Inspection on 09/09/09 for Darwin House

This inspection was carried out on 9th September 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Darwin House 22/07/08

Darwin House 04/09/07

Darwin House 06/09/06

Darwin House 18/01/06

Darwin House 30/06/05

Darwin House 12/02/05

Darwin House 16/08/04

Darwin House 17/06/04

Darwin House 11/05/04

Darwin House 24/02/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Darwin House Darwin Lane Sheffield South Yorkshire S10 5RG Lead Inspector Shelagh Murphy Key Unannounced Inspection 9th September 2009 10:15 DS0000002955.V377612.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Darwin House DS0000002955.V377612.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Darwin House DS0000002955.V377612.R01.S.doc Version 5.2 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 6017 whitakerhilary@tiscali.co.uk Darwin House Limited Hilary Margot Whitaker Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Darwin House DS0000002955.V377612.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd July 2008 Brief Description of the Service: Darwin house is a residential care home providing personal care for up to 25 older people. It is situated in a residential area of Sheffield. The facilities were on three floors accessed by a lift. Seventeen single and five double rooms were available. Each of the bedrooms were provided with en-suite toilet facilities, five rooms had en-suite showers. A variety of communal lounge space, as well as a communal library room and dining room were provided. A central laundry and kitchen served the home. Sufficient bathing facilities were available. The home had pleasant landscaped gardens with seating for service users. The home had a car park. A copy of the previous inspection report was on display and available for anyone visiting or using the home. Information about how to raise any issues of concern or make a complaint was on display in the entrance hall. The manager confirmed that the range of fees from 1st April 2009 were £550 £700 per week. Additional charges included newspapers, hairdressing and private chiropody. Darwin House DS0000002955.V377612.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is zero star. This means that people who use the service experience poor quality outcomes. As a result of a serious incident at the service in August 2009, a decision was made to undertake a key inspection. The inspection focused on the health, safety and welfare of the people currently living at the service. Shelagh Murphy (Regulation Inspector) and Chris Taylor (Regulation Inspector, Enforcement Team) carried out this unannounced visit to the service over one day and the total time spent on site was 11 hours. In the report we make reference to `us’ and `we’. When we do this we are referring to the inspector and the Care Quality Commission. We used a variety of information as well as our findings from the visit to assess the quality of service offered to people who live at this home. The Annual Quality Assurance Assessment (AQAA) report was sent to the inspector prior to the site visit. This report detailed what the home was doing well, what had improved since the last inspection and any plans for improving the service in the next twelve months. Some information from the AQAA is included in the main body of the report. We also spent some time observing a lunchtime meal being served to people who lived at the home to gauge, how staff at the home supported them. It gave us some insight into how staff interacted with people and also an indication of peoples’ well being. We also spoke to two staff. And the stakeholder surveys used for the last Annual Service Review in July 2009 have been used in this report. We have used comments from the people who use the service, relatives and staff comments as well as our site visit, to base our judgements as to the quality of the service. Some comments and feedback from these stakeholders have been included in this report. On the day of the site visit opportunity was taken to make a partial tour of the premises, inspect a sample of care records, check records relating to the running of the home and look at some of the homes policies and procedures. The inspectors checked all key standards and the standards relating to the requirements outstanding from the homes last key inspection, in September Darwin House DS0000002955.V377612.R01.S.doc Version 5.2 Page 6 2008. The progress made has been reported on under the relevant standard in this report. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the service does well: People live in a very comfortable and homely environment. The bedroom and communal areas were nicely decorated and there were homely touches throughout the home. Fresh cut flowers, silver service luncheons and wine with meals if requested. People are encouraged to maintain their independence. People with low dependency needs can lead a very independent lifestyle within and outside the home. Staff treat people with the utmost respect and people’s privacy and dignity is protected by these staff approaches. For example staff call people by their preferred name of address. This respects people’s dignity. People had some opportunities to take part in activities and social events. For people who have support networks outside the home this is ideal. For people who may not have these networks, they made need more planned activities. People’s families and friends are made to feel welcome and can visit at any time. People are offered wholesome meals in comfortable and pleasing surroundings, at a time which meet their needs. People can choose from a selection on the menu. Staff were observed to be kind and very patient. They were observed to go out of their way to meet people’s requests. And were very discreet in supporting people to meet their needs. We checked to see if people and their relatives and friends are confident that their complaints will be listened to. There was evidence that