Inspection on 11/12/07 for Dene House

This inspection was carried out on 11th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Dene House 22/08/06

Dene House 01/11/05

Dene House 18/05/05

Dene House 12/01/05

Dene House 21/04/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

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

CARE HOMES FOR OLDER PEOPLE Dene House Dene House 12 Cleveland Road Torquay Devon TQ2 5BE Lead Inspector Peter Wood Key Unannounced Inspection 11 December 2007 10:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Dene House DS0000018346.V352791.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dene House DS0000018346.V352791.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dene House Address Dene House 12 Cleveland Road Torquay Devon TQ2 5BE 01803 293077 NO FAX 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) Mr John James De`Ath Mrs Madeleine De`Ath Mr John James De`Ath Care Home 12 Category(ies) of Dementia - over 65 years of age (12), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (12), Old age, not falling within any other category (12) Dene House DS0000018346.V352791.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd August 2006 Brief Description of the Service: Dene House provides residential care for up to twelve older people who may also have a mental health problem or mild dementia. Physical frailty is expected, but the service is not for people with major mobility or behavioural problems. Dene House is a Victorian villa, close to the centre of Torquay. People who live in the home occupy two of the four floors, and there is a stair lift. There is a large lounge and good-sized dining room, both with pleasant outlooks. There are other small rooms which may be used as lounges in combination with some of the smaller bedrooms. All bedrooms are single. The bath has a seat which lowers the occupant into the water, and there is a wheelin shower. There is an accessible garden with suitable garden furniture, a marquee and a barbeque, and a small level lawn. There are at least two people on duty at all times. Outside the hours of 8am - 6pm the Registered Provider takes on all duties, with back-up from his wife who is also a Registered Provider and is involved in social but not personal care. Care and accommodation are offered in an informal atmosphere which promotes People who live in the home feeling of self-determination. Fees range between £250 and £450 dependent on the need of the individual resident. Copies of the inspection reports can be viewed at the home or can be obtained via the CSCI website. Dene House DS0000018346.V352791.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and undertaken over one day in December 2007. The focus of this inspection was to inspect all key standards and to seek the views of people who live in the home, staff, relatives and professional visitors to the home, the latter mainly using survey forms. At the time of writing this report five people who live in the home returned the survey form “Have your say about Dene House”. Two relatives returned a form. One staff member, and one health professional returned their form. We (the Commission for Social Care Inspection, hereafter termed “we”) consulted all people who live in the home who were home at the time of the inspection. We spent considerable time with the Registered Provider / Manager and his daughter who acts as his deputy examining documentation, particularly that relating to client assessment and care planning, staffing and health and safety. We selected and closely examined a selection of files of staff and people who live at the home. We also consulted briefly the other staff member while she was on duty. We undertook a full tour of the building while we observed directly and indirectly the way the home operates. We also took into account the Annual Quality Assurance Assessment written by the Registered Provider / Manager and his daughter, extracts of which are quoted in this report. What the service does well: The registered provider / manager and his deputy daughter write in the Annual Quality Assurance Assessment: “We are committed to caring for the residents that live here, within an homely environment as possible. The proprietor / manager living on the premises and the support of a small staff framework, some of whom are family, allows for a close relationship between carers and residents to develop. Together we aim to give our residents a good quality of life in a relaxed atmosphere where they feel valued and respected as individuals.” Dene House offers a home to elderly people, some of whom may have a range of mental health problems. The home aims to give their clients a good quality of life without too many restrictions, in a relaxed atmosphere. It does particularly well in offering its services to those people whose characteristics and / or lifestyle would probably not fit a more conventional or formal style of home. The home’s staff team, several of whom are family members, have good relationships with the people who live in the home and are accepting of those characteristics and / or lifestyle which other homes may find difficult to accept. People who live in the home described staff as being very kind and caring. People who live in the home described living here as “good” and “this is my home”. They said they feel safe here, and were happy with their Dene House DS0000018346.V352791.R01.S.doc Version 5.2 Page 6 environment and food. A relative commented: “My [relative] is