Inspection on 29/11/07 for Derham House

This inspection was carried out on 29th November 2007.

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

The inspector 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 02/06/08

Derham House 18/06/07

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

CARE HOMES FOR OLDER PEOPLE Derham House Harwood Hall Lane Upminster Essex RM14 2YP Lead Inspector Sandra Parnell-Hopkinson Unannounced Inspection 29th November 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Derham House DS0000069403.V355315.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.V355315.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 Barchester Healthcare Homes Ltd Manager post vacant Care Home 64 Category(ies) of Dementia - over 65 years of age (32), Old age, registration, with number not falling within any other category (32) of places Derham House DS0000069403.V355315.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To include two named people under 65 in the dementia unit. Date of last inspection 18th June 2007 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 £516 - £950 per week. Derham House DS0000069403.V355315.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a second unannounced key inspection undertaken by two inspections, namely the lead inspector Mrs. Sandra Parnell-Hopkinson and Mrs. Julie Legg. The site visit took place on the 29th November 2007 between the hours of 09.00 hours and 16.45 hours. Both the manager and the compliance officer were available throughout most of the time of the site visit. During the visit the inspectors were able to speak to many residents, visiting relatives and staff members. A sample of residents’ files were viewed and case tracked, together with the viewing of medication administration records (MAR), staff rotas, training schedules, activity programmes, maintenance records, accident records, fire safety records, menus, complaints records, staff recruitment processes and files. The inspectors were also able to talk to the manager regarding equality and diversity issues, and she was able to demonstrate a good understanding of the many issues relevant to these areas. People using the service were asked how they wished to be referred to in this report, and the majority said residents. In view of this the term resident/s is used in this report. What the service does well: Dining tables were laid in both dining rooms so that they looked welcoming in an endeavour to make dining a positive experience. In discussions with the assistant chef, the inspectors were satisfied that she was aware of any special health related dietary needs, together with likes and dislikes of the residents. Comprehensive pre-admission assessments are undertaken by people who are qualified to do so. Also prospective residents and family members are invited to visit prior to making a decision. During the inspection one family of a prospective resident were being shown around the home, and one of the family members commented “it is nice to see so many smiling faces.” The maintenance records were found to be in very good order and up to date. The home is well maintained and provides a pleasant environment for residents accommodated on both units. Monthly Regulation 26 visits as required under the Care Homes Regulations are undertaken by the organisation, and a copy of these reports are retained in the care home. Derham House DS0000069403.V355315.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Derham House DS0000069403.V355315.R01.S.doc Version 5.2 Page 7 Care plans continue to focus on health care needs, with little attention to the social and daily living activities for residents. Again there was little indication that the social needs of residents are being met. On Foxhall Unit, which accommodates people living with dementia, there was little evidence that the Memory Lane resources are being used for the benefit of the residents. On Bridge Unit there was some evidence of activities being undertaken by the activities co-ordinator, but the general staff interaction with residents continues to need improvement. According to many of the relatives and residents, staff are too busy undertaking the basic care needs for residents and have little time for other things such as social activities. Life histories are an important aspect of the care planning for each individual, and such information must be made more readily available to care staff. Improvements are still required around communication between staff, relatives and residents. Many of the staff have English as a second language and the organisation must ensure that all staff working in the home are able to communicate appropriately with residents and relatives, as well as with each other to ensure that a quality service is being provided. Improvements are also necessary in the moving and handling of residents. A quote from a questionnaire was “the care staff overall do have the right skills and experience, but at times I have seen people moved from a seating position where they could have for a few hours, into a standing position, and not given time to stretch or get their balance before being walked to the toilet. Also at times when someone is lying down on a couch or recliner being pulled up quickly and put into a wheelchair without any explanation of what is happening.” There does still appear to be a constant change of staff which obviously has an impact on the key worker system and on consistency of care for vulnerable people, and a