Inspection on 25/01/06 for Docking House

This inspection was carried out on 25th January 2006.

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 30/10/05

Docking House 18/05/05

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 Norfolk PE31 8LS Lead Inspector Mrs Lella Andrews Unannounced Inspection 25th January 2006 10:00a X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Docking House DS0000042254.V278990.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Docking House DS0000042254.V278990.R01.S.doc Version 5.1 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 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) 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 DS0000042254.V278990.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th October 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. Docking House DS0000042254.V278990.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Inspection was unannounced and was carried out by two Inspectors between 10am and 5.15pm on Wednesday 25th January 2006. Two members of staff were spoken to on an individual basis and the Inspectors spoke to three residents. Inspectors spent time observing staff supporting the residents, looked at records and undertook a tour of the communal areas. The Manager and the Proprietor were both present for most of the Inspection, including feedback at the end of the Inspection. The purpose of this Inspection was to follow up on the requirements that were made following the Inspection in October 2005 and so not all of the National Minimum Standards were inspected on this occasion. What the service does well: What has improved since the last inspection? There have been a lot of improvements in the Home since the previous Inspection. The Proprietor and Manager have addressed the majority of the requirements made during the previous report and those that have not yet been met have plans in place to address them. The staffing levels have increased so that staff now have more time to spend with residents on an individual basis. A member of staff is taking the responsibility for ensuring that activities take place. Equipment has been purchased and it was pleasing to see that the residents in the dementia unit seemed to really enjoy the activities taking place in the afternoon. Additional training has been provided to the staff team and more is planned to take place shortly. This should provide improved knowledge and confidence for the staff team. Two of the experienced care staff have been promoted to become Senior care staff and feedback to the Inspectors indicates that staff and management feel Docking House DS0000042254.V278990.R01.S.doc Version 5.1 Page 6 that this is a positive step. This will provide additional support to staff and also improve the monitoring of the care being provided. The concertina doors on two of the toilets have been replaced which improves the privacy for the residents. Plans are in place to provide a shower room in the dementia unit, which will mean that the residents do not have to go to the other side of the Home to use the bathroom. An Occupational Therapist and Falls Assessor have both visited the Home and made recommendations with regard to improving the environment for residents with dementia and those with poor mobility. The layout of the lounge/dining areas in the dementia unit have been reorganised and now provide areas for small groups of residents to sit or to have meals. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Docking House DS0000042254.V278990.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Docking House DS0000042254.V278990.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were measured EVIDENCE: N/A Docking House DS0000042254.V278990.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 9 The care plans do not contain detailed guidance to staff about how to meet the resident’s needs. Improvements are needed to ensure that the residents receive medication at the most effective times. EVIDENCE: Six of the care plans were seen. There is evidence that some of the manual handling and pressure area assessments have been reviewed recently which is an improvement on that seen during the previous Inspection. A recent moving and handling assessment for one of the resident’s states that the hoist is now needed when assisting the resident with mobility. Staff and the resident themselves told the Inspector that this is taking place. This means that the care plans reflect better the actual care that is given. However, none of the care plans actually contain detailed guidance to staff about how to meet individual needs. For example, there is no clear guidance to staff about how to provide care to the resident who is in bed all of the time. Docking House DS0000042254.V278990.R01.S.doc Version 5.1 Page 10 Another resident has significant physical health needs but there is no clear written guidance to staff about how to meet these needs. In some instances, the information is written in the daily notes but this would be difficult for staff to refer to and new staff would not know that the information is present at all. It is clear that the staff are working at improving the care plans but there is still some way to go to ensure that clear written guidance is available to staff about how to meet individuals needs. The recent appointment of two senior care staff should assist with this process, as they will be able to undertake some of this work rather than the Manager having to do it all. The Inspector looked at the medication system. The majority of the previous requirements relating to medication have been met. The key is now kept more securely and there are procedures in place to ensure that medication is obtained from the pharmacy promptly. The requirement for there to be clear written guidance about the use of individual PRN (as required) medication has not been met and is repeated in this report. This is even more important now that two of the residents are prescribed controlled drugs. It was noted that one of the residents medication had not been given at the correct intervals and it is required that all residents receive medication at the prescribed times so that they are most effective. It is strongly recommended that the Home changes to a proper medication trolley which will make the current system of administration both safer and less time consuming. It is also recommended that the controlled drugs are kept locked within the locked medication cupboard and that a separate register is kept of these with the signatures of two staff on each occasion. Docking House DS0000042254.V278990.