Inspection on 21/02/08 for Docking Grange

This inspection was carried out on 21st February 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 18/08/08

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 27/09/2008.

CARE HOME ADULTS 18-65 Docking Grange Sandy Lane Docking Kings Lynn Norfolk PE31 8NF Lead Inspector Lella Hudson Unannounced Inspection 21st February 2008 06:15 Docking Grange DS0000066607.V360110.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.V360110.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.V360110.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) Julie Mayhew – not registered Care Home 34 Category(ies) of Learning disability (34) registration, with number of places Docking Grange DS0000066607.V360110.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. 16th October 2007 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.V360110.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report contains information gathered since the last Key Inspection which was carried out on the 16th October 2007. It includes information gathered from the following sources: An unannounced random inspection which was carried out on the 4thDecember 2007 to follow up requirements made at the previous Key Inspection. Investigations into complaints/concerns raised since the last Key Inspection Meetings with representatives from the organisation Notifications and reports sent to the Commission from the organisation Completed surveys received from health/social care professionals and staff An unannounced visit which was carried out between 6.15am and 3.15pm on the 21st February 2008. This visit was carried out by two Inspectors and included discussions with the Manager, staff and clients, observation of staff supporting clients, inspection of records and a look around the accommodation - The Home continues to be managed by a temporary Manager although the organisation will be interviewing for a permanent Manager in February 2008 with the intention of there being some handover time before the temporary Manager leaves. Following the last Key Inspection the Commission met with the Responsible Individual and other representatives from the organisation to discuss the Commissions concerns about the care provided at the Home. Since then, the organisation has kept the Commission informed about action taken to make improvements and of plans for further improvements. Some improvements were noted at the Random Inspection (Dec 07) and further improvements were seen at this Inspection (Feb 08). However, the organisation are aware of the importance of maintaining the improvements that have already been made and of the work that still needs to be done to improve outcomes for the clients. The quality rating for this service is ONE star. This means that the people who use this service experience ADEQUATE outcomes. Docking Grange DS0000066607.V360110.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The organisation is aware of the need for further improvements in most areas of the Home and has plans in place to address the issues. Some of the areas still in need of improvement are as follows: - increased staffing to enable clients to be supported in an individual way and to be able to access meaningful activities on a regular, consistent basis - increased training for staff so that they have the knowledge and skills to meet the individual needs of clients - continuing improvements in the accommodation provided - involving the clients in making choices and decisions about issues that affect them Docking Grange DS0000066607.V360110.R01.S.doc Version 5.2 Page 7 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.V360110.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.V360110.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 assessments was not used to provide guidance to staff about meeting client needs EVIDENCE: The organisation gave a verbal agreement to the Commission in December 2007 that they would not admit any more clients until improvements to the service provided had taken place. Therefore, this standard has not been able to be reassessed and the judgement above reflects the situation found at the last Key Inspection. Docking Grange DS0000066607.V360110.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 adequate This judgement has been made using available evidence including a visit to this service. The care plans and risk assessments provide basic information and guidance for staff about how to meet the clients needs but need further improvement The clients have little control or choice about the majority of issues affecting their lives EVIDENCE: At the last Key Inspection the standard of the care plans and risk assessments was poor with little information or guidance provided to staff about how to meet individual needs. The investigation into a complaint made by a social worker about the care that one of the clients receives was found to be substantiated and one of the key factors was that the care plan and daily records were poor and that there was no-one responsible for reviewing and monitoring the care provided or the records of this. Docking Grange DS0000066607.V360110.R01.S.doc Version 5.2 Page 11 Following the Key Inspection the organisation undertook to review the care plans and to ensure that the quality of these was improved. At the Random Inspection it was noted that this process had started. The organisation notified the Commission that this process has been completed and during this visit to the Home it was noted that all of the three care plans seen by the Inspectors had been reviewed and updated. The care plans are now easier to read as all relevant information is in one file, rather than two. The information in the care plans, including the risk assessments, is basic and is quite task orientated. These