Inspection on 05/10/06 for Davey Court

This inspection was carried out on 5th October 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Davey Court 11/09/07

Davey Court 07/06/06

Davey Court 07/09/05

Davey Court 23/12/04

Davey Court 25/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Davey Court Buckingham Close Exmouth Devon EX8 2JB Lead Inspector Sue Dewis Key Unannounced Inspection 5 &10 October 2006 08:30 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 Davey Court DS0000039203.V307003.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. Davey Court DS0000039203.V307003.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Davey Court Address Buckingham Close Exmouth Devon EX8 2JB 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) 01395 273860 01395 222480 marlene.smith@devon.gov.uk http/www.devon.gov.uk/adoption.htm Devon County Council Mrs Jacqueline Cecilia Franklin Care Home 43 Category(ies) of Dementia - over 65 years of age (43) registration, with number of places Davey Court DS0000039203.V307003.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home may continue to care for four named people in the category OP, for as long as the unit can meet their needs. The maximum number of placements including that of the 4 named persons will remain at 43 That on the termination of the placement of any of the four named people, the registered person will notify the Commission and the particulars and conditions of this registration to allow up to four people in the category OP to live at the home will reduce by one. 7th June 2006 Date of last inspection Brief Description of the Service: Davey Court is registered to provide specialised care for up to 43 people with dementia. Davey Court is situated on the outskirts of Exmouth in a quiet residential area. The building consists of two floors and there is level access to both. The first floor is served by a passenger lift. There are attractive gardens outside. Although most bedrooms are small, all are single rooms, and there is ample communal space including 4 dining areas, 4 lounges and a conservatory. A copy of the last inspection report was pinned to the notice board in the entrance hall. The weekly fee for the home is £556.57 Davey Court DS0000039203.V307003.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection started 8.30am on 5 October 2006 by Sue Dewis and Louise Delacroix. A second visit was made on 10 October 2006 by Sue Dewis and Susan Lyons. The inspection was completed by a further visit by Sue Dewis on 31 October 2006. A total of 17.5 hours were spent at the home by the inspectors. The inspectors used a variety of methods including pre-fieldwork planning and used a completed pre-inspection questionnaire that had been filled in by the temporary unit manager. A full tour of the building was undertaken, with all rooms being inspected. Comment cards were sent out to 13 residents, 16 staff and 9 care managers and district nurses. At the time of writing the report responses had been received from 4 residents, 5 staff, one care manager and 2 district nurses. During this inspection, time was spent talking to five residents individually, and several more in a group setting. A total of two and a half hours was spent by one inspector observing the experience of residents sitting in two of the lounges. Six care plans were inspected. Eight members of staff were spoken with individually about their role and duties, and several others were spoken with briefly during the tour of the building. One member of staff was spoken with over the phone. The registered manager for the home is on sick leave and a temporary manager who is registered for another home, is covering this absence. What the service does well: The home generally provides a comfortable setting for residents, with staff wishing to provide a good quality of care to them. There was some good practice observed and individual attention given to residents. Residents are able to personalise their own rooms by bringing items of furniture etc. into the home, and several rooms reflected the personality of the occupants. It was good to see the awareness demonstrated by one of the members of staff in relation to a resident’s preferences in food. Davey Court DS0000039203.V307003.R01.S.doc Version 5.2 Page 6 Staff were aware of what to do if they saw a resident being treated badly. Staff and visitors felt that the manager was approachable and they would be able to discuss things with her and that she got things done. One resident said that they had thought they should move nearer their relatives ‘ but I’m happy here’. There were adequate numbers of staff on duty. There are good recruitment practices and there is a variety of training available to staff. What has improved since the last inspection? What they could do better: While there have been substantial improvements in many areas, and a large number of requirements and recommendations from the last report have been met, there is still much improvement needed. Staff need to be able to access care plans to ensure that they are up to date with the changing needs of residents, and care plans need to set out the dayto-day care needs of the residents, and their wishes relating to dying and death. Advice given by healthcare professionals needs to be followed more closely. All medication must be signed for at the time it is given to residents, and care must be taken to ensure mistakes made by the pharmacy are addressed. Davey Court DS0000039203.V307003.R01.S.doc Version 5.2 Page 7 Redecoration is required in several areas of the home and attention needs to be paid to eliminating unpleasant odours. To maintain residents’ privacy and dignity is met, bolts need to be fitted to all toilet doors, and to ensure that residents get help if they require it, the cords on the alarms in the toilets need to be untied. All staff must be reminded of the need to ensure that all communication with residents is dignified and respectful. Not all staff were aware of the complaints procedure, and there is still a lack of communication between staff and duty managers. This has led to one complaint being made, along with an allegation of abuse by agency workers. Staffing levels need to be kept under constant review as resident numbers increase. There is still no formal review of the quality of care at the home, and the temporary manager is given little external support. The position relating to the registered manager must be resolved and visits must take place each month by a representative of Devon County Council. The Commission must be notified of any incidents that adversely affect the wellbeing of residents. 