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Inspection on 22/05/06 for Diamond House Care Home

Also see our care home review for Diamond House Care Home for more information

This inspection was carried out on 22nd May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home has a staff group who appear enthusiastic and committed to trying to provide good care to service users that helps to create a homely atmosphere. Service users and staff state that they have confidence in the manager. There is a relatively low turnover of staff and stable staff team. The home provides a suitable range of activities to service users with differing needs and preferences.

What has improved since the last inspection?

There was evidence throughout the inspection of a more robust management approach toward meeting the requirements of the National Minimum Standards, and in achieving good outcomes for service users. Greater care and attention has evidently been paid to practice in a range of areas from pre-admission assessment, privacy and dignity issues for service users, the home`s environment, health and safety issues and dementia care (where the most notable improvements have been made). Service users accommodated on the first floor of the home have an improved environment that is more homely and better suited to their needs. This area was free from offensive odours. Service users now have free access to their bedrooms, access to an improved activities area, a generally more stimulating environment and access to finger foods and fresh fruit throughout the day. There was evidence of a greater well being of service users throughout the home at this inspection.

What the care home could do better:

Although no deficits to the staff training programme were identified, the level of NVQ trained staff remains below the 50% required. Though, it is acknowledged that progress is being made toward this target. Care planning in several instances falls short of providing care staff with the information they need in order to meet identified needs. Reviews of care plans should be undertaken with greater care and accuracy to reflect actual changes in service user need and care requirements. Careful monitoring of staffing levels and an understanding of appropriate procedures is required in the event of staff shortfall or absence.

