Inspection on 07/06/06 for Davey Court

This inspection was carried out on 7th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 05/10/06

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 Unannounced Inspection 7 and 9 June 2006 9:30 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.V292590.R01.S.doc Version 5.1 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.V292590.R01.S.doc Version 5.1 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 jackie.franklin@devon.gov.uk 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.V292590.R01.S.doc Version 5.1 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. 7 September 2005 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.V292590.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection started on 7 June 2006 at 9.30 am. Two inspectors, Sue Dewis and Louise Delacroix undertook the inspection and went back on 9 June 2006 to complete the fieldwork. The two inspectors each spent 12 hours at the home. The inspectors used a variety of methods including pre-fieldwork planning and using a completed pre-inspection questionnaire that had been filled in by an assistant manager at the home. Survey forms were sent out to 14 staff, one social services team ‘Helpdesk’, 18 residents and their relatives and 12 GPs. At the time of writing the report the inspectors had received completed forms from 3 staff, 5 residents and 10 GPs. Eighteen members of staff, ten residents and three visitors were spoken to over two days of inspecting. Devon County Council has recognised that there were many outstanding issues at the home and have kept The Commission informed of their plans to improve matters at the home and independent audits have been undertaken. In order to ensure that the many outstanding items from the previous report continue to be addressed, an experienced manager of another home (Elaine Brown) is managing the home on a temporary basis. This manager has only just started at the home and therefore has not had time to begin to address these issues. The Commission is confident that with sufficient backing and support improvements will be made. What the service does well: The inspectors saw evidence of some good practice around the home, with service users being offered choices by some staff. Recruitment procedures at the home are good and ensure protection for residents. Some residents, who were able to express themselves verbally, indicated that they were happy with their lives at the home. One comment card indicated that the resident was happy with being warm and well fed. Davey Court DS0000039203.V292590.R01.S.doc Version 5.1 Page 6 Many of the staff have been at the home for a long time and would welcome the opportunity to have more guidance and leadership at the home. Staff felt that they provided good care to residents. What has improved since the last inspection? What they could do better: There are many aspects of the care at the home that need to be addressed, and it is hoped that over the coming months the temporary manager will begin to do this. Matters identified for particular attention at this inspection include the following. The home must ensure that there is a rigorous admission procedure, including thorough assessments and consultation, to ensure the needs of any prospective resident can be met. Residents’ care plans must provide staff with sufficient information to ensure they can safely care for and meet the needs of the residents. The plans must incorporate risk assessments for all aspects of life at the home and include, nutritional, medication and continence assessments. Procedures relating to medication administration must be improved. The home must explore ways to actively involve residents within the running of the home, ensuring their privacy and dignity is maintained, and offering meaningful choices, especially in relation to food. Stimulation for residents, including interaction with staff and activities must be improved. Davey Court DS0000039203.V292590.R01.S.doc Version 5.1 Page 7 Staff must receive specialist training to enable them to understand the issues around caring for people with dementia. Consideration should also be given to ensuring staff receive training in caring for residents who may be dying. Steps must be taken to improve communication within the home and to ensure all staff are aware of the needs of the residents and that staff feel able to raise concerns with any manager and know they will be listened to. Care must be taken to ensure that the home is free from hazards, and that residents and staff can move safely around the home and garden. Fire safety procedures around the home must be improved so that all staff are aware of what to do in the event of fire. Improvements to the environment must continue, ensuring that the home is free from hazards and unpleasant odours, and provides the residents with a homely comfortable environment. A procedure must be put in place that allows for the monitoring of quality within the home. 