Inspection on 10/10/07 for Derwent House

This inspection was carried out on 10th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Derwent House 30/09/09

Derwent House 17/09/08

Derwent House 01/09/06

Derwent House 06/12/05

Derwent House 16/05/05

Derwent House 05/10/04

Derwent House 21/04/04

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

CARE HOMES FOR OLDER PEOPLE Derwent House Ulverston Road Newbold Chesterfield Derbyshire S41 8EW Lead Inspector Susan Richards Unannounced Inspection 10th October 2007 09:30 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 Derwent House DS0000035815.V347575.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. Derwent House DS0000035815.V347575.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Derwent House Address Ulverston Road Newbold Chesterfield Derbyshire S41 8EW 01246 347515 01246 347517 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) www.derbyshire.gov.uk Derbyshire County Council Mrs Janet Elizabeth Greenfield Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Derwent House DS0000035815.V347575.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st September 2006 Brief Description of the Service: Derwent House is located on the north-west outskirts of Chesterfield in a busy residential area, close to local shops and amenities and on a direct bus route to Chesterfield town centre. The home is registered to provider personal care and support for up to forty people, having all single room accommodation, provided over three floors. Wheelchair access is provided throughout the building, which is suitably adapted to assist those people who may have mobility problems, including a shaft lift and emergency call system throughout. There is a range of communal lounge and dining rooms, including quiet areas and assisted bathroom and toilet facilities are located on each floor. Grounds and gardens are well maintained and include an internal courtyard/garden area with seating for people. People are provided with care and support from a team of care and hotel services staff led by a registered manager, who also has deputy and external management support via Derbyshire County Council. The home provides both short-term respite and long term care provision. Fees charged are as follows: Short-term care - £98.50 per week. Long term care - £301.84 to £381.84 per week. Long-term care fees are dependant on each person’s individually assessed needs. Additional charges are made for hairdressing, private chiropody, newspapers and toiletries. A copy of the home’s service guide and the most recent inspection report are available for people in the main reception area. Derwent House DS0000035815.V347575.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. For the purposes of this inspection we have taken into account all the information we hold about this service. This includes our previous key inspection report of 01 September 2006 and information provided in our annual quality assurance questionnaire completed by the home. We sent thirty surveys to residents at the home and received twenty-four returns and we have included peoples’ views collated from those. At this inspection there were 37 people accommodated at the home. We used case tracking as part of our methodology. This involved the random sampling of three people, whose care and service provision was more closely examined. We spoke with people about the arrangements for their admission and also the care and services they receive. We looked at their written care plans and associated health/care records and inspected their private and communal accommodation. We spoke with staff and management about the arrangements for their recruitment, induction, training, deployment and supervision. Examined related records and observed some of staffs’ interactions and approaches with people. We spoke with the registered manager about her role and responsibilities and about the management and monitoring arrangements for the home. What the service does well: What has improved since the last inspection? Derwent House DS0000035815.V347575.R01.S.doc Version 5.2 Page 6 A revised format concerned with the better record keeping of peoples’ individually assessed needs and care planning is now in place and is being introduced. Matters regarding medicines management and administration, identified by the supplying pharmacist are mostly achieved. One bath has been replaced with new. There are various areas of redecoration within the home. The appointed manager is now registered with the Commission. Written notifications are now forwarded to the Commission regarding the death of any person, or any illness, accident or incident, which may adversely affect any person residing at the home. A copy of the most recent certificate of maintenance for the hard wiring in the home is available for inspection and is satisfactory. What they could do better: Provide clear and transparent information about fees for people within the home’s service guide, to better inform and assist them in choosing a home. Ensure people are provided with a copy of their service agreement specifying arrangements made and keep a copy of this within their personal file at the home. Ensure the full and proper recording of peoples’ needs assessment and care planning information, so as to provide for and demonstrate accountability in respect of peoples care. Consider the implications of the Mental Capacity Act in respect of peoples’ individual assessment and care planning records. Ensure that baths installed at the home are all accessible and capable of meeting peoples’ needs. Operate management systems for calculating staff numbers required, which accords with Department of Health guidance, to ensure that there are always sufficient staff provided as are appropriate for peoples’ health and welfare. Develop a falls prevention strategy, which includes the regular auditing of falls and incidents at the home Derwent House DS0000035815.V347575.R01.S.doc Version 5.2 Page 7 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. Derwent House DS0000035815.V347575.R01.S.doc Version 5.2 Page 8 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 Derwent House DS0000035815.V347575.R01.S.doc Version 5.2 Page 9 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): NMS 1, 2, 3 (NMS 6 was not assessed as the home does not provide for intermediate care). Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People are not sufficiently informed to assist them in choosing a home and the home’s record keeping does not effectively account for peoples’ care needs. EVIDENCE: At our previous inspection of this service we judged that as individuals’ assessment information is provided on peoples’ admission by care management only. This is not sufficient to adequately inform as to whether the home is able to meet people’s needs. Derwent House DS0000035815.V347575.R01.S.doc Version 5.2 Page 10 We made a recommendation that assessment information be fully completed to ensure that it can be properly determined as to whether people’s needs may be met by the home. We also recommended that a copy of people’s contracts be kept with their care files. In our annual quality assurance questionnaire completed by the home they say they always carry out an extensive individual assessment process prior to people’s admission to the home, to ensure that their needs may be met. And that this includes written confirmation to that person with 72 hr and 6 weekly reviews to ensure that their needs can continue to be met. They also say they provide up to date information for people about the home’s services and that they establish good relationships with people and including care managers. They say that their records evidence this. They say they have improved by ensuring staff undertake training relevant to the care of people accommodated and feel they could improve further by developing their community links in seeking to establish a more flexible resource to support carers. They also state that they intend to improve by establishing a residents’ committee, although do not clarify as to how any of the above improvements relate to the standards in this section, which are concerned with peoples’ admission and assessment. Of the twenty four of our survey returns we received from people who use the service, the majority say that they did not receive a contract and were not provided with sufficient information about the home before they moved in for them to make the decision to move in there. Results of the home’s most recent residents survey are displayed in the home for people to see. These include that around of 50 of people surveyed said that information they received about the home to help them to choose was either fair or poor, although the design of the graph results makes it impossible to differentiate between fair and poor. At this inspection we spoke with the manager about how information is provided for people to assist them in choosing whether to live at the home. We also looked the home’s service guide and also requested to look at written copies of the individual placement agreements for those people case tracked. The service guide does not contain information about fees charged, although there is a copy of a standard form of contract. The guide refers people to request a copy of the service user reference guide for information about terms and conditions of residence. Derwent House DS0000035815.V347575.R01.S.doc Version 5.2 Page 11 Copies of people’s placement agreements are not kept in peoples’ care files. The manager thought that they are stored centrally, by Derbyshire County Council. The home’s satisfaction survey results displayed (as referred to above) include that sixty percent of people felt the home to be excellent/good in meeting their needs, although forty percent said fair/poor. (Although again, with no other differentiation). We looked at the recorded needs assessment information for those people case tracked. These consisted mainly of initial placement assessment information as provided by way of care management arrangements. The home is in the process of introducing a comprehensive needs assessment and care-planning format, which includes personal service plans, for each person. However, there is considerable work to be undertaken in respect of their completion and although management have completed many of the personal service plans, these are not currently working documents for staff. Needs assessment information recorded for those people case tracked is also variable in terms of the assessed personal safety needs and risk for those people, with some omissions. Derwent House DS0000035815.V347575.