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Inspection on 27/04/07 for Docking House

Also see our care home review for Docking House for more information

This inspection was carried out on 27th April 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

What has improved since the last inspection?

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE Docking House Station Road Docking Kings Lynn Norfolk PE31 8LS Lead Inspector Kim Patience Unannounced Inspection 27th April 2007 10:00 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.V337954.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 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.V337954.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Docking House Address Station Road Docking Kings Lynn Norfolk PE31 8LS 01485 518243 01485 518436 care@dockinghouse.co.uk 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 Position Vacant 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.V337954.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st December 2006 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 have dementia 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.V337954.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took approximately 8 hours to complete. During the inspection, several residents were spoken with, two members of staff were interviewed and the manager was spoken with. In addition, records relating to residents, staff and the running of the home were inspected. Observation of residents and staff engaged in their daily routines also were made. The acting manager was present throughout and provided with feedback at the close of the inspection. Since the last inspection the home has appointed a new manager who commenced on 2nd April 2007. This is the third inspection in the last 12 months, the inspection held in May 2006 showed that there were a significant number of concerns and some requirements were repeated from the previous two inspections. The inspection in December 2006 showed that the home started to make progress in some key areas and the service was given a new rating making it just adequate. Since that inspection no further progress has been made and in some areas there has been a decline in standards. The home has its third manager in the last 9 months and the provider has not demonstrated commitment to making improvements. Some aspects of the service are of an unacceptably low standard and need to be addressed urgently. What the service does well: What has improved since the last inspection? • Since the last inspection in December there have been no significant improvements and those seen at the last inspection have not been sustained. Docking House DS0000042254.V337954.R01.S.doc Version 5.2 Page 6 What they could do better: • • • The home must update the statement of purpose and service users guide and provide a copy to all people wishing to use the service. The home must not admit residents outside of their category of registration and registered numbers. The home must make improvement to care plans, risk assessments and health assessments. This requirement was made for the third time at the inspection in May 2006. Some improvements to the medication arrangements and practice must be made. The privacy, dignity and respect of people who use the service must be promoted at all times. A requirement was made in relation to this at the inspection in May 2006. The home must assess people’s social and emotional needs and provide meaningful activities and stimulation. A requirement was made in relation to this in May 2006. Residents must be given choices and autonomy must be promoted. The meals and mealtime experience must be improved. Menus must be developed and take into account resident’s preferences, offering choice. A requirement was made in relation to this in May 2006. The cook must be provided with training on nutrition in order to cater for people with special dietary requirements. Food served to all residents must be wholesome, appealing and be of good nutritional value. A requirement was made in relation to this in May 2006. The home should find a way of displaying the menu of the day that is meaningful to people who are cognitively and visually impaired. A requirement was made in relation to this in May 2006. The home must increase staffing levels to ensure that they are sufficient to meet people’s holistic needs. This requirement was made for the third time at the inspection in May 2006. The home must provide staff with training and produce a training plan that demonstrates a commitment to training each year. The home must provide new staff with induction training that meets the skills for care common induction standards. DS0000042254.V337954.R01.S.doc Version 5.2 Page 7 • • • • • • • • • • • Docking House • • Staff must be provided with regular supervision. The home must have internal quality monitoring mechanisms and identify deficits in the service. A requirement was made in relation to this in May 2006. Monthly regulation 26 visits must be conducted. The requirements of the environmental health department must be met. The home must conduct an audit of accidents and incidents that have occurred so far this year and provide the commission with a report on the findings and action. All areas of the home must be of sound construction and standard of furnishings and cleanliness must be improved in some areas. The home must produce a plan of maintenance and renewal to show how the improvements will be made. All areas of the home must be safe for people using the service. Requirements in relation to risk and maintaining safety were made for the second and third time in May 2006. • • • • • 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 House DS0000042254.V337954.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Docking House DS0000042254.V337954.