Inspection on 18/12/06 for Digby Manor

This inspection was carried out on 18th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Digby Manor 03/12/08

Digby Manor 03/03/06

Digby Manor 31/08/05

Digby Manor 15/02/05

Digby Manor 10/08/04

Digby Manor 03/03/04

Digby Manor 16/12/03

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Digby Manor 908 Chester Road Erdington Birmingham West Midlands B24 0BN Lead Inspector Monica Heaselgrave Unannounced Inspection 18th December 2006 11:20 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 Digby Manor DS0000016745.V316628.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. Digby Manor DS0000016745.V316628.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Digby Manor Address 908 Chester Road Erdington Birmingham West Midlands B24 0BN 0121 373 2333 0121 382 1719 janet.alrubaie@shonali.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Janet Al-Rubaie Mr Jafar Safar Al-Rubaie Mrs Janet Al-Rubaie Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Digby Manor DS0000016745.V316628.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd March 2006 Brief Description of the Service: Digby Manor provides 24-hour care for 26 service users, who are 65 years or older. It is situated in a residential area of Erdington on the main Chester Road. It can be difficult to locate when driving bye on the main road, staff often advise callers that the home is virtually opposite the Digby public house. The house is approached via a private driveway with off road parking to the front, and good-sized gardens to the rear, providing level access for service users. The home is made up of two detached houses that have been tastefully converted and linked together. There are 18 single rooms and 4 double or twin, some having en-suite facilities which provide a good degree of privacy for service users. All bedrooms are lockable, and furnished to a good standard providing spacious accommodation in which service users can bring their own furniture. There is a passenger lift to access each level of the property, and ramped access to the rear. Grab rails are fitted in communal areas to provide support to service users. A call system is provided in all rooms in case assistance is required. Communal bathrooms and toilet facilities are located on both the ground and first floor, these fitted with aids suited to those people who require assistance, this includes raised toilets, hand grab rails, hoist equipment and walk in level access to the shower. The home has hoisting equipment available for service users who have decreased mobility. There are two lounge areas, one open plan that leads to the dining area, and one smaller quieter lounge for those who may wish not to socialise or enjoy a little quiet time. A conservatory to the front of the property also provides a smoking area for those who wish to smoke. Communal areas are comfortably furnished, and fairly spacious, allowing for service users to enjoy a range of indoor activity including pet therapy. The reception area has notice boards, which display information about forthcoming events and other articles that may be of interest to service users Digby Manor DS0000016745.V316628.R01.S.doc Version 5.2 Page 5 and or their family. Throughout the home toilet and bathroom areas have been nicely signposted to enable service users to locate them more easily. The current charge for living at the home is £375-£410 per week. Additional charges include chiropody, and hairdressing. Digby Manor DS0000016745.V316628.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The fieldwork of this unannounced inspection took place over 9 hours, enabling the morning, lunchtime and evening routines to be observed. Prior to the inspection the inspector received a pre inspection questionnaire completed by the manager, this gave some information about the home. The inspector also received completed questionnaires from ten service users, six relatives and spoke with one family at the time of the visit. The experiences of visiting professionals were reviewed from the previous visit to the home. Without exception all the comments were positive and included: ‘An excellent home due to very caring and committed staff.’ ‘ Very pleased with the care that the staff provide.’ ‘I love being here I am looked after very well.’ ’I love living here I feel safe and secure.’ ‘Food is remarkable always plenty of choice and presented 200 ’. The inspector looked at the management of medicines and then a tour of the building followed. Lunch was observed. The care plans, daily records, medication, and accommodation of four service users, was looked at in detail to explore how their needs are met. Staff files were reviewed and three members of staff were interviewed in private. Records relating to the recruitment, training, supervision, and work patterns of staff were also examined to ensure they met with service users needs. The views and opinions of the service users were sought and the care delivered to service users was observed. Examination of the procedures in place to protect the health and safety of service users was undertaken. What the service does well: Digby Manor is extremely well run, with a sustained track record of high care standards consistent with the last two inspection reports. Regular assessment of needs and good care planning has meant that service users health and social care needs are well met, and they receive individualised care. The management of medication and healthcare is very good, there are systems in place, which ensure all concerns are monitored and followed up. Digby Manor DS0000016745.V316628.R01.S.doc Version 5.2 Page 7 A high number of staff is employed and all are trained to at least NVQ 2 with some training made available to help staff develop particular skills in meeting the specific needs of service users. There is a particularly nice welcoming atmosphere at Digby Manor and the service users and families speak very highly of the care team. The food offered is well prepared and meets the nutritional needs and personal choices of the service users. The homes environment is pleasant and well equipped to meet the needs of older people in a safe manner. The garden is a particular good feature; easily accessible to any service users who wished to use it. Various activities inside and outside the home take place on a regular basis ensuring service users have interesting and stimulating activity. 