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s health care needs are reasonably well met and their rights to respect, dignity and privacy are promoted. The efficient and timely completion of the revised care-planning format being introduced by the home. Should provide better accountability for people’s care. EVIDENCE: At our last key inspection of this service we judged that people’s written care plans are insufficient in the information they provide to direct staff as to how people’s needs are to be met. However, people’s autonomy, independence and individual rights to dignity and respect are promoted and encouraged, which enhances their daily lives. Derwent House DS0000035815.V347575.R01.S.doc Version 5.2 Page 13 We made a number of recommendations - that people’s care plans provide sufficient information necessary to direct staff as to people’s required individual care interventions; to ensure that care plans are regularly audited to ensure they are properly formulated and up to date and are reflective of people’s dependency needs. We also recommended that the matters raised by the supplying pharmacist in their record of their last visit are complied with and that people’s wishes and instructions with regard to death and dying are ascertained and recorded. In our annual quality assurance questionnaire completed by the home, they say that people’s health care needs are effectively accounted for, including medicines, which staff trained to NVQ level 4 are responsible for and with strict adherence to the home’s policy and procedural guidance. They say they always promote people’s autonomy and individual choice and maintain good relationships with outside health and social care professionals. They say that individual records, feedback from people and regular auditing provide good evidence of the above. They say they have improved over the last twelve months by the introduction of a particular computer system concerned with record keeping, aiming to ensure that relevant people are kept better informed. They feel they could improve by reviewing their link worker care delivery system and they aim to improve further by the active use of their computer system referred to above. Of the twenty four of our survey returns we received from people, eight say they always receive the care and support they need; ten say they usually do; three say they sometimes do, one said never and two said they do not know. Eighteen people say that staff listen and act on what they say; one said eventually but sometimes have to be reminded; x3 said they sometimes do and sometimes don’t and x2 said they don’t know. Eight people say they always received the medical support they need; x13 say they usually do; x2 say they sometimes do and one said they did not need medical support At this inspection we spoke people about their care and support, including arrangements for their healthcare and medicines administration. We examined related records, including people’s care plans and records of medicines administration. We also spoke with staff about the arrangements for the organisation and delivery of peoples’ care. People spoken with said they usually receive the care and support they need, and that staff work hard to provide them with their care and support, but that Derwent House DS0000035815.V347575.R01.S.doc Version 5.2 Page 14 there are sometimes issues about staff availability. (See Staffing section of this report). All felt that they had reasonably good relationships with staff, who they say treat them with respect. Care staff said that they operate a key worker system for the organisation of care delivery. That they write peoples’ daily records but felt they are behind in writing people’s written care plans due to staffing constraints and the increasing frailty and dependency needs of people accommodated. Staff felt that people’s increasing dependencies are not effectively accounted for in determining staffing levels. (See also Staffing section of this report). They also said that there are increased falls. (See also management section of this report). Comments made under Section One of the report also apply here in respect of peoples’ recorded needs assessment and care planning information, for which the revised format is comprehensive. Although work has commenced in formulating people’s care plans, there is considerable work to do to ensure their timely full recording and operational use. The arrangements for people to access outside healthcare professionals are suitably accounted for in respect of those people case tracked. The arrangements for the management and administration of peoples’ medicines are also satisfactory, including training arrangements for staff responsible for these. Medicines storage is congested and information about medicines for staff by way of the British National Formulary is out of date. Management advised us that an additional trolley has been requested and a new BNF ordered. Derwent House DS0000035815.V347575.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): NMS 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Peoples’ lifestyle preferences are usually promoted in accordance with their choices and expressed wishes and they receive a balanced nutritious diet. Although the full completion of the person centred needs assessment and care planning format being introduced for each person, should better account for this. EVIDENCE: At our last key inspection of this service we judged that activities provided generally suit people’s expressed preferences. That regular outside contacts are encouraged and supported and that these assist in contributing to a pleasant atmosphere and an overall high level of individual satisfaction. That people’s dietary needs are catered for with balanced and varied foods, which meet people’s tastes and choices. Derwent House DS0000035815.V347575.R01.S.doc Version 5.2 Page 16 We recommended that the activities programme should continue to be developed in consultation with people. In our annual quality assurance questionnaire completed by the home, they say that they provide a good range and choice of activities for people in consultation with them. That they promote good relationships with the local community and with people’s families and supporters and that their residents meeting are planned in advance with circulated agendas for people and that minutes of those meetings are provided in suitable formats. They say