Inspection on 02/06/08 for Derham House

This inspection was carried out on 2nd June 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Derham House 29/11/07

Derham House 18/06/07

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Derham House Harwood Hall Lane Upminster Essex RM14 2YP Lead Inspector Mrs Sandra Parnell-Hopkinson Unannounced Inspection 2nd June 2008 08:45a 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 Derham House DS0000069403.V365188.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. Derham House DS0000069403.V365188.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Derham House Address Harwood Hall Lane Upminster Essex RM14 2YP 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) 01708 641 441 01808 641 743 catherine.mcaweaney@barchester.com www.barchester.com Barchester Healthcare Homes Ltd Care Home 64 Category(ies) of Dementia (64), Old age, not falling within any registration, with number other category (64) of places Derham House DS0000069403.V365188.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP 2. Dementia - Code DE The maximum number of service users who can be accommodated is: 64 29th November 2007 Date of last inspection Brief Description of the Service: Derham House is a single storey purpose built home providing care with nursing for sixty-four older people, some of whom have dementia. Opened in 1996, there are two separate 32 place units, Foxhall for those service users with dementia, and Bridge for those service users with a nursing need. Both units have a lounge and a dining room. All bedrooms are single and have ensuite toilet and washbasin. The building is fully accessible to wheelchair users. It is situated in a quiet rural area of Upminster within the London Borough of Havering, behind Harwood Hall Equestrian Stables, with a long drive leading to the main entrance of the home. The grounds are well maintained with two enclosed courtyard gardens. Upminster Station (District Line) is approximately two miles away, and other public transport is limited. A copy of the statement of purpose and last inspection report was available in the reception area of the home, and a copy of the statement of purpose can be obtained on request to the manager of the home. At the time of this inspection fee levels ranged from £950 per week, with negotiated fees being agreed with local authorities and primary care trusts. Derham House DS0000069403.V365188.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use the service experience adequate quality outcomes. This was an unannounced key inspection undertaken by the lead inspector Mrs. Sandra Parnell-Hopkinson together with a colleague Mrs. Julie Legg. It took place on the 2nd June 2008 and commenced at 08.45 hours over a period of 9 hours. An acting manager was available throughout the inspection, and was available for feedback at the conclusion of the visit together with the Regional Operations Director, two unit managers and another manager employed by the organisation. The inspection process included information contained in the annual quality assurance assessment (AQAA), previous regulation 37 notifications and regulation 26 reports, a tour of the home, questionnaires returned from residents, relatives and staff. We were also able to talk with many of the residents, visiting relatives and staff during the visit. We case tracked 12 people who use the service, together with viewing staff rotas, training schedules, activity programmes, accident records and menus. We have been told previously by people at the home that they would prefer to be called ‘residents’ and, therefore, this term is used in this report. What the service does well: We found that dining tables were laid to make them look welcoming. The menus are varied and there is emphasis on all residents being encouraged to eat 5 portions of fresh fruit and vegetables daily. Meals are well presented and residents are always offered a choice at each meal. The cook has a very good knowledge of the likes and dislikes of individual people. One comment made to us was “the home provides a well balanced presentation of meals.” However, we did find that some people did not have an enjoyable experience, and this is commented upon below in “what they could do better.” Recruitment procedures are robust and staff do not begin working at the home until the necessary references and POVA first, or the criminal records bureau disclosure has been received. New staff undertake induction training, and ongoing training is available to all staff. Comprehensive pre-admission assessments are undertaken by staff who are trained and qualified to do these, and prospective residents and/or family Derham House DS0000069403.V365188.R01.S.doc Version 5.2 Page 6 members are encouraged to visit the home before making a decision that Derham House is the right home. Comments made by relatives were “A friend recommended Derham but I also visited two others but came back to my first choice”; “We visited three homes in all but we picked Derham because it is near to where we live and it means I can pop in most days to see Mum”; “My brother and I are happy with our choice.” We found that the administration of medication was of a good standard on both Foxhall and Bridge units, and that controlled drugs and other medications were being stored appropriately. The administrative functions within the home are also very good. The previous inspection report, statement of purpose and service user guide are always available in the reception area of the home. What has improved since the last inspection? What they could do better: Since the last key inspection the then general manager has resigned and the organisation put in two managers (who are currently registered managers at other homes owned by the organisation) to manage the home during the recruitment of a new general manager. Whilst the two interim managers have tried hard, and indeed meeting the health care needs of residents have improved, there is no sense of leadership within the home. This was confirmed in discussions with staff, residents and relatives. A comment made by a Derham House DS0000069403.V365188.R01.S.doc Version 5.2 Page 7 relative in a questionnaire was “the home lacks leadership and consistency amongst staff and care.” We recognise that the organisation has taken more time on this occasion to recruit a suitable general manager, and we have been told that a person has been appointed who, hopefully, will be taking up the post within the next month. We are, therefore, hopeful that there will be leadership at Derham House which will be to the benefit of residents and staff, and an improvement in the quality of care being delivered. There has been a very high level of staff turnover, and this has been confirmed by the organisation in the annual quality assurance assessment (AQAA), and also in discussions with residents and relatives. One resident told us “there is a huge staff turnover and so there is no consistency. You often don’t see the same face twice.” With a new general manager in post, it is hoped that work will be undertaken to forge a strong consistent staff group, who will work in a very person centre way for the benefit of the vulnerable residents at Derham House. Staff are receiving supervision but changes to this could be made so that it is more effective around identifying care practices which require improvement. We were able to observe breakfast being served on both units and the majority of residents did not appear to be having an enjoyable experience. The organisation does publicise the fact that it offers a “fine dining experience.” Some residents were left with meals in front of them that were getting cold. Cups of tea were not given to residents generally until the end of the meal, and when a member of staff was asked why this was, the response was “they will be full up with fruit juice and cereal so we give it to them afterwards.” Residents should be given a choice of when they want to have a cup of tea, and not a member of staff making that decision. In Bridge unit there was only 1 member of staff assisting a resident with eating, and this was not being done in an appropriate a caring manner. Tables were still being cleared before all residents had finished their meal. We did address the issue of mealtimes on Foxhall unit at the last key inspection and a recommendation was made that this should be reviewed. It was evident that little had been done in this area because the issues remained the same. Insufficient assistance being given to residents, noisy and not enough dining tables for all residents. We observed at least 4 residents in the dining room who were sat in wheelchairs but without a table. This was again addressed during the visit with senior management, and we are hopeful that this matter will be addressed in a speedy manner. It is essential that all residents have an enjoyable experience at mealtimes, and should not be subjected to offhand treatment by staff. Improvements are still required around communication between staff, relatives and residents. We noticed that many of the staff have English as a second language, and did not engage/interact readily with residents. Staff appeared Derham House DS0000069403.V365188.R01.S.doc Version 5.2 Page 8 very task focused, and some of the staff were not delivering care in a person centred way. Again strong leadership and on the floor supervision of care practices is required so that residents benefit from good quality care. Although care plans have greatly improved, these still do not contain information on end of life wishes, same gender care, sexuality and night care wishes. 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. Derham House DS0000069403.V365188.R01.S.doc Version 5.2 Page 9 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 Derham House DS0000069403.V365188.R01.S.doc Version 5.2 Page 10 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): 2, 3 and 5 (standard 6 does not apply to this service) People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to the service. Prospective service users and/or their relatives are given information needed to enable them to decide if they want to live at Derham House, and a full assessment of their needs is undertaken prior to them making a decision to move in. The statement of purpose and service user guide is made available for all prospective service users and their relatives, and all are invited to visit the home before making a decision. This information should enable people to decide if the home can meet their needs. EVIDENCE: We noticed that the statement of purpose and service user guide is available in the reception area of the home, as is the last key inspection report produced by the Commission. Derham House DS0000069403.V365188.R01.S.doc Version 5.2 Page 11 The files of 3 recently admitted residents were looked at and all contained a comprehensive pre-admission assessment and this had been used to produce the care plan. We spoke to relatives who had visited other homes, and comments included “I visited other homes but I liked the atmosphere here. I am pleased with my choice and mum has settled well and said she likes it here”. A comment