CARE HOMES FOR OLDER PEOPLE
Darwin House Darwin Lane Sheffield South Yorkshire S10 5RG Lead Inspector
Janis Robinson Unannounced 30 June 2005 08:45am 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 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 CS0000002955.V197767.R01.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Darwin House Address Darwin Lane Sheffield South Yorkshire S10 5RG 0114 230 1414 0114 230 7039 None Darwin House Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Christine Frudd (undergoing registration) PC Care Home only 25 Category(ies) of OP Old Age (25) registration, with number of places Darwin House CS0000002955.V197767.R01.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 12 February 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 are 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 CS0000002955.V197767.R01.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over 7 hours from 8.45am to 3.45pm. A second inspector was present during the morning of this inspection. 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. The lunchtime meal, a reading activity group and interactions between staff and residents were observed. Twelve residents, the majority of staff and two visitors were spoken with. Discussions with the homes deputy manager took place. The registered manager was not present during this inspection. What the service does well:
The interactions observed between residents and staff appeared patient and respectful. Residents said staff were `wonderful’, `excellent’, and ‘ caring and considerate’. Visitors said they were very happy with the care and services provided for their relative. A service user guide had been provided to each resident to give him or her information about the home. The manager undertook assessments prior to admission, to ensure individual needs could be met. 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. 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. Darwin House CS0000002955.V197767.R01.doc Version 1.30 Page 6 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 and in the main well maintained, with maintenance programme, which identified and carried out any redecoration and repairs needed to maintain the high standards. The environment was clean and fresh smelling. Communal areas contained homely touches to provide a comfortable 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. The central laundry and kitchen were well equipped to meet residents’ needs. Agreed levels of staff were being maintained. A staff training record was in place, and individual training records were maintained. A recruitment procedure was in operation to ensure the safety of residents. A business plan was in place, and insurance cover was provided. Records within the home were stored securely, to safeguard confidentiality. Health and safety procedures were identified and carried out, and systems were checked and serviced to maintain a safe environment. Mandatory training took place, to equip staff with the essential skills needed. What has improved since the last inspection? What they could do better:
Insufficient staff time was provided to enable staff and residents to undertake spontaneous trips out of the home, or participate in some activities within the home. Consultation with residents needed to take place regarding the food provided, and systems put into place to ensure the food is well cooked. A consistent procedure to record any complaints needed to be made available to staff, to ensure all relevant information was recorded. The complaints book in use required some additions to ensure all relevant action was taken.
Darwin House CS0000002955.V197767.R01.doc Version 1.30 Page 7 Some external window frames had worn paintwork and the homes stair carpet was worn in places. Consultation regarding the call system at the home needed to take place with an identified resident to ensure appropriate equipment was provided to meet their needs. Regulation 26 visits by the registered provider to monitor the service needed to take place, and reports of these visits kept at the home. Staff supervision needed to place at least 6 times each year to ensure all staff received appropriate support and guidance. Staff required refresher training in infection control. 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 CS0000002955.V197767.R01.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Darwin House CS0000002955.V197767.R01.doc Version 1.30 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 standard(s) 1,3,4 and 5. Standard six does not apply to this home. A statement of purpose and service user guide were available, to inform residents about the home. Assessments of needs were undertaken prior to admission to ensure that the needs of prospective residents could be met. 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: Each resident had a service user guide, to inform him or her about the home. Assessments of needs were in place, and copies of social workers assessments were obtained prior to admission, if available, so that a decision could be made about whether the residents’ needs could be met. Darwin House CS0000002955.V197767.R01.doc Version 1.30 Page 10 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. One relative said that they were very happy with the care provided to their loved one, and were always kept fully informed by the staff. They said the home was ‘excellent’. Darwin House CS0000002955.V197767.R01.doc Version 1.30 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 standard(s) 7,8, 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. 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 resident said`I am very well looked after, the staff are very kind’. Several residents said` the home is very good’.
Darwin House CS0000002955.V197767.R01.doc Version 1.30 Page 12 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. The wishes of residents were sought regarding death and dying, which were recorded in plans to ensure these were carried out. Darwin House CS0000002955.V197767.R01.doc Version 1.30 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 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. Some residents raised concerns regarding the standard of cooking at some meals. 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 week day, who 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. However, several residents said they would prefer further activities to be provided with the care staff, and would enjoy the opportunity to take short trips out to the local community. All of the staff said that insufficient staff were provided to facilitate spontaneous activities and trips out. 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. Visitors said that they were always made to feel welcome, and were always kept informed by the staff.