that their records and residents comments and feedback evidence this. They say they have improved over the last 12 months by establishing links with the Alzheimer’s society with two residents visiting the Alzheimer’s café and that a monthly events calendar is openly displayed for people. They feel they could do better by encouraging people to make full use of the choice of lounges available and also by providing a safe area where people can make drinks and snacks, to include their visitors. They aim to improve over the next twelve months by providing the above and by reviewing people’s nutritional needs in accordance with nationally recognised guidance. They also intend to liaise with other Derbyshire County Council homes in order to share best practise in this area and to start a dominoes league with six other residential homes to encourage social interaction between these. Of the twenty-four of our surveys returned from people, seventeen say that activities are always arranged by the home, which they can take part in (one said these are good with more trips out); five say they usually are and two say they sometimes are. Twelve people say they always like the meals at the home; nine people say that they usually do and three say they sometimes do. At this inspection we spoke with people about their daily living arrangements, including activities, contacts with relatives and friends and meals provided. We also took into account records kept in relation to the above. Dedicated activities staff is employed and information is displayed on the residents’ notice board by way of a month calendar of events and activities organised for people, both within and outside the home. There is also a hair dressing room, with a visiting hairdresser who regularly provides a service for people at the home and a reminiscence and activities room, together with a wide range of activities equipment. Derwent House DS0000035815.V347575.R01.S.doc Version 5.2 Page 17 Details of recent and planned activities included coffee mornings, manicures, clothing sales, church services, residents meetings and entertainment from Derby Opera Company. There were two people accommodated at the time of this inspection with diverse differing religious beliefs and needs, including one person, case tracked. Discussions with that person confirmed they are encouraged and supported to practise their faith in accordance with their wishes and beliefs. People spoken with said they are reasonably satisfied with the arrangements for activities and all said they receive visitors or visit their friends and relatives as they choose. On the morning of our inspection a number of people were engaged in flower arranging. They also confirmed that entertainments and trips out of the home are also organised, with recent improvements in the provision of the latter. Many spoke of the garden area, film shows and entertainments, which they enjoy. Staff felt that activities are reasonably well organised for people and advised that a kitchenette area is now provided for people to make drinks and snacks. However, some expressed concerns about peoples’ safety and potential risks, which may be associated in terms of its location to the main kitchen, which is accessed via this kitchenette. (See Management section of this report). The revised needs assessment and care planning format being introduced at the home is more person centred and provides opportunity for improved record keeping and accounting for peoples known lifestyle preferences and daily living choices, although is not fully implemented as yet. People spoken with said they usually enjoy their food, although some felt the quality and choice had reduced of late. Reference was made to leftover Sunday meat served on Monday, being overcooked and tough. Some staff said that the variety and choice for soft diets for people could be improved. Individual table menus are provided which offer an alternative to the main meal. We observed the organisation and arrangements for people at lunchtime. Tables were attractively set and people receive the assistance they needed in a calm and unhurried manner. Derwent House DS0000035815.V347575.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The majority of people are confident to raise concerns and to complain and are protected from abuse. EVIDENCE: At our last key inspection of this service we judged that the home’s systems to promote peoples’ safeguarding from abuse and its clear and accessible complaints procedure, ensures that people may be confident that any issues raised will be acted on effectively and promptly. In our annual quality assurance questionnaire completed by the home, they say that they have a strong commitment to promoting people’s rights and safeguarding people and in ensuring that people are provided with the information they need to make a complaint. They also say they take complaints seriously and ensure that any complaints made are fully investigated. They say that their records, information they make available for people and feedback from them evidences the above. They say they have improved over the last twelve months by their positive encouragement for people to express their views. They feel they could improve further by providing smaller group meetings with people and by Derwent House DS0000035815.V347575.R01.S.doc Version 5.2 Page 19 developing their link worker role, which they aim to do over the next twelve months. Of the twenty-four of our surveys returned from people, seven people say they always know who to speak with if they are not happy; ten people say they usually do; three say they sometimes do and x three say they do not know. One person said they are never