Inspection on 04/08/06 for Dee House

This inspection was carried out on 4th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Dee House 10/01/06

Dee House 04/07/05

Dee House 11/01/05

Dee House 06/07/04

Dee House 12/02/04

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

CARE HOME ADULTS 18-65 Dee House 20 Sealand Road Chester Cheshire CH1 4LB Lead Inspector Judith Morton Key Unannounced Inspection 4th August 2006 09:30 Dee House DS0000006547.V299561.R01.S.doc Version 5.2 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 Dee House DS0000006547.V299561.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Dee House DS0000006547.V299561.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dee House Address 20 Sealand Road Chester Cheshire CH1 4LB 01244 375820 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) Muir Group Housing Association Limited Ms Joy Swainson Care Home 9 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (9) of places Dee House DS0000006547.V299561.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 9 service users in the category MD (Mental disorder, excluding learning disability or dementia) The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection 10th January 2006 2. Date of last inspection Brief Description of the Service: Dee House is care home for nine people who have mental health needs which is owned and operated by Muir Group Housing Association Limited. Located on Sealand Road, within a mile of Chester City Centre, the home was opened in 1991 and extended in July 2000 to provide three additional places. The premises comprise two terraced properties linked by a conservatory extension to the rear. Accommodation for residents comprises nine single bedrooms (on two floors), two lounge areas, a dining room, kitchen and separate laundry. Standards of décor, furnishings and fittings are good throughout the home, as are standards of hygiene and cleanliness. Residents are encouraged to participate in the running of the home, and they are supported by staff to make full use of community facilities/amenities for shopping, recreation, education and healthcare. The manager had recorded in the pre-inspection questionnaire that was returned to The Commission for Social Care Inspection on 13th July, that the weekly charge of living at Dee House was £343.34. Dee House DS0000006547.V299561.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit, part of the key inspection for this service, took place over 4 hours on 04/08/06. Two of the resident’s files were checked during the visit along with other documentation, including, menus, activities timetable, medication records and staff training records. There were five of the nine residents at home during the visit. They all completed questionnaires and met with the inspector in the lounge to give their views on living at Dee House. What the service does well: What has improved since the last inspection? What they could do better: The residents’ views of how their day has been, how they felt their care has been, did they enjoy the activities/college/work/meal etc should be included in the daily records whenever possible. Documentation for the residents, such as service user guide, care plan, residents meeting minutes, should be produced in alternative formats for those residents who have difficulty in reading long documents. Dee House DS0000006547.V299561.R01.S.doc Version 5.2 Page 6 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. Dee House DS0000006547.V299561.R01.S.doc Version 5.2 Page 7 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 Dee House DS0000006547.V299561.R01.S.doc Version 5.2 Page 8 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 Quality in this outcome area is good. This judgement has been made using available evidence and a visit to the service. The information available for residents, together with the detailed assessment, would give the residents confidence that their needs could be met at Dee House. EVIDENCE: The home has a comprehensive statement of purpose and service user guide that provides information about the home, the facilities available and the qualities and qualifications of the staff team. However, these documents are lengthy and consideration should be given to producing them in alternative formats for any residents who have difficulty in reading them. (See Recommendation 1) Residents spoken with confirmed that they were happy living in the home and the home continued to meet their needs. One resident said Dee House “more than adequately meets my needs”. Two resident’s care files were checked. Both contained a detailed assessment of the residents’ needs. Additionally the residents had been asked for their preferences - ie. what time they liked to get up/go to bed, what likes and dislikes they had etc – and this was recorded in their files. Dee House DS0000006547.V299561.R01.S.doc Version 5.2 Page 9 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, 8 & 9 Quality in this outcome area is good. This judgement has been made using available evidence and a visit to the service. The level of support provided to the residents, dependent on their assessment of need, enables all of the residents to participate in daily life as independently as they are able. EVIDENCE: The files that were checked both contained care plans. The plans covered all aspects of the resident’s daily life skills, physical, health, social and emotional needs. Health needs were recorded separately and covered chiropodist, dentist, GP, optician, psychiatrist etc. Dates when appointments were due or had been met were recorded. The care plans were signed by the residents and were being reviewed three monthly. The staff record daily how the resident has been and what they have done. As the residents all have good levels of communication, consideration should be given to including the residents’ own views of their day in this daily record. (See recommendation 2) The residents were supported by the staff in making some decisions about aspects of their life. The level of support would be appropriate to the level of dependency of the resident. Dee House DS0000006547.V299561.R01.S.doc Version 5.2 Page 10 The residents were consulted about aspects of daily life that would affect them. Residents meetings were held to discuss things such as the menu, holidays, days out, jobs within Dee house etc. Risk assessments had been completed where necessary and were held in the individual files. Residents were