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. Davey Court DS0000039203.V307003.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 Davey Court DS0000039203.V307003.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): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is now a suitable referral and assessment procedure in place that will assure prospective residents that their care needs can be met. The home does not provide intermediate care. EVIDENCE: Since the last inspection the assessment procedures have improved and the temporary manager is following the correct Devon County Council procedures. There is now a formal procedure and there was evidence that the temporary manager had visited and assessed a prospective resident. There have been no new admissions to the home. Several residents, whose care managers have wished to place them at the home, have not been admitted, as their needs were assessed as being too high for the home to be able to meet. The home does not provide intermediate care. Davey Court DS0000039203.V307003.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has made some progress with regard to record keeping and care planning, but further improvements will ensure that staff are full aware of the needs of the residents. All medicines are stored securely and administered, but some aspects of the system receiving medicines into the home have the potential to place service users at risk. Though the health care needs of residents are generally well met there is some evidence that advice is not always being followed. Residents are not always communicated with in a manner that respects their age and dignity. Davey Court DS0000039203.V307003.R01.S.doc Version 5.2 Page 11 EVIDENCE: Care plans have recently been changed and now contain much more useful information. At present, the full care plans are not easily accessible to staff, though there are plans to address this, once building works have been completed. Though the plans are now available to staff and they are encouraged to look at them. At the moment, the daily recordings and activity logs are the primary written ways in which the needs of the residents are passed on to staff coming on shift. Two of the care assistants spoken with seemed to be confused about the difference between care plans and the daily recordings and although they said they see the care plans when a new resident is admitted, they may not look at them again. Care plans contain general information on the resident as well as a full needs assessment, a handling assessment, individual risk assessments as well as some instructions to staff about the help each resident required. However, none of the care plans looked at contained a completed personal history for the resident. Nor did they contain information relating to their wishes concerning arrangements to be made following their death. The information on the help each resident required was limited and did not contain specific and detailed information on how the resident’s needs should be met on a day-to-day basis. A visitor said that they felt that their relative’s health had significantly improved since moving to the home. A member of staff said that they tried to encourage residents to drink throughout the day to help prevent urine infections, and this was seen during a two-hour period of observation. A more physically able resident spending time in their room was also seen to have a drink with them. This shows that staff encourage all residents to take enough fluids. Some care records showed that residents’ health needs were being monitored through up to date toileting and medicinal cream charts, but in another file, concern had been noted that the person had a sore area but there was no record of this being addressed in the following four days. On the first day of inspection two health care professionals expressed concern that some advice they have given has not always been passed on or been acted upon. They felt that information about residents’ health was not always readily available, and that as a result there was sometimes a delay in the home responding, as new staff came on shift and were unaware of the request for information. These comments were also echoed on three survey forms that Davey Court DS0000039203.V307003.R01.S.doc Version 5.2 Page 12 have been received. The temporary manager felt that staff do generally follow any advice that is given by health care staff. There has recently been an allegation of abuse against two agency workers at the home. This is currently being investigated through the Devon Safeguarding People procedure. Part of this complaint also related to the lack of information on the needs of residents, given to staff who were new to the home. This issue is being addressed by the temporary manager. Staff told the inspector that they are given a verbal handover on any changes to the needs of residents. However, this may be some while after they come on duty, and therefore they may not have complete