Inspection on 08/06/06 for Dauntsey House Care Ltd

This inspection was carried out on 8th June 2006.

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 02/05/07

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 Key Unannounced Inspection 10:00 8 and 20th June 2006 th 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.V299053.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.V299053.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.V299053.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd February 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 and therefore 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 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. Dauntsey House has recently changed ownership. The Registered Provider is now, 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 continues to be Mrs Mair Rowles and the staff team have also remained the same. Dauntsey House Care Ltd DS0000067268.V299053.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 on initially on the 8th June between the hours of 9.15am and 5.30pm. The inspection was concluded on the 20th June 2006 between 9.30 and 2.50pm. Mrs Mair Rowles the Registered Manager was available throughout the inspection and feedback was given as required with the main points concluded at the end of the visit. Mr Stephen Press was visiting the home on the second day of the inspection and therefore, discussion about future provision was held. Mr Press confirmed that the initial transition period had occurred successfully without disruption to residents. Mr Press reported that his main concern was to further develop a resident focused service and to improve the already established good practises within the home. Mr Press continued to report that attention is currently being given to developing the profile of Dauntsey House. This includes, enhancing the physical environment both inside and out and enabling residents to be more involved within the local community. Mr Press expressed a strong value base and agreed that, in time, he would like to develop further opportunities to address residents’ social needs. Mr Press also reported that he was a firm believer of staff training and therefore anticipates a clear focus that will build on the existing range of subjects already undertaken. At the start of the inspection a tour of the building was made and the inspector met with residents within their private accommodation and in communal areas. Some residents’ care was examined in greater detail through discussions with specific residents and staff. The viewing of associated documentation took place and comment cards were sent to a number of relatives and health care professionals in order to gain feedback about the service. In total seven comment cards from relatives, two from health care professionals and ten from residents were received. Six relatives confirmed that they were happy with the overall care provided and all were made to feel welcome in the home. One relative reported ‘I have been very impressed with the care at Dauntsey House. They ensure a homely atmosphere and give individual attention to all needs. My XX is very happy there.’ Another stated ‘Excellent care home and staff. Very homely and extremely good food, facilities, comfort and attention to residents’ individual requirements from a caring, personal view. A very professional service indeed.’ Further comments included ‘access from the road is steep – rather difficult for wheelchairs’ and ‘usually only two residents go into the garden daily (weather permitting.) All the rest just sit in the lounge, hall or conservatory.’ Such comments were forwarded to Mrs Rowles and to Mr Press. During the visit, all verbal feedback from residents was extremely positive. Such comments included the dedication of staff, positive interactions with the new provider, standards of cleanliness and meal provision. Dauntsey House Care Ltd DS0000067268.V299053.R01.S.doc Version 5.2 Page 6 Within the inspection, other forms of documentation such as menus, accident reports and recruitment records were also viewed. The inspector observed the process of assisting residents to their chosen destinations following the lunchtime meal. During this time a number of poor practises were observed which are identified within the main text of this report. All matters were discussed with Mrs Rowles at the time and on investigation, contributory factors appeared apparent. Mrs Rowles is therefore required to monitor the situation and a random inspection to target such areas will be undertaken. As such practices were not observed on the second day of the inspection and had not been apparent at previous inspections, on this occasion, the quality rating of the service has not been affected. Further consideration however, will be given to the matter following the findings of the anticipated random inspection. All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. Such matters are described in detail within this report. The judgements contained in this report have been made from evidence gathered during the inspection, which included the visit to the service and taking into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? Since the last inspection, developments have been made to the environment. This has included a number of rooms, which have been decorated and further additions to the garden. Dauntsey House Care Ltd DS0000067268.V299053.R01.S.doc Version 5.2 Page 7 Nutrition and pressure care management are now addressed within individual plans of care and staff have consulted with a dietician regarding specific needs of one resident. The systems of managing the kitchen have been significantly developed in an ordered and efficient manner. The application form has been revised and is now a clear document, which requests the required information. What they could do better: 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. Dauntsey House Care Ltd DS0000067268.V299053.