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.V292590.R01.S.doc Version 5.1 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.V292590.R01.S.doc Version 5.1 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 4 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Generally there is no proper assessment completed by the home, prior to people moving into the home. Without this there is no assurance that care needs will be met. EVIDENCE: Service users are only admitted to the home through Social Services care management process. The home accepts emergency admissions. Generally, residents’ care files had paperwork from care management teams or hospital discharge teams but the quality of information varied, which was also confirmed by staff. There were no pre-admission assessments completed by the home. A member of staff explained that it was not usual practice for prospective residents to be assessed by the home. It is therefore difficult for the home to prove that the home can meet prospective residents’ needs. During the inspection, a resident was met who did not meet the home’s Davey Court DS0000039203.V292590.R01.S.doc Version 5.1 Page 10 category of dementia. Looking at their care records, and talking about their care needs with a member of staff confirmed this. One comment card from a resident indicated that the resident’s son had had information about the home prior to their admission. The home has a condition of registration that four named residents who did not have a diagnosis of dementia could remain at the home, and that the Commission should be notified that when these residents were no longer living at the home. Until a request was made by inspectors for information relating to these residents, the Commission was not notified that three residents were no longer living at the home. The home does not provide intermediate care. Davey Court DS0000039203.V292590.R01.S.doc Version 5.1 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, 10 and 11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is no clear or consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet the needs of the residents. All medicines are stored securely but some aspects of the administration system have the potential to place service users at risk. In order to ensure there is good health care promotion, risk assessments should be completed. EVIDENCE: Despite previous requirements to improve care plans, this has not yet happened, although it has been recognised that a new system needs to be introduced. Care plans should describe the care, health and social needs of each person living in the home and recognise their individuality. Four care Davey Court DS0000039203.V292590.R01.S.doc Version 5.1 Page 12 plans for people who were case tracked (see summary for explanation) were looked at in detail, and nine others were used to compare with. None of them fully described the needs of residents, particularly residents’ social needs. One resident had recently received a significant visit, which had dramatically affected their mood. Some staff spoke about this visit but there was no record in their care plan that it had taken place and no action plan as to how to reassure the resident. Their risk assessment had not been updated and still indicated that their behaviour was low risk. Monthly reviews do not consistently take place and do not cover all aspects of care. Risk assessments are poorly completed and contain general statements such as ‘follow guidelines from violence and aggression training’. This statement is particularly unhelpful to the large number of agency staff that work at the home and have not attended the same training. Individual plans of care do not contain a clear record of health visits and staff said these visits were not always written down. Staff confirmed that they were often reliant on handovers for this type of information but these varied in quality. It was explained that staff starting at different times throughout shifts hampers effective handovers. If managers are unable to provide a handover there is no clear responsibility for staff working on the floor to provide this as there are no seniors. A poor quality handover was observed during the inspection between care staff. It was mainly task based rather than focussing on the individual needs of residents. Comment cards from health care professionals indicated that they were generally satisfied with the care at the home, though one indicated that they felt that the home could not always meet the healthcare needs of the residents. Residents’ mental health needs are poorly addressed in their individual plans of care, despite the home’s registration category. For example, it is recorded in a risk assessment that when one resident becomes agitated they should be left to their ‘own devices’, whilst ensuring their safety. There is no further entry relating to this and no consideration of what might trigger their anxiety and what can be done to reduce these triggers. Another person’s records contain a similar lack of analysis of the resident’s experience. During the inspection, an altercation was heard between two residents, when a carer intervened they tried to reason with both parties, which caused further conflict, and then left the room again. There was no evidence of using strategies of distraction or occupying the residents. In one person’s notes it was recorded that they had lost a toenail, there was no further details apart from a note that the district nurse was due in. Some individual records of care contain ‘cream charts’ but these are not consistently completed, which was recognised by a senior member of staff. The ‘cream Davey Court DS0000039203.V292590.R01.S.doc Version 5.1 Page 13 chart’ for a person who had been identified as high risk for ‘skin problems’ was also incomplete. In the daily notes for one resident a sore was identified in January 2006, which was reported, but no further reference was made to the action taken after this entry. The home has no records of the weights of residents for the period of December 2005, February 2006, March 2006, April 2006, May 2006. Staff also explained that the current style of weighing scales is inappropriate for many of the residents. Generally, records showed that residents’ weights were fairly stable. However, the records for October, November 2005 and