Inspection on 18/08/08 for Docking Grange

This inspection was carried out on 18th August 2008.

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 7 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 21/02/08

Docking Grange 16/10/07

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 05/12/2008.

CARE HOME ADULTS 18-65 Docking Grange Sandy Lane Docking Kings Lynn Norfolk PE31 8NF Lead Inspector Lella Hudson Unannounced Inspection 18th August 2008 10:25 Docking Grange DS0000066607.V370310.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.V370310.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.V370310.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.V370310.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. 21st February 2008 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 Hollies,) 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.V370310.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is NO STAR. This means that the people who use this service experience POOR quality outcomes. The Home was purchased by Concensus (Caring Homes) in June 2006. At the Key Inspection in October 2007 the quality rating of the Home was Poor but some improvements were made and the quality rating increased to Adequate at the Key Inspection in February 2008. A Random Inspection was carried out on the 30th July 2008 to monitor compliance with the requirements that had been made at the previous Key Inspection. The requirements had not been met and so the Key Inspection was brought forward and found that the requirements have still not been met. Enforcement action is now being considered. This report contains information gathered about the Home since the last Key Inspection, which includes the Random Inspection (July 08) and a visit to the Home carried out by two Inspectors on the 18th August 2008. It also includes information provided by the Home in the form of notifications, information provided by a range of health/social care professionals, information about concerns/complaints and also information provided with surveys that were completed by health/social care professionals (4), residents (14), staff (6) and relatives (9). The residents had all been supported by staff to complete the surveys. Some of the comments within the surveys are as follows: “we provide good care to the residents” (staff) “we have a lot of agency staff” (staff) “..they have really tried to bring everything up to scratch” (staff) “we have always been welcomed” (relative) “there seems to be a very high staff turnover which is worrying” (relative) “staff keep…clean and well dressed and have a friendly attitude” (relative) “I feel it would be a better place if it had more regular staff” (relative) “need to improve contact with other agencies” (health/social care professional) “need more experienced staff and a higher level of staff” (health/social care professional) “staff are friendly and willing to undertake requests” (health/social care professional) “staff would benefit from training….” (health/social care professional) A Code B notice was given to the Manager at the start of the visit to the Home. This legal notice explains the powers that Inspectors have to remove documents from the Home which may be needed if enforcement action is to be Docking Grange DS0000066607.V370310.R01.S.doc Version 5.2 Page 6 taken with regard to the lack of compliance with the requirements previously made. There has been many changes to the management of this Home over the last two years. The most consistent period of management has been between July 2007 and July 2008 when a temporary manager was in post. A new manager was appointed in July 2008 but at the random Inspection she informed us that she was leaving the following week. The organisation have appointed Matt Dale as the new manager of the Home. He has previously managed another Home within the Consensus organisation. He had started working at the Home the week before our visit. What the service does well: What has improved since the last inspection? What they could do better: There are several requirements which have been outstanding since the Inspection in October 2007. There has been little, if any, progress towards meeting these requirements and there seems to have been little recognition by the organisation that these improvements need to be made. The staffing levels are not adequate to meet the needs of the residents. A review of the staffing needs to be done to ensure that there are adequate Docking Grange DS0000066607.V370310.R01.S.doc Version 5.2 Page 7 numbers of care staff, domestic and catering staff as well as staff available to support residents to take part in meaningful activities. Staff need to be provided with appropriate training, particularly with regard to the specific needs of the residents, such as epilepsy, challenging behaviours, continence and safeguarding. Work needs to be done with regard to improving the communication skills for the staff so that those residents who have difficulties with verbal communication are better able to voice their opinions and to be understood. Residents need to be much more involved in making decisions about issues that affect them. Staff do try to obtain their views about basic decisions but this needs to be developed much further. The care plans and risk assessments need to be more detailed so that they provide detailed guidance for staff about how to meet the needs of the residents. Staff need to have time to be able to read these documents and to become familiar with them. There needs to be adequate levels of management within the Home and this needs to be consistent so that staff and residents have consistency and appropriate support. 