provide guidance for staff about how to meet the clients basic needs and are an improvement on the care plans that were seen previously. There is also evidence that information is being reviewed as it changes, for example, one of the care plans had been updated straight away following a client falling. However, there is a need for further improvements and so the requirement about care plans is repeated within this report. For example, one of the care plans contains information about how to fit continence pads but there is no information within the care plan about the clients need for this assistance. When the Inspector asked staff about this she was told that the client does not use continence products. The same client has a care plan with regard to his behaviour which states that staff should have an understanding of low arousal and de-escalation techniques but discussions with staff show that they do not have a clear understanding of what this means. The training records do not provide evidence that staff have received appropriate training with regard to this. Another care plan seen still does not have a detailed plan for the clients pressure care needs despite the client having pressure sores and receiving care from the District Nurses with regard to this. Again, the risk assessments are an improvement on those seen previously but there is still a need for further improvements and for these to be more individually focused. For example, one of the clients has risk assessments with regard to fire safety, medication and financial arrangements but these are universal and not written specifically for the particular client although it has their name on it. There are risks associated with this client having unsupervised access to the gardens which are not secured but there is no risk assessment for this. Therefore the requirement about risk assessments is repeated in this report. Discussions with staff provided confirmation that the care plans are easier to understand and to use as working documents. Staff said that they do read the care plans and that there are now better systems in place for recording information and for the storage of confidential information. Docking Grange DS0000066607.V360110.R01.S.doc Version 5.2 Page 12 The communication needs of the clients are very mixed with some clients able to communicate effectively verbally and others with no verbal communication at all. The care plans need to include more information about the individual communication styles for each of the clients. According to the training matrix provided by the Manager some of the staff attended training with regard to communication about eighteen months ago and so this is an area in which all staff need to attend the initial training or an update. The staffing situation has improved since the last Inspection although there is a need for further improvements. The numbers of staff on each shift have increased and regular agency staff are being used rather than different staff each time. This means that staff are able to build up relationships with the clients and get to know them better. Staff said that they are encouraged to obtain the clients views and to offer choices. Records show that clients meetings have recently started to take place in the individual houses and that clients views are starting to be sought. However, the communication difficulties and the staffing situation still mean that clients are not fully involved in making choices about their care and about how they wish to spend their time. The Inspectors were told at the last Inspection that the keyworker scheme was going to be introduced and this has clearly not moved forward since that time except for one client who has a named key worker as a result of a complaint made by the social worker. It is recommended that an effective key worker scheme is in place. There have been changes to the shift times and so there are now less staff working “long days” although some still do follow this shift pattern. Handovers are now more organised and staff spend time together to obtain information about the previous shift. Staff said that the handovers are much more effective and that they take place at the beginning of every shift. The staff surveys all state that there is “usually” good communication amongst the staff team. All of the staff who spoke to the Inspectors said that this is an area that has improved greatly since the last Inspection. The staff at the Home are responsible for looking after money on behalf of the majority of the clients. The Inspector was shown the system in place and looked at records relating to one clients money. The clients do not have individual bank accounts, all benefits are paid into a joint corporate account and then money is ‘requested’ from Head Office. It was possible to audit the individual clients money that the Inspector was shown against the records and receipts and there are regular checks in place to audit the cash held. However, there is a need for a clear financial care plan to be kept for all clients Docking Grange DS0000066607.V360110.R01.S.doc Version 5.2 Page 13 and for there to be more information kept in the Home about the individuals money held at Head Office. A requirement is made about this. Docking Grange DS0000066607.V360110.