January 2006 showed that one resident had lost a significant amount of weight but there was no clear action plan to address this. A food and drink monitoring form was seen for this resident but this was inconsistently completed, stopped without explanation and had no agreed goal. Poor fluid and food intake was identified in 12/7/05 as a risk for this person but no strategy was in place in their care records. Staff confirmed that this was still a concern and that the resident now received build up drinks. Another resident’s records showed that in a four month period they had lost a stone in weight with a record of 6 stone in January 2006. Neither of these residents had a record of their current weight. There is no nutritional tool used by the home to compensate for unsuitability of the scales. There has been no continence training in the home in the last two years according to a permanent member of staff. The trainer cancelled training and a member of staff said that the completion of continence charts was not consistent. However, two carers felt well supported by the district nurse team. There were several incidents of residents needing support with wet clothing during the inspection, and one resident said that they had wet themselves trying to find a toilet. Daily care notes also showed that wet clothing regularly has to be changed for some residents. Several residents’ rooms smelt strongly of urine. All of these examples indicate that continence could be better managed within the home. Daily notes in residents’ care plans were appropriately written and examples were seen of respectful and friendly conversations with residents and staff. Staff sat next to residents when they supported them with meals, which is good practice. Residents looked well cared for and appeared appropriately dressed. However, some visitors commented that their relative’s clothes were sometimes lost and occasionally people were given clothes to wear that did not belong to them. Some staff acknowledged this was a complaint by relatives, and that it did happen particularly for respite residents, and explained that there were no cover arrangements in place if the regular person in the laundry was away from work. Inappropriately worded signs were seen in some residents’ rooms, that compromised their privacy and dignity. Named continence monitoring sheets were left in a public area. One communal toilet had no lock. Davey Court DS0000039203.V292590.R01.S.doc Version 5.1 Page 14 Some staff did not always value residents’ right to confidentiality and respect. For example, one carer was walking with a resident, who had been incontinent, the carer told another colleague who was further down the corridor about what had happened. This conversation was loud enough that it could be heard through a closed glass door. Another member of staff was seen shutting the door in the face of a resident asking for help. A third member of staff was heard saying to a resident who was asking for help, ‘what’s the matter now? You’re all right’. The member of staff then walked past them. Comment cards received from one staff also indicated that they felt some staff at the home needed training in respecting residents’ wishes. Three members of staff raised concern that staff could not always provide a peaceful and respectful environment for residents who were dying. None had been given specific training in this area since working for Devon County Council. Only three members of staff have received training in this area according to records, and all these people according to care staff are not regularly involved with ‘hands on’ care of people who are dying. Four residents’ files were checked and none contained the ‘last wishes’ of residents. This is particularly relevant when the resident has no representative to advocate for them. Poor recording of religious belief and faith further compounds this problem. Topical creams were seen on top of the safe in the office. These creams did not have an ‘opened on’ date on them, as although the creams are changed every month it is good practice to be able to evidence when the creams were first used. On the first visit, medication was being put into pots by the Assistant manager, who signed the MAR (Medication Administration Record) sheet, then given to a care assistant to give to the resident. Therefore the person actually giving the medicine did not sign the MAR sheet, which means that the person ‘potting’ the medicines could not confirm the correct medicine was given to the appropriate resident, and the person administering the medicine could not confirm the correct medicine had been put into the pot. On the second visit, this practice had stopped, but the staff member who was giving out the medicines was seen to leave the trolley opened and unattended in the main hallway while giving medicines to the resident. Both are unsafe practices. No resident at the home self medicates. Following the inspection the inspector was sent a copy of the risk assessment policy for anyone who wished to self medicate. This did not take into account individual strengths of residents or look at ways in which residents could be enabled to self medicate When not in use medicine trolleys were securely stored. Davey Court DS0000039203.V292590.R01.S.doc Version 5.1 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 poor. This judgement has been made using available evidence including a visit to this service. Residents are able to maintain contact with family and friends. The home does not offer a suitable range of activities and entertainments to suit individual interests. Meals are nutritious but improvements could be made to ensure that