able to go out to activities, such as the pub, local park, without the support of staff if it had been assessed that they, or any members of the public, were not at risk by them doing so. Dee House DS0000006547.V299561.R01.S.doc Version 5.2 Page 11 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): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence and a visit to the service. Activities are made available so that the residents can access local facilities, participate in new experiences and lead fulfilling lives in the community. EVIDENCE: The residents participate in everyday social activities within the community. Some residents also attend a day centre for part of the week. The residents had been on holiday to Blackpool again this summer. All spoken with said that they had enjoyed it. They said it was better as they went there last year so knew what there was to do and where to go. The staff agreed with this and felt that the familiarity gave reassurance and confidence to some residents, enabling them to have a calm and relaxed holiday. One resident wrote in the questionnaire that help is needed in finding a job and in other aspects of their life. Staff should seek and record the resident’s aspirations more closely so that they can offer the appropriate level of advice and support. (See recommendation 3) Dee House DS0000006547.V299561.R01.S.doc Version 5.2 Page 12 There is a timetable of weekly activities on the resident’s notice board. The residents are encouraged to develop daily living skills and a list of jobs that they are required to contribute to are listed on the residents’ notice board. This includes setting the tables, helping with laundry, vacuuming and keeping their own room tidy. The residents are free to receive visitors, with their consent at any time. They are also able to visit family and maintain friendships. One resident said they wrote to a member of their family each week. Those residents who were at Dee House during the site visit gave their permission for the inspector to view their rooms. The rooms were of varying size but were all well furnished and decorated. The soft furnishings coordinated with the décor and the rooms were clean and bright. All of the rooms seen had been personalised to varying degrees and reflected the residents’ interests. Staff were observed to interact appropriately and politely with the residents. The staff at lunchtime were not joining the residents at the tables but kept a discreet distance in the kitchen, rather than standing around while people were eating. They explained that staff would join the residents for their evening meal. The residents were seen to freely move around Dee House and chose where they wanted to spend their time. There was a clearly designated smoking lounge; those residents who smoke were fully aware of this and did not attempt to smoke elsewhere in the home. There is a menu available, which is reviewed by the staff and the suggestions are put to the residents for their view. The menu includes healthy options for those residents who require careful monitoring of their dietary intake because of weight or diabetes. The manager should consider producing menus and activity resources in written and photographic/leaflet form. (See also recommendation 1) Dee House DS0000006547.V299561.R01.S.doc Version 5.2 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 & 21 Quality in this outcome area is good. This judgement has been made using available evidence and a visit to the service. The residents take measured risks and receive appropriate levels of support, which enables them to remain as independent as possible in all aspects of their lives. EVIDENCE: The residents spoken with said that they felt the staff were very supportive and understanding of their needs. The staff offer support at a level dictated by the assessment of the residents’ dependency or mental health at the time. The residents’ physical and emotional health needs were attended to by health professionals and the staff at Dee House. There is evidence of the involvement of the GP and community psychiatric nurse who visit the home regularly to review the medication and progress of the residents. It is not always appropriate, because of the nature of the service, for residents to maintain their own medication. Risk assessments were present for those residents who store and administer their own medication and they sign the medication administration sheet (MAR) at the end of each week. This was seen on the MAR sheets checked. All MAR sheets were accurate. The medication trolley is held securely in a small room off the manager’s office, both of which are lockable. Dee House DS0000006547.V299561.R01.S.doc Version 5.2 Page 14 Policies and procedures are in place in the home to ensure residents are cared for with respect up to and including the time of their death. Residents of the home have made their wishes known to the staff regarding their religion and their wishes for after their death; this information is recorded in their care plan. Dee House DS0000006547.V299561.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome area is good. This judgement has been made using available evidence and a visit to the service. The involvement of and discussion held with the residents before important decisions on issues that effect their lifestyle are made, means that the residents wishes, choices and rights are maintained. EVIDENCE: The residents spoken with and the questionnaires received showed that the residents felt their views were being sought and acted upon. Residents meetings were also held periodically, giving the residents the opportunity to voice their opinions. A written complaints procedure, which included contact details for the Commission for Social Care Inspection (CSCI), was displayed within the home. Residents said that they were aware of how to make a complaint if they were unhappy with any aspect of the care and support they receive at Dee House. No complaints have been recorded by the home or received by CSCI about the home. Written policies for the protection of vulnerable adults were in place and the home also had a copy of the local authority’s protocols and procedures for adult protection. The staff training records revealed that staff had not undertaken any form of training around the protection of vulnerable adults and this should be provided for all staff so that poor practice can be recognised and reported. Dee House DS0000006547.V299561.R01.S.doc