CARE HOMES FOR OLDER PEOPLE
Dennyshill Glenthorne Road Duryard Exeter Devon EX4 4QU Lead Inspector
Dee McEvoy Unannounced Inspection 15th March 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Dennyshill DS0000021926.V277929.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dennyshill DS0000021926.V277929.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Dennyshill Address Glenthorne Road Duryard Exeter Devon EX4 4QU 01392 259170 NO - SEE BELOW 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) Mrs Tracey Victoria Anne Hibberd Care Home 9 Category(ies) of Learning disability (9), Learning disability over registration, with number 65 years of age (9), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (9), Physical disability (9), Physical disability over 65 years of age (9) Dennyshill DS0000021926.V277929.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Main client group MH(E) mental handicap who are elderly Client group MH mental handicap (learning disability) [40 years and over] Client group MH(PH) mental handicap with physical disability [40 years and over] 18th October 2005 Date of last inspection Brief Description of the Service: Dennyshill is situated in a quiet area of Exeter, close to the university. Nine older people with a learning disability live at the home. All accommodation is provided on one level. There are two double rooms and five single bedrooms. There is one bathroom with a level entry shower and a bath, which is not assisted. The manager/owner lives on site. Dennyshill DS0000021926.V277929.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second unannounced inspection of the current inspection year and was undertaken in approximately five hours. The standards met at the previous inspection on 18 October 2005 were not inspected on this occasion. This inspection focussed on key National Minimum Standards, which had not been inspected at the previous inspection or those, which were the subject of previous requirements and/or recommendations. There were eight residents living at the home at the time of the inspection, with one vacancy; the inspector saw or met and spoke with seven of them, four were spoken with in some depth. Some residents were unable to express their views but appeared comfortable and at ease in their surroundings. The majority of the residents have lived at the home for a number of years. All staff on duty, including the registered manager were spoken with during the inspection. The Commission received comment cards from one resident and one relative in respect of the service. During the inspection the inspector looked around the home, which was clean and comfortable. A number of records were inspected, including residents’ care notes and personal monies, training certificates, recruitment files and maintenance certificates. The manager had completed a pre-inspection questionnaire prior to the inspection. What the service does well:
Dennyshill provides a homely environment for residents. Four residents asked were happy living at the home and felt well cared for, comments included, “This is a happy place” and “The best thing is the staff.” Other residents, unable to communicate clearly, appeared well cared for and staff were observed to interact in a positive and respectful way with them. Written comments in the visitors book from family members and other visitors to the home, such as community nurses, chiropodist and church visitors were very positive about the care provided and the atmosphere; comments seen included, “The overall care is excellent”, “It is always a pleasure to visit” and “This is a very happy place with caring staff.” The home was clean and free from unpleasant odours throughout which is to be commended in view of continence levels. One visitor wrote, “The home is always free from smells…”, a relative wrote, “The overall standard of cleanliness is excellent.” Dennyshill DS0000021926.V277929.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
Three residents asked could not identify any improvements for the home, one said, “There is nothing to improve. This is a nice little home.” Good manual handling assessments had been completed but manual handling plans need to be developed and reviewed to reflect the changing needs of the residents and ensure safety. Although residents said they were happy with the food provided, the home could better enable residents to be involved in planning menus. Staff demonstrated some good practice in relation to infection control, however policies and procedures need to be developed further to ensure good practice is maintained and procedures are followed. The manager is to ensure that recruitment is robust by obtaining all necessary ID for new staff, in this case a recent photograph. Dennyshill DS0000021926.V277929.R01.S.doc Version 5.1 Page 7 The home must continue to develop and implement formal quality assurance to ensure that residents and interested others, such as families, influence how the service develops and performs. 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. Dennyshill DS0000021926.V277929.R01.S.doc Version 5.1 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 Dennyshill DS0000021926.V277929.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The manager is aware of the home’s ability to meet the needs of potential residents. EVIDENCE: Admissions to the home are rare and there have been no new admissions since November 2004. One potential resident was referred to the home recently but following assessment of their needs the manager declined the referral as she felt the home could not meet the individual needs of that particular person. The manager was also keen to maintain the ‘stability’ of the home and would take into account the current residents’ views and needs when admitting a new person. Dennyshill DS0000021926.V277929.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 The staff treat residents with respect and have a good understanding of their health and personal care needs, which are documented in care plans. However without fully developed manual handling plans and regular reviews residents could be at risk. The management of medication has improved with accurate records maintained. EVIDENCE: Two care plans were looked at on this occasion and the inspector met/saw both residents. The manager and staff have worked to continue the improvement in care planning, ensuring that some essential information is available to guide staff when delivering care. Goals have been set for maintaining good health, and leisure and interest pursuits for example. All staff spoken with had a good knowledge and understanding of residents’ individual needs and preferences, for instance, staff were aware of one residents preferences when it came to food, and described the assistance available to another resident to maintain contact with family members. This was confirmed by the resident and clearly stated in their care plan. Care plans examined had been reviewed on average bi-monthly; reviews seen were comprehensive. The manager told the inspector that reviews for February were being completing.
