CARE HOMES FOR OLDER PEOPLE
Dennyshill Glenthorne Road Duryard Exeter Devon EX4 4QU Lead Inspector
Louise Delacroix Unannounced Inspection 18th October 2005 2.30pm 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.V252251.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dennyshill DS0000021926.V252251.R01.S.doc Version 5.0 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.V252251.R01.S.doc Version 5.0 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] 11th March 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.V252251.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place in the afternoon over three and a half hours. On arrival, two people were in bed, three people were sitting in the lounge watching a film, and two people were watching television in their own rooms. Two people were attending a social club for older people. All the residents were met and five of them contributed to the inspection. Two members of staff were on duty, and they and the manager took part in the inspection. Care files, staff recruitment and training files, fire records, medication and daily records were inspected. What the service does well: What has improved since the last inspection?
Some of the requirements from the previous inspection have been met. The manager has to include the required relevant information. A radiator that was identified as putting a resident at risk of burns has now been covered. A format has been set up for recording complaints and additional sockets added to residents’ bedrooms to prevent wires from trailing. Three out of seven recommendations have been met. Residents have been issued with Terms and Conditions, and all staff have undertaken training in Adult Protection. Guidelines for medication and help with food in care plans have been improved and the dates for portable electrical wiring have been provided. Dennyshill DS0000021926.V252251.R01.S.doc Version 5.0 Page 6 What they could do better: 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.V252251.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dennyshill DS0000021926.V252251.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6 The home makes information available and encourages visits to enable people to make a decision about whether they wish to move to the home. EVIDENCE: The manager has up dated the service user guide and confirmed that residents have been provided with the Terms and Conditions of their stay. Since the last inspection in March 2005, no new residents have moved to the home. The majority of staff have worked with most of the residents for many years and showed a good knowledge of their needs. The staff were seen to be interacting appropriately with residents, and understanding their individual communication methods. Staff working during the inspection have not received training specific to people with learning difficulties. On the last inspection, the newest resident said they had been able to visit the home, have a meal and stay the night to enable them to make a decision as to whether they wished to live there. On this inspection, another resident also confirmed that they had been able to visit. The home does not provide intermediate care.
Dennyshill DS0000021926.V252251.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 Care planning is improving, although further work is needed to evidence resident involvement and to update reviews. EVIDENCE: The manager has been working on improving care plans and the guidance within them, to make them more informative. This is still work in progress so only one file was looked at during this inspection. Recommendations made on the last inspection, linked to this care plan. Monthly reviews have been started but are not up to date. None of the residents or their representatives have signed their plans, although the manager agreed that if some of the residents were supported with reading their plan, they then could make an informed decision about whether they were in agreement with the content. Otherwise, where possible residents’ representatives should sign care plans on their behalf. Staff and the manager confirmed that no residents have pressure sores but explained the type of precautions being taken for one resident whose skin is vulnerable. Another resident had a clean dressing on a cut, which had been recorded in the daily notes and staff had also explained how it had happened.
Dennyshill DS0000021926.V252251.R01.S.doc Version 5.0 Page 10 Several residents have pressure-relieving mattresses on their beds and people were seen using specialist cushions to protect their skin. Staff explained that one of the residents was becoming physically frail and that their fluid and nutritional intake needed to be monitored. However, there was no clear record to evidence how this need was being met i.e. the amount eaten or drank. Daily records for several residents demonstrated that the home had contact with GPs and district nurses. One district nurse has written in the visitors’ book ‘…residents cared for exceptionally well’. The manager felt the home was well supported by healthcare professionals. Training certificates were seen for staff members, all of whom administer medication. Since the last inspection, improved care planning documents more clearly how a resident’s medication may be administered with food. Staff said there were no controlled drugs on the premises. Medication is kept in a locked cupboard. The home operates a monitored dosage system from a local pharmacy. The medication administration records were checked and contained gaps in places, with unsigned handwritten additions detailing new prescriptions. There is no list of staff signatures. Dennyshill DS0000021926.V252251.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 Residents are supported to access the local community to meet their social and religious needs, and maintain contact with friends and family. EVIDENCE: Two residents spoke about how much they enjoyed attending a social club several times a week and another person spoke about attending a Mother’s Union group. Other people spoke about attending church and staff also confirmed that communion is provided at the home for one service user. Residents confirmed during conversation that they were visited by friends/family, which was confirmed by the visitors’ book and by staff. They said they were also supported to go and stay with friends/family by the home providing transport. Two residents said they did not go out but did not seem unhappy with this arrangement. The manager said that as some residents’ care needs had increased it was becoming more difficult to go out on trips but felt this was something she wanted to address. This will be revisited in a future inspection. Dennyshill DS0000021926.V252251.R01.S.doc Version 5.0 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The home has a satisfactory complaints system whilst staff demonstrate an awareness of their role in protecting vulnerable adults from harm. EVIDENCE: The home has a complaints procedure, which contains relevant information. There is now a format for recording complaints, although the manager and the staff said there have been no complaints since the last inspection. Two members of staff on duty showed an understanding of the protection of vulnerable adults and their duty to report concerns. Training certificates for this area of work were seen for all members of staff. Dennyshill DS0000021926.V252251.