These contained specific information on all aspects of personal, social and health care needs. The plans included information on the staff action required to ensure assessed needs were met. Residents were aware of their right to access their records, but chose not to do so. The plans contained detail of all health care contacts, appointments and treatments, and access to these was available to ensure health was maintained. Moving and handling, and nutritional risk assessments had been undertaken for all residents to keep them as safe and healthy as possible. Staff were observed respecting privacy by knocking on doors before entering. The interactions between staff and residents appeared respectful and caring. Residents made some positive comments about their care. One
Darwin House DS0000002955.V263976.R01.S.doc Version 5.0 Page 11 resident said ‘I am very well looked after, the staff are very kind’. Several residents said ‘the home is very good’. Residents’ health was monitored and access to specialists at hospitals, chiropodists, dentists and other health care professionals was available. Residents confirmed that they could see their GP and other professional visitors in private. A medication policy was in place. Senior staff administered medication and had received training to ensure safe procedures were followed. Medication administration records were fully completed and up to date. Two residents at the home self-administered medication. Written consent had been obtained and secure storage had been provided to maintain safety. The wishes of residents were sought regarding death and dying, which were recorded in plans to ensure these were carried out. Darwin House DS0000002955.V263976.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Residents were able to make choices about how they spent their time. Some activities were offered to residents, to promote choice and maintain interests. The home had an open visiting policy, in order to develop and maintain good relationships with residents’ family and friends. The home provided a varied menu and choices were offered to respect personal preferences. EVIDENCE: Residents said they were able to get up and go to bed when they chose, and were seen to use different areas of the home according to their preference. An activities worker was employed to visit the home for a few hours each weekday, which helped to provide a range of appropriate social opportunities in the home. Residents were free to join in any organised activities, all said they enjoyed the range of activities offered. All of the residents spoken with said the range of activities had improved as short trips out of the home were routinely available for them. Residents confirmed that they were able to see their visitors in private. Those spoken to said their visitors could come at any time, and the home helped them maintain contact.
Darwin House DS0000002955.V263976.R01.S.doc Version 5.0 Page 13 Residents were able to bring personal items with them into the home. All of the bedrooms were individually personalised and very homely. This was important to residents as it helped them retain control over their immediate environment. The menu was varied and a balanced diet was provided to maintain residents health. Residents spoken with said the standard of cooking had improved and the meals were now always well cooked. All of the residents said the food was very good. Some residents chose to eat their meals in their rooms and this was respected. Choices were offered on a daily basis. The mid day meal was well presented and the dining room attractively set out. Darwin House DS0000002955.V263976.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 A clear and accessible complaints procedure was in place, to ensure residents’ rights were protected and any concerns listened to and taken seriously. Procedures for the recording of complaints had improved to ensure appropriate information was sought and retained. An adult protection procedure was in place, to ensure residents safety was promoted. EVIDENCE: Each resident and representative had been provided with a copy of the homes complaints procedure. This contained relevant detail and informed the reader of who to contact outside of the home to make a complaint, should they wish to do so. All of the residents said they had no concerns and could go to the manager and staff to sort out any worries they had. The pro-forma used to record complaints was easily available to staff, to ensure complaints were recorded consistently. Records of complaints detailed the action taken and the outcome of the complaint. An adult protection procedure was in place, which contained information on the Department of Health guidance ‘No Secrets’. The staff training record examined indicated that some staff had undertaken training on adult protection to equip them with the skills needed to respond appropriately to any allegations. This training needed to take place with further staff to ensure the whole team were provided with relevant information. All residents said that they felt safe at the home.