well looked after”. What has improved since the last inspection? What they could do better: The registered provider / manager and his deputy daughter write in the Annual Quality Assurance Assessment: “We will strive to maintain a homely atmosphere and environment where our residents feel at home. We will maintain the annual review of documentation. The plan is to continue with decoration and to start updating furnishings. Staff training when courses are due for renewal”. The Registered Provider / Manager has now been awarded the Registered Manager’s Award and should complete the small remaining amount of work to achieve NVQ4 in Care and Management during the next few months. While congratulations go out to him for his recent achievement, these qualifications should have been achieved by December 2005, so this requirement remains outstanding. The Registered Provider must achieve the NVQ4 in Care and Management by (the end) of 2005. This was a requirement at the previous inspection, the date specified in the National Minimum Standards. This is to enhance the professionalism of management and so enhance the quality of care given to people who live at the home. This date has been extended. Dene House DS0000018346.V352791.R01.S.doc Version 5.2 Page 7 All medications should be administered as prescribed and changed only on the explicit directions of the doctor. A separate plan of care for all medicine prescribed to be administered “when required” must be drawn up to make it clear to all staff administering the medicine, when and why the medicine is to be given and the actions to be taken after administration. A separate sheet must be used to record all advised dose changes from the prescribing doctor. These measures are to ensure the health and safety of people who live at the home. The owner / manager must notify the Commission about events which adversely affects the well-being or safety of any person who lives at the home, as detailed in Regulation 37. These include the death, serious injury or illness of any person who lives at the home, the outbreak of any infectious disease, any theft or accident in the care home, or any allegation of misconduct. A recommendation made at the last and previous inspections deserves repeating. Whilst part of the charm of this home is the informal “lived-in” feel, the owner should update the furniture, furnishings and decoration in the home to enhance the quality of life of people who live there. 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. Dene House DS0000018346.V352791.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dene House DS0000018346.V352791.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The systems for admission are reasonably thorough and allow people who live in the home and their relatives to be confident that their needs can be met. EVIDENCE: The registered provider / manager and his deputy daughter write in the Annual Quality Assurance Assessment: “We feel our admission procedure is reasonably thorough and comprehensive. The aim is to enable residents and their relatives to have information and time to be able to make a confident decision that their needs can be met. The home’s practice is good in using this documentation to attempt to ensure that only those residents whom the home can assist are admitted. All prospective residents are encouraged to visit before deciding to move in and where possible, given a choice of rooms. All prospective residents are encouraged to visit before deciding to move in and where possible, given a Dene House DS0000018346.V352791.R01.S.doc Version 5.2 Page 10 choice of rooms. The Pre Assessment form together with information from relevant healthcare professionals and discussion with the resident and their family is used to assist us in gaining a comprehensive picture of the clients needs and expectations. An important part of the assessment decision is the impact upon the security and stability of the existing residents. We would rather have rooms empty and the home under occupied to safeguard this priority. Service user guide and statement of purpose are available for all to view. Contracts are in place for each resident. ” As part of the inspection process we (The Commission for Social Care Inspection, hereafter referred to as ‘we’) examined assessment documentation of four people who live in the home. Examination of this documentation, consultations with and questionnaire returns from the provider / manager and his deputy daughter, staff, relatives, visiting professionals and people who live in the home substantially evidence the statements as above. New people who may come to live in the home are admitted only on the basis of a full assessment and are invited to visit the home and to move in on a trial basis before they make a decision to stay. The assessment documentation is quite well designed, reasonably thorough and comprehensive, and works for this home. The home properly uses their assessment documentation to ensure that only those people whom the home can help are admitted, taking into account the effect of any new admission on the incumbent people who live in the home. The owner does, indeed, leave rooms empty and his home therefore under-occupied to safeguard the security and stability of the existing residents. The home does not offer intermediate care. Dene House DS0000018346.V352791.