CARE HOMES FOR OLDER PEOPLE
Digby Court St Christophers Lane Bourne Lincolnshire PE10 9AG Lead Inspector
Julie Western Unannounced 12 July 2005 09.30 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. Digby Court C53 C04 S2352 Digby Court V238198 120705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Digby Court Address St Christophers Lane Bourne Lincolnshire Lincs PE10 9AG 01778 422035 01778 394404 manager.digby@osjctlincs.co.uk The Order of St John Care Trust 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) Mrs Tina Stebbings Care Home 37 Category(ies) of Old Age (OP) - 37 registration, with number of places Digby Court C53 C04 S2352 Digby Court V238198 120705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 8/12/04 Brief Description of the Service: Digby Court is a purpose-built home for up to 37 older people, which was formerly owned by the local Authority and is now owned by the Orders of St. John Care Trust, who manage a group of 16 homes across the county. The home is a two-storey building set in its own grounds close to the town centre of Bourne, which has a good range of shops and facilities. Accommodation comprises 33 single rooms and 2 shared rooms and on the day of the inspection the home was fully occupied. There are gardens to the rear and a car park to the front of the building. The home has a day care centre for up to 10 people daily, which is part Local Authority funded; it did not form part of the inspection. The kitchen also prepares 54 Meals on Wheels weekly, up to 10 meals Mon-Fri. for the Day Centre and 10 meals for members of the ‘Evergreen Club’ once a week. Digby Court C53 C04 S2352 Digby Court V238198 120705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over 4 hours. A partial tour of the building took place and care records were inspected. The main method of inspection used was called ‘case-tracking’; this involved selecting three residents and tracking the care they received through the checking of their records, discussions with residents and care staff and observation of practices. Some policies and procedures were examined and records concerning the safety of the home were also seen. 5 of the 36 residents, 5 of the 47 care and ancillary staff and one visitor were spoken with. The Manager was present throughout the inspection. N.B. Feedback comments were sent too late to be included in this inspection report. What the service does well: What has improved since the last inspection?
The rolling maintenance programme was still in progress and following the previous inspection report the first floor corridor has been redecorated, including new carpets and kick-plates to doors. The Manager has increased the staff complement by two, which has allowed more time for staff to address the needs of residents . Care plans have been reviewed and the number of assessments has been reduced where they have been found to be unnecessary [for example, Waterlow scores where there is no history of pressure areas]. The Manager has completed her National Vocational Qualification at Level 4 and the home has achieved the International Standards Organisation 9000 award, which is internationally recognised. Digby Court C53 C04 S2352 Digby Court V238198 120705 Stage 4.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Digby Court C53 C04 S2352 Digby Court V238198 120705 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 Digby Court C53 C04 S2352 Digby Court V238198 120705 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) 1-6 The home clearly sets out what it intends to do for its residents and this information is freely available to residents. Prospective residents are encouraged to take time before making the decision to move into the home on a permanent basis. EVIDENCE: The statement of purpose and the residents’ handbook were examined and were very comprehensive. The service user guide was easy to read. And residents also received a copy of the Quarterly Trust magazine. The day care room, which was located off the main entrance, gave prospective residents a chance to experience life in a residential care home, since they ate meals with the residents and shared some of the activities. Some residents had also been to the home for respite care or rest care in one of the two beds block booked by Social Services . Digby Court C53 C04 S2352 Digby Court V238198 120705 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) 7-11 The home’s records give a clear indication of the needs of residents and enable staff to meet their needs with sensitivity and regard for their privacy and dignity, including their wishes on dying. EVIDENCE: The three care plans looked at in depth contained clear and comprehensive assessments, were reviewed regularly and were signed where possible by the service user or relatives/advocates. Daily information was sometimes repetitive and staff members spoken with said this was time-consuming. The Manager is currently evaluating the need for some of the assessments such as Waterlow pressure scores where there is no pressure area identified. There was a clear medication policy and the pharmacist visited regularly. Residents said they felt safe and well looked after; one said ‘I chose this home because they treat you like a person and not like a ‘blob’. The staff team were observed carrying out their duties with kindness and sensitivity towards the residents, especially when attending to their personal needs. A visiting District Nurse said that the standard of care at the home was very good; the atmosphere was always pleasant and friendly and the staff members were helpful and knowledgeable. Staff confirmed that they had training on death and dying during their induction at Wellingore Head Office.
