Inspection on 02/05/07 for Dauntsey House Care Ltd

This inspection was carried out on 2nd May 2007.

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

Dauntsey House Care Ltd 08/06/06

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Dauntsey House Care Ltd Dauntsey House Care Ltd 9 Church Street West Lavington Devizes Wiltshire SN10 4LB Lead Inspector Alison Duffy Unannounced Inspection 09:30 2nd May 2007 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 Dauntsey House Care Ltd DS0000067268.V335472.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dauntsey House Care Ltd DS0000067268.V335472.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dauntsey House Care Ltd Address Dauntsey House Care Ltd 9 Church Street West Lavington Devizes Wiltshire SN10 4LB 01380 812340 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) Avenue Care (Fareham) Limited Mrs Mair Rowles Care Home 20 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (4), Old age, of places not falling within any other category (16) Dauntsey House Care Ltd DS0000067268.V335472.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th June 2006 Brief Description of the Service: Dauntsey House is a residential care home that is registered to care for twenty older people. The home does not provide intermediate or nursing care. Any nursing task would need to be undertaken by the Community Nursing Service. Dauntsey House is located within the village of West Lavington approximately six miles from Devizes. The building has been a care home for over forty years. There are eighteen single rooms and one twin. The twin room is often used as a single room and has an en-suite toilet and shower facilities. Residents are able to furnish their room as they wish and therefore all are individual in style. Rooms are on the ground and first floor and there is a passenger lift for easier access. The home has a main lounge, conservatory and a separate dining room. Additional seating is also available within the main entrance hall. All areas are comfortable, homely and furnished to a good standard. There are large, well-maintained gardens providing various seating areas. The Registered Provider is Avenue Care (Fareham) Limited and the Director is Mr Stephen Press. Mr Press is also responsible for another care home and therefore spends his time between the two services. The Registered Manager is Mrs Mair Rowles. Staffing levels are maintained at two or three in the morning and two in the evening. There is sometimes an additional 10am-6pm shift. At night there are two waking night staff. The fees for living at the home are between £450.00 and £550.00. This does not include items such as hairdressing, chiropody, dry cleaning, newspapers or other personal items. Dauntsey House Care Ltd DS0000067268.V335472.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place initially on the 2nd May 2007 between the hours of 9.30am and 4.10pm. Ms Jenni Grant, assistant manager was on duty and assisted the inspector with locating information. Mrs Rowles was unavailable due to being in Salisbury, undertaking initial assessments of prospective residents. Mrs Rowles was spoken with on the telephone and recent developments within the home were discussed. It was agreed that a second day to complete the inspection would be needed, as understandably, Ms Grant did not have access to staff files. This was arranged and took place on the 9th May 2007. Mrs Rowles and Mr Press were available throughout. On the first day of the inspection a number of residents were met with privately in their bedrooms. Care planning and daily records were viewed and the medication systems examined. The lunch time period was observed and discussion took place with the staff on duty. The second day of the inspection was spent viewing staffing information, including training and recruitment and further discussion with residents. Discussion took place with Mrs Rowles and Mr Press regarding developments, which have been made since the change in ownership last year. Health and safety and quality assurance systems were also discussed. Feedback was given to Ms Grant on the first day of the inspection and to Mrs Rowles on the second. As part of the inspection process, surveys were sent to the home for residents to complete, if they wanted to. Comments cards were also distributed to residents’ relatives. Some GPs and care managers were contacted for their views. Feedback was positive with a number of residents expressing their satisfaction of living within the home. Comments received from relatives included ‘we are very impressed with the care my XX receives’ and ‘Dauntsey House provides a very caring home like environment where clients feel valued and supported. My aunt says ‘the girls are wonderful.’’ Further feedback is reported upon within the main text of this report. In response to asking how the home could improve, comments included ‘doubtful if this is possible should be a model for all to follow’ and ‘from our XX’s point of view, we do not feel that the care home needs any improvements. XX is very happy there.’ All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: Dauntsey House Care Ltd DS0000067268.V335472.R01.S.doc Version 5.2 Page 6 There is a clear admission and assessment procedure, which ensures prospective resident’s needs can be met within the home. Mrs Rowles is clear regarding the criteria for admission. Care plans contain good detail and are used as working tools. Plans are updated as required and formally reviewed on a monthly basis. Medication is well managed and residents have regular access to health care provision. Residents are able to choose their preferred routines and spend their time as they wish. Meal provision is of a good standard and offers variety and choice. The cook encourages feedback and regularly meets with residents to enable this. Residents’ bedrooms are personalised to a high degree and are viewed as individual private space. Residents are consulted with on a regular basis and are clear about raising their concerns. What has improved since the last inspection? What they could do better: All care plans contain a number of assessments such as nutritional, tissue viability and manual handling. Some assessments however, identify a risk or a cause for concern, but control measures are unclear. While in practice, risks appear to be addressed, this must be evidenced within documentation. Follow Dauntsey House Care Ltd DS0000067268.V335472.R01.S.doc Version 5.2 Page 7 up intervention, to aspects such as a sore area, must also be identified within documentation. Displaying local adult protection reporting procedures and regularly revisiting these with staff would further enhance knowledge. While cleanliness in the home is of a good standard, certain areas would benefit from a ‘high clean.’ 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. The summary of this inspection report can be made available in other formats on request. Dauntsey House Care Ltd DS0000067268.V335472.R01.S.doc Version 5.2 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 Dauntsey House Care Ltd DS0000067268.V335472.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are given sufficient information to make an informed choice about their admission. There is a clear admission policy, which assures potential residents’ needs can be met within the home. EVIDENCE: All potential residents are given a copy of the home’s Statement of Purpose and Service User’s Guide. Both documents have been recently revised to take into account the new ownership of the home. Both are well written and informative. The Statement of Purpose would benefit however, from greater detail regarding the range of needs, which can and cannot be met within the home. The term EMI should also be clarified. The fee structure of the home is also required. The Service User’s Guide gives a welcoming approach and comments upon commonly asked questions in a user-friendly manner. Dauntsey House Care Ltd DS0000067268.V335472.R01.S.doc Version 5.2 Page 10 Four comment cards were received from residents in response to the inspection. All confirmed they had sufficient information, before making their decision to move into Dauntsey House. One said ‘I came in for a short period.’ All four residents also stated that they had contracts. Mrs Rowles confirmed, that contracts had been reissued, taking into account the home’s new ownership. Of those residents spoken with regarding their admission, both confirmed that their family had found the placement. They confirmed they had the opportunity to visit, yet choose not to. On the first day of the inspection Mrs Rowles was not in the home as she was undertaking a number of assessments of potential residents. Later in the inspection, Mrs Rowles confirmed that she meets all prospective residents in their own environment. If she believes the home is able to meet the individual’s needs, she encourages them to visit to Dauntsey House. This could be for coffee, a lunchtime meal or for the day. Within the assessment process Mrs Rowles also speaks to relatives and any key health care professionals. If funded by a placing authority, a copy of the care manager’s assessment is gained. Mrs Rowles is very clear regarding the level of need that can be met within the home. She also takes into account the needs of existing residents so that the ethos of the home, being relaxed and homely, is maintained. In the event of Mrs Rowles being faced with a prospective resident who really wants to live at the home, yet there is some uncertainty of meeting need, a respite stay may be offered. This enables a more detailed assessment over a longer period of time. If a resident has an admission to hospital, an assessment is undertaken before they are able to return to the home. This is to establish whether the home can continue to meet their needs. Assessment documents, regarding two of the most recent admissions to the home were viewed. The new format covered key aspects of need including personal care, mobility, continence and social activity. Medical history, medication and risk were also addressed. The assessment, through circling category of need, gave a level of dependency. In some instances, terms such as, ‘unable to eat/drink unaided’ and ‘requires help with continence’ were stated. The actual assistance required was not evident. Within discussion, Mrs Rowles was able to verbally clarify the required support. It was recommended that such knowledge should be applied to documentation. Dauntsey House does not provide intermediate care and therefore standard 6 is not applicable to this service. Dauntsey House Care Ltd DS0000067268.V335472.