Inspection on 20/06/06 for Delaware House

This inspection was carried out on 20th June 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Delaware House 20/06/07

Delaware House 14/03/06

Delaware House 24/08/05

Delaware House 24/02/05

Delaware House 09/07/04

Similar services:

Claremont House

Chesham House

Oak Ridge

Argyll House

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

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

CARE HOMES FOR OLDER PEOPLE Delaware House Maplin Way North Shoeburyness Essex SS3 9PS Lead Inspector Sarah Axam Unannounced Inspection 20th June 2006 08:00 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 Delaware House DS0000059047.V291265.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. Delaware House DS0000059047.V291265.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Delaware House Address Maplin Way North Shoeburyness Essex SS3 9PS 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) 01702 588501 johnhase@southend.gov.uk Southend on Sea Borough Council Manager post vacant Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (6), Old age, not falling within any other category (24) Delaware House DS0000059047.V291265.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Personal care and accommodation to be provided to no more than twenty-four (24) service users over the age of 65 (OP). Personal care and accommodation to be provided to no more than six (6) service users with a Mental Disorder (MD). Number of service users to who personal care and accommodation is to be provided shall not exceed twenty-four (24). 14th March 2006 Date of last inspection Brief Description of the Service: Delaware House is owned by Southend on Sea Borough Council, and provides residential care for up to 24 older people. In addition the category of registration enables the home to accept those older people who have a formal diagnosis of dementia. The care home is situated within a residential area of Shoeburyness. The area benefits from good public transport links. Shops and other local amenities are a short distance away. The home has large grounds surrounding the property and there is on site visitors parking. The fees per week are a flat rate of £805.63.Additional charges are made for hairdressing, chiropody and taxi services, although the home does provide free transport to residents who use the homes minibus. The Registered Person has copies of recent CSCI inspection reports available in the home for prospective service users and/or their relatives. Enquirers can also down load copies of the inspection reports from the CSCI Internet web sight. Delaware House DS0000059047.V291265.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During the Inspection the team leader on duty and the manager of the home were present throughout the inspection process. A tour of the home took place and Staff, relatives and residents were spoken with during this inspection. The Key inspection site visit took place over a period of 8 hours. The visit mainly focused on the all Key standards and all of the requirements from the last inspection report. In addition, Information was also taken from the regulation 26 submitted by the Registered Provider. Letters have been sent out to local doctors, funding authorities and social workers requesting feedback of the service provided by the home. The home had implemented a quality questionnaire and which has been sent out to relatives and other professionals and this, together with any other added details affecting the service information, will be included in the next inspection report. What the service does well: What has improved since the last inspection? What they could do better: There still needs to be further development of risk assessments including other professional’s agreements on outcomes and action plans. ‘Specific’ dementia training for staff needs implementing. Individualised activities need further development and a separate role for activities co-ordinator needs addressing. The home needs to develop proper signage for residents with dementia. Some damage has occurred to the fencing in the back garden, it needs either repairs or replacement. Delaware House DS0000059047.V291265.R01.S.doc Version 5.1 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. Delaware House DS0000059047.V291265.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 Delaware House DS0000059047.V291265.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, 4 & 6 Quality in this area is adequate. This Judgement has been made using available evidence including a visit to this service. Prospective residents and their relatives are given a service user guide which informs them of the services provided and they also are encourage to visit Delaware prior to any admission. This allows prospective residents and there families make an informed choice as to whether or not Delaware House will met their needs. EVIDENCE: All care plans included initial assessments carried out prior to admission. There was evidence that individuals and their families had visited Delaware and that service user guide had been given. All care plans have recently been reorganised and gives a comprehensive break down of each resident needs including associated risks. However in some care plans risk assessments did not clearly evidence that all parties, such as a multidisciplinary team, had agreed the action that may restrict or infringe on an individuals rights. This type of risk assessments need to be developed further so that it clearly records, evidences and shows that consultation with all parties involved had gone ahead and had all agreed to the final outcome of action to be taken. The staff team have had a number of recent training packages, which includes mandatory and ‘specific’ client need led training. Organised training both Delaware House DS0000059047.V291265.R01.S.doc Version 5.1 Page 9 mandatory, NVQ and ‘specific’ client led training are planned through out this year. The home does not provide intermediate care. Delaware House DS0000059047.V291265.