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.V370310.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.V370310.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. Information from ongoing assessments are not used as the basis for the residents care plan EVIDENCE: Following the Inspection in October 2007 the organisation gave a voluntary undertaking not to admit any further clients to the Home. Following the Inspection in February 2008 the organisation said that they would consider further admissions but none have actually taken place since then. Therefore, it has not been possible to look at whether pre admission assessments have been made and form the basis for the residents care plan but ongoing assessments have been undertaken by health/care professionals and these have not all been used to formulate a care plan and not all of the staff are aware of the assessments. Docking Grange DS0000066607.V370310.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 Quality in this outcome area is Poor This judgement has been made using available evidence including a visit to this service. The information within the care plans is not sufficient to ensure that the residents needs are met in a consistent way Residents are not fully involved in making decisions about issues that affect them. EVIDENCE: At the Inspection in February 2008 we had been notified by the organisation that all of the care plans and risk assessments had been reviewed and completed and the examples that we saw at that time confirmed this. However, during the random Inspection in July 2008 and during this Inspection it was seen that very little further work has been done to the care plans and that they have not been regularly reviewed or updated. Docking Grange DS0000066607.V370310.R01.S.doc Version 5.2 Page 11 For example, at the random Inspection it was noted that one of the care plans dated January 2008 indicates that the review date is to be six months from the date of the care plan and there was no evidence that this had taken place. Another care plan states that a review should have taken place in April 2008 but with no evidence that this had taken place. During this visit we saw further evidence of other care plans which had not been reviewed or updated but we did also see that one of the care plans had been updated following recent changes for one of the residents. However, not all of the staff who spoke to us were aware of the new care plan. During this visit to the Home we looked at three care plans. None of them contained enough information to ensure that staff have clear guidance about how to meet the residents needs. For example, one states that the resident needs to use the hoist and sling when bathing but there is no detail about which sling or which hoist this should be. The same care plan states that the resident needs help at meal times but no details about how this should be provided. Discussions with staff about the needs of residents showed that there is some uncertainty about whether staff need to receive additional training to assist this resident at mealtimes and the care plan is not clear about this either. The care plan for one of the residents does not contain any plan or guidance about epilepsy but there is a chart to record seizures on therefore indicating that the resident has epilepsy. This was confirmed by the staff. Two of the care plans state that staff should use “low arousal” techniques when supporting the residents with challenging behaviours but staff have not received this training and were not aware of what these were when asked about it. Discussions with staff showed that they are aware of the care plans and that the majority have read them, however, they are not all aware of some recent changes to care plans relating to a couple of the residents. New staff said that they are being encouraged to read the care plans but that this will take some time due to the number of residents living at the Home. An allegation was referred through the Safeguarding procedures in June 2008 and one of the statements made during the investigation into this situation which was carried out by the organisation was that the member of staff involved was not clear about the care required by one of the residents. A complaint was made to the Home in May 2008 by a social worker. One of the aspects of this complaint was that the staff have a lack of knowledge about the care needs of the resident and that there was a lack of preparation for reviews. The Manager had apologised for this situation and undertaken to improve the planning for reviews in future. It was also noted during the random Inspection and during this visit to the Home that the financial care plans have not been updated and so there is still a Docking Grange DS0000066607.V370310.R01.S.doc Version 5.2 Page 12 lack of clear information about how the residents money is managed and who is responsible for doing so. The Manager said that he intends to change the format of the care plans to that used elsewhere within the organisation. The new format encourages a much more person centred approach. Two of the care plans have been completed as part of the staff training about this. Another manager from within the organisation was present at the Home during our visit and was introducing the new format to a member of staff. The requirements about the need to improve the care plans and risk assessments have not been met. This means that there is no clear guidance for staff about how to meet the residents needs. It is particularly important that this is in place considering the high