Inspection on 19/02/08 for Defoe Court

This inspection was carried out on 19th February 2008.

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

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

Defoe Court 14/10/08

Defoe Court 16/05/07

Defoe Court 20/06/06

Defoe Court 28/11/05

Defoe Court 06/06/05

Defoe Court 16/12/04

Defoe Court 10/06/04

Defoe Court 05/03/04

Similar services:

The Highlands

Turret Villa Retirement Home

Moor House

Blenheim House

1 Lanark Close

Mendip House

Beaconsfield Court Care Home

Ann Charlton Lodge

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

CARE HOMES FOR OLDER PEOPLE Defoe Court Defoe Crescent Newton Aycliffe Co Durham DL5 4JP Lead Inspector Tanya Newton Key Unannounced Inspection 19th February 2008 10:00 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.V358672.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.V358672.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 www.southerncrosshealthcare.co.uk Southern Cross Home Properties Limited Mrs Lynn Clark Care Home 41 Category(ies) of Dementia (10), Old age, not falling within any registration, with number other category (31), Physical disability (4) of places Defoe Court DS0000039763.V358672.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 31 Physical disability - Code PD, maximum number of places: 4 2. Dementia - Code DE, maximum number of places: 10 The maximum number of service users who can be accommodation is: 41 16th May 2007 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 £456:00 - £ 512:16 with additional charges for hairdressing, chiropody, newspapers and toiletries. Defoe Court DS0000039763.V358672.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Mrs Newton and Mrs Lowther carried out the inspection between the hours of 10am and 4pm. The visit was unannounced. During the site visit we looked at a number of records, which included health and safety records, care plans and policies and procedures. We observed how people were looked after to see what life was like for them and spoke to staff, management and people living in the home and some visitors. What the service does well: What has improved since the last inspection? The statement of purpose has been updated to reflect individual fee arrangements and to inform people they will be charged extra for door safety devices, to prop open doors, should they require them. It also reflects that interest from people’s personal allowances are going into a communal fund and not being paid to the individual. Efforts have been made to ensure good preventative pressure area care is being planned and implemented. The standard of care planning had improved. Most staff had received training in the protection of vulnerable adults (POVA) and are now aware of both the company policy and the local authority procedures in place. Fire doors are no longer wedged open as door guards are now in place. Defoe Court DS0000039763.V358672.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Defoe Court DS0000039763.V358672.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.V358672.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 and 3. People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. People’s needs are properly assessed prior to admission. EVIDENCE: The service has updated its statement of purpose. This sets out the aims and objectives of the home, and includes a service user’s guide, which provides information about the service and the type of care the home offers. The guide is made available to individuals in written and audio formats. People moving into Defoe Court are provided with a statement of terms and conditions (a contract). This sets out in detail what is included in the fee, the role and responsibility of the provider, and the rights and obligations of the individual. Six case files were looked at. All contained an assessment from the placing authority. Assessments in the main were detailed and contained sufficient Defoe Court DS0000039763.V358672.R01.S.doc Version 5.2 Page 9 information to form the basis from which the care plan could be written. There were some gaps in the recording, a common theme being people’s religious preferences, care manager name and financial appointee details. All people spoken to say that either they or their relative had been able to come and view the home prior to them moving in. The home does not admit people for intermediate care. Defoe Court DS0000039763.V358672.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. People who use the service experience adequate quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Care plans are not written in sufficient detail and risk management is not always fully addressed. EVIDENCE: Six care plans were viewed, each individual has a care plan but the practice of involving people with the development and review of their plan is variable. Care plans in the main contained sufficient information to deliver a person’s care. Most did not contain any information regarding people’s religious beliefs. Some sections of the care plan were not completed. There was limited information recorded about people’s social needs. Communication could be better addressed within care plans. Some of the care files viewed stated “none” under the communication section. There was no reference to individual forms of non-verbal communication. This approach is not person centred. Defoe Court DS0000039763.V358672.R01.S.doc Version 5.2 Page 11 Although risk assessments were included within care plans not all were signed and one person whose care plan identified the need for a risk assessment on the safe use of bedrails did not have one. Another person had a nutritional assessment, which stated that the person should be weighed weekly. This was not taking place. All people spoken to say that they are well cared for and that their health needs were being met by the home. People are able to see GP’s, opticians, district nurses and other visiting professionals within the home. Comments included “the care is alright, I am treated alright, the staff knock on my door and they speak to me nicely. They answer buzzers quickly” and “I’m well looked after, the girls are nice”. Medication systems were viewed. Medication was being stored, recorded and administered safely to people living at the home. Privacy was discussed with people living at the home. Most people said that staff knocked on doors before entering their bedrooms and that they had a choice regarding when they would like a bath. One person said that they would like to spend longer in the bath, as time was limited to five minutes. The manager said that this would not be a problem. Defoe Court DS0000039763.V358672.