CARE HOMES FOR OLDER PEOPLE
Dial House 7-9 Dynevor Road Bedford MK40 2DB Lead Inspector
Sally Snelson Unannounced 13th July 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dial House I51 S44871 Dial House V235152 130705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Dial House Address 7-9 Dynevor Road Bedford MK40 2DB 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) Category(ies) of registration, with number of places 01234 356555 01234 402444 Dialhousecare@aol.com Dial House Care Ltd Vanessa Simic Care home with nursing 50 OP D(E) PD MD 50 20 5 10 Dial House I51 S44871 Dial House V235152 130705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. THE HOME CAN ACCOMMODATE A MAXIMUM OF 50 SERVICE USERS OF EITHER SEX. 2. NO ONE FALLING INTO THE CATEGORY OF YOUNGER ADULT 40-65 YRRS MAY BE ADMITTED TO THE HOME WHEN THERE ARE ALREADY 5 PERSONS IN THIS CATEGORY 3. NO ONE WITH A DIAGNOSIS OF DEMENTIA MAY BE ADMITTED TO THE HOME WHEN THERE ARE ALREADY 20 PERSONS IN THIS CATEGORY 4. NO ONE WITH A DIAGNOSIS OF MENTAL DISORDER MAY BE ADMITTED TO THE HOME WHEN THERE ARE ALREADY 10 PERSONS IN THIS CATEGORY. Date of last inspection 12th March 2005 Brief Description of the Service: Dial House has been developed from two large Victorian properties to provide care for 50 service users over the age of 65 years who require care with or without nursing. The registration also allows for up to 20 of the service users to have a diagnosis of dementia and 10 a mental health condition. 5 service users over 40 years but under 65 years can also be cared for. Those service users under the age of 65 years are to be assessed by the manager as having similar needs to those service users already being cared for. The home is situated a short walk away from the town centre of Bedford, and its rail and bus services. There are a number of domestic properties in the area that have been converted into care establishments. The home has an area at the front that can be used for parking as the road outside has zoned parking. The home also has attractive well-maintained gardens and sun terraces to the rear which can be accessed easily by service users. Dial House I51 S44871 Dial House V235152 130705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over a three and-a-half hour period from 8pm on the 13th July. The focus of the inspection was to look at the care provided for service users during the evening and the early part of the night. The inspector took the opportunity to speak to staff, service users and visitors. The two nurses on duty were present throughout and the inspector fed back to one of them at the end of the inspection. Feedback was given to the deputy matron the next morning. What the service does well:
The inspection took place at the end of a very hot day. Nearly all of the service users had been provided with an electric fan in their bedrooms, and a number of additional fans were positioned throughout the home. It was noted that service users had choices. At 8pm the majority were still up, either sitting in their bedrooms or in one of the communal lounges. Some had chosen to get ready for bed, one service user said, “My nightdress is much cooler, I would like to wear it all day”. The last service user to go to bed chose to go at midnight. All of the service users were offered a hot or cold drink during the evening and had a choice of sandwiches or biscuits to go with it. One gentleman was enjoying a tot of whisky before retiring. It was clear that the staff work hard to ensure that service users receive the correct care. Care plans had been sensitively written and included all the relevant information. One service user was reading her care plan and said it was correct, she also said “all the staff are so lovely here”. She was aware of the complaints procedure and what to do if she was unhappy with her care. Service users had recently enjoyed excursions to Cadbury’s world and Olney market. A cockney evening, a quiz night and an entertainer were planned for the summer. One service user said “ We had a picnic in the park which reminded me of my younger days”. The home was well decorated and clean throughout. A visitor said that when her mother had become ill she had looked at a number of homes, and had chosen Dial House because it was bright and airy.