unhappy. Eleven people say they know how to make a complaint and, although thirteen say they do not know how. At this inspection we looked at how information is provided for people about how to complain. We also spoke with people about their knowledge and confidence to complain. We spoke with the manager and staff about the management and handling of complaints and including complaints received, since our last key inspection. We also spoke with staff about how people are protected from abuse, including procedures to follow and staff training and instruction. There is a written complaints procedure in place for the home, which is displayed. Information is also provided within the home’s service guide/brochure about how to complain. There are no known complaints received by the home since our last key inspection. People were very clear as to whom they would speak with if they had a concern, were unhappy or wished to complain. They said that any concerns they had are usually dealt with without the need to make a formal complaint Staff spoken with is conversant with then home’s clear policy and procedural guidance regarding complaints, recognising abuse and responding to and reporting of any allegation or suspicion of abuse of any person. Derwent House DS0000035815.V347575.R01.S.doc Version 5.2 Page 20 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): NMS 19, 22, 24 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall, people benefit from an environment, which is clean, comfortable and kept in a reasonable state of repair and renewal, although not all bathrooms installed are capable of meeting people’s assessed needs, which may also impact on their choice. EVIDENCE: At our last key inspection of this service, we judged that the home is generally reasonably maintained and people with an attractive and homely place to live. We made two recommendations that the bath to the first floor bathroom should be replaced and the assisted bath should be repaired to provide comfort and choice for people. Also that redecoration of the hall and ‘making good’ Derwent House DS0000035815.V347575.R01.S.doc Version 5.2 Page 21 where items have been removed in toilets, and where new windows/doors have been put in should take place. In our annual quality assurance questionnaire completed by the home, they say that they provide an accessible, comfortable, warm, friendly and inviting home, which is clean and hygienic. That it is suitably equipped and adapted to meet people’s needs. That people’s privacy is well promoted. And they are involved in choices of furniture and décor. They say that their records, auditing and feedback from people evidence the above. They say they have improved over the last twelve months in terms of key areas of health and safety compliance and quality improvements and in providing a reminiscence room and a garden project. They feel they could improve further by providing a dedicated facility for people to make their own snacks and drinks, which is to be undertaken over the next twelve months. They also aim over the next twelve months to provide a ‘quiet’ room and to redecorate corridors and some bathroom and toilet areas. Of the twenty-four of our surveys returned from people eight say that the home is always fresh and clean; thirteen say it usually is and three say it sometimes is. One person said that one of the bedroom wings has a strong smell of urine. At this inspection we looked at the private and communal rooms used by those people case tracked, together with the laundry facilities. All of these areas are clean, odour free, comfortable and reasonably well decorated and maintained. All bedrooms are provided with wash hand basins, lockable storage and suitable locks to doors. An additional quiet room is provided since our last key inspection with a view to purchasing Snoezelen sensory equipment to assist in providing a calm relaxing atmospheres for those with confusion. People spoken with said they are satisfied with their environment. Their rooms are personalised and there are some aids to orientation and reminiscence around the home. Bathrooms are a little stark in their décor. The bathroom on the top floor is no longer used given peoples’ mobility needs and we are advised that this is requires replacement. A new rise and fall bath has been provided to the first floor bathroom since our last key inspection, although staff say there are difficulties in its use due to lack of space when transferring people and to the position of the grab rail. Derwent House DS0000035815.V347575.R01.S.doc Version 5.2 Page 22 The laundry facilities are clean, tidy and well organised, with separate labelled laundry baskets for people’s clean laundry. Derwent House DS0000035815.V347575.R01.S.doc Version 5.2 Page 23 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): NMS 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People are supported from a staff team, who are effectively recruited, inducted and trained. However, management approach in calculating care staff numbers required does not effectively account for peoples’ needs, which may place them at risk. EVIDENCE: At our last key inspection of this service we judged that a trained and competent workforce meet people’s needs, although the limitations on staff time sometimes impact on quality. We recommended that there should be a review of staffing hours to ensure that staff planning and deployment arrangements take account of people’s dependency levels, the size of the building and the allocation of short term care placements. We also recommended that attempts should be made to recruit additional relief staff. In our annual quality assurance questionnaire completed by the home