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, 9,10 & 11 Quality in this area is adequate. This Judgement has been made using available evidence including a visit to this service. Care Plans have been re-organised and reflect and highlight all residents’ individuals’ needs. The care plans include all aspects of an individuals needs and there has been progress made in this area, however they still need further development. The review of clients care plans is evident and have all been completed. EVIDENCE: On the day of inspection 6 client individual care plans were inspected. Staff consistently completed records and reviews of Care plans that are carried out monthly. Nutrition and pressure sore assessments have been developed. Medical care provided by healthcare professionals had been regularly recorded. The home benefits from the support of a Dementia link Nurse who visits every 2 to 4 weeks. This supports staff by being an advisory and sharing of information service and also gives the consultants involved with individuals care regular updates on their present situation. There has been a significant improvement in this area since the last inspection. There has been some progress at including wishes, views and aspirations of individuals in general within the care plans and information is now in place regarding terminal care and funeral arrangements. However in general within care plans there still needs to be development of residents and relatives involvement. Delaware House DS0000059047.V291265.R01.S.doc Version 5.1 Page 11 Observation during the inspection showed residents to be well cared for, clean and properly looked after. During the inspection a local GP was called out and it was noted that treatment offered to this individual was provided in a place of privacy and of the individuals choice. Both residents and relatives spoken to felt that the quality of care was good. A Monitored medication dosage system is in place for each resident. Medication is stored in a lockable cabinet and the administration records were being maintained in accordance with agreed procedures. Record sheets had been correctly recorded and signed for. Training records indicated that all staff had medication training. Delaware House DS0000059047.V291265.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this area is adequate. This Judgement has been made using available evidence including a visit to this service. Progress has been made regarding activity plans for each individual, however activities in general still need further development. Relatives and friends are encouraged to have regular contact with the home. A variety of regular nutritious meals were being provided. EVIDENCE: Since the last Inspection the manager and Team leaders have implemented a ‘personal activities plan’ for every resident and this is also reflected in the activities diary. The manager of the home and senior management are looking into hours to employ an activity co-ordinator as staff on shift have little time to fit in any’ quality’ activity time for residents due to the nature of needs of the client group on a day to day basis. Observation on the day of inspection and talking to staff and residents, it is clear that staff on duty are making the use of the time they have to engage residents in activities within the home. One resident has shown particular interest in gardening and has been encourage by the manager and staff to ‘help out’ the handyperson to maintain the garden, which has been very positive use of resources. Observation during the inspection demonstrated how staff supported residents to make choices and encouraged them to maintain and retain skills to be independent, whilst still supporting them appropriately. Staff was seen to be consulting and asking service users permission before going into peoples bedrooms and generally having meaningful interaction with the residents. Service Users rooms were Delaware House DS0000059047.V291265.R01.S.doc Version 5.1 Page 13 personalised and clean with free from odours. Residents and relatives spoken with spoke highly of the staff team and felt that the manager and staff in general were approachable friendly and caring. Relatives and residents also informed me that they could have visits at any time and were made to feel welcome. During Inspection breakfast and lunchtime was observed and it was noted that the residents were encouraged to have a choice of foods available that day. Menu’s looked nutritious and reflected residents tastes. On the day of inspection residents were asked about the food provided and were very complementary about the food provided, the way it was served and how staff supported them during meal times. Food smelt and looked appealing and was presented nicely. Both meal times were unrushed and had a relaxed atmosphere. Staff was seen supporting residents discreetly to eat meals. Staff were also seen to encourage other residents to use their limited skills by letting them eat unhurried and not worrying about mess caused by allowing them to maintain this independence. Staff were heard and observed to offer different types of cultural foods for both residents’ preferences, encouragement to eat a better diet and because of cultural heritage. This is good commendable practice and evidences that staff are working in an antidiscriminatory way, recognising residents diversity and individualism. Delaware House DS0000059047.V291265.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this area is good. This Judgement has been made using available evidence including a visit to this service. The home has a complaints procedure and each service users and relative has A service users guide that highlights the complaints procedure. The homes policy and procedures and training of staff appear to protect residents from abuse. EVIDENCE: Since the last inspection there has been no complaints. The manager informed me that he holds 3 monthly relative meetings and this can be a forum for people to bring any issues to his attention. The manager or all staff are available when relatives visit and if they need to raise any concerns or sensitive issues privately they can do so. Relatives spoken with on the day of inspection were complementary about the care provided within the home and felt all staff are approachable. A number of staff spoken with regarding the protection of adults evidenced to me that they knew the correct response and procedures to follow. Delaware House DS0000059047.V291265.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this area is good. This Judgement has been made using available evidence including a visit to this service. On the whole the outside environment is pleasant, attractive and provides appropriate and practical usage for the residents of Delaware House. The home environment provides a clean, comfortable and safe environment in which to live in. The home and layout needs to be developed for the specific client group at Delaware House. EVIDENCE: On the day of inspection the home was observed to be clean, tidy and odour free. Overall the home environment present no health and safety issues, the environment was homely comfortable and practical for the use of residents at Delaware House. However a large number of the residents at Delaware house have dementia and others issues, for those residents Delaware is decorated in a familiar colours and patterns and would not support residents in coordination, reference to where they are or recognition of familiar routes. This needs to be developed by means of appropriate signage, colours, pictures and different forms of familiar reference for individuals on the outside of their room doors. This may support residents to recognise and retaining some independence around the home, to be able to easier identify their own Delaware House DS0000059047.V291265.R01.S.doc Version 5.1 Page 16 bedrooms, offices, dining rooms etc. The garden has been developed and provides a pleasant area for residents to use. However some fencing in the garden needs to be repaired or re-placing due to quite significant holes appearing, which could pose a Health and Safety issue. Delaware House DS0000059047.V291265.