made on a returned questionnaire was “Before putting my mum into Derham House I had looked at about 25 nursing homes and Derham House comes out top of the list, and I would recommend it to any one.” Derham House DS0000069403.V365188.R01.S.doc Version 5.2 Page 12 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 and 11 People who use the service experience good outcomes in this area. We have made this judgement using available evidence including a visit to the service. The health and personal care needs for residents on both units are set out in individual care plans, which are reviewed on a monthly basis, and they can be sure that their health and personal care needs are met. Residents can be assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. EVIDENCE: We looked at a total of 12 care plans (6 on each unit) and found that all contained a care plan. It was obvious that improvements had been made to the care plans as they are more comprehensive and identify the individual’s personal, social, health, cultural and religious needs. However, care plans still require attention as there was little evidence of preferred place of care/end of life wishes, same gender care or sexuality. There was evidence on some of the files of detailed care plans around wound management, and also where a resident had diabetes. Blood sugar monitoring was being undertaken in accordance with the care plan. Turning charts were being completed appropriately and at the time of the action being undertaken. Fluid charts Derham House DS0000069403.V365188.R01.S.doc Version 5.2 Page 13 appear to be used on an ad hoc basis, and are not being completed as necessary. This was discussed with the acting manager and the ad hoc use of all charts is being reviewed. All of the files viewed showed evidence of the involvement of health care professionals such as GP, chiropodist, dentist and optician. One relative commented “Mum has seen the chiropodist and the optician since she has been here.” During the visit we saw visiting dentists and they did raise concerns around the fact that families were making decisions that residents could not have new dentures because they could not afford them. We were very pleased to note that the acting manager did address this issue by informing the dentists that if the resident needed new dentures and had consented to this, then the new dentures must be provided. Issues resulting from this would be taken up with the social worker for the individual resident. Where residents are referred for a hospital appointment then there is evidence that they are being assisted to keep these appointments. We observed that daily recordings are being kept but information recorded is generally limited to statements such as slept well, ate well, took part in some activity and had a bowel movement. Daily recordings were not related to the care plan outcomes so there was no way of monitoring as to whether outcomes identified were being achieved for any of the residents. However, when we spoke to staff they were very knowledgeable around the needs of the individual residents. The issue of daily recordings was addressed as part of the inspection feedback. Residents are weighed on admission and then generally on a monthly basis. Where there have been concerns, such as weight loss due to reduced appetite, the GP has been advised and the resident’s weight has been monitored weekly or fortnightly. Where a referral is necessary to a dietician or a nutritionist then this is being done. We were able to speak to some relatives who were visiting a resident who was bed bound, and they told us “the staff are very good at caring for him, he is always clean and there are never any offensive odours even though he is doubly incontinent. His mouth is always clean and looks fresh.” This was supported in discussions with another relative, who was visiting somebody else, and in care plan documentation. We found that accidents are now more rigorously being recorded with the necessary notifications being sent to the Commission, but unfortunately we did find that two incidents of unexplained bruising had been recorded in the daily records for the individual resident, but had not been notified to the Commission nor recorded in accordance with the organisation’s policies and procedures. This matter is being dealt with by the acting manager and has resulted in possible disciplinary action being taken by the organisation. Derham House DS0000069403.V365188.R01.S.doc Version 5.2 Page 14 On both units the medication was checked against the Medication Administration Records (MAR) charts. The charts had been completed appropriately and the amount of medication remaining was correct. Liquid medication was checked and all bottles had the date recorded of when first opened written on the label, which should ensure that usage does not go beyond the in-use shelf life. The medication storage rooms were inspected and we found them to be very tidy with all medicines stored in a locked medicine cupboards. The medicine fridge storage temperature records were correct and up to date. The Controlled Drugs registers were examined and all entries had been appropriately recorded with two signatures. On one MAR chart they had crossed through that medication had been stopped by GP but this instruction was not signed or dated. One resident had a penicillin allergy and although this was recorded on both the care plan and the MAR chart but this information had not been highlighted. We are recommending that any allergy should be highlighted in a prominent position on the care plan and the MAR chart to avoid