Inspection on 20/10/08 for Dean House

This inspection was carried out on 20th October 2008.

CSCI found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Dean House 11/03/08

Dean House 05/07/06

Dean House 29/11/05

Dean House 24/06/05

Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Dean House 67 Sea Lane Angmering On Sea Littlehampton West Sussex BN16 1ND     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sheila Gawley     Date: 2 0 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Dean House 67 Sea Lane Angmering On Sea Littlehampton West Sussex BN16 1ND 01903784217 01903784217 deanhouse1@aol.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Miss Maria Ann Eagland,Mr Dean Talbot Williams care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Dean House is a care home registered to accommodate up to 27 residents in the category of old age. It is a detached property located in the village of East Preston, close to local amenities, and only yards from the sea. The property consists of 22 single and three double bedrooms all of which are on suite. In addition there is a sitting room, a dining room and a large sunroom to the rear. There is an accessible garden. Mr. Williams and Miss Eagland privately own the service. The registered managers post is vacant. The fees range between 410 and 650 pounds monthly. 0 Over 65 27 Care Homes for Older People Page 4 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection was carried out on 20/10/08. This report will also reflect evidence gathered on two random inspections carried out by a pharmacy inspector on 11/06/08 and 28/06/08. These inspections were as a result of a safeguarding referral. The last key unannounced inspection to this service was on 11/03/08. The requirements of those pharmacy inspections have been met but other issues have been highlighted. Prior to the inspection all files held by the Commission were reviewed as were any comments or complaints received by us, The Commission was in receipt of an Annual Quality Assurance Assessment from the Home In January 2008. Care Homes for Older People Page 5 of 25 On the day the premises were inspected, staff and people who use the service were spoken to. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 7 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good because all people who use the service have had assessment prior to admission. This judgement has been made using available evidence including a visit to this service. Evidence: Documentation is in place to complete pre admission assessments on prospective admissions, which the acting manager confirmed were completed. These were seen in the care plans and covered all physical, personal and social need. Care Homes for Older People Page 9 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is adequate because people who use the service have care needs assessed and met but the handling of medicines although improved still has errors in administration. This judgement has been made using available evidence including a visit to this service. Evidence: All people who use the service have a plan of care. This plan shows assessment of physical, mental and social need. There is a personal profile of individuals and care needs in relation to health and hygiene, food and diet, continence, sleeping, spiritual, social and leisure. Risk assessments are in place to record risk of falls, pressure areas. There are daily records, weight is monitored monthly and there is evidence of monthly review. All care plans have a photograph of the person it refers to. Care was observed being offered in a quiet and respectful manner. Care Homes for Older People Page 10 of 25 Evidence: There are now clear policies and procedures in place for ordering, receipt,storage and administration, including self administration and return of medicines.The policy on self administration was not very comprehensive and the acting manager started to update during the inspection. The requirements of the last random were met in that policies and procedures are in place and all staff had training in medicines in June and certificates were seen. Medicines were correctly stored, there is a fridge in place and temperatures are monitored. There were not any drugs stored in the fridge at this time. Controlled drugs were correctly stored and were accurately accounted for. Medicine administration charts were inspected and all were up to date, however the blister pack for one person who uses the service had one tablet in it for Friday 17th, midday dose. There was no explanation as to why this drug had not been administered on that day and yet had been signed for. This may indicate that the information received in training is not fully embedded in practice as yet. Care Homes for Older People Page 11 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good because the lifestyle experienced in the home meets peoples expectations. This judgement has been made using available evidence including a visit to this service. Evidence: There is a good activity programme in the home and residents are supported in maintaining contacts with family, friends and the local community and are able to exercise choice and control over their lives. There is an activities volunteer who attends Monday to Friday and involves people who use the service in games such as bingo, quizzes, crafts and music. There is a Sunday sherry morning and there is communion monthly. There is a music for health workshop monthly and people who use the service can be taken for a walk to the local shops or beach. People who use the service spoken to stated that they enjoyed the activities. There is a varied menu in place which offers choice. People who use the service confirmed that they enjoyed the food. People who use the service were seen to enjoy Care Homes for Older People Page 12 of 25 Evidence: the lunch served in a pleasant dining room. The acting manager stated that the opinions of residents are sought when menu changes are planned. This is done informally by asking people in the lounge. Care Homes for Older People Page 13 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is poor as people are not fully protected from harm. This judgement has been made using available evidence including a visit to this service. Evidence: There is a complaints book in which complaints can be recorded. Recent complaints were dealt with appropriately. The is a complaints procedure in place but which was not on display. The acting manager stated that she would do this today. Safeguarding procedures are in place and staff have had training on safeguarding. It was not apparent that this training had been embedded into practice as unsafe fittings such as broken window restrictors have not been addressed. People who use the service are not fully protected from harm due to several environmental factors detailed in the environment section of this report. The two random pharmacy inspections carried out on 11/06/08 12/08/08 were undertaken as a result of safeguarding referrals in relation to medicines. The requirements from these inspections have been met however there was still one error noted on this occasion. That people be fully protected from abuse will be a requirement of this inspection. Care Homes for Older People Page 14 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality outcomes in this area are poor because there are risks to the health and safety of people who use the service because due to a lack of window restrictors and radiator covers. The maintenance of the home is not proactive. This judgement has been made using available evidence including a visit to this service. Evidence: The property is a detached house with single and double rooms all with en suite facilities. Communal areas include a sitting room, a dining room and a conservatory. These rooms are pleasantly furnished and are homely in character. There is a well kept garden with a water feature. On inspection of the premises several shortfalls in the standards were noted. Several