CARE HOMES FOR OLDER PEOPLE
Ditton Priors Residential Home Ashfield Road Ditton Priors Bridgnorth Shropshire WV16 6TW Lead Inspector
Pat Scott Unannounced Inspection 27th June 2006 10:00 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 Ditton Priors Residential Home DS0000020719.V296973.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. Ditton Priors Residential Home DS0000020719.V296973.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Ditton Priors Residential Home Address Ashfield Road Ditton Priors Bridgnorth Shropshire WV16 6TW 01746 712656 01746 712076 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) www.guardiancaregroup.co.uk Guardian Care Homes (UK) Ltd Mrs Margaret Alsop Care Home 23 Category(ies) of Dementia (10), Old age, not falling within any registration, with number other category (13) of places Ditton Priors Residential Home DS0000020719.V296973.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 9th January 2006 Brief Description of the Service: Ditton Priors Residential Home is registered to provide care for a maximum of 23 older people, of whom 10 may be designated as suffering from ‘dementia’ and 13 designated ‘old age’ and ‘not falling within any other category’. The Home is situated on the edge of the small Shropshire Village of Ditton Priors with most rooms enjoying uninterrupted views of the Shropshire countryside. It has extensive well-maintained grounds with many shrubs, trees, flower borders, lawns and patios, and an area where vegetable produce is grown for use in the Home’s Kitchen. The Home, purpose built as a residential care Home during the 1970’s, has since been extended to provide additional care places. Mrs Margaret Allsop is the Registered Manager. The Home is part of the Guardian Care UK Group. Guardian Care Homes (UK) Ltd make their services known to prospective service users in: The Statement of Purpose, Company Brochure and web site which also contain their contact e mail address. It was stated by the manager that the report is displayed in the entrance hall to the home. Ditton Prior’s services rates are reviewed annually and service users are notified one month in advance. The only additional charges to service users are for hairdressing, dry cleaning, chiropody, private telephone installation and calls and newspapers. Fees for Ditton Priors as of 1st April 2006 are: £380-£420. All service users pay monthly by direct debit usually two weeks in advance and two weeks in arrears. Ditton Priors Residential Home DS0000020719.V296973.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A range of evidence was used to make judgements about this service. This includes: information from the provider, staff records kept in the home, medication records, discussion with people who use the service, discussions with the staff team, discussion with the manager, tour of the premises, previous inspection reports, quality assurance process, Fire Authority reports, Environmental Health Office reports, observation of care experienced by people using the service and views of visiting relatives. As some service users accommodated have varying types of dementia outcome judgements are based also on observation and written evidence. Service user views are recorded where appropriate. What the service does well: What has improved since the last inspection? What they could do better:
The statement of purpose/service users guide needs to be kept up to date and reviewed on an annual basis. If up to date, clear information is provided then people will be enabled to make an informed choice about admission to the home. Contracts/terms and conditions must clearly set out the fees to be paid by each party when other funding arrangements are in place. It must be quite clear to the service user what element of the fee they are responsible for paying and what element a third party will be liable for. Controlled drugs need to have the correct storage cabinet.