quote from a returned questionnaire was “my worry is that because of the constant change of staff, and the level of foreign staff working here, people’s needs are treated as a whole rather than individually. I don’t believe the staff know everyone’s habits and ways and therefore, you have to start over again writing notes for carers telling them your relative’s personal needs.” Mealtimes on Foxhall Unit did not appear to be the enjoyable experience that it should have been. Some residents were left with meals in front of them that were getting cold because care staff were busy giving assistance to other residents. Residents were not being offered a choice at lunchtime and it appeared that they were given the meal that care staff said they liked. Tables were cleared before all residents had finished their meal. Consideration must be given to the use of assistive technology in the bedrooms of those residents who require assistance, but who are unable to use the current emergency call system. Derham House DS0000069403.V355315.R01.S.doc Version 5.2 Page 8 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.V355315.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.V355315.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. EVIDENCE: All of the 10 files viewed had a copy of a comprehensive pre-admission assessment, and these had been undertaken by a person qualified and experienced to do so. Information had been obtained from the prospective resident where possible, family and health/social care professionals, as well as being in receipt of an assessment that had been carried out by a local authority where necessary. From the assessment and other relevant information, a care plan had been drawn up, which identified the residents’ needs and how these should be met. Derham House DS0000069403.V355315.R01.S.doc Version 5.2 Page 11 Residents and relatives are able to visit the home prior to a resident moving in. There was evidence of this during the inspection as a prospective resident’s family were viewing the home and being shown around. A comment made by one of the family members was “it is nice to see so many smiling faces.” The statement of purpose and service user guide were available in the reception area of the home, and a copy of the service user guide was seen in some of the bedrooms visited by the inspectors. All residents have a contract if self-funding or a statement of terms and conditions if supported by a local authority. Contracts are in accordance with recommendations made by the Office of Fair Trading. It will be important for the organisation to ensure that information in the home is also provided in different formats more suited to residents who may have dementia or sight impairment or other disability, which may affect a person’s reading ability. Derham House DS0000069403.V355315.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 adequate 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 generally are reviewed on a monthly basis. Residents can generally be sure that their health and personal care needs are met but improvements are still required. Residents can be assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. EVIDENCE: FOXHALL UNIT The inspector was satisfied that each resident has their own care plan, although these are still very health focused. 5 of these care plans were case tracked and related documentation inspected. Resident’s health, personal and some social care needs are set out in individual plans but not all of the care Derham House DS0000069403.V355315.R01.S.doc Version 5.2 Page 13 plans accurately reflect their current needs. For example in one part of a person’s care plan it stated unable to make decisions but on the next page it stated able to communicate her needs and make decisions. There was still limited information on meeting the dementia care needs of residents and the care plans did not generally include end of life matters. Care plans on wound management were detailed, and it was evident that there is involvement from a tissue viability nurse when necessary. Care plans for residents who are diabetic were also in place, and blood sugar monitoring is being done in accordance with the care plan. However, some care plans indicate that when a resident is in his/her bedroom they should be checked every hour, but there was no evidence that this was actually being done. The care plans, although they have been transferred to a new format, still demonstrated little sense of the person, and therefore, they need to be more person-centred. Of the 5 files that were examined only one contained evidence of the resident’s life history. The gathering of this information for all residents could then be used in a more meaningful way in planning individual care, and as a basis for staff to gain more insight and knowledge of the resident. All residents are weighed on admission and thereafter monthly and this was evidence from the files. Where weight loss, or gain, is causing concern referrals are being made to the GP or to the dietician/nutritionist. Nutritional/fluid record charts were examined and it was evident that these are not always completed appropriately. This was discussed with the nurse in charge of Foxhall Unit who confirmed that often care staff complete the charts at the end of the shift. Nursing staff must be clear that such records are clinical and therefore, the responsibility of the nursing staff. The inspector did observe that fluids are being freely offered to residents at regular