Inspection on 18/05/05 for Docking House

This inspection was carried out on 18th May 2005.

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 but made no statutory requirements on the home.

Other inspections for this house

Docking House 12/01/09

Docking House 19/12/07

Docking House 27/04/07

Docking House 21/12/06

Docking House 25/05/06

Docking House 25/01/06

Docking House 30/10/05

Docking House 17/02/05

Docking House 06/01/05

Docking House 01/03/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Docking House Station Road Docking Kings Lynn PE31 8LS Lead Inspector Lella Andrews Announced 18 May 2005 9.30am th 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Docking House I55 s42254 Docking House v218310 (an) 100505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Docking House Address Station Road, Docking, Kings Lynn, Norfolk, PE31 8LS 01485 518243 01485 518436 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) ARMS Associates Ltd Mrs L Brooks Care Home 28 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (10) of places Docking House I55 s42254 Docking House v218310 (an) 100505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: n/a Date of last inspection 17 February 2005 Brief Description of the Service: Docking House is a residential home for 28 older people in the village of Docking situated between the towns of Hunstanton and Fakenham. There is a post office and shop close by. The home is supported by two G.P. practices. It cares for 18 older residents who are mentally frail and 10 older residents who need care in a residential setting. The accommodation is all on the ground level which is divided into two units to offer the support to the two types of older people requiring care. The home has shared and single bedrooms with hand wash basins. The proprietor is in the process of upgrading the property to improve the accommodation which will benefit the service users. Docking House I55 s42254 Docking House v218310 (an) 100505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Inspection was announced and took place between 9.30am and 6.30pm on Wednesday 18th May 2005. The Inspector had lunch with the residents living in the dementia unit. The Inspector spoke to two staff on an individual basis, and to the Manager and the Proprietor throughout the Inspection. Four residents spoke to the Inspector. A tour of the building was undertaken. The Inspector received completed comment cards from two health professionals, six relatives and fourteen residents. It is not clear how many of the residents were able to complete the comment cards alone or what type of staff assistance was given to some residents to complete them. What the service does well: The Proprietor has made a great deal of improvements over the last two years to both the environment and the care provided to the residents. The Manager has worked at the Home for twenty years and provides a consistent, enthusiastic approach to the management of the Home and she is now supported in this role by the Proprietor who is at the Home for three days each week. The decoration and furnishings of the Home have been greatly improved. The majority of the carpets and floor coverings have been replaced, as have the majority of windows around the Home. There is an ongoing plan to replace all of the bedroom furniture and the bed linen which has made a big improvement to those rooms which have been finished. The staff team work well together and are supportive of each other. They are kind to the residents and positive about working at the Home. The Manager and staff are very supportive towards relatives and make them feel welcome when they visit. A comment from one of the relatives completed comment cards was that they are “wonderful staff” and another comment card particularly mentioned the high standard of care that their relative had received. Docking House I55 s42254 Docking House v218310 (an) 100505 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: The Proprietor must ensure that suitable staffing levels are provided at all times in order to meet the needs of the residents and to ensure the safety of residents and staff. The required staffing levels must be provided despite staff being on holiday or off sick. The rotas must also be a true reflection of the staff on duty at any one time as currently the hours which the Proprietors mother works in the Home are not recorded as such. The additional staffing should enable some of the issues, which have been identified as not meeting the standards, to be addressed. The Proprietor has an ongoing maintenance plan and intends to continue to improve the facilities for residents and staff. This is particularly important in the dementia unit which needs to have some furniture replaced and the provision of a bath with hoist. The Proprietor and Manager need to consider how the areas of the dementia unit can be better identifiable to residents with dementia. Communication with the residents with dementia needs to be reviewed to ensure that residents are able to retain as much control over their own lives as possible. Docking House I55 s42254 Docking House v218310 (an) 100505 Stage 4.doc Version 1.30 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. Docking House I55 s42254 Docking House v218310 (an) 100505 