CARE HOMES FOR OLDER PEOPLE
Daw Vale 56 West Cliff Road Dawlish Devon EX7 9DY Lead Inspector
Sharon Goldsworthy Announced 26 April 2005
th 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. Daw Vale D54-D07 S32522 Daw Vale V213411 260405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Daw Vale Address 56 West Cliff Road, Dawlish, Devon, EX7 9DY 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) 01626 863447 info@devon.gov.uk Devon County Council Ms Paula Ann Hannaford 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 D54-D07 S32522 Daw Vale V213411 260405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Physical Disability over the age of 55 years Date of last inspection 24th November 2005 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, doctor’s 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 D54-D07 S32522 Daw Vale V213411 260405 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was announced and took place on the 26th and 27th April 2005. This inspection consisted of conversations with a sample of residents, staff on duty and the Manager, a tour of the building, sampling records and observing care practice. Nine pre-inspection questionnaires were received from both residents and relatives. The Manager present on the day of this inspection has since moved to another Devon County Council home and a new Manager is now in place at Daw Vale. 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. There are currently only two vacancies for staff, which it is hoped will be filled shortly. Both residents and relatives 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 and the fact that three times a week they are offered a cooked breakfast. Some spoke of the most recent activities they have attended with enthusiasm, such as reminiscence, quizzes and exercises. Care practice observed was appropriate and given with respect. Care was given promptly when required and staff were cheerful, chatty and empathetic. Staffs demonstrated a good knowledge of their resident group and seem to work well as a team. 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 D54-D07 S32522 Daw Vale V213411 260405 Stage 4.doc Version 1.30 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 D54-D07 S32522 Daw Vale V213411 260405 Stage 4.doc Version 1.30 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 Daw Vale D54-D07 S32522 Daw Vale V213411 260405 Stage 4.doc Version 1.30 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) 6 Residents assessed and using the rehabilitation unit at Daw Vale are helped to achieve full independence and return home through a dedicated and individualised programme. EVIDENCE: No new residents have been admitted to the long stay unit in the last few weeks. Residents on the short-term rehabilitation unit were spoken with, although records were not seen for these individuals in any detail. As such Standards 2,3, 4 and 5 will be assessed at the next inspection. The home has a dedicated rehabilitation unit on the ground floor of Daw Vale with a dedicated care and therapeutic staff team. All residents in this unit sign up to an individualised programme of rehabilitation to regain independence with a view to returning home. Many of these residents have come to Daw Vale direct from hospital, following falls or strokes. Residents on this unit spoke very highly of the staff and the care they have received since moving to the unit. All spoke of their rehabilitation programmes
Daw Vale D54-D07 S32522 Daw Vale V213411 260405 Stage 4.doc Version 1.30 Page 9 and exercise programmes. One stated that she has regained her confidence that was needed and felt secure enough to return home now. On the day of this inspection a resident had a fall in this unit. Staff were observed responding rapidly to this incident and were extremely calm and supportive to the resident. A GP was present on the unit at the time and the necessary care was given very promptly. Daw Vale D54-D07 S32522 Daw Vale V213411 260405 Stage 4.doc Version 1.30 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 The resident’s health, personal and social care needs are set out in their care plans. However, daily records require more detail to ensure that the home has documented evidence that where an illness or injury has occurred, there has been sufficient and adequate follow up. Medication is stored, administered and recorded appropriately, therefore ensuring that residents are protected when receiving medications. Residents are treated with respect and privacy is upheld. EVIDENCE: Seven care plans and daily care notes were seen on the day of this inspection. Care plans were found to be complete for all seven, with the exception of one resident (admitted in September 2004) where a risk assessment was not complete. It is vital that all such information is completed as soon as possible after the time of admission, to ensure continuity of care and prevent the individual being placed at risk of harm. The daily care records of three residents were viewed in detail. All three had either been ill recently or had very specific needs. Care notes indicated that an
Daw Vale D54-D07 S32522 Daw Vale V213411 260405 Stage 4.doc Version 1.30 Page 11 issue of concern had been identified, but then did not follow this up with what action was taken to address this; e.g. “soreness to the bottom and urine very smelly” and then “cream applied”. There was no record of a GP/DN being consulted for treatment or what the cream was and who had authorised its use. Another example is that of a resident reported to be causing a large amount of disruption to other residents. There was no specific and detailed record of this in the daily care notes and no mention of having raised this issue with the resident’s family and social worker in the care notes or care plan. The Manager was able to evidence two other books currently being used to record daily occurrences by senior staff and night staff. The Manager was advised to stop using these records, as they are not in line with the current Data Protection Act 1998, and that there is no system in place to ensure that this information is then duplicated into the residents formal records. This would also prevent duplication of these records. It is vital that care records are kept up to date and provide adequate information to ensure the continuity of care. The medication system was found to be stored appropriately, administered correctly and recorded as required. 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. A number of residents were spoken with and observed during the day of this inspection. All confirmed that they are treated with respect, called by their name of preference and treated with dignity when care is given. Care staff were observed knocking on residents bedroom doors before entering, being sensitive and respectful when offering care and had good relationships with individuals. Daw Vale D54-D07 S32522 Daw Vale V213411 260405 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14 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: The Activity Officer post is currently vacant. This was a part time post and it is hoped that this will be filled in the next few weeks. 