residents are encouraged, wherever possible, to make a real choice. EVIDENCE: The home did not offer a stimulating environment, although residents were heard being asked by staff about their choice in music. Carers often seemed task orientated rather than spending time with residents. For example, laying tables, sorting laundry and making drinks. There is a lack of co-ordination around activities and no overview as to what is provided. There is a lack of recognition of residents’ individual interests, as these are not recorded in individual plans of care. Davey Court DS0000039203.V292590.R01.S.doc Version 5.1 Page 16 However, on the second visit, one inspector sat in the upstairs lounge and observed residents leaving the dining room and sitting in the lounge. There was especially good interaction between one member of staff and the residents. There was good eye contact and general chat as each resident was helped into the lounge, where they were offered the choice of where they wished to sit, and whether they wanted to listen to music, watch the TV or enjoy the quiet. There was much laughter and chat as this was happening. However, one resident was left at the door of the lounge, by another care assistant, the resident was unable to walk to a chair unaided and had to grab hold of another resident to enable them to reach a chair. Two visitors said they were able to visit when they wanted to and described some staff as helpful, kind and welcoming. Staff were heard complaining that activities equipment was missing. Activity records were inspected on both floors and showed that activities did not occur daily. Where activities were offered, it was often recorded that small numbers of residents participated. One carer commented that nobody wanted to participate in an offered activity but no alternative was recorded. Staff confirmed that trips outside of the building rarely took place. Nine residents were asked about how they passed the time, most were uncertain what happened, and several linked this question with the routine of meals and marking time. Some liked to watch TV and the garden. One person was identified by a number of staff as needing one to one support but all felt that they did not have the time to provide this. The person was seen sitting with their head in their hands and looking withdrawn. Visitors said they were unaware of activities. The home is registered to meet the care needs of people with dementia but care records show a lack of expertise in this area. One care assistant who was spoken with, had worked at the home for approximately two years and had no training in working with residents who may have dementia. Examples were seen of restricting residents’ freedom and ability to choose. One resident was identified as having anxiety and a risk of getting lost ‘because of disorientation’ and the recorded strategy was for ‘care staff to monitor whereabouts, secure unit’. This does not recognise the experience of the resident, and how frightening or frustrating it might be to feel lost. There is no recognition of maintaining independence. The home environment does not enable residents to take control over their lives as the general signage is poor and residents’ doors all look alike. In another person’s individual plan of care there is conflicting information about their ability to exercise choice. For example, the resident is ‘to remain in a room upstairs so (they) cannot see doors to outside space…escort (them) in the garden’, which contrasts with ‘enable (resident) to wander both floors when garden is made safe’. Plans have started to make the garden safe so that residents have the choice as to which areas of the home they use. Staff Davey Court DS0000039203.V292590.R01.S.doc Version 5.1 Page 17 explained that they offered choice with regards to the menu but often residents could not remember what meals were when they were described. On both visits the cooks on duty were supplied by an agency. Neither cook was aware that there were residents who were vegetarian. Staff were aware of this, but told the inspector that they knew the residents would eat the meal on those days and so did not feel it necessary to tell the cooks. Care staff said that they were aware that the cook had on various occasions prepared vegetarian meals for these residents. On the first day of inspection the cook made milk pudding with artificial sweeteners, so that residents with diabetes could be offered the same sweet as other residents. Two lunchtime meals were observed. One meal was calm and unhurried; with food being presented in a manner suitable for the individual needs of residents e.g. plate guards. There was a relaxed atmosphere with residents and staff chatting, and people choosing where they sat and when they ate their meal. Staff were heard offering choice. The atmosphere of the second meal was tense and rushed, with poor communication between the staff group, and little eye contact between staff and residents. Residents were not heard being told what the meal was and many appeared subdued. The seating arrangements caused a problem for some residents. Furniture was sticky and the tables were not attractively set out. Condiments were not available and there was no choice of drink, although staff confirmed there was a selection but they had not been offered. Davey Court DS0000039203.V292590.R01.S.doc Version 5.1 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 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Complaints are not always handled correctly and complainants are not always assured that their concerns will be listened to and acted upon. Staff training in adult protection issues is satisfactory