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Docking House I55 s42254 Docking House v218310 (an) 100505 Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4 and 5 Detailed information about the Home and the service that it provides is available to prospective residents and their relatives. The assessments that are now undertaken by the Manager are more detailed than those used previously and so provide additional information on which to base a decision about whether the Home can meet the residents needs. The Home does not provide Intermediate Care. EVIDENCE: The Statement of Purpose and Service User Guide have been recently reviewed and updated. These documents contain the information required by regulation and standards. The challenge for the Proprietor now is to ensure that the service provided matches the standard of that described in these documents. The statement of terms and conditions contains the required information, however, it is recommended that this document is more clear about the definition of “advocacy” so that residents and their relatives are clear that it means the provision of a staff escort during appointments etc. Docking House I55 s42254 Docking House v218310 (an) 100505 Stage 4.doc Version 1.30 Page 10 The Manager has recently started to use a more detailed assessment document which then provides the basis of the residents care plan. The Manager advised that she visits prospective residents at their own home or in hospital. Residents confirmed that they were encouraged to visit the Home with their relatives prior to making the decision to move in. The written information available about the Home is clear about the range of needs that can be met at the Home. Staff have received relevant training, including training about working with people with dementia. Docking House I55 s42254 Docking House v218310 (an) 100505 Stage 4.doc Version 1.30 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 10, 11 A new care plan format has recently been introduced and these provide better information to staff with regard to meeting residents personal and health needs, although additional detail needs to be added to ensure this is provided in a consistent way. The health needs of the residents are being met. The residents do not all feel that their right to privacy is upheld at all times. Staff make extra effort to ensure that residents who are dying receive care and support at that time. Relatives are also supported in a caring way. EVIDENCE: Four of the care plans were looked at. These are using a new format which has very recently been introduced. This includes risk assessments relating to falls, moving and handling, pressure care, mental health and physical health. These documents provide good basic information about the individual residents needs but it is required that additional information is provided to ensure that Docking House I55 s42254 Docking House v218310 (an) 100505 Stage 4.doc Version 1.30 Page 12 staff are provided with clear guidance about how to meet those needs. For example, one of the care plans identified that a resident was at high risk of pressure sores but there was no clear guidance to staff about how to prevent this. Another example is of a care plan identifying that a resident needs staff assistance to move around but does not include details about how staff should provide this. It is required that risk assessments are undertaken for the use of bedsides. The Home links with two GP practices and the District Nurses visit as necessary. The Inspector received two completed comment cards from health professionals and both indicate that they are satisfied with the overall care provided. However, one stated that on occasions staff do not seem aware of changes in residents care and one stated that there has recently been improvements in the ability to see residents in private, which would indicate that this had previously been a problem. The Manager has recently attended training with regard to the prevention of falls and intends to put some of this training into practice. This is a positive move towards reducing the number of falls experienced by residents. Staff spoke about the need to respect the privacy and dignity of the residents and were seen to speak to residents in a respectful and kind manner. However, three of the comment cards completed by residents indicate that their privacy is not always respected. One comment card indicated that a resident felt that staff do not treat them well and one indicated that they did not feel safe at the Home. Whilst the Inspector did not see, or hear, any evidence during the Inspection to confirm this view it is recommended that the Proprietor undertakes a process of consultation with residents about these issues as part of the Homes own quality assurance process. The Home has five shared rooms and although there are screens provided in these rooms privacy is reduced for residents who share rooms. Staff described the care that residents receive when they are dying. Unless there is a medical reason why it shouldn’t happen then residents are able to stay at the Home if that is what they wish to do. Staff spend time with a resident who is dying if there are no family to do so, however, it is difficult to see how this can take place given the staffing levels on