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 summer barbecues and parties are organised. 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. However, there remains the need to devise a full programme of activities that can offer something for everyone and some that would meet individual’s needs and interests. The Manager stated the intention to work with the newly appointed activities officer to devise a varied programme of activities and a suitable format on which to record activities that individuals participate. Daw Vale D54-D07 S32522 Daw Vale V213411 260405 Stage 4.doc Version 1.30 Page 13 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) 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. 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. A group of residents have made a complaint to the Manager about the behaviour of a resident who is causing them some distress. The Manager was able to demonstrate that action has been taken to address these concerns. 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 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 is a need for nine members of staff 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 D54-D07 S32522 Daw Vale V213411 260405 Stage 4.doc Version 1.30 Page 14 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, 26 Residents live in a generally 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, the lounge on the long stay unit and some bedrooms. All corridor woodwork was being re-varnished on the day of the inspection. A new carpet has been put in the rehabilitation unit dining room. The home has obtained visits and reports from both an Occupational Therapist and Environmental Health. Both had some minor recommendations that have been addressed. A Requirement remains outstanding from the last inspection report 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. 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 D54-D07 S32522 Daw Vale V213411 260405 Stage 4.doc Version 1.30 Page 15 Daw Vale D54-D07 S32522 Daw Vale V213411 260405 Stage 4.doc Version 1.30 Page 16 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) 27, 29, 30 There are sufficient levels of staff to meet the needs of the current resident group. Residents are protected from the homes recruitment policy and practice. Staff receive induction and training to ensure they are competent to care for the residents. EVIDENCE: There are currently only two staff vacancies; one is for a part time activity officer the other is a full time care assistant. The Manager hoped that both would be filled in the next few weeks. The homes rota evidences that the home provide the minimum levels of staff previously agreed with the Local Authority inspection unit. On the day of the inspection, there appeared to be enough staff on duty to meet the needs of the current resident group. The home operates a thorough and appropriate recruitment procedure. Three staff personnel records were seen and found to contain all the required documentation, with the exception of one recently recruited member of staff whose identification photograph was not on file. This is required along with all the other documentation to ensure the safety and protection of residents. The Manager felt able to obtain this in the next few days. Staff training records were viewed. The home has a comprehensive induction and ongoing training programme. Recent training includes; Fire Safety (all staff), Falls Prevention, First Aid, Manual Handling, Infection Control, Food Hygiene, Medication Awareness and Administration, Managing Violence and
Daw Vale D54-D07 S32522 Daw Vale V213411 260405 Stage 4.doc Version 1.30 Page 17 Aggression, Protection of Vulnerable Adults from Abuse and Health and Safety. Senior staff have completed the following; Supervision, Risk Assessments, Boots Medication Administration in addition to the above. Ten staff have completed NVQ to Level 2, three have completed NVQ to Level 3 and three are starting NVQ at Level 2 and two to Level 3. Where staff have not completed any of the above training, there is evidence on their profiles that this training is being provided in the next year. 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 D54-D07 S32522 Daw Vale V213411 260405 Stage 4.doc Version 1.30 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 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) 38 The health, safety and welfare of residents and staff are promoted and protected. EVIDENCE: The home has comprehensive policies and documentation in place to evidence that all required health and safety checks are carried out as required. The fire alarm and self-closing doors were tested on the day of the inspection and found to be in working order. Documentation was found to be up to date and accurately completed. As mentioned previously, the home has obtained visits and reports from both an Occupational Therapist and Environmental Health. Both had some minor recommendations that have been addressed. A Health and Safety assessment has been completed in 2004, in relation to radiators and window restrictors and all recommendations have again been complied with.
Daw Vale D54-D07 S32522 Daw Vale V213411 260405 Stage 4.doc Version 1.30 Page 19 Legionella and Asbestos assessments have been completed and were seen at the last inspection visit – November 2004. Daw Vale D54-D07 S32522 Daw Vale V213411 260405 Stage 4.doc Version 1.30 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 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 4 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 3 15 x
COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x 3 Daw Vale D54-D07 S32522 Daw Vale V213411 260405 Stage 4.doc Version 1.30 Page 21 yes 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 7 Regulation 17(1) Requirement Ensure that daily care notes record an appropriate level of follow up and monitoring in relation to falls, injuries or illnesses. Provide the CSCI with an agreed action plan with timescales indicating when refurbishment of the premises will take place, in particular new windows. (Previous timescale given 30/1/05) Timescale for action 30 May 2005 2. 19 23(2) 30 June 2005 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. 4.
Daw Vale Refer to Standard 7 12 12 18 Good Practice Recommendations Ensure that all care plans record sufficient and specific information in relation to care needs and assistance required. Extend the Activity Officer post in terms of hours, which in turn will extend the activity programme. Expand the activity records to use as more of an evaluation tool. All staff must attend as planned certificated training in relation to the Protection of Vulnerable Adults from Abuse
D54-D07 S32522 Daw Vale V213411 260405 Stage 4.doc Version 1.30 Page 22 5. 19 Continue with the refurbishment and redecoration programme to freshen and update the premises to add further to a more homely environment. Daw Vale D54-D07 S32522 Daw Vale V213411 260405 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 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
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