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. The summary of this inspection report can be made available in other formats on request. Digby Manor DS0000016745.V316628.R01.S.doc Version 5.2 Page 8 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 Digby Manor DS0000016745.V316628.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 5, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is good written information available to help prospective service users make a choice about moving into the home. An established assessment and admission procedure means service users can generally be confident that the home will meet their needs and that they know what to expect from the home. EVIDENCE: Service users have comprehensive information about what to expect from the home. The Statement Of Purpose and Service User Guide is given or read to service users to aid understanding. The inspector received ten comment cards from service users saying that they had been given sufficient information about the home, or that their family had on their behalf. There is a well-established, pre- admission and assessment process. This includes the service user, their family, and any relevant professionals involved with the care of the service user. Visits to the prospective service user in their own home or hospital have been undertaken to support this process. Trial Digby Manor DS0000016745.V316628.R01.S.doc Version 5.2 Page 10 visits have also been a regular feature prior to moving in. Four service users were case tracked to explore how well their needs are known by the service. These service users have significant health care needs and a level of risk relating to dementia, disability, pressure care and incontinence. The files examined showed that each had an assessment on file prior to moving to the home. This provided a good account of the individuals needs. It was positive to see that there was significant information relating to risks, for instance, ‘suffers vertigo, prone to falls or disorientation’. Risks relating to disability were detailed and provided sufficient information to guide staff in keeping the person safe. Each service user had a ‘Getting To Know you,’ information sheet. This was comprehensive and is completed by the individual or by their family or advocate. It was very informative giving good detail as to what’s important to the service user, for instance ‘I like a glass of sherry’. ‘ I don’t wish to attend church’. ‘I enjoy regular walks but think progressive mobility is silly.’ ‘I have my own independent friends.’ ‘I like to have a packet of mints on me every day, and have support to shop regularly for essentials’. It was positive to see that the cultural and religious needs of service users were explored and that their assessment included useful information about aspects of their care important to them. For example providing authentic foods for people of Irish ethnicity. Assessments are reviewed, and included relevant clinical guidance, from the clinical consultant, district nurse, and incontinence team. This detail was included in the written assessment and provided staff with good guidance in delivering care to the service user. This is good practice and ensures that as more information comes to light, this is added to the service users’ care plans and that the aids or equipment service users require are in line with their assessment and current clinical guidance. Care plans are reviewed and summarised on a monthly basis, and include contributions from the service user, key worker, family and other professionals who are involved in the care of the individual. One file seen included several updates relating to the specific healthcare needs of the service user. It was positive to see that staff are methodical and careful in their approach to reviewing the sometimes very complex and changing needs of the service user, this means service users benefit from a good standard of care and continuity, and can be assured their needs can be met by the home. Digby Manor does not provide intermediate care. Digby Manor DS0000016745.V316628.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Regular assessment of needs and good care planning has meant that service users health and social care needs are well met, and they receive individualised care. The management of medication and health-care needs remains at a consistently high standard, ensuring service users, some of whom have complex health-care needs, receive their medication in a timely and safe manner. Service users are treated with respect and are clearly happy in the company of staff. EVIDENCE: Care plans are developed for all service users the four files examined had a plan of care generated from the initial assessment. The files of those service users case tracked showed a variety of health care needs, some very complex. These included the management of continence, risk of falls, manual handling Digby Manor DS0000016745.V316628.R01.S.doc Version 5.2 Page 12 needs and poor tissue viability, which could give rise to pressure sores developing. It was positive to note that a tissue viability assessment had been undertaken and that the risk of developing pressure sores and the action to be taken to minimise this risk, was incorporated into the care plan, so that staff know how to respond to this need. There had also been an assessment of equipment that might reduce the risk of pressure areas, and this was seen to be in place. The service users bedroom was viewed and had a pressure relieving mattress and chair cushion. There was written instruction in the care plan regarding a regular turning routine, and this was being carried out, this ensures the risk of developing pressure sores is as far as possible, minimised. A second file had showed a risk of falls. A risk assessment had been undertaken and a detailed care plan showed how this person was to be supported in a safe manner. This bedroom was viewed and staff had been careful and thoughtful with the layout in order not to create obstacles for