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care planning is detailed and reflects individual need and personal choice. While potential risks are addressed in practice, documentation must evidence such intervention. Residents benefit from regular access to health care provision. Medication systems are well managed, which minimise the risk of error. Staff promote residents’ privacy and treat individuals with respect. EVIDENCE: Since the last inspection, a new care planning format has been introduced. The system ensures a consistent framework and enables all information to be located in one file, which is readily accessible. Those plans viewed, were well written and contained high levels of detailed information. This included individual preferences and daily routines. All contained a life history summary, details of social interests and family contacts. Each plan also contained a record of weight, medical intervention and assessments such as tissue viability, nutritional and manual handling. Within nutritional assessments, some identified areas of concern yet preventative measures were not clear. Care staff and the cook were able to explain a number of measures, which Dauntsey House Care Ltd DS0000067268.V335472.R01.S.doc Version 5.2 Page 12 were used to ensure adequate food and fluid intake. This information should therefore be recorded within short-term care plans. In one instance, the use of a syringe for drinks was observed. While the resident’s reflux and their ability to refuse, minimised any potential risk, an assessment regarding the residents swallowing should be considered. Mrs Rowles reported that further guidelines would be recorded within the residents care plan to ensure safety aspects are fully addressed. Some preventative measures were in place, in relation to those residents at risk of developing a pressure sore. Special mattresses and cushions were in situ yet not always stated within care plans. One care plan highlighted the need for the resident to be turned two hourly in the night, yet there was no record of this practice. Within daily notes there were some entries highlighting sore areas of skin. There were occasions whereby follow up intervention was not evident. Mrs Rowles believed this to be a recording issue, as she felt staff are attentive and readily address such matters. Mr Press also reported that such matters are generally addressed within short-term care plans and then monitored and concluded as appropriate. Mr Press and Mrs Rowles agreed to monitor and discuss this area with staff. Staff are advised to also document the size, colour and depth of the area, in order to monitor the healing process. A number of residents have signed their plan yet in the event of restricted ability, key workers have signed, on the resident’s behalf. Mrs Rowles reported that family involvement is encouraged and signing care plans, is in progress. There was evidence of regular review and changes had been made as required. Within a tour of the accommodation it was noted that two residents did not have access to a call bell. Staff explained, that due to their condition, the residents were unable to use the bell. Staff said they made regular checks. This should be formalised within the residents’ care plan. Other residents confirmed that they could use their bell at any time and staff would come quickly. Staff confirmed that they encourage residents to ring their bell even if this is for a cup of tea in the night. Within comment cards, three residents confirmed they always, receive the care they require. One said usually. Individual comments included ‘I am satisfied with the care I receive’ and ‘I am, in my view exceptionally looked after and my needs provided by for the staff of Dauntsey House.’ Also, ‘I have been most pleasantly surprised with the care and attention and friendliness that I have received since coming to Dauntsey House. Four residents confirmed that they always receive the medical support they require. Within comment cards received from relatives, four confirmed that the home meets the needs of their relative or friend. They also reported that they were kept informed of important matters. Individual comments included ‘the care home managed XX’s recent [illness and rehab] very much better than the [specialised] unit to which XX had been admitted initially.’ Also, ‘our friend is Dauntsey House Care Ltd DS0000067268.V335472.R01.S.doc Version 5.2 Page 13 very happy living at this care home.’ One health care professional confirmed satisfaction with the service. Each care plan contained a section for recording medical intervention. Various entries highlighted GP and district nurse input. There was also evidence of various blood tests and referrals to specific specialists, such as the physiotherapist. The medication administration charts also gave evidence of medical intervention, with the commencement of antibiotics and topical creams. One cream required a specific application but guidelines were not identified on the resident’s care plan. Mrs Rowles explained this would be addressed. Within another plan, diabetes was stated although there was little information about the condition’s management. Mrs Rowles reported that the GP had expressed the need for a ‘normal diet’ with monitoring, only if unwell. It was suggested that guidelines confirming the resident’s typical blood sugar levels be in place. One resident spoke of a recent illness and said the doctor had been called. Another confirmed the doctor is called when needed but the district nurse is seen regularly. Medication is administered via a monitored dosage system. This is ordered and delivered to the home on a monthly basis. Ms Grant reported that staff collect any ‘one off’ prescriptions at the local pharmacy in Market Lavington. Currently, no residents take control of their own medication. A number of certificates, demonstrating staff medication training, were displayed in the office. Some were dated 2004. Mrs Rowles confirmed that refresher training had been undertaken and the updated certificates needed displaying. Mrs Rowles has a record of those staff responsible for administering medication. The medication records demonstrated satisfactory