radiators are still not covered. The laundry did not have any soap or hand towels, neither did another bathroom and toilet. Many toilets did not have toilet roll holders. A toilet seat in one room was damaged. Several first floor rooms did not have functioning window restrictors. The acting manager stated that about 50 do not work. The lino in one en suite was lifting, and the carpet in another room had a large permanent stain. In the staff toilet the sink was coming away from the wall. That these Care Homes for Older People Page 15 of 25 Evidence: risks to the health and safety of people who use the service will be requirements of this inspection. The plaster in some areas was in a poor state of repair. A maintenance book is kept and the issue of the lifting lino had been recorded in it. The last inspection report highlighted the home as being shabby and in need of attention and we were informed that this would be addressed. Regulation 26 reports were inspected and these did not highlight any of the shortfalls noted on this inspection. There was not any regulation 26 report for September, the last one being on the 13th August. Bedrooms are mostly comfortable and personalised with adequate furniture but as stated above the flooring was damaged and stained in some areas. Doors do not have locks. There are appropriate toilet and bathing facilities. Laundry facilities are appropriately sited. There is a hand wash basin but there was not any soap or hand towels present. That this risk of spread of infection be rectified will be a requirement of this report. Care Homes for Older People Page 16 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality outcomes in this area are poor because although there is a staff training programme in place shortfalls in health and safety issues indicate that the training is not transferred to practice. A staff file inspected did not have the required documentation and CRB and POVA first were not completed prior to commencement of employment. This judgement has been made using available evidence including a visit to this service. Evidence: Two carers and the acting manager were on duty, this appeared to be sufficient to meet the needs of people who use the service. There was support from a cook and a cleaner. Staff were observed offering care in a respectful manner. 50 of care staff have National Vocational Qualification Level 2 and seniors have NVQ Level 3. The acting manager commences The Registered |Managers Award tomorrow. People who use the service spoken to stated that the staff are caring, one stated They are great, they are encouraged to care There is a training programme in place and staff receive training in POVA, moving and handling, fire, health and safety and Control of Substances Hazardous to Health and Care Homes for Older People Page 17 of 25 Evidence: infection control. It is unclear if this training is embedded into practice as there was still a medication error and risks to people who use the service are not recognised and rectified. Induction files were seen and were complete. One recruitment file inspected showed that have Criminal records Bureau Clearance or POVA first were not in place prior to commencement of employment. There were not any references on file. Care Homes for Older People Page 18 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality outcomes in this outcome area are poor because the home is not run in the best interests of people who use the service and health and safety issues are not addressed. This judgement has been made using available evidence including a visit to this service. Evidence: The acting manager does not intend to register with the Commission and the registered provider is advertising for a new manager. Evidence of this was seen. The proprietor was in receipt of a serious concern letter from the Commission as there has not been a registered manager in post since October 2006. The certificate on display was not correct, showing the name of the previous registered manager, which is an offence against The Care Standard Act 2000. The acting Care Homes for Older People Page 19 of 25 Evidence: manager found the certificate we had issued in October 06, showing the registered manager as Post Vacant, in the office and rectified the situation during the inspection. The complaints procedure was not on display and the acting manager agreed to put this up. Although some survey forms are in existence the home is not currently surveying people who use the service, their relatives or health care professionals. The regulation 26 visits carried out by the proprietor did not highlight any of the environmental issues found on this inspection. The regulation 26 visits were not up to date the last one having been done on August 13. One recruitment file inspected did not have Criminal records Bureau Clearance or POVA first in place prior to the commencement of employment. There were not any references in this file. Although the home stated at the last inspection that they do not handle money for people who use the service their money is actually paid into the Dean House account. receipts for expenditure are held locally. The need for money to be paid into individual accounts was discussed with the acting manager. There are not regular residents meetings at present but the acting manager stated that a she discusses issues such as menu change with residents during morning coffee. All residents spoken to stated that they are happy with the way the home is managed. Staff stated that they are supported and training needs are met. Staff supervision is in place. Many environmental problems are not addressed, many upper floor windows do not have restrictors, doors do not have locks, several radiators are not covered. no soap or hand towels in the laundry, missing toilet roll holders chipped paint, lifting lino and stained carpet Care Homes for Older People Page 20 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 21 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 18 13 The registered person to make arrangements, by training or by other measures to prevent service users being harm or suffering abuse or being placed at risk of harm or abuse The lack of full hand washing facilities in the laundry, the lack of window restrictors and the lack of radiator covers may cause harm to people who use the service. 29/12/2008 2 24 12 The registered person to 30/12/2008 ensure that the care home is conducted in a manner which respects the privacy and dignity of service users. The absence of door locks does not ensure the privacy of people who use the service Care Homes for Older People Page 22 of 25 3 29 19 The registered person to operate a thorough recruitment to ensure the protection of service users. A staff file inspected did not have the required documentation and crb and POVA first were not completed prior to commencement of employment. 30/12/2008 4 33 26 Where the registered person 30/12/2008 is not in day to day charge of the home then the care home will be visited under this regulation and the premises inspected and a report written on the conduct of the home. Regulation 26 visits are not comprehensive or up to date. 5 33 24 The registered person shall establish and maintain a system for reviewing at appropriate intervals and improving th quality of care provided in the home. Quality assurance systems are not in place 30/12/2008 6 35 20 The registered person shall 30/12/2008 not pay money belonging to any service user into a bank account unless the account id in the name of the service user and the account is not used by the registered person in connection with the carrying on or the Care Homes for Older People Page 23 of 25 management of the home of the home Money belonging to people who use the service is paid in the homes bank account. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 24 of 25 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - 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. 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