usage of agency staff at the Home which has been ongoing for many months. Staff told us that they have attended training about the use of the key worker system but that this is not yet in place. Staff told us that the longer period of time that they now have as a crossover between the early shift and the afternoon shift means that they have enough time to carry out an effective handover. The residents in each of the houses are encouraged to meet on a weekly basis to discuss any issues that they would like to talk about. This usually includes planning the menus for the following week and any activities that they may wish to do. During the random Inspection we were told by one of the residents that they wanted to go shopping that day but that they could not do so as there were not enough staff on duty. During this visit to the Home we observed staff asking residents for their preferences about a limited range of issues such as whether they would like a drink and where they wanted to spend their time. The communication needs of the residents living at the Home are very varied with some residents being able to effectively communicate verbally and others who have no verbal communication at all. The care plans do not contain detailed information about the communication needs of the residents and so it is not clear to the staff about how the individual communicates. One of the care plans that we saw states that the resident should be shown objects as a way of communicating. This was not seen to take place during our visit to the Home. A group of staff have been met with the Communication Development Worker in order to agree how to improve the communication systems in place. We have seen a record of agreements made at that time but saw little, if any, evidence of the work actually in practice. There are some signs around the Home which have been made into both symbol and word formats. Docking Grange DS0000066607.V370310.R01.S.doc Version 5.2 Page 13 Docking Grange DS0000066607.V370310.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. Residents are not supported to take part in meaningful activities on a regular basis and they are only helped to exercise choice and control in a limited range of issues affecting their lives Residents receive an appealing, balanced diet. EVIDENCE: Staff have worked hard to try to improve the opportunities for residents to take part in meaningful activities but they are hampered by the staffing levels and the location of the Home as it is necessary to have a driver available if residents wish to go further than the limited facilities in the village of Docking. There are 29 residents living at the Home and we were told that approximately six attend formal day services each day. The other residents are reliant on staff at the Home to support them to access activities both within the Home Docking Grange DS0000066607.V370310.R01.S.doc Version 5.2 Page 15 and away from the Home. The Home does not employ staff specifically to support residents with activities and there is no increase in staffing when all of the residents are at Home during the weekends. One of the improvements that has been made is that some of the residents have been on holiday this year and others have holidays planned in the forthcoming weeks. Residents told us how much they are enjoying these. They also said that they have been able to go out to lunch and to go shopping recently. However, these opportunities are limited and only a few residents can be supported to take part in activities away from the Home at a time. For example, one of the care plans that we saw states that the resident likes going to shops and restaurants and for a ride in the bus. When we looked at the record of activities in the residents care plan we noted that between 1st July 2008 and the 10th August 2008 (approximately 6 weeks) there were no records of the resident having been out of the Home. The only activities within the Home listed in that period was two sessions of external entertainers and one foot massage. The care plans contain basic information about the residents next of kin and family but there are no clear details about what support the resident needs, if any, to maintain contact with family and friends. For example one of the care plans written in January 2008 states that the staff should support the resident to maintain contact with his family but there are no details about how this should be done and who should be doing it. In 2007 the organisation made alterations to the catering arrangements that were previously in place. The large catering kitchen is now not used and there is a cook employed only between Monday to Friday. The cook works in the very small kitchen at Daphnes and provides the lunchtime meal for the residents living at Daphnes and the Flat (Hollies). The staff working in Caddows and Badgets do the cooking for the residents living there and at the Coach House. At weekends there is no dedicated cook and so the care staff are responsible for cooking all meals. The staffing levels are not adequate to meet the needs of the residents and this further reduces the staff available to support individual residents. Four of the residents require specific training for staff to be able to safely support them to eat/drink. The care plan for one of the residents who needs this support has been seen by us previously and contains detailed information about how this support should be provided. As previously mentioned in this report we saw another care plan during this visit which did not contain enough information for staff to be able to safely provide support at mealtimes to the resident. There was