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.V299053.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. The assessment process is well managed which minimises the risk of inappropriate placements. While prospective residents are able to visit the home and gain information verbally, written information does not give an accurate reflection of service provision. Contracts are in place, yet with the change of ownership, all need to be reviewed and re-issued. EVIDENCE: As there has recently been a change of ownership, the Statement of Purpose and the Service User’s Guide need to be up dated to reflect this. Matters within the documents, such as training qualifications also need to be up dated. Some information such as an arrangement with the local taxi firm, to provide a free trip into Devizes and the deployment of an Occupational Therapist need to be removed as such services, are no longer apparent. Dauntsey House Care Ltd DS0000067268.V299053.R01.S.doc Version 5.2 Page 10 Since the last inspection there have been a number of new admissions to the home. Through discussion with Mrs Rowles it was evident that a detailed assessment process is in place. This includes various discussions with the prospective resident’s main family members, a visit to meet the prospective resident in their own environment and a visit to Dauntsey House. This was confirmed when the assessment process of the two most recent residents was examined. Both had been assessed, while in previous residential care placements. Such assessments were fully documented and additional information from the care home was in place. One resident’s family had supplied clear, written information regarding their parent’s needs and wishes. Key themes had been highlighted for staffs’ reference. Mrs Rowles confirmed that appropriate placements are essential and therefore if there are any concerns, the placement is refused. An assessment period of a month is always given before confirmation of the placement. This is appropriately confirmed in writing. Within comment cards received from residents, seven reported they received sufficient information about the home before they moved in. Two reported that they had insufficient information. Four residents also reported that they didn’t have contracts. Mrs Rowles confirmed that Mr Ley, the previous director before the change of ownership, had undertaken all financial and contractual matters so she was unaware of such. Due to Mr Ley’s efficiency however, Mrs Rowles believed all residents would have had a copy of the terms and conditions although such documentation may have been given to relatives. It was agreed that Mrs Rowles would investigate and address matters accordingly. On the second day of the inspection Mrs Rowles confirmed that copies of all contracts are stored securely in what was Mr Ley’s office. Mrs Rowles confirmed that Mr Press was currently in the process of updating all documentation in line with the change of ownership. All residents would therefore receive a new copy of their terms and conditions, which they would have the opportunity to sign accordingly. Dauntsey House does not provide intermediate care and therefore despite a key standard, NMS 6 is not relevant to this service. Dauntsey House Care Ltd DS0000067268.V299053.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Since the last inspection, care plans have reduced in quality. In some cases, insufficient detail and omissions of information could potentially lead to unmet need. Not applying the care plans in practise also placed some residents at risk. Residents’ health care however is well managed with appropriate intervention from various health care personnel. Medication systems are also efficient therefore minimising the risk of error. Established systems are in place to promote residents’ rights, yet on the day of the inspection certain practices compromised such dignity and respect for some. Quality in this outcome area is good yet care planning and its implementation, is in need of attention, in order to bring it to its original standard. This judgement has been made from evidence gathered both during and before the visit to the service. EVIDENCE: All residents have a care plan which is regularly reviewed and includes additions such as medication changes or a GP’s instruction. The plan is a working tool and therefore stored securely in the downstairs office. The format has a number of printed headings in order to ensure matters are addressed. Mrs Rowles reported however that a new care plan format is being considered, Dauntsey House Care Ltd DS0000067268.V299053.R01.S.doc Version 5.2 Page 12 as the existing format does not give sufficient space for information. This view was confirmed, as the plans did not appear to give a fully accurate