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 adequate This judgement has been made using available evidence including a visit to this service. Clients are supported to take part in some meaningful activities but the quality and quantity of these are mixed and not consistent for all clients Clients receive appropriate support at mealtimes and receive a varied diet EVIDENCE: At the last key Inspection there were very few clients, apart from those attending external day services, who were supported to take part in any meaningful activities, either in the Home or in the community. Staff have worked hard to improve this situation for the clients and discussions with staff and documentary evidence confirm this. However, there is still a need for big improvements in this area in order for all clients to be supported to have Docking Grange DS0000066607.V360110.R01.S.doc Version 5.2 Page 15 meaningful activities in their lives and to be able to make choices about how they spend their time. The staffing situation has improved with increased numbers and better consistency of staff on duty which has enabled staff to better plan activities both within the Home and within the community. Staff are enthusiastic about supporting clients with activities and have worked hard to increase the opportunities for clients but the current staffing levels still do not enable this to take place on a regular basis for all clients. The requirement with regard to increasing staff numbers is repeated in this report. The location of the Home, in a small rural village, does not make it very easy for staff to support clients to become part of the local community or to take part in activities. Most activities away from the Home need detailed planning and involve some form of transport. At the time of the last key Inspection the organisation had reviewed the staffing situation and so there was very little domestic cover and no catering staff employed. Whilst the intention was to encourage clients to be supported to carry out their own household tasks this was not happening in practice due to poor staffing levels. Since that Inspection the organisation has employed a chef through an agency for five days per week. Staff said that this has been a big improvement for several reasons. It means that staff are free to spend their time with the clients rather than having to plan and prepare meals and it also means that the clients are receiving a more balanced, healthy diet of a better quality with individual dietary needs being better met. The chef is enthusiastic about his role and has an understanding of the individual dietary needs of clients. He also has an understanding of the individual dietary choices and preferences of individual clients. Clients said that they enjoy the meals that he prepares. The main meal of the day was seen during the visit to the Home and this looked and smelled appetising. The clients who needed additional support with eating received this in a sensitive and appropriate way. Overall, the mealtime was a more relaxed and enjoyable occasion in the main house (Daphne’s) than was seen during the previous visit to the Home. The clients who attend external day services take packed lunches with them and although these have improved there is still some room for further improvement with these as the ones seen on the day of the Inspection were of the same quantity for all clients, regardless of gender, age or clients choice. Staffing input at mealtimes is high as there are several clients who need one to one support to eat and this can take considerable time. Staff said that they Docking Grange DS0000066607.V360110.R01.S.doc Version 5.2 Page 16 are able to spend this time with individual clients and this was seen to be taking place during the visit to the Home. The staffing levels are not increased at the weekends and as all of the clients are at home as there are no external day services taking place then the opportunities for supporting clients on an individual basis are limited. There are no separate domestic or catering staff employed at weekends and so staff are responsible for these tasks as well. This means that at weekends the staffs roles become much more task orientated with little time for individual support. Some of the more independent clients are encouraged to take part in their own household tasks such as cleaning and cooking in reality this only takes place with a few of the clients. At the time of the last Inspection the Commission had received two complaints from relatives of clients about the care that they were receiving and the lack of communication between the Home and relatives. The last key Inspection and a further complaint investigation visit found these complaints to be substantiated. The Manager said that systems have improved for maintaining contact with relatives and that the introduction of the key worker scheme will further improve this. Docking Grange DS0000066607.V360110.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 adequate This judgement has been made using available evidence including a visit to this service. The clients basic physical and emotional health needs are met but this is often in a reactive rather than a proactive way Recent improvements mean that medication is managed safely EVIDENCE: The improvements in the care plans provide staff with increased knowledge about how to meet individual personal and healthcare needs although there are still some gaps in the records as previously mentioned in this report. Staff were able to give much more knowledgeable and consistent answers to questions about individual clients needs and this is also due to the increased staffing levels and better consistency of agency staff. Docking Grange DS0000066607.V360110.R01.S.doc Version 5.2 Page 18 Since the last key Inspection the staffing levels at night have been improved. There are now three night staff on duty each night although one of the Inspectors arrived at the Home at 6.15am and there were only two night staff on duty. Staff said that this had been due to someone calling in sick at very short notice and they had been unable to cover the shift but that this was now a rare occurrence and that there were usually three staff on duty. Duty rotas and discussions with clients confirmed this. As previously mentioned in this report there is still a need to improve