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health, personal and social care needs of people who live in the home are met and they are treated respectfully. The home’s practices relating to medication administration substantially protect the people who live in the home from risk. Some minor improvements would enhance this protection. EVIDENCE: The registered provider / manager and his deputy daughter write in the Annual Quality Assurance Assessment: “Residents’ views and wishes are taken into account through discussion for their plan of care and lifestyle requirements within the home. Residents are asked what they would preferred to be named prior to arrival. The resident’s health, personal and social needs are met and they are treated respectfully. Residents have the choice of their preferred local GP practice and the home will ensure access to this and other health care services as required. Where residents would like they are supported in their Dene House DS0000018346.V352791.R01.S.doc Version 5.2 Page 12 capacity for self care but when required, assistance is provided dependent on the wishes and needs of the client. The staff are respectful of the residents right to privacy and dignity. The occupied bedrooms have locks on the doors and staff will knock before entering. There is allocated quiet area within the dinning room to allow for quiet time or alternative private visiting area. Residents can have private telephone calls and one has her own mobile phone. Residents have their own personal wardrobes and clothing at all times. Residents and their family wishes are followed when dying and visits are unlimited, and support offered to family and staff.” As part of the inspection process we examined care planning documentation of four people who live in the home. This substantially confirmed the owner / manager’s statements as above. People who live in the home have quite good care plans, generated from the quite good assessments, documenting their personal care needs. Appropriate daily records are kept, and typed up weekly by the Senior Carer / Deputy, who also up-dates care plans monthly. We saw that specialist advice is sought regarding the physical and mental health problems of people who live in the home. The home has good policies, procedures and practices for the proper administration of medication. People who live in the home are able to selfmedicate on the basis of risk assessment and their own wishes. The home operates a “Boots style” medication administration system, though the MAR sheets are replaced by the home’s own design of “month-at-a-glance” spreadsheet which is a simple tool designed to reduce the risk of drug errors. Medication requiring refrigeration is properly kept in a locked medication fridge with a separate cool compartment. Management at the home keep themselves informed about new practices and have a copy of the recently – published booklet from the British Pharmaceutical Society “The Handling of Medicines in Social Care”. We saw, however, that some medication was not always administered as prescribed, but rather treated as PRN (Latin Pro Re Nata = “as and when needed”) when there was no written evidence that the prescribing doctor had given such instructions. The home must act in accordance with written instructions from the doctor. A requirement is made and advice given in this area. People who live in the home were observed to be, and reported that they were, treated with respect by staff. Although the comment was made at the last inspection rather than at this one, it is so powerful and poignant that it is worth repeating. A person who lived at the home contrasted the genuine care and respect shown to people who live in this home by comparing her experience of living in a previous care home in which people were not respected. The other home “broke my spirit”, she told us, which took some time for this home to restore. Survey returns evidenced confidence in the quality given. One commented: “My [relative] is well looked after”, “Deals with each residents’ need and respects their privacy”. Dene House DS0000018346.V352791.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities provide daily interest for the people who live in the home. Contact is maintained with friends and families. People who live in the home are encouraged to exercise choice and meals are nutritious and varied. EVIDENCE: The registered provider / manager and his deputy daughter write in the Annual Quality Assurance Assessment: “At Dene House we aspire to operate as an extended family. Residents are encouraged, if they would like, to be involved in the chores and tasks around the house. They are free to go out and meet friends and family and continue with their personal social, cultural and religious lifestyle. There are regular in house activities such as musician, word games, entertainer. Some residents like to play dominoes amongst themselves, and there are occasional craft or baking activities. Torbay in Bloom is one of our annual events, residents have a container of bedding plants to fill, people can choose whether or not they partake. Trips out are organised either for individuals e.g. a client wishing to go to the shops or theatre alone or for the Dene House DS0000018346.V352791.R01.S.doc Version 5.2 Page 14 group e.g. a recent trip to see the Red Arrows and walk around the Fair, pantomime etc. Birthdays for each person are celebrated with a gathering, cake, present, and sometimes a buffet tea, occasional fun games or sing-along dependent on the residents wishes. When the residents want to partake the summer brings lunch or teas in the garden with maybe a game of