Inspection on 20/04/07 for Dell Residential Home (Sudbury)

This inspection was carried out on 20th April 2007.

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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Dell Residential Home (Sudbury) 19/05/08

Dell Residential Home (Sudbury) 06/12/06

Dell Residential Home (Sudbury) 23/05/06

Dell Residential Home (Sudbury) 29/07/05

Dell Residential Home (Sudbury) 25/04/05

Dell Residential Home (Sudbury) 25/11/04

Dell Residential Home (Sudbury) 22/09/04

Dell Residential Home (Sudbury) 10/07/03

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

CARE HOME ADULTS 18-65 Dell Residential Home (Sudbury) Cats Lane Great Cornard Sudbury Suffolk CO10 6SF Lead Inspector Claire Hutton Key Unannounced Inspection 20th April 2007 10:00 Dell Residential Home (Sudbury) DS0000024372.V336600.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Dell Residential Home (Sudbury) DS0000024372.V336600.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dell Residential Home (Sudbury) DS0000024372.V336600.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dell Residential Home (Sudbury) Address Cats Lane Great Cornard Sudbury Suffolk CO10 6SF 01787 311297 01787 313385 the.dell@craegmoor.co.uk 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) Speciality Care (Rest Homes) Limited Mrs Marianne Banks Care Home 48 Category(ies) of Learning disability (48) registration, with number of places Dell Residential Home (Sudbury) DS0000024372.V336600.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th December 2006 Brief Description of the Service: The Dell is a permanent care home for adults with a learning disability. The Dell was first registered in 1987 as a core and cluster home where small groups of service users are accommodated in bungalows, each bungalow forming a selfcontained unit. Over time, additional bungalows have been built to bring the home to the present capacity of 48. The current registered owners, Speciality Care (Reit) Homes Ltd, purchased the home in 1995 and have agreed that the Dell has now reached its maximum desired capacity. Craegmoor Healthcare Ltd acquired Speciality Care in March 1998. Each bungalow accommodates six service users and provides its own laundry and some catering facilities, communal areas and gardens. Bungalows are grouped around a central day care facility. The main kitchen and office/administration building access to the site is by way of a private drive. The home is situated within a quiet residential area with good links to Sudbury town centre. The buildings are modern, purpose-built units and offer a good standard of accommodation. All service users have good-sized private bedrooms all have a wash hand basin. Fees range from £460.00 to £1210.00 weekly depending upon assessed need. Dell Residential Home (Sudbury) DS0000024372.V336600.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that focused upon the core standards relating to Adults (18 – 65). It took place over two days. The process included a tour of bungalows two to eight, discussions with residents and staff, observations of staff and resident interaction, and the examination of a number of documents including residents care plans and associated documents, medication records, the staff rota, recruitment, training records, menus and records relating to health and safety. The report has been written using accumulated evidence gathered before and during the inspection. Six completed residents surveys were received, one comment card was received back from relatives/visitors. All replies were generally complimentary. Six comment cards were received back from staff, most of which complimented the new acting manager Throughout the two days the inspector met several of the residents, three of whom were spoken with privately and were able to express themselves and talk about what it was like to live at The Dell. Thirteen staff were met and spoken with, most had an opportunity to speak in private with the Inspector. This inspection visit was conducted at the home to also note progress made on the twenty one requirements made at the key inspection in December 2006. What the service does well: What has improved since the last inspection? Since the last key inspection in December 2006 the driving influence for development and change has been the appointment of the acting manager Kelly Cox. She had brought about measurable change at the home that was needed urgently to address concerns held by the commission and the placing authorities. Recruitment of new staff, use of agency staff and use of staff from other homes owned by the same organisation has seen an increase in the level of Dell Residential Home (Sudbury) DS0000024372.V336600.R01.S.doc Version 5.2 Page 6 support offered to residents. One staff member said “staff moral was so low, I dreaded coming to work, now since the acting managers’ been appointed I’m happy to come to work. Things have improved”. Senior managers in the organisation are currently reviewing staffing levels at the home. Person centred care plans are being developed. Four were seen in one house. These have pictures to aid the residents understanding and are completed with the residents, so this process will take time. The day centre facilities at the home had for some time not been utilised. An activities co-ordinator had been appointed and the day care facilities have a new name ‘The Zone’. The new co-ordinator was met and her plans to audit what currently happens and seek the views of the residents was under way as well as starting to provide trips out and craft sessions. Catering at the home is under review. The home also had nine residents out of the category of registration. Discussions with the commission have moved matters forward and the home are applying to have a condition to accommodate the nine named individuals over the age of sixty-five. What they could do better: The main focus that must be continued