though poor communication within the home has the potential to place residents at risk of harm or abuse EVIDENCE: The home follows the Devon County Council Complaints procedure. A new procedure has recently been introduced to enable staff to raise concerns/offer suggestions for improvement/receive feedback on their suggestions. No staff spoken with had used this new procedure. Only one file is kept for complaints, incidents and notifications made to the Commission. The inspector had difficulty in seeing where incidents and complaints had been followed up. One complaint, from a relative, referred to the general unkempt appearance of their relative. Though the form indicated that staff should be made aware of the issues there was no evidence that this had happened. Staff told the inspectors, and training records and staff files showed that staff had received training in POVA (Protection Of Vulnerable Adults) issues. Staff Davey Court DS0000039203.V292590.R01.S.doc Version 5.1 Page 19 also gave good responses as to the action they would take if they suspected abuse was occurring in the home. However, staff told the inspectors that they were aware that bad practice by some staff (including agency staff), such as ‘being snappy’ with residents had been reported to senior staff, but that nothing had been done about this. Some members of staff described keeping concerns until their supervision rather than reporting concerns as soon as they happened. This may mean that residents are at risk from this delay. Since the last inspection the Commission has received two complaints. Both complainants raised issues relating to the hygiene of the home. One also raised issues relating to the handling of a previous complaint and poor induction for staff. On both occasions the provider had investigated the complaints and sent copies of their findings to the Commission. The complaints were found to be upheld. Davey Court DS0000039203.V292590.R01.S.doc Version 5.1 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 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The standard of the environment within the home is poor, and does not provide residents with a clean, safe, comfortable and homely place to live. EVIDENCE: Visitors and staff commented on the poor state of repair of some areas of the home, particularly carpets in the corridors. One sluice room had ripped flooring, and one communal bathroom has concrete showing through the plaster, holes and marks on the walls, poor décor, and chipped and dusty wood. Chairs in one of the lounges were stained on the headrests and furniture in one of the dining rooms was sticky. The kitchenette area in the lower corridor had a dirty sink and cupboards, with broken handles. Work is currently being carried out to make the garden safe for residents to use. Davey Court DS0000039203.V292590.R01.S.doc Version 5.1 Page 21 Residents are not able to lock their door from the outside and one resident said that sometimes other residents walked into their room by mistake. Nine bedrooms were inspected; two smelt strongly with urine (they were visited twice on the first day of inspection and on the second day of inspection), and an immediate requirement was made to address this. The Commission has since received notification that these two rooms are being refurbished. Four had stained wallpaper and/or marked, unclean carpets. However, staff interviewed showed a respect for residents’ privacy and their belongings but explained that domestic staff sickness and holiday was not covered, which made it hard to keep on top of the work. Throughout the home, paper towels and liquid soap were seen. Staff were seen wearing protective aprons and gloves, and a member of staff described infection control measures, including identifying the mops used for different areas of the home. Davey Court DS0000039203.V292590.R01.S.doc Version 5.1 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 poor. This judgement has been made using available evidence including a visit to this service. The procedures for the recruitment of staff are robust and offer protection to residents. Training in specific areas such as dementia must be improved in order to better meet the needs of residents. EVIDENCE: Staffing rotas show that there are generally eight care staff on duty each morning till early afternoon and seven from then till 9.30pm when two night care assistants and one night care officer come on duty. There are also domestic staff, a handyman and cook and an assistant manager on duty during the day-time period. However, when any domestic staff are away from the home, there has been no cover for their hours, leading to cleaning not being done as required. Staffing levels are maintained by a heavy reliance on agency staff. Efforts are made to try and maintain consistency. Staff said that on some shifts all staff were from an agency, apart from the manager. Agency staff spoken to had not received training in the care of people with dementia, which is the home’s Davey Court DS0000039203.V292590.R01.S.doc Version 5.1 Page 23 registration category. Records show that the majority of permanent care staff have not received training in the care of people of dementia. Staff have received general training including manual handling, conflict resolution and working with vulnerable adults. Staff training records are kept in a manner, which makes auditing difficult as they do not contain dates. However, staff were generally positive about the training available to them, and those who had attended training on the care of people with dementia could give examples of how it had changed their practice or outlook. The files of the