boules. Residents’ interests and outings are recorded in the day book and diary plan and kept in the careplan. Daily menus are documented, likes and dislikes are recorded in the care plan. Some clients handle their own financial affairs, whilst others have support from family / advocate. service user guide and age concern offers contact address for external advocates should residents require it. Residents are able to arrange to bring personal furniture with them as agreed prior to admission, and its assessments for the room. They are encouraged to bring any other effects to personalise their room and residents opinion is sort when decorating.” Comments from management, staff, relatives, visiting professionals and people who live at the home substantially confirms the statements above. People who live in the home are encouraged and enabled to do as much for themselves as possible. Dene House operates rather like an extended family. People who live in the home consulted over the pleasant lunch (with a choice of menu) expressed their satisfaction that the home “suits” them. People who live in the home are obviously “at home” here, demonstrated by, for example, laying the table themselves. They can come and go as they please while many enjoy the regular activities such as twice weekly physical exercises, weekly visiting musician, regular quizzes, etc. They have a range of activities from which to choose whether or not to partake. People who live in the home said that every resident’s birthday, or a couple’s wedding anniversary, is celebrated with a cake. The day is as structured or as flexible as any resident wants it to be, and the home is able to accommodate the differing needs of the individuals who live here. A relative commented:“ “They try very hard to do all they can i.e. birthday parties, Halloween, and of course Christmas. They like to entertain”. Dene House DS0000018346.V352791.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints and suggestions from people who live in the home, relatives or other visitors to the home, are treated seriously. They are listened to and issues resolved promptly. EVIDENCE: The registered provider / manager and his deputy daughter write in the Annual Quality Assurance Assessment: “Any complaints and suggestions from the resident is taken seriously. They are listened to and we endeavour to resolve issues promptly. Staff have had NVQ training which includes communication, whistle blowing, no secrets etc and they have access to the homes associated guidelines. There is a clear simple complaints form and procedure. The information for making a complaint is held in the policies, as well as the service users guide and is easily accessible. This information has the inspectorate contact details. The previous inspectorate report said that residents consulted reported that they were listened to and expressed confidence that appropriate action would be taken. We feel good relationships and communication with our residents and ourselves has a positive influence. Residents are listened to and comments taken seriously and any requests acted upon as soon as possible. Staff have had NVQ training which includes good communication skills, whistle blowing, no secrets etc and they have access to the home’s policies and Dene House DS0000018346.V352791.R01.S.doc Version 5.2 Page 16 procedures. Staff training promotes the best practice approach to listening and communicating with residents.” The home has a complaints policy, process and notice, which includes the contact details of the Regulation Inspector should a resident or visitor to the home have a wish to contact the Commission. There is also a Complaints and Suggestion Book, though nothing is recorded in this, reflecting the informal nature of this home. There have been no complaints. The home follows the good practice promoted in the National Minimum Standards that issues are resolved before they escalate to become complaints. People who live in the home consulted reported that they were listened to and expressed confidence that appropriate action would be taken if they were to make a complaint. The provider / manager and his deputy demonstrated that they knew how to respond appropriately should there be a suggestion of abuse. A relative commented: “Concerns raised have always been dealt with.” Dene House DS0000018346.V352791.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home live in a “lived-in” style of home that is far from luxurious but meets their needs. EVIDENCE: The registered provider / manager and his deputy daughter write in the Annual Quality Assurance Assessment: “Dene house is Victorian Villa on four floors, the middle two of which contain residents Bedrooms. We provide our residents with a bedroom that will allow them to feel safe, secure and comfortable. Some bedroom accommodation consists of a couple of rooms which some residents prefer to keep divided as a bedroom and a separate lounge. Residents can have their own possessions (which could include furniture) around them and the rooms reflect the occupants character. There is a large Dene House DS0000018346.V352791.R01.S.doc Version 5.2 Page 18 lounge and good size dinning room with pleasant outlooks. The pleasant private garden is overlooked through the huge window, which allows for a lot of light to enter the room. The carpet has been replaced this year due to the discolouration caused by the sun. The room is furnished in a homely manner and there is room and flexibility to allow for different