Inspection on 06/12/06 for Dell Residential Home (Sudbury)

This inspection was carried out on 6th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 21 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) 20/04/07

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 Jan Davies Unannounced Inspection 6th December 2006 09:30 Dell Residential Home (Sudbury) DS0000024372.V323478.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.V323478.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.V323478.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.V323478.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd May 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 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 high standard of accommodation. All service users have goodsized private bedrooms. Fees range from £460.00 to £1210.00 weekly depending upon assessed need. Dell Residential Home (Sudbury) DS0000024372.V323478.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was a key unannounced inspection, carried out on a weekday between the hours of 9.30am and 17.00pm by two inspectors. The Registered Manager and senior representatives of Craegmoor were present during the inspection. Residents and staff of the home fully contributed to the inspection process. The inspection involved a tour of the premises, discussions with staff and residents and the examination of a number residents care plans and staff files of any staff employed since the last inspection. The inspectors also looked at a variety of other documents including policies, procedures and medication records. This report assesses key standards and reassesses those that were not entirely met at the time of the previous inspection this year. What the service does well: What has improved since the last inspection? What they could do better: The home must review the situation for all those residents who do not come into the home’s current registration category as a matter of urgency. It is recognised that the home employs two domestic staff to clean the eight bungalows on a rota basis but a system for maintaining cleaning and laundry equipment must be implemented to maximise hygiene, washing and cleaning routines and minimise the risk of cross infection to service users. All electrical equipment essential to washing and cleaning routines must be continuously in good working order and kept serviced and maintained. Dell Residential Home (Sudbury) DS0000024372.V323478.R01.S.doc Version 5.2 Page 6 Staff must not be involved in hazardous duties such as carrying heavy laundry baskets out of bungalows to another site for washing (and also in so doing leaving bungalows unoccupied and leaving residents without staff support.) Appropriate induction, training, support and supervision should be in place to ensure that all staff working in the home and undertaking personal care duties, including all new employees and existing employees who have not received this to date, have the competencies and skills to meet the needs of the service users. Staffing levels must be reviewed to ensure that the safety and welfare of the service users are safeguarded at all times and that staff are not performing duties outside of their job descriptions and competence base. Staff of opposite gender should not routinely perform personal care tasks without this being agreed as part of the care plan. Any agreement must involve advocacy, where residents are unable to make such a decision themselves, and be formally written into the care plan. Security arrangements within the home must be addressed. Any person visiting the home must be asked for identification and additionally vetted by staff before entering bungalows. The home has risk assessments in place, which cover a wide range of issues for each service user, however, they need to be revised to make them specific to the individual and not used as a generic model. Information not relevant to the service user needs to be removed. A system must be in place to ensure that all staff are aware of the content and instructions within risk assessments. Monthly monitoring reports must be available in the home and be up to date. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Dell Residential Home (Sudbury) DS0000024372.V323478.R01.S.doc Version 5.2 Page 7 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.V323478.R01.S.doc Version 5.2 Page 8 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): 1,2,3,5 Quality in this outcome area is poor. Service users cannot be assured that individual aspirations and needs are always assessed. The home is currently caring for residents who are above the age range of that referred to in the home’s current registration details and statement of purpose. If the home is to provide a ‘home for life’ the statement must reflect how it intends to continue to do so.’ This judgement has been made using available evidence including a visit to this service. EVIDENCE: From visiting all bungalows it was apparent to the inspectors that the home was caring for residents with a wide range of disability and with diverse learning needs. Additionally the home has continued to care for residents beyond the age range referred to currently on the certificate of registration and not all residents in this category are ‘covered’ by any variation to that certificate. This could constitute an offence under the terms of the Care Standards Act 2000 and the situation must be re-assessed urgently. Dell Residential Home (Sudbury) DS0000024372.V323478.R01.S.doc Version 5.2 Page 9 In view of the above the home is effectively caring for a number of people whose needs may not be most appropriately catered for within the terms and conditions of their contracts with the home and within the scope of the home’s statement of purpose. All residents affected must be reviewed at the earliest opportunity with the involvement of their placing authority to ascertain the continuing appropriateness of their placement in the home. An application for variation demonstrating the home’s ability to continue to care for residents currently outside of the registration category must be made to the Commission. Not all residents had had the opportunity to ‘test drive’ the home before admission and this should be offered as part of the pre- admission arrangements. ‘User-friendly’ information about the home should be developed and available for prospective residents. Dell Residential Home (Sudbury) DS0000024372.V323478.R01.S.doc Version 5.2 Page 10 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): 6,7,8,9 Quality in this outcome area is poor. Service users cannot expect to have their personal, health and social care needs fully identified. Risk assessments are not personalised and must be made more specific to the individual and more consistently followed. Service users are not always consulted on all aspects of life in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspectors looked at care plans randomly in all bungalows. The plans covered aspects of personal, health and social care. However, some sections had not been completed, as had been the situation at the time of the last two inspections this inspection year. Section 9 of a number of care plans stated that the key worker was to involve the service user in completing “My book and my way forward”. This was blank in some care plans and missing from others. Dell Residential Home (Sudbury) DS0000024372.V323478.R01.S.doc Version 5.2 Page 11 Discussion with the manager confirmed that the feedback received about this document was that where there were communication difficulties they were based on staff judgements rather than the opinion of the service user. There was no evidence to demonstrate that advocacy had been sought nor an independent view obtained. Action plans of statutory reviews had not been incorporated into the on going plans for residents. The manager informed the inspector that this has been raised with Craegmoor and plans are in the process of being revised to be more person-centred and ‘tailor-made’ to the needs of individual residents. However this had been the situation at the time of the previous 2 inspections and this visit confirmed that the necessary progress had not been made within appropriate time scales. Care plans contained risk assessments for each service user, however these were blanket risk assessments that contained a lot of detailed information some of which was not relevant to the individual. This had been the situation at the time of the previous 2 inspections. One resident had furniture and equipment removed from their room ‘because of their destructive nature’ and for their protection. This information was not recorded in their care plan as should be the case and nor was there evidence that this action had been formed as a result of a care plan review. This situation had been referred to at the time of the last 2 inspections. Entries in the log/day book of one bungalow referred to one resident ’wandering in the grounds in just short sleeved top----7.45am----no carer in bungalow’ (the date was a day in November that had been particularly cold.) ‘resident found in corridor at 8am unattended—no carers were in the bungalow’ (had gone off shift prior to the handover occurring with the oncoming shift member.) ‘resident wandering—potentially dangerous situation and highlighting the problem of staff not supervising-----’ One female resident, aged 88yrs was assisted to the toilet by the male carer on duty. Their care plan specified that they needed help with ‘all aspects of their personal hygiene’ and there was no assessment in place as to the appropriateness of this being done by a carer of the opposite gender. The carer in question had no available guidance to assist them with this task. The home must have a policy and procedure in place to assist all staff with situations where personal care being given by a carer of the opposite sex to the resident. Dell Residential Home (Sudbury) DS0000024372.V323478.R01.S.doc Version 5.2 Page 12 As was the situation at the time of the last 2 inspections there was no clear policy and procedure and training in place for staff to ensure relatives and service users know what action would be taken in the event of the challenging behaviour of a service user and that a consistent approach is taken at all times. Dell Residential Home (Sudbury) DS0000024372.V323478.R01.S.doc Version 5.2 Page 13 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): 12,13,14,15,16,17. Quality in this outcome area is adequate. Service users cannot always expect to be supported to take part in appropriate activities within the home and in the community and have the opportunity to mix with other adults due to minimal staffing arrangements. Service users cannot always expect staff to be able to support them to maintain appropriate relationships within a risk assessment framework. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The atmosphere in the bungalows seen was calm and the relationship between service users and staff members was observed to be relaxed and friendly. It was clear from discussions with staff and entries made in care plans that service users maintain appropriate relationships. Relatives visit the home on a regular basis. However their views and those of representatives such as social workers were not in evidence in care plans. Dell Residential Home (Sudbury) DS0000024372.V323478.R01.S.doc Version 5.2 Page 14 One resident has recently had to stop a much-enjoyed church related community activity due to their increasing age and dependency and need for 1-1 staff support with this. Recordings from the daily log confirmed that the home was responsible for planning and arranging day services as appropriate and attendance at social events and identifying any possible employment opportunities. Outings such as shopping trips, social visits and visits to local events were either not taking place or not recorded as occurring. Regular reviews were held and helped to identify new opportunities while ensuring the existing arrangements remained relevant and appropriate however care plans did not regularly identify outcomes expected or practical steps to be taken to achieve positive outcomes. Menus seen confirmed that meals provided were wholesome and were planned to take account of residents’ dietary needs. A number of people living in the bungalows were spoken to and everyone who commented on the food said it was good. The inspectors were present during the main meal of the day and the quality of this was satisfactory. Dell Residential Home (Sudbury) DS0000024372.V323478.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome area is poor. Residents cannot always expect to receive personal support in the way they prefer and to have their physical and emotional health needs identified and monitored. They cannot always expect to have their prescribed medication administered correctly. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Medication administration records were checked in different bungalows and it was found that these were not always being signed for to show that medication is given. This was the case for eye-drops that were not being recorded as given. Communication between some staff and residents was limited due to language difficulties as staff members from overseas do not all speak English fluently. Domestic staff members were being routinely used in personal care routines without access to appropriate supervision and training and, (as referred to previously in this report) this was not specified in their job descriptions. Dell Residential Home (Sudbury) DS0000024372.V323478.R01.S.doc Version 5.2 Page 16 As was the situation at the time of the previous 2 inspections this inspection year, female residents were routinely given personal care by male carers without being offered a choice in this. There were no records in care plans to show that this has been discussed with residents and the outcome of that conversation. There were no procedures in place for carers to guide or advise on providing care for residents of opposite gender. At the time of the inspection bungalow 5 was without staff for a period of time and residents were allowing access to callers without any vetting arrangements. Staff talked to the inspector about the long hours they were working without appropriate breaks and rotas showed staff working in excess of 48hrs on duty including a ‘sleep-in’ period. Several members of staff do not have the appropriate qualification or training to undertake care duties but are left in sole charge of bungalows on occasions. Not all residents were having an annual holiday (if their family was not taking them), as the home was not providing this for them. In bungalow 8 three care plans were identifying residents’ access to community involvement, clubs and activities that are no longer taking place. The residents in bungalow 8 had a lack of equipment to stimulate their interest and there was insufficient information in care plans for staff to follow to advise on how to make time spent during the day meaningful and interesting for residents. Staff members have had insufficient training to develop skills and interests for residents and provide appropriate stimulation to them. Dell Residential Home (Sudbury) DS0000024372.V323478.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is adequate. The home has an appropriate complaints procedure in place and but residents cannot be assured that there are sufficient strategies in place to protect them from harm until all staff have completed the relevant training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was no information about the home’s complaints procedures in some bungalows. The information in the home’s reception area referred to the role of the CSCI. The home has a complaints procedure in place and this is summarised in the Statement of Purpose and Service User Guide. It includes information on how to make a complaint and the stages and timescales of the complaints process. The complaints log had previously indicated that relatives had difficulty in finding staff who should be in attendance in bungalows at all times and this situation was still the case at the time of this inspection. Complainants have contacted the Commission of Social Care Inspection about this issue, which is an on going staffing issue for the home and needs priority attention. A complaint from a relative about lack of suitable furniture in their relative’s room had been actioned. However there was no information available to show that this had been done and