two most recently appointed staff were inspected and both contained all the required information relating to recruitment, including two written references and satisfactory CRB (Criminal Records Bureau) checks. However, there were no records to indicate that staff had received an induction. One of the newer staff said that she had not received an induction, though another staff member who had been at the home for some time said that she had received an induction at the local hospital then ‘shadowed’ staff at the home. Six staff spoken to said there was low morale within the staff team. They said this was because of uncertainty about the future of the home, a ban on smoking and a lack of leadership. They also commented on staff leaving and high levels of sickness from work. Davey Court DS0000039203.V292590.R01.S.doc Version 5.1 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, 36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has not been well managed and this generally results in poor practices that do not promote and safeguard the health, safety and welfare of the residents. The home has no methods in place to check the quality of the services and facilities provided. EVIDENCE: The registered manager is currently on sick leave and a manager from another home has just transferred over for a three month period. Therefore, she has not had any time to implement changes. Davey Court DS0000039203.V292590.R01.S.doc Version 5.1 Page 25 Staff told inspectors that there was poor communication between assistant managers in the office, which included poor quality handovers. One staff told the inspector that she would not bother telling some assistant managers about things as nothing was ever done. One staff said that she had reported bad practice to an assistant manager, but another assistant manager was unaware of this. Some staff reported concerns that some of the managers did not spend time on the floor and were therefore unaware of the needs of the residents. They felt that too much time was spent in the office, although one manager was singled out as being approachable and taking action on concerns. During the inspection, it was observed that the management team had a heavy workload hampered by answering the telephone and the front door. There is little administration support at the home. This has recently been recognised by an internal audit and is due to be addressed. Staff spoken to said they received adequate supervision sessions combined with staff meetings, although they did say these were often cancelled. There was no evidence of a quality assurance program for the home in order to ensure the home is run in the best interests of the residents. A ‘communications book’ is maintained by the senior staff in the office. This book contains much personal information about individual residents that would be more appropriately recorded on residents’ care plans. The recordings are not signed by the person making the entry. In a communal area, washing up liquid and air freshener were found in an unlocked cupboard, which has the potential to put residents at risk. An immediate requirement was made to make this area safe. One radiator in a resident’s room did not have a cover fitted, and as this resident has poor mobility, they may be at risk of falling against the radiator and suffering burns. Records relating to fire safety at the home were well maintained and indicated that the appropriate checks had been made and that staff had received appropriate training. However, the inspectors noticed that there were no fire extinguishers in strategic locations around the home. The inspectors were told that this was because staff had been told that they must not use the extinguishers. Further discussions with staff indicated that there was a varying range of confidence and knowledge in this area. One person had worked at the home for six months and said that they wouldn’t have a clue what to do as they had received no training, two people said they had been told not to use the fire extinguishers, other people said they had not been told this but had not been trained in using them, one person said they had fire training two years ago, and another said they had received no training apart from fire drills Davey Court DS0000039203.V292590.R01.S.doc Version 5.1 Page 26 despite working at the home for two years. Some staff seemed unclear as to whether they stayed with residents or went to the fire panel for instruction. Staff were unaware whether risk assessments had been carried out for individual residents. They said one resident became very agitated by the fire alarm bells. The inspectors tried to contact the Devon Fire and Rescue Service (DFRS) about their concerns, but could not. They contacted a representative of Devon County Council who agreed to contact DFRS for their advice, he also arranged for an adviser from Devon County Council to visit the home. Information provided subsequently indicates that the above concerns have been addressed. Davey Court DS0000039203.V292590.R01.S.doc Version 5.1 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 1 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 1 1 X X X 2 X 1 STAFFING Standard No Score 27 1 28 1 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X 2 3 X 1 Davey Court DS0000039203.V292590.R01.S.doc Version 5.1 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. Standard 1. OP3 Regulatio n 14(1) (c) (d) Requirement The registered person shall not provide accommodation to a service user at the care home unless…there has been appropriate consultation regarding the assessment with the service user or a representative of the service user, and confirmed