Digby Court C53 C04 S2352 Digby Court V238198 120705 Stage 4.doc Version 1.40 Page 10 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) 12-15 Social activities are extensive and well promoted, creating a variety of events and activities which residents are informed about. The residents exercise choice about which activities, if any, they wish to participate in and what meals they want to eat; the menu needs reviewing. EVIDENCE: The home employs an activities organiser who works 7 hours weekly; she is responsible for seeking the views of residents about what they wish to take part in. On the day of the inspection a game of indoor skittles was being played in the main lounge. Residents and staff confirmed that there was a great deal of choice regarding the activities and events at the home. The activities calendar showed that recent events had included a a film show, picnic tea, bingo and coffee mornings. Future events included a quiz, exercises, handicrafts, a mystery tour and entertainers. The midday meal was nutritious and residents said how much they enjoyed them. There was a menu board displaying the day’s meals including the alternative choice. Two residents said they would like more variety such as Chinese or Italian food and the cook said the current menu was being reviewed as it contained a lot of pastry and roast meat. Residents confirmed that they were frequently asked for their choices of future meals. The kitchen staff also prepared up to 22 meals on wheels. Digby Court C53 C04 S2352 Digby Court V238198 120705 Stage 4.doc Version 1.40 Page 11 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) 16-18 The home’s complaints procedure is clear and gives residents and their relatives the confidence that comments and concerns will be listened to; there is a robust adult protection procedure. EVIDENCE: Residents spoken with said they did not wish to complain but knew how to make a complaint. The home had received four complaints in the last twelve months; all had been responded to appropriately and within the given time. A suggestions box was located in the front entrance hall but the Manager said that residents preferred to come to her directly. There was a clear adult protection procedure, which was linked to the Local Authority procedures. All staff members spoken with had received training on adult abuse and were knowledgeable about complaints. Digby Court C53 C04 S2352 Digby Court V238198 120705 Stage 4.doc Version 1.40 Page 12 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) 19,22,24,26 The residents live in a comfortable and pleasant environment with both private and communal space, which is generally suitable for their needs. EVIDENCE: The home has a rolling maintenance rota and recent improvements have included the redecoration of two bedrooms and the refurbishment of the first floor corridor including new kick-plates to doors and new carpeting. Risk assessments are carried out on the premises to ensure that residents are safe from any potential hazards. One resident who is blind had been assisted to move around the home by the placement of raised symbols on walls; another resident said ‘I like my room it’s very comfortable’. . The main lounge is not large enough to accommodate all residents at one time and the Manager said that approval was being sought to extend it by some 4 metres. Overall the standard of decoration internally was good and afforded residents a great degree of comfort. The grounds were attractive and offered seating areas in good weather. Digby Court C53 C04 S2352 Digby Court V238198 120705 Stage 4.doc Version 1.40 Page 13 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) 27,28 Staff numbers are in sufficient quantity for them to be able to care for the residents. Staff members are suitably trained, qualified and competent; they undergo a thorough induction programme before commencing their duties. EVIDENCE: The residents were very positive about the care they received from the staff. One resident said ‘they are very kind and friendly and we can have a joke with them - nothing is too much trouble for them’. The most recent staff member to be appointed confirmed that she had given two references, which were followed up, a CRB check and undertaken an induction programme before commencing work and staff records confirmed this. Training records showed that statutory training was completed. Six staff members had National Vocational Qualification at Level 2 with three currently undertaking it. A full staff meeting was held two weeks ago and minutes were available for all staff. The staff rota showed that there were enough staff numbers according to the staffing matrix and shifts were staggered to accommodate the needs of residents. The needs of residents had decreased slightly since the last inspection and the Manager had appointed two extra posts; all staff and residents said they thought there were enough staff to complete their tasks in the given time. However, the activities co-ordinator needed extra hours and it was hoped that her hours would be extended to allow her to give more time with residents. . Digby Court C53 C04 S2352 Digby Court V238198 120705 Stage 4.doc Version 1.40 Page 14 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) 31-33,35, 36, 38 The home is managed competently and the staff are supported and supervised in carrying out their respective roles. The views of residents are listened to and they are involved in decisions affecting them. EVIDENCE: The quality assurance manual demonstrated a positive approach to seeking the views of residents and residents spoken with said they were constantly asked for their views on matters concerning the running of the home. Quality assurance questionnaires were in residents’ folders. A quality assurance manager has now been appointed and is working at the Headquarters in Wellingore. The Trust also has a training manager, who organises an extensive programme of training for all staff. The home has the ISO 9000 award and the Investors in People award. The manager is looking at ways of maintaining the very large policies and procedures manuals so that staff members can gain easy access to them.
Digby Court C53 C04 S2352 Digby Court V238198 120705 Stage 4.doc Version 1.40 Page 15 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 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 x 3 x 3 x 3 STAFFING Standard No Score 27 3 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 x 3 x 3 3 x x Digby Court C53 C04 S2352 Digby Court V238198 120705 Stage 4.doc Version 1.40 Page 16 None 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 OP19 Regulation 23[2][a] Requirement The registered provider must forward plans for creating additional communal space for residents. Timescale for action 6th September 2006 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP15 Good Practice Recommendations It is a recommendation that residents needing to have their food cut up have this done in the kitchen; this allows residents more dignity Digby Court C53 C04 S2352 Digby Court V238198 120705 Stage 4.doc Version 1.40 Page 17 Commission for Social Care Inspection Unity House, The Point Weaver Road Lincoln LN6 3QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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