the care plans with regard to individual needs. There is also a need to improve the recording systems for clients health appointments as these are not always recorded appropriately and there is currently no clear format which notifies staff when health appointments/check ups are due. The Manager said that they intend to implement the Health Action Plans which are recommended to be in place for adults with a learning disability but that they are currently waiting for a delivery of these to arrive. Again, the development of the key worker system will support this improvement. The complaint investigation found that the personal and healthcare needs of one of the clients were not being met at the Home and therefore the client moved from the Home. As stated above, improvements have been made and the clients needs are being better met. However, there are still improvements that need to be made, particularly with regard to the opportunities for individual clients to be consulted about their care and make choices about how this is provided. Staff who spoke to the Inspectors were enthusiastic about their roles and are working hard to improve the quality of the service provided. The staff are aware of the importance of respecting privacy and dignity when supporting clients and were observed to do this as a matter of course. Although staff morale appears to be much better than at the time of the last visit to the Home they still become frustrated when they are not able to provide the standard of care to the clients that they would like to be able to due to constraints outside of their control. The Manager showed the Inspector the system in place for storage, administration and recording relating to medication. The Inspector observed a member of staff administering medication and this was done in an appropriate manner as per the Homes medication procedure. Medication is stored separately in each of the houses. In some areas some improvements are planned to ensure better facilities for staff to be able to complete paperwork. Docking Grange DS0000066607.V360110.R01.S.doc Version 5.2 Page 19 At the last key Inspection a requirement was made with regard to the need for clear guidance about medication which is prescribed on an “as required” (PRN) basis. At the random Inspection this requirement had not been met and was repeated. It was seen during this visit to the Home that this requirement has now been met. The Inspector was told that it is only the Manager, deputy manager and senior care staff are responsible for the administration of medication and that they have all received appropriate training. The training record confirms this except for the date on which the Manager undertook this training as this is currently blank. The administration of medication can take a long time, particularly in the mornings and clearly occupies the senior staffs time and concentration during that time. If the senior member of staff is counted as part of the staffing hours for that shift then this means that there are less staff available to support the clients. The staff surveys all state that they receive relevant training and that it enables the staff to meet the clients needs. However, the training records show that staff have received little training with regard to specific clients needs and this requirement is repeated in this report. Since the last Inspection concerns have been raised by District Nurses and Dispensary staff about the lack of staff understanding about continence and pressure care issues and appropriate medication ordering procedures. The Manager of the Home is currently liaising with the GP practice to address these issues and was able to show the Inspector improvements that have already been made. Surveys were received from four health/social care professionals in January 2008 and these contain some mixed views about the service provided at the Home but all contained some negative comments. For example, two state that there is good communication with the Home and two state that this only happens “sometimes”. Three state that staff understand the needs of the clients and one states “mostly”. The answers to the question about whether they are satisfied with the overall care provided were very mixed with two stating “no”, one stating “probably” and one stating that their response is mixed. All four stated that they had made complaints or received complaints about the Home. Some additional comments were made such as: “incontinence pads are badly applied” Docking Grange DS0000066607.V360110.R01.S.doc Version 5.2 Page 20 “pressure relieving equipment not always used” “prescriptions not always picked up on time” “advice not always carried out” “client now has a key worker” “lack of continuity of staff”. “standard of accommodation has improved” A comment was made on one of the surveys which stated that there is rarely soap or towels in clients bedrooms. During this visit to the Home there was soap and towels in the majority of the bedrooms although these were missing from a couple of the rooms. Docking Grange DS0000066607.V360110.