some shifts. Relatives are able to have meals at the Home and to spend the night there if they wish to when spending time with a relative. The Inspector observed the sensitivity that was shown towards a family whose relative was dying. Docking House I55 s42254 Docking House v218310 (an) 100505 Stage 4.doc Version 1.30 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 The residents cultural and religious needs are met but more attention needs to be paid to meeting individual social and recreational needs. Relatives and friends are made to feel welcome at the Home and are able to visit their relative at any time. Residents who have good communication skills are offered choices and are able to have more control over their lives than those residents who have dementia and difficulties with communication. Residents receive wholesome, appealing meals but more attention needs to be paid to offering choices to residents with dementia. EVIDENCE: Staff were heard to offer residents choices about where they would like to spend their time, what they would like to drink/eat and what time they would like to get up. One of the residents did not get up until late and said that they always make their own decisions about when to get up and go to bed. This view was confirmed by the staff who said that residents go to bed and get up at times that suit them. They said that some residents like to get up very early and others like a lie-in. Docking House I55 s42254 Docking House v218310 (an) 100505 Stage 4.doc Version 1.30 Page 14 Communication with the residents with dementia can be difficult and it was seen that residents who live in the dementia unit do not get offered as many choices as residents with better communication skills. The staffing levels on occasions means that staff do not have the time that is necessary to communicate meaningfully with people with dementia. Staff are kind and caring to those residents with dementia but there is little stimulation in the way of activities or time for staff to spend with residents on a one to one basis. The Statement of Purpose indicates that there is a member of staff who is responsible for organising activities but there was little evidence of this during the Inspection. Residents said that in the summer they go on some day trips and that occasionally they go out for a walk. The care plans show that one of the residents had been accompanied to the church when he wished to go. The Home has a mini bus to enable residents to go out. The local vicar visits to hold communion once per month and there are occasional visits to the Home by entertainers. The Home has a range of board games and activities available but there is very little time for staff to engage in these activities with residents. Four of the comment cards completed by residents indicated that there are not enough activities provided. The lack of time to engage residents in activities is a frustration for staff also. It is required that the leisure interests of the residents are assessed and that appropriate activities are provided. This may be more easily actioned once the Manager has attended the one day training she has booked with regard to the provision of activities for older people. All six of the comment cards completed by relatives indicate that they are made to feel welcome at the Home when they visit and that they are able to see their relative in private. Two comment cards indicated that relatives did not feel that they were kept informed about the needs of their relative and this may also be an area that the Provider might wish to review as part of the internal quality assurance process. Staff were seen to make relatives feel welcome and to provide information when asked by relatives. The Manager spoke to several relatives on the phone throughout the day and was helpful and polite. As stated earlier, it is easier for staff to encourage residents with good communication skills to make their own choices and to retain control over aspects of their life. This is more difficult with residents with dementia who have communication difficulties. The staff have received training with regard to working with residents with dementia but the staffing levels may not be enabling them to put this training into practice. There is often only one member of staff working in the dementia unit although the intention is to always have two members of staff working there. Currently the bedroom doors in the dementia unit are locked during the day. The Manager advised that this is because residents wander around other Docking House I55 s42254 Docking House v218310 (an) 100505 Stage 4.doc Version 1.30 Page 15 peoples rooms and move things around. This practise of locked bedroom doors has been in place for several years and it is recommended that the Home review this and unlock the bedroom doors so that residents have access to their own rooms during the day. Whilst it is understood that staff will unlock a door if they are asked to it is unlikely that a resident with dementia will be able to ask for their bedroom door to be unlocked. It is also recommended that each bedroom door has some form of identification on it that is personal to the resident whose room it is, rather than a name plate as residents with dementia may not be able to recognise this. It is