a satisfactory outcome reached. Complaints’ Dell Residential Home (Sudbury) DS0000024372.V323478.R01.S.doc Version 5.2 Page 18 information should demonstrate the home’s response at each stage of the process including the outcome. Staff spoken to confirmed that they had training on the protection of vulnerable adults as part of their induction. The manager confirmed that the home works within the guidelines of the Suffolk Inter Agency Policy and Procedures for the Protection of Vulnerable Adults. Records of incidents were seen during the inspection and discussed with the deputy manager. The home would benefit from a physical intervention policy to develop clear advice to staff trying to manage any challenging behaviour. This should identify specific risks for residents e.g. one resident was at risk of absconding and during the inspection their specific ‘whereabouts’ was not known. Training records and conversations with staff indicated that physical restraint training had taken place but not for all staff. Staff records contained evidence of appropriate recruitment checks including Criminal Record Bureau (CRB) checks. When asked residents confirmed that, most of the time, staff listen to them and help them to achieve their wishes as appropriate. Dell Residential Home (Sudbury) DS0000024372.V323478.R01.S.doc Version 5.2 Page 19 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): 24,25,29,30 Quality in this outcome area is poor. This judgement remains the same from the previous three inspections in that systems of cleaning have improved but repairs to standard cleaning and laundry equipment must be done to ensure that service users live in a clean and hygienic environment. (At the last 4 inspections laundry equipment was not in good working order in all bungalows.) This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspection began with a tour of the bungalows and meeting residents and staff. Bungalows varied in relation to cleanliness and odour control. It was acknowledged that the levels of dependency of residents vary within the bungalows. Staff members care for residents and in addition are expected to undertake domestic duties. It is recognised that the home employs two domestic staff to clean the eight bungalows on a rota basis but a system for maintaining cleaning and laundry Dell Residential Home (Sudbury) DS0000024372.V323478.R01.S.doc Version 5.2 Page 20 equipment must be implemented to maximise hygiene, washing and cleaning routines and minimise the risk of cross infection to service users. All electrical equipment essential to washing and cleaning routines, especially washing machines and clothes’ driers, must be continuously in good working order and kept serviced and maintained. Manual handling equipment identified for residents in line with their occupational health assessments and care plans were still not being provided. A recording in the daybook in one bungalow refers to the shower not working for over a month. Staff must not be involved in hazardous duties such as carrying heavy laundry baskets out of bungalows to another site for washing (and also in so doing leaving bungalows unoccupied.) Inspectors saw care plans in this bungalow that specified that residents must have close supervision at all times. On a tour of bungalows not all were staffed and although reluctant to do so, residents allowed entry to callers without staff approval in advance for this. Security must be improved by clear and available risk assessment of all situations that could pose a risk to residents. Generally the level of cleanliness and hygiene was good and a credit to staff who undertake those duties. However arrangements for this remain erratic and staff with designated cleaning duties in bungalows may be ‘called upon’ to assist elsewhere in the home on an ‘as needed’ basis. Residents’ rooms were personalised and residents were pleased and proud to show the inspectors how their rooms were decorated. Dell Residential Home (Sudbury) DS0000024372.V323478.R01.S.doc Version 5.2 Page 21 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): 31,32,33,34,35,36 Quality in this outcome area is poor. Residents can not be assured that there will be sufficient staff on duty at all times to meet their needs nor can they be clear about the roles and responsibilities of the staff looking after them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the inspection there were staff members undertaking personal care duties whose job descriptions did not specify this and who had been recruited as cleaners. While it is understood that the nature of care work requires a flexible approach from staff to meet the needs of residents it is inappropriate for staff who have not been principally employed for this purpose, and whose job description does not primarily specify a care role. It was evident also that they are not qualified or appropriately trained to be involved in giving personal care to residents. Dell Residential Home (Sudbury) DS0000024372.V323478.R01.S.doc Version 5.2 Page 22 Apart from one bungalow where the staffing ratio is higher (2 carers to 5 residents with high dependency level needs) there is regularly only one staff per bungalow and a ‘floating’ carer to help out across the site. At the time of the inspection there was one staff member to six residents in one unit. The ‘floating’ member of staff was occupied in another bungalow for some time. In another bungalow one staff member was on duty alone where a resident’s care plan specifies the need for assistance, by