Inspection on 05/04/05 for Derriford House

This inspection was carried out on 5th April 2005.

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

Derriford House 06/10/08

Derriford House 09/10/06

Derriford House 10/10/05

Derriford House 20/09/04

Derriford House 15/04/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Derriford House Pinewood Hill Fleet Hampshire GU51 3AW Lead Inspector Peter J McNeillie Unannounced 05.04.2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Derriford House Version 1.10 Page 3 SERVICE INFORMATION Name of service Derriford House Address Pinewood Hill Fleet Hampshire GU51 3AW 01252 627364 01252 629481 derriford.house@hot mail.com Derriford House Ltd Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Carolyn Lunn CRH 30 Category(ies) of OP - 30 registration, with number of places Derriford House Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: none Date of last inspection 20.09.2004 Brief Description of the Service: Derriford House is a privately owned and operated care home offering accommodation for up to 30 persons over 65 years of age. All residents are accommodated in single rooms, the majority of which are provided with ensuite toilet and washing facilities.The home is located in the North Hampshire town of Fleet, adjacent to public transport local facilities/shops and the nearby towns of Aldershot and Farnboroughand within easytravelling distance of Guilford,Basingstoke and Reading. Derriford House Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During this inspection the inspector who had inspected the home on previous occasions talked with a number of service users, a visiting health care professional, care staff, support staff, the manager and the joint owners of the home. Evidence was also gathered from a tour of the building, reading records (including care plans), the previous reports and a selective audit of residents money. What the service does well: What has improved since the last inspection? What they could do better: The manager acknowledged the need within the home for the quality of the daily note taking by care staff to improve and be in some instances be expanded to give a cleared picture of the day to day needs etc of individual residents. Derriford House Version 1.10 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Derriford House Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Derriford House Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3and 4 The home has a well developed and comprehensive assessment system which identifies residents needs and any risks which ensures needs can be met. EVIDENCE: All potential service users are visited prior to admission and a detailed assessment of their needs and risks undertaken by the manager or another member of senior staff. Records seen confirmed when assessments are carried out residents are consulted. In the sample of files inspected in one instance the original assessment of need /risk was missing. A verbal undertaking was given by the manager this document would be found or replaced. Records seen comments by residents and an interview with a visiting health care professional confirmed that consultations take place to ensure that assessed and changing needs can be met. Those consulted included GPs, geriatricians, continence advisors, physiotherapists, occupational therapists and care managers. Derriford House Version 1.10 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,and 10. The arrangements for planning care to ensure that the health and personal care needs of residents are satisfactory. Daily records on individual residents need to improve. EVIDENCE: Residents when spoken to expressed total satisfaction with the care they were receiving, the manner in which it was delivered also confirmed they were consulted about the contents of their individual care plan. Care plans which were reviewed monthly and based on individual assessments of need and risk contained information on how identified needs were to be met. Residents confirmed any personal care was given in private, staff always knocked and waited before entering their bedroom and that they were able to make and receive telephone calls in private. Some residents had fitted personal telephones. In the sample of files viewed one plan had been mislaid. A verbal undertaking was given by the manager this missing document would be replaced. All securely stored drugs and medication was administered by staff who had received training from a local college. Some of the entries in the individual daily records of care delivered lacked detail or failed to follow up on previous entries. The manager informed the Derriford House Version 1.10 Page 10 inspector she had previously noted this deficit and was in the process of training care staff to improve the quality of their recording. Care staff were observed to address residents in a polite manner and knock and wait before entering bedrooms. Residents confirmed this was usual practice. Derriford House Version 1.10 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 and 15 The social activities family contacts and the provision of varied and nutritious meals were well managed and reflected service users interests and choices. EVIDENCE: Residents spoken to praised the quality of their day to day lives. Terms such as” The best”, ”Better than a four star hotel” and “We want for nothing” were some of the terms used to describe living in the home. From comments made the inspector formed the view that routines were arranged to meet the needs of the service users and not the needs of the home/staff. Visitors were welcome at any time, residents were able to receive and converse with visitors in private. A list of in-house and community activities was on the notice boards, these included bingo, quizzes, clothes parties and visits to local clubs and societies eg Red Cross, Darby and Joan, Rotary etc. The inspector observed a music and movement activity overseen by a qualified physiotherapist taking place. The quality, quantity, and choice of food served came in for particular praise from the residents. A full and varied menu based on individual likes ,dislikes and choices was available. The inspector from his observations confirmed the varied choice and excellent presentation of the main mid day meal. Derriford House Version 1.10 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The protection of service users and arrangements for responding to and recording complaints were satisfactory. EVIDENCE: Residents confirmed they felt comfortable in raising any concerns they had with