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this area is adequate. This Judgement has been made using available evidence including a visit to this service. The number of staff on duty, their experience and skill was able to meet the needs of residents. Recruitment records were in place and to a good standard. Staff have had mandatory and specific client related training and further training is planned throughout this year. EVIDENCE: The staffing ratio has improved since the last inspection. On the day of inspection there were sufficient numbers on duty, which included team leader cover. The manager is in the process of interviewing the last two care workers needed to complete the team. The need to rely less on agency staff has improved. There is a good recruitment and selection policy in place and contained all necessary checks required. All staff had enhanced CRB checks and are Pova checked before being offered a contract of employment. Staff receive regular supervision and new appraisal systems are in the process of being developed. The manager is currently arranging to study for the N.V.Q.4 Registered Managers Award and has submitted an application to the Commission for Social Care Inspection for registration. A quarter of the staff team have completed the NVQ2 and other staff are currently waiting to start this training. Staff commented that they felt the manager and team leaders were approachable and that training provided had enhanced their knowledge, skills and understanding of the current client group. Nearly all of the staff team have undertaken the protection of vulnerable adults and protecting rights in care environment training and further training is booked for the rest of the staff team to complete this. The dementia training initially provided may not of been Delaware House DS0000059047.V291265.R01.S.doc Version 5.1 Page 18 that appropriate to the present day client group. It may be that a more specific client related dementia training would benefit further resident’s quality of life by better equipping the staff with the appropriate tools in which to work with. Delaware House DS0000059047.V291265.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this area is good. This Judgement has been made using available evidence including a visit to this service. Management systems are good and the home is run in the best interests of residents. There is evidence to show that the acting manager with staff teamwork have together to developed the service and improved the standards of care. The management has responded robustly & rectify matters of health & safety when identified. There is a quality Assurance monitoring process implemented. EVIDENCE: The home has just developed a quality assurance system and surveys have gone out to relatives and other professionals who use the service. The home has had one response back from a community liaison nurse that was very complementary about the service. Once all these surveys are back the manager will collate and make a plan of action according to the outcomes and will forward this to the CSCI. Good liaison and communication has taken place with relatives who are invited to a three monthly meeting and speaking with Delaware House DS0000059047.V291265.R01.S.doc Version 5.1 Page 20 relatives on the day of inspection seemed to reflect this being the case. The manager and staff are observed to have good communication between the team; reflective practice and problem solving strategies are evidenced in minutes from the team leaders and staff meetings. Presently the manager and staff take overall responsibilities for all service users monies within the home. A sample check was made of residents personal allowances that were being safeguarded by the home and financial transactions had been properly documented, signed for and with the appropriate receipts on file. Staff spoken to on the day of inspection showed a good knowledge and awareness of health and safety issues and have had training on universal infection control procedures and that these were being followed. Delaware House DS0000059047.V291265.R01.S.doc Version 5.1 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 X X 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 2 X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Delaware House DS0000059047.V291265.R01.S.doc Version 5.1 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 OP4 Regulation 18(1) Requirement Timescale for action 01/09/06 2. OP7 15 3. OP12 16(2)(m) and (n) The registered person must ensure that the home can meet the assessed needs of residents and ensure that staff are provided with specific dementia training which reflects the client group they presently work with to enable them to meet these needs. The registered person must 01/08/06 ensure a comprehensive and detailed risk assessment must be written for all residents whose rights maybe infringed upon. This is in relation to the use of cot sides, roller ball chairs and the use of a multi-disciplinary team being involved but not recorded on assessment. 01/09/06 The registered person must ensure that suitable arrangements are made for all residents to receive a varied programme of `in house` and community based activities. Previous timescale of 01/02/06 and 14/05/6 not met. Delaware House DS0000059047.V291265.R01.S.doc Version 5.1 Page 23 OP22 4. Reg (23) (1ab) (2a) The registered person must ensure that the physical design and layout regarding the use of appropriate signage throughout the home can meet the assessed needs of residents with Dementia. The registered person must ensure that the external environment is kept in good repair. This is in relation to the garden fence that needs repairing or replacement. 01/12/06 5. OP22 Reg 23 (2)(b) 01/08/06 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 OP28 OP31 Good Practice Recommendations 50 of care staff should achieve NVQ Level 2 The registered manager should attain NVQ Level 4 in Care and Management. The registered person must ensure that the quality assurance system action plan is forwarded to the CSCI. 3. OP33 Delaware House DS0000059047.V291265.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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. 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