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is poor. The home has a pre-admission assessment process and all people wishing to use the service have their needs assessed prior to admission. However, the home cannot demonstrate that people are fully aware of the services and facilities offered before moving in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an admissions procedure. People who are considering a stay at the home are invited to visit and view the accommodation. Their needs are assessed and they are informed of whether the home can provide an appropriate service that meets their needs. During a discussion with the acting manager it became apparent that the home does not have a brochure pack and recent admissions to the home were Docking House DS0000042254.V337954.R01.S.doc Version 5.2 Page 10 not provided with information relating to the facilities and services. The statement of purpose and service users guide is available for people to see, but not provided. See requirements. Both documents are in need of updating and contain out of date information about management and staff. See requirements. In addition, it was found that the home accommodates 22 people with dementia when only registered for 18. Four people with diagnosed dementia are now accommodated in the residential wing outside of the category of registration, there is evidence to show that at least two of those people were admitted in the last month. See requirements. Docking House DS0000042254.V337954.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is poor. The home cannot demonstrate that the health, safety and wellbeing of people who use the service is fully promoted and protected due to concerns with assessments of need and uncertainties about the safe administration of medicines. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans and associated records relating to people who use the service were inspected. The new care plan format introduced in August last year has now been fully implemented for all residents. The format itself is good and prompts the assessor to look at all aspects of holistic care and this is good practice. However, the care plans inspected were incomplete or the information lacked detail and a person centred approach. For instance the social and emotional Docking House DS0000042254.V337954.R01.S.doc Version 5.2 Page 12 needs of people with dementia are not properly considered and there was no plan of care as to how needs in this respect should be met. See requirements A GP survey returned to the Commission stated that although physical needs are met social, however, emotional needs are not met and the home could make improvement here. The survey also stated that some health needs such as pressure care were not always met. In one of the three residents files inspected two did not contain pressure sore assessments or nutritional needs assessments. See requirements. The care plan format prompted the assessor to look at preferences and support needed in respect of meals, but did not contain enough detail and in one case what was recorded in the care plan did not match what was observed during the meal time period. Risk assessments were written in some cases, but not in all and one file inspected did not include important risk assessments for emotional abuse and social isolation, even though observations showed that this resident was exposed to this risk due behaviours that were not being addressed properly by the home. See requirements. Care plans written in August were reviewed in November and have not been updated or reviewed since. See requirements. It is extremely disappointing that any improvement seen at the last inspection has not been sustained and a decline in standards can be seen once again. At the inspection in May, requirements were made for the third time in relation to care plans and risk assessments. Medication arrangements were inspected and the findings are listed as follows: Medication storage. Medicines are stored in a small room within a small staff rest area. The majority of staff have access to the room, but not all to the medicine storage facilities. Senior staff with the responsibility for administering medicines hold the keys. However, untrained night staff have access to the medicines so that they can administer PRN medicines if needed. This is of concern because residents cannot be assured that such medicines will be administered to them by staff trained to undertake this task. See requirements. The home has a medicine trolley, which is suitable for transporting medicines around the home. Docking House DS0000042254.V337954.R01.S.doc Version 5.2 Page 13 There were no controlled drugs in use on the day of inspection, however, the home has the systems in place for the management and storage of controlled drugs. The home has a refrigerator for the storage of medicines requiring a low temperature. Handling of medicines The lunchtime medicines round was observed in brief. The senior care assistant brought the medicines trolley into the dining room and took two tablet pots to two residents seated at the dining table. The care assistant was not seen to dispense the tablets in the dining area and not seen to sign the charts after they were taken by the residents and this is unsafe practice. See requirements. However, medicine administration observed following this was good. A communication book seen in the medicines room stated that on one day a residents medicines were in the trolley for administration and this might indicate that medicines were already prepared for administration, which is unsafe practice. See requirements. Receipt, disposal, recording and administration. The home uses a monitored dosage system (MDS) supplied by a pharmacy some distance from the home, which is said by the manager to cause some problems with supply and the home is considering switching suppliers to the local dispensing GP surgery in the hope to improve the service. Currently, most medicines are supplied in a 28-day MDS and those that cannot be dispensed in this way are supplied in their original packaging. Medication administration records (MDS) are also pre-printed by the pharmacy and the cover sheet showed an identifying photograph of the resident. This is good practice. The records were inspected and no obvious errors were identified. There were no gaps in the charts and the receipt of medicines was