also recommended that consideration is given to making the corridors, toilets and bathrooms more recognisable to residents with dementia through the use of appropriate signs/prompts. This recommendation is repeated from the previous Inspection. Both dining areas have written menus which offer a choice for meals. The residents without dementia were able to read the menu and make a choice about their meals but this was not possible for the majority of residents with dementia. It is recommended that the menu is provided in an alternative format which is more meaningful to these residents, for example, consideration given to the use of photographs. There is a cook on duty every morning until 1.30pm and she prepares and cooks a hot meal for lunch. The cook will also prepare tea, depending on what is on the menu, and also makes cakes. The cook said that she is able to order the necessary ingredients and that these are always provided. She advised that mainly fresh ingredients are used. She has recently bought new equipment also. The cook is aware of the residents who need special diets. The Inspector had lunch with residents living in the dementia unit and sat with three residents in the dining area. It is recommended that the layout of the dining area in the dementia unit is altered as the tables are very close together and it is difficult for staff to assist residents to the table. The meal was tasty and the residents said that they also enjoyed it. However, the meal was extremely hot and staff did not appear to be aware that residents were eating it whilst still very hot. It is required that staff ensure that meals are of a suitable temperature when provided to the residents to prevent burns/scalds. One member of staff sat with a resident who needed assistance during the meal and another member of staff was available to hand out meals and clear the tables. Residents in both sides of the Home said that they enjoy the meals and that they are offered biscuits and cakes during the day, including at supper time. Staff said that if residents get up in the night that they are offered a hot drink and a snack. All of the comment cards completed by residents indicated that they enjoy the meals. Docking House I55 s42254 Docking House v218310 (an) 100505 Stage 4.doc Version 1.30 Page 16 There are no kitchen staff employed during the afternoon and therefore one of the afternoon care staff has to prepare tea, if not been done by the cook, and then to wash up and clear away after the meal. This is not acceptable as it reduces the care staff to two to provide care for all of the residents. It is also not hygienic for staff to be in the kitchen and then possibly to be assisting residents with personal care and then in the kitchen again. Staff and the Proprietor said that the Proprietors mother prepares tea on the three days a week that she is at the Home, however, this is not recorded on the rota. It is required that additional staff are provided in the afternoon to prepare tea and clean up afterwards. It is recommended that the Proprietor consider the provision of a dishwasher as this would reduce the amount of time that staff are required to be in the kitchen. Docking House I55 s42254 Docking House v218310 (an) 100505 Stage 4.doc Version 1.30 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Staff have received training and have an understanding of Adult Protection issues which will help protect the residents from abuse. EVIDENCE: All staff, except those very recently recruited, have received training with regard to the protection of vulnerable adults. Staff are aware of adult protection issues and of the procedures for reporting suspicions of abuse. Staff are confident that the Manager and Proprietor will deal appropriately with any allegations of abuse. Residents said that staff are kind to them and very helpful. However, as previously mentioned in this report two of the residents completed comment cards indicated that a resident did not feel that staff treat them well and one did not always feel safe at the Home. Docking House I55 s42254 Docking House v218310 (an) 100505 Stage 4.doc Version 1.30 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 23, 24, 25 and 26 The Proprietor has undertaken a great deal of work to improve the living environment for the residents with the result that the residents live in a safe, well maintained environment which has some areas which are still in need of updating. EVIDENCE: The Inspector was shown around the Home with the Manager. Not all of the bedrooms were seen but all of the communal areas were seen. The Home is split into two distinct areas, each with their own bathrooms, bedrooms and communal lounge/dining areas. The doors between the two areas are not locked but have alarms for staff to identify which doors are being opened. The doors to the reception area have recently been replaced. The glazing had not been fitted and although the Proprietor advised that this was due to be completed the day of the Inspection it had not been done by the time the Inspector left the Home and so a requirement is made with regard to this. Docking House I55 s42254 Docking House v218310 (an) 100505 Stage 4.doc Version 1.30 Page 19 New carpets have been fitted throughout the communal areas and corridors. The majority of the