this in writing. (The registered person must meet, where practicable, with prospective service users and/or their representatives, prior to admission). The registered person shall not provide accommodation to a service user at the care home unless…there has been appropriate consultation regarding the assessment with the service user or a representative of the service user. (The registered person must meet, where practicable, with prospective service users and/or their representatives to ensure that people outside of the home’s category are not admitted unless DS0000039203.V292590.R01.S.doc Timescale for action 21/09/06 2. OP4 14 (1) (c) 21/09/06 Davey Court Version 5.1 Page 29 3. OP7 15 (1) 4. OP8 5. OP9 6. OP9 7. op10 discussed with CSCI). Unless it is impracticable to carry out such a consultation, the registered person shall, after consultation with the service user or a representative of his, prepare a written plan [ the service users plan] as to how the service users needs in respect of his health and welfare are to be met. (Care plans must include the health; personal and social care needs of each resident. Risk assessments must be updated previous timescale of 05/10/05 not met.) 12 (1) (a) The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. (There must be a review of how residents are supported with continence issues. A new system must be put in place to monitor residents’ weights with action to be taken clearly recorded. Health visits and advice, and the action taken must be clearly recorded.) 13(2) The registered person shall make arrangements for the recording and safe administration of medicines received into the home (creams must be marked with an ‘opened on’ date) 12(2) The registered person shall so far as practicable 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 12(4)(a) The registered person shall make suitable arrangements to ensure DS0000039203.V292590.R01.S.doc 21/09/06 21/09/06 21/09/06 21/09/06 21/09/06 Page 30 Davey Court Version 5.1 that the care home is conducted in a manner which respects the privacy of service users. (This relates to staff conversations overheard in a corridor and inappropriately worded signs) 8. OP18 The registered person shall make 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. CSCI must be informed of all adverse events in the home). 13(4)(c ) The registered person shall ensure that unnecessary risks to the health or safety for service users are identified and so far as possible eliminated (this relates to flooring and general maintenance of the home) 16 (2)(K) 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. 18 (1) (a) 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 all care staff have knowledge/training in the care of people with dementia). 18 (1) (c) The registered person shall (i) ensure that the persons DS0000039203.V292590.R01.S.doc 13 (6) 21/09/06 9. OP19 21/09/06 10. OP26 21/09/06 11. OP27 21/09/06 12. OP30 21/09/06 Page 31 Davey Court Version 5.1 13. OP31 14. OP33 15. OP38 16. OP38 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). 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.) 24(1)(2) The registered person shall (3) 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 23 (4) (a) The registered person shall after (d) consultation with the fire authority take adequate precautions against the risk of fire, including the provision of suitable fire equipment and make arrangements for persons working at the care home to receive suitable training in fire prevention. 13 (4) (a) The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards. (Ensure that all cleaning fluids are locked away in areas DS0000039203.V292590.R01.S.doc 21/09/06 21/09/06 21/09/06 21/09/06 Davey Court Version 5.1 Page 32 17. OP38 accessible to residents). 13 (4) (a) The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. (A radiator cover must be fitted to the radiator in room 33). 21/09/06 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. 2. Refer to Standard OP7 OP10 Good Practice Recommendations Care plans should be reviewed monthly and updated to reflect changes. Cover arrangements for the laundry should be reviewed, and systems put in place to ensure that residents’ clothes are not lost, and that residents are wearing their own clothes. The privacy and dignity of the service user who is dying should be maintained at all times, and staff should be supported in this area of care through training and discussion. The home should ensure that is adopting current good practice models of end of life care. The service user’s wishes concerning terminal care and arrangements after death should be discussed, recorded and carried out. The home should consider how residents are informed about the menu to make it more accessible and to promote choice. For example, a menu with photographs. The management of meals should be reviewed in order to make them a relaxing and enjoyable experience. All staff should be reminded to report concerns of poor practice immediately to a senior member of staff. Doors to residents’ private accommodation should be fitted with locks suited to their capabilities and accessible to staff in an emergency that can be locked from the outside Cover arrangements for the domestic staff should be reviewed to ensure that the home is clean and odour free 3. OP11 4. 5. 6. 7. 8. 9. OP11 OP15 OP15 OP18 OP24 OP26 Davey Court DS0000039203.V292590.R01.S.doc Version 5.1 Page 33 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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.V292590.R01.S.doc Version 5.1 Page 34 - 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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