up to date information on the residents whose needs they are expected to meet. Staff said that care plans are not usually used during these handovers, and there is much reliance on verbal communication between staff in respect of the changing needs of residents. This means that the quality of information passed on to staff about changing needs relies heavily on the communication skills of the person giving the handover, with little written evidence to back this up. Medication was seen to be stored and administered correctly It was noted that the medication recording had not been signed for one resident’s eye drops and it was not clear whether they had been given. Medication should be signed for at the time it is administered. The pharmacy had in error, sent medication to be taken regularly, in the wrong coloured blister pack (usually used for ‘when required’ medication). Staff were aware that a mistake had been made and were following the correct instructions. However, this could be confusing and needed to be addressed. Staff who administer medication have received training from a local pharmacy, although this did not involve their knowledge being tested. There have been no changes to the self-medication policy and therefore there the individual strengths of residents are not taken into account and ways in which residents could be enabled and supported to self-medicate are not explored. Two hours were spent in the main lounge so that the experience of residents could be observed. Positive conversations were heard between residents and some staff, which recognised residents’ individuality and focussed on their life experience. Some staff were also heard checking with residents that they had understood what the resident had said, which is good practice. One member of staff was seen responding to residents’ verbal and nonverbal ways of communicating, therefore helping them feel more comfortable and reassured, and evidencing the skilled approach of the staff member. During this time a resident said to the staff member ‘you are a dear’ and ‘nice girl’. Residents appeared appropriately dressed, which helps maintain their dignity. Concerns over residents wearing others’ clothing have now been addressed with the laundry assistants now being back at work. Women were seen with their handbags, which they said were important to them, and one resident Davey Court DS0000039203.V307003.R01.S.doc Version 5.2 Page 13 seemed to enjoy keeping busy either looking in their bag or wrapping a paper towel around their hand. Three communal toilets were checked, and all had working and suitable locks, which could be opened in an emergency but also helped maintained dignity and privacy for residents. However during the full tour of the building it was noted that two of the toilet doors did not have suitable locks fitted to them, so it was not possible for residents to use these two toilets in private. On the last visit, suitable locks were being fitted to residents’ bedrooms to afford them more choice and privacy. Some staff were able to describe the way in which they maintained residents’ privacy and dignity and confirmed that this had formed part of their induction. One staff member gave good examples of when they have acted to ensure the dignity of two particular residents’ was maintained. However, on three occasions, during observations in both lounges, communication by some staff detracted from the residents’ dignity. For example, talking about residents to another member of staff while the resident was with them, outpacing residents, which means some staff spoke too quickly and therefore did not give the resident time to respond, and joking inappropriately and invading the personal space of a resident who had been identified as unwell. On the final occasion, a staff member distracted an anxious resident by promising them a cup of tea several times, but did not then give them a cup during the half hour of observation, which may have left the resident feeling more unsettled. Davey Court DS0000039203.V307003.R01.S.doc Version 5.2 Page 14 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 using available evidence including a visit to this service. Residents are able to maintain contact with family and friends. There is a good variety of activity available, though the home does not always offer suitable stimulation to suit the individual needs of all the residents. Meals are nutritious and efforts are made to ensure that residents are encouraged, wherever possible, to make a real choice. EVIDENCE: Residents at the home experience varying degrees of dementia and their abilities also vary widely. Some residents are content sitting in the lounges listening to music or watching TV, while others need more stimulation. One staff member said that they ‘interact with the residents all the time’. Residents’ plans of care showed that some residents appeared to have regular interaction with staff through communal activities such as singing or through one to one chats. Discussion between staff and a resident showed that they Davey Court DS0000039203.V307003.R01.S.doc Version 5.2 Page 15 were supported to use local shops on a regular basis, and this was confirmed in a staff handover. However, another resident’s file had gaps of eight days between any recorded activity or task, such as watching television, sorting out belongings in their room and listening to music, which suggests a lack of stimulation and occupation for that individual. One resident knew where the activities notice-board was, which detailed the activities of the week that included a quiz and bingo. Staff were seen supporting a number of residents with a game of bingo. Staff were also seen sitting with an individual resident, and looking through a magazine with them, which the resident appeared to enjoy. A number