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards will be inspected on the next inspection. Dennyshill DS0000021926.V252251.R01.S.doc Version 5.0 Page 14 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): 27,28,29,30 The staffing group is stable and experienced but current recruitment procedures have the potential to put residents at risk. EVIDENCE: Two members of staff were on duty, which is appropriate for the number of residents. A staff rota is not kept on display instead time sheets are kept. The manager was out shopping for the home but returned half way through the inspection. The manager and staff said that she had ‘a hands on’ role in the mornings to provide a third person to support residents with their personal care needs. Currently there is one member of staff who provides sleeping cover at night, with the manager acting as back up. The manager explained that she is monitoring this situation because of the increased needs of residents and has asked for Social Services to review their care needs. There are seven people on the staff team, including the manager. Two people have NVQ 3. This should be a minimum 50 by 2005. The manager said they were trying to encourage staff to undertake this training. The home has a stable staff group of seven with three people from the same family, and also two sisters from a different family. This year another person was recruited to the staff team for the first time in a number of years. Their staff file contained two references and one form of ID, plus a current CRB dated after their start of employment. However, the home’s job application form does not allow for gaps in employment to be followed up and a clear
Dennyshill DS0000021926.V252251.R01.S.doc Version 5.0 Page 15 POVA check had not been confirmed prior to them starting work. A second form of ID and photo are also needed. Staff training certificates were seen and show that generally mandatory training has been achieved for all staff i.e. first aid, medication, moving and handling, plus food hygiene. The manager said that induction training to TOPPS standards had been given to a new member of staff. Dennyshill DS0000021926.V252251.R01.S.doc Version 5.0 Page 16 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): 33,36,37,38 A lack of up to date fire training and safety checks has the potential to put residents at risk. EVIDENCE: The home does not have a quality monitoring system in place. This prevents residents, family and visitors from formally contributing to the way the service is developed. This is an outstanding requirement from the last inspection. Staff confirmed that the manager had a ‘hands on’ approach and therefore oversees their practice on a daily basis. However, this does not allow for one to one discussion around training needs, concerns and personal development. Residents’ records do not contain photos of the people living at the home. One member of staff has not received fire training since starting at the home, and other staff members are overdue fire training by four months.
Dennyshill DS0000021926.V252251.R01.S.doc Version 5.0 Page 17 Fire records are also out of date with the last monthly checks taking place in August 2005 and the last weekly checks taking place on 9th September 2005. Fire extinguishers have been serviced at an appropriate timescale. Window restrictors have not been fitted to windows that have been identified as putting residents at risk. A new lock has been added to the bathroom door, which can be accessed from the outside in case of emergencies but the bolt has not been removed from the top of the door. Regular recorded checks are not carried out to check the safe positioning of bed rails and that the hot water temperature is appropriately regulated. Dennyshill DS0000021926.V252251.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 N/A 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 x x x x x x x x STAFFING Standard No Score 27 2 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 2 x x 2 2 1 Dennyshill DS0000021926.V252251.R01.S.doc Version 5.0 Page 19 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 OP29 Regulation 19 Schedule 2 Requirement 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). The registered person shall establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the home. A photograph of the service user must be kept as part of their records. The registered person shall after consultation with the fire authority make arrangements for persons working at the care home to receive suitable training in fire prevention. The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to
DS0000021926.V252251.R01.S.doc Timescale for action 30/11/05 2 OP33 24 (1) 31/12/05 3 4 OP37 OP38 17(1) (a) Schedule 3 23 (4) (d) 31/12/05 30/11/05 5 OP38 13 (4) (a) 30/11/05 Dennyshill Version 5.0 Page 20 their safety. (Window restrictors must be fitted to the windows identified as posing a risk to residents). 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 OP7 Good Practice Recommendations Care plans should be reviewed monthly with clear outcomes recorded. Care plans should signed either by the resident or their representative. Records should be kept of the fluid and food intake for frail residents to evidence how their dietary needs are being met. A list of name and initials for staff administering medication should be kept with the MAR sheets. The codes at the bottom of the MAR sheet should be used rather than leaving a gap. Handwritten additions to the MAR sheets should be signed and checked by two members of staff. A copy of the duty rota should be kept and displayed of people working at the home, and a record of whether the roster was actually worked. Gaps in employment history should be followed up and recorded. Staff should have regular recorded supervision, including one to one and team meetings. Regular recorded checks should be made to check bed rails are safely positioned and that the hot water is appropriately regulated. The certificate for when the electrical hard wiring was checked should be copied and sent to the commission. The bolt on the bathroom door should be removed. 2 3 OP8 OP9 4 5 6 7 OP27 OP29 OP36 OP38 Dennyshill DS0000021926.V252251.R01.S.doc Version 5.0 Page 21 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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