Inspection on 27/02/06 for Dean Wood Manor

This inspection was carried out on 27th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Dean Wood Manor 26/02/09

Dean Wood Manor 22/05/08

Dean Wood Manor 22/08/07

Dean Wood Manor 20/12/06

Dean Wood Manor 11/05/06

Dean Wood Manor 11/10/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Dean Wood Manor Spring Road Orrell Wigan Greater Manchester WN5 0JH Lead Inspector Lindsey Withers Second Inspector Kath Unannounced Inspection 27th February 2006 08:25 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 Dean Wood Manor DS0000064122.V275433.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dean Wood Manor DS0000064122.V275433.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Dean Wood Manor Address Spring Road Orrell Wigan Greater Manchester WN5 0JH 01942 223982 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) www.mimosahealthcare.com Mimosa Health Care Limited Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (43), Physical disability (1), Physical disability of places over 65 years of age (8) Dean Wood Manor DS0000064122.V275433.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home is registered for a maximum of 50 service users, to include: Up to 43 service users in the category of OP (over 65 years of age) Up to 8 service users in the category of PD(E) (over 65 years of age) plus one service user in the category of PD (named service user) The service should employ a suitably qualified and experienced Manager who is registered by the CSCI. The Home must be appropriately staffed at all times. The numbers and skills mix of the staff must meet the needs of service users. 11th October 2005 2. 3. Date of last inspection Brief Description of the Service: Dean Wood Manor is located off the main Orrell to Standish road. The premises comprising Dean Wood Manor are based around an original Grade II listed building that has been extended to provide accommodation to a total of 50 people. The gardens surrounding the home are extensive and wellpresented. Car parking for visitors is good. The registration categories (i.e. the groups of people who can be admitted) are under review, but at the time of this inspection a total of 8 people under the age of 65 and one person over the age of 65 with a physical disability could be admitted, and 43 elderly people. Residents living at Dean Wood Manor receive personal care only (residential care) or nursing care. The development of a 7 bedded unit was nearing completion. The registration process to approve accommodation for people under the age of 65 with mental health needs was in progress with CSCI at the time of this inspection. Formerly known as Orrell Hall, Dean Wood Manor is part of the Mimosa group of homes. The Mimosa philosophy is Where people matter. The stated aim is to provide all residents with the kind of individual care they need, whilst maintaining their independence, dignity and freedom of choice. Dean Wood Manor DS0000064122.V275433.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by two inspectors over a 7 hour period and was unannounced. The main focus was on those areas not assessed during the previous inspection, so that over both visits all key standards were looked at. Part of the time was spent with the Manager temporarily in charge of the home, the Registered General Nurse on duty, and the Administrator going through the paperwork that has to be kept to show that the home is being run properly. Part of the time was spent watching practice in the main lounges and dining areas. The Inspectors had conversations with six members of staff and seven residents. Part of the information in this report makes reference to a recent complaint investigation at the home, and the subsequent monitoring visits that took place. Conversations with staff, residents, and relatives, together with the evidence found during visits to the home, have helped to form the judgements made by the Inspectors as to the quality of care being provided at Dean Wood Manor. The general outcomes of the inspection, together with examples of the evidence found, were discussed with the Manager temporarily in charge at the time of the inspection. It should be noted that the home’s Manager had resigned his post and the new Manager had yet to start. The new Manager is due to join Dean Wood Manor on 13th March 2006. What the service does well: All residents have their own bedrooms, which are large enough for them to bring in mementoes to make their private room more personal to them. Staff work hard to keep the home clean and smelling fresh, and to make sure the premises and grounds are well-maintained. In the main, staff are very respectful when speaking to residents and will take the trouble to make a cup of tea for someone, or stop and have a chat, work permitting. One resident expressed real affection for the people who look after her, saying they were kind and considerate. Although staff say that the past few months have been difficult, they are keen to make improvements, so that residents will have a better life. Completely independent of each other, two members of staff said that they now looked forward to coming to work. Dean Wood Manor DS0000064122.V275433.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Dean Wood Manor DS0000064122.V275433.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dean Wood Manor DS0000064122.V275433.