they say that they have well qualified and experienced staff who are effectively recruited, inducted, trained and deployed to meet the people’s needs. Derwent House DS0000035815.V347575.R01.S.doc Version 5.2 Page 24 They say that their records and feedback from residents evidences the above. They say they have improved over the last twelve months by increasing dedicated activities staff hours thereby improving access to activities, recreation and leisure for people. They also provided details of the number of care staff hours provided in the week before completing this questionnaire. They feel they could improve further by a review of staff roles and responsibilities and by seeking to provide a flexible housekeeping and services team. Of the twenty-four of our surveys returned from people, seven people say that staff is always available when they need them; twelve say that they usually are and five say that they sometimes are. At this inspection we spoke with people about staff availability. We also spoke with staff about the arrangements for their recruitment, induction, training and deployment and examined related records. People said that staff are usually available when they need them, although not always, particularly during the late afternoon/evening and sometimes at night. Staff spoken with confirmed satisfactory arrangements for their recruitment, induction and training and say that arrangements for their induction and training are good. Related records examined are reflective of this. However, care staff say that planned staffing arrangements in terms of their numbers and deployment, are not always adequate or satisfactory. They say that there are often significant deficits at evenings and weekends, when they also provide cover for teas and laundry with no additional hours provided. They say that at those times lounge areas are sometimes left unattended. They also feel that the increasing frailty and dependency needs of people are not properly accounted for in relation to staff deployment and that falls and injuries to people may be increasing, with three people requiring two or more staff during the day and at night. Staff responsible for administering medicines advised that medicines rounds take considerable time to undertake given peoples’ medical/medicines needs. We looked at the home’s accident records, which recorded a substantial number of falls not witnessed occurring during the evening or at night, where people are found on the floor, some resulting in significant injuries. The AQAA detailed average occupancy levels at thirty-seven residents and provided some information as to peoples’ dependencies. We discussed the arrangements for staff planning and deployment with the registered manager, who confirmed that it is usual to have four care staff from 7am until 1.30 pm Derwent House DS0000035815.V347575.R01.S.doc Version 5.2 Page 25 reducing to three until 2.30 pm. Also that a further two care commence at 2.15 pm until 4.30 pm increasing to three from 4.30pm until 8.30 pm with two care staff at night. The manager advised that peoples’ dependencies are not currently accounted for in determining staffing levels and that the residential forum staff tool is not used as guidance. However, she had recently collated information about peoples’ dependencies and provided these to external management with regard to staffing arrangements at the home. Management cover during the day is additional to this and an activities coordinator is also provided morning and afternoon from Monday until Friday. However staff gave examples of weekend mornings where there have recently been only three care staff on duty. Additional care staff is sometimes available during the day or at night from the Rapid Response team to which they are employed to provide for people residing within the local community. However, their availability is dependent on no rapid response work being required, which is their primary responsibility. Information provided in our annual quality assurance questionnaire gave a total of 513.5 care staff hours provided in the week preceding completion of this along with 149 additional hours provided (plus 152 other hours provided, although not for the purposes of personal care). Using the residential forum staffing tool for guidance we calculated care staff hours required for up to thirty seven people of either twenty medium and seventeen low dependency needs and also for ten medium and twenty seven low dependency needs. The former calculated that 888.96 care staff hours are required (which includes 190.16 staff overheads) and the latter calculation gave 641.21 care staff hours (including 137.12 staff overheads). These calculations are for care staff hours only. They include an estimate of hours for activities, but not for hotel services staff. Derwent House DS0000035815.V347575.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): NMS 31, 33, 35 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall, the home is fairly well managed and run, for the most part in peoples’ best interests. However, application of recognised management tools for determining care staff levels and falls prevention may better promote peoples’ interests. EVIDENCE: At our last key inspection of this service we judged that the home is well managed and run in peoples, although without a registered manager. Derwent House DS0000035815.V347575.R01.S.doc Version 5.2 Page 27 We made a requirement that the appointed manager must make a formal application for registration with the Commission. (This is achieved and registration approval granted by us). In our annual quality assurance questionnaire completed by the home they say that the home is well managed