times throughout the day. The residents on Foxhall all have a diagnosis of dementia and, therefore, it is vitally important that where it is indicated, food and drink intake is recorded accurately to ensure their health and well being are not being put at risk. Residents’ files have written evidence that there is involvement from other health professionals including dietician, dentist, optician and chiropodist, as well as GP and hospital outpatient appointments. This was confirmed in discussions with relatives, who were visiting at the time of the inspection. Risk assessments are routinely undertaken on admission for all residents around nutrition, moving and handling, falls and pressure sore prevention. A comment made on a questionnaire was “the carers on the EMI unit are, with some exceptions, very capable and hold the unit together. During four years I have witnessed how they have worked with several Derham House DS0000069403.V355315.R01.S.doc Version 5.2 Page 14 nationalities with success. They, the carers, have a very difficult task to meet the needs of 32 residents.” Where residents have generally remained in bed because of frailty, the manager is now working well with staff to ensure that these residents now spend some time out of bed. BRIDGE UNIT The files of 5 residents were inspected and case tracked, and all had a comprehensive pre-admission assessment on file. There was a noticeable improvement in the care plans, although these are still very health orientated. Again there was little evidence of night care plans and end of life needs. Risk assessments are being undertaken, and where hourly monitoring is required there was evidence in two of the bedrooms visited that such monitoring is being undertaken with the necessary records being maintained. Care plans for wound management were good, and advice and input had been sought from the tissue viability nurse. As on Foxhall Unit, where residents are unable to use the emergency alarm system to call for assistance, the use of assistive technology should be considered. At the previous inspection this was discussed and the inspectors were informed that this is considered an intrusion on the privacy of residents. It is reiterated that, within a risk assessment framework, that residents have the appropriate resources to summon help when alone in their bedrooms. This was discussed with the new manager, who has undertaken to review this matter. The weights of all residents are recorded monthly, or more frequently where need indicates, and where concerns are highlighted due to weight loss/or continuous weight increase, the necessary referrals are made for specialist input and advice. General Nurses only administer medication, and Medication Administration Records (MAR) were inspected on both units and were found to be in good order. Each file had a recent photograph of the resident and any known allergies clearly recorded. All medication was being stored appropriately in a locked trolley with the nurse in charge holding the key. Controlled drugs were being stored in a separate cupboard and evidence showed that two nurses are recording the administration of these drugs. In discussions with some members of staff on both units, it was evident that they do not always look at the care plans because of shortage of time. It is Derham House DS0000069403.V355315.R01.S.doc Version 5.2 Page 15 essential that the care plans are available to all staff, and especially to new staff, before they commence the shift so that the care required by residents is delivered by the staff. Again this is the responsibility of the nurses in charge. Daily recordings on both units require attention. This is because the daily recordings are not reflective of the care plans. For example on many of the files it states that five fruit and vegetables must be offered each day, but there was no evidence in any of the files that this is being monitored by the care staff. With the recent introduction of the Mental Capacity Act 2005, and the need for residents to be enabled to make decisions about their daily lives, it is essential that the daily recordings reflect this. This was discussed with the manager during the inspection, and she has undertaken to address this important area. There was evidence that accidents are being recorded and necessary after monitoring is being done. Again, although care plans were not detailed as to end of life wishes, in discussions with staff members it was apparent that they were committed to giving care and comfort to residents who are dying, and that their death would be handled with dignity and propriety with their spiritual needs, rites and functions being observed. Some concerns have been raised regarding the current lack of physiotherapy input, and a comment received was “I don’t always know if the agency staff are aware of my mother’s specialist requirements. I am very concerned now the physiotherapist has left, and the new manager has informed me that there is no intention of the 4 hours per week being replaced with another physiotherapist. The old physiotherapist had a lot of input as to the manual lifting care of residents – who will do this now?” The issue of door closures is now being addressed by the organisation, and this is being done within a risk assessment framework. Some bedroom doors have already been fitted with such closures, and there is now a rolling programme for this to be done throughout the home. In discussions with some residents, they confirmed that this has made a difference