CARE HOME ADULTS 18-65
Dean House 267 Wellingborough Road Rushden Northants NN10 9XN Lead Inspector
Mrs Helen Wilson Unannounced Inspection 17th February 2006 1:30pm Dean House DS0000063723.V282351.R01.S.doc Version 5.1 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 Dean House DS0000063723.V282351.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 Adults 18-65. 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. Dean House DS0000063723.V282351.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Dean House Address 267 Wellingborough Road Rushden Northants NN10 9XN 01933 350225 01536 726496 deanhouse@communitycaresolutions.com 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) Community Care Solutions Limited Vacant Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Dean House DS0000063723.V282351.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 3rd October 2005 Brief Description of the Service: Dean House, purchased in April 2005 by new owners Community Care Solutions Ltd, provides personal care for a maximum of nine adults with care needs due to Learning Disabilities. The premises are located anonymously in a Victorian terrace within easy walking distance of the small towns shopping centre and local leisure facilities. Service users share a communal living area, dining room, kitchen and two bathroom and one shower room facilities. There are five single bedrooms and two double rooms. Laundry services are provided in-house. Dean House DS0000063723.V282351.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is on outcomes for Service Users and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. This inspection was carried out by giving the home three hours notice of the inspector visiting on the afternoon of Friday 17th February 2006, three hours were spent in the home. The inspection included a full tour of the premises, a review of selected records, conversation with a service user and discussion with the Acting Manager. The primary method of inspection used was ‘case tracking’ which involved selecting two service users and tracking the care received through review of the selected case records. There are currently eight people living at Dean House. The introduction of the new manager to the home has been very positive for its service users and for development of the staff team. Requirements and/or recommendations identified at the previous inspection were reviewed. All had been met. There were no immediate requirements or recommendations made at the time of the visit. Two requirements and two recommendations are stated in this report. What the service does well:
The home has recruited a manager and during the inspection she showed confidence, and had insight and knowledge of the needs of all eight people living at the home. An application for registration of the manager has not yet been submitted to CSCI. Since November 2005 the manager has been developing care plans and risk assessments for each service user with their input and by making fresh contact with family members for information about each individual’s previous background. Day centre workers have been asked to contribute to reviews of
Dean House DS0000063723.V282351.R01.S.doc Version 5.1 Page 6 care plans. The care plans were discussed with the manager and some advice was given about areas that should be more detailed to ensure that staff have full guidance on how specific care is to be given. Overall there is much more clarity about each person’s care needs and a determination to develop lifestyle changes. All records concerning monies belonging to the service users are kept on the premises and individual service users have an interest bearing bank account for individual savings. The home’s daytime and night staffing levels have increased in the last two weeks in response to one person’s care and health needs. The manager also works on three shifts per week supporting service users and learning about their individual abilities and care needs. Service users attend two day centres with long established transport arrangements in place. One service user has regular weekend visits to family members. The home has made appropriate contact with the local GP surgery for the referral of service users to other health care professionals such as the continence advisor and community/hospital consultants. Service users have recently started to go with staff to local supermarkets for the household weekly food shopping, a newly introduced experience for several of the people living at Dean House. One service user confirmed that meals were good. The manager follows clear procedures for fire protection system checks and staff have been given fire refresher training at monthly staff meetings: house maintenance issues are identified, reported and actioned What has improved since the last inspection?
The home’s two bathrooms have been refurbished with new bathroom suites, overhead shower heads, new tiled walls and new flooring. An additional walkin shower room has been installed on the ground floor to provide easy access to all service users. Ground floor corridors, lounge, dining room and the staircase have been improved by new flooring either in carpet or laminated wood giving service users a brighter living environment. . Ground floor corridors, dining room and the lounge area have been repainted, new sofas provided in the lounge and window curtains have been replaced. Service users can now choose to eat at one of three separate dining tables allowing people’s dignity to be retained and conversations to develop.