Dennyshill DS0000021926.V277929.R01.S.doc Version 5.1 Page 11 Care plans seen had not been signed by residents or their representatives, although one resident had signed a statement confirming that they did not want locks on their door. It was appreciated that it would be difficult for all residents to be involved in the care planning process but the home must ensure that those residents who can are given the opportunity. Where this is not possible relatives or advocates could be involved. One relative wrote in response to the home’s survey, “The home always informs me of any changes.” Care plans looked contain photos of the people living at the home. Risk assessments were generally good and covered road safety, wandering and certain behaviour such as aggression. New manual handing assessments had been completed for two residents and manual handling plans are to be developed from the assessments. One manual handling plan requires review as the resident’s capability and need had changed. As recommended at the last inspection, records are kept of the fluid and food intake for frail residents to evidence how their dietary needs are being met. As a follow up from the previous inspection the medication administration records were checked. All were completed accurately, where hand written entries were seen two signatures had been obtained to verify accuracy. A list of specimen signatures is now available to ensure accountability. One resident requires medication to be ‘mixed’ with food to aid swallowing; this is documented in the care plan and the manager told the inspector that the G.P and district nurse were aware of this practice. Those residents who could respond confirmed that staff respected them and treated them well. Staff demonstrated an awareness of the importance of treating residents as individuals, for example one staff member said that they always had time to sit and chat with individual residents, another said they always knock before entering residents’ rooms. Interaction between staff and residents was observed to positive and respectful, one staff member said, “We treat residents as we would like to be treated.” Dennyshill DS0000021926.V277929.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 & 15 Residents are encouraged to maintain their independence and exercise choice in their daily lives. Residents enjoy the food, and the home endeavours to ensure individual preferences and needs are met. EVIDENCE: One staff member told the inspector that people’s independence was encourage and choice was offered on various levels, for example what residents choose to wear or what they prefer to eat. Some residents were seen walking around the home freely and choosing where to sit, some residents chose to stay in their rooms. One resident enjoys washing up in the kitchen and a risk assessment had been completed to enable her to continue this activity safely. Residents spoken with said that they liked the food provided; roast was a particular favourite. No menus are available but food is freshly prepared daily and home cooked by the staff with residents’ preferences taken into consideration. Staff showed a good awareness of residents’ dietary needs and likes. A daily record is kept of the food provided at each mealtime, which presented a fairly well balanced diet. The inspector was told that although a daily alternative was not available as such, different dishes would be prepared for individual residents where wished. One resident told the inspector she
Dennyshill DS0000021926.V277929.R01.S.doc Version 5.1 Page 13 wasn’t sure what she was having for lunch but also said that she didn’t really mind not knowing. There is a pleasant dining area within the kitchen. Although residents were satisfied with the food provided at the home, they could be encouraged and enabled to participate in the planning of meals. Dennyshill DS0000021926.V277929.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Better evidencing of decision-making is needed prior to using reclining chairs, to safeguard residents’ welfare. EVIDENCE: It was noted that one resident uses a reclining chair (a potential form of restraint) in order to maintain safety; this was not recorded in the care plan nor reflected in risk assessments. Consent for the use of this chair had not been obtained. Dennyshill DS0000021926.V277929.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 & 26 A comfortable and clean standard of accommodation is provided for the residents. Without specialist equipment and advice being sought from other professionals when considering the manual handling needs of the residents, safety cannot be promoted or maintained. EVIDENCE: Dennyshill provides a homely and comfortable environment for residents; there is a communal sitting room and a dining area in the kitchen. There is a large area of decking outside the kitchen and the inspector was told that residents enjoy this area in good weather. The furnishings are of a domestic nature. Residents spoken with were happy with the surroundings. The home has some specialist equipment such as a hoist, walking aids, grab rails and level access is available to promote and maximise independence for residents. One resident’s mobility had deteriorated and staff were assisting with transfers, which could have the potential to injure the resident. To further assist staff with manual handling and in order to maintain safety when moving
Dennyshill DS0000021926.V277929.R01.S.doc Version 5.1 Page 16 and handling residents other equipment should be explored, such as turntables and handling belts. When issues of mobility become complex the manager should seek advice from other professionals, such as occupational therapist and physiotherapist. The home was clean and smelt fresh throughout. Comments were seen in the visitor’s book, which confirmed it was unusually like this. A small laundry room has the necessary equipment to meet the requirements of the resident’s laundry. All staff spoken with were aware of the principles of good infection control and knew how to deal with soiled linen. Staff also told the inspector that the necessary equipment for protection was available, for example gloves and aprons. The home has a basic infection control policy but this needs some further development to include precautions to be taken when dealing with infected substances and how to manage infectious diseases, such as MRSA. The manager said that infection control training for staff was being planned. Dennyshill DS0000021926.V277929.R01.S.doc Version 5.1 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 & 29 The present staffing arrangements appear to meet the needs of the residents. Recruitment, with the exception of one element, is generally robust enough to protect residents. EVIDENCE: A duty rota has been produced since the last inspection, which shows who is on duty at any time. During the inspection two care staff and the registered manager were on duty, which appeared to