two staff, for all personal care needs. The occupational health and physiotherapy assessment report for the resident was specific that they required the immediate and regular assistance from two carers. One staff on duty could not provide the level of care to adequately meet the assessed needs of this resident and also allow for appropriate care arrangements for the other residents in the bungalow. The report also specifies the need for the resident to be moved with a hoist but this had not been provided at the time of the inspection although inspector were shown documentation to show that this had been ‘ordered ‘ from a supplier. This was a repeat of the situation found at the previous 2 inspections and reflects inadequate care practice. Staffing competence and levels need to be reviewed to ensure that there are sufficient trained staff on duty to meet the needs of the service users and to ensure their safety at all times of the day and night. A number of staff members were spoken with about care plans and behaviour management strategies. They were unable to explain the care provided to residents in a way that was consistent with the care planning arrangements, which were generalised, out of date and did not consistently describe nor advise on the plan of care to be followed. Staff members spoken with agreed with the inspector that the care plans were not comprehensive enough for them to follow. Not all staff spoken with were receiving formally recorded supervision. This was the situation at the time of the previous 2 inspections. The registered manager should ensure that all staff receive formal supervision at least 6 times a year and more regularly in line with development needs. Dell Residential Home (Sudbury) DS0000024372.V323478.R01.S.doc Version 5.2 Page 23 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): 37,39,42 Quality in this outcome area is adequate. Residents can not always be assured that their health, safety and welfare is promoted and that their views under-pin the monitoring arrangements of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s policies and procedures were available for inspection and included health and safety codes of practice. However relevant policies were missing that are needed to protect the interests of service users. There was insufficient information available for staff to guide them in a professional manner with their duties. Dell Residential Home (Sudbury) DS0000024372.V323478.R01.S.doc Version 5.2 Page 24 The relevant policies have been referred to previously in the report. Staff spoken with and training records examined evidenced that the home ensured staff had received essential health and safety training during their induction programme including Manual handling, Fire Safety, Food Hygiene and First Aid. However there were no risk assessments in place for staff who were transporting laundry while washing machines in their bungalows were not working. The manager had provided a staff-training matrix, prior to this inspection, which indicated that the members of staff had received induction and foundation training. However, this training did not cover all the relevant areas for the resident group living at the home. Residents care plans, daily records and minutes of residents meetings did not demonstrate the home’s commitment to actively seeking the views of residents. Inspectors observed that staff members tried to give residents choice wherever possible. The home had also recently completed an annual quality assurance review which had included some consultation with residents, relatives / advocates, other professionals and staff. Monthly visiting reports were not up to date as the last one available was dated 11/09/06. The inspectors found that the Quality Assurance Review report was a general summary of achievements since the opening of the home and did not include an action plan based on the results of the review. Dell Residential Home (Sudbury) DS0000024372.V323478.R01.S.doc Version 5.2 Page 25 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 2 2 2 3 2 4 x 5 2 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 3 26 X 27 X 28 X 29 1 30 3 STAFFING Standard No Score 31 1 32 2 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 2 2 x LIFESTYLES Standard No Score 11 X 12 2 13 2 14 3 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 2 1 x 2 X 2 X X 2 x Dell Residential Home (Sudbury) DS0000024372.V323478.R01.S.doc Version 5.2 Page 26 Yes 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 YA6 Regulation 12 Requirement The Registered must ensure that relatives’ views and those of representatives such as social workers are in evidence in careplans and regular reviews. Timescale for action 01/02/07 2. YA6 15 3. YA16 12 The Registered Providers must 01/02/07 ensure that that all relevant information relating to care planning about residents’ needs are recorded in their care plan with evidence that any action had been formed as a result of a care plan review. (This situation had been referred to at the the last 2 inspections.) The Registered Providers must 01/02/07 ensure that there must be is written evidence to demonstrate that advocacy has been sought or an independent view contained for residents. The Registered Providers must ensure that all residents ‘outside ‘ of the home’s registration age range are reviewed at the earliest opportunity with the involvement of their placing DS0000024372.V323478.R01.S.doc 4. YA1 5,6,12 01/02/07 Dell Residential Home (Sudbury) Version 5.2 Page 27 authority