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. People who use the service experience adequate quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Although people are able to make some choices and decisions at Defoe Court, social and recreational activities should be more readily available and based on people’s interests. EVIDENCE: The home does have an activities co-ordinator and some activities do take place. This includes trips out and in house activities like bingo. Feedback from people living at the home regarding the activities provided was poor. The majority of people spoken to said that they stay in their rooms. Few people were seen using communal areas. The manager and staff said that activities were being offered to people. The manager was advised to carry out a social assessment for each person, to find out the types of social activities that people would like to be involved in. The home should also improve the recording around activities and record when activities are offered to people but declined. People should also be supported in their religious observation. Comments from people living at the home included “entertainment is not good here, I have never been asked what I would like to Defoe Court DS0000039763.V358672.R01.S.doc Version 5.2 Page 13 do, I want to do activities with like minded people. Very few opportunities to go out unless your family takes you, the manager chooses who goes”, “not much going on socially”, “socially, not for me I like to stay in my room, staff do come in and chat to me though”, “socially, there’s not much going on at the moment, I enjoy reading” and “we get out occasionally and play bingo, I like the T.V”. All people who were spoken to during the inspection said that visitors could visit at any time of day. One of the visitors said that they were always made welcome and able to have a meal or a drink when visiting the home. People were asked if they were able to make choices and decisions about their lives. Most people said that they could choose what they wanted to eat each day, as there was always a choice of two main meals. Some people said that they could choose what day they would like a bath, other people said that this took place on set days. Most people said that they did not feel that they had a choice regarding social activities or going out. Comments regarding the food were good. A choice of meals is offered and menus are displayed outside dining areas. One of the people spoken to said “I had a bacon buttie this morning, I could have had sausage or egg you get a choice” and “the food is good, you get a choice and its well prepared”. “There are too many sandwiches at tea, its that or soup, I would like a pie or something like that”. All of the people spoken to said that they were asked on a daily basis what they would like to eat”. Defoe Court DS0000039763.V358672.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. People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. People can be confidant that their concerns and complaints are dealt with appropriately and that safeguards are in place to protect them from abuse. EVIDENCE: There are clear policies and procedures for staff to follow regarding complaints. The complaints procedure is included within the service users guide. It is also displayed in areas throughout the home. The home had received two complaints since the last inspection, one of the complaints was upheld and the other was partially upheld. All people spoken to during the inspection said that they would feel confident in raising any concerns or complaints to either the manager or the staff on duty. There are clear procedures for dealing with adult protection. The policy links with the local authority procedures for safeguarding adults. All staff said that they would “whistle blow” (tell someone) if they saw or heard any practice which may have a negative impact on people living at the home. Most staff have now been trained in adult protection. Defoe Court DS0000039763.V358672.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. People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. People live in a comfortable and homely environment. EVIDENCE: A tour of the environment was taken. The home was clean and well maintained. Bedrooms were furnished to individual style and taste and many people had bought their own items of furniture with them to personalise their room. Specialist aids are provided in bathrooms to aid people’s mobility. This included grab rails and overhead ceiling tracking hoists. All of the bedrooms within the home have en-suite facilities. Lounge and dining areas are located in areas throughout the home. The home has one smoking area, which is situated upstairs in the dementia unit. One of the people who smoke said that they would like a smoking area on the ground floor, as they were unable to access the smoking room independently. Defoe Court DS0000039763.V358672.R01.S.doc Version 5.2 Page 16 Concern was also raised regarding the lack of ventilation within the smoking room. Comments from people living at the home included “My bedrooms lovely, warm and cosy” and “I have my own computer, books and TV, I also have my own phone”. Defoe Court DS0000039763.V358672.