functions e.g. blackboard games all can see, group singing, card table games, dancing, crafts etc. Consultations with management, staff, people who live at the home, their relatives and professional visitors, and our own observations substantially confirm the statements above, much of which has been quoted from the last inspection report, so does not need repeating further here. Dene House is a tall, detached corner building with four floors, the middle two of which contain resident’s bedrooms. The providers live in the lower ground flat. The top floor is used for storage. There is a stair lift up the main flight of stairs. People with mobility problems can be accommodated on the ground floor, but the house is not suitable for people who are dependent on wheelchairs. The house has undergone considerable remodelling over the years, which provides valueadded character but has resulted in some non-standard features, such as several different levels and rooms which have been divided at the large windows. Dene House is a comfortable “homely home”, with a need for on-going maintenance, refurbishment and redecoration throughout. Much of the furnishings, decoration, furniture, fittings and tidiness could be described as poor. There is not a written programme of improvements, but the Registered Provider has worked steadily to meet the environmental standards and maintain the building. All radiators considered to be hazardous to people who live in the home have been covered following a risk assessment to minimise the risk of people who live in the home receiving a burn. Likewise, hot taps considered to be hazardous have been fitted with thermostatic valves to minimise the risk of people who live in the home receiving a scald. Although the office / boiler room / laundry room does not meet the detail of the National Minimum Standards, the lack of such as impermeable floor and wall coverings does not detract from the outcome directly affecting people who live in the home of an efficiently run, warm home which provides a good laundry service. There are WCs in reasonably easy reach of all bedrooms, the dining room and the lounge, though one of the WC’s (on the landing) does not benefit from a wash-hand basin, which would probably prove impossible to fit. Two ground floor bedrooms have an en suite WC, and one has its own bath. There is a bath with a hydraulic bath seat on the first floor, and an accessible shower on the ground floor. There is a call bell in each bedroom and bathroom. Although the house could benefit from brightening up, it is clean and on the day of inspection free from any unpleasant odour. The house is safely protected from Dene House DS0000018346.V352791.R01.S.doc Version 5.2 Page 19 fire. All fire doors are properly fitted with “Dorguard” type devices and closed when the fire alarm (or other loud noise!) is sounded. Access to the garden is via a ramp from the front around the side to the rear. It has a flat lawn area suitable for boules, and has several flower beds and suitable garden furniture, a marquee and barbeque. Dene House DS0000018346.V352791.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home are cared for by staff with sufficient competence and numbers to meet their needs. They are protected by the home’s recruitment processes. EVIDENCE: The registered provider / manager and his deputy daughter write in the Annual Quality Assurance Assessment: “We are fortunate in having a stable staff base willing to meet the needs of the clients. The staff, some of whom are family members are appropriately recruited, inducted and trained as evidenced by the staff files. Because of the experience and skills gained through training the staff, both internally and externally we feel we are able to offer our residents continuity in their individual plan of care and at the same time the flexibility to allow the clients daily choices. Staff are valued and their opinions and views are listened to, respected and encouraged. Staff are trained as required by CSCI in food Hygiene, Moving and Handling, First Aid and also attend other relevant courses e.g. Protection of Vulnerable Adults. There is 50 of staff trained to NVQ 2 or above, the senior carer also has NVQ3, NVQ 4 and the RMA qualification. The Manager has NVQ 2, RMA and will soon complete NVQ 4. The work schedule is through the staff rota on display in the kitchen. The Dene House DS0000018346.V352791.R01.S.doc Version 5.2 Page 21 registered provider / manager lives in the home and is available throughout the day and the night. We have a recruitment process which sets out procedure and checks to be carried out on employment and induction of new staff.” As part of the inspection process we examined the personnel files of four people who work at the home. We consulted the owner / manager at some length, observed staff on duty and consulted with them to some extent. We also observed people who live at the home and consulted with them. We additionally received survey forms from people who live at the home, their relatives and other visitors. These sources confirm the owner’s statement in the AQAA, above. Staff are appropriately recruited, inducted and trained, as evidenced by the employees’ files. Numbers and competence of staff, by reason of experience and increasingly by training, is good at this home. The home undertakes CRB checks and undertakes proper references. The home provides training in health and safety topics as required, and enables staff to undertake NVQs (National Vocational Qualification). As stated above, the Registered Provider / Manager has recently obtained the Registered Manager’s Award and will shortly additionally have NVQ level 4. Qualifications of other staff are stated above. Achievement in these qualifications will add professionalism to the instinctive caring qualities of owner and staff. The Registered Provider lives on the premises and so is available throughout the day and night. A relative commented that staff are: “very well trained” and ““My [relative] is well looked after”. One staff member says: “I like working in this homely atmosphere. Everyone is kind and there is good teamwork with my colleagues.” Dene House DS0000018346.V352791.