recorded on the chart. Doses were highlighted and where doses were variable this was indicated on the chart. This is good practice. An audit of medicines was completed and medicines not included in the MDS were selected at random. It was not possible in all cases to audit the medicines effectively as there were no carry forward figures on the chart making it difficult to find a start point and made the records unreliable. Therefore, the audit was abandon and a requirement is made that the home establishes a proper audit trail of all medicines. See requirements. Docking House DS0000042254.V337954.R01.S.doc Version 5.2 Page 14 There were no prescribed medicines for PRN use (as required) however, the home has a procedure for the use of PRN’s. The home has a record of the disposal of medicines. In relation to privacy and dignity, it cannot be said that the home fully promotes privacy and dignity and there are numerous examples in this report. See standards 7, 12 – 15 and 19-26 See requirements. Docking House DS0000042254.V337954.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is poor. The home cannot demonstrate that people’s social and emotional needs are being met and that people’s choice and autonomy is promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As already mentioned in standard 7, the home is not properly assessing peoples social and emotional needs and therefore activities offered are not person-centred based on peoples life experiences and interests. See requirements. The home does not have a plan of activities, but some entertainment and group activities are done on an ad hoc basis. See requirements. The mealtime experience was observed in the unit, which accommodates people with dementia. Docking House DS0000042254.V337954.R01.S.doc Version 5.2 Page 16 The layout of the dining room has been changed since the last inspection. The tables have been placed together to form two long tables, one to seat 10 people and the other to seat 8. This style of dining is institutional and it could be said that this arrangement is for the convenience of the staff and not the residents. One resident refused to sit at the table, as she did not get on with another resident seated there already. Tables were laid with tablecloths, paper napkins and cutlery and this is good. However, drinks had already been poured before people were seated, one table had glasses of orange and the other blackcurrant. People were not offered a choice of what they would like to drink or where they would like to sit. One resident remained in the lounge area, as she required assistance to dine, the care assistant sat with the resident and this is good practice, but there was very little conversation. Communication was also hindered by the fact that the domestic was vacuuming the lounge during the early part of lunch. The noise from the vacuum and the kitchen was high and did not help to create a calm relaxed environment. One resident was shouting constantly and trying to get some attention from staff but for the most part he was not acknowledged. Other residents were telling him to ‘shut up’ as they became more and more agitated. People were being seated at the tables at approximately 12.20, however, lunch was late and was not served until some 15 minutes later, and then meals were brought out very slowly over the following 20 minutes. During this time there were visible signs of agitation and some residents were asking if they were going to get a meal. Rotas show that there were three members of staff scheduled for duty in this area during lunch (see standard 27 for details of staffing levels), one was assisting people with meals in the lounge and their rooms, one was administering medicines at 12.30 and one was assigned to the residential area. Staff were in and out of the kitchen assisting the cook (one extra member of staff was brought in for 12.00, but not included on the rota). At times there were no staff in the dining room and residents clearly needed some support and prompting to eat. One resident sat for some time moving the food around on his plate until a member of staff came out with another meal and he told her he did not know what to do with his food so she placed the fork in his hand, cut up his food and went, he was then able to eat his meal. There were other examples similar to this and people would have benefited from staff sitting with them, prompting and supporting. Instead staff were very task focussed and wanted to get the meal served and plates cleared as quickly as possible. At times all the staff were in the kitchen chatting and Docking House DS0000042254.V337954.R01.S.doc Version 5.2 Page 17 washing/clearing up instead of in the dining room with residents interacting supporting and helping to make mealtime a pleasant and stimulating social experience. The meal itself was already plated and people were not offered choices about the food they wished to have. The menu showed that the meal was fish, mash potato and peas, however there was not enough fish for everyone so some were given fish fingers. The food was served with a white sauce already poured over and people had no choice about whether they wanted it or not. Four weekly menus were on display in the dining room, however the print was so small that anyone with visual or cognitive impairments would have some difficulty reading them and therefore they were of little value. See requirements. In the residential unit the menu was written on a small white board, but when speaking with a resident in the dining room he said ‘don’t take any notice of the menu’, ‘as people are often not able to choose from it’. He stated that at teatime the options were usually cheese on toast or sandwiches and that people never knew what they were having for lunch it was just placed in front of them. He also said that the food was a big issue and there was nothing they could do about it. Another resident said the home cannot cater for all tastes and it was easier for them to serve one meal. See requirements. The standard of food was an issue at the previous inspection in May 2006 and it is of concern that this continues to be an issue. It was said by staff that on four days a week they are responsible for serving the teatime meal, which is usually prepared by the cook before she leaves at 2pm. This was an issue at previous inspections and takes staff away from providing care. The provider had assured the Commission that a teatime kitchen assistant had been employed to do tea’s, but it appears this only happens on a Thursday, Friday and Saturday. See staffing requirements. Docking House DS0000042254.V337954.