the service user concerned. A third file for a service user identified concerns with continence management. It was positive to see that the appropriate advice had been sought from the continence team and that continence aids were in place and a regular toileting programme adopted. In this manner the service users dignity is promoted and the welfare protected. Assessment information had been gathered and utilised to develop a good and detailed care plan for daily living, there was good correlation between the assessment information and care plan. The plan of care contained significant key points; and set out in detail the action that needed to be taken by care staff to ensure all aspects of the health, personal and social care needs of the service user are met. Service users with cognitive impairment are referred to specialist services to help meet their needs. Care plans demonstrated how these needs would be met. Good dementia care looks at both strengths and weaknesses, and it was positive to see that the sometimes aggressive behaviour demonstrated was detailed in the care plan and staff had guidance in how to manage it and understand it from the point of view of the service users’ confusion and disorientation. Staff had received training in dementia care, and this is positive. The manager has ensured that the social and or background profiles for service users are detailed so that staff know the values preferences, and lifestyle of the service user they are looking after, and can plan for this in a positive manner. It was positive to see that where health concerns are noted, staff seek medical advice without delay, this ensures the health care needs of service users are met. Records showed that health professionals such as the G.P. district nurse, Digby Manor DS0000016745.V316628.R01.S.doc Version 5.2 Page 13 dentist and consultants offer clinical advice as to how needs should be met. This service has had consistently good comments from visiting health care professionals who state that staff follow clinical advice and manage healthcare needs well. During the visit it was observed that the lounge and communal areas were staffed consistently ensuring service users who are vulnerable to falls, or confused had the support they needed to keep them safe and comfortable. The medication administration records (MAR) were kept well. There were no gaps in signing for medication. There was a photograph of each service user to assist with identification. The storage of medication was secure making it safe for service users. The home had a copy of medication administration policies and procedures and showed that they were aware of what they contained. Regular audits are carried out to ensure that all medication is given out correctly and signed for this ensures that any errors made can be picked up quickly and rectified. Staff who administer medication have received appropriate training to do so. Staff was competent and careful through the drug round, and safe practice was observed. One service user said ‘I have my medication on time for which I am grateful because it was something I wasn’t doing.’ The complex needs of service users’ involve external healthcare support from the district nurses and Palliative care team. Staff spoken with had a very good knowledge of the medication they were responsible for, and it’s impact on the individual. This was particularly good to see, because at times individual service users may not be able to demonstrate their pain or discomfort, but staff are skilled in looking for the signs and will seek immediate advice from the palliative care team who specialise in this area, ensuring service users are not unnecessarily exposed to pain. The care staff are currently handling, with competence and care, some challenging situations, and managing these extremely well. Staff had good knowledge of the care routines of service users. Observations showed that staff know who needs assistance and in what areas. One service user said ‘staff know what help I want and they are very good with their support.’ There was good support to assist service users moving around the home, and accessing the toilet areas. Service users were spoken to in a kind and consistent manner. Personal hygiene needs were attended to; service users appeared well cared for, appropriately dressed and comfortable. Some service users described aspects of their personal care they maintained independently, they were happy with these arrangements. The arrangements for, and facilities available to service users for personal care ensure that the privacy and dignity of service users is both protected and promoted. Staff provided a good insight into individuals’ routines demonstrating that these are known and respected. Digby Manor DS0000016745.V316628.R01.S.doc Version 5.2 Page 14 Service users described their preferred routines regarding bathing, and were particularly positive that they had use of en-suite facilities, which provided privacy. Some use the communal bathrooms, which are fully equipped to assist people who have difficulties, whilst maintaining their dignity. Service users confirmed that they have access to a phone in private, and handle their own mail and private affairs. Where this was not possible, arrangements were seen to be in place for these to be handled independently from the home. Digby Manor DS0000016745.V316628.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is positive consideration of service users who may have limited capacity to exercise choice in their lives, they benefit from the support offered by a caring staff team. A good level of consultation with service users and their families ensures contact arrangements are respected, encouraged and supported. A wholesome balanced diet was offered which promotes the well being of the service users. EVIDENCE: A programme of events designed to provide interest and stimulation was on display in the foyer. This was varied and included regular exercise classes, music afternoons, quizzes, coffee mornings and art and craft sessions. Service users said that activities are a regular feature, as is entertainment, celebrations and parties. Those service users spoken with particularly favoured a music and mobility session. One questionnaire said ‘I have gone on all the trips which I have enjoyed, and staff have sorted out Ring and Ride so I am able to go and see my friends independently.’ Digby Manor DS0000016745.V316628.R01.S.doc Version 5.2 Page 16 Service users said there is a visiting library, and magazines and papers can be ordered and delivered on request. Those records sampled showed good assessment information which included looking at the identity of a person, their faith, their interests, and experiences, and any particular social or cultural interests the person has. It was particularly positive to see that where individuals have conditions that may prevent them from articulating their interests, this is considered. For instance, in relation to autonomy where someone struggles to make their needs known the ‘Getting To Know You’ information sheet filled in by family members, clearly identified the routines and interests preferred by the individual. In this way service users were offered activities that staff know they previously enjoyed. This included when they enjoyed a drink of whiskey, whether they wished tea in the morning, what size meals they preferred and whether they wished to engage in a regular activity important to them, for instance weekly shopping. It is positive to see that the particular interests of service user are explored, recorded and offered to them. The daily records looked at for the previous month, gave good detail that would allow staff to monitor whether these things were being offered or taken up by service users. This is an accurate means of monitoring whether service users are engaging in activities, and was particularly positive in showing that a great deal of positive social activity is made available, and a lot of effort and time is put into supporting service users in this area. A visiting relative said that activities are always planned and offered. A big improvement has been seen in both mobility, and in socialising, where as previously the service user would not come out of their room. Several people were able to describe flexible routines in relation to getting up and retiring to bed, personal care, and routines personal to them. This was also seen to be the case at the time of the visit. It was positive to see that service users were enjoying meaningful activities, some service users were relaxing in their rooms, or chatting in the lounge, and some had been for a walk or played board games. A visit to the garden centre was planned for the next day, and looked forward to by service users spoken with. Most commented upon their enjoyment of the party two days previously. One service user said ‘I have been to Walsall Lights and enjoyed all the trips, they are good.’’ Contact with family and visitors is known and respected. Visiting relatives said that staff had provided snacks and refreshments and a private room in which to talk and relax. Staff described the importance of assisting service users and their families to maintain contact, and a list of planned social events was on display to encourage this. Digby Manor DS0000016745.V316628.R01.S.doc Version 5.2 Page 17 Meals in the home, featured highly in service users estimations. A number of service users commented very favourably, upon the quality and variety of food. The questionnaires returned to the Commission included very favourable comments from service users in relation to the meals provided. ‘Food is good, really enjoy it.’ ‘Very good never refused a thing.’ ‘Always given an alternative if there is something I don’t like.’ Menus showed that a variety of meals are offered to service users, this included cultural choices and preferences such as bacon and cabbage for people of Irish descent. Service users said that they are offered an alternative to the main meal if they do not like it. Menus are planned with the cook, manager and service users and are devised around the service users preferences. The manager said that new menus are being drafted with a view to making them more nutritionally balanced. The lunchtime meal was nicely presented with service users saying the portions were to their liking. Service Users were seen to have appropriate support to eat their meals. Records were seen to show that food and fluid intake is monitored where concerns regarding weight loss are evident. Records are taken regularly of service users weight where it is considered they are at risk. It was positive to see that concerns regarding food, included consultation with and guidance from the relevant health professionals who were involved in monitoring this area of care. Digby Manor DS0000016745.V316628.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and their relatives were confident that their concerns would be taken seriously, and have access to the complaints procedure should they need to make a complaint. Staff showed that they are able to protect vulnerable service users in their care. EVIDENCE: The Commission have received no formal complaints about this service. Service users spoken to were clear that they would speak to the manager if there were a problem. ‘I’ve got nothing to criticise but know I can go to the manager or staff.’ As part of the fieldwork process service users and their relatives were provided with questionnaires to seek their views about their experiences at Digby Manor. The inspector received ten completed questionnaires from service users stating that they knew how to make a complaint and how to access the complaint procedure. Six relatives questionnaires were returned, of these all knew the process and relatives were generally happy with the relationship they had with the manager and staff team and were confident that any concerns they had would be listened to and acted upon. The complaint procedure includes all the information required to assist a person to make a complaint. A record is maintained to include the nature and Digby Manor DS0000016745.V316628.R01.S.doc Version 5.2 Page 19 outcome of the findings. A Compliments and Complaints log is maintained several compliments had been received. An established quality assurance system is in place and includes seeking service users and relative’s views. Service user and carer meetings are held