to their feeling of wellbeing, and that they no longer feel isolated. Derham House DS0000069403.V355315.R01.S.doc Version 5.2 Page 16 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 the manager is aware that still more needs to be done. All residents are encouraged to maintain contact with family and friends. Frequent staff shortages/changes impact on the ability of residents to exercise choice and control over their lives. However, a wholesome and balanced diet is provided in pleasing surroundings. EVIDENCE: Since the previous inspection a new activities co-ordinator has been employed, and some improvements were observed on the day of the inspection. Time was being spent by the activities co-ordinator with residents on Bridge Unit, and some time spent on Foxhall Unit. However, all staff need to be made aware of the fact that activities are the responsibility of everybody employed in the home. This does include sitting and talking to residents and just spending some time with them. A comment made by a relative was “the new activities co-ordinator is very enthusiastic and with support I feel she will bring some pleasure to the residents.” Some residents have been Derham House DS0000069403.V355315.R01.S.doc Version 5.2 Page 17 involved in the decoration of the Christmas trees on both Foxhall and Bridge Units. However, another comment made was “my mother is permanently in a wheelchair, but if it wasn’t for the fact that family are there 4-6 times a week she would not be taken out for a push up to the stables and around the gardens as we do this every visit weather permitting. Other residents who do not have so many visitors do not seem to move from their ‘place’ in the lounge. A lot more should be done for social activity if they had more staff.” There is now a programme of activities for larger groups. On both units some staff were seen to be interacting with residents, but there were still some staff who were observed not interacting at all. A more person centred activities programme needs to be developed and consideration given to the specialist needs of people living with dementia. For instance more individual activities focusing on the individual’s needs and cognitive functioning, and including the use of life histories, together with small group activities. The inspectors were able to speak to several residents on Foxhall Unit, and one lady was able to tell the inspectors about her previous employment, where she was born and many other things about her life but this was not reflected in her care plan. A further comment received was “my mother is not here by choice – her daily life is nothing but routine. There is very little to break the routine. I understand the activities are on a budget. The activities are crucial to quality of life but they are very basic – i.e. basic crafts. It is a constant battle as one activities person cannot plan trips out without other carers available, but there is not enough staff to do this. The home’s mini bus does not seem to get used for trips out as I think it should. They need more stimulation for the able residents – they could set up suitable tables in front of residents in the lounge to do things when no staff are available such as jigsaws, letter writing, Christmas cards.” As previously stated the care plans are still very health focused, and much more must be done to reflect the social care needs of each resident. All residents require some motivation and stimulation which is why the development of life histories are very important. All staff must recognise the important part that they can play in the encouragement and motivation of all residents in the home, and certainly those residents living with dementia. The home has created a ‘Memory Lane’ in the corridors on Foxhall Unit, but these resources are still not being utilised by staff for the benefit of the residents, despite some of the staff having received training. During the inspection not one resident, with staff assistance, was observed to be walking along the corridors to enable them to be involved in reminiscence and handling objects of ‘yesterday’. A comment made by a relative was “lack of social activities is a major problem for the EMI unit. My belief is that such activities are better than all the drugs prescribed.” Derham House DS0000069403.V355315.R01.S.doc Version 5.2 Page 18 Residents on both units are encouraged to bring into the home some of their own possessions and this was evident when visiting residents’ bedrooms. Personal radios, televisions, photographs, pictures, ornaments and small pieces of furniture, including armchairs and cabinets, were in situ. The lack of appropriate signage on Foxhall Unit restricts the ability of residents to locate their own bedroom, toilets or other rooms thus restricting choice of freedom of movement around the building and could lead to residents entering the rooms of others, by mistake. Complementary therapists have visited the home, and it is planned to offer this service within the home. An open day has been planned for the end of November so that residents and relatives can experience the therapies free of charge on the day. Obviously, for future sessions there will be a charge. Lunch was observed being served on Foxhall Unit but it was not evident that residents were being given a choice, although there were two choices. It appeared that staff made the decision for them. Pictorial menus were not available and the inspectors did not observe any intention on the part of staff to give