reflection of need. For example within one plan it was stated that the resident walks with a cane and communicates well. This particular resident was however being led by staff and did not engage in any form of communication. It was also evident that the resident was diabetic although there were no guidelines within her care plan of the condition’s management. Another plan highlighted the need for stimulation yet this was not explained and there was no evidence within daily records of such interaction. As part of the care plan, emotional and support needs were identified as headings. Mrs Rowles was informed of the need to ensure staff give clarity within their writing as in some cases ‘cheerful lady’ and ‘TLC’ are recorded. These terms require clarity within a factual account so that staff are clearly aware of what is required. Leisure is also highlighted within the plan, although as Mrs Rowles reports, space is insufficient to give clear information. This was evident when one resident, within conversation was passionate about past interests. Despite such passion, the areas of interest were not identified within the plan and therefore not addressed as possibilities to re-establish. All care plans contain a manual handling, pressure care management and nutritional assessment. Pressure care management is also appropriately documented on the front of the care plan in order to ensure staffs’ awareness of such. Within one nutritional assessment and associated daily records, losing weight had been identified as an issue. Mrs Rowles was therefore informed of the need to ensure staff address this within the resident’s plan of care. Following the last inspection, greater intervention involving a resident with low weight, had been documented. A dietician had also been contacted for advice and guidance. A record of weight for each resident is maintained and each plan details information such as chiropody and medical intervention. Matters such as allergies are also clearly evidenced. Through observation however, it was identified that specific matters such as bruising and sore areas had not been fully documented and therefore the cause of such could not be identified. These matters must be addressed accordingly. Within a number of care plans, instructions were in place stating that residents must receive supervision when walking. In practise however, during a lunch time period, staff did not adhere to such instruction. Residents were therefore placed at risk of falling, which is totally unacceptable. This is discussed in more detail within the staffing section of this report although staff must ensure that identified care provision is followed through and appropriately delivered. Within comment cards, all relatives confirmed that they were kept informed of all matters and were also consulted with, in the event of their relative not being able to make decisions. Six residents reported they always receive the care and support they require, two said ‘usually’ and one said ‘sometimes.’ Mrs Rowles is therefore advised to investigate this further. Dauntsey House Care Ltd DS0000067268.V299053.R01.S.doc Version 5.2 Page 13 Through discussion with residents it was evident that GPs are called as required and there were no problems with health care provision. Within the inspection a GP had been called and visited at lunchtime. Such timing, as discussed later in this report caused difficulties, which Mrs Rowles is now addressing. One resident spoke of seeing the District Nurse on a regular basis and another stated ‘you just need to let the staff know in the morning and they will call the Doctor for you.’ Within care planning information there was evidence of additional services such as chiropody, the opticians and general outpatient appointments. Within comment cards received following the inspection, one GP confirmed that the surgery was satisfied with the overall care provided to residents. Within the form however, it was raised that medication was ‘usually’ managed appropriately. Mrs Rowles reported that there have not been any drug errors and all medication is always administered as prescribed. The context of this comment could therefore not be identified. A comment card returned from a District Nursing Sister reported ‘I view the care given by members of the staff to be of a high standard. Nutritional status of residents is good. Skin integrity is maintained and visits requested are appropriate and timely. The residents appear happy and content and never have complained or voiced disquiet to me. I do see them alone at times so they have the opportunity.’ Within comment cards, six residents confirmed that they receive the medical support they need. Three said ‘usually’ and one said ‘sometimes.’ The home operates a monitored dosage system for medication administration. Mrs Rowles undertakes the responsibility of ordering all medication and the receipt of such. All medication is stored appropriately in a trolley and a locked wall mounted cabinet. The trolley is also locked and attached to the wall. Medication procedures are readily accessible and the storage of medication was ordered and well managed. Key staff who have undertaken medication training undertake the responsibility of administering medication. All documentation was satisfactory completed although Mrs Rowles was advised to ensure staff record when one or two tablets have been given within a variable dose of medication. Two members of staff had signed all hand written medication instructions and any changes in medication had been identified within individual plans of care. Through discussion it was evident that Mrs Rowles manages the timescales of medication reviews and contacts the GP as required to remind them of such. Staff promote residents’ privacy through established systems such as knocking on doors before entering and addressing individuals by their preferred forms of address. Such aspects were clearly evidenced within the inspection. All personal care is undertaken in private and residents reported total satisfaction with the care received. A number of matters however, which are detailed within the staffing section of this report, highlighted that residents’ dignity, at times, was being compromised. All such matters occurred through staff not being available and not sufficiently engaging with residents. Dauntsey House Care Ltd DS0000067268.V299053.R01.S.doc Version 5.2 Page 14 Dauntsey House Care Ltd DS0000067268.V299053.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 at least once during a 12 month period. 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 from evidence gathered both during and before the visit to the service. The home is relaxed and residents are encouraged to follow their preferred routines. While residents appear generally content with existing arrangements of social activity, the development of opportunities may benefit some and encourage further involvement. Visitors are welcomed and hospitality is evident. Nutrition and its effect on wellbeing are clearly demonstrated through an appealing menu. EVIDENCE: Through discussion with residents it was evident that the home is relaxed and individual preferences are respected. For example residents spoke of remaining in their own room if required and staying in bed if tired. They continued to report that there is no pressure and ‘you can be yourself.’ It was reported that some activity in the home is provided and walks outside in the garden are important to some. Others confirmed that they were happy as they are and did not want to be involved in any organised activity. One resident however missed the opportunity of going out into town and sometimes found getting personal shopping difficult. Mr Press reported that he was in the process of arranging such time and anticipated he would undertake the role himself as a positive aspect of developing relationships with residents. Such resident Dauntsey House Care Ltd DS0000067268.V299053.R01.S.doc Version 5.2 Page 16 involvement has commenced as Mr Press described the interactions and the work of some residents, with pruning and planting the gardens of the home. On the day of the inspection classical music was being played in the hallway and conservatory, which appeared popular with residents. Organised activity however was not evident. In the past, an occupational therapist was employed who facilitated a specific weekly activities programme. Since she left however, care staff have undertaken the responsibility. While it is noted that many residents do not want to be involved in any arranged social activity, current staffing levels do not give the required flexibility to satisfactorily address this area. Through discussion with Mr Press it was evident that, social activity and community involvement were key themes of anticipated development. In order to enable this however, a review of existing staffing levels is required. With plans of care, interests such as ‘likes dogs’ were evident. Such phrases would however benefit from ways in which the interest could be incorporated into practice. Mrs Rowles agreed that such matters would be investigated. Within comment cards three residents confirmed that suitable activities are provided and five said ‘usually.’ One said ‘sometimes.’ Residents confirmed that they are able to receive visitors at any time of the day. Such flexibility was expressed as an important factor and it was also reported that they could meet in private accommodation or in any of the communal areas. Visitors are offered refreshments and are also able to take a meal with their relative or friend. Some residents go out with their relatives on a regular basis, which again was reported to be invaluable. Residents are encouraged if they wish to take part in the local community and some attend the local village day service/luncheon group as required. Dauntsey House aims to promote residents’ choice and autonomy and this is clearly stated within information given before admission. Residents are encouraged to furnish their private accommodation as they wish and use the area as their own space. This includes remaining in their room for meals and choosing preferred routines. One resident confirmed ‘the home is as much a home as it can be and restrictions are minimal and only in place to ensure needed order, when lots of people live together.’ Regular residents meetings are held and if individuals do not want to attend, they have the option of meeting individually with Mrs Rowles or another member of staff. A number of residents spoke positively of their interactions with Mr Press with an assurance that they ‘just needed to ask.’ A varied menu offering a choice at each meal was clearly displayed on the notice board in the main entrance area. All feedback from residents regarding the quality, variety and presentation of food was very positive. The home has recently appointed a catering manager and with a team of cooks, the catering arrangements were reported to be working well. Discussion took place with the Dauntsey House Care Ltd DS0000067268.V299053.R01.S.doc Version 5.2 Page 17 catering manager and it was evident that a commitment to provide a good standard of home, cooked food was paramount in terms of physical health and general well being. With the change of ownership it was reported that many changes, such as different suppliers had been introduced although all were appropriate. On the second day of the inspection the lunch consisted of liver and bacon or stuffed peppers. Fresh lemons were also in place ready to be used within the homemade lemon meringue pie. It was reported that diabetic and vegetarian diets are currently catered for. The alternative to the main meal is often a vegetable dish, as it was reported unacceptable to offer a quick alternative to a vegetarian. A record of lunch and tea is maintained and any alternatives are identified. Within comment cards received from residents, five residents reported that they ‘always’ liked the meals and four said ‘usually.’ Dauntsey House Care Ltd DS0000067268.V299053.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The complaints procedure is readily accessible and residents appeared confident that they would raise matters as required. The risk of abuse to residents is minimised through the home’s organised systems of adult protection. EVIDENCE: There is a copy of the home’s complaint procedure on the notice board in the main hallway above the visitor’s book. The procedure is therefore readily accessible to visitors and is clearly written with the required information. Feedback from comment cards confirmed that five relatives were aware of the complaints procedure. In one instance, although not aware of the procedure, the relative reported that they would be unlikely to use it. Residents meetings are regularly held in order to raise any issues at an early stage. If residents are unable to attend the meeting, all are seen on an individual basis. Residents confirmed that they would have no hesitation in raising any matters with a member of staff or Mair. It was reported that Mair is excellent and would solve issues if at all possible. A number of residents spoke of the recent change of ownership and although they miss Mr and Mrs Ley, the new proprietors appear to be ‘genuine and very nice.’ Since the last inspection there has been two formal complaints reported to the CSCI. Both were initially referred to the Vulnerable Adults Unit. One remained within the Vulnerable Adults procedure and was recognised as unsubstantiated. The other was passed to Mrs Rowles to investigate. As both complaints were concerning individual residents, all Dauntsey House Care Ltd DS0000067268.V299053.R01.S.doc Version 5.2 Page 19 complaint correspondence had been filed on individual files. Mrs Rowles was therefore informed of the need to develop a central record of complaints. Within comment cards received from residents, six reported that they knew who to speak to if they were unhappy. Mrs Rowles has recently developed a handbook for staff regarding adult protection. The booklet contains a brief summary of the possible areas of abuse and signs to recognise such. It also clearly identifies the referral process. The booklet is currently in the process of being printed although all staff will have a copy on completion. It is expected that the contents of the booklet will also be discussed within formal supervision. The ‘No Secrets’ pamphlets are also available for staff reference. Through discussion it was evident that Mrs Rowles would have no hesitation in raising issues through the Vulnerable Adults procedure. Her responsibility to ensure the safety of the residents at Dauntesy House and other vulnerable people appears paramount. Dauntsey House Care Ltd DS0000067268.V299053.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. Dauntsey House is homely, furnished to a good standard and conducive to residents’ needs. All private accommodation is individual in style and personalised according to individual wishes. Communal areas are comfortable and offer a choice of seating areas. There is a good standard of cleanliness and risks to residents are minimised, through the implementation of various safety measures. EVIDENCE: Dauntsey House is a large property, which has residents’ accommodation on the ground and first floor. A passenger lift is in place to provide level access. There are eighteen single rooms and one twin. The twin room is generally offered as single occupancy and has an en-suite shower room. All other rooms have bathroom facilities within close proximity. The rooms vary in size and two are smaller than the advised space requirements. These rooms however are clearly identified within the home’s Statement of Purpose. On a tour of the Dauntsey House Care Ltd DS0000067268.V299053.R01.S.doc Version 5.2 Page 21 accommodation it was noted that all rooms had been individually furnished and a number had been redecorated. Mr Press confirmed that a major refurbishment of the decoration of rooms and the replacement of carpets is planned although due to the size of the home, this will be an on going