also a lack of clarity amongst the staff team about which of the residents need staff to have received additional training before supporting them with meals. Docking Grange DS0000066607.V370310.R01.S.doc Version 5.2 Page 16 Residents said that they like their meals and that they are involved in making choices about these. The Speech and Language therapist is involved in assessing the needs of the residents and for providing training to the staff. There have been difficulties in ensuring that agreed plans for training go ahead due to changes in the staffing rotas and lack of communication between the Home and the training provider and the most recent training planned for 12th August has now been postponed to 26th September. There is a need for all staff to attend Food Hygiene training as they are now all involved in the preparation of meals. According to the training audit which the Manager gave to us only 39 of staff have attended this training. The majority of this training has been through e-learning via the computer. This training matrix only covers the permanent staff who work at the Home and so it is not known how many of the agency staff have received this training. There were no records available for us to see about which staff have received the additional training so as to be able to support individual residents at mealtimes. One of the staff told us during the random Inspection that on occasions there has only been one member of staff on duty who has received the additional training and so the residents who need this extra support have to wait for meals as only one staff can support them. Docking Grange DS0000066607.V370310.R01.S.doc Version 5.2 Page 17 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 personal and healthcare needs of the residents are not met consistently EVIDENCE: As previously mentioned in this report the care plans are not detailed enough about how individual residents needs should be met. One of the residents is epileptic but there is no care plan in place for this. There are not enough details about the support that residents need at mealtimes and for personal care. One of the residents has very clear guidance, provided by the health team, about how to support them with their behaviour and this is kept in the same folder as the care plan but there is no cross reference made in the care plan to refer staff to it. Some staff are aware of it and have read it and others have not. Staff have not received the training which is specified that they should use when supporting this resident. Staff did not give us consistent responses about the support that particular residents need when we spoke to them. Docking Grange DS0000066607.V370310.R01.S.doc Version 5.2 Page 18 It is particularly important that this is in place due to the high usage of agency staff who do not all know the residents well. It is also particularly important for those residents who have communication difficulties as they are not able to tell staff how they wish to be supported. The care plans also do not contain information about residents appointments for regular health checks up such as dentist, optician, well man/woman checks. We were told that the Health Action Plans have recently been provided and so these will start to be used shortly. The requirement for training to be provided to staff about the specific needs of the residents, such as epilepsy, mental health, challenging behaviours, communication and continence has not been met. The training matrix does not even list these subjects as part of the training plan for the Home. The matrix shows that the majority of the permanent staff have received moving and handling training. One of the staff has recently completed Training the Trainers course so that she can provide Moving and Handling training to staff. Prior to the last Key Inspection there had been some complaints made by the Dispensing Manager at the GP surgery. Prior to this visit to the Home we contacted them to find out if there have been improvements. The Dispensing Manager said that the way in which medication is ordered has been improved but that there have still been occasions when medication has run out and that errors have been made. In May 2008 the District Nurse had made a complaint about the levels of care provided to the residents, lack of staff understanding of the needs of the residents and of residents missing hospital appointments. We spoke to her in July 2008 and she said that there have been improvements in the staff understanding of the needs of the residents and that the staff have provided good care to one of the residents whose health has declined recently. As previously stated in this report there have been difficulties in organising training with regard to supporting residents with eating and also that there is little evidence of the communication work in place which was agreed between staff and the Communication Development Worker. The staffing levels are not adequate to meet the needs of the residents. Several of the residents need the hoist for all mobility needs and this means that two staff are needed to support them at these times. Several of the residents need support at mealtimes and four need staff who have received specific training to support them at these times. There is a high use of agency staff, some of whom have received this additional training. During this visit and during the random Inspection staff told us that often residents have to wait to be helped to get up or go to the toilet or to have their meals as this relies on having enough staff to assist residents and for those staff to have received the appropriate