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. The home cannot provide sufficient evidence that people are protected, but there are systems in place for people to raise concerns and complaints. However, some improvements are still needed here. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure that continues to be well publicised. However, on inspection of the service users guide, the complaints procedure contained within does not contain up to date information about who people can complain to if not happy with the service. The complaints procedure must include the local social services and the Commission for Social Care Inspection. See requirements. The home still has a comments and suggestions box in the reception area and this is good practice. The home has an adult protection policy and procedure. However, not all staff employed have been provided with training on the subject. Although staff spoken with knew how to raise concerns. See requirements. Docking House DS0000042254.V337954.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is poor. The home cannot demonstrate that they provide an environment that is safe and promotes the health safety and welfare of people who use the service and staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises was completed. Some improvements to the fabric of the building can be seen. For instance some areas have been redecorated and re-carpeted, which is good. However, there is still much improvement to be made. Docking House DS0000042254.V337954.R01.S.doc Version 5.2 Page 20 The dining room furniture in both dining rooms needs to be replaced and the dining room chairs are not suitable for older people with mobility problems and the tables are in a poor condition. During the inspection it became apparent that the home does not have enough usable bathrooms for all residents. There are three bathrooms and one shower room in the building, this means the ratio of bathrooms to the number of residents is adequate. However, two of the bathrooms cannot be used as they do not have assisted baths and residents cannot manage to get in and out of the bath independently. Only one bathroom has an assisted bath that has been installed since the last inspection, which is good, however this is used for all residents and is not adequate. The shower room does not have a lock on the door. One bathroom entered was filled with clutter and a bath was propped up against the wall. There was a strong stench in the room making it impossible to stay in there for any length of time, the water in the toilet was black. This bathroom is situated in the dementia wing and is not locked; therefore it poses a risk to people health and safety. The bathrooms contained unnamed toiletries indicating that they are for communal use, this has been a requirement at previous inspections and it is of concern that this practice continues, particularly as the Commission was given written assurances that the practice would cease. Staff stated that the home charges £5 per month for toiletries and the same products are supplied to all residents who are not provided with any choice about what they wish to use. Some resident’s rooms were entered and at least two had strong offensive odours. One room was very sparse and it was hard to believe anyone was staying in the room. The bed was made, but the bed cover was heavily soiled. The lino flooring was rippled and coming away from the floor making it unsafe. The floor was sticky and covered with wet and dried urine and there were faeces under the sink. There were no towels or soap and the room could be described as filthy. (The room was entered in the afternoon when the cleaner had already completed her tasks for the day). The décor was in a very poor state and the door needs replacing. The wardrobe did not contain any clothing and both the wardrobe and bedside cabinet were in a poor state and filthy outside and in. It is clear the home are not meeting this persons needs and the conditions were wholly unacceptable. A member of staff said that the door to the room is generally locked during the day to keep the resident out and that her clothing is kept in the laundry to stop her taking them out of the wardrobe. This is a restriction of her rights and must be addressed. Docking House DS0000042254.V337954.R01.S.doc Version 5.2 Page 21 In the corridor outside the quiet lounge in the dementia unit there was clutter causing a hazard and this must be removed. The laundry facilities were inspected and found to be messy. It was not clear how soiled laundry and clean laundry were kept apart. Soiled linen is collected by staff in the mornings in open baskets and taken to the laundry room for washing. There are commercial washing machines and dryers available. Clean laundry was seen piled on top of the dryer close to a bucket containing soaking soiled laundry. Staff are responsible for doing the laundry throughout the day and this takes them away from care tasks. (See standard 27 for details on staffing levels) Clean laundry is taken to another room and folded and hung ready for ironing. This room was previously used as a safe and has a heavy metal door that does not lock. Residents in the dementia unit could access this room and this would cause a hazard to their safety. In addition, the light was found to be on in the room, which was full of clothing, bedding and paper products. This poses a fire hazard and a risk to people’s safety. People living in the home do not currently have access to an outdoor space and the home must address this. There is a small safe garden, which can be accessed through patio doors in the quiet lounge, but there are some hazards due to changes in levels from path to garden. The home is required to provide the Commission with an improvement plan to address the above points in relation to the environment. See requirements. The home was inspected by the environmental health department in March 2007 and there were three contraventions to the health and safety at work legislation and three legal requirements all to be met within three months of the report being issued. The home must comply with the requirements of the health and safety at work act. (See standard 38 for more information) Requirements are made in relation to the above concerns. Docking House DS0000042254.V337954.