this was the case on some occasions and clearly people had been listened to and action taken to resolve their complaints. Darwin House DS0000002955.V377612.R01.S.doc Version 5.2 Page 7 We took a partial tour of the building with the senior staff to ensure that people live in a well-maintained environment. The home was clean, tidy and homely. Each person had their own bedroom, and each room has en-suite facilities. This helps to protect people’s dignity and encourages independence. People who live in the home were protected by the recruitment and selection policy and procedures in place. The staff had all been checked to ensure they were appropriate to work with vulnerable people. Adequate numbers of care staff were on duty, on the day of the inspection, to ensure that most people’s diverse needs can be met. The staff had completed adult safeguarding training to ensure they could recognise when safeguarding procedures needed to be implemented. What has improved since the last inspection? What they could do better: Each person who lives at the home had a needs assessment, compiled by the senior carer on duty on the day they are admitted to the service. These needs assessments were not adequately detailed to ensure that the service could meet people’s full needs and this placed some people’s health, safety and welfare at risk. Each person had a care plan, compiled by the senior carer on the day of their admission and because the information in the needs assessment was not detailed enough neither were the care plans. The care plans had been regularly reviewed, but the lack of detail to inform staff how to support people safely meant that some people’s needs were at risk of not being met. There was no evidence in the care plans checked that as a person’s cognitive or physical needs were changing significantly, that the care plans had been adequately amended to reflect this increased dependency. This placed people at risk of harm. Darwin House DS0000002955.V377612.R01.S.doc Version 5.2 Page 8 The risk assessments checked were not adequately detailed. And the control measures put in place were in some cases wholly inadequate to protect people from significant harm. People had the opportunity to take part in some social events and activities; however, because there was no identified member of staff to co-ordinate these activities, some people’s needs in this area were not being met. One person told us, “Activities are not regular enough because it depends on what staff are available and weekends are particularly quiet”. A member of staff told us, “We don’t have an activities co-ordinator and so I have taken on the role but this is alongside my current job and therefore I cannot offer people the consistency I would like to”. The current systems in place to deal with complaints were not adequate. As the records checked showed that some, but not all complaints made to and about the home had been recorded and dealt with appropriately. This places people’s rights at risk. The systems in place to safeguard and protect people from abuse were not adequate as we found evidence that a safeguarding alert and outcome was not recorded at the service. This places people at risk of harm. The current systems in place to ensure that all of the aids, adaptations and equipment people use to aid their mobility were inadequate. As some people’s needs had not been assessed or reassessed. There was no evidence that risk assessments had been devised for the use of some of this equipment or that any checks to ensure people’s ongoing safety had been carried out. This does not protect people’s health, safety and welfare. The activities and social events for people were limited, due to the lack of a designated worker. This did not ensure people’s social and leisure needs are met. Staff that were designated responsibility for assessing and compiling full needs assessments, care plans and risk assessments were not adequately trained and skilled to perform this task. The systems in place for recording and monitoring accidents in the home were inadequate. The current management arrangements at the home were inadequate to ensure consistent leadership to staff. Darwin House DS0000002955.V377612.R01.S.doc Version 5.3 Page 9 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Darwin House DS0000002955.V377612.R01.S.doc Version 5.3 Page 10 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.V377612.R01.S.doc Version 5.3 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 was checked. Standard 6 is N/A. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have their needs assessed on admission to the home. However, the lack of detailed information on the needs assessment records would make it difficult to identify if the persons needs could be adequately met at the home. The service does not provide intermediate care. EVIDENCE: We checked three people’s needs assessments. All, except one of the people living at the home were exclusively private fee payers and therefore it is the registered manager’s responsibility to ensure people’s needs are assessed prior to them moving into the home. We were told that managers do go out to Darwin House DS0000002955.V377612.R01.S.doc Version 5.3 Page 12 assess people prior to them being admitted to the home but we could not find the records of these assessments on the files we checked. We asked a senior carer who completed needs assessments about the process they followed. They advised it was completed on the day the person was admitted to the service. We checked three people’s needs assessments. On these assessments, there was no date or name of person compiling the report on the forms. A senior member of staff told us they had not received specific training to complete the needs assessments; however they had covered this topic during an NVQ 3 care award. The needs assessment forms being used covered all of the relevant needs areas which CQC would expect, however, the content of the information was lacking