is the development of the person centred care plans for each resident. This along with completing and implementing the review of staffing levels will be a measurable benefit to the resident group. The staffing review must look at each residents needs and wishes but also the guiding principles of this home, which is about small group living in separate bungalows each of which provides a differing service. Residents feel strongly that bungalows should not be closed due to staff shortages. Also the catering review that is current must be completed. The views of the resident group are starting to be taken into account, but this too must be further developed through the use of advocacy and become integral to the homes running. Environmental matters such as repairs to showers must be attended too along with making bungalows wheelchair accessible if a resident their uses a wheelchair. Matters of health and safety regarding fire and safe food management must be addressed promptly. Please contact the provider for advice of actions taken in response to this Dell Residential Home (Sudbury) DS0000024372.V336600.R01.S.doc Version 5.2 Page 7 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. Dell Residential Home (Sudbury) DS0000024372.V336600.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dell Residential Home (Sudbury) DS0000024372.V336600.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5. People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People who use this service can be confident that there is information available about the home. In the recent past they not have known that the home could meet their needs, but this is set to improve. EVIDENCE: The Dell had nine residents outside of their registration category accommodated at the home. Following discussions with the commission the home will continue to care for these residents and apply for a variation in the form of a condition that allows the home to accommodate the nine named individuals over the age of sixty five. The organisation is now clear that if they wish to change the categories of people cared for this must be discussed and agreed with the commission, and appropriate registration granted. One the first day of inspection a number of staff were attending training at the home on working with the elderly. As part of the application the commission has received a revised statement of purpose. The view of the residents about whether they had received enough information before they moved in was unclear as this was not answered upon the surveys received. Dell Residential Home (Sudbury) DS0000024372.V336600.R01.S.doc Version 5.2 Page 10 No new residents have been admitted to the home since the last key inspection. The home have agreed not to admit any new residents for two months until standards have been raised with regard to staffing levels and person centred care plans are in place. Requests were made to see the assessment completed before placement at the home for two individuals. One was available and showed the person was knowingly placed at the home over the registration category age. One assessment was not available. Contracts were requested for three individuals and these were in place. These were based upon standard local authority contracts but also specified that they were based upon ‘the individual care program’. This is taken to mean the individually assessed needs from which a care plan is developed. The local authority who place people at the home have conducted reviews at the home and continue to make regular visits to the home to ensure the needs of the residents continue to be met. However they are currently not placing at the home until they see an improvement in standards as reported by the commission. A discussion was held with the acting manager around when a vacancy occurs being quite sure of compatibility within the stated bungalow. This was clearly understood by the acting manager and she was aware of the wide varying degrees of ability and disability within each bungalow and what each bungalow could offer. Dell Residential Home (Sudbury) DS0000024372.V336600.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 People who use this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People who use this service have a care plan in place, but currently the majority of these are not person centred and residents cannot be assured they are up to date and known by those who support them. Majority of residents do not have individual risk assessments that promote individual independence. Those people who control this service are beginning to listen to the resident group. EVIDENCE: Care plans and associated records were requested for five residents of varying abilities across different bungalows. In three cases when a care plan was requested staff were able to locate the documents held in a grey ring binder in the bungalow. In the fourth case a staff member said the documentation had been taken to update and was not available. This information could not be tracked down before the end of the visit. In the fifth case on day one the staff member said the care plan had gone to hospital with the individual. This was Dell Residential Home (Sudbury) DS0000024372.V336600.R01.S.doc Version 5.2 Page 12 located on the second day of inspection and the resident had returned from hospital. The care plans in the grey folders were on the whole confusing to read as they were in no particular order. A lot of the information was years old and one had to search to check if it was the most up to date information available. The risk assessments in the folders were the same generic assessments copied into each file with a different name on the top. Individual manual handling risk assessments were seen to be in place. The new care plans being developed were completed for a small number of residents. The manager explained that six staff have received training in how to complete these and the process was under