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 The records that are made of pre-admission assessments are not sufficient to confirm that a person’s needs have been fully assessed prior to admission to the home. There was insufficient information on which to base a plan of care. There was insufficient information available to confirm that assessed needs, including specialist needs, are being met for all residents living at the home. Staff have not received appropriate training to enable them to deliver specialised services. EVIDENCE: A qualified nurse carries out pre-admission assessments. Those pre-admission assessments seen in five residents’ files (which were chosen at random) were either not complete or did not contain sufficiently detailed information to determine whether the person’s needs could be met at Dean Wood Manor. The home has a comprehensive pre-admission assessment document (QR5003) but, generally, this had not been used to its full potential. Little information had been gathered that related to a person’s social profile, that is, their social interests, hobbies, and religious or cultural needs. Dean Wood Manor DS0000064122.V275433.R01.S.doc Version 5.1 Page 9 Because the written records relating to residents were not kept in good order, for example, pages mis-filed, information could not easily be checked to the plan of care. In conversations with two residents, one said that she had made the right decision to come to live at Dean Wood Manor; the other said she wanted to leave because her needs were being ignored. Both comments were relayed to the person temporarily in charge of the home at the end of the inspection. The registration categories for the home were being reviewed with CSCI but, in the February/March 2006 newsletter, Dean Wood Manor is described as a “care home specialising in taking care of the older person with Dementia”. There are residents living at Dean Wood Manor who have specialised needs including those with mental health problems, dementia or other cognitive impairment, or physical disabilities resulting from a specific condition or age and general poor health. The majority of these residents were living at the home when Mimosa took it over in July 2005, but some have moved in since that time. For some residents, this specialised care is provided from community or hospital services. There was insufficient evidence in care plans or seen in practice during the course of this inspection and at recent monitoring visits, to confirm that the needs of these residents are being met from within the home. For example, residents nursed in “bucket” chairs remained in the chair for most of the day – including into the late evening as seen by an Inspector on one occasion - in the same lounge, including for meals. These residents are not given the opportunity to socialise, for example, by joining others in other parts of the home though it was clear to the Inspectors that one or two residents wished for some personal contact and attention. Those residents with dementia who appear to like walking through the home’s corridors, do so all day without punctuation from other activity or form of occupation, though, without being encouraged to, they did stop and speak with Inspectors. One lady sat with the Inspectors while they were doing their paperwork, and read through magazines that were requested by the Inspectors for her. At a previous visit, one resident had continually shouted, “Help me, help me”, but was largely ignored. Staff use phrases such as, “It’s what they do”, “She does it all day long”, and “They like to wander”. Residents who find themselves in the inner garden are said by staff to have “escaped”. These are all indications that staff are unfamiliar with good practice relating to dementia care. Dean Wood Manor DS0000064122.V275433.R01.S.doc Version 5.1 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 the following standard(s): 7, 8, and 10 Care plans contain insufficient information to guide staff in how they should care for individual residents so that the person’s needs and expectations are met, or to demonstrate that their changing needs are identified. Care plans to not demonstrate that all that can be done is done to enhance a person’s wellbeing. Comments from relatives, residents, social care professionals, and other interested parties, together with the gaps in information contained in the written record, support the judgement that residents’ health care needs are not being met with any consistency. In the main, residents are treated with respect and their right to privacy and dignity is upheld. However, there is culture for staff to be task orientated to the point where residents are overlooked, and for residents to be labelled. This must be eradicated if residents are to be truly respected. EVIDENCE: A sample of five residents’ records was looked at on this occasion. A further six had been reviewed at a recent monitoring visit to the home. Files had not been consistently maintained so the records were not easy to follow. Neither Dean Wood Manor DS0000064122.V275433.R01.S.doc Version 5.1 Page 11 was it quick to see where changes to the resident’s needs or preferences had been identified. Care planning within Mimosa Healthcare is based on the Activities of Living produced by Roper, Logan and Tierney, the principle being that a care plan is developed for each area of need within the 12 activities recorded on the checklist. There was no written evidence to confirm that this principle had been followed with any consistency at Dean Wood Manor. Some residents’ records were completely blank; some contained brief information; some entries were undated and other dates were incorrectly recorded. Where care plans had been written, they had not been reviewed at least four weekly. The Community Psychiatric Nurse, the Social Worker, and the home’s Manager