CARE HOMES FOR OLDER PEOPLE
Davey Court Buckingham Close Exmouth Devon EX8 2JB Lead Inspector
Michelle Oliver Unannounced 7th September 2005 10:00hrs 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 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 D54 D06 S39203 Davey Court V243726 070905 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Davey Court Address Buckingham Close Exmouth Devon EX8 2JB 01395 273860 01395 222480 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Devon County Council Mrs Jacqueline Cecilia Franklin Care Home 43 Category(ies) of DE(E) Dementia - over 65 (43) registration, with number of places Davey Court D54 D06 S39203 Davey Court V243726 070905 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1 The home may continue to care for four named people in the category OP, for as long as the unit can meet their needs. 2 The maximum number of placements including that of the 4 named persons will remain at 43 3 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. Date of last inspection 5 May 2005 Brief Description of the Service: Davey Court provides 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 (4 dining areas, 4 lounges, a conservatory) of high quality, nicely decorated and with comfortable furniture. Davey Court D54 D06 S39203 Davey Court V243726 070905 stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place on Wednesday 7th September 2005 from 9.am to 2.pm.and was conducted by Michelle Oliver and Anita Sutcliffe. An assistant manager was present throughout the inspection. The inspector spoke to a number of service users, staff and a visiting social worker during the visit. The atmosphere in the home was warm, welcoming and friendly and residents were relaxed, and comfortable. The inspectors looked around the home, a number of records were inspected, which included service users’ care plans, staff recruitment files and fire logbook, The manager and staff were very helpful on the day of the inspection and a lot of positive discussions took place throughout the inspection. What the service does well: What has improved since the last inspection?
The environment has been made safer by the introduction of risk assessments for a kitchenette area on the first floor. Some building work is planned that will further improve the safety of this area. Improvement in the recording of the receipt and administration was seen. Details of service users preferred activities and interests have been sought and recorded. A member of staff is responsible for the activities programme at the home and staff daily undertake these with service users. The home was very clean with no offensive odour at the time of the visit. The domestic and care staff are to be commended for this improvement.
Davey Court D54 D06 S39203 Davey Court V243726 070905 stage 4.doc Version 1.40 Page 6 Hand washing facilities have been provided throughout the home thereby improving the infection control procedures. Although the home continues to have staff vacancies, staffing levels are met by consistent agency staff who know the service users, and their needs, well. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Davey Court D54 D06 S39203 Davey Court V243726 070905 stage 4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Davey Court D54 D06 S39203 Davey Court V243726 070905 stage 4.doc Version 1.40 Page 8 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 standard(s) None of these standards were assessed at this visit. EVIDENCE: Davey Court D54 D06 S39203 Davey Court V243726 070905 stage 4.doc Version 1.40 Page 9 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 standard(s) 7, 9, & 10. The staff and management team at Davey Court promotes Service users dignity, however their privacy is not always protected. Improvement is needed in the care planning process to ensure that staff are aware of service users’ needs. Some recording of drugs administration is not being attended to. EVIDENCE: The home promotes residents’ welfare in co-operation with families and health care professionals. Current care plans do not detail how service users’ health and welfare needs are to be met. One service user did not have a care plan. A requirement was made at the last inspection that care plans should be improved to include service users needs and how the staff will meet these needs. Four service users care plans were looked at. None of them clearly indicated needs, how they would be met, dietary needs, personal preferences and involvement of the service users or their relatives/representatives. An immediate requirement was made at the time of this visit that an action plan outlining the plans for making this area safe is sent to the Commission within two weeks. Davey Court D54 D06 S39203 Davey Court V243726 070905 stage 4.doc Version 1.40 Page 10 The recording of medication received into the home and when administered has improved. One service user’s medication had been discontinued but the current medication chart did not indicate this. This is a potentially unsafe system as the medication could have been given as the chart indicated that it was still a prescribed medication. Several pots of topical creams and ointments were not dated when opened or expiry date recorded. Some creams were stored in a locked bathroom in conditions that did not comply with the recommended temperatures for them to be stored at. One topical cream being used for a service user had been prescribed for another. It was explained to the assistant manager that these are the property of the person for whom they were prescribed and dispensed. It is not legal for these products to be supplied or used for any other person. No service users were looking after their own medication. There was no evidence that a risk assessment had been undertaken before this decision was made. A service user, who was due to be discharged to their home soon, said that they looked after the medicines at home but when they came to Davey Court she was asked to hand it over to the care staff. All service users who were able to communicate said that they are looked after very well by all staff at Davey court. They also said that staff treat them courteously and with respect. Staff are aware of the importance of respecting service users privacy. They were seen knocking on doors and waiting for a reply before entering. However, some of the service users wander into other service users’ rooms. At the time of the visit a service user had gone to a room, got into bed and removed their dentures. Staff said that some service users go into rooms and remove belongings. Davey Court D54 D06 S39203 Davey Court V243726 070905 stage 4.doc Version 1.40 Page 11 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 standard(s) 12, 14 & 15. A comprehensive programme of activities is about to be started for all service users at Davey Court. Meals are well managed and provide daily variation and interest for people living at the home. Service users are encouraged to make choices and to maintain their independence. EVIDENCE: Service users’ care plans include details of service users wishes in relation to interests and activities they would like to undertake. A member of staff has taken on the role of activities organiser at the home and a named carer will be responsible daily for carrying out the programme. At the time of the visit some service users had gone out in the mini bus to collect some day care clients and the service users on the first floor had a singsong and dancing. Service users took part in an exercise session during the afternoon. The new programme of activities is due to start on 12th September 2005. A variable, nutritious diet is provided at the home. This was confirmed by service users and from the meal on the day of the visit. A menu is displayed in the dining room. Davey Court D54 D06 S39203 Davey Court V243726 070905 stage 4.doc Version 1.40 Page 12 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 standard(s) 18 Satisfactory arrangements are in place for protecting residents and responding to concerns. EVIDENCE: There was no evidence to suggest that the service users at Davey Court are anything but well cared for and protected from harm at Davey Court. Davey Court provides a rolling programme of training and updates in the prevention of adult abuse. All staff said that they would report any bad practice to a senior member of staff. A senior member of staff was unsure of the correct alerting procedure if an issue was reported to them. A recommendation has been made that an update in training in alerting is undertaken. Davey Court D54 D06 S39203 Davey Court V243726 070905 stage 4.doc Version 1.40 Page 13 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 standard(s) 19, 24, & 26 Davey Court provides a generally comfortable well maintained environment, which promotes independence, but privacy arrangements could be improved. Infection control procedures are good. EVIDENCE: The home was clean with no unpleasant odours. The domestics and staff are to be commended for this improvement. Hand washing facilities are available throughout the home, soap and paper towel dispensers having been fitted since the last inspection. Service users’ bedrooms are pleasant and many had been personalised, however service users are not able to lock the door to their rooms if they wish. Davey Court has attractive grounds. These are accessible to service user, however paving stones are uneven, branches of a tree are low and spreading and present a risk of injury or harm to service users and visitors who may walk around the area. An immediate requirement was made at the time of this visit that an action plan outlining the plans for making this area safe is sent to the Commission within two weeks.