way. These new care plans are in yellow ring binders. The quality of these new plans is good. The format meets all the standards. There are pictures and symbols with the words to make them more accessible to the residents. Evidence of review is easily seen. One staff member explained that to go through each section with a resident and thereby ensuring they understand and agree before they sign each section can be time consuming as it needed to be done in stages so as not to overwhelm the resident. This showed good understanding of the processes involved. However in another bungalow where there were four care plans in yellow folders, these had to be pointed out to one regular member of staff who did not know what the documents were. A second member of staff in the same bungalow was asked if they were aware of the new care plans. This member of staff did not understand sufficient English to understand the question. This staff member was observed caring for a very disabled resident in a kind and gentle way, but would have had difficulty in communicating with the resident. There was need for her colleague to translate. The daily statements for two individuals were looked at in detail to follow through incidents that had been reported to the commission. Both individuals had a fall that had resulted in an injury that required medical attention at hospital. The detail of the daily record made by staff was poor. There was no description of how the incident occurred or may have occurred. In one case the manager has been asked to investigate further as there was conflicting accounts of the events. In the other case the daily record stated the wound received and the medical help obtained, even though it was stated that a member of staff was present at the incident. In relation to review of care plans there is an expectation that following an event or return from hospital a review of the care plan would be completed to note any changes to practice for staff to meet the changing needs or to take action to prevent a reoccurrence. Three care plans following such incidents and a hospital admittance had not been reviewed and there were no specific instructions to staff. Dell Residential Home (Sudbury) DS0000024372.V336600.R01.S.doc Version 5.2 Page 13 With regard to decision making and consultation of residents, these matters will be addressed in the new person centred care plan format. The acting manager was able to evidence recent residents meetings and that she was in the process of contacting a local advocacy agency for their support to residents with decision making. Feedback from the six residents surveys was positive with residents saying they usually make decisions about what to do each day. The manager confirmed that the situation with male staff giving personal care to female residents remains the same and that this issue is yet to be addressed. There is currently a review of the catering at the home and this was mainly being dealt with by the area manager and at this stage did not have any resident contribution. The activities co-ordinator was consulting individuals on their preferences around day care. Dell Residential Home (Sudbury) DS0000024372.V336600.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 16 and 17 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People who use this service can expect to see a development in activities during the day on offer to them. Residents can expect to be listened too with developing systems coming in place, but not all of the residents have good quality wholesome appealing food. EVIDENCE: On the first day of inspection the day centre on site now called ‘the zone’ was not operational. This was due to staff training. However on the second day it was open. There were eleven residents there in the afternoon and they were doing a variety of individual activities such as art craft and games. Two residents were sat in comfortable chairs chatting. There were sufficient staff available to support them. That morning the ‘music man’ had visited. His music appeared popular with residents and staff who recounted his visit. He has been a long standing regular to The Dell. Dell Residential Home (Sudbury) DS0000024372.V336600.R01.S.doc Version 5.2 Page 15 The newly appointed activities co-ordinator spoke of the developments that were happening. As part of the developments she had ascertained what was currently happening for residents accessing external day facilities. And had visited the largest local provider to develop links. Numbers of people accessing external day care pursuits include 4 residents going full time to the local day centre, 8 other people going part time. Three people go to another day resource and 5 people access an ASDAN educational course which is a creative art course. There are 4 people who go horse riding and a couple of people were said to access swimming. In an evening there is little that is accessed outside the home. A small number of people go to the local gateway club when staffing levels permit and this was said to be once every 2 or 3 weeks. The new co-ordinator was found to be enthusiastic about developing more choices based upon individual preferences and was seeking views of residents to develop individual day plans. She also kept a record of all activities and was kindly using her own laptop and printer to develop these services. There had been a recent visit to the zoo and to see a show in the evening. Residents spoken with were very pleased with these outings. On the first day of inspection one resident said they had been to the shops and on the second day a small group of residents went to the shops. Two staff members were concerned that residents had not had a holiday and no holiday was planned. The acting manager was able to evidence residents meetings that had taken place in bungalow 1, 2 and 5. She also had a residents meeting for the whole site planned. These meetings were called ‘your voice’. The