receipt and administration of medication. Handwritten instructions were countersigned and variable doses of medication were clear. Ms Grant reported that homely remedies are not used, as a GP would be consulted. The medication was stored in locked cupboards and a trolley, attached to the wall. The keys are double locked yet the initial key was easily accessible. Mrs Rowles confirmed she would address this. Due to the volume of medication, bottles of liquid medication were stored on the bottom of the trolley. This meant, that during a drug round, the bottles would be easily accessible. Mrs Rowles confirmed space would be made in the trolley. Staff were observed to knock on doors and wait to be asked in before entering. Interactions were also undertaken in a respectful manner with the residents’ preferred form of address used. One resident was noted to have a commode in their bedroom but they did not have a lock on their bedroom door. They said they could use the commode at any time. When asked about ensuring privacy, the resident said ‘I don’t mind. The staff are good and let me know when they’re coming in. There are no males down this end so it really doesn’t matter.’ Minutes of a recent residents’ meeting gave evidence that locks on doors had been recently discussed. Mrs Rowles confirmed that for those who wish to have a lock, arrangements are made. All care plans contained details of Dauntsey House Care Ltd DS0000067268.V335472.R01.S.doc Version 5.2 Page 14 individual preferences of male or female company. There are currently no male staff, so care provision from the opposite gender has not been addressed. All residents were well groomed with jewellery and coordinated clothing. The ability to choose clothing and individual preferences for particular styles were detailed on care plans. Those residents spoken with were entirely satisfied with the service they received. This was also confirmed within comment cards, whereby three said they always receive the care and support they need. One said sometimes. Individual comments included ‘I’m satisfied with the care I receive’ and ‘I am in my view exceptionally looked after and my needs provided for by the staff at Dauntsey House.’ Dauntsey House Care Ltd DS0000067268.V335472.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The development of external trips out, has given residents greater opportunities. Contact with family and friends is promoted and hospitality from staff is given. Residents are able to follow their preferred routines and make choices about their daily lives. Catering arrangements are well managed, enabling residents, a varied and healthy diet. EVIDENCE: During the afternoons, a member of staff is designated to organise an activity. This may include games, quizzes, reminiscence, flower arranging or baking. One afternoon is given to watching old films and snacks are served. During the afternoon of the inspection, many residents were sitting outside with Ms Grant. A number of residents confirmed they enjoy their own time in their room and do not get involved with the home’s activities. One resident stated that crosswords, radio and the television were enjoyed. Another commented about Holy Communion, although they did not want to go out to church. Since the last inspection, external activities have commenced. This has included a visit to a local pantomime and a drive to see the bluebells at Savernake Forest. A trip to Longleat is planned and various entertainers have been arranged. Mr Press has taken a resident shopping and to visit Salisbury cathedral. Younger people Dauntsey House Care Ltd DS0000067268.V335472.R01.S.doc Version 5.2 Page 16 from the local school continue to visit, a string quartet has performed in the home and hand bell ringers from a local village are planned. A programme of events is displayed on the notice board. Within comment cards, three residents said there are always activities in the home that they can take part in. One said usually. One said ‘sometimes I choose not to participate in the activity provided.’ Another said ‘I like my television and read my books.’ Residents continue to receive regular visits from friends and family yet visitors are discouraged from visiting at mealtimes. This was due to the last inspection, when visitors at lunchtime, dominated staff time. This impacted on residents’ care and placed some at risk of falling, through not receiving adequate supervision with their mobility. There was no evidence of this, during this inspection. Residents are able to take part in community events, as they wish. If relatively able, attendance at the local luncheon club is welcomed. Mr Press felt community involvement is extremely important and is therefore looking to develop ways of further integration. Some residents spoke of following their preferred routines such as getting up when they wanted to, having meals in their room and spending their time as they wanted. One resident said ‘staff respect what you want to do.’ Choices of routines are stated within individual care plans. Routines are flexible, yet residents usually have their bath on the same day each week. A member of staff confirmed that this assures the same member of staff is on duty, in order to promote residents’ dignity. If however the resident, chooses not to have their bath, alternative arrangements are made. Residents are encouraged to manage their financial affairs for as long as they are able. From written information given by Mrs Rowles, before the inspection, many residents have given this responsibility to their family or other representatives. Within comment cards, one resident said they always enjoy the food. Three said sometimes. Individual comments included ‘I enjoy my food,’ ‘only on rare occasions have I refused a dish’ and ‘the food is quite nice and sufficient.’ Within discussion, residents confirmed that the food is very good. One said, ‘the meals are fit for the Queen – we eat very well here.’ Another said ‘the cook is marvellous.’ Meal provision is given high priority in relation to its contribution to good health and contentment. There is a five-week menu, which contains varied meat, fish and vegetarian dishes. There is a choice of each meal. A survey has recently been carried out to determine which meat, residents prefer. Food is also discussed within each residents meeting. The catering manager reported that she welcomes feedback. She often attends residents meetings and also tries to serve the second course of the lunchtime meal, to enable regular interactions with residents. Discussion took place regarding individual preferences. The catering manager explained that flavours of yoghurts, for Dauntsey House Care Ltd DS0000067268.V335472.R01.S.doc Version 5.2 Page 17 example are purchased according to individual wishes. Specific dishes may also be created from the ingredients of the main choice of meal. On the day of the inspection, there was roast lamb and a vegetable bake. The inspector enjoyed the vegetarian option. The meal was well presented and appetising. Three residents have their food liquidised. The catering manager explained that this is not ideal for individuals, although all are eating well and receiving the required vitamins and minerals, for a healthy diet. Dauntsey House Care Ltd DS0000067268.V335472.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaint procedure is readily accessible and residents are aware of how to raise their views if they are unhappy. Adult protection systems are in place although revisiting the topic on a regular basis and displaying reporting procedures, may further assist staff in their knowledge. EVIDENCE: The complaint procedure continues to be clearly displayed on the notice board in the entrance hall. However within comment cards, two relatives said they were unaware of how to make a complaint. It was suggested that copies of the complaints procedure are re issued, to those relatives who may not be regular visitors. It was noted that a number of residents were unable, due to their health condition, to verbalise a concern. This was discussed with staff, who reported that the identified residents, would clearly show their displeasure, if they wanted to. One member of staff believed family members would also raise any issues. Other residents said they would tell a member of staff if they were unhappy. One resident said they would tell their daughter. Another said ‘I haven’t really thought about it, I haven’t needed to.’ Within comment cards four residents said they knew how to make a complaint. One said ‘I don’t have any [complaints.]’ Another said ‘I tell one of the carers if I’m not happy with something.’ Dauntsey House Care Ltd DS0000067268.V335472.R01.S.doc Version 5.2 Page 19 Information sent to CSCI before the inspection confirmed that there have been no complaints reported to the home. No complaints have been reported to CSCI. As there was no evidence of adult protection procedures in the main office, it was recommended that a copy of the local reporting procedures should be displayed on the notice board. Mrs Rowles confirmed that all staff have been given their own copy of the ‘No Secrets’ documentation. They have also completed an in house booklet containing various questions about adult protection. It was suggested that this area should be re-visited, as one member of staff who was asked a hypothetical question about abuse, was unclear of their responsibility. Mrs Rowles confirmed this would be undertaken. Dauntsey House Care Ltd DS0000067268.V335472.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Dauntsey House is homely, comfortable and well maintained. Potential risks from aspects of the environment have been addressed, therefore promoting residents’ safety. Attention to ‘high cleaning’ would further enhance the existing good standards of cleanliness within the home. EVIDENCE: Staff reported that Mr Press has plans to redecorate all areas of the home. This includes re-carpeting areas, such as the main lounge and dining room. Staff acknowledged that this would take time, yet improvements so far have been positive. Bedrooms have been refurbished when vacant and the garden has been further landscaped. Staff reported that all bedding has been replaced and new cutlery, crockery and tablemats have been purchased. Mr Press confirmed there are plans to substantially improve the environment. Mr Press confirmed eight bedrooms have been redecorated. Residents are encouraged to bring their own furniture with them on admission, so all rooms are personalised Dauntsey House Care Ltd DS0000067268.V335472.R01.S.doc Version 5.2 Page 21 according to individual wishes. As stated earlier in this report, residents do not routinely have a lock on their bedroom door. All are asked if they wish to have the facility. During a tour of the accommodation, no health and safety issues were identified. Hot water regulators, radiator covers and window restrictors were in situ. Fresh flowers were located in the entrance hall and many houseplants were in the conservatory. During the afternoon of the inspection, a member of staff was cleaning the carpet in the main lounge. It was noted that cleanliness within the home was of a good standard. However, there were a number of ceilings, which had dark, established cobwebs around them. Mrs Rowles reported she would address this with the staff team. Within comment cards, four residents confirmed the home is always fresh and clean. Residents spoken with also expressed satisfaction with their environment. Dauntsey House Care Ltd DS0000067268.V335472.