of age appropriate magazines were easily accessible for residents who wished to look at them. A member of staff was seen supporting two residents to help lay the tables, both of whom responded positively to this attention and it appeared to distract them from the anxiety they had been originally showing. One resident then was offered the choice of spending time in the day unit, which they seemed happy about. However, in the morning of the first day of inspection, a television was left on in one of the lounges for two hours and during this time only one resident looked at it, and this only amounted to ten minutes. The television was on at quite a loud volume and several residents appeared tired and were trying to sleep in their chairs. Residents told an inspector that they sometimes joined in activities or did puzzles; otherwise they sat and watched TV or went to sleep A relative said they always felt welcomed whatever time they visited. Another relative said that they felt happy with the care in general, but would like to see more stimulation and be more formally involved with their relative’s care, for example, attending reviews of their care. Staff felt there was now greater choice for residents e.g. a wider range of fruit juices and food. A staff member said that a resident who prefers not to have male carers, is only given personal care by female staff. Residents were seen being offered a choice of drinks and biscuits, and a choice of where they spent their time. The acting manager explained that they are currently concerned about one resident whose actions can have a negative impact on other people living at the home. The home has been advised by health care professionals that the person should spend more time in their room. However, the acting manager is concerned as this is not the resident’s choice and she is seeking further advice on meeting the resident’s needs. Staff felt there is now improved communication between care staff and kitchen staff, resulting in a better outcome for residents. For example, staff working in the kitchen said they now received good feedback from staff about residents’ Davey Court DS0000039203.V307003.R01.S.doc Version 5.2 Page 16 likes and dislikes. In discussion, they also demonstrated their knowledge around specialist preparation of food. Staff were positive about increase in funding, which has resulted in extra staffing for the kitchen, allowing a wider range of food to be offered, and improved equipment to assist with this. A resident said that they thought the food was good. The temporary manager and the catering team have been exploring ways of making a choice of menu more easily accessible to residents. One inspector sat with three residents at tea time. Residents had a choice of tuna pasta bake or soup. One resident did not want either and was offered a choice of sandwiches, which they accepted and enjoyed. It was good to see that one member of staff recognised that although one resident was vegetarian they may not necessarily know that they were eating meat. Therefore the member of staff was particularly vigilant in ensuring that the correct meal was given to the resident concerned. Davey Court DS0000039203.V307003.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a clear complaints procedure at the home, ensuring that any concerns are acted upon. Arrangements for protecting residents are generally satisfactory. However, poor communication within the home has the potential to place residents at risk of harm or abuse. EVIDENCE: Care staff said that if a relative or resident wished to complain they would direct them to one of the senior staff. Care staff also said that they would take the complaint to the manager on behalf of the resident. In line with Devon County Council’s policy, there is a clear and simple complaints procedure displayed in the hallway. Not all staff were familiar with the procedure, however, those that were spoken with would ensure that the complaints were dealt with. Completed comment cards from three residents indicated that they would know how to make a complaint. One visitor said that they had confidence that staff would address any concerns based on their experience of discussing problems with the home. Another said that they had had to complain when their relative was first Davey Court DS0000039203.V307003.R01.S.doc Version 5.2 Page 18 admitted. However, everything was fine now and that they understood who was in charge and therefore who to complain to. Staff said that if they saw a resident being treated inappropriately they would report it and if they felt nothing was done they would pursue it. However, staff that were spoken with were confident that the managers would deal with any such concerns that were raised. Staff said, and records confirmed that they had received training in relation to the protection of vulnerable adults. They were all aware of who they could report concerns to within the organisation, but one person lacked knowledge on the potential role of outside agencies i.e. the Police or CSCI. There has recently been an allegation of abuse against two agency workers at the home. This is currently being investigated through the Devon Safeguarding People procedure. Part of this complaint also related to the lack of information on the needs of residents, given to staff who were new to the home. This issue is currently being addressed by the temporary manager. Davey Court DS0000039203.V307003.R01.S.doc Version 5.2 Page 19 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, 21, 22, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recent investment has improved the appearance of the home, creating a comfortable and safe environment for those living there. However, there are further improvements needed EVIDENCE: The building is easily accessible by those