residents the opportunity of choosing a meal. One lady who had previously told a nurse that she did not want anything to eat, with some encouragement she changed her mind and it was the nurse who decided what she would eat. Although some staff were seen to be giving assistance to residents who required help with eating, and this was given in a sensitive and caring manner, it was evident that more staff were required at this peak time as some residents were left with a meal in front of them, which was getting cold while they were waiting for help. The inspectors also observed that the tables were cleared of both cruets and tablecloths before all residents had finished their lunch. This was discussed with the manager during the inspection, and hopefully steps will be taken to ensure that all residents receive the assistance required before their meal gets cold. One the day of the inspection one of the meals was lasagne, cauliflower and potato. Because of the lack of colour combination this meal did not look particularly appealing. This was discussed with the cook, who accepted this and agreed to ensure that future meals would be looked at for colour appeal. Some comments received were that the food generally was good, for example a relative commented “Derham has an excellent restaurant with a varied menu during a four week cycle. Given they have to cope with 50 of residents on pureed and some with diabetes plus ethnic menus, they provide in our opinion excellent service.” However, another relative said “menus needs more imagination, especially the chef special – I don’t think older people like chicken burgers or chicken nuggets. Too much salt in veg and potatoes. More fresh vegetables not just over cooked cabbage or carrots. I know these are easy to liquidize for those having purees, but those who don’t are left with over cooked tasteless veg. Derham House DS0000069403.V355315.R01.S.doc Version 5.2 Page 19 The casseroles are over cooked, the chicken always tough, meat is poor quality cuts. The shepherds pie needs to be less salt and brown on top – not watery. Some crusty rolls for the few who would like them and fresh crispy salad. The inspectors did observe that plated seasonal fruits and biscuits were delivered to the units during the morning, and these were being enjoyed by the residents. There is such a contrast in opinion and perhaps the manager could look into why there seems to be such differences. On Bridge Unit there was a large flat screen television on the wall but again this could not be seen by all of the residents who were sat nearby. For example two residents were sat in chairs immediately alongside the wall where the television was sited. They could not see the television, but obviously could hear it but had no means of changing their position either to move completely away, or to be in a position to see the screen, because there were no other seats available nor staff members concerned enough to give assistance. Again this was discussed with the manager and hopefully there will be some reorganising of chairs in this lounge so that all residents are able to see the television, or who can sit in a more appropriate position if they do not wish to watch television. There is still an issue as to who is responsible for ensuring that plants are watered, and that the water in flower vases is changed. This comment was made to the inspectors both during the visit and also on some returned questionnaires. Visiting times are very flexible and visitors confirmed that they could visit at any time. Residents have the choice as to where they see their relatives and friends, either in the lounge, garden or their own bedroom and there is also a larger ‘blue lounge’ which is situated between the two units. One relative told the inspectors that “the blue lounge is a haven.” The signing-in book indicated that there is a steady stream of visitors to the home. All of the relatives spoken to stated that they were made to feel welcome. The sensory garden has been completed, thanks to the efforts and hard work of the maintenance staff and this is being officially opened in January 2008. Although many negative comments have been received, there is an underlying hope that the new manager has begun to make positive changes. The new manager and the new activities co-ordinator do appear to be addressing many of the issues, and the introduction of relatives’ forums has been positively received. One comment received was that “the fact this care home has had no manager for a while has been the cause of so many problems. I must say since the new manager started things have improved and her door is always open to any concerns anyone has.” Derham House DS0000069403.V355315.R01.S.doc Version 5.2 Page 20 Derham House DS0000069403.V355315.R01.S.doc Version 5.2 Page 21 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. Verbal complaints are now recorded and are always dealt with appropriately. 