Dean House DS0000063723.V282351.R01.S.doc Version 5.1 Page 7 The home has purchased new beds for some service users and two bedroom carpets are on order. 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. Dean House DS0000063723.V282351.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dean House DS0000063723.V282351.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 The home has clear information available and distributed to state the services available to existing and potential service users. EVIDENCE: The home has a Statement of Purpose and a Service User Guide issued to each service user living in the home. There have been no recent admissions however admission procedures followed by the company allow for assessments, trial visits, etc. The case file records for current service users evidence that care needs of individuals have been recently reassessed to bring care plans up to date. Dean House DS0000063723.V282351.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9,10 The home provides care and support planned around the individual service user’s needs EVIDENCE: Since November 2005 the manager has been developing care plans and risk assessments for each service user with their input and by making fresh contact with family members for information about each individual’s previous background. Day centre workers have been asked to contribute to reviews of care plans. The care plans and risk assessments were discussed with the manager and some advice was given about areas that should be crossreferenced and more detailed to ensure that staff have full guidance on how specific care is to be given. Overall there is much more clarity about each person’s care needs and a determination to develop lifestyle changes. All records concerning monies belonging to the service users are kept on the premises and individual service users now have an interest bearing bank account for individual savings. On checking records it was noted that at least one person still has a substantial amount of personal monies held in a noninterest bearing account and available for saving; it was discussed and
Dean House DS0000063723.V282351.R01.S.doc Version 5.1 Page 11 recommended to the manager that unused monies should be more regularly transferred to savings accounts of the individual to attract interest. All records relating to service users are locked away securely. Dean House DS0000063723.V282351.R01.S.doc Version 5.1 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The home has made good progress in supporting service users to have ordinary and appropriate lifestyles. EVIDENCE: Service users attend two day centres with long established transport arrangements in place. One service user has regular weekend visits to family members. Service users have recently started to go with staff to local supermarkets for the household weekly food shopping, a newly introduced experience for several of the people living at Dean House. One service user confirmed that meals were good. Dean House DS0000063723.V282351.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Although there were some errors in medication the home has acted quickly to resolve these; overall the home ensures that service users are helped to access healthcare services appropriately. EVIDENCE: Each service user is registered locally with GP, dentist, optician where necessary and receive other specialist healthcare where identified. Case files demonstrate that the home involves healthcare professionals appropriately and confidential records are kept of health matters. The home has made appropriate contact with the local GP surgery for the referral of service users to other health care professionals such as the continence advisor and community/hospital consultants. A check of the medication system showed that there were, for two particular dates, staff signatures missing from the medication administration record sheets. The manager stated she was already actively talking to identified staff regarding this. Medication supplies awaiting return to the pharmacist for disposal were not recorded into the disposal record; this record must be made at the point of setting drugs aside. The manager immediately rectified this and has stated that staff will be given new directions.
Dean House DS0000063723.V282351.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 The home operates in an open manner that would enable people to raise any concerns. EVIDENCE: There has been one recent complaint made to the home and to CSCI regarding faults on the fire alarm system that were causing problems and interruption to neighbours. This complaint was upheld, remedial action quickly taken by the home and apologies and reassurances given to the complainant. Service users were seen to have a warm interaction with staff and were confident in their conversations. Dean House DS0000063723.V282351.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,30 The environment is being updated with the public areas showing good progress and is brighter and more appropriate for the service users. Bathrooms and shower facilities are of high quality and support service users’ needs. The needs of one occupant in a double room are a potential risk to the health and safety of the other occupant. EVIDENCE: The home’s two bathrooms have been refurbished with new bathroom suites, overhead shower heads, new tiled walls and new flooring. An additional walkin shower room has been installed on the ground floor to provide easy access to all service users. Ground floor corridors, lounge, dining room and the staircase have been improved by new flooring either in carpet or laminated wood giving service users a brighter living environment. . Ground floor corridors, dining room and the lounge area have been