CARE HOMES FOR OLDER PEOPLE
Daw Vale 56 West Cliff Road Dawlish Devon EX7 9DY Lead Inspector
Sharon Goldsworthy Unannounced Inspection 1st March 2006 09:40 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 Daw Vale DS0000032522.V262911.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. Daw Vale DS0000032522.V262911.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Daw Vale Address 56 West Cliff Road Dawlish Devon EX7 9DY 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) 01626 863447 01626 888854 Devon County Council Vacancy Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (19), Physical disability (12) of places Daw Vale DS0000032522.V262911.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Physical Disability over the age of 55 years Date of last inspection Brief Description of the Service: Daw Vale is a care home providing personal care and accommodation for 31 Older People within the category of old age, with or without physical disability. It has 12 beds for short stay use and for rehabilitative care, for people with physical disability over 50 years of age. The home is located on the outskirts of Dawlish, close to shops, a library, churches, doctors surgeries, a hospital, pharmacies, communal gardens, public houses, a post office and a railway station. All bedrooms are for single occupancy. The home has gardens and patio areas with seating and ample parking spaces to the front. Daw Vale DS0000032522.V262911.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection is the second of this inspection year. It was unannounced and took place over five hours. The Inspector met with staff on duty and sample of residents in the long stay unit, conducted a tour of the premises, viewed care practice and looked at a selection of documentation. A discussion with and feedback was given to the acting manager when he came on duty at 1.30pm. Since the last inspection, there has been a change of management in the home. The Inspector has had regular contact with the now acting manager and has received an application for their registration with the CSCI. Devon County Council are currently undertaking a review of a number of its care homes, including Daw Vale. A consultation process is being undertaken and a decision will be reached in early April 2006 as to Daw Vale’s future. As such all placements to the long stay unit have currently been suspended. There are currently sixteen long-term residents in this home. What the service does well:
Daw Vale provides a range of services from day care, short-term (respite) care, a rehabilitation unit and long stay care. Each has a dedicated unit within the home. A large number of the residents on the long stay unit have been gradually introduced to the home through the day care or short-term care units. Much of the staff team have worked in the home for some years, in particular the senior staff team and are knowledgeable of their residents and their individual needs. Residents continue to state that the care is good, that the staff are knowledgeable, kind and very caring. All residents spoken to confirmed that they are happy in the home and feel that their needs are being met. Many residents spoke highly of the food in home. Care practice observed was appropriate and given with respect. Care was given promptly when required and staff were cheerful, chatty and empathetic. The home is commended for its training programme and commitment to providing a good level of training to ensure that staff can meet the needs of its current resident group. Daw Vale DS0000032522.V262911.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? 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. Daw Vale DS0000032522.V262911.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Daw Vale DS0000032522.V262911.R01.S.doc Version 5.1 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 the following standard(s): 3 Residents only move into the home having had their needs assessed and assured that their needs can be met in this home. EVIDENCE: Most long term residents in this home have entered the home through the day care, short term respite or rehabilitation units. Most are currently placed at the home through Devon County Council. A sample of five resident records were viewed on the day of this inspection visit. All of these records include the placing authority referral, a care management assessment of needs and the homes initial assessment of needs. Daw Vale DS0000032522.V262911.R01.S.doc Version 5.1 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 the following standard(s): 7, 9 The resident’s health, personal and social care needs are set out in their care plans, with the need for this to be further improved. Residents are generally protected through the home’s medication policies and procedures. EVIDENCE: Five care plans and daily care notes were seen on the day of this inspection. The Acting Manager has created and implemented a new set of care planning documents. Care plans were found to be complete for all five inspected. However, there remains a need for these documents to be completed in much more detail than they currently are to ensure that care givers have all the information required with which to assist individuals with care needs. Examples of this are where a resident is reported to require “assistance with feeding”, “requires frequent checks” or “may require assistance with washing and dressing”. The daily care records for all five residents were also viewed in detail. Again these documents have been reviewed and updated documents implemented and in the main there has been an improvement in record keeping since the
Daw Vale DS0000032522.V262911.R01.S.doc Version 5.1 Page 10 last inspection. As at the last inspection however, some care records need to detail where follow up action has been taken or where specific monitoring has been required. Examples of this are where a resident is reported to have “a heel that is dry” on the 13th Feb 06. There is then no other mention of this until the 17 Feb 06, when care records state, “broken skin on heel – dressing applied – will get the DN to check on Monday”. On Monday 23rd Feb 06 records state “DN visited to see heel – keep an eye on and cream – cream applied”. There is then no other mention of monitoring or ongoing treatment of this resident’s heels. The Acting Manager stated his intention to re-iterate the need for these records to be sufficiently detailed and record all details. The medication system was found to be stored appropriately, administered correctly and recorded as required, with the exception of three records that were not signed on one morning in the previous week. The Deputy Manager on duty was unable to identify the person responsible from other records. From observation of the medications themselves, it appears as though this medication was however, administered. Photographs of all individuals are at the front of administration records. Controlled Drugs are also stored and recorded appropriately. These systems ensure that those residents receiving medication from care staff are protected from harm or abuse. However, the Acting Manager reported that some errors in the administration