Dial House I51 S44871 Dial House V235152 130705 Stage 4.doc Version 1.40 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. Dial House I51 S44871 Dial House V235152 130705 Stage 4.doc Version 1.40 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 Dial House I51 S44871 Dial House V235152 130705 Stage 4.doc Version 1.40 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) 3,4,and 6 Thorough assessments of service users before admission ensured that their needs could be met at Dial House. EVIDENCE: Relatives spoken to as part of the inspection stated that they had visited the home prior to admission. One relative reported that initially her mother had been admitted for a trial period. The inspector did not have access to contracts or terms of conditions as the inspection was out of office hours; these will be sampled as part of the announced inspection planned for October. There was evidence that staff took enquiry details from relatives or social services. One of the senior members of staff then made a pre-admission visit to assess the service user before agreeing that Dial House could meet their needs. The service users spoken to reported having all their needs met by caring staff. Dial house was not providing intermediate care at the time of the inspection.
Dial House I51 S44871 Dial House V235152 130705 Stage 4.doc Version 1.40 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) 7,8,9,10 and 11. The comprehensive care planning system ensured that staff were aware of the care needs of the service users and the actions they must take to meet these needs. EVIDENCE: Care files, that included the care plans, were stored in the individual service users bedroom. It was noted that the care plans had been regular reviewed and updated and in many cases signed and agreed by the service user or a relative on their behalf. The care plans had some pre-written instructions; however the inspector was confident that additional information was included as necessary. The information from the care plan and any associated assessments were sufficient for a staff member, who did not know the service user, to provide the correct and appropriate care. Where a service user had been admitted to a non-nursing bed appropriate advice and support was sought from community health staff. Health and welfare was regularly assessed. All service users were weighed and had a blood pressure check at least once every month. Nutritional needs and
Dial House I51 S44871 Dial House V235152 130705 Stage 4.doc Version 1.40 Page 10 assessments to assess the risk of developing pressure areas were also regularly carried out. There was evidence that opticians, chiropodists and dentists visited regularly. It was noted that a service user who smoked in her bedroom did not have a care plan or a risk assessment to support her smoking. Her family confirmed that she was never left to smoke unsupervised. The majority of the medication was given via a metered dose system. The inspector witnessed two nurses correctly administering a controlled drug Medication was stored appropriately and regular medication fridge and storage temperatures were recorded. There were occasional omissions in the recording of the administration of medication. The inspector noted that on more than one occasion there was a ‘?’ in the space for the signature. The deputy manager confirmed that when a member of staff noted that an omission had occurred the ‘?’ was used until the responsible staff member was next on duty and could confirm why it had not been signed. A senior staff member should audit the omissions to identify any trends and staff who might benefit from extra medication training. Staff were observed treating service users with respect and dignity throughout the inspection. Service users were spoken to kindly and staff knocked on doors before entering. All of the service users and/or their families had agreed a final days plan which was kept on file. Dial House I51 S44871 Dial House V235152 130705 Stage 4.doc Version 1.40 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) 12,14 and 15 A varied menu suggested that service users were served a balanced diet. EVIDENCE: Because the inspection took place in the evening the inspector did not observe activities taking place. However, around the home, there were a number of examples of the activities that service users had been involved in; including card making, singing and art. One of the service users showed the inspector a card that she had made for a relatives birthday. A weekly activity plan was publicised in the home; this plan ran from 10am to 6pm and included three to four different activities a day. Service users had recently enjoyed excursions to Cadbury’s world and Olney market. A cockney evening, a quiz night and an entertainer were planned. Each of the service users had an activity plan that detailed the type of activity they enjoyed in the past, and the outcomes following any activities in which they participated. During the evening service users were offered hot or cold drinks and sandwiches or biscuits. It was noted that the dining room was prepared for the next meal and each of the tables had a vase of flowers on it. Dial House I51 S44871 Dial House V235152 130705 Stage 4.doc Version 1.40 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: This standards were not assessed Dial House I51 S44871 Dial House V235152 130705 Stage 4.doc Version 1.40 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) 19,20,24 and 26 The pleasant décor and the attention to detail meant that service users had a safe, comfortable environment in which to live. EVIDENCE: The home was clean and tidy throughout. Service users were accommodated in single and double rooms. There were 34 single and eight double bedrooms. The inspector spoke to a married couple sharing a double room. The husband was spending the first night with his wife who had been accommodated sometime previously. They were both happy to be able to be together. All of the double rooms had screens to ensure privacy. Service users were offered the opportunity to decorate their bedrooms with small pieces of furniture or items from home. On the door of one bedroom was a sign to ‘be aware of a free flying bird’ as one service user had a cockatiel which occasionally came out of its cage for a fly around. Communal space was divided into small areas offering service users a good choice of where they spent their time.