any misunderstanding or overlooking of this vital information by staff, and certainly any staff who may not be familiar with the individual resident. We received some comments from relatives such as “I am happy the way they look after Mum, they change her bedding and nightie every day, she always looks nice and clean”. “Mum is always dressed nicely, her clothes are clean and they match up her jumpers with her skirts and trousers.” Staff talked about residents in a respectful and sensitive manner, but again generally there was little interaction from many of the care staff. We observed a situation where a resident was obviously distressed and calling out but she was generally ignored by care staff. Eventually the two activity co-ordinators went to her assistance and eventually managed to calm her down. A letter had been sent to the home from a relative of a respite resident, and an extract reads “on behalf of my father and family, I would like to sincerely thank you all for your care and kindness in looking after father during his short respite care stay with you. His time spent at Derham House, was most beneficial in building him up again following his discharge from hospital. The dedication of staff was most exemplary.” Derham House DS0000069403.V365188.R01.S.doc Version 5.2 Page 15 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 and 15 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to the service. More residents are now finding that the level of activities within the home has improved, but still more needs to be done so that all residents can enjoy a more fulfilled life. All residents are encouraged to maintain contact with family and friends, but high staff turnover impacts on the ability of residents to exercise choice and control over their lives. However, a wholesome and balanced diet is provided but changes need to be made so that all residents can enjoy their meals in pleasant surroundings. EVIDENCE: The home has recently recruited two activity co-ordinators who both work 25 hours each a week. There has been an improvement in the activities that are being offered to residents, and during our visit we saw residents on both units being encouraged to take part in activities. However, we observed that it was generally left to the activity co-ordinators to organise activities for residents, and again we were not able to observe a great deal of interaction between care staff and residents. With few exceptions care staff appeared very task orientated with little understanding of person centred care. For example a Derham House DS0000069403.V365188.R01.S.doc Version 5.2 Page 16 resident on Foxhall unit was observed to be quite distressed and care staff just ignored her. Nothing changed until the activity co-ordinators went over to the resident and eventually pacified her with other distractions. As mentioned at a previous inspection, all staff need to be aware that activities are everybody’s responsibility and this includes sitting and talking to residents. Foxhall unit accommodates people living with dementia and there is a ‘memory lane’ resource along the corridors. Although we were told that care staff have undertaken further training in the use of the memory lane resource, this training was not observed to be put into practice during our visit. There are two lounges on Foxhall unit but residents are all generally seated in the large lounge, with 1 or 2 residents choosing to sit in the area outside of the nurses station. The smaller quiet lounge was not really used, and the television was left on with nobody sitting and watching. We also observed that many residents appear to be left in wheelchairs for the major part of the day, and we could find no evidence on care plans that this was for the benefit of the individual resident. An assumption could be that it was more for the benefit of staff to reduce moving and handling. On Bridge unit, again there are two lounges and the majority of residents are either seated in the large lounge or have chosen to remain in their bedrooms. The television was permanently on in this lounge, and again as identified at a previous inspection, some residents are seated alongside the television and would have no way of actually watching a programme. A comment made by a relative was “often residents are just left watching television, and generally it is a totally unsuitable channel on. Staff do not spend much time talking to residents or otherwise engaging with them.” Staff were not seen to be interacting with residents, and during the afternoon a member of staff was just sitting watching residents. It is extremely important that staff remember that Derham House is the home of the people living there, and that together with personal care needs, people also have social, emotional and other needs which should be being met by staff employed to care for them. On each unit there is a list of the weekly activities which include music and movement, painting and arts and craft as well as 1:1 sessions with the residents. Residents have also been involved in making Easter bonnets, assisting with cake making and decorating biscuits. The co-ordinators have been given a budget to buy equipment such as games, playing cards, art & crafts equipment. However most of these activity resources are only available when the co-ordinators are present. It was suggested that some of the activity resources be left out so that care staff could also undertake some of these activities with the residents. On the day of the inspection on Foxhall Unit some of the residents enjoyed a musical session with some of the more