to ascertain the continuing appropriateness of their placement in the home. 5. YA1 5,6,12 The Registered Providers must 01/02/07 ensure that all residents must be are within the home’s category of registration or be ‘covered’ by any variation to that registration. The Registered Providers must 01/02/07 ensure that a system for maintaining cleaning and laundry equipment be implemented to maximise hygiene, washing and cleaning routines and minimise the risk of cross infection to service users. The Registered Providers must ensure that manual handling equipment identified for residents in line with their occupational health assessments is provided. The Registered Providers must ensure that all electrical equipment for cleaning is repaired, maintained and remain for use of the residents of the bungalow 01/02/07 6. YA29 14 7. YA29 14 8. YA24 23 01/02/07 9. YA36 18 The Registered Providers must 01/02/07 ensure that staff must are not involved in hazardous duties such as carrying heavy laundry baskets out of bungalows to another site for washing without the situation being risk assessed. The Registered Providers must ensure that staff do not leave bungalows unattended at any time where residents care plans specify that this is unacceptable. The Registered Providers must ensure that monthly visiting reports must be available in the DS0000024372.V323478.R01.S.doc 10. YA33 17 01/02/07 11. YA37 33,26 01/02/07 Dell Residential Home (Sudbury) Version 5.2 Page 28 12. YA42 13,23, home to demonstrate appropriate monitoring is in place. The Registered Providers must ensure that policies for safeguarding the welfare and security of the service users are reviewed. (This is a repeat requirement from the last 2 inspections.) The Registered Manager must ensure that the care plans are 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 2 inspections.) The Registered Manager must ensure that individual risk assessments carried out for each service user of any activities and identified risk are specific to the individual and discussed with the service user to form part of their individual plan. (This is a repeat requirement from the last 2 inspections.) 01/02/07 13. YA6 12.1 01/02/07 14. YA9 14.2 01/02/07 15. YA20 13 The Registered Providers must 01/02/07 ensure that staff who administer medicine comply with the home’s policy and procedure for the recording, handling and, administration of medicines. (This is a repeat requirement from the last 2 inspections.) The registered individual must ensure that there is complaints’ information and a system in place to make immediate response to service users and their relatives when they need to speak to staff. (This is a repeat requirement DS0000024372.V323478.R01.S.doc 16. YA42 13,23 01/02/07 Dell Residential Home (Sudbury) Version 5.2 Page 29 from the last 2 inspections.) 17. YA31 19,18 The Registered Providers must 01/02/07 ensure that job descriptions for staff differentiate between which staff can give personal care to residents and staff who had been recruited as domestics. The Registered Manager must 01/02/07 ensure that staffing levels are regularly reviewed to reflect service users changing needs and ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of the service users. (This is a repeat requirement from the last 2 inspections.) The Registered Providers must ensure that an appropriate hoist be provided for the resident whose physiotherapy assessment specifies this. The registered individual must ensure that all residents have access to appropriate activities and community involvement in line with their care plans. (This is a repeat requirement from the last 2 inspections.) 01/02/07 18. YA33 18 19. YA29 14 20. YA13 13,14,15 01/02/07 21. YA18 17,15 The Registered Manager must 01/02/07 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 2 inspections.) Dell Residential Home (Sudbury) DS0000024372.V323478.R01.S.doc Version 5.2 Page 30 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 YA39 YA23 Good Practice Recommendations The Annual Quality Assurance Review should be developed into a process that includes a systematic cycle of planning. The home should develop a physical intervention policy to give clear advice to staff trying to manage any challenging behaviour including specific risk assessments e.g. absconding behaviour. Care plans should identify outcomes and practical steps to be taken to achieve positive outcomes. 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 complaints procedure should be available in all bungalows with staff appropriately briefed to respond to relatives about complaints and how to make them. Complaints’ information should demonstrate the home’s response at each stage of the process including the outcome. The registered manager should ensure that all staff receive formal supervision at least 6 times a year and more regularly in line with development needs. Residents care plans, daily records and minutes of residents meetings should demonstrate the home’s commitment to actively seeking the views of residents. Staff members should have sufficient training to develop skills and interests for residents and provide appropriate stimulation to them. DS0000024372.V323478.R01.S.doc Version 5.2 Page 31 3. 4. YA6 YA1 5. YA23 6. YA22 7. YA36 8. YA6 9. YA35 Dell Residential Home (Sudbury) Dell Residential Home (Sudbury) DS0000024372.V323478.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.V323478.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. 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