detail and failing to highlight for example peoples mental health needs and personal risks to safety. None of the three needs assessments we checked were devised using a person centred approach or adequately detailed to ensure the service could accurately assess whether peoples needs could be met at the home. Examples of this were; A person with Dementia was admitted to the service with very scant details of their, `Mental health and cognition’ needs. Under this heading staff had recorded, “Can make needs known but does suffer from Dementia”. Another example was under the needs area, `Personal safety and Risk’ staff had not recorded anything, it was left blank. This information is not adequate to ensure staff can devise a detailed care/healthcare plan from these assessments and therefore this does not protect people from harm. Darwin House DS0000002955.V377612.R01.S.doc Version 5.3 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 were checked. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We observed and people told us that they were treated with dignity and respect. People had individual care plans and risk assessments, however, these did not contain adequate information to ensure staff knew how to meet people’s needs appropriately. This means that people’s health, safety and welfare was not adequately protected. People were protected by the homes medication policies, procedures and practices. EVIDENCE: We checked three peoples care plans. We found that each person’s health, personal and social care needs were laid out on separate care plan sheets. Some had the persons name on them others did not. They detailed the area of needs, aims and care instructions and were generally regularly reviewed. Darwin House DS0000002955.V377612.R01.S.doc Version 5.3 Page 14 However, they had not been devised using a person centred approach. They had been devised using the initial needs assessment carried out by staff at the home and this meant the initial care instructions to staff were not adequately detailed. They did not inform staff of how, when and why the persons needs should be met in this way. Because of this the subsequent care plan reviews were also inadequate to ensure people’s needs were fully met. We were told that the senior carers, who had been designated responsibility to devise and review care plans, had completed some care planning training as part of their NVQ3 care award, however, we found that the quality of these care plans may mean the staff were not adequately skilled or trained in this process as the quality of the information in the care plans was inadequate. Because the initial care instructions were not detailed, even when a persons needs were highlighted as changing e.g. “Can make their needs known but can become confused”, this had been put under the heading `Care instructions’. This identified a person’s need but did not instruct staff of how to support the person. It did not detail for example, when this can happen, how to reorientate the person, or what the staff were to do to support the person at these times. This means that people’s needs may not be met adequately. The vast majority of care plan reviews stated, `no changes’. It was clear to us from further information in the care plan, e.g. person having falls outside the home, wandering outside the service and from speaking to staff that they were struggling to support this person adequately. This may mean that the person’s safety is not adequately maintained. Due to this we asked whether this person’s, full needs had been reassessed to see if the placement was still appropriate to maintain their safety. We were advised that this was being undertaken at the time of our site visit. In another example of a care plan, where changes to peoples needs had been identified by the staff, a person’s continence needs changed greatly; however, the detail of how staff should support the person to meet these needs was not clear. The care instructions for example were, “has become quite confused as to toilet needs, staff to monitor and record changes”. This did not advise that the person needed extra staff support and in which way the care staff were to provide this to the individual. This means that people’s personal care needs may go unmet. This does not protect their dignity. We discussed this with the person in charge on the day of our site visit that had already identified that this was an area of concern. They informed us that all of the people in residence were currently being reassessed by a professional person, trained to complete needs assessments. And after this process each person would be supported to develop a more detailed care plan, in order to ensure staff fully understood how to support people. This was a positive response from the service. Darwin House DS0000002955.V377612.R01.S.doc Version 5.3 Page 15 At the last key inspection carried out in July 2008. We recommended that care plans should be devised using a person centred approach. This recommendation had not been carried out. We then looked at the risk assessments which are devised to ensure peoples safety is maintained and we found that, overall staff had identified areas of risk appropriately and were reviewing these on a regular basis, but again it was the lack of detail in these assessments and subsequently the lack of detail in how staff were to manage these risks safely which we would identify as inadequate to ensure peoples safety. We found conflicting and contradictory information concerning how to support a person who became confused and this did not protect their welfare. We checked to see if people were being supported with medication appropriately. The staff told us they used the Lloyds pharmacy system of pre packed medication. That the pharmacist made quarterly checks and told us the medication trolley was kept in a safe room with the door locked. We observed a partial medication round and found the senior staff were administering medication to