mobile residents enjoying a dance with the activity co-ordinators. On Bridge Unit they enjoyed a version of ‘basketball’. Monthly entertainment is being organised and the co-ordinators are hoping in August to arrange a fete. Both of the coDerham House DS0000069403.V365188.R01.S.doc Version 5.2 Page 17 ordinators are enthusiastic, and with the input and active co-operation of all of the staff the residents could receive a programme of activities that is person centred and innovative, and be an enhancement to the quality of life currently being experienced by residents at Derham House. One resident told us “weekends seem very quiet and it’s a shame there is no entertainment or even on a nice sunny day carers could find time to take some of us into the gardens. It does get a bit boring at times.” We did find that generally residents were clean and well groomed, but comments made by some relatives include “We visit her daily and notice sometimes she has not been changed regularly as she is doubly incontinent”; “we always have to ask for her nails to be cut and kept clean”; “I am sure mum would like a bath more than once a week but this, apparently, is not possible.” We were told that there had been problems with several of the bathrooms being out of use for a short period of time, and that one shower room needed a total refurbishment. On the day of our visit the shower room refurbishment was almost completed. However, it is not acceptable that any resident should have to go without a bath if they have requested one, and again the taking of a bath or shower should not be limited to 1 a week, but should be at the choice and frequency of the individual resident. Although during this visit there were no noticeable offensive odours, a comment made on a returned questionnaire was “If you walk into the lounge area late in the afternoon the smell of urine is sometimes overpowering. There are other people in the same state as my mother (cannot communicate) who have not been toileted. I have actually witnessed one particular person who was sitting in the same chair the whole day – meals in front of them as well.” In contrast another comment was “the staff are happy and caring. Although they get very busy sometimes they still try to attend to every one. I looked at about 25 nursing home before deciding on Derham, and Derham House comes out top of the list and I would recommend it to any one.” During a tour of the home we saw that bedrooms had been personalised and that residents are encouraged to bring into the home some of their own possessions. Though pictorial menus were not visible on Foxhall unit, we did observe that staff plated up both choices of lunch and allowed residents to choose which meal they wished to have. Lunch was a choice of beef or pork with mashed potatoes, carrots and brussel sprouts, followed by rhubarb crumble and custard. Many of the residents require assistance with eating their meals and there are at least four relatives that come into the home to assist their loved ones with eating their meals. One relative commented “Mum is such a slow eater, sometimes it can take an hour for her to eat her meal and I don’t think there is enough staff on at mealtimes to allow her that Derham House DS0000069403.V365188.R01.S.doc Version 5.2 Page 18 amount of time to eat her meal”. Another relative stated “I always come in at lunchtime and assist her with feeding as I am not convinced she would be given the amount of time she needs to eat her meal”. Though some of the residents receive their meals in their bedrooms there are still not enough chairs and tables in the dining room on this unit. Some of the residents stay in their wheelchairs, two residents sit in their wheelchairs with small tables in front of them and another two residents sit in their wheelchairs with no tables but with a member of staff sitting next to them holding the plate and assisting the resident with feeding. The experience of sitting in the dining room is not conducive to this being a sociable and pleasant experience for many of the residents. Many residents also have to sit for an extended period before they are served. This can be quite distressing especially for people who are living with dementia. We also observed that the tables were cleared of both cruets and tablecloths before all residents had finished their breakfast. We observed breakfast being served on Bridge unit and there was a choice of breakfast; some residents were eating a cooked breakfast, some had different cereals and others had toast. Glasses of fruit juices were evident but none of the residents had a cup of tea. When a member of staff was asked as to why a cup of tea was not available, she replied that tea was always served after breakfast. Many of the residents required assisting with eating and only one care worker was seen in the dining room assisting a resident. The care worker had the bowl of porridge underneath the resident’s chin and was just spooning the porridge in, there was no conversation between the care worker and resident. Some of the other residents who required assistance where just sitting there, with one resident’s head almost in her breakfast. Again when this was brought to the attention of one of the nurses, her attitude was that “oh, she is often like that.” This was not an acceptable response from a person responsible for caring for elderly vulnerable people. Fresh fruit platters are offered either in the mornings or afternoons and plates of sandwiches are left in the fridge for residents’ supper. The cook advised us that there is going to be a change in the menus