Inspection on 16/10/07 for Docking Grange

This inspection was carried out on 16th October 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Docking Grange 30/12/09

Docking Grange 03/02/09

Docking Grange 18/08/08

Docking Grange 21/02/08

Docking Grange 03/10/06

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Docking Grange Sandy Lane Docking Kings Lynn Norfolk PE31 8NF Lead Inspector Lella Hudson Unannounced Inspection 16th October 2007 09:00 Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 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 Docking Grange DS0000066607.V353217.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 Adults 18-65. 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. Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Docking Grange Address Sandy Lane Docking Kings Lynn Norfolk PE31 8NF 01485 518428 01485 518436 docking.grange@hotmail.co.uk www.concensusupport.com Caring Homes Healthcare Group Ltd 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) Manager post vacant Care Home 34 Category(ies) of Learning disability (34) registration, with number of places Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Any service user, of either sex, accommodated over the age of 65 must also have a learning disability. Any service user, of either sex, accommodated with dementia must also have a learning disability. 3rd October 2006 Date of last inspection Brief Description of the Service: Docking Grange is a private residential care home that provides accommodation for up to 34 Service Users. The home consists of the original building (Daphnes and the flat,) and three modern houses built at the rear of the home (Badgets, Caddows and The Coach House) All bedrooms, except for one, are single and most of the bathrooms and shower facilities are suitable for use by Service Users with a Physical Disability. Whilst every Service User has their own house within the Home and staff are allocated to different areas, the Home is actually run as one. Many of the Service Users have lived at the Home for many years. The home has pleasant grounds, which are well maintained and accessible for all Service Users. The Home is in the village of Docking, which is approximately eight miles from the coast and approximately fifteen miles from both Kings Lynn and Fakenham. Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Docking Grange had been owned and managed by the same family for many years. The Home was bought by Consensus, a part of Caring Homes Healthcare Ltd, in June 2006. There have been five different people managing the Home since then. Two were appointed as managers but did not complete their probationary period, two were senior managers within the company who managed the Home temporarily and there is currently another temporary manager who has been moved from another Home within the organisation. This report contains information gathered about the service since the last key inspection (October 2006) which includes that gathered during an unannounced visit to the Home which was carried out by two Inspectors on 16th October 2007. During the visit to the Home the Inspectors spoke to the Manager, staff and clients, looked around the accommodation and inspected records. The Annual Quality Assurance Assessment (AQAA) form was completed and returned to the Commission as requested. However, the information in this document did not reflect the situation at the Home. Completed comment cards were received from four relatives, four of the clients and two of the staff. The clients comment cards are mostly positive. The relatives comment cards contained mixed views with some feeling that they are kept well informed, that they are happy with the care and that the staff have the right skills and experience and others stating that they are less satisfied with these areas. Some of the additional comments are as follows: “…very pleased the new owners have continued to provide the same excellent care” “…always made to feel welcome” “…less informed since…been taken over” “too many agency staff” “needs better communication” The staff comment cards both highlight poor communication, poor staffing levels and lack of training as negative aspects of the Home. Additional comments were made about the good support provided by the current manager. In September 2007 the Commission received complaints about the Home from an anonymous source, a social worker and a relative. A further concern was also received from another social worker. The majority of these complaints/concerns were found to be substantiated. Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 6 On arrival at the Home the Inspectors were told that the Manager, Julie Mayhew, was at a meeting at the organisations head office. Once notified of the unannounced visit the Manager returned to the Home and was present for the majority of the visit. Very brief feedback was provided to the Manager about the Inspectors concerns and an Immediate Requirement form was left with regard to medication. Following the visit a letter requiring urgent action was sent to the Responsible Individual of the organisation with regard to the poor staffing situation. Another visit to the Home was carried out two days later to provide detailed feedback to the Manager and one of the senior managers from the organisation. Fees for the Home are negotiated on an individual basis, depending on the needs of the clients. These currently range from £441.00 to £998.00 per week. What the service does well: What has improved since the last inspection? The Home has employed an administrator to take on some of the tasks that the Manager previously was responsible for. A ramp has been fitted in The Flat which makes it easier for wheelchair access. Some rooms have been redecorated. Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 7 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. Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Although an assessment was undertaken prior to admission the actions agreed have not been adhered to EVIDENCE: Records were seen which provide evidence that an assessment was carried out prior to one of the clients moving into the Home earlier this year. However, the information contained within this assessment has not been adequately translated into an effective care plan and actions agreed at that time have not taken place. This was confirmed through discussions with a relative and social worker of the client involved. Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 & 10 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The care plans and risk assessments do not provide adequate guidance for the staff about how to meet the clients needs The clients are not involved in making decisions about issues that affect them EVIDENCE: The AQAA states that the format of the care plans has been reviewed and updated but this is not the situation that the Inspectors found on the day of the visit. A selection of care plans were seen. Although these contain a lot of information some of this is out of date or just not relevant to meeting the day to day needs of the clients. There is no evidence of regular reviews and updating of the information within the care plans and risk assessments. Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 11 For example, the pre admission assessment information for one of the clients states that there are needs around pressure care and behaviour but there are no care plans for either of these areas. There is a care plan which states that regular contact with relatives should be maintained but no information about who is responsible for this, how often it should take place or how. There was also no information, and the care plan had not been updated, following a recent review of the clients care that had taken place. Another client has been assessed as being at a very high risk from choking by the multi disciplinary team and so there are some very clear guidance provided by the Speech and Language therapist. However, these have not been crossreferenced with the care plan and the most recent guidance from the therapist (Feb 07) is not present at all. One of the issues raised by the anonymous complainant (Sept 07) was with regard to the food that one of the clients receives. Discussions with the Manager showed that the complaint was substantiated and that the client was not receiving food with the correct nutritional value. There was no written information to indicate why the staff were giving the wrong food to the client. The Manager addressed the situation as soon as it was brought to her attention by the Inspector. The daily notes for one of the clients states that the district nurse visited to treat pressure areas but there is no care plan in place with regard to this or any information recorded about whether this is still a need for this client or not. One of the clients has a detailed risk assessment (dated June 07) about the risks associated with her having access to the gardens alone as there is nothing to prevent her going on to the road. This indicates that the client is at high risk of having an accident and the actions specified to prevent this is that staff must always be with her when outside and that gates will be fitted to prevent access to the road. The gates have not been fitted and the client was seen wandering around the gardens alone on numerous occasions during the two days that the Inspectors were in the Home. The requirement for clearer care plans that was made at the last Inspection has not been met and is repeated in this report. It is also required that risks are properly recognised, assessed and action taken as necessary to reduce the risks. The staff who spoke to the Inspectors said that they do not have time to read the care plans, or to regularly review them. One of the agency staff said that they had not even seen a care plan despite having worked at the Home for a few shifts but did not feel that they would have had time to read them. A member of staff was asked questions about the support that clients need at Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 12 mealtimes and was unclear about what this should be. They said that they did what other staff told them to do or what they observed other staff doing. The Home does not have a key worker system in place. The assistant manager has recently attended training with regard to this role and the Manager said that it is expected that all staff will receive this training. The lack of a key worker system and the general lack of consistent staffing means that the clients needs are not being monitored or reviewed. Of the four clients comment cards two stated that they are involved in making decisions, one stated “sometimes” and one stated “no”. It is difficult to see how clients are involved in making decisions that affect their lives in any consistent meaningful way with the staffing situation as it currently is. Some of the staff do know the clients very well and are working very hard to try to ensure that their needs are met and that they are able to live a life that has meaning to them. However, this is very difficult when the current staffing situation means that they are working in a very task orientated way. Clients have little choice about the routines of the day such as getting up, going to bed, time of meals. There is also little choice about how they spend their days. For those clients with communication difficulties there is also little choice about how they receive the care that they need as they are not able to tell the staff and the care plans do not contain adequate information. It is required that the clients wishes and feelings are taken into account with regard to the care that they receive. At the time of the last Inspection the majority of the staff had attended an introduction to communication course and it was recommended that at least two staff attend the Total Communication course so that they are able to assess and plan for the clients communication needs. This has not taken place. Many of the clients do not have verbal communication and so it is very important that the staff have a good understanding of alternative ways of communicating to enable the clients to be able to have as much of a say about their lives as possible. The staff comment cards highlighted that communication between the staff team is not always as good as it could be and that this can lead to information about clients needs not being passed on. As the majority of staff work long 12 hour shifts there is often not a formal handover in the middle of the day but this means that the staff who do work shorter shifts are reliant on reading the communication book/daily notes to find out what has taken place during the morning. This is not a reliable way of handing over information to staff. Staff said that a more formal handover takes place in the mornings and evenings. During the walk around the Home the Inspectors saw that the daily notes, containing personal information about the clients, had been left on the table in Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 13 the lounge after handover had taken place. There were no staff in this room but clients were present, therefore confidentiality was breached. It is required that the clients privacy and dignity is respected. Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The clients do not have opportunities to be involved in meaningful activities Clients do not always have the choice of meals and do not consistently receive the support that they need at mealtimes EVIDENCE: Those clients who attend formal day services away from the Home are the only clients who are currently receiving any form of meaningful activity. Staff said that the current staffing levels do not enable them to regularly spend time with clients on an individual basis, either in the Home or away from the Home. Staff said that on the occasions when they do have enough staff they will try to take some of the clients out. The Manager has worked during the evenings to enable clients to go out on occasions. Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 15 The care plans are not detailed about what clients may like to do with regard to meaningful activities, whether this is work based or leisure interests. The daily notes show that occasionally clients are encouraged by staff to take part in household tasks such as laundry or cleaning their bedrooms. The staff rarely have time to encourage such involvement. Two of the care plans seen both state that the clients likes to go out but there is very little evidence, through records and discussions with staff, that this actually takes place. For example, for one of the clients there are no recorded activities in the daily notes between 29/09/07 and 15/10/07. A look at the clients records of financial expenditure for this client for the period of 11/07/07 to 10/10/07 (approximately three months) show that they paid for one reflexology session, two haircuts and two musical sessions that took place at the Home. The Home does arrange for reflexology sessions to take place for some clients although the expenditure records and daily notes indicate that this is not happening on a regular basis. Musical sessions (Memory Lane shows) also take place within the Home. The AQAA states that the clients take part in meaningful activities but the Inspectors saw no evidence of this. Three of the clients comment cards state that there are good activities and one states “no”. The staff comment cards and discussions with staff confirm the lack of activities for clients and the lack of time that they have to spend with clients on an individual basis. As previously mentioned, a relative and a social worker made a complaint which includes the lack of communication between the Home and others involved in the clients life. The care plan for this client does not include details about the arrangements in place for maintaining contact with relatives. The relatives comment cards contain mixed views about the Home with three stating that the Home “usually” keeps them up to date with issues affecting their relative and one stating that they are always kept up to date. Additional comments were made such as: “very pleased that the new owners have continued to provide the same excellent care” “…always made to feel welcome” “…less informed since….took over” “…needs better communication” Since the last Inspection there have been some changes to the staffing structure and the Home no longer employs catering and domestic staff apart from one part time domestic member of staff. The staff are now expected to undertake all catering and domestic tasks. Considering that the staffing levels are now lower than they were at the time of the last Inspection this means Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 16 that the staff have even less time to spend with the clients on an individual basis. One of the Inspectors spent time in Daphnes and there were considerable periods of time when the clients were alone in the lounge or dining area with no staff present. None of the clients there are able to call for help if they needed assistance and the majority of the clients are unable to move about unassisted. One of the improvements made since the last Inspection is that now all meals are planned separately for each of the houses and clients mainly eat within their own house rather than coming over to the main house for their meals. This means that clients can be more involved in the planning and preparation of meals. However, the current staffing situation means that this is not happening on a regular basis as it should. The Inspectors sat with clients at lunch time in two separate houses. The clients at the Coach House set the table and got their own drinks. There were no staff present during the meal and one of the clients had invited a friend to eat with them. The meal was relaxed and the clients like being able to invite their friends to join them. The clients were using plastic beakers with Christmas motifs on rather than glass ones. The table was set with dessert spoons but, when asked, the clients didn’t know if they were going to have a dessert or not. The menus were seen for one of the houses and this included a number of quick and easy meals rather than ones chosen for their nutritional value as well as the clients choice. One of the Inspectors spent time in Daphnes over the lunch time period. The dining room is not large enough for all clients to eat together and so the mealtime had two “sittings”. There is a table in the lounge and staff said that usually some of the clients have their meals there but due to the lack of regular staff on duty it was felt best to have two sittings so that the staff were all in the same room. As previously mentioned in this report there are serious concerns about the lack of clarity for staff about the dietary needs of one of the clients. The client has been given food on occasions which does not meet her nutritional needs. The staff are not all aware of the important guidance that should be in place with regard to her dietary needs. Training records show that only five staff have attended Food Hygiene training. Three of the clients have food which is liquidised and the meal that was seen was liquidised together into one bowl with no distinction between the separate parts of the meal. All three of these clients need one to one support at mealtimes. Other clients need support of various degrees at mealtimes also. Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 17 Two of the clients have large wheelchairs and there is not much room in the dining room once other clients are there also. Staff and other clients were seen to climb over the legs of the two clients and to continually walk by and knock into them or their wheelchairs whilst they were having their meals. Staff were seen to try to spend time with clients to support them to have their meal but were constantly called away to deal with other situations. Clients did not all receive the support that they needed in a consistent way. The Inspectors went to Daphnes soon after they arrived at the Home and some of the clients were up and sitting at the dining table. One of the clients said that they were waiting for breakfast. When the Inspectors went back to Daphnes at 10.20am (over an hour later) the domestic member of staff was getting breakfast ready as the clients were still waiting for breakfast. This situation is not acceptable. Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The clients personal and healthcare needs are not being consistently met The medication system has improved which should prevent further errors EVIDENCE: This report already includes many examples of how the personal and healthcare needs are not being consistently met. A further example is that one of the clients was sitting next to a packed bag and he told the Inspector that he was waiting to go to hospital that day for an operation. The Manager said that the operation had been cancelled as there had not been enough staff on duty for him to attend hospital and that the client had been informed of this. The care plans do not contain enough detailed guidance for staff about how to meet the personal and healthcare needs of the clients and the agency staff do not know the clients well enough to be able to provide the care they need. Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 19 The Manager said that all clients have recently had dental and optical check ups as the dentist and optician visited the Home. The usual staffing levels at night are for there to be two waking night staff for the whole Home. This is not adequate for the needs of the clients. Some of the clients who have lived at the Home for a long time are becoming increasingly frail and there are several clients who need two staff to assist them with mobility or personal care. The Manager said that there is usually a member of the afternoon staff who stays on duty until 9pm so there are three staff between 8pm to 9pm. This is still not adequate. Discussions with clients and staff show that clients are having little choice about what time they get up or go to bed and that this is entirely dependent on the staff on duty at that time. Some clients were still getting up at Daphnes at 11am on the day of the visit and there was no evidence to indicate that this was due to clients choice. The training records show that little training has been provided to staff about the specific needs of the clients. For example, the records indicate that no staff have attended training about pressure care prevention or epilepsy awareness and seven staff only have attended training about dementia. It is required that staff receive training specific to the needs of the clients. The AQAA states that a monitored dosage system has been introduced to the Home but does not include information about the six medication errors that have occurred in the last few months. The Commission was notified of the errors and the organisation arranged for a medication audit to be carried out by someone from within the organisation. The result of the audit was for several recommendations to be made which the Manager said have been met. She said that a further audit will be carried out shortly to ensure that improvements have been consistent. The medication cupboard at Daphnes has been moved to a more suitable place and the introduction of the monitored dosage system is an improvement. The training records show that approximately half of the staff have attended medication training but the Manager said that further training is booked for the other staff to attend. Due to the level of agency staff working at the Home the permanent staff often have to leave the area of the Home which they are working in to administer medication to clients elsewhere in the Home. On the day of the visit there would only be one permanent member of staff on duty by the evening with three agency staff. Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 20 On arrival at the Home the Inspectors saw a bottle of tablets and some ear drops on the side in the office. Clients have access to the office when staff are in there. The Manager said that this medication should have been returned to the pharmacy. An Immediate Requirement notice was left at the time of the visit. Some clients are prescribed PRN (as required) medication and there was no written guidance to staff about the circumstances in which this should be given despite the Manager saying that she had written this. A requirement is made about this. Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The Home has policies and procedures in place to protect the clients but the current staffing situation means that the risk of harm to the clients has increased EVIDENCE: The Home has a complaints procedure which is displayed around the Home in a simple format. It may be difficult for clients to feel confident enough to raise concerns with staff who they do not know very well. There are also no regular opportunities for clients to raise concerns such as regular client meetings or care plan reviews with keyworkers. However, the staff who know the clients well are better able to recognise if they are not happy about something and express a clear desire to provide a good service for the clients and a wish for the service to be improved. The Commission has received an anonymous complaint and two complaints from social workers, one of which was confirmed by a relative. The majority of the issues raised in the complaints have been found to be substantiated through this Inspection. Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 22 The Home has policies and procedures relating to the protection of the client. According to the training record only six of the permanent staff have attended training with regard to the protection of vulnerable adults. A requirement is made about this. The staff who spoke to the Inspectors were clear about the action they would take if they were concerned about any possible abuse of the clients and they have confidence that the Manager would deal with it appropriately. The Manager has taken appropriate action with regard to referrals to the adult protection team. The current situation at the Home is not providing enough protection for the clients. The risk of harm to the clients, caused possibly unintentionally, has increased due to the current staffing situation. Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28 & 30 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The environment is poor in several areas of the Home and does not provide comfortable and homely accommodation for the clients EVIDENCE: The Inspectors were shown around the Home and saw all of the communal areas and the majority of the bedrooms. The Home is made up of five different living areas. The quality of the accommodation in the three houses (Caddows, Badgets and Coach House) is generally higher than that in Daphnes and The Flat. Some areas of the Home are dirty and have an unpleasant smell. There are still some areas in the houses which would benefit from redecoration and refurbishment. For example, in Badgetts the toilet seat is broken and the floor Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 24 of the shower room is in poor condition. The bathroom in Caddows also needs refurbishing. The majority of the bedrooms in the houses are nicely personalised with the clients clearly having choice about the decoration. The condition of the accommodation in The Flat has improved in some areas as a ramp has been fitted to the kitchen step so it is now easier for staff to negotiate this area with the hoist and to support clients in wheelchairs. The lounge has also been redecorated. There was a broken window in the kitchen area but this was being replaced on the second day of the Inspectors visit. The bathrooms in The Flat are in urgent need of refurbishment and redecoration. The accommodation in Daphnes is in a very poor condition. The bedrooms are in need of refurbishment and redecoration. The condition of some of the beds/mattresses is poor with old hospital beds being used and thin mattresses. The majority of the mattresses are plastic covered so as to be waterproof but these are being used with only a sheet covering them and no mattress cover being used so they are likely to be uncomfortable. Several plug sockets/light switches were seen with tape over them. Plug sockets in one of the bedrooms had had silicone put around them to prevent the client pulling them out. The siliconed plugs were removed during the time of the Inspectors visit. It is required that problems with electrical items are addressed swiftly and by someone who is competent to do so. The bathrooms are in poor condition and not decorated in a homely manner. The dining room has been redecorated which is an improvement. Despite a recommendation made at the last Inspection the telephone still rings very loudly throughout Daphnes which is an intrusion into the clients lives. The Manager said that they will discuss this with the company who are shortly going to be fitting a new call bell system throughout the Home to see if there is a way to divert this to pagers the staff carry. At the last Inspection the Manager said that the organisation had carried out their own audit of the accommodation and that she was waiting for a copy of the planned maintenance programme. Since the last Inspection it is clear that some redecoration and replacement of furniture has occurred but the size of the Home and the amount of work that needs to be done means that this is not sufficient. The Home has a maintenance member of staff who works hard to maintain the buildings but there is too much work to do when redecoration and refurbishment is included in his role. At this visit the Manager said that she had just received a copy of the five year maintenance plan for the Home. A copy was given to the Inspector. This plan is not satisfactory. For example the walls in Daphnes lounge have holes in them and are in need of redecoration. According to the plan this will be done Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 25 in Year 2 but it is not acceptable for the clients who live there to have to wait over another year to have a lounge which is attractively decorated and with no holes in the wall. It is required that the work is carried out to ensure that the Home provides comfortable, clean and attractive accommodation for the clients. It is required that the organisation provide the Commission with a revised plan showing dates for when the work will be completed. The Home used to have separate catering and domestic staff working on a daily basis. The organisation have changed the staffing structure and there is now only one part time domestic member of staff. The care staff are now responsible for the cleaning and cooking, with the intention being that the clients are involved in these tasks as well. As previously mentioned in this report the staffing situation is poor and the staff do not have time to do these additional tasks. As some of the clients are becoming frailer and needing additional equipment, such as electric beds and hoists, the bedrooms are not large enough for these to be used easily. Also, one of the clients who moved to the Home in February 2007 needs the door handles lowered so that he is able to move around his home. This has not taken place and nor has the provision of new bedroom furniture which the social worker and relatives said was agreed prior to his admission to the Home. Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Staffing is not provided in adequate numbers to meet the needs of the clients Staff are not being provided with the training and supervision necessary to carry out their roles effectively The permanent staff are enthusiastic and are working hard to meet the needs of the clients EVIDENCE: The Inspectors spoke to several of the permanent staff and they are enthusiastic about working with the clients and clearly want to provide a good standard of care for them. However, they are frustrated at the limitations placed on them through the current staffing situation and the many changes of management that the Home has had over the last sixteen months. Some staff were observed to talk kindly and respectfully to the clients and some of the clients clearly felt comfortable enough to ask staff for things they wanted. Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 27 However, the current staffing levels clearly are not enough to meet the needs of the clients. Even when the number of staff on duty is an improvement on the numbers there on the day of the visit it is likely that at least two staff on each shift are agency staff. The Manager said that it can be difficult to ensure that the same agency staff work at the Home but that she does request this from the agencies. At the time that the Inspectors arrived at the Home there were three agency staff on duty with three permanent members of staff. Two of the permanent members of staff had previously been domestic staff but have been working as care staff since the beginning of this year and the other member of staff has worked at the Home for six months. Of the three agency staff one was on her first day, one had previously worked at the Home for four shifts and the other agency staff is working a few shifts each week at the Home. This report contains many examples of the poor outcomes for clients and many of these can be linked directly to the current staffing situation. These serious concerns were discussed during the Inspectors feedback and a letter requiring urgent action was sent to the Responsible Individual of the organisation, Mr James Boyd. The letter requested that the organisation write to the Commission by the 27th October detailing action to be taken to address the situation. The requirement within this letter is repeated below. It is required that at all times suitable qualified, competent and experienced persons are working at the Care Home in such numbers as are appropriate for the health and welfare of the clients. The AQAA states that the organisation has a robust programme of staff development and training, including with regard to individual specific clients needs. The training records, staff comment cards and discussions with staff do not provide evidence for this statement. In fact, staff have commented that there is not enough training specific to the needs of the clients. A requirement has already been made with regard to this. On the day of the visit the deputy manager and three care staff were attending training in Ely. There has also been some issues about the location of training as some of the care staff do not drive and some training provided by the organisation is not provided locally. The AQAA does recognise that recruitment has been a challenge for the organisation and that ongoing recruitment is taking place. The Manager confirmed this and also explained some of the difficulties in recruiting in a rural location with poor public transport links. The Manager has also recognised that the current system of staff working 12 hour shifts is not appropriate to the needs of the service and there are currently consultations taking place with staff about altering the pattern of shifts. Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 28 A selection of staff files were seen and these contain the necessary information, including proof of identity. Staff confirmed that they were asked to complete a Criminal Records Bureau disclosure prior to starting work at the Home. Staff said that they have received formal supervision but that this has not been provided regularly. The Manager said that there is now a plan for staff supervision. It is expected that the senior care staff will also carry out formal supervisions but they have not yet received training for this. A recommendation is made about this. Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 29 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The lack of consistency of management of the Home has led to poor outcomes for the clients The health and safety of the clients and staff is at risk of being compromised EVIDENCE: The Home was bought by Consensus in June 2006 and since then there have been five managers, including the current Manager. Two managers were appointed who did not stay beyond their probationary period and a senior manager took on the management of the service in between the other Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 30 managers. Julie Mayhew was previously working at another service within the organisation and has been managing the Home on a temporary basis since July 2007. It is expected that she will remain in post for at least another six months or until a permanent manager can be recruited. The Manager intends to apply for registration with the Commission. The changes in management have meant that the staff team feel unsettled and that there is a lack of clear direction for the Home. Relatives and staff comment cards make reference to the negative outcomes of the constant changes in staffing and management. Staff comment cards and discussions with staff do indicate that staff feel that this Manager provides good support and that they have confidence in her to move the service forward and to make improvements for the clients. They said that she is approachable and that she tries to keep them informed of changes. The previous owners of the Home did not have a system of senior care staff and this is an improvement that has been introduced by this organisation. However, one of the senior care staff has recently chosen to relinquish this responsibility and so there is only one senior care staff. One of the night staff has been appointed to the other seniors post and will start working on days as soon as cover is found for her night shifts. This will mean that the management team will comprise the Manager, the deputy manager and two senior care staff. Considering the problems that need to be addressed, the size of the Home and the complexities of the needs of some of the clients it may be beneficial to further