who are wheelchair users; there is also free access throughout the home. The garden is being landscaped to provide a safe area in which residents can wander alone or with staff. There has been a general improvement to the decoration and cleanliness of the home, and it was good to see that some of the individual bedrooms have been redecorated and re-carpeted. Davey Court DS0000039203.V307003.R01.S.doc Version 5.2 Page 20 A member of staff spoke positively about the improvements to the home’s environment. They felt the choice of pictures from the local area had received a positive response from residents, provided a good method of orientating residents to their location and a helpful aid for conversation with residents. A resident was also positive about the impact of the pictures. However, many of the bedroom doors need to be repainted. Also, in several bedrooms ceilings and walls were in need of redecoration as paint was flaking or dirty. One bedroom in particular had a large stain on the ceiling, which appeared to be from water damage, this was drawn to the attention of the manager. In one bedroom the radiator cover was loose and two bedroom doors were difficult to close with the doors having to be pulled hard, making a loud noise. There is a range of aids and adaptations throughout the home to enable the residents to be as independent as possible, and to assist staff with moving and handling of residents. With the exception of one, all the alarm pull cords in toilets were tied up out of reach. This means that if a resident felt unwell whilst using the toilet or needed assistance they would be unable to summon help. Residents have been able to bring some of their own furniture and possessions into the home with them and the rooms reflect the personality of its occupant. There was no odour in the communal areas of the home, and a staff member said they felt more positive about showing prospective residents and their families around as a result, and that a recent visitor had responded positively to the cleanliness of the home. However, on the second visit, it was noticed that there was an unpleasant odour in one of the bedrooms. The inspectors checked the room twice and on both occasions the odour prevailed. There is a well-equipped laundry at the home and now that the laundry assistant is back at work at the home, concerns over residents wearing others’ clothing have been minimised. Staff told the inspectors and records confirmed that they had received training in infection control procedures. Disposable gloves and aprons were available to staff and there is liquid soap and paper towels in toilets and bedrooms in order to minimise the risk of cross infection. Davey Court DS0000039203.V307003.R01.S.doc Version 5.2 Page 21 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. This judgement has been made using available evidence including a visit to this service. The deployment and numbers of staff available throughout the day and night are generally sufficient to meet the current needs and numbers of residents. The procedures for the recruitment of staff are robust and offer protection to residents. Training for staff at the home is good and further training in caring for people with dementia will help staff better meet the needs of the residents. EVIDENCE: On each visit there were eight care staff working in the home, with four care staff on each floor. Domestic staff and kitchen staff, plus the temporary manager and duty officer were also working at the home. Staff felt that generally, the numbers of staff on duty during the day were sufficient to meet the needs of the current residents. However, one member of staff expressed some concern that night time was very busy and they felt that they were not always able to give residents the care they needed. Currently there are 2 care assistants and one night care officer on duty. This means one care assistant on each floor and the night care officer ‘floating’ between the two. The temporary manager acknowledged that there were occasions when nights were very busy, Davey Court DS0000039203.V307003.R01.S.doc Version 5.2 Page 22 but no concerns had been raised with her about the needs of the residents not being met. There have been no new admissions to the home for several months, and resident numbers are below those that the home is registered for. While staffing levels are satisfactory for the current numbers and dependency levels of residents, care must be taken to ensure the levels remain satisfactory once resident numbers begin to increase. Care staff told the inspectors that there is still a strong reliance on agency staff, although where possible the same staff are used to maintain continuity of care. Some agency staff have been working at the home for a number of months. A member of staff said this reliance was often in the evenings. One member of staff expressed concern that a small number of agency staff are reluctant to work with residents with complex care needs, which can be problematic. Staff said in September there had been a high dependency on agency staff because of sickness and annual leave, and the acting manager was open that this had been a difficult period to staff. It was during this time that the alleged abuse occurred. Also during this time concerns were raised about the use of a hoist by agency staff. The duty officer reacted quickly to ensure they used the correct hoist and procedures and followed this up the next day with their respective agencies. Some staff said there are still problems with communication, which can mean that residents’ changing needs are not always passed on to the next shift or to people starting shifts half way through the day. It was noted on the day of the inspection that one member of staff received a handover only after they had been on shift for