had reviewed one person’s plan of care. Neither the resident nor a relative or other supporter is recorded as having attended the meeting. Very little information had been written on the review sheet. No outcomes were recorded in the file. It was not clear, therefore, whether the meeting had been beneficial in relation to outcomes for the resident. However, though the remainder of one person’s file did not meet the required standard, there was evidence to show that a new problem had been identified, that a plan of care had been written, and that it had been reviewed and updated within a few days. The person had subsequently been admitted to hospital for treatment. Each resident’s file contained risk assessments relating, for example, to moving and handling, pressure sore/skin tissue viability, or falls. Across the files comprising the sample inconsistencies in recording were evident. One person’s moving and handling assessment had not been completed, and there was no risk assessment relating to falls even though this person had had a recent fall and suffered a head wound. Another person’s risk assessment had not been updated since August 2005 despite the person having had had four falls between November 2005 and January 2006. One person had been assessed as “very high risk” of developing a pressure sore in September 2005, but had not been reviewed again until February 2006. However, one person’s record contained a risk assessment that was appropriate to the resident and which instructed staff as to how they must act in order to minimise the risk and keep the resident safe. There were few entries in care plans to indicate the types of professional visitors to the home. The extent to which the home involves health and social care professionals are involved in the care of residents could not, therefore, be assessed. A weekly named carer diary had been introduced but appeared to have been dispensed with after five weeks. Dean Wood Manor DS0000064122.V275433.R01.S.doc Version 5.1 Page 12 Though nutritional assessments were in place, weights had not been recorded for some time. The weighing scales were broken and, in any event, were not an appropriate type to use with a person who is immobile or unable to stand. No other method had been used to assess whether a person was maintaining, losing, or gaining weight. Two relatives told the Inspectors that they thought their relative had been losing weight; one resident’s weight had been checked during a clinic appointment and a half stone weight loss recorded. Both relatives said they have advised nurses at Dean Wood Manor of their concerns. In calls to the CSCI duty desk, messages had been left that related to residents losing weight. The CSCI and the Social Services Department had reported this lack of weight recording to the home’s management but no action had been taken, and was discussed again at this inspection. In a telephone conversation on the day following the inspection, the person temporarily in charge of the home said that new portable, digital weighing scales had been ordered. There was no written evidence to show that residents or their relatives had been involved in the care planning process. Some records contained a signature sheet but these had not been completed. In one-to-one conversations and in telephone conversations with five relatives, four had expressed their dissatisfaction with the standard of care being provided at Dean Wood Manor. One relative said he thought the standard of care was improving. Since the conversations took place, two residents have left the home and moved to an alternative care setting. Three relatives had emphasised the poor level of personal hygiene, particularly relating to the cleanliness of finger nails, grooming, and cleanliness of clothing. Two also spoke about the lack of communication from staff regarding the resident’s health care. One relative had not been told about a resident’s fall. One relative had not been told about an incident involving the resident. One relative had told the Inspectors during a previous visit that she never felt entirely happy when leaving her relative at the home. She said she didn’t feel “comfortable”. All relatives said they had voiced their concerns to members of staff at the home. It was evident that the requirement, made following a complaint investigation at the home, for all information relating to a resident’s health and well-being to be recorded in the care plan, had not been achieved within the stipulated timescale for action, i.e. 17th January 2006. In a letter to CSCI dated 17th January 2006, Mimosa’s Operations Director wrote that, “We are continually auditing the home’s care plans and have adopted the NMC’s approach to recording and record keeping using Ropers model of nursing care. This, therefore, identifies assessment, planning, implementation and evaluation of care. It is the company’s policy to provide high standards of nursing care and we recognise the importance of good care planning.” The number of shortfalls that were seen in the care plans does not support this assertion. Dean Wood Manor DS0000064122.V275433.R01.S.doc Version 5.1 Page 13 Speaking with residents, it was clear that one or two had some insight into the level of care that they received. One resident said she got to see her GP whenever she needed to, that staff were careful and considerate when helping her to move about, and that she was given assistance to maintain a good level of personal hygiene. This person had also attended hospital for surgery. Another resident felt that she was not receiving the care that she needed. She particularly disliked having