training. Docking Grange DS0000066607.V370310.R01.S.doc Version 5.2 Page 19 We observed staff supporting residents in a positive and kind manner. There was lots of chatting between residents and staff as well as humour. Staff who spoke to us were positive about supporting the residents and keen to make improvements to the care provided. We looked at the medication system in use during this visit. The deputy manager said that the ordering system has been changed so that only half the medication is ordered each time so that each is ordered on a fortnightly basis. This reduces the time taken to order and to check the medication when it arrives and has reduced errors. We were notified of two medication errors that took place at the Home and the outcome of a medication audit that took place as a result of those errors in July 2008. The audit carried out on that date showed that there were 12 errors found. The majority of these were with regard to the administration record not having been signed but as some of the medication was liquid it was not possible to ascertain whether it had been given or not. It was discovered that one client had not received medication (two different tablets) on three occasions. The information sent to us included action that had been taken to address this situation with staff. There is still a need for clearer information about the PRN (as required) medication which is prescribed as one of the residents is prescribed Stesolid and this is present in the medication cupboard but we were told that staff are not trained to administer this and would need to call for an ambulance if the resident needed it. This is not recorded on the administration chart. It is only the permanent staff who administer medication and they must receive training prior to doing this. The training matrix shows that there are several staff who have not done this training. Medication training is not included on the audit of training that is completed on a monthly basis. Docking Grange DS0000066607.V370310.R01.S.doc Version 5.2 Page 20 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. Complaints are taken seriously but residents are not fully protected from abuse EVIDENCE: The complaints procedure is displayed around the Home both in words and in symbols. The procedure in the policies and procedures file has the wrong contact details for the Commission. As previously mentioned in this report there are many residents living at the Home who have communication difficulties and improved skills for the staff would increase the opportunities for residents to raise any concerns/complaints that they may have. The staff who know the residents well can often tell if a resident is not happy about something but as there are a lot of agency or new staff this is not always possible. As already mentioned in this report a social worker made a complaint in May 2008 about the lack of preparation for reviews and the lack of understanding by staff about the residents needs. The Manager investigated this situation and we were advised of the outcome. There have been two situations between residents which have been referred through Safeguarding procedures, one referral made by a social worker and one by the Home. We saw one of the care plans for one of the residents involved and it had been updated to include guidance for staff about how to manage the particular situation but not all of the staff who spoke to us are aware of this which therefore may put other residents at risk. Docking Grange DS0000066607.V370310.R01.S.doc Version 5.2 Page 21 In June a referral was made through Safeguarding procedures by the Home. We were not notified of this situation as we should be. The outcome was that the situation was investigated by the organisation and we have now been advised of the outcome of this. The training matrix provides evidence that the requirement for all staff to have received Safeguarding training has not been met. This was confirmed through discussions with staff. The Manager said that there are no records in the Home about the training that the agency staff have received Safeguarding training. One of the staff has now completed Training the Trainers course to provide Safeguarding training to the staff team. Docking Grange DS0000066607.V370310.R01.S.doc Version 5.2 Page 22 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 & 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The quality of the accommodation is mixed with some areas providing homely and comfortable accommodation and others in need of improvement EVIDENCE: At the time of the Inspection in October 2007 the standard of the accommodation was very poor but a great deal of improvements have taken place since then. However, there are still areas in which further improvements need to be made. The Home is divided into five separate living areas. There are three small houses (Caddows, Badgets and the Coach House) which provide accommodation in more ordinary style houses. Each client has their own bedroom and there is a shared bathroom, dining room, lounge and kitchen in each house. Level access showers have now been provided in two of the houses. Docking Grange DS0000066607.V370310.R01.S.doc Version 5.2 Page 23 In the older part of the Home the accommodation is divided into two separate living areas. Daphnes provides accommodation on the ground and first floors. All residents have their own bedrooms, some of which are still in need of redecoration and refurbishment despite agreement by the organisation that this would take place. Prior to the Inspection in October 2007 a complaint had been received from a relative and one of the elements of