and run in a manner, which promotes people rights and best interests. And that this can be evidenced from the records they keep and feedback from people. They say they have improved over the last twelve months by ensuring senior staff are suitably trained, by access to good IT support systems and by ensuring privacy for individual staff supervisions to take place. They feel they could improve senior staffs IT skills to enable better use and understanding of the current system and aim to ensure that relevant staff are trained to do so over the next twelve months along with a review of their filing system to enable easier access. At this inspection we spoke with staff about the management arrangements at this home, looked at the home’s quality assurance and monitoring systems, including arrangements for consultation with people who use the service and we examined the arrangements for the management and handling of peoples’ personal monies for those people case tracked. We also spoke with staff about the arrangements for ensuring safe working practises, made general observations in relation to their promotion during our tour of the building and looked at some related records. The latter included the arrangements for reporting and recording of accidents. A full formal system for quality assurance and monitoring of the home is now in place and in process of rollout and includes mechanisms for full systems and service auditing, aims and action planning and reviews, although at this stage there is no formal annual development programme in place. Revised strategies for team development and communications are also developed for implementation. There are also formal established arrangements in place for formal consultation with people who use the service, including satisfaction questionnaires. The results and findings of the most recent of these is displayed at the home, although there is no information available for people in terms of any action to be taken as a result of these. Peoples’ views about the home are also included in its service guide/brochure. Staff spoken with confirmed that overall there are satisfactory management arrangements in place for ensuring safe working practises, including training, provision of suitable equipment and access to recognised policy and procedural guidance. Derwent House DS0000035815.V347575.R01.S.doc Version 5.2 Page 28 There are no observable hazards noted during our tour of the building and satisfactory details regarding the maintenance of equipment are provided within our quality assurance questionnaire completed by the home. However, given staff comments about peoples’ safety in relation to the location of kitchenette recently provided for residents’ use and access, we spoke with the manager about this, who agreed to undertake a suitable risk assessment process in respect of this. We also spoke with the manager about mechanisms for the regular auditing of falls and accidents at the home. Derwent House DS0000035815.V347575.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 2 1 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 2 X 3 X 3 STAFFING Standard No Score 27 1 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Derwent House DS0000035815.V347575.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 OP1 Regulation 5(1)(ba)(bd Requirement Timescale for action 28/02/08 2. OP2 5(3) 3. OP3 14(1) & (2) 4. OP7 15(1)(2) Clear and transparent information must be provided about fees for people within the service guide, to better inform and assist them in choosing a home. (This must accord with that stated under Regulation 5 (amended Nov 06). Where a local authority has 28/02/08 made arrangements for the provision of accommodation and personal care to any person at the home, the registered person must supply that person with a copy of the agreement specifying the arrangements made. Peoples’ assessed needs must be 28/02/08 fully recorded, kept under review and revised at any time when it is necessary to do so having regard to any change of need or circumstances. An up to date written plan must 28/02/08 be provided for each person accommodated as to how their needs in respect of their health and welfare are to be met. This must be available to the individual, kept under review and DS0000035815.V347575.R01.S.doc Version 5.2 Derwent House Page 31 5. OP22 23(j) & (n) 18(1) (a) 6. OP27 revised as necessary. All baths installed must be accessible and capable of meeting peoples’ assessed needs. At all times staff must be provided in sufficient numbers and skill mix as are appropriate for the health and welfare of people accommodated. 01/04/08 31/12/07 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. 4. 5. Refer to Standard OP2 OP14 OP16 OP27 OP38 Good Practice Recommendations A copy of people’s individual service agreement should be kept in their care file. Consideration should be given to the implications of the Mental Capacity Act in respect of peoples’ individual assessment and care planning records. Consideration should be given to possible solutions, which may assist in increasing people’s awareness as to how to make a complaint. A recognised system should be operated for calculating staff numbers required, in accordance with guidance by the Department of Health. NMS OP 7 also applies here. The home should seek to develop its falls prevention strategy, which should include the regular auditing of falls and accidents at the home. Derwent House DS0000035815.V347575.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Derwent House DS0000035815.V347575.R01.S.doc Version 5.2 Page 33 - 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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