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 14 Activities have started to be provided within the Home and the residents are enjoying these. Staff are spending additional time with those residents with dementia but training is still needed so that communication can be improved. EVIDENCE: One of the recently appointed senior care staff has taken on the responsibility of finding out what activities the residents are interested in and the Home have recently purchased a lot of equipment to enable various activities to be carried out. A book about the provision of activities to those with dementia has also been purchased. It is pleasing to see that the Proprietor has taken this issue seriously and is encouraging staff to spend time with the residents in this way. The member of staff taking the lead on this issue is enthusiastic about this role and has started to try different activities with residents. During the afternoon staff spent time in the dementia unit assisting residents with various activities and it was very positive to see and hear the residents joining in and lots of conversations going on about the activities. It is recommended that the Docking House DS0000042254.V278990.R01.S.doc Version 5.1 Page 12 member of staff responsible for organising activities on each shift is identified on the rota. Activities are also being encouraged in the side of the Home for people without dementia. A table has been set up in one of the small lounges so that jigsaws can be left out and two of the residents were keen to get on with this during the afternoon. Residents said that they are enjoying doing something constructive with their time. Staff were seen and heard to offer choices to the residents in a variety of situations. This can be much more difficult to do when residents have difficulty with verbal communication. The commencement of activities and the additional staff being provided should all assist with this process. However, the requirement for staff to undertake training about working with older people with dementia is repeated in this report. It was noted that communal toiletries are provided in the bathroom. It is required that the residents have their own toiletries so as to promote individual choice and dignity. Docking House DS0000042254.V278990.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were measured EVIDENCE: N/A Docking House DS0000042254.V278990.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 25 and 26 There are still some areas of the Home in need of updating/improvement but the Proprietor has started to address these and has plans to improve the remaining areas so that the needs of the residents are met. EVIDENCE: A tour of the communal areas of the Home was undertaken by the Inspectors. Several improvements have been made. The Manager explained that the Falls Advisor from the PCT (Primary Care Trust) has recently visited to assess the environment and made some recommendations to improve the environment for the residents with dementia. The Manager and Proprietor will consider the recommendations once they receive the assessors report and make plans for implementation. An Occupational Therapist has been to visit the Home to advise about the suitability of a bathroom in the dementia unit. Agreement has been made to refurbish the shower room which is currently used as a store so that this will Docking House DS0000042254.V278990.R01.S.doc Version 5.1 Page 15 provide a level access shower for the residents. The Proprietor said that the builder is due to visit later that day and that he expects the work to begin shortly. The provision of a shower room located in the dementia unit will meant that residents do not have to go to the other side of the Home to use the bathroom and will also provide a choice about whether they have a bath or a shower. It was noted that all of the toilets had towels, soap and toilet rolls, which is an improvement on the previous Inspection. The Proprietor said that he has purchased the necessary equipment to provide soap dispensers and paper towel dispensers which will improve the level of infection control provided. He also said that the toilet areas are due to be retiled which will also be an improvement as some of them are in need of redecoration. The two toilets which previously had concertina type doors have had new doors fitted which improves the levels of privacy and dignity for those using them. The Manager has plans about improving the environment with regard to the needs of the residents with dementia which includes the provision of suitable items on the bedroom doors to assist residents in knowing which is their room. The layout of the lounge/dining room in the dementia unit has been reorganised and improved. There are now dining tables and chairs in each of the rooms which provides more space for the residents and staff at meal times. It also means that the lounge chairs can be organised into small groups and encourages residents to chat together. This was seen to be happening on the day of the Inspection and is pleasing to see. New tablecloths have been purchased for the dining tables. The Manager said that the hot water regulators have received attention and are now working properly. The hot water in the bath was measured and found to be satisfactory. The Inspector was told that the maintenance member of staff keeps a weekly log of different hot water outlets and staff measure the bath water prior to a resident getting into the bath. It was noted that some of the radiator covers need some attention and the Proprietor said that this was taking place in the next few days. The Home felt warm in all areas and the residents said that the temperature was comfortable for them. There are still areas in the Home which have an unpleasant odour. This is particularly in the dementia unit and it is required that this is addressed. It was noted that although the Home looked clean and tidy there were areas with large cobwebs, particularly in the toilet areas. The Home has not increased the number of domestic hours provided despite a requirement to do so and this requirement is repeated in this report. Docking House DS0000042254.V278990.