this was the poor state of the bedroom that their relative has at Daphnes. During this visit we looked at this room again and found that it is still in the same poor state. The room is bare with nowhere for storage of incontinence pads which were lying on the floor. The bed is a stark metal bed which looks very institutionalised and the chest of drawers has broken drawers. We saw that there were two sets of bedroom furniture stored in one of the unused rooms in the Home and we were told that these had just been delivered but it was not known who they were for and would be given to residents who need them most. Residents are not being involved in the choosing of new bedroom furniture. The main lounge in Daphnes was decorated and refurbished after the Inspection in October 2007 and is greatly improved. However, curtains were ordered several months ago and they have still not all been put up. The Manager said that there have been problems with the supplier. The organisation has recently installed a new call bell system which means that staff are now able to contact each other more easily through the use of pagers. When we visited in July 2008 there was a very large display panel fitted in the middle of the wall in the lounge at Daphnes and the call bell was loud and intrusive. We told the organisation that residents and staff were not happy about this situation. During this visit we noted that the panel has been changed to a smaller one and has been moved. Also the sound of the call bell has been changed to one which is less intrusive. A bathroom on the first floor has been refurbished to provide a new bath which raises up and which has an integral hoist. There have been many delays in the fitting of this bath and it had just been completed prior to our visit. Staff said that the residents who have used it seem to like it. The flat, known as Hollies, provides accommodation on the first floor only and there is a lift to this areas. The bathrooms in this area have also been refurbished in the last few months. At the random Inspection we were told that all of the Fire Officers requirements have been met in this area following his last visit but during this visit to the Home we were told that the kitchen is only used for making snacks and drinks as the Fire Officer has required that additional fire doors be fitted prior to cooking being done in the kitchen. Docking Grange DS0000066607.V370310.R01.S.doc Version 5.2 Page 24 The Home only employs one domestic member of staff and she works part time hours in the Coach House only. The care staff are expected to carry out the rest of the domestic tasks, including laundry. Docking Grange DS0000066607.V370310.R01.S.doc Version 5.2 Page 25 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): 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 levels are not adequate to meet the needs of the residents and staff do not receive the appropriate training and support to enable them to carry out their roles effectively EVIDENCE: Despite several requirements the staffing levels have not increased sufficiently to meet the needs of the residents. At the last Key Inspection the staffing had increased slightly and the organisation said that it was carrying out a staffing review which they would provide us with a copy of. We have still not received this but we were told that it considered that 10 staff were necessary to meet the needs of the residents. The situation regarding the high use of agency staff has not improved. Efforts are made to have the same agency staff who have worked there before so that they know the residents but this is not always possible. Recruitment is always ongoing but there has been a continual turnover of staff. Docking Grange DS0000066607.V370310.R01.S.doc Version 5.2 Page 26 During the random Inspection it was noted that there had been times when there had been ten staff on duty but that this was not regular and that there had been times when there were only six staff on duty, including the Senior staff. There is no increase in staffing at weekends when all of the residents are at home and there are no domestic staff or cook on duty. We looked at the rotas for July and August 2008 (not including week beginning 2nd August) and did some analysis of these. This included 56 morning/afternoon shifts: - 27 occasions when there at least 10staff on duty, including the senior - 3 occasions when only 6 staff on duty, including the senior and including agency staff. On one occasion 4 out of the 6 staff were agency - the rest of the shifts were covered by between 7 – 9 staff including the senior and agency staff. - 4 shifts with no senior on duty. We spoke to staff during our visit to the Home and they said that the staffing levels have been improved but that they are still not enough to ensure that the needs of the residents are met and to support residents to take part in meaningful activities. The organisation provided us with a copy of the training matrix and the latest training audit. This shows that the requirements made about the need for additional training have not been met. As previously stated, one of the staff members has recently attended Training the Trainers so that she can provide training in three subjects directly to the staff. The Manager said that the organisations training department also provide training. The organisation promotes the use of e-learning but this relies on staff having time to do this and the staff having the appropriate IT skills. Staff said that they receive support from the seniors but that there have been recent changes in Managers which is unsettling. One of the seniors has worked at the Home