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. People who use the service experience adequate quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Although staff numbers and training seemed to meet the needs of the people accommodated, recruitment practices may place people at risk. EVIDENCE: Five care staff were on duty with a nurse throughout the day. Some of the staff said that there had been some problems with sickness recently which sometimes impacted on the service. Comments regarding staff were positive and included “staff are great, can’t fault any of them, they do what they can, they are great”, “staff are alright, once you get to know them, polite and friendly”, “most of the staff are nice, some of them are off at the moment”. Staff recruitment files were looked at. One of the three files audited did not contain two references, and two recent management checks also identified a further two people who had been employed without gaining two references. Two references must be obtained before people start work. This helps to protect people living and working at the home. Staff training was looked at. Most staff had been trained in protection of vulnerable adults (POVA) and all staff had been trained in manual handling. There is a qualified first aider on each shift. All staff administering medication had received training in the safe handling of medicines. Some staff had Defoe Court DS0000039763.V358672.R01.S.doc Version 5.2 Page 18 attended training in pressure and wound care. Fourteen of the twenty-five care staff employed have gained an NVQ at level 2 or above. The manager and two staff had received training in dementia. This is going to be rolled out to other staff working in the home. Defoe Court DS0000039763.V358672.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, 36 and 38. People who use the service experience adequate quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Although management arrangements in the home are generally good, both the quality assurance checks and health and safety checks failed to pick up matters, which should have been addressed prior to this visit. EVIDENCE: The manager is a qualified nurse who has also gained the registered managers award. Feedback from people living at the home, the care staff and relatives was mainly positive regarding the manager. People living at Defoe Court knew the manager by name and said that they found her approachable. Comments included “I like it here and I get on well with the manager” and “We can go to the manager with any problems, she is supportive and holds meetings for staff and residents”. Defoe Court DS0000039763.V358672.R01.S.doc Version 5.2 Page 20 Quality assurance systems were also looked at. Questionnaires are sent out to people using the service annually. Questionnaires are also available in the entrance foyer for relatives and visitors. Regulation 26 visits were being carried out and a report maintained on the premises. The home manager and the operations manager carry out monthly audits. Although management audits were being carried out regularly, they had not identified the health and safety issues recorded below. A random check on three people’s money was carried out. Two signatures are recorded where money is withdrawn or deposited and receipts are maintained for all expenditure. Supervision records were looked at. Supervision was not being provided regularly for staff and staff confirmed this during discussions. All staff should be receiving regular supervision. Some people had only received one supervision session in the last year. The manager said that supervision had commenced for all staff. Health and Safety records were looked at. The electrical wiring report dated June 2007 had been assessed as unsatisfactory and had a number of faults, which needed to be rectified. The gas safety certificate dated March 2007 for the kitchen burner and grill was also assessed as unsafe. A warning letter was sent to the home requiring that this work be done so that people were safe. All works required were completed prior to this report being issued in draft. Defoe Court DS0000039763.V358672.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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 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 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 Defoe Court DS0000039763.V358672.R01.S.doc Version 5.2 Page 22 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. Standard OP7 Regulation 15 (2) Requirement Care plans need to be more detailed to include sufficient information regarding people’s religious preferences, their social needs, communication and risk management. Where possible people should be consulted about their plan. Care plans need to contain more detail to ensure that people’s health needs are fully met. This includes weight charts where a risk assessment has identified the need for weekly weights to be taken and bed rail assessments where people may require them for their safety. A programme of activities must be developed which responds to service user’s preference and needs. (Previous timescale 31/03/08 not met). Two references must be gained prior to people starting employment at the home. Quality assurance systems should be improved so that important health and safety issues are identified and actioned DS0000039763.V358672.R01.S.doc Timescale for action 30/04/08 2. OP8 15 (2) 30/04/08 3. OP12 16(2(n)) 30/04/08 4. 5. OP29 19(1(b) (c)) 26(4(b)) 31/03/08 30/04/08 OP33 Defoe Court Version 5.2 Page 23 6. OP38 13(4(a)) more effectively. Health and Safety issues must be addressed within a reasonable timescale. 31/03/08 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. Refer to Standard OP3 OP14 OP19 Good Practice Recommendations Assessments should include further detail around religion and social occupation. A social assessment should be carried out so that people’s individual choice and opinion can be sought regarding the activities provided. An alternative smoking area should be considered taking into account the needs and wishes of people accommodated in the home. Ventilation in the smoking room should also be addressed. Any staff member that has not received training in POVA should do so. All staff should be receiving regular supervision. This should take place at least six times each year. 4. 5. OP18 OP36 Defoe Court DS0000039763.V358672.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. 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