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home enjoy a well-managed home run in their interests. The owner and his staff team strive to provide an accepting, stimulating and safe environment that respects and protects people who live there. EVIDENCE: The registered provider / manager and his deputy daughter write in the Annual Quality Assurance Assessment: “The views and experiences of the residents is that they live in a well managed home run in their interests. A past inspectorate report also states that we strive to provide an accepting, stimulating and safe environment that respects residents rights and best Dene House DS0000018346.V352791.R01.S.doc Version 5.2 Page 23 interests. The residents views, opinions and ideas are continously being encouraged and used in monitoring the success of the home in meeting its aims and objectives. The Registered Provider has over 23 years experience in managing residential care and is working through the NVQ4 having completed the RMA. Documentation is in good order and some has been updated.” As part of the inspection process we consulted the owner / manager at some length, observed staff on duty and consulted with them to some extent. We also observed people who live at the home and consulted with them. We additionally received survey forms from people who live at the home, their relatives and other visitors. These sources confirm the owner’s statement in the AQAA, above. It is particularly pleasing to note the achievement of the registered provider / owner in obtaining the Registered Manager’s Award since the last inspection. This qualification will add professionalism to the instinctive caring qualities of the management and staff of the home. People who live at the home said they enjoyed living here, particularly for its homely atmosphere. One person told us that she had searched all over Torbay before finding this home. A relative comments: “Very well run and caring home”. When asked: “how do you think the care home can improve” a relative replied: “I don’t”. Dene House DS0000018346.V352791.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 3 3 3 2 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Dene House DS0000018346.V352791.R01.S.doc Version 5.2 Page 25 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 OP9 Regulation Reg 13 (2) Requirement All medications should be administered as prescribed and changed only on the explicit directions of the doctor, to ensure the health and safety of people who live at the home. A separate plan of care for all medicine prescribed to be administered “when required” must be drawn up to make it clear to all staff administering the medicine, when and why the medicine is to be given and the actions to be taken after administration. This is to ensure the health and safety of people who live at the home. A separate sheet must be used to record all advised dose changes from the prescribing doctor. This is to ensure the health and safety of people who live at the home. The Registered Provider must achieve the NVQ4 in Care and Management by (the end) of 2005. This was a requirement at DS0000018346.V352791.R01.S.doc Timescale for action 11/12/07 2. OP9 Reg 13 (2) 11/02/08 3. OP9 Reg 13 (2) 11/02/08 4. OP31 Reg 10 (3) 11/03/08 Dene House Version 5.2 Page 26 the previous inspection, the date specified in the National Minimum Standards. This is to enhance the professionalism of management and so enhance the quality of care given to people who live at the home. This date has been extended. 5. OP1 Reg 37 (1) (2) 11/01/08 The registered person shall give notice to the Commission without delay of the occurrence of (a) the death of any service user, including the circumstances of his death; (b) the outbreak in the care home of any infectious disease which in the opinion of any registered medical practitioner attending persons in the care home is sufficiently serious to be so notified; (c) any serious injury to a service user; (d) serious illness of a service user at a care home at which nursing is not provided; (e) any event in the care home which adversely affects the wellbeing or safety of any service user; (f) any theft, burglary or accident in the care home; (g) any allegation of misconduct by the registered person or any person who works at the care home. (2) Any notification made in accordance with this regulation which is given orally shall be confirmed in writing. Dene House DS0000018346.V352791.R01.S.doc Version 5.2 Page 27 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 OP19 Good Practice Recommendations You should update the furniture, furnishings and decoration in the home to enhance the quality of life of people who live there. Dene House DS0000018346.V352791.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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