CARE HOMES FOR OLDER PEOPLE
Defoe Court Defoe Crescent Newton Aycliffe Co Durham DL5 4JP Lead Inspector
John Trainor Unannounced Inspection 10:00 16th May 2007 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 Defoe Court DS0000039763.V338461.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 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. Defoe Court DS0000039763.V338461.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Defoe Court Address Defoe Crescent Newton Aycliffe Co Durham DL5 4JP 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) 01325 316316 01325 316633 defoecourt@schealthcare.co.uk Southern Cross Home Properties Limited Mrs Lynn Clark Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41), Physical disability (4) of places Defoe Court DS0000039763.V338461.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Up to 4 persons above the age of 55 may be accommodated within the category of PD commensurate with the home’s Statement of Purpose. 20th June 2006 Date of last inspection Brief Description of the Service: Defoe Court is a registered care home with nursing. It is owned by Southern Cross Home Properties Ltd and located in a residential area of Newton Aycliffe, close to all local amenities. The home is situated in its own private grounds and provides personal care and accommodation for up to 41 older people. The home is purpose built for older people and is on two floors. Personal accommodation and communal areas are located on both floors. Service areas are located on the ground floor. At the time of inspection fees ranged from £432:00 - £ 485:00 with additional charges for hairdressing, chiropody, newspapers and toiletries. Defoe Court DS0000039763.V338461.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The home provided information to the Commission for Social Care Inspection before an unannounced site visit, lasting seven hours. We used this information to give a guide as to what care would be like in the home and tell us what areas we needed to look at to get further evidence. During the site visit we inspected records including health and safety records, care plans and recording. We watched how people were looked after to see what life was like for them and spoke to staff, management and people living in the home. For some of the inspection there were two inspectors. What the service does well: What has improved since the last inspection? What they could do better:
People could not always be assured the home would be able to meet all of their needs before they made a decision to move into the home. Improvements were needed to the homes statement of purpose to make sure people could make an informed choice when deciding to move into the home. People did not have their health and personal care needs consistently well met and in one case someone’s health suffered because of poor care delivery. Care planning was inconsistent. More attention was needed to risk management and task specific detail. Plans also needed more detail of personal preference so care could be specifically tailored to the individual. Some people did not feel that staff were always on hand to help them when they needed it. One
Defoe Court DS0000039763.V338461.R01.S.doc Version 5.2 Page 6 said, “why you never see them, not much, you’re sat here on your own a lot of the time.” Efforts needed to be made to ensure good preventative pressure area care was planned and implemented in order to ensure that people were not at risk and received appropriate care. Nurses and care staff needed to receive up to date pressure care training and training in the use of equipment. People did not have a lifestyle that always reflected their personal preference or choice. They were under stimulated and the home needed to develop activities which met people’s needs. One person said, “As an overall description it’s boring, I cannot walk far so I haven’t got a choice.” People could complain and have their complaints investigated though they were not always protected by the correct implementation of the homes policies and procedures on abuse. Some doors were being wedged open though the home’s fire safety plan said this mustn’t happen. Doors must not be wedged unless by devices approved by the fire officer for this purpose. There was not enough attention to ensure procedures for keeping people safe were implemented. Checks were needed to demonstrate the safety of the electrical hard wiring and the gas installation in the home. Some aspects of the home were managed well with procedures in place to ensure safety. These were not always followed. Better leadership was needed to build on the strengths the home had. 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. The summary of this inspection report can be made available in other formats on request. Defoe Court DS0000039763.V338461.R01.S.doc Version 5.2 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 Defoe Court DS0000039763.V338461.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People could not always be assured the home would be able to meet all of their needs before they made a decision to move into the home. EVIDENCE: Files inspected had pre admission assessments and an interim care plan based on the assessment. Detail was not always good but was consistent with the home’s terms and conditions that said an interim plan would be formulated whilst assessment continued. Some files had single assessment process assessments or Social services assessments. The quality of recording on the pre populated assessment forms varied. Some were more detailed than others. One person had been assessed but there was not enough detail in assessment or planning to ensure protection. There was insufficient detail in a plan to manage their needs.
