Inspection on 24/08/05 for Delaware House

This inspection was carried out on 24th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Delaware House 20/06/07

Delaware House 20/06/06

Delaware House 14/03/06

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 Mrs Michelle Love Unannounced Inspection 24th August 2005 09:00 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.V249278.R01.S.doc Version 5.0 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.V249278.R01.S.doc Version 5.0 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 (6), 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.V249278.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Personal care and accommodation to be provided to no more than 24 persons over the age of 65 (OP). Personal care and accommodation to be provided to no more than 6 persons with Dementia (DE). Personal care and accommodation to be provided to no more than 6 persons with Mental Disorder (MD). Number of service users to whom personal care and accommodation is to be provided shall not exceed 24 (twenty four). 24th February 2005 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. Delaware House DS0000059047.V249278.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken by two inspectors, Michelle Love and Sarah Buckle. The inspection lasted about ten hours. As part of the inspection process, a lot of time was spent sitting in the lounges, talking to residents, care staff and relatives. A range of records and documents were inspected and a tour of the premises undertaken. An application to formally register the acting manager is currently being processed by the Commission. An application to vary the home’s registration has been received since the unannounced inspection. What the service does well: What has improved since the last inspection? What they could do better: The registered provider needs to ensure that the care planning processes for residents are implemented. Records must be detailed and comprehensive and regularly reviewed. A programme of activities/meaningful stimulation must be provided for all residents. The registered provider must ensure that sufficient hours are provided for an activities co-ordinator and that the hours are flexible. Delaware House DS0000059047.V249278.R01.S.doc Version 5.0 Page 6 The acting manager/registered provider needs to spend time looking at the way staff work and how staff spend their time during the day. The registered provider must ensure that current gaps pertaining to staff training are addressed. Staff training must include mandatory/specialist courses, which meet the specific needs of residents currently residing at Delaware House. A organised system for staff supervision must be implemented as soon as possible. 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.V249278.R01.S.doc Version 5.0 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.V249278.R01.S.doc Version 5.0 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 and 5 Prospective residents are assessed by the home prior to admission. Prospective residents have the opportunity to visit the care home prior to admission so as to make an informed choice as to whether or not Delaware House is a care home they wish to live in. EVIDENCE: A Pre Admission Assessment was completed for the newly admitted resident prior to their admission to the care home. On inspection of the documentation this was relatively detailed and informative. No evidence was available to indicate whether or not the prospective resident and/or their representative visited the home prior to admission or that they were admitted from hospital. No dependency profiles were completed depicting residents High, Medium and Low needs. Delaware House DS0000059047.V249278.R01.S.doc Version 5.0 Page 9 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 and 11 All residents residing at the care home have an individual plan of care depicting their individual care needs. Current care planning processes are poor and lack specific clarity and detail. The systems for resident consultation are inconsistent with little evidence to indicate that resident’s views are sought and acted upon. EVIDENCE: On inspection of five care plans these were inconsistently completed with some elements of the care plan containing relatively detailed and informative information, whilst other elements lacked specific detail. Risk assessments were not devised for all areas of assessed risk i.e. one resident’s assessment made reference to them displaying occasional episodes of aggression/inappropriate behaviours. No information was recorded pertaining to the specific nature of the aggression, possible known triggers and strategies for staff to deal with the inappropriate behaviours. A new care plan format/risk assessment system is to be implemented in due course and all current care plans to be reviewed and rewritten. Daily care records were written each day however evidence of staff’s interventions to deal with certain situations and information relating to specific support given to residents was limited in some Delaware House DS0000059047.V249278.R01.S.doc Version 5.0 Page 10 cases. No formal assessments were evident in relation to dependency profiles, pressure sores, falls, continence and nutrition. Rapport and interaction between residents and care staff was observed to be positive. Staff spoken with demonstrated an awareness of resident’s needs. One relative spoken with was concerned that her father’s glasses had gone missing on a few occasions and that on the day of inspection when she visited he was wearing glasses that had different lens (1x clear lens and 1x bifocal lens) and that care staff had not noticed. The home’s storage arrangements for medication were satisfactory. The acting manager and all team leaders are appropriately trained to administer medication. A list depicting the names/signatures and initials of those able to administer medication was readily available. A few omissions were observed within the medication administration records (MAR) whereby staff had not signed the records to indicate that medication had been administered to and received by residents. The homes medication audit system confirmed the omissions and evidenced that one resident’s medication had gone missing e.g. “ 23.8.05-6 tablets have been signed for 10 have gone since yesterday”. Delaware House DS0000059047.V249278.