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. The home cannot provide sufficient evidence to confirm that people who use the service are cared for by staff in sufficient numbers who are adequately trained and competent. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Copies of the staff rotas for the four weeks prior to the inspection were taken and the last two weeks were analysed. The home is currently accommodating 27 residents, 22 of whom have a diagnosis of dementia. The home is separated into two areas, one residential and one dementia, however, four people with dementia are now living in the residential area. The rotas show that the home aims to have 5 staff on duty in the mornings 7am – 2pm, 4 in the afternoons 2pm – 9pm and 2 during the night 9pm – 7am. However, at times these numbers are lower and on three of the fourteen mornings analysed there were only four staff on duty in the mornings, on five occasions only three in the afternoons falling to two one afternoon and on one occasion one member of night staff. Docking House DS0000042254.V337954.R01.S.doc Version 5.2 Page 23 Care staff have responsibility for laundry duties throughout the day and night, domestic duties at the weekend and on four days of the week are responsible for serving tea. It was also said that night staff are getting people out of bed from 5.30am, as the day staff do not have sufficient time to get people up in a timely manner. The homes target numbers are already low and it is expected that the ratio of staff per residents would be 1 to every 5 in dementia and 1 to every 7 in residential. This means the homes target staffing levels should be 6 staff on duty throughout the waking day. There is evidence throughout the report that people’s holistic needs are not being met and together with a high number of accidents (see standard 38) people may be at risk due to a lack of proper supervision. The home is required to increase the overall staffing levels and must consider employing an additional member of staff to cover laundry duties and for the preparation and serving of meals at teatime. In addition, the domestic arrangements must be reviewed and increased to ensure that a good standard of hygiene and cleanliness is maintained. The domestic currently works between 8-1pm. See requirements At the inspection in May 2006 a requirement was made in relation to the adequacy of staff for the third time and it is of concern that this is a recurrent issue. The home is not offering staff the opportunity to undertake NVQ training and currently have only one member of staff doing the course. See requirements. Since the last inspection there has been very little formal training and the home does not have a training plan for 2007. Staff files relating to new members of staff showed that they had only completed a two-day induction programme as an introduction to the home and no other training had been planned. See requirements. This is of concern as there is evidence of poor practice and a culture of care that does not promote the best interests of residents. Staff must be trained, as this is the only way of raising standards of care. See requirements. Two new staff files were inspected and found to contain identification, an application form, a POVA check and two references and this is good practice. However, one reference relating to a previous employment was written in August last year and brought by the candidate. The home must apply for references in order to validate the source and ensure the information is correct. Docking House DS0000042254.V337954.R01.S.doc Version 5.2 Page 24 Both members of staff had commenced employment before the CRB check had been received, but not without a POVA check and this is safe practice. However, staff commencing employment on this basis must be supervised by a named worker, until the CRB is received and there was no evidence that this was in place. See requirements. Docking House DS0000042254.V337954.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is poor. The home cannot demonstrate that there are sound management systems necessary to provide a well-managed, safe service that meets the expectations of people who use the service and staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the homes acting manager has left and another has been appointed. The new manager commenced on the 2nd April 2007 and has therefore only been in post for a short time and not long enough to effect real change. Docking House DS0000042254.V337954.R01.S.doc Version 5.2 Page 26 It is of concern that the home has been with out a registered manager now for approximately 9 months and this is the second manager to be appointed in the last seven months. The home is not being well managed at present and there are many areas of improvement to be addressed following this inspection, the proprietor must support the new manager by providing adequate resources, both human and financial to ensure the necessary changes are made. See requirements. Since the last inspection the quality assurance manager is no longer employed by the home. Therefore, there is little evidence that the home has any quality assurance monitoring in place. In addition, there does not appear to have been a regulation 26 report since February 2007. See requirements. The home holds a small amount of money for some residents and has systems in place for ensuring that this is managed correctly. This is good