people and then signing for this. These staff told us they had been trained to administer medication. We then checked the medication records of three people we case tracked and these showed that medication had been recorded appropriately with the name of medication dosage and frequency clearly stated and staff had signed to confirm the medication had been administered. The medication was kept in a clean and secure cabinet and the senior staff responsible for administering medication told us they had been trained to carry out these procedures. This ensures that people are protected from harm. We observed whether staff treated people with dignity and respected their privacy and throughout the inspection we found that they did. Examples of this were; staff knocked on peoples bedroom doors and waited for a response prior to entering their rooms, staff called some people by their titles e.g. Mrs or by their first names dependent on how people wished to be addressed. This ensured people were treated as individuals and respects their privacy. One relative was asked for their views of the service and their comments included, “The home is amazing in the care and understanding they show, to a person who is totally dependent”. Although people were generally satisfied with their care and support, we found that recording systems were inadequate to protect people’s welfare. Darwin House DS0000002955.V377612.R01.S.doc Version 5.3 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 were checked. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some people need more opportunities to meet their social, cultural and recreational needs. People received wholesome and appealing diets in surroundings, which met their needs. EVIDENCE: Overall, we found that some people found the lifestyle experienced in the home matched their expectations and preferences and satisfied their social, cultural, religious and recreational interests and needs. However, there were other people who wanted a more organised and consistent approach to meet their recreational and social needs. On the day of our site visit the staff were organising a quiz with some of the people who live at the home. People were observed to enjoy this activity. Darwin House DS0000002955.V377612.R01.S.doc Version 5.3 Page 17 There was also a notice board which indicated when church service, outings and entertainment were planned for people. From the AQAA report the registered manager told us that, “We offer armchair aerobics, every Friday and Bingo every Wednesday and various other activities as requested by people”. This helps to support people’s social opportunities. However, it would appear that this was inadequate to meet some people’s needs as the activities were not consistently available or organised. One person told us in a survey that, “Activities are not regular enough because it depends on what staff are available. And weekends are particularly quiet”. A member of staff told us, “We don’t have an activities co-ordinator and so I have taken on the role but this is alongside my current job and therefore I cannot offer people the consistency I would like to”. In our last key inspection report from July 2008 we recommended that the service employ an activities co-ordinator to enhance the organisation of activities and events in a consistent manner to meet people’s needs. The person in charge at the time of our visit confirmed that this had not happened. We observed that people were supported to maintain contact with their family and friends as they wish. Several relatives were visiting on the day of our visit. Staff told us that relatives can visit at any time. People who live at the home confirmed their relatives can and do visit them regularly. We checked to see whether people were helped to exercise choice and control over their lives. We observed people to be offered everyday choices, such as choice of meals and drinks, where people wanted to go in the home and whether they wished to take part in activities. We observed lunchtime in the home, it was well organised. There were four staff supporting people, by serving food and drinks. The meal time was relaxed. Staff were seen to prompt and coax people to eat. We also observed that people received a wholesome and appealing balanced diet, in pleasing surroundings at times convenient to them. People were offered wine with their lunchtime meal and were served at the table by the staff. Staff were respectful, supportive and encouraging towards people. This protects people’s dignity. The menus were varied and offered two or more choices at every meal. Snacks and drinks were available at all other times for people. However, we found that some meals were not being recorded in people’s care files or daily notes. For example it looked like one person had not had an evening meal for over a week and when we enquired why this was we were advised that the person’s relatives buy in food for their tea. This information was not included in the notes to ensure that people’s dietary needs are being met. Darwin House DS0000002955.V377612.R01.S.doc Version 5.3 Page 18 Darwin House DS0000002955.V377612.R01.S.doc Version 5.3 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were checked. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The current systems in place to record complaints, adult safeguarding allegations and concerns were not robust enough to ensure people’s rights, safety and welfare were adequately protected. EVIDENCE: We checked to see if people were confident that their complaints would be listened to, taken seriously and acted upon. This is what we found, From the AQAA report the manager told us, “We have a complaints policy and procedure and all complaints are taken seriously and acted upon without delay”. They went on, “Records are maintained of complaints received. These include; the complaint, the action taken, the outcome and the resolution of the complaint”. The AQAA report told us that the service had received 4 complaints since the last inspection in July 2008. We found that there had been more than 4 complaints made over the last year. We found 6 complaints in the file and also knew of complaints made about the home which had been passed to us and the local adult safeguarding team. This information was not in the Darwin House DS0000002955.V377612.R01.S.doc Version 5.3 Page 20 complaints file. The present system of loose leaf filing of complaints was not adequate to ensure that all complaints made to the service could be checked adequately, as there was no way of knowing if any sheets were missing. This may not ensure that complaints were collated and monitored effectively. This may not fully protect people’s rights. We checked to see how people were protected from abuse. From staff training records we could see that all of the staff had completed adult safeguarding training over the last two years. From interviews with two staff we know that they understood their responsibilities and the procedures to follow should any allegations of abuse be disclosed to them. From the AQAA report the manager has reported that, “We arrange regular training sessions, carried out by outside professionals, to cover all types of abuse and ensure staff are up-to date regarding any form of abuse”. These practices help to safeguard people. From the AQAA report we were told that no allegations of abuse had been made, and that one safeguarding adult’s investigation had been completed. We found records relating to this investigation, which had been completed by a manager from another service. The outcome of this allegation had been unfounded. Darwin House DS0000002955.V377612.R01.S.doc Version 5.3 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 22 and 26 were checked. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely and comfortable environment. However, their safety within the home could be compromised by the lack of robust checks made to some people’s aids and adaptations. EVIDENCE: We took a partial tour of the building with the senior carer to ensure that people live in a well-maintained environment. This is what we found; There were no malodors in the home. The house was clean, tidy and homely. We checked all communal areas; there were three lounges and a dining room. All were decorated to a high standard. There were nice touches like flowers, Darwin House DS0000002955.V377612.R01.S.doc Version 5.3 Page 22 magazines, and a bible were seen to be provided. Each room had a call bell to ensure people could ask for staff help should they need it. The dining room was set out with small tables and easy to move chairs. There were seventeen single and five double bedrooms. All were en-suite and some had en-suite shower rooms. We checked three bedrooms. In one bedroom we found a call bell by the bed. The room was nicely decorated and personalised. We checked and the window in the room had restrictors fitted. This helps to protect people from harm. The two other rooms checked were also nicely decorated and furnished to meet people’s personal needs. The senior carer told us, that a new call bell system had been installed which provides a print of staff response times. In addition night staff press ‘reset’ when they complete checks and this also records that the check has been completed. This will ensure that managers can check if people are being supported within a reasonable timeframe. This helps to protect people’s welfare. We then checked to see if people had access to appropriate aids and adaptations to support their mobility in the home. We found that the communal aids such as a stand aid, mobile and bath hoist we were shown had been checked and certified as safe. However, we were also told that some people admitted to the home who had brought in their own aids, had not been reassessed to ensure their needs could be appropriately met with this equipment. There were no risk assessments in place for these aids and as a result of a recent incident, they had been removed to ensure people’s safety. The lack of needs assessments and risk assessments placed people at risk of serious harm. The laundry system was checked and found to be safe. This protects people’s health and welfare. The garden areas were well managed, tidy and attractive. There was space for people to sit outside. People who live at the home told us in surveys that, “The home is run in a relaxed and friendly fashion, but professionally managed. It is kept clean and the staff are lovely”. Another person said, “Darwin House provides a home like environment for me to live in”. Darwin House DS0000002955.V377612.R01.S.doc Version 5.3 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 were checked. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who lived in the home were protected by the recruitment and selection policy and procedures in place. Adequate numbers of staff were on duty to ensure that people’s diverse care and support needs could be met. The staff that were required to carry out needs assessment and care planning must be suitably trained to ensure that people’s needs are adequately identified and whether these can then be met. EVIDENCE: We checked to see if people’s needs were met by the numbers and skill mix of staff. On the day of our visit there were two care assistants, a senior supervisor, and a staff supervisor on duty. They were supported by a domestic staff, an administrator and a cook. This was observed to be an adequate staffing level to meet people’s care and support needs. However, the care staff told us they were also responsible for laundry and to offer activities to people. This means Darwin House DS0000002955.V377612.R01.S.doc Version 5.3 Page 24 that staff time is taken away from care duties and could result in people’s needs going unmet. Another member of staff told us it was difficult to organise activities and to offer consistency to people when they were working on a care shift. A recommendation to employ an