Ditton Priors Residential Home DS0000020719.V296973.R01.S.doc Version 5.2 Page 6 The overall delivery of the laundry service is good. However, in order to improve the level of risk to service users from infection, soiled laundry should be sluiced in a washing machine with a sluice wash. Soiled laundry should be placed in red alginate bags which are then placed in the machine. This method reduces the handling risks associated with heavily soiled laundry and improves health and safety for staff and services users. Policies and procedures for the handling of soiled laundry should then be amended. The laundry room must have a separate hand wash facility. Food must not be stored in the laundry room. Boxes of tights, socks and net pants must be disposed of if not reclaimed by the original owner. The recruitment folder of a new staff member was lacking in certain elements to demonstrate that good employment practice has been carried out. Robust recruitment is imperative to ensure that only suitable people are employed to work with vulnerable service users. An induction process to meet that set by ‘skills for care’ has not been conducted for the new care assistant. Supervision of staff has not been regularly maintained. A yearly plan is in place to ensure that staff are adequately trained in order to carry out the care to meet services users needs. They are able to assess, plan, provide and monitor the outcomes of care for service users. An induction programme in line with NTO requirements must be established. Supervision is an important element which brings together all these practices and ensures that staff are competent to do their job and that competency is maintained. The planned supervision process must be implemented. 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. Ditton Priors Residential Home DS0000020719.V296973.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 Ditton Priors Residential Home DS0000020719.V296973.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): 1,2,3,4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives are given information in order to choose a home which will meet their needs. They have their needs assessed and a contract which clearly tells them about the service they will receive. EVIDENCE: A mixture of information is given that includes a brochure, leaflet, statement of purpose dated March 2005 and a welcome guide setting out the aims and objectives of the home. The organisation of this material could be improved so that there is no confusion for management as to what is the latest format to use. Records of terms and conditions are kept on individual files. This details what service the service user can expect to receive for the fee they pay and the
Ditton Priors Residential Home DS0000020719.V296973.R01.S.doc Version 5.2 Page 9 terms and conditions of occupancy. These documents need to reflect the actual fees paid when another party is involved in the funding of the care. Care files seen contained a pre-admission assessment and an admission assessment of need. Ditton Priors Residential Home DS0000020719.V296973.R01.S.doc Version 5.2 Page 10 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care, which a service user receives, is based on their individual needs and aims to promote good health. EVIDENCE: Each service user has a care file. Evidence was seen of service user involvement in the development of these. The plan includes basic information necessary to plan the individuals’ care and includes a risk element. These are being reviewed and transferred into a new format. The Regulation 26 report of April 25th 2006 states that all new documentation is now in place in all files. This was not the case at this inspeciton. A community nurse stated that there are very good communication links with the home and that the health needs are catered for very well. The home has a system for dealing with medication within the home. Records were correctly completed for all medicines received, administered and disposed of. The homes training plan includes the topic of safe administration of
Ditton Priors Residential Home DS0000020719.V296973.R01.S.doc Version 5.2 Page 11 medicines and evidence of this having been carried out was seen. The home needs to provide the correct storage cabinet for controlled medicines. Staff spoken with were aware of the need to treat service users with respect and spoke of how they consider dignity when delivering personal care. Service users comments include “ yes staff are very attentive and I don’t feel like I am on display”. “ I can sit and do what I like and staff always check on me, but they don’t burst into my room”. Ditton Priors Residential Home DS0000020719.V296973.R01.S.doc Version 5.2 Page 12 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to participate in social activity and keep in contact with family and friends. Residents receive a healthy, varied diet according to their assessed requirement. EVIDENCE: Service users, who were able to give an opinion, were very complimentary about the food provided. They were able to state what they had chosen for lunch and said that staff come round and ask them their preference from the menu each day. The home has a main kitchen but with very little storage space. Some food is kept in a cupboard on the first floor and potatoes were seen stored in the laundry room which is not good practice. Service users are enabled to enjoy a full and stimulating life style with a variety of options to choose from. The staff seek the views of service users and consider their varied interests and abilities and concentration span when planning and arranging activities. The hairdresser visits the home on a regular basis.
Ditton Priors Residential Home DS0000020719.V296973.R01.S.doc Version 5.2 Page 13 One service user was to enjoy a birthday celebration with a party being arranged. Staff were also organising a fete. Pictures were on display of recent outings. Service users said that they are never forced to participate in anything and there is a lot going on to choose from. Diversity is considered and respected when supporting service users faith needs. Ditton Priors Residential Home DS0000020719.V296973.R01.S.doc Version 5.2 Page 14 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have access to a robust, effective complaints procedure that enables them or their supporters views to be listened to and acted upon. Staff are provided with training regarding adult protection. This provides staff with the relevant knowledge to safeguard service users from many types of abuse. EVIDENCE: Staff are provided with training regarding adult protection. This provides staff with the relevant knowledge to safeguard service users from many types of abuse. The CSCI has not received any complaints about the home. Nor have their been any recent adult protection issues. Service users were seen to speak easily to staff and were comfortable in their company. Staff were heard to communicate well with service users to ascertain their well-being. Ditton Priors Residential Home DS0000020719.V296973.