CARE HOMES FOR OLDER PEOPLE
Daw Vale 56 West Cliff Road Dawlish Devon EX7 9DY Lead Inspector
James Rose Unannounced Inspection 10th October 2007 09:00 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.V349352.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Daw Vale DS0000032522.V349352.R01.S.doc Version 5.2 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 lesley.valentine@devon.gov.uk http/www.devon.gov.uk/adoption.htm Devon County Council Lesley Jane Valentine 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.V349352.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users in the physical disability category may be accommodated from the age of 55 years. 7th December 2006 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, 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. The weekly cost of care at the home is: lowest £281.00 and the highest £372.00. Daw Vale DS0000032522.V349352.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and was undertaken over 7 hours. A questionnaire had been completed by the home and evidence of what the home is like was obtained from consulting four residents individually; other residents were seen in small groups. Four visitors to the home were also asked for their views. Samples of care and management records were examined and three external healthcare professionals were asked for their views of the service provided. Three members of the care team were also interviewed individually, in private. A complete tour of the home was undertaken as part of the inspection process and the registered manager assisted throughout. What the service does well: What has improved since the last inspection?
Two requirements were raised at the last inspection, one called for a dedicated care team to be available to work with people requiring intermediate care, and the other one required that each resident in the home had an individual care plan available. Both of these requirements have been satisfied. The home has a redecoration programme running, which is undertaken by a member of the staff team. Daw Vale DS0000032522.V349352.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Daw Vale DS0000032522.V349352.R01.S.doc Version 5.2 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.V349352.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. Quality in this outcome area is good. Comprehensive assessments are undertaken of a prospective resident, prior to them moving into the home. This process is being developed further. Residents referred for intermediate care are given good assistance to maximise their independence and return home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The long stay residents have their needs assessed in the areas of health, personal and social before they move into the home. This ensures that their needs can be met by the service offered. Five assessments were examined at the time of the inspection and these were then discussed with the manager who had agreed to develop the process further to enable the home to provide a more ‘client centred’ approach. In the case of an emergency admission a full assessment is undertaken as a matter of priority within 72 hours. Residents who are admitted for intermediate care are helped to maximise their independence in order that they can return to their own home as soon as
Daw Vale DS0000032522.V349352.R01.S.doc Version 5.2 Page 9 possible. Persons admitted solely for intermediate care stay at the home for a maximum of six weeks. Since the last inspection carried out on the 1st March 2006 44 persons have been through the intermediate care facility at the home. Daw Vale DS0000032522.V349352.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. Quality in this outcome area is adequate. There is a comprehensive care plan available for each resident in the home. Health needs are fully met. Residents are able to self medicate. There were some problems with the home’s administration of medication records; this means that people are not protected by robust procedures. All the residents consulted felt they were always treated with sensitivity and respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was a comprehensive care plan in place for each person receiving a service at the home; five of these were examined in detail as part of the inspection process. Health and personal needs were well covered, the social needs required some development and this was discussed with the registered manager. It has been agreed that the necessary development will b e undertaken in the home and the more detailed approach will be in place within two months. This process will enable the home to provide a ‘client centred’ service to residents. Three healthcare professionals were consulted who provide a service to the home and they all had confidence in the service provided.
Daw Vale DS0000032522.V349352.R01.S.doc Version 5.2 Page 11 The care plans in the home were agreed with the person to whom it concerned and these residents advised that all their needs were met by the service provided. Residents who wish to self medicate are able to do so subject to a risk assessed approach to ensure they have the capacity and are safe. The medication administration recordings undertaken by the home were examined medication was checked and booked in when received, and issue record was available and unused medication was recorded and returned to the pharmacist. At the time of the inspection there were substantial gaps in the issue record of medication supplied to residents. A requirement has been raised in this report to ensure that a complete record is maintained. Residents were consulted in groups and four were seen individually in private during the inspection. They all advised that they were always treated with respect by their carers and care was observed as being delivered in a sensitive way. Residents were not rushed when mobilising and time was given to allow residents to answer questions after thinking about their answer. Daw Vale DS0000032522.V349352.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. Residents advised that they enjoyed life and there were enough activities at the home. There are good visiting arrangements and residents are encouraged to maintain contact with family and friends. People are well enabled to make their own decisions about matters that affect them. The meals provided are good and to people’s liking. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Five residents were consulted individually in private during the inspection and others were seen is small groups, they all advised that they enjoyed life at Daw Vale and added that they had plenty of activities. When asked no suggestions were made of any additions residents would like to have. The activities programme is displayed in the home to keep residents informed and entertainers are retained every two months. Trips out are organised when weather permits. As previously mentioned in the report the home is going to develop the social element of the care planning process further to provide a more ‘client centred’ approach for residents. Daw Vale does not have any restrictions on visiting and people are made welcome when they arrive. Four visitors were asked for their views during the