meet the needs of the residents. Since the last inspection 3 staff have enrolled to start NVQ 2 and 3, ensuring that residents are supported by staff with the necessary training. The manager is a NVQ assessor, but is waiting to complete a refresher course so that she can support the staff undertaking NVQ courses. There is a stable staff team at the home and only one staff member has been recruited in the past year. As required at the last inspection, a second form of identification has been obtained for this person but a recent photograph is still needed. Since the last inspection the manager has improved the application form for new staff to ensure that gaps in employment are recorded and followed up. Dennyshill DS0000021926.V277929.R01.S.doc Version 5.1 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Residents and staff benefit from the experience and the open and friendly approach of the Manager. The further development of formal quality assurance will ensure that residents’ views are sought and acted upon. The administration of residents’ personal monies are safeguarded and managed correctly. The health and safety of residents is in the main being promoted. However, one issue must be fully addressed in practice, to ensure the welfare of residents and staff. EVIDENCE: The registered manager has several years experience of managing a care home for older people with a variety of needs, and clearly knows the residents well. She has completed a national vocational qualification in care (NVQ 3) and told the inspector that a City & Guilds management qualification had also been obtained. She has a ‘hands on’ approach and works as a member of the team
Dennyshill DS0000021926.V277929.R01.S.doc Version 5.1 Page 19 regularly throughout the week. Two residents said that the manager was always around if they needed to talk to her. Staff said that they could go to the manager “at any time with any anything”. Three staff described her as ‘approachable’. One said, “She is brilliant as a boss.” The home has started to establish a formal quality assurance system and responses from a recent comprehensive survey were seen from relatives and visitors. Responses seen were very positive and comments included, “The overall care is excellent” and “The staff are friendly” and “Thank you for the endless care and attention.” The manager is to undertake a similar survey with the residents and produce a report reflecting the outcomes. The manager is appointee for several of the residents and assists with the management of their personal monies. Currently residents’ monies are paid into the home’s business account, which is not ideal. However evidence of good practice included individually kept records, receipts and cash balances, and two signatures are obtained for each transaction. Three residents’ monies looked at tallied exactly. Since the last inspection the manager has put into practice formal staff supervision/appraisal. Two staff said they had received ‘appraisals’ which had been “helpful”. The format used encourages staff to reflect on their strengths and weakness and identify training to further develop their skills. The manager was reminded that staff supervision should take place at least 6 times a year. All staff have been booked on manual handling up-dates in March and May following a recent accident at the home. (See standards 7 and 22 for further reference to safe manual handling.) Confirmation of these training dates was seen from Exeter City Council. Staff confirmed that since the last inspection they have undertaken fire safety training; training certificates dated for January 2006 were seen. The fire safety records verified that the necessary checks are carried out. Three staff were undertaking food hygiene training later this week with Exeter City Council and two more staff were booked for later in the month. Confirmation for this training was seen. The manager told the inspector that thermostatic mixer valves were fitted to all taps to reduce the risk of scalding, however regular recorded checks are not made to ensure hot water temperatures are appropriately regulated. The manager showed the inspector window restrictors, which had been fitted to windows identified as putting residents at risk. A record of checks was seen for portable appliances, with various plugs having the necessary date label in place. An electrical inspection schedule dated April 2005 was satisfactory. Regular recorded checks are now carried out to ensure the safe positioning and maintenance of bed rails. Accidents are recorded appropriately and reported to the necessary authorities, including CSCI.
Dennyshill DS0000021926.V277929.R01.S.doc Version 5.1 Page 20 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 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 X X 2 X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 3 2 Dennyshill DS0000021926.V277929.R01.S.doc Version 5.1 Page 21 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 OP7 Regulation 15 (2) (a, b & c) Requirement The registered person shall – (a) make the residents plan available to the resident; (b) keep the residents’ plan under review (with particular reference to manual handling needs); (c) where appropriate and, unless it is impracticable to carry out such consultation, after consultation with the resident or a representative of his, revise the care plan. Timescale for action 12/04/06 2. OP29 19 Schedule 2 3. OP33 24 (1) The registered person shall not employ a person to work at the care unless he/she has obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of Schedule 2. (Staff files must contain all the required checks and information i.e. ID) Previous timescale of 30/11/05 not met.) The registered person shall establish and maintain a system for reviewing at appropriate intervals and improving the
DS0000021926.V277929.R01.S.doc 12/04/06 15/06/06 Dennyshill Version 5.1 Page 22 quality of care provided at the home. And you must supply a copy of these reviews to the Commission, and make a copy available to residents. (Previous timescale of 31/12/05, 30/6/05 & 31/12/05 not met) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard OP15 OP18 OP22 OP26 OP38 Good Practice Recommendations It is recommended that residents are encouraged to participate in the development of menus. It is recommended that reclining chairs are only used when included as part of the care plan and risk assessment and where consent has been given. It is recommended that professionals, such as physio and OT, be consulted when assessing specialist equipment or complex manual handling needs. It is recommended that policies and procedures be developed in order to manage infection control effectively. It is recommended that regular recorded checks be made of hot water temperatures to ensure it is appropriately regulated. Dennyshill DS0000021926.V277929.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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