for a long time and knows the residents very well. There are three seniors at the Home, one of which has just started working at the Home. Formal supervision does not take place on a regular basis, even for the member of staff subject to a Safeguarding referral. The organisation has a system of shadowing for new members of staff which means that they should not be counted as part of the rota until they finish this period of induction. The rotas show that the new Senior was the only senior on duty for two of the shifts during his second week. Also, during our visit the new senior staff was on duty in one of the houses with a member of staff who had also only just started work at the Home. Both of these staff should have been shadowing other staff. The Manager said that this had only occurred for a short period of time as the permanent member of staff was called away. Docking Grange DS0000066607.V370310.R01.S.doc Version 5.2 Page 27 The Manager said that there is no information available about the training and experience that the agency staff have and that he has arranged to meet the agency manager to discuss this and has asked him to fax copies of the information so that it is available in the Home. The organisation has clear recruitment procedures. We checked two of the recruitment files and these contained evidence that the necessary checks have been carried out. Docking Grange DS0000066607.V370310.R01.S.doc Version 5.2 Page 28 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 Home lacks leadership and direction so the service provided is not consistent or person centred. The views of the residents are not routinely sought. EVIDENCE: Between 2006 and July 2007 there were several changes of Manager at this Home. During periods without a Manager the organisation ensure that a peripatetic manager and the RI provides additional support to the Home. Between July 2007 and July 2008 one of the organisations Managers managed this Home on a temporary basis. A new Manager was appointed in July 2008 and during our random Inspection told us that she was leaving during the first week in August. The organisation has appointed a manager, Matt Dale, from Docking Grange DS0000066607.V370310.R01.S.doc Version 5.2 Page 29 elsewhere in the organisation to manage the Home on a permanent basis. He has the appropriate qualifications and experience to take on this role and started working at the Home the week before our visit. Mr Dale has a good understanding of the improvements that are still outstanding and told us some his plans to address these. The Home is large and there is usually only one senior member of staff on duty who has a number of responsibilities which also include answering the telephone and dealing with all enquiries when the administrator is not working. We have not been notified of events as we should have been over the last few months. These include medication errors and the suspension of a member of staff. The requirements made at the last Key Inspection are still outstanding. The Home has recently sought the views of the residents as part of their quality assurance system. However, there is little evidence that the residents views are sought and listened to throughout the year and little evidence that the Home is run in the best interests of the residents despite staff working hard to try to achieve this. We looked at a small selection of health and safety records which show that regular maintenance and servicing of equipment takes place. Docking Grange DS0000066607.V370310.R01.S.doc Version 5.2 Page 30 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 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 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 3 LIFESTYLES Standard No Score 11 X 12 1 13 1 14 1 15 2 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 X 1 1 1 X X 2 X Docking Grange DS0000066607.V370310.R01.S.doc Version 5.2 Page 31 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. This requirement had a timescale of 15/08/08 which has not been met. It is required that risks are identified, assessed and that clear guidance is provided to staff about how to manage the risks This requirement had a timescale of 15/08/08 which has not been met. It is required that the clients wishes and feelings are taken into account with regard to their care This requirement had a timescale of 15/08/08 which has not been met. It is required that staff receive training specific to the individual needs of the clients. This includes, amongst other subjects: DS0000066607.V370310.R01.S.doc Timescale for action 31/10/08 2. YA9 13 31/10/08 3. YA7 12 31/10/08 4. YA19 18 30/11/08 Docking Grange Version 5.2 Page 32 Safeguarding Adults Food Hygiene Continence care Communication Moving and Handling Behaviours which challenge This requirement had a timescale of 15/08/08 which has not been met. 5. YA20 13 (4) It is required that clients receive 18/08/08 their medication at per dispensing instructions and that accurate records are kept of this It is required that at all times 18/08/08 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. This requirement had a timescale of 15/08/08 which has not been met. It is required that a financial care 31/10/08 plan is kept for each client This requirement had a timescale of 15/08/08 which has not been met. 6. YA33 18 7. YA7 13 (6) 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 Docking Grange DS0000066607.V370310.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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.V370310.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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