activities co-coordinator was made at the last key inspection in July 2008 and had not been actioned. Staff told us in a survey carried out recently, when asked what improvements could be made at the home, “Ensure staffing levels are always maintained”. We checked the staffing rota, over the last four weeks and found that the service was always covered with four staff on the morning shift, three staff on the afternoon shift and two staff at night time. There was only one incidence in which, an agency worker was required to cover a shift. This enabled staff to provide a consistent service to people. A relative told us, “The main strength of Darwin House is the staff they employ. They are always cheerful, kindly, patient and skilled”. It was clear to us that the service has a robust recruitment procedure that has the needs of people who use the service at its core. We checked three staff recruitment files and all had been checked to ensure they all had the appropriate records to meet the regulations in order to keep people safe. The home had internal development training, and we were shown the formal training plan. Which showed that all of the mandatory training required, had either been completed or booked for this year. And that over 70 of staff had completed the NVQ2 in care awards. There was scant information on the induction training that staff had completed and no information about how their competence in areas had been checked. From our observations staff showed respect for people, their relationships were informal and friendly at all times. This protected people’s dignity and welfare. Staff told us that they did not have regular formal supervision, although they had bi-annual appraisals. We then checked the appraisals and found they covered areas such as rotas, key worker responsibilities and training. We found the supervision record contained very limited information. This is an area which needs to be developed to ensure staff have the necessary knowledge, skills and training to support people appropriately. Staff told us that staff meetings were not held on a regular basis. From our observations, staff interviews and staff surveys it was clear that some staff believe that communication with the management team could be better, one person told us in a survey, “The home could improve on communication between staff”. Darwin House DS0000002955.V377612.R01.S.doc Version 5.3 Page 25 Darwin House DS0000002955.V377612.R01.S.doc Version 5.3 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 38 were checked. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were not fully protected by the management structure and systems in place. EVIDENCE: People lived in a home which had been run and managed by an experienced, registered manager. However, since March 2009, they have been on extended periods of sick leave. The person in charge on the day of our inspection informed us that the registered manager will not be returning to the service Darwin House DS0000002955.V377612.R01.S.doc Version 5.3 Page 27 due to ill health. This has meant that the service has been managed by the deputy manager. The manager’s absence had clearly had an adverse effect on the leadership of the service, as many inadequacies in systems have been picked up at this inspection. To rectify this we were told that a new manager has been employed and it was planned that they would begin their role at the end of September 2009. We checked to see if the home was run in the best interests of people who live there. One person told us in a survey, “The home does well in all aspects of care; it’s a first class establishment. Keep up the good work”. The staff told us, “We provide a pleasant atmosphere”. Some one else told us, “The level of care provided is to a high standard”. A health professional told us, “There is a very good team spirit at the home I cannot fault anything”. From our observations during the site visit and our analysis of records after the inspection it was clear that the staff try to provide a person centred service and they do for the majority of people. However, it was clear that if people’s dependency levels increased during their stay, we found that that the staff were not adequately skilled or trained to adapt their approaches, to meet people’s more complex needs. And the management and recording systems in place were not adequate to highlight these deficiencies. This did not adequately protect people’s health, safety and welfare. We checked three people finances, which were kept by the home. All transactions were recorded by two signatories and receipts given. The finance records maintained were clear and the keys to the finance safe were only held by three people. The finance sheets which were signed were then sent to people or their relatives or representatives. We saw evidence that the service had health and safety policies and procedures in place; the owners had also been proactive and employed a Health and Safety Company to support them in managing health and safety within the service. There was evidence the company had undertaken a health and safety visit in April 2008. At this time an action plan was drawn up to address all of the issues they had highlighted. Although this highlighted numerous issues including “Implement checking, testing and servicing of equipment”, “training needed for users equipment” and “risk assessments needed for all equipment and control measures”. There was no recorded evidence, that we saw, which confirmed if or how the action plan had been addressed and this does not fully protect people’s health, safety and welfare. We then checked accident records and found that the current system in place was not adequately robust. This was because all of the accidents were written up on loose leaf sheets, which were not numbered and some of the forms used, were for the purpose of recording staff accidents. There was a monthly Darwin House DS0000002955.V377612.R01.S.doc Version 5.3 Page 28 record of