CARE HOMES FOR OLDER PEOPLE
Derby House Nursing Home 12 Broad Walk Buxton Derbyshire SK17 6JS Lead Inspector
Stuart Hannay Unannounced 4th July 2005 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 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. Derby House Nursing Home DC52 C02 S2052 Derby House Nursing Home V228131 150605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Derby House Nursing Address 12 Broad Walk, Buxton, Derbyshire, SK17 6JS Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01298 23414 01298 23334 Derby House Nursing Home Limited Mr Derek Andre Brindley Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places Derby House Nursing Home DC52 C02 S2052 Derby House Nursing Home V228131 150605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: One off variation for 2 YPD Clients Date of last inspection 27/10/04 Brief Description of the Service: The home provides nursing care for up to 31 older people. It is situated in the heart of Buxton in a residential area. The home is an older building which has been adapted to meet the needs of people with mobility problems. Bedrooms are on three floors. Derby House Nursing Home DC52 C02 S2052 Derby House Nursing Home V228131 150605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Seven service users, three relatives and two staff members were interviewed during the inspection. An inspection was made of the premises and a range of records relating to care and health and safety were checked. A check was made of the medication system. What the service does well: What has improved since the last inspection?
Progress had been made in ensuring that service users (and relatives where appropriate) had been consulted about their care plans. The home is working towards having a manager with a recognised qualification in management.
Derby House Nursing Home DC52 C02 S2052 Derby House Nursing Home V228131 150605 Stage 4.doc Version 1.30 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. Derby House Nursing Home DC52 C02 S2052 Derby House Nursing Home V228131 150605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Derby House Nursing Home DC52 C02 S2052 Derby House Nursing Home V228131 150605 Stage 4.doc Version 1.30 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 standard(s) 1 3 The home has information for potential service users and their relatives which gives an accurate idea of the service provided. Service users are fully assessed prior to them coming into the home. EVIDENCE: The home has written information about the service in the form of a Service Users Guide, which described the care and range of services provided. The home has a formal assessment tool, which is completed prior to any service users being offered a place at the home. It covered all aspects of the potential service user’s health and social needs. All the service users who were interviewed said that the home was able to meet their needs. Derby House Nursing Home DC52 C02 S2052 Derby House Nursing Home V228131 150605 Stage 4.doc Version 1.30 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 standard(s) 7 8 9 10 The care plans demonstrate that the home is able to meet the health and care needs of the service users. The medication system ensures that service users medication is properly administered and recorded. Service users said that they are treated with dignity and respect. EVIDENCE: Each of the service users had an individual plan of care which had been reviewed regularly and kept up-to-date. Service users care plans are held on the computer and on printed formats. Amendments to the care plan can be made on the computer and the person making the change can be identified by the use of passwords. The plans covered all aspects of health and social care; relevant external professional help had been identified and provided, such as GPs and chiropodists. The home has incorporated recommendations made at its sister home in a recent inspection. None of the service users currently manage their own medication – all those interviewed were happy for the home to manage their medication on their behalf. The medication system appeared to be well-managed, storage facilities were generally good, there was no apparent overstocking of medication. Bottles and boxes were clearly and individually labelled. The system had been checked by the home’s pharmacist. The siting of the controlled drugs cupboard should be checked with the
Derby House Nursing Home DC52 C02 S2052 Derby House Nursing Home V228131 150605 Stage 4.doc Version 1.30 Page 10 pharmacist to ensure it meets the current standards. Service users said that the staff treat them with dignity and respect and that they make every effort to respect their privacy. Derby House Nursing Home DC52 C02 S2052 Derby House Nursing Home V228131 150605 Stage 4.doc Version 1.30 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 standard(s) 13 14 15 Relatives and friends are welcomed at the home and encouraged to be involved in their care where appropriate. Routines are flexible and individual preferences are respected. EVIDENCE: Service users and their relatives said that visitors were welcome at the home. They said that there were no real restrictions on the times that they could visit. The service users said that there were no restrictions on how to spend their day and that the staff tried to ensure that routines did not overly restrict their choice, however, preferred daily routines were not recorded in the care plans. The food was not fully checked, however most of the service users said that they liked it and that there was plenty available. One service user who had a liquidised diet said that the staff did not always know what the liquidised food was when they served it up. Derby House Nursing Home DC52 C02 S2052 Derby House Nursing Home V228131 150605 Stage 4.doc Version 1.30 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 standard(s) 16 There was an open atmosphere at the home which encourages service users and relatives to voice any concerns. There was a formal complaints procedure to complement this. EVIDENCE: The service users and relatives interviewed said that they would have no hesitation in reporting their concerns to the senior staff or the home’s owners. The owners stated that they encourage relatives or service users to raise any issues about the care. There is a formal complaints procedure which contains all the required information. Derby House Nursing Home DC52 C02 S2052 Derby House Nursing Home V228131 150605 Stage 4.doc Version 1.30 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 standard(s) 19 23 24 26 The home provides a