project. Communal areas consist of a main lounge, an adjoining conservatory and a separate dining room. Seating is also available within the entrance hall. All areas are comfortable and pleasantly furnished. The fireplace in the lounge has recently been opened up in order to create a homely effect and additional lighting has been purchased. Mrs Rowles reported that much of the bedding has been replaced and new crockery is expected shortly. The property is well maintained and has radiator covers in place to all areas accessible to residents. All hot water outlets have been fitted with individual fail-safe devices and windows on the first floor have restrictors. Some pipe work has also been boxed in. All areas of the home seen on the day of the inspection were cleaned to a good standard and odour free. Appropriate signage was in place to identify recent cleaned areas. Residents reported that they were totally satisfied with the standard of the environment. Such comments included residents own accommodation, the gardens and the cleanliness of all areas. Within comment cards received from residents, ten residents reported that the home is always clean and fresh. Dauntsey House Care Ltd DS0000067268.V299053.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good, yet on the first day of the inspection certain practices were poor and placed some residents at risk. This judgement has been made from evidence gathered both during and before the visit to the service. Without domestic staff at weekends, the home does not meet the minimum staffing levels, as agreed with the previous registration authority. Depending on the outcome of monitoring lunchtime arrangements, staffing levels may also be inadequate at key times of the day. Risks to residents are minimised through efficient recruitment procedures and training is given high priority. In certain circumstances, further engagement with residents, including greater attentiveness would further the wellbeing of residents. EVIDENCE: The staffing roster demonstrates that there are currently two carers and a senior carer on duty throughout the waking day in the week. There is also a cook who undertakes total responsibility for all catering arrangements. This reduces however, at weekends to two care staff and a cook. Without domestic staff, the home is not meeting its minimum staffing levels and therefore this must be addressed. At night there are two waking night staff and a senior member of staff is also on call to assist as required. On the day of the inspection, the practise of assisting residents from the dining room after lunch was observed. Within care planning information, it had been documented that a number of residents required support with walking and Dauntsey House Care Ltd DS0000067268.V299053.R01.S.doc Version 5.2 Page 23 must not be left unattended. These residents however were making their way, very precariously, back to their seats and staff were not in attendance. Due to this, such residents were at risk of falling. Mrs Rowles reported that staff always walk with some residents as standard practise and was therefore not aware, why on this occasion, it did not happen. It appeared that there were insufficient staff to meet such need. On further investigation, Mrs Rowles stated that all staff had been called away therefore leaving the dining area unattended. It was agreed this must not happen and a review of the staffing arrangements and the anticipated tasks at this time is required. On the second day of the inspection, Mrs Rowles reported that she had addressed the matter with all staff and Mr Press had also addressed his displeasure in written form. Within the more detailed investigation it appeared that all members of staff had been called away through requirements of family members and a GP and therefore did not give their priorities to residents. In response to this, visitors have been asked to refrain from visiting at mealtimes. During the above period, it was observed that staff were not engaging with residents and certain situations were poorly dealt with. For example, one resident was distressed by her poor mobility and the associated pain. The staff member did not recognise this and was totally disengaged from the resident. Another resident was very unsettled and kept getting up from her chair. Staff kept telling and assisting the resident to sit back down yet no forms of distraction were used. The resident was unsupervised and later fell. Within further discussion with Mrs Rowles and the deputy manager it was evident that the resident was unwell and such agitation was uncommon. The resident therefore required greater supervision, which was not received or documented within her plan of care. A further incident of poor practice was observed when a chair was needed to stop a resident from falling to the ground. The resident once seated, was left in the hallway without any further staff assistance. There was no reassurance or enquiry to ascertain whether the resident was all right or if he needed anything after his ordeal. All such matters were discussed with Mrs Rowles, as issues with practice needed further investigation. Mrs Rowles reported that she would speak to the members of staff although expressed surprise of the occurrences, as staff are generally very caring and attentive. On the second day of the inspection Mrs Rowles confirmed that the staff had felt the identified period was extremely busy although there was no particular reason other than this, which explained the interactions. Mrs Rowles was therefore informed of the need to monitor the situation and address matters as required. Within general discussions with residents, positive feedback about the staff was given. All reported that they were friendly, very helpful and worked hard. One resident said ‘they are all absolutely delightful and that one over there’ (pointing to a senior carer) ‘is an absolute angel.’ Further comments included ‘they will do any thing for you’ and ‘they give me my bell at night so that I can call them if I need them.’ One resident, although believing her individual needs were met, felt the staff are too busy and do not have time to stop. The Dauntsey House Care Ltd DS0000067268.V299053.R01.S.doc Version 5.2 Page 24 resident confirmed that this was not meant in a negative way. She was concerned on behalf of the staff because their workload appeared too high. Within comment cards, five residents stated ‘staff are always available when you need them.’ Four stated ‘sometimes’ and one stated ‘never.’ One resident stated that the home could do with a better call bell system. In relation to the question ‘do the staff listen and act on what you have to say,’ seven stated ‘yes’ but two stated ‘no.’ Mrs Rowles is therefore advised to investigate this matter, especially in light of the observations identified within the inspection. Within a comment card, one resident confirmed ‘you can speak to some staff more than others.’ The recruitment documentation of the two most recent members of staff were viewed and all required information was in place. The application form was however disjointed and lacked space in some areas. Mrs Rowles reported that a new format had been developed and this will be used as required in the future. The form was viewed and was much improved. In both cases the required references were in place and a POVAFirst check and CRB disclosure had been requested. A medical declaration was also in place. Mrs Rowles confirmed that the recruitment procedure is carefully considered due to her responsibility of ensuring the safety of residents. Training is given high priority and Mrs Rowles has a large visual training plan in the office, which is used as a working tool. It is aimed to cover a topic each month. This assures staff are up to date with their mandatory subjects and a learning culture is developed. Recent areas have included infection control, adult protection, medication administration and fire safety. Six staff currently have NVQ level 2 and one member has NVQ level 3. There are also two members of staff who are undertaking level 2 and one is planning to start level 3. The home has one NVQ Assessor. Dauntsey House Care Ltd DS0000067268.V299053.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 at least once during a 12 month period. 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 from evidence gathered both during and before the visit to the service. Dauntsey House is enthusiastically managed and efficient, organised management systems are in place. While feedback is sought from various stakeholders, a formalised system of auditing the service would ensure further development of service provision. Health and safety is given priority yet some residents’ personal safety is compromised through staff not following specific care planning directives. EVIDENCE: Mrs Rowles has been the Registered Manager of Dauntsey House for over five years and continues to be very motivated, conscientious and enthusiastic. She is very organised within her role and is committed to the service that is provided. Mrs Rowles spends a high level of time within the home although is not part of the working roster. Positive relationships were seen with residents Dauntsey House Care Ltd DS0000067268.V299053.R01.S.doc Version 5.2 Page 26 and a friendly yet firm approach was observed with staff. Mrs Rowles strives to achieve her expected standards and has developed her practice through ongoing training. Mrs Rowles currently has NVQ levels 2, 3 and 4 and also has the Registered Manager’s Award. Although feedback is regularly encouraged through informal discussions and forums such as residents’ meetings the home does not have an established quality assurance system. It was agreed, due to the change of ownership, that discussion regarding various systems should take place with Mr Press. A system possibly used in Mr Press’ other registered care home may be useful in order to adapt to meet the needs of Dauntsey House. Mrs Rowles agreed that this area would be addressed. Residents are encouraged to manage their financial affairs or pass the responsibility to a family member or representative if required. Staff do not become involved in any financial matters and the home does not hold any money on behalf of residents for safe-keeping. Information regarding staff members’ responsibilities within the acceptance of gifts and beneficiaries of wills are clearly stated within the staff members’ handbook. The handbook is currently in the process of being up dated and it is then expected that all staff will sign for their personal copy. The environment is well maintained and at present, Mr Press is organising various repairs to the outside of the building. As stated earlier in this