CARE HOMES FOR OLDER PEOPLE Diamond House Care Home Bennett Street Downham Market Norfolk PE38 9EJ Lead Inspector Mr Jerry Crehan Key Unannounced 22nd May 2006 12:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Diamond House Care Home DS0000065214.V296585.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Diamond House Care Home DS0000065214.V296585.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Diamond House Care Home Address Bennett Street Downham Market Norfolk PE38 9EJ 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) 01366 385100 01366 385600 Ashbourne (Eton) Limited Mrs. Judith Elizabeth Eglen Care Home 42 Category(ies) of Dementia - over 65 years of age (42), Old age, registration, with number not falling within any other category (42) of places Diamond House Care Home DS0000065214.V296585.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 13th December 2005 Brief Description of the Service: Diamond House is a care home providing residential care for up to 42 older people including service users with dementia. It is situated on the edge of the town of Downham Market and is within easy reach of local facilities including shops, pubs and other community facilities. Diamond House is purpose built with accommodation provided on two floors, service users with dementia occupy the first floor. Stairs and passenger shaft lift service floors. There are 38 single rooms and 2 shared rooms. There are patio and garden areas that are visible from a number of service users bedrooms. Diamond House is one of several homes in Norfolk owned by the proprietors. Diamond House Care Home DS0000065214.V296585.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 6.45 hours. Opportunity was taken to tour the premises, look at care records and policies, and communicate with the home’s service users in addition to visiting relatives and professionals, staff and the manager. The inspection report reflects regulatory activity since the last inspection and evidence from inspection of Key Standards. Four comment cards were received prior to the inspection from service users and relatives, which gave broadly favourable responses about the home. What the service does well: What has improved since the last inspection? What they could do better: Diamond House Care Home DS0000065214.V296585.R01.S.doc Version 5.2 Page 6 Although no deficits to the staff training programme were identified, the level of NVQ trained staff remains below the 50 required. Though, it is acknowledged that progress is being made toward this target. Care planning in several instances falls short of providing care staff with the information they need in order to meet identified needs. Reviews of care plans should be undertaken with greater care and accuracy to reflect actual changes in service user need and care requirements. Careful monitoring of staffing levels and an understanding of appropriate procedures is required in the event of staff shortfall or absence. 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. Diamond House Care Home DS0000065214.V296585.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Diamond House Care Home DS0000065214.V296585.R01.S.doc Version 5.2 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 the following standard(s): 3&6 The assessment process for admission to the home is satisfactory. EVIDENCE: A review of a sample of service user files provided evidence of assessments completed by placing authorities, or pre-admission assessment completed by the home. The home does not provide intermediate care. Diamond House Care Home DS0000065214.V296585.R01.S.doc Version 5.2 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 the following standard(s): 7, 8, 9, 10 The care planning and review system is improved and in the majority of instances adequately provides staff with the information they need to meet the health and care needs of service users. Though there are instances when the information needed is not available and reviews not accurate. EVIDENCE: A sample of service user care plans was reviewed. These set out care requirements in reasonable detail and were evidently reviewed on a regular basis. However, it was noted that monthly reviews which indicated ‘no change’ to care requirements were not always accurate, as there was evidence within care plans and daily records of changes in need. Care plans for service users with identified challenging behaviour explain behaviours satisfactorily, though need to go on to advise staff as to the action they should take when challenging behaviours are exhibited. Similarly, care plans for service users who are identified as at risk from pressure sores or falls should set out more clearly for care staff the action they are required to take to manage these aspects of care. It is acknowledged that service user care plans are improving however, and that the home is in a period of transition toward another care planning format. Diamond House Care Home DS0000065214.V296585.R01.S.doc Version 5.2 Page 10 A visiting GP spoken to at the time of the inspection confirmed that the home uses their service appropriately and that the health care needs of service users are well met. Service users spoken to also appeared satisfied with the healthcare provided at the home, and confirmed that there is access to a range of health professionals including GP’s, opticians and chiropodists. There are currently no service users accommodated at the home who take responsibility for administering their own medication. Medication administration records were satisfactory. Storage arrangements were also reviewed. It was recommended at the last inspection that the practice of labelling drug trolley door shelves with service user names and storing their medication above the label be considered only as a guide for staff with responsibility for administering medication. This practice had almost ceased except for three names on the door shelves of the ground floor drugs trolley. It is evidently clear that individual medication can become mixed, and therefore presents the risk of its being wrongly administered. Not all care staff have responsibility for administering medication to service users. Consequently, it is recommended that arrangements for the administration of PRN medication be recorded in the service user care plan in order that these staff aware that this medication can be given when required by trained colleagues. When asked whether care staff listen and act on what they say, service users gave favourable responses. Service users spoken to indicated that their right to privacy is respected at the home, and that visitors are made welcome and can be seen in private if they wish. At the time of the inspection all service user bedroom doors were lockable, and lockable facilities within bedrooms provided. Telephone facilities have been provided to enable service users to make or receive telephone calls in private if they wish. Diamond House Care Home DS0000065214.V296585.R01.S.doc Version 5.2 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 the following standard(s): 12, 13, 14 & 15 The social and recreational options available satisfy the needs of service users. Contact with relatives is supported and the home supports choice for service users. Food on offer at the home provides choice and variety, and is provided in a way that is suitable to the needs of service users. EVIDENCE: A dedicated activities coordinator provides a weekly group activities programme for service users. In addition to group activities there is a published programme of ‘one to one’ activities that focuses on service users who are likely or less able to take part in group activities. Some service users spoken to stated that they appreciated this opportunity, which is sometimes a discussion or a walk to a local café. It was noted that improvements have been made to the first floor environment for activities with a dedicated room allocated containing objects of interest or stimulation. Service users were observed to use this facility with or without support from staff. The home is commended for its efforts to provide this improved area for service users. Service users indicated that their visitors were made welcome at the home at any time of their choosing, and that they usually saw visitors in the privacy of their own rooms. Some service users participate in local community activities. Diamond House Care Home DS0000065214.V296585.R01.S.doc Version 5.2 Page 12 The home supports choice for service users and control over their lives in many areas. Examples of this include supporting contact with relatives and friends, providing privacy for service users wishing to make or receive calls, and to bring and keep their own possessions with them at the home. At the time of the inspection service users gave a good response as to the quality of the food available at the home. This was reflected in favourable comments within comment cards received prior to the inspection. The meals seen at the time of the inspection looked wholesome and appealing, the main meal option being gammon with mashed potatoes, mixed vegetables and gravy. It was also clear that there were at least two main meal options available at lunchtime. Another notable improvement in practice since the last inspection of the home is the provision of finger foods for service users with dementia. These were available along with fresh fruit in communal areas of the home. Diamond House Care Home DS0000065214.V296585.R01.S.doc Version 5.2 Page 13 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 the following