Defoe Court DS0000039763.V338461.R01.S.doc Version 5.2 Page 9 People who were spoken to said they and their relatives had information about the home before they moved in. Those paying privately were charged more for their care and had separate contract and terms and conditions. The provider did not inform them the cost of their care would be different if any third party was funding it. People were being charged for safety devices that would enable them to prop open their room doors whilst still managing any risk in case of fire. This information was not included in the list of additional charges in the contract or terms and people should be made aware before they decide to move in. People were not informed that the interest from the service user account was pooled into the service user fund. Defoe Court DS0000039763.V338461.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People did not have their health and personal care needs consistently well met and in some cases people’s health suffered because of poor care delivery. EVIDENCE: Medication was stored, recorded and seen to be administered safely and had recently been audited by the pharmacist. The manager also audited medication regularly. The majority of people spoken to had glowing reports of the care saying the staff were all good and their needs were met. Some comments from people living at the home included that the care was, “brilliant, the staff are very good.” Another said, “they look after me very well, they look after us all very well.” People said they could have showers or baths when they wished. Care plans were in the main good though were not consistent in terms of detail or revision after evaluation. Some care plans lacked task specific detail and individual preference was not clear. In particular care
Defoe Court DS0000039763.V338461.R01.S.doc Version 5.2 Page 11 planning around pressure area care and wound management did not have enough detail to be clear on the treatment people should have been receiving. One person had suffered a severe pressure sore as a result of care practice in the home and they had to go into hospital because of this. Assessment was not always transferred into a care plan and changes to care, though recorded in evaluation sheets, did not result in the plan being revised so people would be able to see at a glance what care was needed. There were reports from district nursing staff that people were being found in wet underclothes when they were treating them despite saying they had asked to go to the toilet. One person said during inspection they did not get the care they required, when they needed it, saying they spent, “all the time telling them, (the staff) in one ear and out the other.” And they didn’t get a response. Another person said of the staff, “Why you never see them, not much, you’re sat here on your own a lot of the time.” Defoe Court DS0000039763.V338461.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People did not always have a lifestyle reflecting personal preference or choice. People were under stimulated. EVIDENCE: People said the food was good and they had no complaints. “Food is fine I’ve got no grumbles with it, all clean cooking like home.” There was a choice and one person made clear his preference was respected. The cook was trained in advanced food hygiene and had done focus on food training. Relatives could visit when they wished. People said they were bored. Activities did take place and occasional outings when the home had the minibus, which was shared with other homes in the group. One person said, “I like the bingo, I play when it’s on but not often.” They said there was no entertainment, “nothing like that.” “As an overall description it’s boring, I cannot walk far so I haven’t got a choice.” There were not many people in communal areas most people seemed to be looked after in
Defoe Court DS0000039763.V338461.R01.S.doc Version 5.2 Page 13 their rooms. Very little interaction was seen between staff and service users other than to provide care tasks and sometimes this was done with little interaction. Defoe Court DS0000039763.V338461.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People could complain and have their complaints investigated but procedures to protect the vulnerable adult were not implemented according to company policy and procedure. This resulted in one vulnerable adult failing to receive adequate protection. EVIDENCE: The home did have policies for complaints and abuse. Staff recently failed to notice or raise an issue of neglect with the appropriate authorities. Subsequent investigations found the home had failed to adequately care for a person’s pressure care needs. All staff involved in the care of this person failed to realise that lack of care and attention resulted in unnecessary suffering. The home’s investigation into the issue appeared flawed and did not recognise the serious failings in the treatment and care of the person. The issue was only raised with relevant authorities after a social services representative went to the home to visit the client. Defoe Court DS0000039763.V338461.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People lived in a clean and comfortable home though there was not enough attention to ensure procedures for keeping people safe were implemented. EVIDENCE: The environment was clean though there was a strong perfumed odour of air freshener as you entered the home rather than a clean fresh smell. Individual rooms and communal areas were clean and decorated and furnished to people’s tastes. One person had their own fridge, computer, television DVD and had obviously made a stamp on their own space. People spoken to were happy with their rooms. The home had a fire risk assessment in place, which had been approved by the fire officer. All rooms had en suite toilet and sink.