acting manager was planned to attend a 2-day course the next day on advocacy, part of which she was hoping to use within the home. One the first day of inspection a visit was made to the main kitchen. The two staff were preparing the main meal of the day for lunch time. The meal was either homemade fish pie or burger and fried potato wedges both came with peas and sweet corn from frozen. This was then kept hot in a hot trolley until staff then came and transported the food in larger plastic boxes to each bungalow. It is from this point that the food can no longer be kept hot. The main kitchen provides the main lunch for five of the bungalows, catering they said for 28 main meals. Residents with the help of staff made the choice of meal 2 ½ days in advance. Kitchen staff said this was the time they required to prepare the meals. The kitchen staff were revising the 4 weekly menus under the guidance of the area manger to show a wider variety of choice to residents with no repetition. They were also planning to show what vegetables accompanied the main meal. The budget for the main kitchen was said to be £260.00 per day. Kitchen staff explained that vegetables were delivered twice a week. There were no fresh vegetables on the first day of inspection and they were expecting a delivery that day which was a Friday. The next day of inspection Dell Residential Home (Sudbury) DS0000024372.V336600.R01.S.doc Version 5.2 Page 16 was Monday and the main meal was homemade chicken pie accompanied by mashed potatoes, swede and sprouts (both from frozen) and gravy. Two care staff from different bungalows both said that there was sufficient food for residents, but that the quality was not always good. The vegetables tended to be from frozen or out of a tin. One survey from a staff member said ‘The food is rubbish, baked beans and spaghetti are in my eyes not vegetables, the meat is always processed and the food is not properly spiced’. Breakfast and evening meals are prepared in the individual bungalows and each day a plastic box is collected which replenishes food stocks requested by the staff. One box was examined and seen to have a variety of snacks and fruit for residents and sufficient food to make the evening meal. In this particular case it was going to be eggs and bread. Bungalows 1, 5 and 6 do there own catering and shopping from local stores. One bungalow visited was preparing their evening meal that was the main meal of the day. This was homemade spaghetti bolognaise, this was different from that planned as a different choice had been made earlier in the week. At lunchtime the residents had not had the planned sandwiches but had requested pancakes instead. The member of staff said that they generally follow the menu, but choice of the residents is important. The staff member said that they found it difficult some weeks to make the £87.50 shopping allowance stretch to cover catering for 5 residents and staff particularly when they had to purchase tin foil, kitchen roll or similar. Dell Residential Home (Sudbury) DS0000024372.V336600.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21. People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People who use this service are not routinely provided with sensitive personal support that ensures privacy, dignity and independence and control over their lives. However health and medication matters are satisfactorily managed and accessed. EVIDENCE: At the previous two inspections the there has bee an issue raised around male staff caring for female residents. ‘Female residents are still routinely given personal care by male carers without being offered choice in this. There were no records made in care plans to show that this has been fully discussed with residents and their families or advocates with the outcome of that conversation. There were no procedures in place that staff spoken with were aware of to guide or advise on providing care for residents of opposite gender’. This matter was raised with the acting manager and she confirmed this was still the case and the matter had yet to be addressed. Dell Residential Home (Sudbury) DS0000024372.V336600.R01.S.doc Version 5.2 Page 18 Two different staff spoken with in two different bungalows had the same concerns around when the home was short staffed then it was practice to close a bungalow down and distribute residents to other bungalows. The staff explained that the residents did not like this to happen and did not want to spend long periods of time in other residents bungalows, but staff were left with no option but to persuade the residents to relocate for the shift. When asked the last time this had happened staff said less frequently now but as recently as one month ago, but could not give a date. In bungalow 7 there was one staff member on duty and three service users. Two of the residents were in day care. A call was received by the staff member to collect one resident from day care. The staff member left the bungalow leaving one resident alone in the bungalow and then returned with another resident in a wheelchair. The staff member was unable to get the wheelchair into the bungalow, as there was a small step for the wheelchair to manoeuvre over. The staff member had to lift the chair with the resident in. This was very difficult for her to do. When asked how much the resident weighed the staff member believed 15 stone but did not know for sure. The resident required personal care as they had urinated through their continence aids and their clothing. This was a source of embarrassment for the resident. There was no care plan available to reference care needs too. The staff member confirmed that on occasions throughout the day she left the residents to do small errands like place the meal order with the kitchen and collect lunch and to take and return residents to day care. The learning disability level of these residents is believed to be moderate to severe with one