to have a bath while staff watched her. She described assistance with bathing as “being mauled” and said she found the process “degrading”. It is acknowledged that the standard of care planning is also of concern to Mimosa, as seen in the audit report completed by the Operations Director. The person temporarily in charge at Dean Wood Manor was aware that care plans needed to be reviewed and had scheduled some to be done during the week of this inspection. In a telephone conversation to the CSCI Inspector the day after the inspection, he reiterated Mimosa’s assurance to improve the written records. Speaking with staff, and observing them as they went about their work, it was noticeable that they were familiar with the residents’ needs and preferences. When asked to clarify the reasons for certain procedures, staff were able to give a full explanation as to the reasons why they did things in a particular way. This was generally because it was what the resident had wanted, or because it was considered by staff to be most beneficial for them. However, the care practice observed is not consistently reflected in the written care plan. Staff were heard to be speak to residents in a respectful way, and one resident spoke at some length about the way she was treated by staff, who were considerate in maintaining her privacy and dignity. This resident spoke about getting telephone messages, which were delivered to her by staff, and said she could not make a telephone call because she could not get to one. However, there is a culture of labelling residents. Staff went to the lounge at meal times to help “the feeders”. Those residents who were unwell were described as “the poorlies”. Terms such as these devalue a resident’s worth and are seen as derogatory. One resident said she gets told where to sit and remarked, “That sounds well to a grown woman”. She said she felt treated like a child. The majority of ladies who were wearing skirts and dresses had bare legs and did not appear to have been encouraged to wear tights or stockings. This was neither dignified nor appropriate for the cold weather. One lady had told the Inspector previously that she did not like anything on her legs, but another lady said she could have “done with something on her legs”. One lady arrived in the lounge without stockings or shoes and it was the laundry assistant who Dean Wood Manor DS0000064122.V275433.R01.S.doc Version 5.1 Page 14 noticed this omission and who went to get them for the resident. Other care staff passing through the lounge had not noticed. Some staff passed by residents and acknowledged them but did not spend any quality time. Some residents appeared to be overlooked unless it was time for them to have a drink or some attention to their personal hygiene. Other staff did acknowledge residents by chatting and passing the time of day, offering to get a cup of tea, or encouraging the resident to walk with them. One Inspector sat in the West Lounge for 40 minutes during which time only one member of staff spent any significant time with residents. Dean Wood Manor DS0000064122.V275433.R01.S.doc Version 5.1 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15. The range of activities and occupation provided for residents is limited by the knowledge the home has about the people who live there. There was insufficient evidence to demonstrate that residents live fulfilling lives. There are few visitors to the home and little contact with the local community. Actively encouraging people to visit and taking residents into the community would improve this situation. There was some evidence to confirm that residents are able to express choices within the activities of daily living. Their ability to control situations can be limited by their capacity, in which case decisions are made on their behalf. Those who can exercise control, do so. Food at the home looked appetising and was generally enjoyed by residents. A review must be undertaken to ensure that food is provided that is offered in sufficient quantities, and which links to each resident’s nutritional assessment. EVIDENCE: A sample of five care plans was looked at during this inspection. The social profile for one long-standing residents indicated that she liked shopping, Dean Wood Manor DS0000064122.V275433.R01.S.doc Version 5.1 Page 16 knitting and poems. No social profiles had been completed on the remainder of the files in the sample. The home’s activities co-ordinator had resigned from her position at the end of the week prior to this inspection. A weekly activities programme had been devised but one member of staff said that few residents took part, for example, only two played bingo. This member of staff asked the Inspectors for ideas on how to develop activities, and advice was given. At previous visits to the home, Inspectors had seen the activities co-ordinator taking one resident for a walk in the home’s grounds, and baking cakes with another resident. During the morning of this inspection music was playing in the West Lounge, which two residents were enjoying and joining in with. Otherwise, there was no evidence of planned activities having taken place. There were no magazines or newspapers available for residents in the communal areas, though there were some large print books. The Inspectors asked for magazines to be found for one resident, who was sitting with them during the inspection. A member of staff brought some from the staff room and the resident methodically worked through the small pile of magazines. The Inspectors found this resident a large print book which she turned the pages of as if reading it, and