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 and 30 The staffing levels have been increased which means that staff have more time to spend with residents There are still some omissions in the records required for effective recruitment procedures, which means that the system in place does not provide the safeguards for the residents that it should. Staff have received some of the planned additional training necessary to carry out their roles effectively. EVIDENCE: The rotas show that there are now four staff on duty each morning and three staff on duty during the afternoon/evening. The staff confirmed that this is now the usual staffing arrangement. This is an improvement on the previous staffing situation and enables staff to spend additional time with residents so as to meet their needs more effectively. The Proprietor has experienced difficulties with recruitment but said that two more members of staff are due to start work at the Home in the next fortnight. The Manager said that she is shortly going to interview staff for the post of kitchen assistant to cover for tea times. The Inspector was told that currently the Manager or the Proprietors mother undertake this role some of the week. The requirement to provide a permanent member of staff to carry out this role Docking House DS0000042254.V278990.R01.S.doc Version 5.1 Page 17 is repeated in this report. A requirement is also made for the rotas to be an accurate record of staff on duty at any time. The Proprietor has recently promoted two of the more experienced care staff to become Senior care staff. The intention is that there will always be a Senior staff on duty if the Manager is not present. This situation has only recently taken place and the staff involved are still in the process of learning their new roles. Staff are enthusiastic about this development and feel that it will be beneficial to the residents and provide support to all members of the team. The Proprietor and Manager have taken steps to address the difficulties that there have been within the staff team and everyone who spoke to the Inspectors, including staff, said that the situation is much improved and that staff work together as a team more effectively. It is expected that the outstanding requirements and recommendations will be able to be put into place much more easily now that the majority of the staffing situations have been addressed. The recruitment files had previously been inspected during an Additional Visit carried out by the Inspector on the 17th November 2005. A requirement was made at that time for the information about staff required by regulation to be present. A selection of files were seen during this Inspection and some omissions are still present. However, the Manager is addressing these and expects to have the necessary information shortly. The Proprietor and Manager have arranged for additional training to be provided to the staff team. Staff attended Protection of Vulnerable Adults training in November 2005. Food Hygiene training was provided in January 2006. Unfortunately the Moving and Handling training that had been booked for January was cancelled by the trainer but the Manager said that arrangements have been made for staff to attend this training shortly. The Proprietor said that he is still researching appropriate training providers for NVQ. It is pleasing to see that the issue of training has been given a higher priority within the Home. It is recommended that each member of staff has a training and development plan. Staff were seen and heard to support residents in a kind and caring way. Residents said that the staff are kind to them and that they work hard to look after them. Docking House DS0000042254.V278990.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 There is improved leadership and support provided to the staff team. EVIDENCE: The Manager has worked at the Home for over twenty years and has extensive experience of managing the Home. The Proprietor and his mother are present in the Home for approximately three days per week but the day-to-day management of care issues are the responsibility of the Manager. During the previous Inspection it was noted that the staff were lacking leadership and support as the Manager had been off work for some time and there was no system in place to replace her management role. However, since that time the Proprietor has promoted two care staff to the role of Senior. As previously mentioned this has only recently taken place but it is expected that this will greatly improve the support provided to the care staff and provide Docking House DS0000042254.V278990.R01.S.doc Version 5.1 Page 19 increased monitoring of the quality of the care being provided to the residents. The Proprietor and Manager have plans in place to provide training and support to the Senior staff to enable them to carry out their roles effectively. It is recommended that staff meetings take place on a regular basis. Docking House DS0000042254.V278990.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X 2 X X X 3 2 STAFFING Standard No Score 27 2 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 2 X X X X X X Docking House DS0000042254.V278990.R01.S.doc Version 5.1 Page 21 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 OP7 Regulation 15 Requirement It is required that the care plans include detailed guidance for staff about how to meet individuals needs The previous timescales of 31/07/05 & 31/12/05 were not met It is required that all staff receive updated training about moving and handling, including the use of equipment It is required that written guidance is available for the use of PRN medication The previous timescale of 30/11/05 was not met It is required that residents are given their medication at the prescribed times It is required that the domestic hours are increased The previous timescales of 31/07/05 and 30/11/05 were not met It is required that the Home is free from offensive odours The previous timescale of 01/11/05 was not met It is required that the residents DS0000042254.V278990.R01.S.doc Timescale for action 31/03/06 2 OP8 13 (5) 31/03/06 3 OP9 13 (2) 28/02/06 4 5 OP9 OP26 13 (2) 18 (1a) 25/01/06 28/02/06 6 OP19 16 (2k) 28/02/06 7 OP14 12 (4a) 28/02/06 Page 22 Docking House Version 5.1 8 OP29 19 9 OP30 18 10 11 OP27 OP27 17 (2) 18 have their own toiletries and that communal toiletries are not used It is required that the Proprietor obtains the information listed in Schedule Two of the Care Homes Regulations for all members of staff prior to them starting work. The previous timescale of 30/11/05 was not met It is required that the staff receive training with regard to providing care for older people with dementia with a particular emphasis on communication It is required that the staffing rota is an accurate reflection of the staff on duty at any time It is required that an additional member of staff is on duty during the afternoon to prepare, serve and clear up at tea time The previous timescale of 30/11/05 was not met 28/02/06 31/03/06 25/01/06 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP9 OP9 Good Practice Recommendations It is recommended that the Proprietor purchase a proper medication trolley It is recommended that the controlled drugs are kept in a locked container within the locked medication cupboard and that a register is kept for this medication which includes the signatures of two staff It is recommended that the rotas include the names of staff responsible for activities on each shift It is recommended that there is a training and development plan for each member of staff It is recommended that regular staff meetings take place 3 4 5 OP12 OP30 OP36 Docking House DS0000042254.V278990.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Norfolk Area Office 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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