regularly and these are used as a means of seeking peoples views and making improvements where needed. Service users and staff felt that there is an open inclusive atmosphere, which enables them to express their views and know that they will be listened to and acted upon. The pre inspection questionnaire completed by the manager prior to the inspection visit stated that Adult Protection Procedures and Whistle Blowing procedures were available, but there was no date to show when these were last reviewed, to ensure they are in line with current good practice. These were not examined at this visit. Staff training records showed that most staff had received training in how to recognise abusive situations and how to respond to them in order to safeguard service users. Staff interviewed during the visit had a good awareness of what to do in such circumstances. The service history showed that no adult protection matter had been raised this year. The financial affairs of service users are managed externally. A small proportion of service users have amounts of money looked after for them. An appropriate accounting record was in place to safeguard service users finances. Digby Manor DS0000016745.V316628.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users live in an environment that is safe, homely, clean, and comfortable. They have the range of equipment necessary to support their care needs, and benefit from high standards of cleanliness and hygiene. EVIDENCE: A full tour of the facilities was not undertaken at this fieldwork visit. All the communal facilities were viewed, and five service users gave their consent for their bedrooms to be looked at. There are two lounges, a conservatory and dining area, in which service users can socialise and relax. These were comfortably furnished, clean and well maintained. It is spacious, enabling service users to access all parts without difficulty. There is a passenger lift to access all floors, and ramped access to the rear gardens. There are lots of plants, ornaments and personal touches throughout. There is ample room for indoor activities to take place. Digby Manor DS0000016745.V316628.R01.S.doc Version 5.2 Page 21 Outdoor space is a particularly good feature of the property, the rear garden is extensive, level and very well maintained, and it has good access for those with wheelchairs or walking aids. The grounds are well kept and have lawns and borders. Service users spoken with said they enjoy sitting out in warmer weather. Assisted bathing, toilet and washing facilities are situated on each of the two floors and within easy access of the communal areas. Some of the bedrooms have en-suite facilities, which enhance the privacy of service users. These facilities meet the needs of those service users who require staff assistance. They were clean, odour free and spacious. Aids and adaptations were seen to include raised toilets, hoists, an emergency call system and hand grab rails, and these enable staff to support service users in a safe and suitable manner. The equipment seen was suited to meeting the needs of the service users. Service users are positive about their surroundings, many have their own possessions around them, which is made possible, by the good size of many of the bedrooms seen. Service users said they were happy with the décor and furnishings in their rooms, which are lockable providing them with security for their possessions. ‘It’s always clean and fresh here staff are very good.’ ‘It’s always very clean staff clean my room daily’. It was nice to see that where service users require space for mobility aids or the use of the hoist, staff had rearranged furniture to make it safe. The bedrooms of two service users’, who are at risk of developing pressure areas, had pressure-relieving mattresses and chair cushions, the specific requirements of these service users was in line with their tissue viability assessment and care plan. The environment is safe, comfortable and continues to be well maintained. Service users themselves consider this an area that is important to them, and enjoy the benefits of a nice homely environment. There is a rolling programme of redecoration and maintenance this ensures the environment is kept safe, and comfortable for service users. The water flow in the tap in the ground floor toilet required fixing, as only a trickle of water was coming through, this appeared to be the valve and the manager asked the staff to adjust this at the time. All areas of the home were found to be clean, and odour free. There are dedicated staff to undertake cleaning and laundry with good infection control procedures in place. Digby Manor DS0000016745.V316628.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. The staffing compliment is good; above the minimum required standards. This means service users have individualised support with their care needs as well as there being good opportunity for staff to plan activities for service users both in and outside of the home. There is a well-established staff team, which ensures continuity of care for service users. Recruitment procedures are robust and protect the needs of vulnerable people. Staff training is structured to ensure staff acquires the skills and knowledge to support service users in a competent manner. EVIDENCE: Staffing levels were assessed and rotas sampled these indicated that between five and six care staff, plus a senior or manager, are on duty in the mornings, with four care staff and a senior on in the afternoons. The staffing compliment is good; above the minimum required standards. This means service users have the support with their care needs as well as there being good opportunity for staff to plan activities for service users both in and outside of the home. The staff seen on duty matched the rota sampled. In addition a cook, and housekeeping staff are employed who ensure that standards relating to food and cleanliness are maintained. The service also has the benefit of an administrative worker. Digby Manor DS0000016745.V316628.R01.S.doc Version 5.2 Page 23 The pre inspection questionnaire submitted to the Commission showed that 84 of the team have NVQ level 2, which ensures that service users are in safe hands. The