accidents kept in the manager’s office, but this only identified the person, date of accident, injury and treatment. It did not identify if any action had been taken or any new control measures put in place to reduce the risk of reoccurrence. This system was not adequately robust to protect people’s safety and welfare. As part of the site visit we examined some of the maintenance and servicing records. The majority of checks were up to date and action was taken by the person in charge to address the areas of concern we highlighted. For example, fire alarm had gaps in weekly tests undertaken, 11/8/09 and then not checked until 25/8/09, as the maintenance person had been on holiday. This did not adequately protect people’s safety. We checked the water from hot water system, in three bedrooms we found it very hot, and was over 45c. This could place people at risk from being scalded. We informed the person in charge of this and they took action to ensure that this was reported and remedied as a matter of urgency. We were also made aware that some aids, adaptations and equipment had been brought in to the service when people were admitted. We were told by the person in charge, these had not been checked and these people had not been reassessed at the time of their admission, (by a professional to identify if this equipment was still appropriate to meet their needs). This placed people at risk of harm. We were informed by the person in charge that all such equipment had now been taken out of use until a reassessment of people’s needs could be made for this equipment. Darwin House DS0000002955.V377612.R01.S.doc Version 5.3 Page 29 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 1 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X 1 X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 x 3 2 1 1 Darwin House DS0000002955.V377612.R01.S.doc Version 5.3 Page 30 Are there any outstanding requirements from the last inspection? No. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement Each person’s needs must be assessed by a suitably trained person to ensure that the home can meet their needs. Needs assessments must be adequately detailed to ensure people’s needs are clearly identified. Each person’s care plan must contain adequate details to ensure that people’s needs and any changes to these needs are clearly recorded and staff know how to meet their needs. Timescale for action 30/10/09 2 OP7 15 30/10/09 3 OP8 15 4 OP16 22 Reviews of care plans must clearly identify people’s needs. Any changes in people’s needs must be clearly identified. People’s health care needs must 30/10/09 be identified. Then clear records of how people’s health care needs are to be met must be recorded. To protect people’s health and safety. The current system in place for 30/10/09 recording and actioning complaints must be reviewed. All complaints must be recorded and investigated appropriately. This DS0000002955.V377612.R01.S.doc Version 5.3 Page 31 Darwin House 5 OP22 14 will better protect people’s rights. All of the people who require any 30/10/09 aids and adaptations in the home must have their needs reviewed, by an appropriately qualified person, in order to ensure that any equipment they are using is appropriate and safe to meet their needs. 30/10/09 6 OP27 18 7 OP28 8 OP31 9 OP33 10 OP37 11 OP38 There must be an adequate number and skill mix of staff on duty to ensure that peoples care, social and recreational needs can be met by appropriately skilled and experienced staff at all times. In order to meet peoples diverse needs. 18 All staff who are required to assess people’s needs compile care plans and risk assessments must have the skills and knowledge to ensure people’s needs are clearly identified and recorded. This is to ensure people’s safety. Regulation An appropriately skilled and 11 trained manager must be Care appointed to ensure that people Standards are living in a well run service. Act 2000 The manager must then apply to be registered by CQC. 35 Effective quality assurance and monitoring systems must be introduced to ensure that the home is managed and run in a safe manner to ensure people’s safety and welfare at all times. 17 Record keeping systems within the home must be robust to ensure that adequate records are kept and made available for inspection. e.g. adult safeguarding records, complaints, accidents etc. 17 To protect people’s health, safety and welfare, accident records DS0000002955.V377612.R01.S.doc 30/10/09 30/11/09 31/12/09 30/10/09 30/10/09 Page 32 Darwin House Version 5.3 must be recorded in detail and then must be monitored. There must then be systems put in place to ensure control measures are applied to prevent unavoidable accidents. 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. 2. 3. 4. Refer to Standard OP7 OP7 OP12 OP30 Good Practice Recommendations Care plans should be written in a more person centred way. Daily records should give more detail. For example how people have spent their time and if they have received any personal or professional visitors. A staff member with dedicated time should be recruited so that the programme of outings and activities is enhanced. Staff training records should include details of the induction and specialist training completed by staff and how their competency in each area has been checked. This will better ensure people are supported by appropriately skilled staff. Staff should be offered adequate support and direction to from their line managers to protect people’s health safety and welfare. All staff should be offered adequate supervision to ensure they are adequately skilled and supported to meet people’s needs. 5. 6. OP31 OP33 Darwin House DS0000002955.V377612.R01.S.doc Version 5.3 Page 33 Care Quality Commission Care Quality Commission Yorkshire & Humberside Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.yorkshirehumberside@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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