Darwin House DS0000002955.V263976.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 and 24 The home was, in the main, maintained to a high standard. The environment was very clean and fresh smelling. The building complied with the requirements of the fire service. Appropriate facilities were provided to meet residents needs. All areas of the home were accessible. Homely touches had been provided to create a comfortable environment. Communal areas were well maintained, and residents’ bedrooms were well decorated and personalised. EVIDENCE: The environment was decorated to a high standard. However, some external window frames had worn paintwork. Redecoration work to the windows had been identified within the homes maintenance programme and quotes had been obtained. Communal areas were attractive, comfortable and the furniture provided was of a good standard. The main stair carpet had been replaced to maintain standards. There was a pleasant garden, and garden seating was provided for residents’ enjoyment. All of the bedrooms were well decorated
Darwin House DS0000002955.V263976.R01.S.doc Version 5.0 Page 16 and highly individual, reflecting the residents’ personal taste. Two bedroom carpets had recently been replaced. All of the residents said that they were very happy with the accommodation provided. A maintenance worker was employed and a maintenance programme was in place to ensure the home was kept safe and well maintained. Darwin House DS0000002955.V263976.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 29 Agreed levels of staff were being maintained. Some staff undertook NVQ training to improve their skills. Recommended levels of NVQ trained staff had not been achieved. The homes recruitment practices ensured a thorough procedure was in operation. However, some of the required documentation was not retained on staff files. EVIDENCE: The homes rota indicated that agreed levels of staff were being maintained. Residents spoken with felt that enough staff were provided. The required 50 of the care staff team trained to NVQ level 2 in care had not been achieved. There was a written recruitment procedure, to uphold the safety of residents. Three staff files were inspected. One contained all of the required documentation. Two files did not contain proof of identity or a photograph. One file did not evidence that gaps in employment history had been explored. One file did not contain two written references, but had one from the most recent employer. CRB (Criminal Records Bureau) and POVA (Protection of Vulnerable Adults) checks had been completed for all staff, to promote safe and efficient recruitment procedures. Darwin House DS0000002955.V263976.R01.S.doc Version 5.0 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 35, 36, 37 and 38 The management’s clear leadership benefited residents and staff. Regulation 26 visits by the responsible individual to monitor took place. Formal staff supervision to develop and support staff, did not take place at the required frequency. The records were stored securely, to respect residents’ rights. Policies and procedures for the smooth running of the home and care of residents were in place and accessible to staff. Staff undertook mandatory training, some updates were required to maintain staff skills. A programme of infection control training had commenced. Several staff still required updates in this training. Fire systems were checked and serviced appropriately. All staff had not participated in a practice drill at the required frequency. Insufficient staff were trained in first aid to ensure a qualified person was on duty at all times. Darwin House DS0000002955.V263976.R01.S.doc Version 5.0 Page 19 EVIDENCE: The manager held a relevant qualification. Staff and residents said the manager was approachable and supportive. The homes director undertook monthly monitoring visits and reports, to ensure the home was running smoothly. Residents’ monies were safely managed. Individual records were maintained of all credits and debits. Receipts were retained. The amounts kept tallied with the records. Formal staff supervision, to develop and support staff, did not take place at the required frequency of six times each year. Records were stored securely in the home to respect residents’ confidentiality. A health and safety policy was in place to protect staff and residents. Fire exits were clear and fire doors closed on their rebates. Records confirmed that fire equipment was checked and serviced. Some staff were not up to date with all aspects of mandatory training to equip them with the essential skills needed to promote the well being of residents. Whilst a programme of food hygiene training had commenced, records indicated that some staff required refresher training in this area. Records of fire practice drills evidenced that these had not taken place at the required frequency to maintain staff skills. Records indicated that insufficient staff were trained in first aid to ensure a qualified person was on duty at all times. Darwin House DS0000002955.V263976.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 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 3 17 X 18 2 3 3 X X X 3 X X STAFFING Standard No Score 27 3 28 2 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X 3 2 X 2 Darwin House DS0000002955.V263976.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP18 OP29 Regulation 18 18 Requirement All staff must be provided with adult protection training. All of the required documentation must be kept on staff files. Proof of identification and a photograph must be retained. (Previous timescale of 31/08/05 not met) Two written references must be obtained prior to commencement of employment. Employment records must evidence that gaps in employment history have been explored. Formal staff supervision must take place at the required frequency of six times each year. (Previous timescale of 31/08/05 not met) Infection control training must be provided to all care staff. (Previous timescales of 15/03/05 and 31/08/05 not met) An audit of staff mandatory training must be undertaken to identify gaps in training. All staff must be provided with training where gaps are identified.
DS0000002955.V263976.R01.S.doc Timescale for action 31/05/06 30/04/06 3 4 OP29 OP29 18 18 30/04/06 30/04/06 5 OP36 18 30/04/06 6 OP38 18 30/04/06 7 OP38 18 31/05/06 Darwin House Version 5.0 Page 22 8 9 OP38 OP38 18 18 Sufficient staff must be trained in first aid to provide a qualified person on each shift. All staff must participate in a practice drill at the minimum frequency of every six months. Records of fire drill practices must be forwarded to the local office of the CSCI. 30/04/05 01/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 2. Refer to Standard OP28 Good Practice Recommendations Fifty per cent of the care staff must NVQ level 2 in care by 2005. Darwin House DS0000002955.V263976.R01.S.doc Version 5.0 Page 23 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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