this resident was subsequently seen, sitting closely beside another resident, going through the book together. One resident was satisfied with the activities she had access to, preferring her own company, the radio and quizzes. Another said she used to play bowls a lot and would like to go out to watch a game, but she knew she could no longer take part. She also said she liked to be outdoors but did not get the chance. She felt she had no sense of purpose. One resident stayed in her room reading and writing. The home’s newsletter for February/March 2006 discusses the extent entertainment, fund-raising and activities. The home must take care that it can demonstrate the claims it publicises are put into action. There were very few entries in the visitor’s book, which was opened on 21st January 2006, and no visitors were seen during this inspection. The Inspectors had had contact either at the home or by telephone with five visitors to the home and their comments are contained within the body of this report. Staff said that visitors are welcome at most times. They said visitors tend to know when it is meal-time and so do not visit at these times. Staff could not locate a copy of the home’s brochure, which would have indicated to new visitors what the arrangements for visiting were. The person temporarily in charge felt that the reason for few visitors might be because dementia can be a distressing condition for families and friends to manage. Education of and engagement with families and friends, together with active encouragement to visit and to join in activities may improve this situation. Dean Wood Manor DS0000064122.V275433.R01.S.doc Version 5.1 Page 17 There was evidence to confirm that some residents exercise choice and control over the way they spend their lives; for others, choices are made by staff on their behalf. When making these choices, some staff did speak to the resident about what they were doing and why they were doing it. However, not all staff behaved in this way. Only one dining room was being used. Some of the residents were sat at the dining tables for some time before the lunch-time meal was served, as if this was a focal point in their day. Dining tables were nicely set with linen tablecloths and napkins. There were no teapots, milk jugs, or sugar bowls, possibly due to resident’s capabilities/safety. No menu was on display, but staff did tell residents of the choices available, for example on this occasion, sausages or shepherd’s pie. The food provided at this meal looked appetising and was well-presented. Two staff were observed serving 16 residents, all of whom needed a little assistance. One resident was walking about quite a lot, but did stop when offered a drink by staff. Residents were not rushed with their meals. Staff were attentive and polite, and wore appropriate protective clothing and hairnets. One resident who took her meals in her room said that staff always asked which option she would like and that she had not been disappointed yet. A number of residents were taking meals in the lounge where they had spent the morning. They were served puréed diets, comprising potatoes, vegetables and meat, each having been puréed separately, and each being served separately. Staff were asked why residents received their meal in the lounge, and said it was because they were “feeders”. Asked if there was another reason, staff said, “No.” The Inspectors noted that puréed diets were served in substantial quantities, but that regular meals were served on small plates. It could not be confirmed during this inspection that a check on the nutritional content of meals had taken place, or that it had been linked to residents’ weights. On the day following the inspection, the person temporarily in charge of the home said that he had spoken to the kitchen who had told him that there was very little waste returned from the dining room. The Mimosa representative said this posed a question for him as to whether or not sufficient food was being made available. He advised that larger dinner plates had been ordered immediately following the inspection, and that a review of the meals provided, including portion control and adequacy, would be undertaken. Dean Wood Manor DS0000064122.V275433.R01.S.doc Version 5.1 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Residents and their relatives expressed the opinion that their complaints have not been listened to, nor action taken, particularly when they have raised concerns with members of staff. The home needs to be able to demonstrate that there is an open culture in which people feel they can make a complaint, raise concerns, or make constructive suggestions. The home has policies and procedures for protecting residents from abuse, and further training has been made available to staff following two recent referrals to the local authority’s Vulnerable Adults team, the outcomes of which were outstanding at the time of this report. A copy of the local authority’s most recent guidance needs to be sourced so that the home has up-to-date information. Mimosa has demonstrated that allegations of abuse by staff are treated seriously and that firm action is taken. EVIDENCE: The home has a complaints procedure, a copy of which is located close to the main entrance door. When the new Manager takes up post, the procedure will need to be updated. At that time, the telephone number of the local CSCI office will need to be included. There is a system for recording complaints. Three complaints had been recorded between September and December 2005. The content of the complaints referred generally to the complainants’ dissatisfaction with care practice and the capability of staff working at the home. A written response had been made to one complainant. Dean Wood Manor DS0000064122.V275433.R01.S.doc Version 5.1 Page 19 A number of complaints had been made to the CSCI, all expressing concern about the standard of care being provided to the home. Complaints came from anonymous sources, as well as relatives and social care professionals. Complaints have been investigated by CSCI, and Mimosa has provided a written undertaking to maintain good standards of care. Visits have been undertaken by Inspectors to monitor the service. The home has a policy and procedure that relates to the protection of vulnerable adults (PoVA). The home did not have a copy of the local authority’s most recent guidance (dated April 2005), and a copy will need to be sourced. The care of two residents had been referred to the local authority’s Vulnerable Adults Team and investigations were in progress at the time of this inspection. One of the residents had moved to an alternative care provider. As a result of these referrals, the local authority had suspended contracts with Dean Wood Manor. The suspension was still in place at the time of this report. Two members of staff said they had attended PoVA training when Mimosa first took over the home in 2005 and said that another course was scheduled to be run in the week after the inspection. Both members of staff said they would have no hesitation in reporting poor practice. One person said she had not received any training in relation to “PoVA” or “abuse”. She did not know about the planned training. There was evidence in interview records that one candidate had identified the potential for abuse in the workplace and that the candidate had said what would be done: “Report it right away.” Dean Wood Manor DS0000064122.V275433.R01.S.doc Version 5.1 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, and 26. The standard of the décor, fabric and furnishings within the home continues to improve. The standard of cleanliness and hygiene has improved significantly. Works needs to be done to improve the heating and ventilation in the West Lounge. Consideration should be given to giving bathrooms a more domestic feel. Consideration should also be given to providing signage appropriate to residents with dementia. With the three above-mentioned exceptions, residents can be assured they will live in clean, comfortable surroundings. EVIDENCE: At the time of this inspection, the home was clean, tidy and nicely presented throughout. Domestic assistants were working systematically, making sure furniture was washed down, floors were cleaned, and bathrooms and toilets kept fresh and tidy. Two members of staff were busy changing beds and explained the system they followed, which included disinfecting mattresses, and wiping down bedframes before fitting new, clean bed linen. Dean Wood Manor DS0000064122.V275433.R01.S.doc Version 5.1 Page 21 Visitors to the home have reported to the Inspectors that the most noticeable improvement to the environment has been that the odour of stale urine has gone. However, Inspectors have identified an offensive odour in the West Lounge on two occasions. The Manager at the time said the odour was as a result of poor ventilation, as a result of which steam from the carpet cleaner could not be extracted. This, it was said, was the cause of the remaining odour. Coupled with the lack of ventilation in this lounge is the fact that it is very cold. The last two temperature readings taken by Inspectors were 60° and 65°, which was not sufficiently warm or comfortable for residents. Additional heaters had been installed but were not having sufficient impact. On the day following the inspection, the person temporarily in charge of the home told CSCI that the problem was more glazing related; heat was being lost through the windows. He said he was looking at installing another layer of glazing and, in the meantime, had instructed staff to encourage residents to wear socks, tights, stockings, etc. and for lap rugs to be used. If the heating and ventilation of this lounge cannot be improved, consideration will need to be given to changing its use, perhaps as a dining room rather than a sitting room. New curtains have been fitted recently in the West Lounge and adjacent corridors. Window blinds have been installed in the small conservatory. At the last inspection, one resident had been thrilled to be moving to a newly decorated, ground floor room, which she had described as “gorgeous”. She expressed her disappointment to Inspectors, advising that she had not, in the end, been allowed to move to this room; it had been allocated to someone else. However, the room she was in had been decorated and she appeared satisfied with this. There are a number of bathrooms and toilets located around the home, which appear adequate for the needs of residents. Only one is decorated in a domestic style. The remainder still need to be given a more domestic feel. Because the home has a stated aim of providing care for people with dementia, some consideration needs to be given to introducing signage for residents that is appropriate to their capacity, for example, pictorial signs for toilets, to assist with orientation. The nurse call system has been upgraded. One resident who spends the day in her room said staff were very good about making sure her call bell was close by. She said, “They never forget”. Dean Wood Manor DS0000064122.V275433.R01.S.doc Version 5.1 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, and 30. Emphasis must be placed on ensuring staff rotas are