bedrooms, bathrooms and toilets have had new carpets, or other floor covering, fitted. The Proprietor is currently in the process of replacing the bedroom furniture in two bedrooms each month. The new furniture is modern and attractive. The majority of the bedrooms now have new duvets, pillows and bed covers. The bedrooms show that residents have been encouraged to personalise their rooms and to bring in small items of furniture to the Home. However, residents in the dementia unit do not have access to their bedrooms during the day and, as previously mentioned in this report, it is recommended that this practice is reviewed. The small lounge in the dementia unit is in the process of being decorated and will be refurbished also. The lighting in the dementia unit has been replaced but the Manager said that there may be additional lighting added once the winter, and darker days, arrives as the current lighting may not be sufficient then. The Home has several toilets which are near to lounge areas and bedrooms. Two of the toilets in the dementia unit have concertina type doors which reduce the privacy afforded to the residents. The requirement made during previous Inspections with regard to rectifying this situation is repeated in this report. The Proprietor advised that he intends to alter these two toilets into one larger toilet area with a proper door. Although there are five bathrooms in the Home there is only one that is suitable to be used by residents who need the hoist. The Manager said that one of the bathrooms in the dementia unit is due to be refurbished and it is required that this bathroom meets the needs of the service users living in this unit. The majority of the residents in both sides of the Home need a hoist to safely get in and out of the bath. Currently residents living in the dementia unit have to go to the other side of the Home to have a bath. The lounge furniture which is in the lounge/dining area of the dementia unit is in need of replacement as it is too low and soft for the majority of the residents to be able to get up from alone and also difficult for staff to assist them to get up from. A requirement is made with regard to this. The majority of the windows in the Home have been replaced and the Proprietors maintenance and refurbishment plan includes the replacement of the remaining windows. The Proprietor said that the hot water temperature is regulated and that all of the radiators are covered. The Home employs two domestic members of staff but one has been off sick for some weeks. This has the effect of the Home only having twenty five domestic hours per week which is not enough. The Home is a large building Docking House I55 s42254 Docking House v218310 (an) 100505 Stage 4.doc Version 1.30 Page 20 and there are several residents who are incontinent which requires a high level of domestic input. The majority of the Home was clean and free from offensive odours on the day of the Inspection, however, at least two of the bedrooms which were seen had an unpleasant odour. The current level of domestic hours does not allow for much more than a surface clean to be carried out. The Proprietor advised that he, or one of his family, undertakes domestic tasks at times but this is not recorded on the rota. The rotas show that when the one domestic member of staff was on holiday there was no replacement for her which puts an increased burden on the care staff. It is required that at all times there are sufficient domestic hours each week. The Home has a small enclosed garden to the rear with attractive views over the countryside. There is a large, uneven, parking area to the front of the Home with benches by the front door which are designated as the smoking area. Docking House I55 s42254 Docking House v218310 (an) 100505 Stage 4.doc Version 1.30 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 The current staffing levels, although improved, are still not sufficient to meet the needs of the residents satisfactorily. The recruitment procedures include the necessary checks to provide safeguards for the residents Training has been improved with the result that staff have received training in subjects which will enhance their skills in providing care to the residents EVIDENCE: The Proprietor is having ongoing difficulties in recruiting permanent staff. The staffing levels have been increased since the previous Inspections and this is a positive step. However, the staffing levels are still not sufficient to ensure a good standard of care can be provided at all times. As previously mentioned in this report the most obvious deficit is with regard to staffing in the afternoons when one of the care staff is required to work in the kitchen. The Home is currently providing three care staff during the morning and three during the afternoon. For the purposes of the staffing calculation used, which is that used at the point that the Home transferred to the Commission, twenty hours of the Managers are counted as care hours. This still leaves a deficit of approximately thirty four care hours per week. If the shortfall in the domestic and catering hours are taken into consideration then there is a shortfall of approximately one hundred hours per week. Docking House I55 s42254 Docking House v218310 (an) 100505 Stage 4.doc Version 