Random inspection report
Care homes for older people
Name: Address: Dewi-Sant 32 Eggbuckland Road Mannamead Plymouth Devon PL3 5HG two star good service 20/03/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Megan Walker Date: 2 3 0 7 2 0 1 0 Information about the care home
Name of care home: Address: Dewi-Sant 32 Eggbuckland Road Mannamead Plymouth Devon PL3 5HG 01752664923 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mannarest Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 34 Number of places (if applicable): Under 65 Over 65 0 34 dementia old age, not falling within any other category Conditions of registration: 34 0 The maximum number of service users who can be accommodated is 34 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) Date of last inspection 2 0 0 3 2 0 0 9 Care Homes for Older People Page 2 of 18 Brief description of the care home Dewi Sant is a care home providing accommodation and personal care for up to thirtyfour older people, some of whom may have a dementia. It is privately owned by Mannarest Limited. The home is a large, three-storey, detached building, converted into a care home approximately forty years ago and located in the residential area of Mannamead. The home is within walking distance of shops in Mutley Plain and close to bus services into central Plymouth and the railway station. All the bedrooms are single and none of them have en-suite facilities. There are eighteen bedrooms on the ground floor, eleven on the 1st floor and four on the 2nd floor. The top two floors can be reached using the stairs or the stair lifts on each flight. Communal rooms are on the ground floor and consist of two lounge rooms, a dining room and a conservatory with doors out onto a patio. Because of the layout of the home it is not suitable for people who use wheelchairs. The home has limited parking space at the back of the house but unlimited on street parking is available at the front. Information about the home, including copies of inspection reports, can be obtained from the home. Care Homes for Older People Page 3 of 18 What we found:
This was a random inspection undertaken by one Compliance Inspector to check compliance with regulation following a safeguarding alert. We were accompanied for part of this visit by two health and social care professionals on behalf of the safeguarding team. The last key inspection of this service was on 20/03/2009 when it was rated GOOD. The fieldwork part of this inspection was unannounced and took place on Friday 23rd July 2010 between 10:40 and 17:45. On our arrival we were met by a senior care assistant who was the person in charge of the home at that time. The registered manager was not present. We were informed verbally shortly after this visit that the registered manager was no longer working at the home. At our last key inspection we found that care plans were poorly written however by the end of the inspection the registered manager had devised a better proforma for care planning to ensure that all aspects of peoples care would be included so that staff knew what care they should be giving. There was a recommendation as a consequence of the key inspection about improving care plans. We were informed in July 2009 by the registered manager Care plans now overhauled. We found on this visit that care plans were poorly written. Information was exceptionally brief about peoples care needs and how staff should meet those needs. In some care plans there were phrases such as non compliant; when chooses to; when feels like it. These are derogatory and suggest a lack of understanding about how to meet individual care needs. We were concerned that nothing had been done to improve the care files since the last key inspection as issues we had identified then we found on this visit too. We found that information provided in health and social care professionals support plans was not found in the homes care plan. We were concerned that the detailed plan of care provided by health and social care professionals was diminished considerably and its context lost in the homes care plan. Clear information why and how to manage individuals risks provided by health and social care professionals were not in the homes care plan. The portrayal of risks was much lower or even non existent. We also found that information provided as part of a pre-assessment from health and social care professionals indicated that Dewi Sant was not registered to meet those peoples needs. During our tour of the premises we found that call bells did not work or had been turned off. We were concerned that people would not be able summon help when they need assistance or in an emergency. We found that some people were isolated by their room location in the home. There was further concern because some did not have a call bell in the room. On two occasions we found one person calling for assistance and a visiting health care professional also reported having found this person calling for staff. We asked the person in charge to review the vacant bedrooms to see if it was possible for people to change rooms. We also asked our safeguarding colleagues to include bedroom locations and suitability in their reviews.