resident having additional physical disabilities. Therefore the support and care level required at times is for two staff. The roster shows one person designated. The staff member sated that she could call the team leader to help on occasions, but shrugged as she said this. In addition the one staff member makes breakfast and evening meal and was responsible for all the cleaning in this bungalow. There was another occasion in bungalow 2 when a resident had urinated through there clothing and staff needed to attend to their personal care. Medication was examined in two bungalows. The systems in place showed good recording and medication is kept are secure. The person responsible for administration of medication in all bungalows is the team leader on duty. A team leader was observed administering medication and her practice was observed as good. The manager confirmed that the supplying chemist booked a full days training for relevant staff on medication administration. Care plans examined showed a wide range of healthcare professionals involved at the home. This included the GP visiting and on occasion giving specialist written advise on administration of medication, speech and language therapists, occupational therapists and very recently the acting manager had ensured the opticians had visited those who required an eye test. There was Dell Residential Home (Sudbury) DS0000024372.V336600.R01.S.doc Version 5.2 Page 19 also evidence of the accident and emergency and hospital services being used when required. In relation to arrangements around death and dying the manager confirmed that arrangements had only been put in place for two residents, but that it was her intention to discuss this subject more widely and ensure more plans and wishes were known and in place for all residents. Dell Residential Home (Sudbury) DS0000024372.V336600.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People who use this service may have found that they were not listened too, but this looks set to change. With regard to protection of adults less able to look after themselves there is some knowledge of matters but this is not as robust as it should be. EVIDENCE: The procedure for complaints had been reviewed and this information had just been compiled and was due to be placed in every bungalow for residents, staff and visitors to have access. The one response from a relative stated that they were unaware of how to make a complaint should they wish too. The response from residents was that they were unaware of how to make a complaint. The home has begun to demonstrate that they are now listening to residents through the residents groups called ‘your voice’. There have been matters referred through the protection of vulnerable adults procedure (POVA) and the commission made this referral after staff approached the commission in a different county. This has duly been investigated. The acting manager had audited training and found that 42 staff had received POVA training. The home had their organisational policy around POVA but did not have an up to date copy of the local procedure and referral system that is agreed between Suffolk Social Services, Suffolk police and the commission. The acting manager agreed to obtain a copy. Staff recruitment records examined contained a criminal records bureau check that included a POVA check. Dell Residential Home (Sudbury) DS0000024372.V336600.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People who use this service can expect to find accommodation that is comfortable, generally clean and homely. Tasks in the scope of a handyman are well maintained, but more major work has previously not been commissioned and addressed thereby putting staff and residents at potential risk. EVIDENCE: The Dell is a large site with lovely well-maintained grounds in which the residents can spend time. Externally the bungalows are well maintained. All bungalows except bungalow 1 were visited. The communal day centre, offices and main kitchens were also visited. Bungalow 8 had recently been refurbished, decorated and equipment purchased such as a television. There were areas of the complex that were nicely maintained and homely, individual bedrooms tended to be individual and full of personal possessions. Dell Residential Home (Sudbury) DS0000024372.V336600.R01.S.doc Version 5.2 Page 22 There is a problem in bungalows 3 and 4 where the bath had been removed and converted into a shower room. There is leaking of water through the wall in to the hall. This has resulted in tiles missing in the showers and wet walls making decorating of the hall impossible. Staff said this had been like it for some time. Bungalow 4 had an electric socket in a damp patch that had tape across it to stop it being used. Other bungalows were baths had been removed and showers installed also showed signs to a lesser extent of the same problem. The ceiling in the hall of bungalow 4 had a hole about 6 inches across and was in need of repair. The acting manager had recently completed an environmental audit and found that not all the bungalows were connected to the nurse call system and therefore residents and staff in bungalows 6 and 7 could not summon immediate help. Bungalow 8 had only 2 nurse call points. As part of the same survey conducted by the acting manager she found that bungalows 6, 7 and 8 are not connected to the alarm system. Bungalow 7 accommodated a person in a wheelchair but did not have level access. Staff explained that if they wanted to use the garden at the back they would use the front door and go round to the back garden, as this was a lower step to negotiate. The person who required lifting in a wheelchair over the small step was larger than average. Following a recent visit made by an environmental health officer a recommendation was made that the units in the main kitchen should be replaced. The acting manager had already addressed the concern regarding the dry store and had obtained a quote to purchase a dishwasher. The cleaner was met and spoken with. On the whole he was satisfied that he had time to do his work and was provided with appropriate equipment. However he did say that he had requested upon a number of occasions over a long period of time for a suitable carpet cleaner to be purchased for the home. Thereby ensuring any carpet could be immediately cleaned, as currently the practice was to arrange to borrow one from another home. The home was clean throughout and no odours were detected. Dell Residential Home (Sudbury) DS0000024372.V336600.