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 which would be further strengthened by increased training for staff The senior staff need to improve the way in which they handle concerns raised with them 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 and communication difficulties also cause a problem if clients wished to make a complaint. However, the recent improved consistency of staffing should improve this situation and the planned communication training will also assist. The staff who do know the clients forms of communication well are sometimes able to recognise if they are not happy about something. All the staff who spoke to the Inspectors were enthusiastic about providing a good service and keen to make any improvements about situations that clients are not happy about. Docking Grange DS0000066607.V360110.R01.S.doc Version 5.2 Page 22 As previously mentioned in this report the Commission has received two complaints from relatives, both via social workers. The last key Inspection provided evidence that one of the complaints was substantiated and a separate complaint investigation provided evidence that the elements within the second complaint were all substantiated. The organisation are dealing with the concerns raised by the District Nurses and Dispensing staff. They are also dealing with a complaint raised by social workers about the wrong equipment being provided to assist one of the clients with mobility. Since the last key Inspection the Manager, a Peripatetic Manager providing support to the Manager and the Responsible Individual have had meetings with the local authority and the Commission to address the concerns raised in the last report and any other ongoing concerns. It is hoped that this will improve the current situation whereby some health/social care professionals feel that their concerns/complaints have not been taken seriously. A comment made within a returned survey from health/social care professionals is that “…staff, particularly the management, are defensive” The Home has policies and procedures relating to Safeguarding vulnerable adults and the staff who spoke to the Inspectors are aware of these. Staff are also confident that any allegations of abuse would be dealt with appropriately by the management team. At the last key Inspection a requirement was made for all staff to attend training with regard to Safeguarding adults. According to the training records provided by the Home this has not been met and so is repeated within this report. Docking Grange DS0000066607.V360110.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 adequate This judgement has been made using available evidence including a visit to this service. Improvements have been made to the environment so that the majority of clients now have comfortable and homely accommodation. EVIDENCE: At the last key Inspection the standard of accommodation was very poor with little redecoration or refurbishment having taken place. Since that time a great deal of work has been undertaken to make improvements and the majority of areas are now homely and comfortable. There are plans in place for further improvements. The Home is divided into five separate living areas. There are three small houses (Caddows, Badgets and the Coach House) which provide ‘normal’ living accommodation with clients having separate bedrooms and a communal Docking Grange DS0000066607.V360110.R01.S.doc Version 5.2 Page 24 bathroom, lounge, dining room and kitchen. The level access showers have been replaced in two of these houses and work is being carried out to complete this in the third house. Some redecoration has also taken place. These houses have evidence of the clients being encouraged to personalise their homes. 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 clients have their own bedrooms, some of which have recently been redecorated and others which are still in need of redecoration and refurbishment. Since the last Inspection the Manager confirmed that mattress covers have been provided for all rooms as it was noted at the last key Inspection that clients were sleeping on plastic mattresses with only a thin sheet over it. During this visit to the Home some of the beds were looked at and the majority of these had the mattress covers on, thereby providing additional comfort, but there were a couple of beds without these on. The recent decoration and reorganisation of the furniture in Daphnes main lounge has made a very big improvement to this area. It is now more homely and attractive and although it is still used as one of the main ‘thorough fares’ in the Home it does have a feel of a ‘lounge’ about it now. This room still does not have curtains and the Manager explained that this was because of difficulties with the company providing them. There are plans in place to provide a larger bathroom with a bath specifically for clients with mobility difficulties and work has recently started on this project. The flat (now known as Hollies) provides accommodation on the first floor only and there is a lift to this area. One of the bathrooms has been refurbished to provide a more suitable level access shower. The emergency call bell system is currently not working and the Manager explained that it is due to be updated and that a company has been appointed to carry out this work. This is particularly important as there are often times when there are no staff within some of the areas within the Home. The staff and clients are appreciative of the improvements that have been made and those which are going to take place. There is a need for the organisation to have a realistic planned programme of maintenance, redecoration and refurbishment so that the recent changes are able to be maintained and further improvements made. The Home still has little dedicated domestic staff time and although the Home is cleaner than it was during the visit carried out as part of the last key Inspection there are still areas which would benefit from more regular cleaning. It is recommended that there is an increase in the number of domestic hours provided. Docking Grange DS0000066607.V360110.R01.S.doc Version 5.2 Page 25 Some of the clients are becoming frailer and needing additional equipment such as electric beds and hoists. At the last key Inspection it was noted that the door handles had not been lowered for one of the clients despite this having been agreed as part of the admission assessment. This has now been carried out and enables the clients to move around the Home more independently. The majority of the bedrooms are not large enough for equipment to be used easily and the Manager must bear this in mind when assessing any prospective clients who may wish to move to the Home. Docking Grange DS0000066607.V360110.