Version 5.2 Page 16 The home might consider including the residents in the training should this be provided ‘in house’ so that they too can recognise when practices are abusive either to themselves or to others. (See recommendation 4) Dee House DS0000006547.V299561.R01.S.doc Version 5.2 Page 17 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence and a visit to the service. Dee House is well maintained so that residents live in a comfortable home in the community. EVIDENCE: A tour of the building was undertaken, which included all the communal areas and the residents’ bedrooms when invited. The home was decorated in a homely manner and all of the rooms were bright with domestic type furniture. The home has a rolling programme of renewals and the manager confirmed that Muir Housing respond promptly to requests for repairs. Bathrooms and bedrooms are fitted with locks to ensure residents’ privacy. There are a number of lounges, a dining area, large garden area and the resident’s own bedroom for residents to choose where they wish to spend their time. Dee House was clean and airy; there were no offensive odours throughout the home. Dee House DS0000006547.V299561.R01.S.doc Version 5.2 Page 18 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): 32, 34 & 35 & 36 Quality in this outcome area is good. This judgement has been made using available evidence and a visit to the service. Staff work well together as a team, with good support from the manager, so that residents have stability, continuity and confidence in the support they receive. EVIDENCE: The residents at Dee House all knew who the manager was and appeared to find the manager approachable as they were seen to freely interact with the manager during the visit. Copies of the staff training records were given to the inspector. They showed that the manager and staff had updated their knowledge through ongoing training. This included, equality and diversity, care of the dying/bereaved, abuse of vulnerable adults, dealing with challenging behaviour, first aid and recruitment and selection (Manager only). However, some staff training records revealed that there was nothing recorded since November 2005, which implied that they had not received any training in 2006. The manager explained that although this was not shown on the training records given, five members of staff had undertaken their NVQ between 2005 and 2006, which included updates on training such as adult abuse awareness. Dee House DS0000006547.V299561.R01.S.doc Version 5.2 Page 19 The staff team at Dee House have worked together for many years, with the exception of a student on placement. This means that staff know the residents well and gives the residents stability and continuity. Two staff spoken with during the inspection spoke highly of the support they receive from the manager, and confirm they have regular supervision meetings with her to discuss their role and needs relating to training. The student member of staff said that he had enjoyed his placement there and had felt supported by the manager and staff. Dee House DS0000006547.V299561.R01.S.doc Version 5.2 Page 20 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, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence and a visit to the service. The level of consultation with the residents ensures they continue to be involved in decision making within the home and therefore the continual development of the service. EVIDENCE: The manager is registered with the Commission for Social Care Inspection and is a qualified nurse (RMN). She achieved the Registered Managers Award in 2005. The manager had maintained her knowledge through further training courses since the last inspection visit. These included equality and diversity, first aid and fire safety lectures. Staff spoke well of the manager’s approachability and the level of support she offers to all of them. The residents confirmed that they have residents’ meetings although they could not say how often these happened. They wrote in their questionnaires, and told the inspector, that they felt the staff listened to them. Dee House DS0000006547.V299561.R01.S.doc Version 5.2 Page 21 The manager should consider producing all documentation that is relevant to the residents, ie, care plans, resident’s meeting minutes etc in alternative formats. (See also recommendation 1) The manager said that there are quality assurance questionnaires, which are sent out residents and families. She told the inspector of at least two occasions where people had been verbally complementary of the service offered at Dee House. Consideration should be given to sending questionnaires to seek the views of social workers, community psychiatric nurses (CPNs), GPs and consultants so that positive comments are recorded and can be relayed to the staff. A report of the findings should also be published with a plan if any areas of improvement are needed. (See recommendation 5) Regular maintenance and safety checks are carried out at Dee House to ensure the safety of the staff and residents. These include fire equipment, smoke alarms, emergency lighting, water temperature checks regarding legionella, electrical wiring and emergency call systems. Dee House DS0000006547.V299561.R01.S.doc Version 5.2 Page 22 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 X 4 X 5 X 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 X 3 X X 3 X Dee House DS0000006547.V299561.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA1 Good Practice Recommendations The manager should consider the following in alternative formats for the residents: • The service users’ guide • Menus and activity resources • Care plans • Residents’ meeting minutes Consideration should be given to including the residents’ own views of how their day has gone in the daily record. Staff should seek and record the resident’s aspirations more closely so that they can offer the appropriate level of advice and support. The manager should consider sending questionnaires to seek the views of Social Workers, Community Psychiatric Nurses, (CPN) GP’s and Consultants. A report of the findings should also be published with a plan if any areas of improvement are needed. 2 3 4 YA6 YA11 YA39 Dee House DS0000006547.V299561.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 Dee House DS0000006547.V299561.R01.S.doc Version 5.2 Page 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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