repainted, new sofas provided in the lounge and window curtains have been replaced. Dean House DS0000063723.V282351.R01.S.doc Version 5.1 Page 16 Service users can now choose to eat at one of three separate dining tables allowing people’s dignity to be retained and conversations to develop. The home has purchased new beds for some service users and two bedroom carpets are on order. Heating levels from the electric panel heaters in two downstairs bedrooms are not sufficient to maintain room temperatures; the additional heaters in use must be affixed to the walls to minimise risk to service users. A recently fitted new carpet in a double bedroom is heavily stained despite regular daily cleaning/shampooing by staff and the room kept well ventilated. Some cabinet furniture has been removed due to being damaged. The identified care needs and behaviour patterns are likely to be ongoing and being kept under review and additional staff employed. The manager has recommended that alternative washable flooring be fitted in the interests of both people sharing the upstairs double room. The home generally was clean, tidy and fresh in all other areas. Dean House DS0000063723.V282351.R01.S.doc Version 5.1 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 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 Changes to staff routines and the implementation of clear care plans are being addressed and will build on the staff team’s long term experience with the group of service users living at the home. Current staffing levels are appropriate to the needs of people at the home. EVIDENCE: Staff are friendly and communicate well with people living there. Most of the support staff have been working with the service users for many years and this has given stability to the home in the past months. Working practices and care planning documentation are being reviewed and introduced carefully by the manager. The home’s daytime and night staffing levels have increased in the last two weeks in response to one person’s care and health needs. The manager also works on three shifts per week supporting service users and learning about their individual abilities and care needs. Individual staff files were not checked during this visit; the manager however confirmed that details from staff files have been established as per CSCI’s proforma of information to be held on the registered premises. Dean House DS0000063723.V282351.R01.S.doc Version 5.1 Page 18 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,40,41,42 The home is managed in a positive manner. The needs of service users are being focussed on appropriately. EVIDENCE: The home has recruited a manager and during the inspection she showed confidence, and had insight and knowledge of the needs of all eight people living at the home. An application for registration of the manager has not yet been submitted to CSCI. Standard 37 will remain unmet until a manager is registered in respect of the home. An Area Manager visits the home monthly and checks that the home is being run and operated to satisfy the company’s procedures. Monthly reports are forwarded to CSCI and confirm that water temperature, room temperatures and call system checks are been carried out weekly and that fire protection and fire evacuation procedures, maintenance carried out and emergency lighting checked on a monthly basis. Dean House DS0000063723.V282351.R01.S.doc Version 5.1 Page 19 The home has established policies and procedures that are available and guide staff. Case file records are organised and daily entries are made. The manager confirmed that training in report writing has been requested for the staff team to ensure consistency and content of reporting. The manager follows clear procedures for fire protection system checks and staff have been given fire refresher training at monthly staff meetings. Following a fire protection inspection on 18 January 2006, the Fire officer has asked that a formal fire risk assessment of the home be carried out and be documented in the registered home. The manager holds a blank document for completion by Community Care Solutions Ltd. This is made a requirement of this inspection report for urgent action. House maintenance issues are identified, reported and actioned Insurance cover is held. The company has a business and financial plan for the home and this inspection has shown that development of the home is being satisfactorily progressed. Dean House DS0000063723.V282351.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 2 26 2 27 4 28 3 29 N/A 30 3 STAFFING Standard No Score 31 x 32 x 33 3 34 x 35 x 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 X 14 X 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 1 x x 3 2 2 3 Dean House DS0000063723.V282351.R01.S.doc Version 5.1 Page 21 NO 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 YA42 Regulation 12 Requirement A formal fire risk assessment of the home must be carried out and must be documented in the registered home to comply with the Fire Officer’s report dated 18/01/06. Additional heaters in use in bedrooms must be affixed to the walls to minimise risk to service users. Timescale for action 31/03/06 2 YA24 12, 13(4) 31/03/06 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 YA26 YA7 Good Practice Recommendations Consideration should be given to replacing the carpet in the upstairs double room with a washable floor surface. It is strongly recommended that, in order for service users to receive the full potential of bank interest on savings, arrangements are made to reduce amounts of personal monies held unused in non-interest bearing accounts. Dean House DS0000063723.V282351.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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