increase the management team with additional senior staff. There is a need for continual monitoring and working alongside of staff to ensure that the clients are consistently receiving a good standard of care. A recommendation is made about this. The overall management of the Home is considered to be poor partly due to the lack of identification of the problems by the organisation and therefore no action taken to identify them. The AQAA was completed and returned to the Commission as requested but the Inspectors could not find evidence to confirm the positive nature of the AQAA and instead found lots of evidence to indicate that outcomes for the clients at the Home are currently poor. It is difficult to understand how the organisation was not aware of the problems if it was undertaking monthly providers visits to the Home. Even when problems have been identified the action proposed is not in a timely manner, for example, the proposed maintenance plan for the Home means that clients will continue to live in poor accommodation for, in some cases, up to five years. Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 31 The Home has recently employed an administrative member of staff which is an improvement as this frees up time for the Manager and deputy manager. The administrator used to work as a care staff and so knows the clients well. A selection of health and safety records were seen and these show that regular servicing is taking place for the fire equipment and mobility equipment. Issues relating to health and safety have already been highlighted in this report. In addition to these, maintenance reports were seen for two of the boilers, both of which recommended action to be taken. The Manager was not aware of these documents nor whether the action had been taken. On the second day of the Inspectors visit the Manager provided a letter from the organisations Facilities Manager confirming that the boilers were serviced in May 2007 (oil fired boilers) and July 2007 (gas fired boilers). Both resulted in recommendations, none of which have yet been actioned. This situation is not acceptable, particularly as a requirement was made at the last Inspection with regard to ensuring that the boilers are suitable for the needs of the clients. It is required that the work is carried out to ensure that the boilers are working safely and effectively. A fire risk assessment has very recently been carried out at the Home and several recommendations have been made. It is required that the home makes adequate precautions against the risk of fire. It is also required that the organisation provide the Commission with a written plan of when the work will be carried out. As previously mentioned in this report the Home does not have a suitable system for involving the clients in the decision making process. There is no formal system in place for reviewing the quality of the care provided at the Home which involves the clients and others involved in their lives eg. Relatives and health/social care professionals. The organisation has monthly provider visits and have completed the AQAA but the quality of these is not sufficient to have identified the problems and addressed them. It is required that the Home has a system in place for reviewing the quality of the care provided. Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 32 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 1 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 1 25 1 26 1 27 1 28 1 29 X 30 1 STAFFING Standard No Score 31 1 32 1 33 1 34 3 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 1 1 2 LIFESTYLES Standard No Score 11 X 12 1 13 1 14 1 15 2 16 1 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 2 X 1 1 1 X X 1 X Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 Requirement It is required that the care plans provide staff with detailed guidance about how to meet the client’s needs. The previous dates of 31/10/06 and 31/12/06 were not met. It is required that risks are identified, assessed and that clear guidance is provided to staff about how to manage the risks It is required that the clients wishes and feelings are taken into account with regard to their care It is required that the privacy and dignity of the clients is respected It is required that medication is stored appropriately An Immediate Requirement was left at the time of the visit It is required that clear written guidance is available about the use of PRN (as required) medication Timescale for action 31/12/07 2 YA9 13 31/12/07 3 YA7 12 30/11/07 4 5 YA10 YA20 4 13 31/10/07 16/10/07 6 YA20 13 16/10/07 Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 34 7 8 YA19 YA42 18 13 9 10 YA24 YA24 23 23 11 YA33 18 12 YA24 23 (2) It is required that staff receive training specific to the individual needs of the clients. It is required that problems with electrical equipment are addressed quickly by someone competent to do so It is required that the Home provides comfortable, clean and attractive accommodation It is required that a plan of work with revised dates is sent to the Commission for the refurbishment and redecoration of the Home It is required that at all times suitable qualified, competent and experienced persons are working at the Care Home in such numbers as are appropriate for the health and welfare of the clients. A letter of urgent action was sent to the RI on 17/10/07 It is required that the boilers in the houses are suitable to meet the needs of the residents. The previous date of 31/12/06 was not met It is required that adequate precautions are taken against the risk of fire It is required that the organisation provide the Commission with a written plan of action to be taken following the fire risk assessment 31/01/08 16/10/07 30/04/08 30/11/07 30/11/07 30/11/07 13 14 YA42 YA42 13 13 31/10/07 10/11/07 Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 35 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 YA36 YA38 Good Practice Recommendations It is recommended that supervision training is provided to staff who are responsible for carrying this out It is recommended that the management team is expanded to include additional senior care staff Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Docking Grange DS0000066607.V353217.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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