complete, taking into account the dependency levels of residents, and taking into account the skills and experience of staff. On a day-to-day basis, the involvement of a Registered Mental Nurse and staff who have experience of caring for people with dementia would significantly improve the quality of life for these residents. To ensure residents are protected by the home’s recruitment policy and practices, new staff must not commence in post without appropriate checks having been made. A candidate’s suitability to work with elderly, vulnerable people would be better tested if open questions and scenarios were used during interview. Staff training must be scheduled, appropriate to the service provided by the home, so that gaps in knowledge are filled, and current techniques and best practice guidelines disseminated. In this way, residents can be assured that staff will be trained and competent to do their jobs. EVIDENCE: Over recent months the staffing levels at Dean Wood Manor have been problematic. A number of staff have left or have been dismissed since Mimosa’s purchase of the home, and several have been on long term sick leave. There have been additional leavers, more recently, of key staff. Dean Wood Manor DS0000064122.V275433.R01.S.doc Version 5.1 Page 23 The staff rotas have been checked by CSCI on several occasions, showing that there have been numerous gaps in the rota where Agency staff have been brought in. There have been occasions where staff have not been available to fill a gap in the rota, at which time the home has been short of staff. This has been confirmed by staff at the home and by Mimosa representatives. Visitors to the home and social care professionals have told Inspectors that they feel the home has regularly been short-staffed. An immediate requirement in relation to staffing was made on 23rd December 2005, and was repeated in a complaint report dated 20th January 2006. Staffing levels at the home had to be improved immediately “and on-going”. On 30th January 2006, staffing levels were still not satisfactory, but no further requirement was made as the original made on 23rd December 2005 was still in place. Although the Operations Director for Mimosa gave CSCI a written, personal assurance that the staff rotas would be prepared four weeks in advance, this was still not evident at this inspection. The rota for the following week had not been completed, and nothing had been written for the weeks after that. A Registered General Nurse is employed 24 hours per day, and has responsibility for the management of care. The home currently does not employ a Registered Mental Nurse. The activity co-ordinator’s post was also vacant. Care staff do not work regular hours on regular shifts and there are days, according to the rota, when there are more staff working than on others, even accounting for agency cover. This does not appear to be because of dependency levels of residents but more to do with availability of staff. Some staff like to work “long days”, over a 14 hour period, so they “can get the hours over with”. Escort duty for residents (where a carer may accompany a resident to an appointment) is not recorded separately or on the staff rotas but this activity may account for some of the anomalies. The presentation of staff rotas has improved now that they are being produced on the computer. A sample of six files for current members of staff was looked at. To assess the quality of the recruitment process, a sample of three files was looked at relating to external candidates. The files for the external candidates showed that application forms had been completed, and a written record of the interview had been kept. The questionnaire sheet showed that questions posed to candidates are closed, rather than open in style. The answers recorded were, therefore, mainly “yes” or “no”, the scope for response being limited by the question. It was not evident, therefore, that a candidate’s suitability for the post had been fully explored. The Administrator said that staff begin in post after a check has been made with the Protection of Vulnerable Adults (PoVA) list and following receipt of two satisfactory references. She understood that a person could then commence in post provided that the Criminal Records Bureau (CRB) disclosure had been sent off for checking. This is against current guidance Dean Wood Manor DS0000064122.V275433.R01.S.doc Version 5.1 Page 24 from the CRB. Subsequent to the inspection, the Inspector spoke with Mimosa’s Provider Relationship Manager within CSCI who confirmed that the position at Dean Wood Manor is the same as it is nationally: staff may not begin in post until receipt of PoVA check, CRB disclosure, and two satisfactory references. There was no evidence on the files to show that staff had received terms and conditions of employment from Mimosa. Some files contained old contracts of employment from the previous owner. One person should have had a variation to contract when she reached age 65 as her terms and conditions appear to have changed. Matters relating to recruitment practice and contracts were discussed with the person temporarily in charge at the time of this inspection. Staff reported that there had been very little in the way of formal training apart from that which took place when Mimosa first took over. Two members of staff said they had had training in mandatory subjects such as First Aid and Food Hygiene, and attended training in the Control of Substances Hazardous to Health (CoSHH). There was little evidence in files comprising the sample that related to recent training though one person had certificates for