and that at lunchtime there will be a starter and then a choice of meat dish and either a fish or vegetarian meal. Relatives’ comments varied regarding the quality of the food “She eats a really good breakfast, a small lunch and a bigger tea and appears to enjoy all of the food”; “I have been here at meal times and the food looks very appetising. Mum seems to enjoy it and has put on a little weight, which is a good thing”; “the food I have seen looks good and he always eats it all”; ”I think the food could be more appetising and not so much soggy vegetables”. One resident commented, “I like the food it is good”. We did make a recommendation at the previous inspection that mealtimes are reviewed, especially on Foxhall unit, so that they are less noisy, more flexible Derham House DS0000069403.V365188.R01.S.doc Version 5.2 Page 19 and will enable all residents to receive the help and assistance they need from care staff who are not rushing about doing other things. It is again recommended that the new manager address this as a matter of urgency. Derham House DS0000069403.V365188.R01.S.doc Version 5.2 Page 20 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 and 18 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to the service. The home’s complaints policy and procedure provides residents and their relatives with the appropriate information to ensure that formal complaints are dealt with promptly. Staff have received training in dealing with complaints and safeguarding adults, and demonstrated an awareness of this during the inspection. Recruitment processes are also robust with references, POVA and criminal records bureau disclosures being obtained and verified, which can assure residents that they will be safeguarded. EVIDENCE: Since the last inspection the Commission has only received 1 anonymous complaint regarding the limited use of bathrooms. Reference to this has been made elsewhere in this report and hopefully the situation is now resolved. From the complaints log held by the home, we are satisfied that complaints are listened to and responded to. However, it is essential that lessons learned from a complaint are sustained in the longer term so that the same complaint is not having to be repeated by different people. Some comments made by residents and relatives include “I have had cause to complain in the past but feel now I would prefer to speak directly to the manager. I did go through the proper channels but by the time it was passed on to the carers and then back to us the message was rather distorted.”. “the response has been ok usually, but then you get a change of carers and information is not always passed on.” Another comment received from a Derham House DS0000069403.V365188.R01.S.doc Version 5.2 Page 21 relative was “complaints are always listened to and concern is expressed, but action doesn’t always follow.” When talking to several residents, however, they did say that they felt that generally their concerns were listened to and action taken, but the change in management has not helped. We were told that the issue of the closed bedroom doors continues to be addressed by the organisation, within a risk assessment framework, and some residents told us that this has really made a difference to their daily lives. We were able to speak to several staff during the visit about safeguarding issues, and are satisfied that they are aware of the action to be taken if they had any concerns about the welfare and safety of residents. Staff told us that they had received training around safeguarding issues and were also aware of the whistleblowing policy. Training records confirmed that this training had been undertaken. The complaints procedure is displayed in the home and many residents and relatives were aware of this. However, we would again recommend that the complaints procedure is produced in different formats to meet the needs of all of the residents accommodated at the home. At the time of this inspection there were no safeguarding adults issues. Derham House DS0000069403.V365188.R01.S.doc Version 5.2 Page 22 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, 20, 21, 23 and 26 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to the service. People can be sure that they will be able to live in safe, comfortable surroundings with their own possessions around them in their bedrooms, and that the home will be well maintained and kept clean and hygienic. EVIDENCE: We walked around the home and found all areas to be clean, hygienic and well maintained and there were no offensive odours anywhere. Appropriate infection control methods were in place and staff were observed to be adhering to these. The sensory courtyard garden has now been completed, and during our visit this was found to be in good order and well maintained. There has been some problems with a lack of maintenance staff, but this issues has now been resolved with the appointment of a permanent member of staff. Derham House DS0000069403.V365188.R01.S.doc Version 5.2 Page 23 We found that all bedrooms visited were clean and had been personalised by each of the residents. Furniture is of a good standard throughout the bedrooms and all communal areas. Appropriate door closures have been fitted to some of the bedroom doors, within a risk assessment framework, and there is a programme in place for other bedroom doors to be fitted with such closures. We have been told that another 14 doors will be fitted by the end of July, 2008. We were also told that some residents had paid for the magnetic door closures for their bedroom doors, but that the organisation