Dial House I51 S44871 Dial House V235152 130705 Stage 4.doc Version 1.40 Page 14 The gardens were attractive and accessible to all of the service users. Outside seating areas were available and service users could view the garden and the container planting. It was noted that some of the bathrooms, possibly because of the bathing aids, were clinical. This was in contrast to other areas of the home, however these areas were large and clean. Dial House I51 S44871 Dial House V235152 130705 Stage 4.doc Version 1.40 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 and 30 Staff were positive about working at Dial House and the training opportunities they were given. This ensured that staff working at Dial house were experienced and qualified to care for the needs of the service users accommodated. EVIDENCE: During the night there were two trained nurses and three carers on duty. One nurse explained that one nurse and two carers were responsible for those service users in bedrooms on the first floor and a nurse and a carer looked after those living on the ground floor. Staff spoken to were very clear of their duties for the night, which included some work in the laundry. Rotas confirmed that during the morning, when there was greatest need, there were eight carers working with two nurses across the two floors, in addition to ancillary and activity staff. The home had it own bank staff to cover outstanding shifts. This meant that the use of agency staff was kept to a minimum. Male staff were employed, and all service users were asked at admission for their preferences as to the gender of staff who cared for them. One of the senior nurses took responsibility for training. She would provide training in-house and also arrange for external trainers, for example from the McMillan service. Many carers had completed or where enrolled on NVQ courses. A qualified nurse reported that she had no problem completing the amount of training required by the nurses registration body. Dial House I51 S44871 Dial House V235152 130705 Stage 4.doc Version 1.40 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) 31,32,33 and 38 The home had an experienced committed manager who ensured strong leadership. EVIDENCE: The manager was a very experienced nurse who had undertaken management training and was involved in care home organisations throughout the county. Even though the manager was absent during the inspection there was clear evidence of her leadership, and that of the senior team. The manager had a clear vision for the home which was influenced by regular questionnaires to staff, service users, service users families and other interested parties. Staff confirmed that regular staff meetings were held where policies, procedures and good practices were discussed. All the required testing of systems and equipment had been carried out. It was noted that all bedrooms had been fitted with doorgards which allowed the
Dial House I51 S44871 Dial House V235152 130705 Stage 4.doc Version 1.40 Page 17 door to be open but ensured they would close if a fire occurred. The last fire and safety checks had taken place 8.7.05. The inspector noted a notice above the baths about fluctuating water temperatures. A problem with the temperature of the water being delivered had obviously been identified and risk assessed. This maybe investigated to ensure that all water is delivered as close to 43 degrees as possible. The health and safety of a staff member was compromised by her wearing open sandals. This had not been agreed with the management or risk assessed. The deputy manager dealt with this situation immediately and the staff member received a warning. Dial House I51 S44871 Dial House V235152 130705 Stage 4.doc Version 1.40 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 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3
COMPLAINTS AND PROTECTION 4 3 x x x 3 x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 4 3 3 x x x x 3 Dial House I51 S44871 Dial House V235152 130705 Stage 4.doc Version 1.40 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 Service users who choose to smoke must have a care plan and a risk assessment to support this. Staff must ensure that medication charts are signed immediately that a medication has been given Timescale for action 01.09.05 2. 9 17 01.09.05 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. Refer to Standard 38 Good Practice Recommendations The temperature that water is delivered should be checked and appropriate action taken to ensure the temperature is as near to 43 degrees as possible. Dial House I51 S44871 Dial House V235152 130705 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection Clifton House 4a Goldington Road Bedford Mk40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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