Daw Vale DS0000032522.V349352.R01.S.doc Version 5.2 Page 13 inspection and they were very positive about the home. Encouragement is provided for residents to maintain their contacts with family and friends. A small telephone room is provided on the ground floor where residents can make calls with complete privacy. Residents were clear that they made their own decisions about matters that affected them and this was confirmed from observations made during the inspection. Time was taken by staff to allow residents to consider their answer to questions asked. Residents consulted advised that they liked the food provided at the home and the arrangements at mealtimes when they are served at small tables sitting up to four persons. The home has a four week menu system and residents are consulted about what foods they would like for their meal on a daily basis, choice is always provided. Daw Vale DS0000032522.V349352.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. Residents and visitors were confident that any complaint raised would be taken seriously and dealt with quickly. Service users are protected from all types of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All residents are given a copy of the home’s complaints procedure as part of the welcome pack when they are admitted into the home. Residents spoken to said they were confident that if they raised an issue it would be taken seriously by staff and a resolution found to their satisfaction. The home has a detailed policy and procedure for adult protection that meets all the legislation and carers are trains in its use. Carers consulted as part of the inspection process were clear on the different types of abuse and what action should be taken if found. Daw Vale DS0000032522.V349352.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. The home is safe, well maintained and comfortable for residents. There are high standards of hygiene apparent throughout. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A complete tour of the building was undertaken as part of the inspection, all rooms were seen. No outstanding maintenance was apparent and the home was free from malodour. There is a running maintenance and redecoration programme in place and some residents’ bedrooms had been redecorated since the time of the last inspection. The facilities of the home were well appointed and new easy chairs have been recently purchased to enhance comfort for people. Currently the home is refurbishing its bathing facilities with a new assisted bath being provided in the near future.
Daw Vale DS0000032522.V349352.R01.S.doc Version 5.2 Page 16 All bathrooms and toilet had good standards of hygiene, as was found throughout the building. Daw Vale DS0000032522.V349352.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 30. Quality in this outcome area is adequate. Residents’ are in safe hands and their needs are met by the care team. The homes recruitment policies are practices are appropriate. There is a deficit in some staff training and supervision. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In general the care team at the home meets the needs of residents appropriately and the care hours remain at the same level as at the last some inspection. However there are some gaps in the home’s procedures. One male member of the staff team who had been at the home a week told the inspector that he was now bathing residents, after shadowing another member of the team for two baths. As this time this person had not had sufficient training to undertake personal care; this is clearly inappropriate. Three carers were interviewed as part of the inspection process, some carers were confused about what training they had received and did not understand some of the procedures. The formal supervisions undertaken with carers were not maintained to the frequency of the legislation and this must be rectified as soon as possible and a requirement has been raised for this purpose. Daw Vale DS0000032522.V349352.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. Daw Vale is managed by a person who is of good character and fit to be in charge. The home is run in the best interest of the residents and their financial interests are appropriately safeguarded. Health and safety and the welfare of residents and staff are seen as most important and given high priority. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of the home is of good character, experienced and fit to be in charge. There are some vacancies in the staff team. Currently the home has a detailed quality assurance system in place to ascertain residents’ views of the service provided at the home. In addition residents meetings are held and individual consultations with residents are also undertaken. The home also has a suggestions box and visitors’ comments book in the main entrance hall.
Daw Vale DS0000032522.V349352.R01.S.doc Version 5.2 Page 19 There are well-recorded procedures in place for the assistance provided to residents with their personal allowance that provide sufficient safeguards. This system is sound but has not been audited recently and this should be undertaken. Health, safety and welfare issues are taken very seriously by the management of the home and detailed records are maintained of issues raised. The home’s recordings of the fire precautions undertaken were in general appropriate, however the weekly tests of the fire alarm system were not up to date and a requirement has been raised to ensure this is maintained. Procedures were in place for the storage and use of harmful chemicals and reports were made of any dangerous occurrences to the authorities concerned as required. Regular checks are made for unwanted bacteria in the home’s water supply and all equipment in the home is regularly serviced to ensure it is safe for residents and staff. Daw Vale DS0000032522.V349352.R01.S.doc Version 5.2 Page 20 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 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 3 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Daw Vale DS0000032522.V349352.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No 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 13 Requirement The registered manager must ensure that all staff adhere to the correct medication administration procedures. The registered manager must ensure that at all times suitably qualified, competent and experienced persons are working at the care home. The registered manger must ensure that all carers are appropriately supervised. The registered manager must take adequate precautions against the risk of fire. Timescale for action 12/10/07 2 OP30 18 10/11/07 3 4 OP36 OP24 18 23 10/11/07 12/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP10 Good Practice Recommendations The registered manager should give residents the choice of the sex of their carer who will provide their personal care.
DS0000032522.V349352.R01.S.doc Version 5.2 Page 22 Daw Vale Daw Vale DS0000032522.V349352.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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