Davey Court D54 D06 S39203 Davey Court V243726 070905 stage 4.doc Version 1.40 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28, 29, & 30. Staff are employed in sufficient numbers to meet the needs of residents. Residents’ benefit from having experienced and friendly staff that have a good understanding of their needs. The procedures for the recruitment of staff are robust but lack of evidence of appropriate documentation may compromise the safety of residents living at the home. EVIDENCE: Staffing levels were within levels agreed by CSCI. Short falls in staffing levels are met by agency staff. Every effort is made to maintain consistency but this has not always been possible. During the visit staff spent time with residents and responded to their needs promptly. Three staff files were looked at. All confirmed that police checks and references had been obtained prior to them taking up employment at the home. The required proof of identity was not included in the files. Davey Court D54 D06 S39203 Davey Court V243726 070905 stage 4.doc Version 1.40 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35, 37 & 38. Service users’ financial interests are safeguarded. Several practices within the home are unsafe potentially putting service users, staff and others at risk. EVIDENCE: The fire logbook was looked at. Fire alarm tests are not regularly being carried out weekly. The gardens are not safe. Paving stones are uneven; branches of a tree are low and spreading and present a risk of injury or harm to service users and visitors who may walk around the area. [Refer to NMS OP Standard 19] Risk assessments for the kitchenette on the first floor are being complied with and there are plans for alterations that will make this area safer for service users. The home does not hold any service users money at the home.
Davey Court D54 D06 S39203 Davey Court V243726 070905 stage 4.doc Version 1.40 Page 16 Davey Court conducts a survey of service users/ relatives/ representatives/ health comments and views of the home annually. There is a suggestions box in the entrance of the home. The management operate an “ open door policy” so that service users and visitors can speak to a senior member of staff at any time if they have concerns or issues to discuss. During the visit several service users and visitors came to the office for various reasons and were attended to quickly and effectively. All records were securely stored in locked filing cabinets. Service users’ care plans are stored in a trolley in a locked bathroom. This was discussed with an assistant manager who said that space is limited and this is the only area where they can be stored and be locked. Recruitment files did not include proof of identity of staff. [Refer to NMS OP29] Davey Court D54 D06 S39203 Davey Court V243726 070905 stage 4.doc Version 1.40 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 x 9 1 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x 2 x 3 STAFFING Standard No Score 27 3 28 x 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x 3 x 3 x 3 1 Davey Court D54 D06 S39203 Davey Court V243726 070905 stage 4.doc Version 1.40 Page 18 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard op9 Regulation 15[1] Timescale for action Unless it is impracticable to carry 05.10.05 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. [ Immediate requiremnt made at time of inspection]. The registered person shall make 05.10.05 arragements for the recording and safe administration of medicines received into the home.[ this relates to topical cream being prescibed for a service user being used by another] The registered person shall so 05.10.05 far as practicable enable service users to make decisions with respect to the care they are to receive and their health and welfare.[ This relates to service users being given the choice of looking after their own medication in accordance with a risk assessment] The registered person shall make 05.10.05
Version 1.40 Page 19 Requirement 2. op9 13[2] 3. op9 12[2] 4. op10 12[4][a] Davey Court D54 D06 S39203 Davey Court V243726 070905 stage 4.doc 5. op29 19[1][b][ 1] Schedule 2 6. op38 23[4] [c][v] suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy of service users.[ This relates to service users wandering into others rooms]. The registered person shall not employ a person to work at the care home unless he has obtained the information specified in paragraphs 1-7 of Schedule 2.[This relates to 2 & 3 of Schedule 2] The registered personshall make adequate arrangements for testing fire equipment at suitable intervals. 05.10.05 05.10.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard op12 op18 op24 Good Practice Recommendations To continue the programme to improve the homes activities programme for service users. For all staff to be aware of the correct up to date alerting procedure of issues of abuse according to DSS procedures. Doors to service users private accommodation are fitted with locks suited to their capabilities and accessible to staff in an emergency. Davey Court D54 D06 S39203 Davey Court V243726 070905 stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection 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 D54 D06 S39203 Davey Court V243726 070905 stage 4.doc Version 1.40 Page 21 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