1.30 Page 22 It is required that the staffing situation is improved so that there are sufficient staff to meet the needs of the residents. The shortfall in the staffing levels means that the staff do not have enough time to provide more than the basic levels of care. Staff have appreciated the recent increase in staffing to provide three care staff during the afternoons but there are still occasions when they are very busy and frustrated at their lack of available time to spend with the residents. One of the relatives completed comment cards indicated that there were not enough staff on duty. The Proprietor advised that both he and his mother are both at the Home for three days per week and undertake tasks that could be considered to be care tasks. However, he does not record these hours on the rota. The Proprietors mother was seen to be assisting care staff during the day. It is required that the rota is an accurate record of the staffing provided in the Home. In the last few months the staff have received a high level of training in subjects relevant to the work that they undertake. Staff said that they found this training to be relevant and interesting. This is a positive improvement within the Home and one that needs to be continued. The Proprietor advised that four staff will be starting NVQ training in September. Three of the personnel files were seen. These included an application form and CRB disclosures for two of the staff. Two staff have been recruited from overseas and although there were police checks on file from their own country it is required that a CRB disclosure is also applied for. The Proprietor advised that the necessary proof of identification checks have been carried out for all staff but that the evidence of this is in his office and therefore was not available during this Inspection. It is required that all records required by regulations are available for Inspection. Staff were seen and heard to support residents in a kind and caring manner. They are knowledgeable about the basic needs of the residents and work hard to meet these. Two of the relatives completed comment cards made additional comments about the high standard of care received by their relative and the kindness of the staff. Two residents told the Inspector that they like the staff, that they know them well and that they are kind. Docking House I55 s42254 Docking House v218310 (an) 100505 Stage 4.doc Version 1.30 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36, and 38 The residents benefit from living in a Home which is well managed by a Manager who is fit to be in charge, caring and is enthusiastic about her role. Work is undertaken to promote the health, safety and welfare of residents and staff but there are areas where this could be improved. EVIDENCE: The registered manager has managed the Home for nearly twenty years and has extensive experience of supporting older people and older people with dementia. The Manager is very caring and works additional hours to cover when there is a deficit within the care hours. The manager has good relationships with the Proprietor, staff, residents, relatives and health professionals. Docking House I55 s42254 Docking House v218310 (an) 100505 Stage 4.doc Version 1.30 Page 24 The Manager has not yet commenced NVQ Level 4 training but has undertaken the same training that the care staff have undertaken recently. She is also involved in a group which are concerned with the prevention of falls by older people and intends to attend training with regard to the provision of suitable activities. The Manager and Proprietor are working together to make improvements to the environment and improve the standards of care delivered to the residents. The Proprietor is present in the Home for at least three days per week and is available by telephone at other times. Currently there is no named senior members of care staff and staff said that they liase with each other when the Manager is not on duty. The management of the Home may be improved by the development of senior care staff so as to ensure that there is always a named senior member of staff on duty in the absence of the Manager, or those occasions when the Manager is busy. The Proprietor advised that a Deputy Manager will be starting work at the Home in June 2005. The Proprietor advised that he has recently purchased a formal quality assurance package to be used at the Home. This is shortly to be implemented. The Proprietor has completed a list of improvements that have been made to the Home over the last two years, many of which have been suggested by staff or residents. This list is displayed around the Home with space for new things to be added to the “wish list”. The Proprietor and Manager have very recently implemented a formal supervision system. The staff said that they appreciate the opportunity to discuss issues on a one to one basis. This process needs to continue so that staff all receive formal supervision at least six times per year. Staff said that they feel that they can discuss issues with the Manager at any time and that they can talk to the Proprietor when he is in the Home. It is recommended that staff meetings are instigated at the Home as currently there are none. As the Home is owned by an organisation it is required that monthly