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. EVIDENCE: From returned questionnaires and in discussions with both residents and relatives, the inspectors are satisfied that complaints are now being listened to and are being addressed in an appropriate manner. One comment made was “we now have a new manager, and things have improved. I am happy with the response if my mother is unwell – the respond appropriately.” Most of the relatives that were spoken to said that they would speak to the manager if they had any concerns or complaints. The also said that they now felt confident that they would be listened to. The issue of the closed bedroom doors is now being addressed by the organisation, within a risk assessment framework, and some residents told the inspectors that this has really made a difference to their daily lives. Derham House DS0000069403.V355315.R01.S.doc Version 5.2 Page 22 Staff that were spoken to during the inspection were aware of the action to be taken if they had any concerns about the welfare and safety of residents, During the training it is essential that all new staff are made aware that the abuse of vulnerable people is not just about physical abuse. Although no poor care practices were observed during the inspection, some comments received from relatives would indicate that some staff are still not always providing care in an appropriate manner. The complaints procedure is displayed in the home and many residents and relatives were aware of this. However, the complaints procedure should also be 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.V355315.R01.S.doc Version 5.2 Page 23 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: The inspectors undertook a tour of the premises 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 there is an official opening planned for January, 2008. Derham House DS0000069403.V355315.R01.S.doc Version 5.2 Page 24 All bedrooms viewed 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 has 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. A visit to the laundry was made 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. However, there is currently one bathroom out of use because of the need to replace the bath, and this is being used for the storage of equipment. The inspectors were informed that a new bath has been ordered, and the supply and fitting of this is still awaited. 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. A comment made by a relative on a returned questionnaire was “I like the location of the home although when leaving at night in the dark, although lit, I do not feel safe neither should the care staff have to walk on these paths. Overall, I am satisfied with Derham House, the décor and facilities are extremely good.” Derham House DS0000069403.V355315.R01.S.doc Version 5.2 Page 25 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 adequate 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. Staff numbers and the skill mix of staff still require attention to ensure that the assessed needs of all of the residents are being met. EVIDENCE: A requirement at the previous inspection was that staffing levels must be reviewed in the light of the high dependencies of many of the current residents. This is now being addressed by the new manager, but difficulties in recruitment are still being experienced mostly due to the location of the home. In the interim temporary/agency staff are being used and the manager is endeavouring to ensure that the same named agency staff are used to provide a level of consistency for the residents. Active efforts at recruiting new staff are being made by the organisation. On the day of the inspection staffing levels were generally appropriate and in accordance with the staff rota. However, consideration must be given to the mealtimes on Foxhall Unit so that all residents who require assistance can be given this by the staff before their meals get cold. This was discussed with the manager who will be looking at various options in an endeavour to resolve this. Derham House DS0000069403.V355315.R01.S.doc Version 5.2 Page 26 The inspectors were able to speak to several staff members, some of whom have worked at the home for several years, and they said that they enjoyed working with the residents, but sometimes more staff were needed. It was also apparent on the day of the inspection that not all staff had a good command of the English language. If staff are caring for vulnerable people who may have hearing problems, or a cognitive impairment due to a stroke or dementia, or speech problems then it is essential that they have a good command of English to enable them to provide the necessary care, and meet the needs of the residents. Training is given a high profile within the organisation, but it is essential that all care staff receive training in equality and diversity issues in its broadest sense, and this should be reflective of the needs of the current residents. However good the training is, it will be ineffective if it is not being implemented in daily work practices. A comment made by one relative was “staff are friendly and know the residents well. They engage with those who can communicate.” Another comment made was “by employing more staff so that they can give more time to helping residents to eat and nurturing them.” A further comment made on a returned questionnaire was “the care staff overall do have the right skills and experience, but at times I have seen people moved from a seating position where they could have been for a few hours, into a standing position, and not given time to stretch or get their balance before being walked to the toilet. Also at times when someone is lying down on a couch or recliner being pulled up quickly and put into a wheelchair without any explanation of what is happening. A random sample of personnel files were examined and found to be in good order with the necessary references, Criminal Records Bureau (CRB) disclosures and application forms duly completed. Gaps in employment history are addressed at interview. Derham House DS0000069403.V355315.