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels have recently been increased yet consideration to the deployment of specific housekeeping staff would ensure care staff have greater time to spend with residents. There is a well-organised, robust recruitment procedure, which minimises potential risks to residents. Training is given high priority and varying opportunities are available, to assist staff in undertaking their role. EVIDENCE: Staffing levels are maintained at generally three staff on duty until 6pm. At 6pm, levels are reduced to two staff. At night there are two waking night staff. While caring for residents, staff also undertake all cleaning and laundry responsibilities. During the afternoon, when the cook is not on duty, staff also prepare high tea and supper. One member of staff confirmed that spending time on a one-to-one basis with residents, other than providing personal care, is not always possible. One staff member had limited time to speak to the inspector. This was understandable, as they were conscious of a greater need to supervise residents both inside the home and in the garden. One resident reported that they did not require much attention from staff. However, they felt staff were stretched and having one extra would make all the difference. As stated within the environment section of this report, some areas of the home would benefit from further ‘high cleaning.’ It was suggested that Dauntsey House Care Ltd DS0000067268.V335472.R01.S.doc Version 5.2 Page 23 insufficient time for staff to address these areas, could potentially be a reason for the shortfall. Mrs Rowles explained night staff clean communal areas, so she did not believe the shortfalls were due to insufficient time. In the past, the home has had specific domestic staff. Mrs Rowles explained that this was unsuccessful, hence the current arrangements. Mrs Rowles reported that staff work well and in her opinion, have sufficient time to undertake their responsibilities. Mrs Rowles reported that since the last inspection, a 10am6pm shift has been introduced within the week and at weekends. Mrs Rowles explained this gave more time and therefore believed staffing levels to be appropriate. Mrs Rowles confirmed that she felt there were advantages to all roles being undertaken by staff. It was suggested that this area should be monitored, especially in terms of currently increasing external activity to residents. Within comment cards, all four residents said that staff always listen to what they say. Three confirmed that staff are always available when needed. One said usually. Individual comments included ‘I only have to ring my bell’ and ‘only on rare occasions are they not available when I need them.’ Within discussion, residents made many positive comments about the staff. These included ‘staff are wonderful – they will do anything for you,’ ‘they are very friendly’ and ‘they know exactly what I need.’ One resident spoke of a number of individual staff and confirmed how good they were. Within comment cards received from relatives, all four confirmed that staff always, have the right skills and experience to look after people properly. Individual comments included, ‘a thorough, caring and considerate staff – at all levels’ and ‘when we visit, all the staff seem very capable and caring towards our friend.’ Also, ‘we feel all the staff really care and help our friend who is nearly blind to have a good quality of life.’ Mrs Rowles is very clear regarding her responsibilities of ensuring a robust recruitment procedure. Documentation of the last three members of staff was viewed. All files were ordered and contained the required information. Application forms were detailed and written references were in place. All staff had commenced employment following a POVA First check. CRB disclosures had also been undertaken. New induction formats have recently been introduced and are being completed as required. Training is given high priority and at present, 86 of staff have NVQ level 2. One member of staff reported that they had just completed level 3. Mrs Rowles confirmed, that she aims to organise at least one training event each month. A training plan is available in the office. This contains details of all staff, the training they have completed and forthcoming sessions. It was evident that all staff are up to date with their mandatory training. Tissue viability training was scheduled for later in the year. However, in response to limited follow up intervention of sore areas, which was identified within this inspection, Mrs Rowles reported she would bring the training forward. Mrs Rowles confirmed Dauntsey House Care Ltd DS0000067268.V335472.R01.S.doc Version 5.2 Page 24 that external facilitators undertake some training. In house training is provided with staff watching videos, discussing topics and completing questionnaires. Dauntsey House Care Ltd DS0000067268.V335472.