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 adequate This judgement has been made using available evidence including a visit to this service. Staffing is provided in adequate numbers to meet the basic needs of the clients The clients would benefit from the staff receiving additional training about specific client needs Staff are working hard to meet the needs of individual clients EVIDENCE: At the time of the last key Inspection the staffing situation was very poor and this was clearly having detrimental effects on outcomes for the clients. Following the Inspection a letter of urgent action was sent to the organisation and the Responsible Individual and the Manager were invited to meet with the Commission to discuss the situation. Since that time the staffing situation has improved. The Home still employs agency staff but discussions with staff and observation of the staffing rotas Docking Grange DS0000066607.V360110.R01.S.doc Version 5.2 Page 27 confirm that regular agency staff are employed so that they become familiar with the clients and the policies and procedures of the Home. Agency staff who spoke to the Inspectors said that they had received basic induction and that they shadowed more experienced staff when they first started working at the Home. As previously mentioned in this report the organisation has increased the night staffing to three members of staff. The Inspector spoke to two of the night staff and they confirmed that three staff is the minimum that is needed during the night to ensure that the basic needs of the clients are met as well as to undertake laundry and other domestic tasks as required. The staffing levels have also been increased during the day. Staff discussions and observations of rotas show that the usual staffing levels are for there to be 7 or 8 staff on duty during the morning and 6 or 7 during the afternoon. Recent consultations with staff has led to a change in the traditional ‘long day’ system of shifts that has been used at the Home. The majority of staff now work shifts of approximately eight hours. This means that there can be approximately ten staff on duty between about 1 – 3pm which provides additional staff to assist with meals and to enable more individual support to be carried out, for example, with activities. The organisation has previously said that the senior member of staff on duty ie. Senior carer, deputy manager and Manager should be supernumerary. The rotas show that this is not happening on a regular basis except in the case of the Manager. If the senior member of staff is part of the staffing rota then, in effect, the staff team are one member short as the senior has to spend a lot of time on management tasks such as liaising with health and social care professionals, administration of medication and sorting out personal monies for clients. Although the increase in staffing numbers and the use of regular agency staff is clearly an improvement to the situation that was in place at the time of the last key Inspection there is still a need for further improvements. The staffing levels currently do not allow much time for staff to support clients to take part in activities and there is no increase in staffing at the weekends/holidays when all of the clients are at home. There is also no increase in staffing at times when clients need support to attend hospital or other health care appointments, some of which may require a member of staff to be away from the Home for considerable time. In addition to this, some staff do not work the whole shift and either start later than the usual time or finish earlier. This can have a particular effect on the support available to assist clients to get up or go to bed. Discussions with staff show that some clients are “encouraged” to go to bed prior to the evening staff Docking Grange DS0000066607.V360110.R01.S.doc Version 5.2 Page 28 finishing their shift due to there being more staff around at that time to assist clients with mobility difficulties. The requirement about staffing is repeated in this report. At a meeting in February 2008 the Responsible Individual said that the organisation are undertaking a review of the staffing needs of the clients and that the Commission will be provided with a copy of this once it is completed. The Commission have not yet received this document. The Inspectors spoke to many of the staff who were on duty on the day of the visit to the Home and also observed staff supporting clients. All of the staff who spoke to the Inspector were pleased about the improvements that have been made and gave examples of how outcomes have improved for clients. They are all enthusiastic about working with the clients and have ideas for further improvements. The general atmosphere within the Home is much improved on that which was felt on the day of the visit as part of the last key Inspection. During the visit to the Home as part of the random Inspection it was noted that one of the recruitment files seen did not contain all of the necessary information. A requirement was made at that time. A selection of files was seen during this visit to the Home and all necessary documents were able to be produced. The Manager explained that recruitment has continued and new support workers have been recruited. A new senior support worker had recently been appointed but had left the Home after a few weeks of working there so this post is currently being advertised again. As mentioned previously in this report the staff are not receiving the necessary training which will provide them with the skills and knowledge specific to the clients who live at the Home. Although additional training has been provided since the last key Inspection there is a need for this to be provided more effectively as it appears to be being provided in a sporadic manner. The requirement about training is repeated in this report. The staff surveys contain mixed views about whether staff receive supervision or not with one stating it happens “often”, two stating “sometimes” and one stating “regularly”. Discussions with staff and the Manager confirm that this is being provided but in a sporadic way which the Manager is aware needs to be improved. The recommendation about this is repeated in this report. Docking Grange DS0000066607.V360110.