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Opportunities for residents to participate within meaningful activities, both `in house` and externally are limited. The meals provided are good offering both choice and variety. EVIDENCE: The home does not have an activities co-ordinator. No specific programme of activities for residents was available and information documented within individual care plans detailing activities undertaken by residents indicated infrequent activities/meaningful stimulation offered and/or provided. It was evident during the inspection that care staff and senior staff are very busy with providing personal care to residents and do not have specific time available to initiate activities for residents. Staff spoken with were disappointed that this element of care could not be provided on a regular basis. One relative spoken with stated that they were equally disappointed that there is a lack of activities available within the care home. Both the lunchtime and teatime meals were observed. Residents were seen to have a choice of menu and adequate sized portions. Care staff, were seen to support those residents who required assistance at meal times, with sensitivity, dignity and respect. Good verbal interaction was noted between care staff and residents. Resident’s comments pertaining to the quality of food provided at Delaware House was positive. Delaware House DS0000059047.V249278.R01.S.doc Version 5.0 Page 12 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): 18 Adult Protection policies and procedures were appropriate so as to ensure that residents are protected from harm or abuse. Staff spoken with demonstrated a good knowledge and understanding of Adult Protection issues which protects residents from abuse. EVIDENCE: No Protection of Vulnerable Adults issues have been highlighted since the last inspection. Staff training records evidence that five members of staff have received Protection of Vulnerable Adults training and eight members of staff have received PRICE (Protecting Rights in a Care Environment) training. The Commission has been notified as part of Regulation 37 requirements of two incidents whereby two residents displayed aggressive and inappropriate behaviours. It was evident that action taken by the registered provider pertaining to both incidents was not necessarily the most appropriate course of action. Following discussion with one resident’s relatives it was evident that decisions undertaken by the home had caused some concern and distress to the family. Both issues have been dealt with separately from the inspection with the acting manager. Delaware House DS0000059047.V249278.R01.S.doc Version 5.0 Page 13 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 The home environment provides residents with a safe and comfortable home in which to live in. EVIDENCE: All residents are provided with a single bedroom. Of those individual bedrooms inspected, all were seen to be personalised and individualised and contained residents personal effects. No health and safety issues were highlighted at this inspection. All areas of the home were clean, tidy and odour free. Some carpets within the home were observed to be heavily stained. A cleaning schedule has been implemented to combat this problem. A quiet room/visitors room is available in addition to communal areas. Residents have access to two payphones on the ground and first floors. A maintenance person is employed at Delaware House for 37 hours per week. During the inspection it was observed that lounge/dining areas on the first floor and residents bedrooms on the first/ground floors are locked as a result of one resident who wanders. Both staff and relatives stated that they feel this restricts other resident’s Delaware House DS0000059047.V249278.R01.S.doc Version 5.0 Page 14 movements and rights around the home. The acting manager was advised that an appropriate solution to the issue needs to be found. Delaware House DS0000059047.V249278.R01.S.doc Version 5.0 Page 15 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 and 30 Staffing levels within the home are generally appropriate to meet the specific needs of residents. No new members of staff have been recruited since the last inspection. Some gaps exist in relation to training for staff. EVIDENCE: Staff rosters showed that agreed staffing levels are being met on most occasions. The staff rosters were well documented and clear but evidenced on occasions that there were insufficient staff on duty. The manager stated that problems had been encountered when using Southend Borough Councils approved agency i.e. agency members of staff did not turn up to cover the duty on some occasions and the shift was left inadequately covered at short notice. Two new external agencies