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is efficiently managed and there is a commitment to ensure a resident focus and a good standard of care. The recently introduced quality assurance system will further enhance this and formalise improvements. Through not dealing with personal monies, residents’ financial interests are safeguarded. Current systems to manage health and safety minimise potential risks to residents. EVIDENCE: Mrs Rowles has been the registered manager of Dauntsey House for approximately five years. She has worked at the home since 1992. Mrs Rowles is committed to maintaining standards and ensures up to date knowledge through regular training. Mrs Rowles has NVQ levels 2, 3 and 4 and also has the Registered Managers Award. Mrs Rowles holds regular staff and residents Dauntsey House Care Ltd DS0000067268.V335472.R01.S.doc Version 5.2 Page 26 meetings. Mr Press confirmed that he visits the home at least two days a week. During this time, he aims to meet staff and residents and also works closely with Mrs Rowles. Through discussion it was evident that Mr Press has a clear focus on ways in which he wishes to develop the home. Mr Press confirmed that everyone has worked extremely hard during the year. Significant progress has been made especially in terms of administration and policies and procedures. Both Mr Press and Mrs Rowles promote residents’ rights and aim to enable residents to live their lives as they wish. The introduction of external trips out and a focus on community involvement are part of the home’s philosophy of promoting quality of life. A quality assurance system has recently been introduced. Mrs Rowles has sent out questionnaires to residents, their relatives and health care professionals. Responses have been received yet the feedback, has not as yet, been formally evaluated. Mrs Rowles confirmed that this is planned, although as yet this has not been completed, due to other priorities. Various audits have commenced and a development plan for the year is documented. Mrs Rowles confirmed that she continues not to be involved with residents’ financial affairs. Personal monies are not held for safekeeping and any expenditure is billed. Mrs Rowles confirmed, the system works well and minimises the risk of potential abuse or error. As stated earlier in this report, the environment is well maintained and attention is given to health and safety matters. The fire log book although currently in two separate files, is well maintained. Records demonstrated satisfactory testing of the fire alarm systems. Contracts were also in place to regularly service the systems. This included yearly check of the fire extinguishers. Staff had received fire instruction and a full evacuation had recently been carried out. An emergency evacuation procedure has also been devised. The care office door was at times being propped open with a wedge. Mrs Rowles confirmed a mechanical device to hold the door open, would be fitted. Residents have a number of individualised risk assessments. Within one care plan it was noted that a resident should not be left alone in the bath. Mrs Rowles was advised to address this area for all residents, within individual risk assessments. An audit of falls has recently taken place. Results gave evidence that the majority, occurred during the night. In response to this, night staff now check residents on an hourly basis. This increases to half hourly or more, if a resident is unwell. Dauntsey House Care Ltd DS0000067268.V335472.R01.S.doc Version 5.2 Page 27 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Dauntsey House Care Ltd DS0000067268.V335472.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 12(1)(a) Requirement The registered person must ensure that any risk identified within tissue viability or nutritional assessments is addressed with adequate control measures. These must be monitored, regularly reviewed and documented with the resident’s care plan. The registered person must ensure that any sore areas, identified on a resident are addressed within a short-term care plan. Follow up intervention must be clearly identified. Timescale for action 30/06/07 2 OP7 12(1)(a) 10/05/07 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 OP1 Good Practice Recommendations The registered person should ensure that greater detail is added to the section, within the Statement of Purpose, of ‘needs that can be met within the home.’ Fees also need DS0000067268.V335472.R01.S.doc Version 5.2 Page 29 Dauntsey House Care Ltd 2 OP3 3 OP7 4 5 6 7 8 9 OP7 OP7 OP18 OP27 OP38 OP38 to be stipulated. The registered person should ensure that terms such as ‘unable to eat and drink unaided’ are avoided. Clear, factual information describing the support required, should be evident. The registered person should ensure that a clear description of any mark or wound is stated within residents’ daily notes. This should include its size, location, depth and colour. The registered person should ensure that a qualified health care professional, assesses the identified resident, in terms of their eating and drinking. The registered person should ensure, that in the absence of being unable to use a call bell, alternative strategies are documented within the resident’s care plan. The registered person should ensure that local adult protection policies are displayed in the office and regularly revisited with staff. The registered person should ensure that staffing levels are regularly monitored and consideration is given to the deployment of specific housekeeping staff. The registered person should ensure that a mechanical device is installed to safely, hold open the office door. The registered person should ensure that the ability to be left alone in the bath is stated within care plans. Dauntsey House Care Ltd DS0000067268.V335472.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Dauntsey House Care Ltd DS0000067268.V335472.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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