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 adequate This judgement has been made using available evidence including a visit to this service. The increased management support for the Home has improved situations for the clients living there The majority of issues relating to health and safety have been addressed and so better protection is provided for the clients EVIDENCE: The Home was bought by Consensus in June 2006 and between that time and July 2007 there were several changes of Manager. The current Manager is there on a temporary basis (probably until July 2008) and has been managing Docking Grange DS0000066607.V360110.R01.S.doc Version 5.2 Page 30 the Home since July 2007. The organisation are currently recruiting for a permanent Manager and interviews are due to take place later this week. The deputy manager has been in post since Consensus bought the Home. The organisation has slowly been strengthening the management team by increasing the number of seniors that are employed. As previously mentioned a recently appointed senior only stayed a few weeks and so there are only two senior support workers currently on the staff team. Unless the senior staff are enabled to work as supernumery members of staff they are unable to carry out the management tasks associated with such a large Home, including working with and monitoring staff. Since the last key Inspection the organisation has taken the Commissions concerns seriously and has co-operated with liaising positively with the Commission and wanting to proactively work with them and the local authority. The organisation swiftly took steps to address many of the requirements made at the last key Inspection. One of the organisations peripatetic managers has been providing additional management support to the Home and the Responsible Individual is now much more aware of what is happening at the Home. This report provides evidence of these improvements and the organisation are well aware of the further improvements that need to be made. The organisation are carrying out monthly visits and completing reports as per Regulation 26 and a full Quality Audit of the Home was carried out by the organisation in January 2008. One of the clients has been supported to attend the clients Forum that is run by the organisation. The Home needs to develop ways of ensuring that the views of the clients themselves are sought about the service provided. This needs to include all of the clients and not just those who are able to communicate verbally. The Inspectors saw a range of documents relating to health and safety issues which provided evidence that regular maintenance and servicing of equipment takes place. The Home has an onsite maintenance member of staff who carries out general tasks and the Inspectors were informed that any specialised work, such as electrical work, is carried out by people qualified to do so. The Home was recently inspected by the Fire Officer who made recommendations about the need for additional staff training and an additional risk assessment relating to the specific needs relating to the clients living at Hollies (The flat). The Manager said that this has not yet been carried out. A requirement is made about this. Docking Grange DS0000066607.V360110.R01.S.doc Version 5.2 Page 31 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 2 26 2 27 2 28 2 29 X 30 2 STAFFING Standard No Score 31 2 32 2 33 2 34 2 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 1 2 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 2 X 2 2 2 X X 2 X Docking Grange DS0000066607.V360110.R01.S.doc Version 5.2 Page 32 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 is repeated It is required that risks are identified, assessed and that clear guidance is provided to staff about how to manage the risks This requirement is repeated Timescale for action 31/05/08 2. YA9 13 31/05/08 3. 4. YA7 YA7 13 (6) 12 It is required that a financial care 31/05/08 plan is kept for each client It is required that the clients 31/05/08 wishes and feelings are taken into account with regard to their care This requirement is repeated It is required that staff receive training specific to the individual needs of the clients. This includes, amongst other subjects: Safeguarding Adults Food Hygiene Continence care Communication Moving and Handling DS0000066607.V360110.R01.S.doc 5. YA19 18 31/05/08 Docking Grange Version 5.2 Page 33 6. YA33 18 Behaviours which challenge This requirement is repeated It is required that at all times 31/05/08 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 is repeated It is required that the Fire Officers recommendations about Hollies are met 15/04/08 7. YA42 23 (4) 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. Refer to Standard YA8 Good Practice Recommendations It is recommended that an effective key worker scheme is implemented It is recommended that the domestic hours are increased 2. YA30 Docking Grange DS0000066607.V360110.R01.S.doc Version 5.2 Page 34 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.V360110.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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