had paid for the actual fitting. In discussions with another relative it would seem that many of the over-thebed tables are in a poor condition, and this was also observed by us during the inspection. We are also told that such tables are being purchased by individuals. We would remind the organisation that essential items of furniture/equipment are its responsibility to provide, and to ensure that all items are maintained in a good condition. We observed that the use of such tables in both bedrooms and in the lounges is essential for some of the residents to aid their independence in eating and drinking, because it enables the food /drink to be left within easy reach. We visited the laundry and this was clean and tidy with appropriate materials in stock. An inspection of the kitchen was undertaken, and again this area was clean and tidy with food being appropriately stored and labelled. There have been problems with several of the bathrooms and one shower room required a total refurbishment. This refurbishment was almost completed during our visit, and the other bathrooms were in use. Call alarms were available in all bedrooms and these were observed to be in reach of residents, but not always able to be used by the individual resident due to cognitive or other disabilities. The fact that some residents are not able to use the emergency alarms was discussed with the manager during this inspection as was the use of assistive technology where appropriate. Derham House DS0000069403.V365188.R01.S.doc Version 5.2 Page 24 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 and 30 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to the service. People who use this service can be sure that they are in safe hands and protected by the home’s recruitment policy and practices. The attitude of a minority of the staff still requires attention to ensure that the assessed needs of all of the residents are being met especially with regard to social care needs. EVIDENCE: We observed that staffing levels on both units comprised 5 care workers and 2 nurses. This was confirmed when looking at staff rotas. However, on one of the units on the previous day there were only 3 care workers until later in the morning, when an agency member of staff arrived for duty. Some staff told us that they enjoyed working at Derham House. However, one member of staff felt she did not have a good induction and that she felt the Organisation could improve the way that induction training was given. This has been recognised by the organisation in the annual quality assurance assessment, and plans are in place for new staff to have an identified mentor to oversee their induction and progress during the first six weeks of employment. Generally staff told us that training was good and moving & handling training was being undertaken on the morning of the inspection. Training records confirmed that a variety of training is on offer to all staff at Derham House. Derham House DS0000069403.V365188.R01.S.doc Version 5.2 Page 25 In the afternoon one of the care worker met with her NVQ assessor and has completed her NVQ 3 in nine months. Nurses are being encouraged to take lead roles in various areas such as wound dressings, leadership and palliative care. Two senior nurses have now been given the title of unit manager, and it is hoped that they will demonstrate sound leadership skills to all staff on their units, and that this will result in improved quality care to all of the residents. Staff recruitment processes are sound and robust as evidenced in previous inspections and confirmed in the AQAA (annual quality assurance assessment). Derham House DS0000069403.V365188.R01.S.doc Version 5.2 Page 26 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, 32, 33, 35, 36 and 38 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to the service. Due to a turnover of General Managers, residents cannot always be sure that they live in a home which is run and managed well because of different management styles and a lack of leadership. However, residents can be sure that their financial interests are safeguarded and that their health, safety and welfare will generally be promoted and protected. EVIDENCE: At the date of this inspection the general manager’s post was vacant, but we were informed that recruitment to this post has been successful, and that the new general manager will be taking up post in the very near future. There is a deputy manager and she has been supported in the interim period with cover by two other managers from within the organisation. This obviously has not Derham House DS0000069403.V365188.R01.S.doc Version 5.2 Page 27 been sufficient to maintain all of the standards, but they have been able to improve health/personal care outcomes for residents. In spite of the interim measures taken by the organisation, the home lacks leadership because of the high turnover of General Managers in the past few years, and the relatively high turnover of other staff (27 as indicated in the annual quality assurance assessment - AQAA) in the past 12 months. Also we were told that the two acting interim managers have totally different management styles, and some staff told us that they feel as if they are being pulled in different directions. It is evident from the AQAA and from discussions with the Regional Operations Manager that the organisation acknowledges that improvements are necessary in the following areas, and it is hoped that the appointment of the new general manager will see rapid improvements in this service. During the inspection some staff mentioned that management