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Ditton Priors is comfortable and homely and service users live in a wellmaintained environment. EVIDENCE: Rooms entered into were personalised according to individual wishes and tastes. Communal areas were clean and comfortable. Service users have access to a large garden. A shed is situated at the front of the house in which people smoke. This area is unsightly and does not give a very good first impression of the premises. The Regulation 26 report by Guardian Care UK for 25th April 2006 states that this facility is a problem and needs replacement or moving. It is recommended that it is removed. Ditton Priors Residential Home DS0000020719.V296973.R01.S.doc Version 5.2 Page 16 The laundry is not equipped to deal with soiled linen. Staff implement procedures to minimise cross infection but improving this facility could reduce the risk further. The manager stated that soiled laundry is sluiced by hand in the sink in the laundry room and that other items of clothing may be washed in it. This is the only sink provided and is also used for hand washing by staff. A separate hand wash sink must be provided. Potatoes were being stored on a shelf in the laundry. Wheelchairs and hoists were seen stored in an assisted bathroom which is a hazard to service users who may enter this room. The regulation 26 report of 25th April 2006 noted this and stated for health and safety reasons these needed to be removed. This has not happened. Ditton Priors Residential Home DS0000020719.V296973.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has made investment in staff development and the staff group are trained or have attended recent training. The home’s procedures provide a safe framework for the recruitment of staff which needs to be followed consistently in order to protect service users EVIDENCE: The registered provider has put a training plan in place to deliver an annual programme to meet statutory requirements. The service has also identified other training that is needed such as dementia. Recruitment of one new staff member had not been carried out according to the home’s policies and induction as per skills for care had not commenced. A criminal records bureau check and POVA 1st check had not been received prior to appointment three months ago and is still outstanding. A photocopy of the check carried out by the previous employer was on the file. Staff communicated well with service users and seemed committed to their work. Service users commented that they were well looked after and that staff were friendly and helpful.
Ditton Priors Residential Home DS0000020719.V296973.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): 31,32,33,35,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The ethos of the home is based on openness and respect with quality assurance systems developed by the registered provider. Staff work to achieve good outcomes for service users in all areas of care. EVIDENCE: The registered manager has the required qualification and experience to meet the standards and aims and objectives of the home. Through discussion she demonstrated that she provides quality care to service users. She acknowledged areas of weakness but also stated that the deputy has departed to work at another Guardian Care Home. This has presented the manager with some difficulties in carrying out her responsibilities. Other professionals, staff
Ditton Priors Residential Home DS0000020719.V296973.R01.S.doc Version 5.2 Page 19 and visitors commented that the manager is very approachable and consistently provides a good quality service. The home actively encourages service users, where able, to manage their own money. Records are kept. These were last checked by the regional manager for the home. Equality and diversity for service users were seen to be promoted throughout the home within the activities and interaction with staff. Quality assurance takes place throughout the service in both a formal and informal manner. Meetings, surveys and day to day contact all provide records to show that service user satisfaction is at the heart of the service. The home keeps records to show that the health and safety of service users is promoted and protected that are checked at the Regulation 26 visits by the provider. Ditton Priors Residential Home DS0000020719.V296973.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 2 2 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 X 3 Ditton Priors Residential Home DS0000020719.V296973.R01.S.doc Version 5.2 Page 21 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 OP1 Regulation 6 Requirement The registered provider shall keep under review, and where appropriate, revise the statement of purpose and service users guide and notify the Commission and service users of any such revision within 28 days. The registered provider shall detail in the contract the amount to be paid by all parties. The registered provider shall install a controlled drugs cabinet. The registered provider shall provide adequate facilities for the storage of food. The registered provider shall provide adequate storage provision for the purposes of the home. The registered provider must install a washing machine with a sluice wash to minimise cross infection. The registered provider shall install a hand wash basin in the laundry The registered manager shall obtain satisfactory criminal
DS0000020719.V296973.R01.S.doc Timescale for action 27/07/06 2 3 4 5 OP2 OP9 OP15 OP19 5A 13(2) 16(2)(g) 23(2)(l) 27/07/06 27/07/06 27/07/06 27/09/06 6 OP26 13(3) 27/09/06 7 8 OP26 OP29 13(3) 19 27/07/06 27/07/06 Ditton Priors Residential Home Version 5.2 Page 22 9 OP30 18(1)(c)(i ) 18(2) 10 OP36 record bureau checks and POVA checks prior to staff starting work at the home. The registered manager shall ensure that an induction programme in line with NTO requirements is established. The registered manager shall ensure that staff are appropriately supervised. 27/07/06 27/09/06 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 OP7 OP19 Good Practice Recommendations To complete the review of care plan documentation in a timely manner To remove the shed from the front entrance area. Ditton Priors Residential Home DS0000020719.V296973.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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