visits are undertaken as per Regulation 26 and that a report is sent to the Commission. The accident book was seen and this records a high number of falls over the last five months. It is recommended that the Manager carries out an audit of these to see if there are any identifiable causes which could be addressed. The Proprietor has purchased a hoist but this is currently not being used. The Manager needs to keep the moving and handling assessments under review to ensure that the hoist is used as soon as is necessary. Docking House I55 s42254 Docking House v218310 (an) 100505 Stage 4.doc Version 1.30 Page 25 The service records for the fire safety equipment were not looked at during this Inspection but the Manager has confirmed that the requirements from the recent Fire Officers Inspection have been carried out. The Manager advised that nine members of staff, including the domestic member of staff, attended training the previous week with regard to COSHH. It was noted that cleaning materials were suitably stored. Staff have recently received training with regard to Fire Safety, moving and handling, First Aid and Food Hygiene. Docking House I55 s42254 Docking House v218310 (an) 100505 Stage 4.doc Version 1.30 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 2 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION 3 2 2 x 3 3 3 2 STAFFING Standard No Score 27 2 28 1 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 2 3 2 x x 2 x 2 Docking House I55 s42254 Docking House v218310 (an) 100505 Stage 4.doc Version 1.30 Page 27 yes Are there any outstanding requirements from the last inspection? 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 7 Regulation 15 Requirement It is required that the care plans include detailed guidance for staff about how to meet individuals needs It is required that risk asessments as carried out for the use of bedsides It is required that the leisure interests of the residents are assessed and activities provided accordingly It is required that staff ensure that meals are an appropriate temperature before being given to residents It is required that the staffing levels are increased during the afternoons It is required that the glazing in the entrance hall doors is replaced It is required that the concertina doors on the toilets are replaced with more appropriate doors It is required that a bath with suitable hoist is provided in the dementia unit It is required that the furniture in the dining area of the dementia unit is replaced by furniture that is more appropriate to the needs Timescale for action 31st July 2005 30th June 2005 31st August 2005 Immediate and ongoing 30th June 2005 30th June 2005 31st July 2005 31st August 2005 31st July 2005 2. 3. 7 12 13 (4c) 16 (2m) 4. 15 13 (4c) 5. 6. 7. 8. 9. 15 25 21 21 20 18 (1a) 23 (2b) 12 (4a) 23 (2n) 13 (2c) Docking House I55 s42254 Docking House v218310 (an) 100505 Stage 4.doc Version 1.30 Page 28 of the residents 10. 11. 26 27 18 (1a) 18 (1a) It is required that the domestic hours are increased It is required that the staffing hours provided are sufficient to meet the needs of the residents THIS REQUIREMENT IS REPEATED FROM THE PREVIOUS TWO INSPECTIONS It is required that the rota is an accurate reflection of the hours worked in the Home It is required that a CRB disclosure is obtained for all members of staff working at the Home It is required that all records required by regulations are available for inspection It is required that monthly visits are undertaken as per Regulation 26 and that a report is sent to the Commission 31st July 2005 Immediate and ongoing 12. 13. 27 29 17 (2) 19 (1) Immediate and ongoing Immediate and ongoing Immediate and ongoing 30th June 2005 14. 15. 29 33 17 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 2 10 Good Practice Recommendations It is recommended that the statement of terms and conditions for residents is clearer about what an advocate does in the terms of this document It is recommended that the Proprietor carries out a consultation with residents to identify any situations where they feel that their privacy and safety may be compromised It is recommended that the layout of the dining area is reviewed to ensure that there is enough room at each table for staff to assist residents It is recommended that the Home has a dishwasher It is recommended that the bedroom doors are unlocked It is recommended that there are clear signs/prompts displayed to identify bedrooms and communal areas I55 s42254 Docking House v218310 (an) 100505 Stage 4.doc Version 1.30 Page 29 3. 4. 5. 6. 15 15 14 14 Docking House 7. 8. 9. 10. 15 32 36 38 It is recommended that the menu is provided in a more useful format in the dementia unit It is recommended that the Home develops a system of senior care staff so that there is always a senior member of staff on duty It is recommended that team meetings take place on a regular basis It is recommended that an audit is carried out of the falls that have taken place at the Home Docking House I55 s42254 Docking House v218310 (an) 100505 Stage 4.doc Version 1.30 Page 30 Commission for Social Care Inspection 3rd Floor, Cavell House St Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 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. 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