practice. The home is not providing staff with any formal supervision and this is a requirement. See requirements. As mentioned in standard 19, the home has recently been inspected by the environmental health department who identified a number of areas that must be improved. These relate to the following: • • • • • • The home does not have a health and safety policy and this is a contravention of the legislation. The home is not adequately assessing risks in relation to staff and this is a contravention of the legislation. The home does not have systems in place for the reporting of injuries, diseases and dangerous occurrences and this is a legal requirement. The home does not have an approved accident report book and this is a legal requirement. The laundry floor was found to pose a risk to peoples safety and this is a contravention of the legislation. The home does not have suitable facilities for staff to take rest breaks and to eat meals and this is a legal requirement. All the above areas must be complied with in three months. See requirements. The accident report books and the incident record forms were inspected in brief. Between the 1st January 2007 and the 27th April 2007 there has been approximately 96 accidents/incidents and this is a high number. Some of the Docking House DS0000042254.V337954.R01.S.doc Version 5.2 Page 27 accidents were attributed to falls and some to incidents between residents. This number of accidents is a concern and may indicate that residents are not being adequately cared for. The home is required to provide a report on the number of accidents that shows the date on which the accident occurred, the time, the nature of the accident/incident and what action was taken to minimise further risk, if any. See requirements. The home is also required to conduct monthly accident audits and provide the Commission with a report. See requirements. Docking House DS0000042254.V337954.R01.S.doc Version 5.2 Page 28 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 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 X X X X X X 1 STAFFING Standard No Score 27 1 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 1 X 1 Docking House DS0000042254.V337954.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO 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 OP3 Regulation 5(2) Requirement Timescale for action 01/06/07 2 3 OP3 OP3 6 Part 24 of the Care Standards Act part II 15(1)&(2) People who are using the service must be provided with up to date information about the services and facilities provided. So that they are informed about what should be provided. The service users guide and 01/06/07 statement of purpose must be reviewed and up dated. The home must not admit people 01/06/07 outside of their category of registration. People who use the service must have their needs fully assessed and reviewed at regular intervals. So that staff can deliver care that meets their needs and expectations. People who use the service must have risk to their safety and welfare assessed and recorded. So that people are protected from harm People who use the service must have their medication administered by trained staff at all times. So that their health and welfare is safeguarded. DS0000042254.V337954.R01.S.doc 4 OP7 01/06/07 5 OP8 13(4) 01/06/07 6 OP9 13(2) 01/06/07 Docking House Version 5.2 Page 30 7 OP9 13(2) 18 (1)(c) 8 OP9 13(2) 9 OP10 12(4)(a) 10 OP12 16(2n) 11 12 OP14 OP15 12(2) 16(2)(i) 13 OP15 16(2)(i) 14 OP16 5(1)(c) 15 16 OP18 OP19 13(6) 23(2b) People who use the service must have their medication administered by staff who are assessed as competent. So that their health and welfare is safeguarded. People who use the service must be assured that medication arrangements are safe and the home have a system to audit medicines. So that their health and welfare is safeguarded. People using the service must have their privacy and dignity promoted at all times. So as to promote their wellbeing. People who use the service must be provided with meaningful occupation and stimulation that meets their assessed needs and expectations. So that their wellbeing is promoted. People using the service must be provided with choice and autonomy. People who use the service must be provided with suitable, nutritious food that meets a reasonable standard and peoples expectations. People who use the service must be consulted about the meals they would like on the menu and provided with a menu that is produced in a format the meets the varying needs of residents. The complaints procedure must include the names of agencies that they can refer to if complainants are not happy with the way their complaint is dealt with. Staff must be provided with training on the protection of vulnerable adults. The home must be of sound construction and kept in a good state of repair externally and DS0000042254.V337954.R01.S.doc 01/06/07 01/06/07 01/06/07 01/06/07 01/06/07 01/06/07 01/06/07 01/06/07 01/06/07 01/06/07 Docking House Version 5.2 Page 31 17 18 OP26 OP27 23(2d) 18(1)&(2) 19 20 21 OP27 OP36 OP33 18(1c) 18(2) 24(1)&(2) 22 OP38 13(4) 23 OP38 13(4) internally. People who live in the home must be assured it is kept clean and reasonably decorated. People who use the service must be assured that their needs are met by sufficient numbers of staff at all times. People using the service must have their needs met by trained and competent staff. People using the service must have their needs met by staff who are adequately supervised. People using the service must be assured they will be consulted about their needs and expectations and the standard of the service will continue to be monitored. People using the service must be assured that the home has systems in place that protect their health and safety and staff. People using the service must be protected from harm and the number of accidents and incidents monitored and reduced. 01/06/07 01/06/07 01/07/07 01/06/07 01/09/07 30/06/07 01/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Docking House DS0000042254.V337954.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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