CARE HOMES FOR OLDER PEOPLE
Derwent House Ulverston Road Newbold Chesterfield S41 8EW Lead Inspector
Brian Marks Unannounced 16 May 2005 1.00 pm 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. Derwent House C52-C02 S35815 Derwent House V227419 160505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Derwent House Address Ulverston Road Newbold Chesterfield Derbyshire S41 8EW 01246 347515 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) Derbyshire County Council Sharon Dawson (Acting manager, not registered) Care Home - personal care only 40 Category(ies) of Old age - 40 registration, with number of places Derwent House C52-C02 S35815 Derwent House V227419 160505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: No conditions recorded Date of last inspection 5 October 2004 Brief Description of the Service: The Home is situated in a busy residential area, close to local shops and services and on direct bus routes to Chesterfield town centre. The home is spread over 3 floors for up to 40 residents, all in single bedrooms, and with a lift to help access to the upper floors and a call system throughout the building in case of emergencies. There are assisted bathroom and toilet facilities on all floors and the home has several lounge areas on the ground floor, and smaller sitting areas on other floors. The home has a large garden that is easy to get into. A short stay respite service is available and a key worker system has been developed to help plan individual care with residents. Derwent House C52-C02 S35815 Derwent House V227419 160505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced visit that took place at the home over an afternoon. Additionally, time was spent in preparation for the visit, looking at previous reports and other documents. At the home, apart from examining documents, care files and records, time was spent looking around the building and speaking to 12 of the residents. The acting manager and staff were also spoken to, and they were observed throughout the visit, looking after and dealing with residents and visitors. What the service does well: What has improved since the last inspection?
New care planning documentation has been introduced that is aimed at improving consistency in delivering care to residents and which should result in improving overall safety of care practices. Levels of overall care staffing have been maintained and the number of domestic staff has increased to ensure that standards of cleanliness and hygiene around the home remain high. Two staff had been appointed to concentrate on improving the standard of activities for residents and, although one has since left the home, the post has been retained and a replacement is due. Derwent House C52-C02 S35815 Derwent House V227419 160505 Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Derwent House C52-C02 S35815 Derwent House V227419 160505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Derwent House C52-C02 S35815 Derwent House V227419 160505 Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 6. People do not come to live at the home without a professional worker identifying the services they need from the home. This makes sure the home can met their needs and that the care provided is right as soon as they move in. EVIDENCE: From the files looked, at all residents came to the home with the help of a care manager who provided the home with an assessment of the type of services needed. From the sample of files looked at, other professionals were also involved in helping to make sure that everything was in place to help individual residents. A care plan was also provided to help make sure that services were properly organised and the home had a new format for describing and planning what the staff would be doing to help individual residents within a ‘personal service plan’. These were completed to a variable standard and one had very few details of how help was to be provided written within it, (See next section also). The home does not provide an intermediate care service so Standard 6 does not apply.
Derwent House C52-C02 S35815 Derwent House V227419 160505 Stage 4.doc Version 1.30 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10. The care of all residents, including health care, was planned and given in a way that respected individuality and privacy, although further work is required with the documentation that supports care activities to ensure consistency and safety. EVIDENCE: The records of three residents were looked at closely and these people were also spoken to during the inspection. The standard of care plans was varied and some had not been reviewed for some time, either by the staff of the home or with supporters from outside. This could lead to help being given that was based on outdated information. Service users confirmed that they had a good relationship with the home’s staff, whom they said worked very hard and treated them with respect and with care – ‘They always knock on the door when they want to see you’. All those that needed it had regular contact with their doctor or nurse, and this was confirmed by the records examined and observation of a District Nurse in consultation with a resident and the manager. None of the residents spoken to looked after their own medicines and this was managed by the home on their behalf. However, although the overall management of medicines was
Derwent House C52-C02 S35815 Derwent House V227419 160505 Stage 4.doc Version 1.30 Page 10 satisfactory, there were a small number of missing signatures on the administration record, which could lead to unsafe practice. Derwent House C52-C02 S35815 Derwent House V227419 160505 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 13 Residents were generally happy with their lives at the home and were able to arrange their lives to suit themselves. A more regular programme of activities was needed to meet the recreational and leisure interests of residents. EVIDENCE: All the residents spoken to talked about the home in very positive terms and about the life they enjoyed there. They are free to use all of the building without any restrictions and to arrange their daily routines to suit themselves. They receive visitors on an unrestricted basis, and a number spoke about the friendships they had developed since they had moved in – ‘I like to sit and chat with lots of different people during the day’. One resident described her regular shopping trip into Chesterfield with the help of a voluntary agency and others said that some people go to the local shops if staff are free to go with them. They also receive visits from people from the local Salvation Army and church who help them to enjoy a regular communion service. Whilst the manager described a newly appointed member of staff being in post to take responsibility for activities, the residents spoken to felt that there wasn’t much arranged on a regular basis and that they spent much of their time sitting in the lounges. There were no written records of activities taking place within the home available for examination.