are being used to provide agency staff at the care home. The staff rosters need to include the full names of all staff and include a key detailing a clear definition of the meaning of E/L/S/AL and other abbreviations. The manager was advised that when staffing levels fall below the agreed staffing level the Commission should be notified on the Regulation 37 Notification document. One relative commented that they felt that there were insufficient numbers of care staff particularly in the evening. They stated that some personal care needs for their member of family were unable to be carried out as a result of inadequate staffing levels. Current staff vacancies include one full time care post and 90 hours for housekeeping. No new members of staff have been recruited to Delaware House since the last inspection. Evidence was available to indicate that all new agency staff receive Delaware House DS0000059047.V249278.R01.S.doc Version 5.0 Page 16 an induction. On inspection of the staff training profile for 2005-2006 this details some gaps pertaining to mandatory training/updates for staff i.e. Basic Food Hygiene, Manual Handling, Basic First Aid, Protection of Vulnerable Adults, Health and Safety, COSHH, Infection Control and Fire Safety. Evidence indicates that the majority of staff have received training relating to dealing with challenging behaviours and dementia awareness. Gaps exist within the homes training schedule in relation to other specialist areas i.e. Catheter Care, Pressure Care, Nutrition, Diabetes, Mental Disorder etc. Currently three members of staff have attained NVQ Level 2, two members of staff have achieved NVQ Level 3 and the manager is undertaking NVQ Level 4. The home is to utilise the services of a specialist nurse for dementia awareness. Delaware House DS0000059047.V249278.R01.S.doc Version 5.0 Page 17 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, 32, 36 and 37 The home is well managed and there is clear leadership, guidance and support for care staff. EVIDENCE: Three members of staff spoken with stated that the home is well run and that they feel supported by the manager. In addition staff commented that they felt the manager was approachable and keen to ensure that Delaware House was a good care home. The manager is aware of the shortfalls and anticipates too resolve issues in the following months. A random selection of records as required by regulation were inspected. Records relating to employers liability, gas and electrical safety certificates, hoist certificates, residents accident records, fire equipment and fire drills were satisfactory. Records pertaining to emergency lighting indicate that this is not currently being tested, as a key to the system is unavailable. A record of hot water temperatures is not recorded regularly. Delaware House DS0000059047.V249278.R01.S.doc Version 5.0 Page 18 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 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 1 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X X X X STAFFING Standard No Score 27 2 28 2 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X 2 2 X Delaware House DS0000059047.V249278.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? 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 The registered person must ensure that the home can meet the assessed needs of residents and ensure that staff are provided with training to enable them to meet these needs. A comprehensive and detailed care plan must be written for all residents. This must detail how all aspects of residents needs are to be met. The registered person must ensure that unnecessary risks for residents are identified and documented. Risk assessments must be comprehensive and detailed. Ensure that appropriate arrangements are made for the recording, handling and safe administration of medicines received into the home. The registered person must ensure that information pertaining to terminal care/funeral arrangements must be documented within individuals care plans. Ensure that suitable DS0000059047.V249278.R01.S.doc Timescale for action 01/03/06 2 OP7 15 01/02/06 3 OP7 13(4)(c) 01/01/06 4 OP9 13(2) 14/11/05 5 OP11 12(2) 01/03/06 6 OP12 16(2)(m) 01/02/06 Page 20 Delaware House Version 5.0 and (n) 7 OP8 12(1)(a) 8 OP27 18(1)(a) 9 OP36 18(2) arrangements are made for all residents to receive a varied programme of `in house` and community based activities. Ensure that proper provision is made for the health and welfare of residents. This refers specifically to residents wearing/having appropriate equipment i.e. glasses The registered person must ensure that at all times there are enough suitably qualified and competent staff on duty to meet residents needs. Ensure that all staff are supervised. 14/11/05 14/11/05 01/01/06 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 3 4 Refer to Standard OP5 OP7 OP28 OP31 Good Practice Recommendations Information pertaining to trial visits for residents should be recorded within individual’s pre admission documentation/care plans. Daily care records should include and detail staff’s interventions. 50 of care staff should achieve NVQ Level 2 The registered manager should attain NVQ Level 4 in Care and Management. Delaware House DS0000059047.V249278.R01.S.doc Version 5.0 Page 21 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. Extracts may not be used or reproduced without the express permission of CSCI Delaware House DS0000059047.V249278.R01.S.doc Version 5.0 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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