standard(s): 16 & 18 There are satisfactory arrangements in place to deal with complaints that service users and relatives are aware of. Service users are protected from abuse by appropriate policies and training. EVIDENCE: Service users both spoken to at the inspection and those who sent comment cards prior to the inspection indicated that they know how to make a complaint. They also indicated that they were clear about who they would speak to if they were not happy, often citing the manager or deputy manager. The home had received one complaint since its last inspection in December 2005. This complaint was sent directly to CSCI who asked the manager to investigate. A satisfactory investigation was carried out by the manager within the required timescale. Although the manager had no recorded complaints aside from the complaint indicated above, it was clear that some expressions of concern had been brought to her attention by relatives or others. It is recommended that a record of concerns be kept and any action taken with accompanying documentation. Records of staff training included training on induction and ongoing training in adult protection. In order to test understanding of the principles and components of training provided, training records included ‘assessment of learning’ in order to test understanding of the principles and components of training provided. Staff spoken to were aware of basic issues connected with adult protection and were aware of the home’s ‘Whistle blowing’ policy. Diamond House Care Home DS0000065214.V296585.R01.S.doc Version 5.2 Page 14 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 the following standard(s): 19 & 26 Service users live in a comfortable and safe environment that provides improved stimulation and interest for service users. EVIDENCE: The home provides a reasonably well-maintained and safe environment. There was evidence of some internal redecoration to dining areas. As indicated in relation to Standard 12 in this report an activities room has been established on the first floor that improves the environment for service users. Although redecoration of the first floor area is still needed, the manager indicated this work is due to be carried out shortly. Despite this there are other notable improvements to the first floor environment including, free access for service users to their bedrooms, the provision of curtains to hallway windows, seating areas with small tables at the ends of hallways, and the provision of themed ‘activity boards’ mounted to walls in the hallways. The environment now provides service users with more of interest and stimulation, and has a more homely feel. The manager and staff are commended for their efforts to improve these aspects of care. Diamond House Care Home DS0000065214.V296585.R01.S.doc Version 5.2 Page 15 The home appeared clean and hygienic. Following the complaint referred to within Standard 16 of this report the manager has instituted measures to regularly monitor odour within the home. At the time of the inspection there were no noticeable odours. Diamond House Care Home DS0000065214.V296585.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 There have been shortfalls in the numbers of staff on duty to meet service user need. Staff recruitment practices and the home’s training programme (other than NVQ) address service user needs. EVIDENCE: There were forty-one service users accommodated at the home at the time of the inspection. There are usually six care staff deployed each morning and five care staff each afternoon to provide care. As indicated earlier in this report CSCI received a complaint about the service that was referred to the manager to investigate. The complaint alleged that the home was inadequately staffed during an afternoon in March. The manager found that the complaint was upheld as there were three staff on duty, rather than the anticipated five staff to cover an afternoon care shift. On investigation during the inspection it was evident that there are clear procedures available for senior staff to follow in the event of anticipated staff shortage, however these were not followed. It was also apparent that the home had not notified CSCI as required by Regulation. There are dedicated administration, kitchen, maintenance and domestic staff, and (as indicated) a dedicated activities coordinator. Comment cards received prior to the inspection indicated that service users either always or usually receive the care and support they need. This was reflected in comments made at the time of the inspection by both service users and visiting relatives spoken to. There are currently eight members of care staff (or 35 of the care staff compliment) at the home who have completed NVQ 2 (or above) training. The Diamond House Care Home DS0000065214.V296585.R01.S.doc Version 5.2 Page 17 manager indicated that a further four staff are working towards the completion of this training. If successful the home will achieve the minimum 50 requirement. Staff files looked at demonstrated evidence of that service users are protected by the home’s recruitment practices. Staff training records seen provided evidence of appropriate induction and ongoing training (including mandatory training) for care staff. Care staff spoken and observed have a good understanding of service users needs. Diamond House Care Home DS0000065214.V296585.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 The home has been well managed by the manager who service users, staff and relatives speak favourably of. The home is run in the best interests of service users. EVIDENCE: The manager has experience within the care sector and has been in post for approximately five years at Diamond House. The manager was a trained nurse and had completed the City & Guilds Advanced Management in Care course. Both service users and staff spoke in favourable terms about the manager. Due to problems with the home’s NVQ training provider the manager’s NVQ 4 training, anticipated at the last inspection has been delayed. However, the manager indicated that she would be undertaking and possibly completing the training within six months. It is recommended that due to the registration of the home for dementia care, the manager pursue further and more advanced dementia related training. Diamond House Care Home DS0000065214.V296585.R01.S.doc Version 5.2 Page 19 The home has a variety of processes to ensure that it is run in the best interests of service users. These include various staff meetings, three monthly service user meetings and relatives meetings twice a year. The home is also subject to regular audits undertaken by the provider, including those required by Regulation. The manager undertakes an annual questionnaire that seeks the views of those living in or associated with the home. It is recommended that the results of these surveys be shared with everyone provided with the questionnaire. Service users financial interests are safeguarded by the home; their relatives manage the vast majority of service users financial affairs. Care staff spoken to stated that they received supervision from senior staff, and staff files looked at showed evidence of supervision being carried out on a regular basis. The health, safety and welfare of service users are largely secured, with the exception of inadequacies in care planning and arrangements for providing staff cover. Diamond House Care Home DS0000065214.V296585.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 Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Diamond House Care Home DS0000065214.V296585.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 15(1) Requirement The registered person must ensure that individual care plans set out action required by care staff to manage behaviour and meet needs. This Requirement Is Repeated The registered person must ensure that reviews of service user care plans carried out reflect changes in need. The registered person must ensure that staff are working in such numbers as are appropriate for the health and welfare of service users. The registered person must ensure continued progress toward meeting a minimum ratio of 50 NVQ 2 (or above) trained staff. The registered person must give notice to the Commission without delay of occurrences required by this Regulation. Timescale for action 22/05/06 2. OP7 15(2)(b&c ) 18(1)(a) 22/05/06 3. OP27 22/05/06 4. OP28 18(1)(a) 30/09/06 5 OP37 37(1) 22/05/06 Diamond House Care Home DS0000065214.V296585.R01.S.doc Version 5.2 Page 22 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 OP9 Good Practice Recommendations It is recommended that the practice of labelling drug trolley door shelves with service user names and storing their medication above the label is considered only as a guide for staff with responsibility for administering medication. It is recommended that arrangements for the administration of PRN medication be recorded in the service user care plan. It is recommended that a record of concerns be kept and any action taken with accompanying documentation. It is recommended that due to the registration of the home for dementia care, the manager pursue further and more advanced dementia related training. It is recommended that the results of customer satisfaction surveys be shared with everyone provided with the questionnaire. 2. 3 4 5 OP9 OP16 OP31 OP33 Diamond House Care Home DS0000065214.V296585.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Diamond House Care Home DS0000065214.V296585.R01.S.doc Version 5.2 Page 24 - 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!