Care Homes for Older People Page 4 of 18 We found that the people who needed assistance to go to the toilet had set times they were escorted there. We overheard one person asking to go to the toilet however the staff member told the person that they would be taken on their way to lunch. It was not lunchtime. We found that most of the people using this service were sitting either in the lounge or in the conservatory. All the frames and other walking aids were lined up in the hall. This meant that anyone who uses equipment to assist with standing and or walking was unable to do so without staff assistance. We found two sets of different dentures, one set in a glass behind a curtain in the treatment room, the other set in a cupboard in a treatment room. The senior care assistant on duty we asked was unable to explain why two people did not have their teeth. We found open and in use prescribed creams on a table in the hall. The staff we asked did not know why or how it got there. We found prescribed medicines, including controlled drugs in a cupboard that was not lockable. This cupboard was situated in the treatment room that was fully accessible to anyone. The door was open for most of our visit. We found a number of doors propped open by various items rather than approved holdopen devices. A staff member told us that all the bedroom doors are kept open to provide ventilation through the home. One member of staff objected that we removed a door wedge. The maintenance person subsequently fitted an approved hold-open device however this door would not close securely into the latch. This means that in the event of a fire people would be at risk. The maintenance person told us that he would check all the doors including those we had identified to arrange an order for more approved hold-open devices that he could fit. We later advised the person who took charge to ensure that as part of the routine maintenance checks as well as routine fire safety checks, all doors have approved hold-open devices in working order, and all doors close securely so that people are at less risk in the event of a fire. We observed part of the staff handover between the morning and the afternoon shifts. This took place in the dining room. A kitchen assistant vacuumed around the care staff throughout this handover making it very difficult to hear important information. When asked if this was usual, we were met with a shrug and inference that the care staff were in the way. We were told the handover usually takes place in the treatment room however this was being used by a visiting health care professional. None of the care staff wrote any notes about the information they were receiving from the senior care assistant going off duty. We were concerned about the attitude of the chef who had little regard for the care staff or tolerance of an inspection that at this time did not concern the kitchen and its staff. We found the the focus of the kitchen staff overseen by an arrogant chef was task and time orientated. Our observations of staff found that they were offhand with some of the people using this service, and pleasant and respectful to others. We found they were willing to support and
Care Homes for Older People Page 5 of 18 assist those people who were more able however they were disinterested or showed frustration with the people who needed more time and 1:1 support. We also found that they congregated in the hallway chatting amongst themselves rather than engaging in meaningful ways with the people residing at Dewi Sant. We found overall much of the communication and interaction we saw was either task based or based around information giving. Again the routines of the day we found were time and task orientated. At the last key inspection most staff files were not available in the home for inspection. A requirement was made for Personnel files for all staff members must be kept in the care home and be available for inspection. On this visit we were unable to find any information about staff training or staff files although there was a locked filing cabinet we could not access. The registered provider informed us during this visit that all the staff files should be kept at the home and she had asked the registered manager to ensure this was the case. As part of a subsequent visit the following week by the safeguarding team, we asked them to check if any staff files were in the locked filing cabinet. There were no staff files to be found at the home. We found a large chart taped on to the treatment room door naming staff who had taken sick leave and the staff who had worked those shifts for them. The staff told us that the registered manager had put it up as a name and shame chart because she did not like anyone going off sick. We removed it and advised a member of staff that it was inappropriate. We found food on the dining room floor from breakfast time. During our visit we spoke to two people responsible for cleaning. One of these people spoke enthusiastically about her job. From our observations she had cleaned thoroughly the areas of the home allocated to her upstairs. During our visit we spoke to the Responsible Individual on the telephone. She told us that she was arranging for someone to act as a temporary manager. She also told us that she had told the senior care staff to ensure they worked in pairs over the weekend. We spoke to the senior care assistant about this. She told us that there were only three senior care assistants, she had already worked all week and had made arrangements for the weekend so would not be working extra time during the weekend. We looked at the staff rota. We found there were three care assistants and one senior care assistant on duty from 14:00 until 21:00; a kitchen assistant was working from 16:00 until 20:00; and two care staff would be working from 21:00 over night. During the morning we had spoken to the Company Secretary acting on behalf of the Responsible Individual about recruiting a temporary manager. She had agreed that she would contact local agencies to find someone who could start as soon as possible. At the end of the afternoon the person whom the Responsible Individual had told had agreed to act as a temporary manager arrived at Dewi Sant. She advised us that she was willing to provide on call cover for the weekend. We explained our findings during this visit. The person taking charge immediately took responsibility of the medicines with the senior care assistant, ensuring that everything we had found was put away in a lockable cupboard. She also made sure that all the controlled drugs were stored securely as required. We found that the senior care assistant did not seem to know why all the medicines had to be stored securely. This person also made a tour of the premises to ensure all fire doors were closed and that