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People who use this service may have found there were limited numbers of staff on duty, but this has recently improved with recruitment and a review is continuing. Staff recruitment, supervision and training is acceptable. EVIDENCE: The weeks roster was requested. This was given but there were gaps in the roster for bungalow 5 - upon request these were retrospectively filled in. The staffing levels for the whole site have improved with between 12 and 14 care staff being on duty during the day and 4 care staff on at night. In order to achieve these levels of staffing the acting manager explained that staff from other homes within the same organisation are used along with agency staff. Including these people there are currently 50 people working at the home. In addition the home employ 3 cleaning staff and there are 3 kitchen staff that cook the main meal of the day. The acting manager, the deputy, nor the activities co-ordinator appeared on the roster. The full name of staff and the hours that they were scheduled to work were no clear on the roster. Dell Residential Home (Sudbury) DS0000024372.V336600.R01.S.doc Version 5.2 Page 24 Currently at the home there are 40 residents. In using the Residential Forum Guidance the acting manager was able to say that 9 people were low dependency, 19 were medium dependency and 12 were high dependency. The management of the home confirmed that due to concerns received regarding staffing levels they were currently reviewing the levels of staffing within the home. Very recently the organisation had sent in a clinical governance team to reassess the staffing levels. From the information supplied by the acting manager there are 14 care staff who hold the NVQ2 in care and another 6 who are working towards it. There are 3 care staff who hold NVQ 3 in care and 1 working towards it. Staff recruitment had been focused upon to increase the number of permanent staff at the home. Recruitment records for 4 new staff were examined. These were found to have the necessary checks in place. Two of these people were new to care and therefore needed to complete the skills for care induction and the manager confirmed this would be the case but there was no evidence of enrolment. With regard to formal supervision 5 of the 6 staff surveyed said they received regular formal supervision. The acting manager explained that since she had started she had made the opportunity for all staff to meet with her. There was evidence of staff meetings with minutes kept. Dell Residential Home (Sudbury) DS0000024372.V336600.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42. People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People who use this service have begun to experience a management which has started to address concerns. There are health and safety matters that currently place residents and staff at risk, but this is believed to be set to improve. EVIDENCE: The registered manager is currently absent from the home. There is an acting manager Ms Kelly Cox in place who came to the home in January 2007. The acting manager is qualified with NVQ 4 in care and holds the registered manager award and the assessors’ award. Six staff surveys were returned and asked about the running of the home. Four staff said they felt the home was well run, one did not answer and one Dell Residential Home (Sudbury) DS0000024372.V336600.R01.S.doc Version 5.2 Page 26 said no – ‘some senior team leaders do not work as a team and from that there is conflict. I feel that under current management things will improve.’ At the inspection thirteen staff were met and spoken with all were overwhelmingly positive about the acting manager and were positive about her efforts to improve matters at The Dell. Three staff expressed concern that things would deteriorate if she were to leave and the registered manager return. A placing authority was spoken with; they have clients at the home have found a change in management that has begun to address concerns that had been expressed. This included a positive comment from a relative. The acting manager has kept the commission informed of events effecting residents at the home by way of notifications. One of these related to a possible intruder. As a result the manager is responding by improving the nighttime flood lighting of the grounds. Each bungalow has a locked front door and visitors were seen to be asked to identify themselves. Suffolk fire service completed an inspection of The Dell five months ago in November 2006. This found fire safety concerns and highlighted them in a report to the home. This inspection found that the work required had not yet been completed. However, the acting manger has completed a fire risk assessment, which has shown areas of concern that may be potential hazards. An example being bungalows 6, 7 and 8 not connected to the fire alarm system. The acting manager gave an assurance matters were being addressed and was aware of the concerns of the fire service regarding fire doors. On the first day of inspection a fire contractor arrived at the home to assess work required on the fire doors. Staff at the home have had fire safety training- the same course was repeated 3 times to ensure all staff attended. Records relating to fire safety checks conducted by the handyman were examined and found to be satisfactory. The handyman also conducted checks of hot water temperatures to ensure water was not hot enough to scald. Records examined were satisfactory. Staff had also under gone training in health and safety matters and COSHH (chemicals hazardous to health) also moving and handling. Further training was planned in first aid and basic food hygiene. Dell Residential Home (Sudbury) DS0000024372.V336600.