does not always display appropriate acknowledgement of the value of staff, and some felt undervalued. A comment made by a member of staff on a returned questionnaire was “if people, e.g. staff and managers were more polite to each other it would certainly help. Usually staff are polite to each other but often managers speak to us as if we were nothing.” Together with evidence of staff interacting poorly with residents and no evidence of real team working it does confirm the lack of leadership which is necessary for any care home to operate effectively for the benefit of vulnerable people living there. We were satisfied that the supervision of staff is being carried out, but again there are improvements which could be made to the current system so that supervision is more effective. Various methods were discussed with the acting manager and the Regional Operations Director during feedback at the end of this inspection. We were satisfied that the home has carried out all health and safety checks, and that maintenance records are up to date as evidenced in the AQAA, previous inspection visits and discussions with the acting manager. Fire drills and alarm testing are regularly undertaken as are water, freezer and refrigerator temperatures. We were also satisfied that the financial interests of residents are safeguarded, and that their best interests are protected by the administration record keeping. From the AQAA it would indicate that approximately 50 of the staff have achieved NVQ level 2, but with the high turnover of staff this figure probably is very fluid. Monthly Regulation 26 visits are being undertaken and reports are being produced in accordance with the Care Home Regulations 2001. Also Derham House DS0000069403.V365188.R01.S.doc Version 5.2 Page 28 Regulation 37 notifications as required under the Care Home Regulations 2001 are also being sent to the Commission. Barchester Healthcare does have a comprehensive quality assurance system, and hopefully this will be more effective with regard to Derham House in view of the areas for improvement identified in this report. Derham House DS0000069403.V365188.R01.S.doc Version 5.2 Page 29 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 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X 3 X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 2 X 3 Derham House DS0000069403.V365188.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO 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 Requirement Timescale for action 30/09/08 2. OP12 16 3 OP14 16 The registered person must ensure that care plans include end of life wishes/night care wishes/same gender care and sexuality. This will ensure that all of the needs of residents are identified and staff will know how these important areas of care are to be met to the benefit of the residents. The registered person must 30/09/08 ensure that all residents are enabled to experience their own preferred lifestyle within the home, and this is to include the taking of a bath/shower, social needs and other recreational interests. This will ensure that the quality of life for all residents is improved 30/09/08 The registered person must ensure that all residents are helped to exercise choice and control over their lives through more interaction from staff and the delivery of person centred care. This will ensure that the quality of life for all residents is improved. DS0000069403.V365188.R01.S.doc Version 5.2 Derham House Page 31 4 OP15 16 5 OP19 23(2) 6 OP30 18 7 OP31 8 8 OP32 OP33 10 9 OP36 18 The registered person must ensure that all residents receive their meals in pleasing surroundings, at dining tables, and with the appropriate assistance being given by staff. This will improve the experience of residents at meal times. The registered person must ensure that all furniture/equipment is maintained in a good condition at all times, and that residents are provided with any furniture and equipment necessary to meet their daily identified needs. The use of appropriate tables will assist residents in maintaining a degree of independence so that food/drink can be placed within their reach. The registered person must ensure that at all times staff employed at the home are competent and have the right skills to provide quality care to residents. This does include the ability of staff to interact with, and communicate effectively with residents and relatives. The registered person must ensure that the newly appointed manager submits an application for registration with the Commission. The registered person must ensure that the newly appointed manager operates the care home so that residents will benefit from the ethos, leadership and management approach of the home so that at all times it is run in the best interests of the residents. The registered person must ensure that all staff receive appropriate supervision to ensure that care practices are DS0000069403.V365188.R01.S.doc 30/09/08 30/09/08 30/09/08 30/09/08 30/09/08 30/09/08 Derham House Version 5.2 Page 32 monitored so that all residents receive care in a person centred way. 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 That consideration be given to the installation of assistive technology where residents are unable to use the existing emergency alarm system. Derham House DS0000069403.V365188.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection London Regional Contact Team 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Derham House DS0000069403.V365188.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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