report, internally, residents’ safety has been taken into consideration through the installation of radiator covers and hot water temperature controls. Contracts regarding the servicing of equipment such as hoists and the passenger lift are up to date and additional contracts including pest control have been arranged. All staff are up to date with mandatory subjects such as first aid, manual handling and food hygiene. Additional topics such as COSHH have also been covered. Within the accident book there were a number of entries detailing falls suffered by residents, who have been identified as unsteady, earlier in this report. Mrs Rowles is therefore required to investigate the causes of such, in terms of the time of day, location and staff deployment. This assessment should be identified within each record. As stated earlier, Mrs Rowles is also required to monitor key times of the day in order to evidence that there are sufficient staff on duty to ensure safe practices. Many of the entries within the accident book contain insufficient detail and therefore greater clarity is required. For example rather than stating ‘found on floor,’ the exact positioning should be identified. In the case of ‘head wound’ specific detail is required. A number of the entries ask for monitoring although this is not evident within daily records. Discussion took place with the catering manager and it was evident that significant changes have taken place within the kitchen’s management. Matters Dauntsey House Care Ltd DS0000067268.V299053.R01.S.doc Version 5.2 Page 27 such as temperature controls, cleaning schedules and record keeping have been developed and now identify a positive, effective system. Dauntsey House Care Ltd DS0000067268.V299053.R01.S.doc Version 5.2 Page 28 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 2 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 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 3 17 X 18 3 3 3 X X 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Dauntsey House Care Ltd DS0000067268.V299053.R01.S.doc Version 5.2 Page 29 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 and 5 Requirement The Registered Person must ensure that the Statement of Purpose and the Service User’s Guide are regularly updated in order to provide an accurate account of the service. The Registered Person must ensure that all care plans accurately reflect the individual’s required care provision. The Registered Person must ensure that guidelines regarding the management of specific conditions such as diabetes are in place. The Registered Person must ensure that the daily records contain a comprehensive account of any matters of ill health. This must include any signs of injury (e.g. bruising or soreness.) The Registered Person must ensure that staff follow directives within care planning information. This must include supervising mobility if required. The Registered Person must ensure that the deployment of staff is increased at a weekend DS0000067268.V299053.R01.S.doc Timescale for action 31/08/06 2. OP7 12(1)(a) 31/08/06 3. OP7 12(1)(a) 31/07/06 4. OP7 12(1)(a) 20/06/06 5. OP7 12(1)(a) 20/06/06 6. OP27 18(1)(a) 14/07/06 Dauntsey House Care Ltd Version 5.2 Page 30 7. OP27 12(1)(a) 8. OP27 18(1)(a) 9. OP33 24 10. OP38 12(1)(a) 11. OP38 12(1)(a) in order to meet minimum staffing levels. The Registered Person must ensure that meal times are fully monitored. Further occurrences of such identified poor practice must be addressed through additional staffing levels. The Registered Person must monitor staff members’ interactions with residents and investigate why two residents reported, within comment cards that staff do not listen and act on what they say. The Registered Person must ensure that a structured quality assurance system is developed and maintained within the home. The Registered Person must ensure that falls are monitored and assessed in relation to staff deployment. The Registered Person must ensure that accident records give a detailed, factual account of the accident. This must include details of the incident, positioning on detection and a description of the injury. Such detail and any follow up action must be stated within daily records. 20/06/06 20/06/06 30/09/06 20/06/06 20/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations The Registered Person should ensure that in the event of a variable dose of prescribed medication, the amount of medication given should be identified within the DS0000067268.V299053.R01.S.doc Version 5.2 Page 31 Dauntsey House Care Ltd 2. 3. 4. 5. OP12 OP12 OP16 OP27 administration record. The Registered Person should ensure that a review of staffing levels is undertaken in respect of developing social activities to residents. The Registered Person should ensure that residents are given the assistance to apply their individual leisure interests in practice. The Registered Person should ensure that a central record of complaints is maintained. The Registered Person should investigate why a resident has reported that the home could benefit from a new call bell system. Dauntsey House Care Ltd DS0000067268.V299053.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 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.V299053.R01.S.doc Version 5.2 Page 33 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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