the homes management and confident any matters raised would be dealt with fairly and promptly. An in house adult protection policy and procedure that operated in tandem with that provided by Hampshire County Council was available. Records confirmed all staff have received training in the protection of vulnerable adults. A complaints procedure which formed part of the homes statement of purpose and service users guide was also displayed on a notice board adjacent to the dining room. Since the last inspection one complaint had been received by The Commission for Social Care Inspection( C.S.C.I.). This complaint which was not substantiated was dealt with by the provider within 28 days of receipt. Derriford House Version 1.10 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 A safe, well maintained, clean and suitably furnished home is provided that meet the needs of service users. EVIDENCE: A tour of the building was undertaken. All of the radiators and hot water pipes had been covered ensuring residents were protected from burning. All of the rooms were fully furnished and if required provided with aids to assist service users. Residents in conversation commented on how hard the cleaning staff worked to maintain a pleasant environment also adding how suitable the high back chairs in the lounges were. An infection policy and procedure was in place. The inspector witnessed minor repairs being undertaken by a handy man. Since the last inspection a fully fitted stainless steel commercial kitchen has been installed. Derriford House Version 1.10 Page 14 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 and 30 Residents needs are met by sufficient numbers of well trained and supported care staff who are recruited and selected using a procedure designed to protect all service users. EVIDENCE: Service users spoken to were full of praise for their carers adding, “nothing was too much trouble”, “we never have to wait” “the girls are brilliant”. The inspector observed a number of instances where one to one contact/care was taking place in an unhurried and caring manner this individual attention was clearly appreciated and enjoyed by service users. At the time of the inspection the care staff were supported by a number of other personnel including, the manager, a cook plus a kitchen assistant,3 cleaners, a handy man and an administrator. The support staff clearly had an influence on how care staff carried out their duties and improved the quality of care available. Records seen confirmed all staff are recruited in accordance with the home’s selection and recruitment procedure which includes the completion of an application form, an interview and satisfactory CRB and reference checks. On commencement all staff are subject to induction training (records seen),a period of probation and extra supervision before a final permanent position is offered. CRB checks for all existing staff have been carried out. The inspector noted all staff also receive an operational pack including a copy of the General Social Care Council’s Codes of Practice on commencement of their employment. As part of their terms and conditions of employment all staff agree to participate in NVQ training initiatives to at least level two. Staff Derriford House Version 1.10 Page 15 turnover is very low. The registered person is a registered accredited trainer in first aid, moving and handling and is a City of Guilds approved 730 trainer (Adults). The manager is an accredited moving and handling trainer. All staff are subject to an induction/foundation course leading to NVQ 2 training. Additional subjects such as dementia, control of medication, the ageing process the care of the dying and food hygeine are also provided in-house. Very comprehensive current training records were available for all staff which also indicated senior staff are encouraged and enabled to assume lead roles for specific areas of training within the home. Following the very robust recruitment and selection process all staff during a probationary period of employment are involved in a set induction and supervision programme based on a TOPPS programme entitled Working in Care Settings. Records seen confirmed all staff receive regular supervision. Staff spoken to stated how much they enjoyed working in the home and the opportunity to participate in training and gain a qualifications. Derriford House Version 1.10 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,35 and 38 The management of the home offers a needs driven service to all of its residents whose financial, health and safety considerations are given paramount consideration. EVIDENCE: Regular satisfaction surveys that seek the views of residents are carried out and records maintained. These surveys are in the process of being expanded to include the views of visiting health care professionals ,residents relatives and friends. Regular visits by the providers and the sending of reports to C.S.C.I. as required by regulation 26 are taking place. As previously commented all of the service users spoken to expressed total satisfaction at the service they were receiving and the manner in which it was delivered. Derriford House Version 1.10 Page 17 The homes owners both visit the home on a daily basis and are available for consultation at all times as is the manager when off duty. A sample audit of service users money deposited for safe keeping was undertaken. The records seen (including receipts ) reconciled with individual cash balances held. A health and safety policy was available. A record of all accidents was available Records were also seen confirming all staff had recently received training in the techniques of moving and handling first aid health and safety and the procedures to follow in the event of fire (including evacuation). All of the hot water supplies to baths were fitted with thermostatic controls set at 43 degrees C. All radiators and hot pipes had been covered. The records of the servicing of equipment employed within the home were available. Derriford House Version 1.10 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x 3 x x 3 Derriford House Version 1.10 Page 19 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action 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 Good Practice Recommendations Derriford House Version 1.10 Page 20 Commission for Social Care Inspection 4th Floor, Overline House Blechynden Terrace Southampton Hampshire, SO15 1GW National Enquiry Line: 0845 015 0120 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. 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