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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) None of these Standards was specifically examined at this inspection. EVIDENCE: Derwent House C52-C02 S35815 Derwent House V227419 160505 Stage 4.doc Version 1.30 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 24 and 26. The home is clean hygienic and offers good standards of comfort to residents in both their bedrooms and communal areas, and this had led to high levels of resident satisfaction. However, some aspects of the home’s environment still need attention in order to completely ensure safety and limit deterioration. EVIDENCE: From the first entrance to the home it can be seen to be clean and hygienic and all residents spoken to were happy with how their room was looked after, how their laundry needs were met and how they enjoyed a comfortable life at the home. Examination of records indicated that hygiene safety had been maintained through a recent inspection by the Environmental Health Officer but that the Fire Officer had not visited for over 3 years. Whilst the fabric of the building had been well maintained and it was decorated to a good standard, the external woodwork paint was flaking and needed repainting as required at the last inspection. Furniture supplied throughout the building is domestic in style and in good condition but one of the bedrooms viewed still has a metal-framed bed, which the service user said was noisy and
Derwent House C52-C02 S35815 Derwent House V227419 160505 Stage 4.doc Version 1.30 Page 14 uncomfortable to sleep on. It was a requirement of the last inspection that all such beds be replaced. Derwent House C52-C02 S35815 Derwent House V227419 160505 Stage 4.doc Version 1.30 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Arrangements for staffing meet the minimum standard for a home of this size and the staff care for the residents in an effective way. EVIDENCE: Examination of the rota indicated that a manager was always on duty with a minimum of 3 care staff and frequently with 4. This is above the minimum standard agreed for this home, although residents said that the staff always seemed to be busy, but not so that they didn’t respond when needed. Discussion with the manager indicated that a new domestic assistant had been appointed since the last inspection, leaving a part-time vacancy only; the standards of hygiene referred to above supported that the staff regime was effective in this area. A resident staying at the home for a short break said that the staff were ‘all different’ and they help her in different ways and to settle in quickly. Derwent House C52-C02 S35815 Derwent House V227419 160505 Stage 4.doc Version 1.30 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 33 The home is currently without a registered manager but is subject to regular outside management support and audit. Better standards can be maintained if uncertainty is removed and responsibility is in the hands of a responsible person. EVIDENCE: The previous manager had recently left the home’s employment, and the manager present during the inspection has been appointed in an acting capacity only. Resident files contained satisfaction surveys and the Social Services Department has an established Section that looks at standards of quality throughout the organisation and advises on how things can be improved. Local officers of the organisation are also involved in looking at improving quality but it was not evident how this has affected this home. The manager
Derwent House C52-C02 S35815 Derwent House V227419 160505 Stage 4.doc Version 1.30 Page 17 said that the home’s service manager visited the home regularly but written reports of the audit visits had not been completed. Derwent House C52-C02 S35815 Derwent House V227419 160505 Stage 4.doc Version 1.30 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 x
COMPLAINTS AND PROTECTION 2 x x x x 2 x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 1 x 2 x x x x x Derwent House C52-C02 S35815 Derwent House V227419 160505 Stage 4.doc Version 1.30 Page 19 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15 Requirement All residents must have a service user plan developed to the same standard of detail and this must be reviewed or evaluated on a monthly basis. All records of the administration of medicines must be signed by the person responsible at the time. The Home must develop a more coordinated programme for the provision of leisure activities aligned to the expressed needs and preferences of residents. (Previous timescale of 31/12/04 not met). The registered person must consult with the Fire Officer regarding the need for an inspection visit. External window frames must be repainted. (Previous timescale of 30/09/04 not met). A programme for the replacement of metal frame beds must be established. (Previous timescale of 30/11/04 not met). Up to date written reports from the responsible individual visiting the Home on behalf of the Provider must be made available Timescale for action 31/10/05 2. 9 13(2) 30/06/05 3. 12 16(2) 31/08/05 4. 19 23(4) 30/06/05 5. 6. 19 24 23(2) 13(4) 31/08/09 31/08/05 7. 33 13(4) 30/06/05 Derwent House C52-C02 S35815 Derwent House V227419 160505 Stage 4.doc Version 1.30 Page 20 8. 31 8 for inspection. (Previous timescale of 30/11/04 not met). The regsitered person must appoint a manager for the home and that person must apply to register with the CSCI. 31.08.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard 7 11 20 33 Good Practice Recommendations The manager should ensure that the transition to new care planning systems is completed as soon as possible. The Home should consider ways of determining residents’ wishes around funeral arrangements and record appropriately. Methods to make the bottom lounge more homely and domestic in style should be further considered. Findings from any quality assurance and monitoring activities should be analysed and applied within the home. Derwent House C52-C02 S35815 Derwent House V227419 160505 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection South Point Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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