Defoe Court DS0000039763.V338461.R01.S.doc Version 5.2 Page 16 Several room doors were being wedged without appropriate devices in contravention of the fire risk assessment in the home. The company make people pay for door guards to be fitted. There was evidence of toiletries left in communal shower and bathrooms with several bars of soap. As bottles and soaps were left there unlabelled there was a possibility staff were using toiletries communally. Also in one bathroom tubs of barrier creams were left these were unlabelled and certainly suggested a communal use. This impacted on the infection control practice in the home. The home did have an infection control policy but it suggested this wasn’t being followed robustly. The home did provide paper towels and liquid soap in bathrooms and communal toilet areas to encourage best practice. Defoe Court DS0000039763.V338461.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s needs were met by a staff team deployed in sufficient number though practices were not consistently good. EVIDENCE: Staff were deployed within residential forum guidance for the amount of people resident and there was a qualified nurse on duty for each shift. Recruitment and selection procedures were acceptable. Staff were being trained and supervised. 58 of staff were trained to National Vocational Qualification level 2 or above. Staff interviewed had training in the protection of vulnerable adults last year. The manager confirmed there was a person qualified in first aid on each shift. One person living at the home said, “everyone from the boss to the cleaners is very good.” The manager was certain the level of night staffing was sufficient to need based on current occupancy though on full occupancy the number would be increased to 1 nurse and 4 carers at night. This would always leave 2 carers on each floor. At the time of inspection there were only 3 carers and one nurse over two floors at night. Defoe Court DS0000039763.V338461.R01.S.doc Version 5.2 Page 18 Some areas of practice in pressure care and wound treatment did not meet people’s needs and identified training deficits. Some people felt staff were not always around when they were needed, “why you never see them, not much, you’re sort of sat here on your own a lot of the time.” Defoe Court DS0000039763.V338461.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some aspects of the home were managed well with procedures in place to ensure safety. These were not always followed. Better leadership was needed to build on the strengths the home had. EVIDENCE: The manager was a qualified nurse with the RMA. During the site visit people living at the home knew who the manager was and seemed comfortable with her. One person said, “Everyone from the boss to the cleaners is very good.” The company had good quality assurance methodology with regular audits on safety, accidents and medication. The manager audited monthly with a service manager or manager from another home doing every other month. Service
Defoe Court DS0000039763.V338461.R01.S.doc Version 5.2 Page 20 users were surveyed on their views and results published in the service user guide. Questionnaires were sent out annually. Regulation 26 visits were taking place and a report was seen. Service user monies were accurate and well recorded. However service user monies were banked in a communal account with any interest going into the service user fund. As people had different levels of balance this means that some people effectively subsidise the fund more than others and all benefit equally. This information is not in the statement of purpose. There were annual chlorination visits to manage the risk from legionella and the last one took place on 31/01/07. Water temperatures were checked monthly and maintained at the point of delivery between 42°C and 43°C. A letter from environmental health was seen to evidence checks were taking place and fridges had been replaced as recommended. The kitchen looked clean and tidy. Bed rails, when used, had bumpers fitted. Risk assessments were in place and they were fitted safely at the time of the site visit. There was a fire risk assessment, which instructed not to use door wedges though door wedges were being used in the home. The home did not have an electrical hard wiring certificate or current landlords gas safety certificate and so could not demonstrate the safety of these installations at the time of the site visit. The home had failed to report the development of pressure sores as required under regulation 37 Care Homes Regulations 2001 (as amended) despite their own policies and procedures instructing this should be done. Defoe Court DS0000039763.V338461.R01.S.doc Version 5.2 Page 21 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 2 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Defoe Court DS0000039763.V338461.R01.S.doc Version 5.2 Page 22 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. 1 Standard OP1 Regulation 5(1(bc, bd)) Requirement Revise the statement of purpose to: Inform people who are paying privately their fee may be different if a person other than the service user was paying it. Inform people they will be charged extra for door safety devices, to prop open doors, should they require them. Efforts must be made to ensure good preventative pressure area care is planned and implemented. There were serious deficits in the care people received in relation to appropriate pressure area care and wound treatment. In order to ensure that people are not at risk and receive appropriate care, nurses and care staff must receive up to date pressure care training and training in the use of equipment A programme of activities must be developed which responds to service user’s preference and needs. Timescale for action 31/07/07 2 OP7 12(1(b)) 04/06/07 3 OP8 18(c (1)) 04/06/07 4 OP12 16(2(n)) 31/03/08 Defoe Court DS0000039763.V338461.R01.S.doc Version 5.2 Page 23 5 OP18 13(6) 6 OP19 23(4A) 7 OP38 13(4(a)) All members of staff must familiarise themselves with company policy and the local authority procedures for the protection of vulnerable adults. Doors were being wedged open contrary to the homes fire risk management plan. Doors must not be wedged unless by devices approved by the fire officer for this purpose. The manager was unable to evidence the safety of the electrical hard wiring or the gas installation in the home. Or that these checks had been completed within required timeframes. In order to clarify safety of these installations you are required to forward a copy of the current electrical hard wiring certificate demonstrating the condition is satisfactory and a copy of the current landlord gas safety certificate. 07/07/07 16/05/07 04/06/07 Defoe Court DS0000039763.V338461.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP1 OP3 Good Practice Recommendations The statement of purpose should be explicit about interest from service user personal allowances going into a communal fund and not being paid to the individual. Assessments should include enough detail to enable planning to meet all of people’s needs especially around management of risks to health, personal preference and social occupation. Care plans should include task specific detail and personal preference to enable staff to know how people should be cared for. Personal allowance account interest should be paid to individuals and not placed into a communal fund. The Commission for Social Care Inspection should be notified if anyone is admitted to the home with a pressure sore or develops a pressure sore whilst resident at the home in line with the company procedure. 3 4 5 OP7 OP35 OP38 Defoe Court DS0000039763.V338461.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: 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
© 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 Defoe Court DS0000039763.V338461.R01.S.doc Version 5.2 Page 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