Care Homes for Older People Page 6 of 18 staff understood they were not to be propped open with anything other than an approved hold-open safety device. We had found a fire safety inspection letter stating that the home was non compliant with aspects of fire safety and we could find no evidence that anything had been done to meet these fire safety requirements. The person taking charge agreed to arrange an independent fire safety inspection as soon as possible the following week. At the end of our visit, because of our concerns about the lack of information in individual care plans, our observations of the staff and their interactions with the people using this service, and our concerns about how people were being supported and offered care, we asked our safeguarding colleagues to arrange reviews of everybody living at the home. This was to ensure that the people using this service were receiving the care and support they need for their individual physical and mental wellbeing. At the end of our visit we advised the person who taken charge that members of the safeguarding team would be calling in over the weekend, as would district nurses; a nurse practitioner would be coming into the home on the following Monday with a Primary Care Trust pharmacist to review all the medicines including its handling and administration in the home; and that we required the registered provider to seek a temporary full time manager as quickly as possible to provide management and leadership for the staff until such time as a resolution had been found regarding the registered manager. What the care home does well: What they could do better:
We have serious concerns about the safety and wellbeing of the people using this service. The health, safety and well being of everyone who uses this service must be the main priority of the registered provider. This can be done by ensuring all staff are fully trained in all aspects of care, including recognising and reporting abusive practice, fire safety, moving and handling, first aid, infection control, and health and safety. This will ensure that all the staff care for vulnerable people in a safe and effective way which does not place them at risk. A further concern from this inspection found that the management style does not promote a home that is run in such a way that creates an open, positive and inclusive atmosphere. The staff are not encouraged to maintain good personal and professional relationships with the people using this service because the registered manager has a
Care Homes for Older People Page 7 of 18 task focused approach towards the provision of care. This means that the people using this service do not benefit from personalised and individual care. Before someone comes to live at Dewi Sant a thorough assessment of their health and social care needs must be carried out to ensure that the home is suitable, that any required equipment is available, and that the staff team are experienced, skilled and competent to meet the persons needs. These assessments need to be documented and include all aspects of personal, health, psychological and social care needs to ensure that peoples needs are fully identified. Once a person moves into a care home, or before, a care and support plan has to be developed with the person and/or relatives and representatives. This is to agree what care the person needs and how the staff team should support them. The care plans in the home need to include all aspects of peoples care needs and how the staff should meet those needs. The plans should include risk assessments for those people deemed to be at risk of falling, night-time routines, communication needs and details of peoples social activities, interests, hobbies and aspirations. Care plans should be signed by the people who live in the home and/or relatives/representatives to show that they have been involved in drawing up the plan and are aware of the content. Care Plans must also be improved to show that care has been reviewed and reflects the care that is actually given. Care records should be informative and portray a positive picture of peoples daily life. Care records must be accurate. These improvements will mean that care staff have accurate records and will be able to provide care in a safe and consistent way. Improvements are needed to the way medicines are managed in the home to ensure that no-one is at risk, and to make sure people always receive their medicines safely as their doctor has prescribed for them. To ensure that peoples wellbeing is supported, the care staff need to develop how they communicate and interact with people so it is effective and follows the care plan. This will ensure that care is given in a consistent way and this will enable the people using this service to feel secure. To ensure that people are cared for in a flexible way changes to work practices and cultures must make certain that work practices fit around the people receiving care, rather than the other way around. People less able to express their views should be consulted about choices in such a way that they are able to make a choice. The registered provider must introduce changes in care practices to ensure that the people who live at Dewi Sant are respected as individuals by the manner in which they are addressed and treated. Communication between staff should improve to ensure staff have accurate information on changes and needs of each person. Communication across staff teams should improve so they work together in achieving a common purpose of providing safe and consistent care that is personalised and individual. Staff must make sure they do not assume that some people consistently want the same things or routines each day. By ensuring staff cultures change at the home will mean that people will feel able to take more control over their daily lives. More social activities and outings should be provided, as well as engaging the people who
Care Homes for Older People Page 8 of 18 live at Dewi Sant in activities of daily life in the home. The safety of people must be a priority in the home. Staff must remember that people need access to a call bell when they are in communal areas or in their bedrooms with no staff presence. Call bells must not be turned off and must be maintained in working order. Fire safety must be a priority for the provider of this service. Staff files must be kept at the care home and made available for inspection. Information about staff training must be made available for inspection. Staff must be able to recognise and correctly report allegations of abuse to the local safeguarding tea. They must know how to report poor practice. This will protect people by making sure allegations are reported correctly, poor practice is managed effectively and appropriately, and poor management does not affect any investigation that needs to take place. Staff must know of the Mental Capacity Act and the Deprivation of Liberty Safeguards. This will enable them to recognise and understand how their care practices could be seen as restraint. The use of restraint must only be used as a last resort and where the use is in the best interest of the person and not for the convenience of staff. A routine programme of maintenance and renewal of the fabric and decoration of the premises should be written and implemented. This will to ensure the people using this service live in a safe, well maintained environment, with routine checks and renew of equipment when it is worn out or corroding. The registered provider must make immediate arrangements to appoint a full time manager. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 9 of 18 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 29 19 No person must be employed 30/06/2009 in the care home before all the required checks and references have been received and are satisfactory. These include a check against the Protection of Vulnerable Adults list, a Criminal Records Bureau check and a full employment history. If a person is employed in the home prior to receiving a satisfactory check from the Criminal Records Bureau, this person must be supervised by a designated staff member at times, and must not escort people who live in the home away from the premises. This is to ensure that suitable people are employed and protect the people who live in the home from risk of harm. 2 29 17 Personnel files for all staff members must be kept in the care home and be available for inspection. This is to ensure that suitable people are employed and protect the people who live in the home from risk of 30/06/2009 Care Homes for Older People Page 10 of 18 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action harm. Care Homes for Older People Page 11 of 18 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 3 14 You must ensure that no-one 31/08/2010 is admitted to the care home unless they have had a satisfactory assessment performed. This is to ensure staff are aware of the needs of the person and have made a decision they are able to meet those needs. This shows that staff are able to meet the needs of the person before they come to the home and to help staff prepare what equipment and training is needed. 2 7 15 You must ensure that care 28/09/2010 plans and risk assessments are accurate, are reviewed to show changes and contain accurate information to enable staff to provide care in a safe and consistent way. This will ensure staff will be aware at all times what care an individual needs. Care Homes for Older People Page 12 of 18 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 3 8 12 You must ensure systems are 31/08/2010 in place to make certain people receive the finer details of care that allows them to make decisions about their lives. This will ensure that care staff involve people in their care. 4 9 13 You must ensure that controlled drugs are stored securely in accordance with the requirements of the Misuse of Drugs (Safe Custody) Regulations 1973 as amended. This is to make sure controlled drugs are safely stored and to comply with current legislation. 20/08/2010 5 9 13 You must ensure that 20/08/2010 arrangements are made to make certain that medication is stored securely and at the correct temperature recommended by the manufacturer. This is to protect people in the home and to make sure that medicines are safe and effective for people. 6 9 13 You must ensure that care 20/08/2010 plans include detailed information for staff about the administration of medicines to people, and risk assessments where people manage their own medicines.
Page 13 of 18 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action This is to make sure people receive their medicines correctly and safely, in the way their doctor has prescribed 7 10 13 You must ensure staff work 31/08/2010 in a way that respects the privacy and dignity of people who use the service including ensuring the language used by the staff to refer to people who use the service is appropriate. This promotes privacy and dignity. 8 12 18 You must ensure that all staff 31/08/2010 consult with people living at the home about their social interests and make arrangements to enable them to engage in a range of activities according to their ability. This includes people less able and those spending considerable time in their bedrooms. This will ensure that everyone living at the home will have a good quality of life and be able to participate in things they enjoy. 9 18 13 You must make 31/08/2010 arrangements for the training of all staff in recognition and prevention of abuse and what to do if abuse is suspected. Care Homes for Older People Page 14 of 18 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Also you must ensure that all staff know about and have an understanding of the Mental Capacity Act and the Deprivation of Liberties Safeguards. This will ensure that the people who use this service are protected from abuse, or the risk of abuse, and their human rights are protected and upheld. The use of restraint is always appropriate, reasonable, proportionate, and justifiable to the individual. Deprivation of Liberty Safeguards are only used in the best interests of the person using this service, and in accordance with the Mental Capacity Act 2005. 10 19 23 You must ensure that the 31/08/2010 premises both inside and outside is suitable for the purpose of achieving the aims and objectives set out in the statement of purpose, and are appropriate to the needs of the people using this service. This will ensure that people live in a well mainitained building that is appropriate to their individual needs. 11 30 18 You must ensure that there is a clear, comprehensive and robust training programme in place so that all staff attend at least all 27/08/2010 Care Homes for Older People Page 15 of 18 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action mandatory training that is accredited. This means that people using this service can be confident they are being cared for by staff who are trained and competent to do their job. 12 31 12 You must ensure that the 29/09/2010 home is managed in such a way that proper provision is made for the health, welfare and safety of the people who use this service. This is to ensure that anyone with managerial responsibilty knows what their role and responsibilites of what they must do and can carry out thier duties. 13 38 23 You must ensure that all fire doors are kept shut unless held open by an approved hold-open device. This is to ensure that the people uisng this service are protected from harm. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 12/08/2010 1 27 You should ensure that staff deployment and skill mix is monitored to show that people who use the service are getting their needs met and not having the level of care affected.
Page 16 of 18 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations This will mean that staff are sufficient in numbers and skill mix to meet the needs of people in the home. Care Homes for Older People Page 17 of 18 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 18 of 18 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