Darwin House CS0000002955.V197767.R01.doc Version 1.30 Page 14 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. Choices were offered on a daily basis. Some residents said the food at the home was good. Several residents said that some meals were not well cooked, whilst others were ‘faultless’, and this prevented them from enjoying their meal on occasion. The inspectors sampled part of the lunchtime meal, and found it to be poorly cooked. The meal was well presented and the dining room attractive. Darwin House CS0000002955.V197767.R01.doc Version 1.30 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 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 required improving 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. Staff were unclear how to record any complaints received, and were unaware of any pro-forma that policies indicated should be used. The record of complaints did not record any complaints received for a number of years. It did not detail of the action taken to resolve a complaint and the outcome of the complaint. It is acknowledged that management at the home had separate, more comprehensive complaints records. A complaint was received by the CSCI. The complaint was investigated during this inspection. Appropriate action had been taken, and advice was given to the deputy manager and owner regarding further action that needed to be taken. Darwin House CS0000002955.V197767.R01.doc Version 1.30 Page 16 An adult protection procedure was in place, which contained information on the Department of Health guidance `No Secrets’. Staff undertook training on adult protection to equip them with the skills needed to respond appropriately to any allegations. All residents said that they felt safe at the home. Darwin House CS0000002955.V197767.R01.doc Version 1.30 Page 17 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 standard(s) 19,20,21,22,23,24,25 and 26. 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 in the majority of areas. However, some external window frames had worn paintwork and the stair carpet was worn in places. Communal areas were attractive, comfortable and the furniture provided was of a good standard. There was a pleasant garden, and garden seating was provided for residents’ enjoyment. All of the bedrooms were well decorated and highly individual, reflecting the residents’ personal taste. All of the bedrooms had en-suite toilet facilities. Five rooms had en-suite showers. There were sufficient communal bathrooms and
Darwin House CS0000002955.V197767.R01.doc Version 1.30 Page 18 showers, which met residents’ needs. A rolling redecoration programme was in place to maintain standards. 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 CS0000002955.V197767.R01.doc Version 1.30 Page 19 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 and 30 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. Some of the required documentation was not retained on staff files. Staff undertook periodic training to keep them up to date. A staff training plan and individual training records were kept to monitor staff training. EVIDENCE: The homes rota indicated that agreed levels of staff were being maintained. Residents and the visitors spoken with felt that enough staff were provided. Of the fifteen care staff, five staff had achieved NVQ level 2 or 3 in care. Five further staff were undertaking the training at level 2 in care. There was a thorough recruitment procedure, to uphold the safety of residents. The deputy manager confirmed that CRB (Criminal Records Bureau) and POVA (Protection of Vulnerable Adults) checks had been completed for all staff, to promote safe and efficient recruitment procedures. Staff files contained the majority of required information, and included written references from last employers. One staff file did not contain proof of identification or a photograph. Darwin House CS0000002955.V197767.R01.doc Version 1.30 Page 20 Staff training records were maintained to ensure all staff had undertaken relevant training. Staff confirmed that they undertook induction and foundation training to familiarise themselves with the home and understand the requirements of their role. Staff said that they received sufficient training to be able to carry out their duties. Residents said that staff had the skills to do their job well. Staff appeared competent to carry out their duties; they displayed an understanding of individual residents needs and were able to give examples of good practice. The interactions between staff and residents appeared positive. Staff had a caring and patient approach. Darwin House CS0000002955.V197767.R01.doc Version 1.30 Page 21 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,36,37 and 38 The management’s clear leadership benefited residents and staff. Regulation 26 visits by the responsible individual to monitor the service did not take 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 in infection control was required. Fire systems were checked and serviced appropriately. Darwin House CS0000002955.V197767.R01.doc Version 1.30 Page 22 EVIDENCE: Staff and residents said the manager and deputy manager were approachable and supportive. The deputy manager evidenced that any issues were identified and prioritised for improvement and action. The management undertook monthly monitoring reports, which were forwarded to their management outside of the home. However, monitoring visits by the responsible individual at the home did not take place, as required. These visits needed to take place on a monthly basis to ensure the home was monitored sufficiently. Whilst staff were observed following care practices by management, and records retained of this, there was no procedure in place for formal staff supervision. Staff supervision, to develop, inform and support staff needed to take place at the required frequency of six times each year. The managers were developing records to use in formal supervision to improve the supervision process. 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 up to date with all aspects of mandatory training to equip them with the essential skills needed to promote the well being of residents. However, records indicated that some staff required refresher training in infection control. The manager was in the process of identifying relevant training. Darwin House CS0000002955.V197767.R01.doc Version 1.30 Page 23 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 1
COMPLAINTS AND PROTECTION 2 3 3 2 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 x x 2 x x 2 3 2 Darwin House CS0000002955.V197767.R01.doc Version 1.30 Page 24 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 12 Regulation 18 Requirement Sufficient staff must be provided to enable a full range of activities inside the home and in the local community to take place. Residents must be consulted regarding the quality of food provided. Systems must be put into place to ensure that all meals provided are well cooked. A consistent system to record complants must be put into place, and all staff made familiar with this. Records of complaints must detail the action taken and the outcome of the complaint. All external window frames with worn paint work must be repainted. The worn staircarpet must be replaced. All of the required documentation must be kept on staff files. Proof of identification and a photgraph must be retained. Monthly monitoring visits must be undertaken by the responsible individuasl. A report from these visits must be kept at the home. A copy must be forwarded to the local office of
CS0000002955.V197767.R01.doc Timescale for action 31/08/05 2. 15 16 31/08/05 3. 16 22 31/08/05 4. 5. 6. 19 19 29 23 23 18 30/09/05 30/09/05 31/08/05 7. 33 26 31/08/05 Darwin House Version 1.30 Page 25 8. 36 18 9. 38 18 the CSCI (Previous timescale of 1/04/05 not met) A system of formal staff supervision must be introduced. Formal staff supervision must take place at the required frequency of six times each year. Infection control training must be provided to all care staff. (Previous timescale of 15/03/05 not met) 31/08/05 31/08/05 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 22 Good Practice Recommendations Residents should be provided with the aids and equipment identified to enable them to feel safe. The manager must explore the feasability of providing additional call system to the identified resident. Fifty per cent of the care staff must NVQ level 2 in care by 2005. 2. 28 Darwin House CS0000002955.V197767.R01.doc Version 1.30 Page 26 Commission for Social Care Inspection 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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