approximately one and a half hours, and this was despite them working alone while covering other staff members’ lunchtimes and laundry duties. The last time they had worked at the home had been five days previously. This is being addressed by the temporary manager. However, staff did say that there was improved teamwork and one person said that it was a ‘great working atmosphere’ and that they felt well supported. The temporary manager has instigated senior care roles, and a senior carer who was spoken with was clear about their role, which they saw as overseeing the work of care staff and ensuring that good practice is maintained. A member of staff was clear and positive about their duties as a key-worker, which they explained involved building a rapport with the resident and their family to provide an individual approach. A visitor said they always felt that they were kept informed of changes and that the staff were knowledgeable. However another said they would like to be involved more formally and perhaps attend reviews. Davey Court DS0000039203.V307003.R01.S.doc Version 5.2 Page 23 Three staff files were inspected, all three contained evidence of an application form, written references, proof of identity and a satisfactory police check. The files also contained copies of training certificates and supervision sessions. A total of eight staff were spoken with over the course of the inspection. Five of these said they had received some training in the area of dementia and one had received a recent update. All said they were up to date with moving and handling practice. One member of staff said she felt she could feedback concerns regarding moving and handling issues to senior staff. A handover was observed and a staff member was reminded to check the moving and handling needs of individual residents, and explanation given about the approach needed for some residents. Staff had also received training in basic health and safety, food hygiene, infection control and fire precautions. Davey Court DS0000039203.V307003.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The temporary manager has a good understanding of the areas in which the home needs to improve, considerable planning was in place indicating how this improvement was to be resourced and managed. The home does not regularly review aspects of its performance through a programme of self-review and consultations, which include seeking the views of residents, staff and relatives. The home is now being well managed and this generally results in practices that promote and safeguard the health, safety and welfare of the residents. Davey Court DS0000039203.V307003.R01.S.doc Version 5.2 Page 25 EVIDENCE: The registered manager is still absent from the home, the temporary manager for the home is registered at another home, which means there are two care homes without registered managers at the homes. Devon County Council must submit plans to CSCI as to how this situation will be resolved. The temporary manager has many years experience of working with older people and they have been proactive in ensuring that the home can meet the needs of the residents, which has led to some re-assessments and a multidisciplinary approach with other agencies, who have offered specialist advice, and where appropriate, residents have been transferred to hospital. A member of staff was positive about the role of the temporary manager and she described her as addressing poor practice by some members of staff. For example, some staff placing greater emphasis on tasks around the home rather than residents’ well being and spending individual time with them. Staff said that they found the new acting manager very approachable and would feel able to speak to her about concerns or issues within the home. They felt that the morale within the home had improved and comments such as ‘easy to talk to’ and ‘gets things done ‘ were made in relation to her. There is currently no quality assurance system in place to monitor the quality of care provided to residents and there have been no recent visits to the home under Regulation 26, by the Responsible Individual for the home. This means that Devon County Council have no external measures in place to monitor the care at the home. Those residents who have money held by the home have these monies correctly administered through a suspense account in line with Devon County Council policy. This means that only very small amounts of money are held for those individual residents, and receipts and signatures are obtained. During a conversation about a particular evening shift it was noted that an incident relating to a resident hitting a member of staff was not recorded. All such incidents should be recorded and the information passed on to other members of staff, in order that the resident can be monitored and the risk of reoccurrence minimised. The pre-inspection questionnaire provided evidence that Davey Court complies with health and safety legislation in relation to maintenance of equipment, storage of hazardous substances, health and safety checks and risk assessments. No hazardous substances were in reach of the residents during Davey Court DS0000039203.V307003.R01.S.doc Version 5.2 Page 26 the visits. The fire logbook, record of fire safety training and accident and incident records were found to be accurate and up to date. The home is correctly insured, with the certificate expiring 31 December 2006. At the previous inspection, concerns were raised in relation to some of the fire precautions around the home. The home received a visit from Devon Fire and Rescue Service (DFRS) who were happy with the situation at the home. So that the risk of burning from hot surfaces is minimised, all radiators within the home are covered, though one radiator was not securely attached to the wall. All windows above ground floor level are fitted with restrictors, in order to minimise the risk of any resident falling from these windows. An agency member of staff said they had received fire training on their first shift at the home, which is safe practice. However, during the inspection, the lead of a vacuum cleaner was left across the floor in two corridors, despite residents walking about. The person who had been using the equipment was not nearby and a member of care staff had to make the area safe. They said this had happened before. Davey Court DS0000039203.V307003.