CARE HOME ADULTS 18-65
Devonshire Manor Care Home 2 Devonshire Road Sherwood Nottingham NG5 2EW Lead Inspector
Stephen Benson Key Unannounced Inspection 6 and 7th June 2006 09:30
th Devonshire Manor Care Home DS0000002196.V293324.R01.S.doc Version 5.2 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 Devonshire Manor Care Home DS0000002196.V293324.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 Adults 18-65. 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. Devonshire Manor Care Home DS0000002196.V293324.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Devonshire Manor Care Home Address 2 Devonshire Road Sherwood Nottingham NG5 2EW 0115 962 2538 0115 9856111 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) Mrs Margaret Ann Webster Joanne Tatia Ault Post Vacant Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Devonshire Manor Care Home DS0000002196.V293324.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. People accommodated will have suffered a head injury. People accommodated will be aged 18 or over. Date of last inspection 24th October 2005 Brief Description of the Service: Devonshire Manor is a care home providing personal care and accommodation for 5 younger adults who have disabilities resulting from a brain injury. The home provides short and long term care and will provide a respite service and accept emergency admissions. The home is owned by Stepforward (Nottingham) which is run as a family business. The home is located in a residential area of Sherwood close to shops, pubs, the post office and other amenities. The home was opened in 1987 and consists of a domestic dwelling with a small extension to the rear. All of the home’s bedrooms are single, and none of the bedrooms have en-suite facilities. Bedrooms are located on 2 floors. The home does not have a lift. The home has a small tarmac courtyard and there is car parking available for 2 cars with further unrestricted parking available on the road. The acting manager said on 7/6/06 that the fees for the service start from £800 per week. Devonshire Manor Care Home DS0000002196.V293324.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first visit to the home since 1st April 2006 by The Commission for Social Care Inspection. The inspection lasted for 5 ½ hours and the main method of inspection used was called case tracking which involved selecting 2 residents and tracking the care they receive through the checking of their records and discussing this with them. Other residents were spoken with and additional records were seen. A discussion was had with the acting manager, care staff on duty and care practices were observed. There were no relatives or visiting professionals present during the inspection. The premises were not inspected in detail but various areas of the home were visited as part of the inspection What the service does well:
The ethos of the home is to encourage residents to make decisions about what they do and how, where they are able to which enables them to be as independent as they are able to. Any new or potential risk is assessed to assess ways of reducing any potential harm. Residents are able to access local colleges or other community resources to follow their interests. One resident said she enjoys working in a local charity shop. This enables residents to follow appropriate activities and participate in the local community. Emphasis is placed on helping residents maintain contact with families so that they can continue those relationships. Residents are able to receive personal support in private and in the way that they prefer. This promotes the privacy and dignity of residents. There are suitable arrangements made so residents attend routine health checks to ensure that their healthcare needs are met an d safe practices are used in the administration of medicines so that residents are not at risk. There is a competent and trained staff group who are able to meet the needs of the residents. Devonshire Manor Care Home DS0000002196.V293324.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Devonshire Manor Care Home DS0000002196.V293324.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Devonshire Manor Care Home DS0000002196.V293324.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New residents are assessed prior to admission. EVIDENCE: There has not been a new admission to the home since the registered manager left. The acting manager said that she has previously assessed residents prior to admission and would follow this practice if any referral is received. The acting manager said that there is a pro forma to use for carrying out assessments. Other senior staff were a little uncertain about the admission process and it is recommended that they are familiar with this. As there have not been any recently admitted residents it was not possible to obtain residents views in this area. Devonshire Manor Care Home DS0000002196.V293324.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans do not clearly show residents goals. Residents make decisions about their lives with assistance as needed. Residents are supported to take risks as part of an independent lifestyle. EVIDENCE: Staff said that care plans are usually prepared and updated by keyworkers. Staff were seen evaluating plans and said that where possible residents are involved in this. Care plans seen covered a range of needs although there were some which would benefit from being more detailed, for example one resident is being helped to learn independent living skills but the care plan is not specific about what needs to be learnt. A discussion was had with a member of staff about how effective this plan was and as a result the member of staff discussed the plan with the resident concerned and made a number of changes to it. Some residents said that staff discuss their care plans with them, although this is not possible for all residents. One resident has been