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 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. With the employment of a new manager, residents can be sure that they live in a home which is run and managed well, and that staff are supervised. It is currently apparent that the home is being run in the best interests of the residents, and they can be sure that their financial interests are safeguarded and that their health, safety and welfare will generally be promoted and protected. EVIDENCE: Since the previous unannounced key inspection, a new general manager has been appointed together with a new deputy manager. It was evident that the new manager is receiving appropriate support from the organisation, and on the day of the inspection the organisation’s compliance officer was visiting the home to follow up on a previous visit. Derham House DS0000069403.V355315.R01.S.doc Version 5.2 Page 28 The new general manager has previous experience of managing a nursing home and is a qualified nurse. Her application for registration is in the process of being submitted to the Commission. It was evident from discussions with the general manager that she is aware of the many issues at Derham House, and is actively endeavouring to address these. Residents and relatives forums have already been held, staffing levels and issues are being addressed, regular supervision of staff is now being undertaken and training requirements for staff are being identified. Residents, relatives and staff all spoke highly of the new general manager, and in spite of some of the negative comments received by the Commission, there has also been a very positive hope and expectation of the manager. Some comments received were “I believe the new manager will do well given she is able to bring forward ideas and staff changes she has outlined, we will support her. Hopefully Barchester will!”; “we now have a new manager – hopefully thing should improve.”; “I must say since the new manager started things have improved, and her door is always open to any concerns anyone has.” As stated in the previous inspection report, the home has carried out all health and safety checks. All gas and electrical checks have been undertaken within the past 12 months and the fire alarm has been serviced this year, and a new fire panel and detector heads have been installed. Fire drills and alarm testing are regularly undertaken as are water, freezer and refrigerator temperatures. The maintenance person carries out daily checks on the safety system, lighting, heating and plumbing. Weekly checks are carried out on doors, windows, nurse call system, décor, fire doors, gardens and catering equipment. Monthly checks are undertaken on wheelchairs, electrical beds and emergency lighting system. Six monthly checks are undertaken on hoists & slings, ladders and yearly checks on the general environment. The inspectors were satisfied that the financial interests of residents are safeguarded, and that their best interests are protected by the administration record keeping. Monthly Regulation 26 visits are being undertaken and reports are being produced in accordance with the Care Home Regulations 2001. Also 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 the organisation will continue to support the new general manager in ensuring that improvements continue to be made at Derham House in the interests of the residents whose home it is. Derham House DS0000069403.V355315.R01.S.doc Version 5.2 Page 29 Derham House DS0000069403.V355315.R01.S.doc Version 5.2 Page 30 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 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 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 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Derham House DS0000069403.V355315.R01.S.doc Version 5.2 Page 31 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(2)(b) Requirement Timescale for action 31/01/08 2. OP27 18(1)(a)( b) The registered persons must continue to improve each resident’s care plan so that these are comprehensive and cover life histories, social needs, and that this plan including other associated records such as fluid, nutritional and other such charts, are regularly reviewed, maintained in an up to date manner with the involvement of the resident and/or his/her relative or representative. This is to ensure that the needs of the individual resident are being met and monitored with their involvement. The registered persons must 31/01/08 continue to review the numbers and skill mix of staff to ensure that at all times these are sufficient and appropriate to meet the needs of all of the residents accommodated at the home. Derham House DS0000069403.V355315.R01.S.doc Version 5.2 Page 32 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 OP15 OP19 OP21 Good Practice Recommendations That consideration be given to reviewing the mealtimes on Foxhall Unit so that all residents receive any assistance required before their meal gets cold. That consideration be given to the installation of assistive technology where residents are unable to use the existing emergency alarm system. That the new bath is fitted as soon as is possible so that residents continue to have a choice of facilities in this area. Derham House DS0000069403.V355315.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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.V355315.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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