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 X X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 3 2 3 X 3 X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 3 2 X 3 X X 3 Davey Court DS0000039203.V307003.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 12 (1)(a) Requirement You are required to ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users (systems must be in place to ensure the advice of health care professionals is followed) You are required as far as practicable to enable service users to make decisions with respect to the care they are to receive and their health and welfare (service users should be enabled to self medicate in line with a suitable risk assessment previous timescale of 05/10/05 and 21/09/06 not met) You are required to make suitable arrangements to ensure that the care home is conducted in a manner which respects the dignity of service users (ensure communications by staff do not detract from the dignity of residents) Timescale for action 31/12/06 2. OP9 12(2) 31/12/06 3. OP10 12 (4)(a) 31/12/06 Davey Court DS0000039203.V307003.R01.S.doc Version 5.2 Page 29 4. OP18 13 (6) The registered person shall make 31/12/06 arrangements to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse (Reported concerns must be recorded and the action taken logged. Communication must be improved between officers-incharge – timescale of 21/09/06 not met) The registered person shall having regard to the size of the care home and the number of needs of service users keep the care home free from offensive odours. The registered person shall, having regard to the size of the care home, the statement of purpose and the numbers and needs of service users, ensure that at all times persons are working at the home in such numbers as are appropriate for the health and welfare of service users. (Ensure that staffing levels are continually monitored) 31/12/06 5. OP26 16 (2)(K) 6. OP27 18 (1) (a) 31/12/06 7. OP30 18 (1) (c) (i) The registered person shall 31/12/06 ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform. (A training audit must be carried out and action taken to meet any identified training needs i.e. dementia training – timescale of 21/09/06 not met) Davey Court DS0000039203.V307003.R01.S.doc Version 5.2 Page 30 8. OP31 21 (1) This regulation applies to any matter relating to the conduct of the care home so far as it may affect the health or welfare of service users. (Poor communication between care staff and managers must be addressed to ensure residents’ needs are met. The role of the officers-in-charge must be reviewed and additional administration support provided to enable them to be ‘on the floor’ and monitor practice and work with residents – timescale of 21/09/06 not met) You are required to visit the home in accordance with this regulation (The responsible individual must visit the home at least monthly, unannounced and report on the visit) The registered person shall give notice to the Commission without delay of any event in the care home which adversely affects the well-being or safety of any service user You must submit plans to CSCI as to how the absence of the registered manager will be regularised The registered person shall establish, maintain, review and improve the quality of care at the home. The registered person shall consult with service users and their representatives and send a copy of any report prepared to CSCI (timescale of 21/09/06 not met) 31/12/06 9. OP31 26 (2) 31/12/06 10. OP31 37 (1)(e) 31/12/06 11. OP31 8 31/12/06 12. OP33 24(1)(2) (3) 31/12/06 Davey Court DS0000039203.V307003.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP7 Good Practice Recommendations You are recommended to ensure all staff are aware of the availability of residents’ care plans You are recommended to ensure that care plans contain sufficient information on how staff are to meet the day-today needs of the residents You are recommended to ensure that staff receive an appropriate and sufficient handover prior to starting their shift You are recommended to ensure that the residents’ wishes concerning terminal care and arrangements after death are discussed recorded and carried out You are recommended to ensure that appropriate stimulation and activities are provided on a regular basis You are recommended to ensure that the lounge is monitored to determine if the TV is required You are recommended to ensure that all staff are aware of the home’s complaints procedure You are recommended to ensure that all staff are reminded to report concerns of poor practice immediately to a senior member of staff You are recommended to ensure that all areas of the home are suitably decorated and maintained You are recommended to ensure that all toilet doors are fitted with suitable locks You are recommended to ensure that service users can access the call bell pulls in all toilets 3. OP7 4. OP11 5. 6. 7. 8. OP12 OP12 OP16 OP18 9. 10. 11. OP19 OP21 OP22 Davey Court DS0000039203.V307003.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton Devon TQ13 7UP 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 Davey Court DS0000039203.V307003.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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