Devonshire Manor Care Home DS0000002196.V293324.R01.S.doc Version 5.2 Page 10 exhibiting challenging behaviour, in particular towards one member of staff, and although the resident has been given a written warning there is not a care plan detailing how this behaviour should be managed. Residents are able to make decisions about their daily routines and how they spend their time. Residents were seen spending time where they wanted and making themselves drinks. One resident said she has a bath and goes to bed when she wants and others said that they had chosen not to continue with their day time activities including going to college. Staff said that they had tried to encourage the resident to continue the course but that they had to respect his wishes. There were a range of risk assessments included on residents files and staff said that they carry out a risk assessment before residents take part in any activity. Residents are assessed as to their suitability to access the kitchen and laundry and whether they are able to go out on their own. One resident said that she used to go to a local day club on her own but has decided that she no longer wants to go. Devonshire Manor Care Home DS0000002196.V293324.R01.S.doc Version 5.2 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to take part in age, peer and culturally appropriate activities. Residents are part of the local community. Residents are able to maintain family relationships. Residents rights are respected and responsibilities recognised in their daily lives. Residents are offered a healthy diet and enjoy their meals. EVIDENCE: The acting manager said that they are aware of the courses available for residents at local colleges and that there are a range of differing day placements used. Staff try to ensure that residents are able to follow interests of their choice. One resident said that he had started going to the gym, which
Devonshire Manor Care Home DS0000002196.V293324.R01.S.doc Version 5.2 Page 12 he enjoyed but he was not interested in college courses. Another resident said she had stopped going to a local club but enjoyed working in a charity shop. Residents make use of local community resources, usually as part of a planned activity as residents normally need escorting when they go out. Residents said that they were disappointed that a local pub had stopped doing karaoke and staff said they were looking for another pub they can go to. One member of staff has recently been allocated the role of activities coordinator and said she has been asking residents what they would like to do. Some new equipment, both indoor and outdoor, has been bought and residents have planted out the flowerbeds. Care plans detailed arrangements for residents to have contact with their families and staff talked about working closely with families. One resident said she enjoyed visits to her family and wanted to arrange to see her nephew. The acting manager said she would see if this was possible. Another resident goes to see his mother every week. Staff were seen talking with residents in a relaxed and respectful manner. Staff said they try to promote residents independence as much as possible and comments from residents included that they do their own washing and ironing, tidy their own rooms and help with chores around the home. One resident said he had cooked the evening meal the previous night. Residents are able to choose the menu and are encouraged to participate in cooking meals where they are able. One resident is responsible for planning, buying and cooking her meals, although can join the rest for Sunday lunch. Residents said that they like the food and have plenty to eat. Devonshire Manor Care Home DS0000002196.V293324.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive personal support in the way they prefer and require. Residents physical and emotional health needs are met. Residents are protected by the homes policies and procedures for dealing with medicines. EVIDENCE: Staff said that where able residents manage their own personal care, but three of the residents do require some assistance. All residents have a single bedroom so any attention can be provided in private. Training has been provided to staff on maintaining residents’ privacy and dignity. Residents described receiving differing levels of support. Arrangements are in place for residents to receive routine healthcare checks and appointments. Records showed that one resident recently had some new glasses and staff were heard discussing dental arrangements. A record is made in residents care plans of all appointments attended. Residents said that