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 2 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 1 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 2 2 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 X 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 3 3 1 3 3 X X X 2 X Dell Residential Home (Sudbury) DS0000024372.V336600.R01.S.doc Version 5.2 Page 28 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 YA3 Regulation 14 (d) Requirement There has been a history that people outside of category have been admitted to this home. Prospective residents must know that the home can meet there needs, therefore the home must not offer a place to someone whose needs it cannot meet. Confirmation of suitable placement must be made in writing. Care plans must be more detailed and individual to each resident’s needs so that staff can approach and respond to them safely and effectively. (This is a repeat requirement from the last 3 inspections.) In order that staff can care and support residents appropriately, care plans must be reviewed and updated with changing needs, particularly when residents have returned from hospital or where there has been an incident. All people using the service must have individual risk assessments DS0000024372.V336600.R01.S.doc Timescale for action 06/06/07 2. YA6 12.1 15.1 06/06/07 3. YA6 15.2 06/06/07 4. YA9 14.2 06/06/07 Page 29 Dell Residential Home (Sudbury) Version 5.2 carried out for any activities and identified risk are specific to the individual and discussed with the resident to form part of their individual plan. (This is a repeat requirement from the last 3 inspections.) 5 YA17 16 (2)(i) The review of catering service must continue and include consultation with residents as currently not all residents receive good quality food. The home must ensure that files show that residents have been consulted about their preferences in relation to care given by carers of an opposite gender. (This is a repeat requirement from the last 3 inspections.) Residents were seen to have their privacy and dignity compromised in respect to continenece care. Personal care such as continence, must be more proactively managed to ensure dignity. Residents must have their independence and control over their lives respected therefore bungalows must not be closed due to staff shortages. There are no plans in place for the majority of residents with regard to their wishes and feelings with respect to death and dying. The showers in bungalows 3 and 4 are leaking with tiles missing and damp in electrical system causing a hazard and residents unable to use showers safely DS0000024372.V336600.R01.S.doc 06/06/07 6. YA18 12 (2)(3)(4) 17,15 06/06/07 7. YA18 12 (1)(4)(a) 06/06/07 8. YA18 YA33 12 (3) 18(1)(a) 06/06/07 9. YA21 12 (3) 15(1) 06/06/07 10. YA24 16 23 (2)(b) (j) 06/06/07 Dell Residential Home (Sudbury) Version 5.2 Page 30 therefore these must be made safe and repaired. 11. YA24 23 (2)(b) The ceiling in bungalow 4 has a hole of approximately 6 inches across and must be repaired. Call bells in bungalows 6,7 and 8 are either missing or insufficient thereby placing staff and residents at potential risk as immediate help cannot be summoned. A suitable system to meet the needs of the staff and residents must be installed. Bungalow 7 accommodates a person who uses a wheelchair, but is not wheelchair accessible. The freedom and independence of the resident is compromised and staff are at risk of injury when manoeuvring over the small step. Action must be taken to make bungalow 7 accessible to wheelchair uses. The current staffing review must continue by taking account of individual needs that must be supported in the separate bungalows, in line with the homes statement of purpose. The outcomes must be implemented to ensure the health, welfare, safety and independence of the residents. Not all staff working at the home were on the roster and full names with times staff worked were not completed therefore the roster was not clear. An accurate record must be kept to definitively show staffing levels at the home. The fire officers’ report of DS0000024372.V336600.R01.S.doc Version 5.2 Page 31 06/06/07 12. YA24 23 (2)(b) 06/06/07 13. YA24 16 23 (2)(a) (n) 06/06/07 14. YA33 18 06/06/07 15. YA33 17(2) schedule 4 06/06/07 16. YA42 23 (4) Dell Residential Home (Sudbury) November 2006 and the fire risk assessment completed at The Dell have highlighted concerns that place residents and staff at increased risk if a fire were to occur at the home therefore those concerns must be actioned as a matter of urgency. 17. YA42 23 (5) 06/06/07 06/06/07 The environmental health th officers report dated 27 March 2007 found four concerns around food hygiene that may place residents at risk therefore the four matters from the report must promptly be addressed. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations Residents should have the opportunity to ‘test drive’ the home before admission. There should be ‘user-friendly’ information about the home for prospective residents. The local up to date POVA policy and procedure should be available and known to staff at the home. All shower rooms on site that were converted from bathrooms should be assessed and action taken if found to be leaking and causing damp. 2. 3. YA23 YA24 Dell Residential Home (Sudbury) DS0000024372.V336600.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 Dell Residential Home (Sudbury) DS0000024372.V336600.R01.S.doc Version 5.2 Page 33 - 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!