of medications has been highlighted recently, and that disciplinary action for the staff members responsible is currently being considered. Daw Vale DS0000032522.V262911.R01.S.doc Version 5.1 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 the following standard(s): 12 The current range of activities offered does not fully meet the needs of all individuals, however, the more able residents have freedom and choice and are enabled to continue with social and recreational activities. EVIDENCE: A care staff member post is now covering the Activity Officer. The residents spoken with reported that some activities are offered on the long stay unit such as reminiscence, quizzes and exercises. Regular entertainers are brought in to the home and regular events such as parties. At the last inspection visit, some residents spoken with reported that they spend some of their time downstairs in the short-term rehabilitation unit, where they feel more able to have discussions and a varied resident group. This is a positive decision and this is supported by the care staff. The Acting Manager feels that there is now a greater range of activities being offered on the long stay unit. There remains the need for the acting activity officer to work on a suitable format on which to record activities that individuals participate in detail. Daw Vale DS0000032522.V262911.R01.S.doc Version 5.1 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 the following standard(s): 16, 18 The system in place for making complaints gives the residents and relatives the confidence that they will be taken seriously and acted upon. The systems, policies and procedures and staff training programme ensures residents are protected from abuse. EVIDENCE: The home has a comprehensive complaints procedure that was found in the Statement of Purpose, Service User Guide and displayed throughout the home. At the last inspection, both residents and relatives confirmed that they are aware of the complaints procedure and that they are aware of how to make a complaint should they wish. Most of the residents and relatives are aware of the Commission for Social Care Inspection (CSCI) and of how to contact them. There are leaflets in the main entrance about the CSCI. The home has a system in place whereby complaints made directly to the home’s manager are passed to Devon County Council to investigate and monitor. The home has policies and procedures in place concerning the Protection of Vulnerable Adults from Abuse, Confidentiality and Whistleblowing. The staff induction programme covers these topics. All staff who have or who are completing NVQ training cover these topics as part of this qualification. There remains a need for eight staff members to complete formal training in relation to the Protection of Vulnerable Adults from Abuse. The home has a rolling training programme that these staff members are booked in to complete. Daw Vale DS0000032522.V262911.R01.S.doc Version 5.1 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 the following standard(s): 19, 26 Residents live in a well-maintained, homely and clean environment EVIDENCE: The home presents as being well maintained, clean and homely. The home has continued with a redecoration programme to the hallways, entrance hall, communal rooms on the long stay unit and some bedrooms. A Requirement remains outstanding from the last three inspection reports that is the responsibility of Devon County Council. Most windows are now in need of replacement. Residents again made comments about the windows on the day of this inspection, stating that some are draughty. Despite previous requests to do so, Devon County Council has not as yet, provided the Commission for Social Care Inspection with an action plan addressing this issue. It must be noted that this is the only issue raised by the residents that was negative. Daw Vale DS0000032522.V262911.R01.S.doc Version 5.1 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 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): None of these standards were considered in depth at this inspection visit. EVIDENCE: Daw Vale DS0000032522.V262911.R01.S.doc Version 5.1 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 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): 33, 35 The home is run in the best interests of the residents and their financial interests are safeguarded through the home’s policies and practices. EVIDENCE: The home has a comprehensive quality assurance programme in place, including; a suggestions box and visitors comments book in the main entrance hall, resident meetings, visitor and resident questionnaires, stakeholders questionnaires, staff meetings, staff supervisions, management meetings and person in control monthly visits. In addition, both the manager’s and senior staff members offices are situated in the main entrance hall and were seen to be open and accessible to visitors and residents at all times on the day of this inspection visit. A discussion took place with the acting manager about the need to devise a clear development plan following collation of all of the above feedback received and to make this available to all residents and other stakeholders. The acting manager feels that this process will be re-initiated and completed following the decision about the home’s future being made in
Daw Vale DS0000032522.V262911.R01.S.doc Version 5.1 Page 16 April 2006. This is acceptable and should the home continue to function as a long term care facility, this would be a good time to fully review the current service and to commit to a development programme for its future improvement. The home holds a number of long-term residents’ monies. Appropriate records were found to be in place with receipts being kept securely and two signatures obtained for any monies put into the fund or taken out. All residents’ monies are currently pooled into one tin and a running balance of the total amount held is kept. The inspector checked the amount of monies held against the balance and found this to be correct. Daw Vale DS0000032522.V262911.R01.S.doc Version 5.1 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X X Daw Vale DS0000032522.V262911.R01.S.doc Version 5.1 Page 18 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 OP7 Regulation 17(1) Requirement Ensure that care plans and daily care notes record an appropriate level of detail and follow up and monitoring (previous timescale 30/5/05) Provide the CSCI with an agreed action plan with timescales indicating when new windows will be fitted (Previous timescale given 30/1/05, 30/6/05) Timescale for action 30/03/06 2. OP19 23(2) 30/04/06 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 OP12 OP18 Good Practice Recommendations Develop and implement more detailed records in relation to activities offered. All staff must attend as planned certificated training in relation to the Protection of Vulnerable Adults from Abuse Daw Vale DS0000032522.V262911.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton 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 Daw Vale DS0000032522.V262911.R01.S.doc Version 5.1 Page 20 - 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!