Devonshire Manor Care Home DS0000002196.V293324.R01.S.doc Version 5.2 Page 14 if they raise any health concerns staff make an appointment and one resident said that a dentist appointment had been made for later this month. There are not any residents who have been assessed as being able to self medicate. Medication is kept securely stored and a monitored dosage system is used. Medicine Administration Records were seen properly completed. Staff have to complete a safe handling of medicines course before they are able to administer medication. Residents said that staff give them their tablets and that they always stay and watch them take them. Devonshire Manor Care Home DS0000002196.V293324.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents views are not listened to and acted upon. Staff are unsure as to how to protect residents from abuse, neglect and self harm. EVIDENCE: There is a complaints procedure in place and a book for recording any complaints in. This book is an old book that is not suitable for this purpose and a new book should be provided. Complaints recorded were all received from relatives, although staff were aware of complaints that have been made by residents. One resident complained during the inspection that she had not been allowed to have an ice cream the previous day, when other residents were given one as she buys her own food. A senior member of staff said she would investigate this using the home’s complaints procedure. There is a copy of the Adult Protection Procedures available in the home, but this file contained other information included in the files making it more difficult for staff to be able to refer to the procedures. Staff were uncertain as to the procedures they should follow in the event of any allegation of abuse. Devonshire Manor Care Home DS0000002196.V293324.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. 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. Residents live in a homely comfortable and safe environment. The home is clean and hygienic. EVIDENCE: The home is an adapted domestic dwelling and does not have any type of lift. There are two bedrooms on the ground floor, which can be used by anyone unable to use the stairs. A handyperson is employed to carry out routine maintenance and repairs. Residents said they like the building as it is an ordinary house. The laundry is located in the cellar and only residents who have been assessed as being able to use this room can do so. A new floor is on order for this area. Residents assist with cleaning the home and said that they feel it is kept clean and tidy. Devonshire Manor Care Home DS0000002196.V293324.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by competent and qualified staff. Residents are supported by the home’s recruitment policies and practices. Residents individual and joint needs are met by appropriately trained staff. EVIDENCE: Staff were seen spending time with residents and listening and talking with them. Staff spoken with demonstrated an understanding of their role and have undergone appropriate training. Residents said that they thought the staff knew what their job entailed. There has been new member of staff appointed recently and the staff file showed that the appropriate checks were carried out prior to the member of staff started working in the home. The acting manager has completed a skills audit form for each member of staff showing what training they have undertaken. The actual training records were not available as these are held electronically and the computer was not operating properly at the inspection. Residents said that staff tell them if they are not going to be at work if they are going on a training course.
Devonshire Manor Care Home DS0000002196.V293324.R01.S.doc Version 5.2 Page 18 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home requires a manager to be well run. Residents believe their views are taken into account in the running of the home. The health, safety and welfare of residents are promoted and protected. EVIDENCE: The registered manger left the position in February 2006. The deputy manager is now the acting manager and the provider said it is intended that she is put forward to be the registered manager. Residents said that the acting manager is doing a smashing job and is the right person for it. Staff said they thought she had stepped in well and provided them with support. The acting manager said that quality assurance forms have been sent to relatives and ones will be sent to residents and staff shortly. A member of
Devonshire Manor Care Home DS0000002196.V293324.R01.S.doc Version 5.2 Page 19 staff said that she holds responsibility for activities and asks residents for their views on these and act upon what they say. The acting manager has introduced a new system for recording fire drills and training. The fire log was fully completed. Residents said that they hear the alarm being tested. Devonshire Manor Care Home DS0000002196.V293324.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 X 3 X X 3 X Devonshire Manor Care Home DS0000002196.V293324.R01.S.doc Version 5.2 Page 21 No 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 YA6 Regulation 15 Requirement The registered person must ensure that care plans detail residents goals and describe how challenging behaviour is managed The registered person must ensure that all complaints are investigated and recorded in an appropriate complaints book. The registered person must ensure that all staff are aware of how to protect residents through use of the Adult Protection Procedures The registered person must appoint a manager for the home Timescale for action 01/08/06 2 YA22 22 01/07/06 3 YA23 13 01/08/06 4 YA37 8 01/08/06 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 YA2 Good Practice Recommendations All staff should be familiar with the admission process. Devonshire Manor Care Home DS0000002196.V293324.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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