recruitment practices remain robust. Seven files sampled showed that identification, references and CRB clearance are obtained prior to staff taking up post. A full application form is completed with previous employment history or previous qualifications. The manager has ensured that all the checks necessary for the safety of service users are undertaken prior to staff taking up post, this is good practice. Staff files showed that new staff undertake a full induction and a matrix is maintained to show when statutory training is required, this ensures any training gaps are identified and that staff are up to date with their training programme. The staff training and induction continues to follow the Skills for Care targets. This will further ensure that staff, have the skills and knowledge to meet the assessed needs of services users accommodated. It was positive to see that service user specific training is included in the training programme. This means staff have the opportunity to develop their knowledge and skill base in such areas as continence management, dementia care, managing aggressive behaviour, protection of adults and infection control. There is a rolling ‘refresher’ programme. Staff said that every three months they do refresher training in all the specific areas relating to the service users needs. Staff knowledge of care needs was found to be good they understood the needs of older people and how to meet these in a positive and caring manner. Their knowledge of individual service users specific needs was well utilised in delivering care. Service users described the manager and staff team in very favourable terms, feeling their needs are respected, understood and well met. It was positive to see that there staff working within policies and procedures designed to promote the care of service users. A gender care policy is in place, and both male and female staff is employed. Service users said that their preferences for meeting their personal care needs are respected. Digby Manor DS0000016745.V316628.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37, 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Systems for service user consultation are good, ensuring the service is run in the best interests of service users. The high standard of health and safety practices promotes the wellbeing of service users and staff. Service users and staff benefit from the leadership and management approach. EVIDENCE: The manager is also the provider of this service. She is experienced in the conditions that affect older service users, and holds the NVQ level 4 in management and care and the Registered Managers Award. She has several years of experience in caring for older persons, and managing a staff team. Digby Manor DS0000016745.V316628.R01.S.doc Version 5.2 Page 25 She is in control of the day-to-day running of the home. Her leadership skills were demonstrably good and all the staff spoken with during the inspection all had a very high regard for her. The registered manager had a clear direction and strove to meet the needs and enhance the lives of both the service users and staff. Service users speak positively about their inclusion in events within the home. The inspector received ten completed questionnaires from service users and six from relatives; these showed they were satisfied with the care standards this service provides. Relatives felt that their concerns are listened to and that they are made welcome and kept involved. Digby Manor uses a quality assurance system to monitor the progress objectively and had scored very well at the last assessment. There is an annual development plan for the home. The views of the service users and staff are considered and their wellbeing is promoted in every way. Regular service user forums are held in addition to occasional forums for family and friends. Information from these forums is used to enhance the lives of service users further. There were no requirements at the last fieldwork visit. Recommendations made to improve practice further have been met. Staff meetings and formal supervision has been consistent and provide a good sense of direction for staff in undertaking their role and responsibilities. Statutory records were very well organised, and well maintained, making it easy to track events that may affect the wellbeing of the service users. Records of service users’ finances held at the home meet the standard. All the records seen balanced with the amount of money held. The home kept individual receipts for all spending of money. Regular financial audits are carried out in order to safeguard service users’ money. There are appropriate arrangements to ensure the health and safety of both service users and staff. Appropriate maintenance and inspection certificates for all appliances were seen. The arrangements for ensuring safe working practices are very good, staff have received appropriate training in these areas this ensures service users are not placed at risk. The use of dedicated staff ensures that all have delegated roles and that tasks are deployed and covered appropriately. This ensures service users needs are acted upon in a consistent and proactive manner ensuring their wellbeing. Digby Manor DS0000016745.V316628.R01.S.doc Version 5.2 Page 26 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 3 X 4 4 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 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 3 3 3 3 3 3 4 STAFFING Standard No Score 27 4 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 X 3 3 3 4 Digby Manor DS0000016745.V316628.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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 OP21 Regulation 23(2)(J) Requirement The water tap in the ground floor toilet requires adjusting to allow a sufficient flow of water. This requirement was acted upon at the time of the visit and is now met. Timescale for action 18/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Digby Manor DS0000016745.V316628.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Digby Manor DS0000016745.V316628.R01.S.doc Version 5.2 Page 29 - 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. 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