Moving and Handling, First Aid, Food Hygiene, and CoSHH. As noted earlier in this report, Mimosa had arranged a course on the Protection of Vulnerable Adults for the week after this inspection. Previously the home had an accreditation through Manchester Metropolitan University to undertake the adaptation of overseas nurses. However, because the home has no qualified mentors currently, and because there has not been a manager in post of a suitable calibre, the adaptation accreditation has been withdrawn. Dean Wood Manor DS0000064122.V275433.R01.S.doc Version 5.1 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 and 36. The employment of a Manager with suitable experience, knowledge, and competence will be central to raising the standard of the quality of care provided at Dean Wood Manor. Supervision sessions provide the opportunity to identify a person’s limitations or knowledge gaps, and to reinforce the home’s philosophy of care. Given the recent history of the home, supervision will be vital to ensuring staff are competent to do the work they are employed to do. EVIDENCE: Since the last inspection the Manager had resigned his position. A new Manager had been recruited and was due to commence in employment at Dean Wood Manor on 13th March 2006. Mimosa’s management team is aware that there are a number of shortfalls evident at Dean Wood Manor, and is confident that the new Manager has the competence and experience required to improve the standards of care provided by the home. Mimosa’s Dean Wood Manor DS0000064122.V275433.R01.S.doc Version 5.1 Page 26 management team has agreed to ensure that the new Manager registers with the CSCI quickly. The formal supervision of staff employed at the home is still not taking place. None is recorded, and staff said they had not attended any supervision sessions, though one person said, “there are regular staff meetings”. Dean Wood Manor DS0000064122.V275433.R01.S.doc Version 5.1 Page 27 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 1 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 X 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X 3 X X X X 3 STAFFING Standard No Score 27 2 28 X 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X X X X 1 X X Dean Wood Manor DS0000064122.V275433.R01.S.doc Version 5.1 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP3 OP4 Regulation 14 12 Requirement Thorough pre-admission assessments must be conducted, and records properly maintained. A plan for improvement in relation to specialised services must be produced, which is in line with current good practice. Care plans must be written for all residents. Care plans must be reviewed on a regular basis. The expectation is that this will be monthly. A written assessment must be made of all identified risks, which is reviewed on a regular basis. Care plans must be developed with the resident and/or supporter. If this is not possible, the reason should be recorded. A record must be kept of each resident’s contact with health and social care professionals. New weighing scales must be purchased and written records of weights maintained. The home must demonstrate adherence to a code of conduct that fosters self-esteem in the DS0000064122.V275433.R01.S.doc Timescale for action 31/03/06 30/04/06 3 4 5 OP7 OP7 OP7 15 15 13 30/04/06 30/04/06 30/04/06 6 OP7 15 30/04/06 7 8 9 OP8 OP8 OP10 12 12 12 30/04/06 30/04/06 30/04/06 Dean Wood Manor Version 5.1 Page 29 10 OP12 16 11 12 13 OP15 OP16 OP18 16 22 13 14 15 OP19 OP27 23 18 16 OP29 19 17 18 OP29 OP30 17 18 19 20 OP31 OP36 8 12 resident, and which respects the individual. An activities programme must be introduced that is suitable for the residents, and which offers therapy, recreation, and occupation. A reviews of meals provided must be undertaken to measure adequacy. The way that complaints and concerns are dealt with must be improved. The home must source a copy of the local authority’s most recent guidance on the Protection of Vulnerable Adults. The heating and ventilation in the West Lounge must be improved. The home must employ at all times staff in sufficient numbers, who have the skills necessary to carry out their duties. New staff must not commence in post without a satisfactory Criminal Record Bureau disclosure. All staff must have an up to date statement of terms and conditions A training schedule must be produced, showing courses and workshops that are appropriate to the work that staff at the home are to perform. The new Manager must apply for registration with CSCI. All staff must receive regular, formal supervision. Records must be kept. 30/04/06 30/04/06 30/04/06 30/04/06 30/04/06 13/03/06 13/03/06 30/04/06 30/04/06 30/04/06 30/04/06 Dean Wood Manor DS0000064122.V275433.R01.S.doc Version 5.1 Page 30 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 5 Refer to Standard OP13 OP13 OP15 OP19 OP21 Good Practice Recommendations Relatives and friends of residents should be encouraged to visit, and to join in with social events. Residents should have the opportunity to do things in their community, if they wish. Residents should be included in social events, such as meal times, and not excluded because of capacity or capability. Consideration should be given to improving signage to assist residents to orientate themselves. Consideration should be given to decorating bathrooms, so that they have a more domestic feel. Dean Wood Manor DS0000064122.V275433.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Dean Wood Manor DS0000064122.V275433.R01.S.doc Version 5.1 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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