clean, safe environment which is well-maintained. Service users have private space which is well-furnished and generally meets their needs. EVIDENCE: The home was clean and tidy on the day of the inspection with no obvious environmental hazards noted. Battery operated door guards were in place to hold open fire doors – these respond to the fire alarm and close automatically and reduce the risk posed by permanent door wedges. Some wheelchairs and lifting equipment was stored on the corridor, whilst this did not pose a health and safety threat, it detracted from the ‘homely’ feel of the home. Bedrooms were very highly personalised and generally decorated to a good standard. Rooms were well furnished and all the service users interviewed said that they were happy with their rooms. There were some minor redecorations required but no major problems. Two of the upstairs bathrooms had been changed to provide an extra toilet. There is a small gap above the partition walls for the two toilets which could provide issues of privacy, given that a person using the bath or the toilet in the bathroom would be able to hear someone using the
Derby House Nursing Home DC52 C02 S2052 Derby House Nursing Home V228131 150605 Stage 4.doc Version 1.30 Page 14 separate toilet, or vice versa. The owners stated that they did not feel this was a major issue as it rarely happened. They said it would be difficult to screen off the toilets as the light fittings straddle both rooms. No service users or relatives raised this as an issue during the inspection. The home does not have a programme for the provision of door locks, as required in previous inspections. The owners said that new service users are offered the chance to have a lock fitted and a key provided if they wish. Derby House Nursing Home DC52 C02 S2052 Derby House Nursing Home V228131 150605 Stage 4.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 There were sufficient staff on duty to meet the needs of the service users. EVIDENCE: Staffing levels were as follows: There is always at least one Registered General Nurse on each shift for up to 31 service users. The morning shift starts at 8.a.m. Between 8.a.m and 1.30 pm there are seven staff. The owner’s son stated that this will include 1 or 2 qualified nurses. Between 1.30p.m. and 3.00 p.m. this drops to 1 nurse and 4 carers. Again, it was stated that there is sometimes an additional nurse on duty. Between 3.00 p.m. and 5.00 p.m., the staffing levels are 1 nurse and 2 carers, sometimes there is an additional nurse on duty. Night staffing levels are as follows: between 8.30 p.m. and 8.00. a.m. there is 1 nurse and 2 carers for up to 31 service users. The owners stated that in their opinion, the reduction in staff numbers during the day did not present any safety issues for the home. They stated that they were generally able to provide any necessary support themselves or that this could be provided by other family members who are involved in the business. There is also the home’s small residential unit across the road which is staffed for 24 hours. The owners said that the levels were agreed with the previous inspector and the previous registering health authority. As acknowledged by the owners, the dependency level of service users is generally growing and the afternoon staffing levels will need to be monitored. Derby House Nursing Home DC52 C02 S2052 Derby House Nursing Home V228131 150605 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 32 37 38 The home is well run by a suitably qualified manager who fosters an open atmosphere which promotes the rights of the service users. The home is generally safe but staff must be reminded to follow health and safety procedures at all times. EVIDENCE: He manager has a wide range of experience in working with older people and has RGN and RMN qualifications. He does not have an NVQ 4 in management, the recognised qualification, however one of the senior nurses at the home is undertaking this qualification and the owners said that she will eventually be put forward as the proposed registered manager. Staff, service users and relatives said that the atmosphere at the home is very open and positive and that the manager and the owners are very responsive to any needs or concerns which they might have. The fire alarm testing records were up-todate and the fire system had been checked by an engineer in May 2005. Staff had undertaken updated fire training and 2 staff interviewed were able to
Derby House Nursing Home DC52 C02 S2052 Derby House Nursing Home V228131 150605 Stage 4.doc Version 1.30 Page 17 clearly describe the fire procedures. There is currently no formal staff supervision system but the prospective manager hopes to introduce one in the future. On the day of the inspection it was found that some cleaning products which should have been locked away were stored in an unlocked cupboard on the second floor. Derby House Nursing Home DC52 C02 S2052 Derby House Nursing Home V228131 150605 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x 2 3 x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 3 x x x x 3 2 Derby House Nursing Home DC52 C02 S2052 Derby House Nursing Home V228131 150605 Stage 4.doc Version 1.30 Page 19 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP7 OP23 Regulation 12 (2) (3) 16 (1) (2) (c) 13 (4) (b) 18 (2) Requirement Care plans should include a list of the service users preferred daily routines. A programme must be introduced to provide locks to bedroom doors.(Original timescale (31/8/04) All cleaning materials potentially hazardous to service users must be kept locked away. All care staff should receive formal supervision at least six times a year. Timescale for action 30/11/05 30/11/05 3. 4. OP38 OP36 25/7/05 30/12/05 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. Refer to Standard OP9 OP15 OP31 Good Practice Recommendations The home should check with their pharmacist that the siting of the Controlled Drugs cupboard meets the current guidelines and standards. Kitchen staff should make care staff aware of the contents of liquidised meals so that service users are aware of what they are being served. The registered manager should pursue training for NVQ Level 4 in Management.
DC52 C02 S2052 Derby House Nursing Home V228131 150605 Stage 4.doc Version 1.30 Page 20 Derby House Nursing Home Derby House Nursing Home DC52 C02 S2052 Derby House Nursing Home V228131 150605 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection South Point Cardinal Square Nottingham Road DERBY, DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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