CARE HOMES FOR OLDER PEOPLE
Dolphin View Harbour Road Amble Morpeth Northumberland NE65 0AP Lead Inspector
Mrs Irene Bowater Unannounced Inspection 25th November 2005 09:30 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 Dolphin View DS0000000510.V266442.R01.S.doc Version 5.0 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. Dolphin View DS0000000510.V266442.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Dolphin View Address Harbour Road Amble Morpeth Northumberland NE65 0AP 01665 - 713339 01665 713223 dolphinviewhome@fshc.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) Cotswold Spa Retirement Hotels Limited (wholly owned subsidiary of Four Seasons Healthcare Ltd) Mrs Susan Davison Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places Dolphin View DS0000000510.V266442.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 19 residents receive Personal Care 23 residents receive Nursing Care Three named service users are known to be outside category OP. One is category MD(E), one LD(E) and one PD. Should any of the named service users leave the home, the Commission for Social Care Inspection must be notified immediately, at which time these places will revert to the category OP. 18th July 2005 Date of last inspection Brief Description of the Service: Dolphin View is a purpose built care home with nursing situated on the edge of the harbour in Amble Northumberland. The home is over two floors, which are accessed by stairs and a passenger lift. Currently all the rooms are for single occupancy. None of the bedrooms have ensuite facilities, however each bedroom has a hand washbasin. There are bathrooms, showers and toilets close to residents’ bedrooms and all communal areas. Specialist baths and toilets are provided for residents with disabilities. There are lounges on both floors with the dining room situated on the first floor. There is access to a garden area to the front of the home, which affords views across the bay and harbour area. Car parking is provided to the rear of the building. Dolphin View DS0000000510.V266442.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place over one day. The registered manager was not available, however all of the staff assisted at various times throughout the inspection. Part of the day was spent examining records and the majority of the day was spent touring the building and talking to residents, relatives and staff. There are some outstanding premise requirements, which have not been met for some considerable time. Following this inspection a warning letter was sent to the provider setting out what action must be taken to meet these requirements within specified timescales. What the service does well: What has improved since the last inspection?
The home now has a Statement of Terms and Conditions (or contract) for residents who are self funding. The care planning process is now up to date and there is evidence that advice from other professionals is acted upon regarding dietary needs and wound care.
Dolphin View DS0000000510.V266442.R01.S.doc Version 5.0 Page 6 The cleanliness and storage of food in the kitchen has been resolved with the return of the cook. The staff have received statutory training with records being available. 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. Dolphin View DS0000000510.V266442.R01.S.doc Version 5.0 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 Dolphin View DS0000000510.V266442.R01.S.doc Version 5.0 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): 2,3,5 The Statement of Terms and Conditions sets out the rights and obligations of both resident and the provider. Residents are fully and appropriately assessed before and after admission. Residents and their representatives are able to “test” the home before deciding to live there. EVIDENCE: Since the last inspection the home are providing terms and conditions (or contracts) for those residents who are self funding. The care plans are formulated from detailed care management and the home own assessments. The two assessments ensure that all residents’ individual needs are met on and after admission. Residents and their representatives are encouraged to visit the home before admission. They are able to stay for a part or a full day, have a meal and get to know other residents and staff. Dolphin View DS0000000510.V266442.R01.S.doc Version 5.0 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): 7,8,9,10 The care plans are clear and give the staff the information they need to meet residents assessed needs. Heath care needs are met with good multi disciplinary working taking place. Medication systems are satisfactory although the recording has the potential to place residents at risk. The staff have formed positive relationship with the residents and care is delivered in a way that promotes and protects their right to independence, privacy and dignity. EVIDENCE: The care plans inspected showed a good level of recording in regards to all aspects of personal, health and social care needs. Risk assessments including dependency analysis, wound care, nutrition and fall prevention were available up to date and amended as necessary. The detail of the daily progress reports was very good showing immediately the daily care delivery given. There was good evidence of GP and other specialist input on a regular basis.
Dolphin View DS0000000510.V266442.R01.S.doc Version 5.0 Page 10 The home has policies in place to ensure the safe administration of medicines. There has been an improvement in recording on the Medicine Administration Records since the last inspection. There was evidence that abbreviations were being used and not all handwritten transcriptions had two signatures. A random audit was satisfactory. All residents spoken with were complimentary about the staff and how they make sure their personal care needs are met. It was evident that the staff and residents have formed good relationships, as the interaction between them was friendly, professional and based on mutual regard. Staff used residents preferred names, knocked on doors and waited for a reply before entering and all care was carried out discreetly and in private. Dolphin View DS0000000510.V266442.R01.S.doc Version 5.0 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): 12,14,15 Social activities are organised and provide stimulation and interest for the residents. Residents are assisted to maintain control over all aspects of their daily living. Dietary needs of residents are catered for with a balanced selection of food. The evening menu does not provide choice and variety. EVIDENCE: The home still benefits from having a designated activities organiser who arranges varied events both inside and outside the home. A programme of activities is readily displayed and there is pictorial evidence of various events that have taken place throughout the summer months. Residents are encouraged to bring items of furniture into the home and their rooms are highly individualised and reflect their lifestyles. The residents and their visitors said there are no restrictions about daily routines, or times for getting up or going to bed. On the day of inspection the dining room was clean, with tables nicely set with tablecloths appropriate cutlery, condiments and napkins. Dolphin View DS0000000510.V266442.R01.S.doc Version 5.0 Page 12 Residents were offered choices for the main course and dessert. Hot and cold drinks were available and offered throughout the meal. Several residents were served their meal in their own rooms. The staff assisted residents in a discreet sensitive manner and the mealtime was a pleasant unhurried occasion. Residents were complimentary about the size and presentation of the meals. They did have a concern that for five nights a week they had soup and sandwiches and on two nights it was a buffet. They all said that they would like a hot alternative to be available. The kitchen was clean and tidy. Foods were suitably stored, records of fridge, freezer and core food temperatures were available and staff were wearing protective clothing. Dolphin View DS0000000510.V266442.R01.S.doc Version 5.0 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): 16,18 The complaints system is satisfactory with residents’ views being listened to and acted upon. Arrangements are in place to protect residents from harm and abuse. EVIDENCE: The complaints policy and procedures are readily displayed and easily followed. The records were clear, with actions and outcomes recorded. There have been no complaints recorded with the Commission this year. Residents and visitors said they would be able to use the procedures if they were unhappy about anything and were confident that the staff would “sort things out immediately”. The home has policies and procedures in place for the Protection of Vulnerable Adults. The training records show that the majority of staff have completed the training programme. Staff were able to discuss what steps to take should there be any allegation or suspicion of abuse in the home. Dolphin View DS0000000510.V266442.R01.S.doc Version 5.0 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): 19,20,21,22, 25,26 There has been some investment, which has resulted in a comfortable, nicely decorated home for residents to live in. There are outstanding environmental and infection control requirements concerning the premises which have not been resolved which has the potential to place residents and staff at risk. EVIDENCE: The location and layout of the home is suitable for the residents’ current needs. The redecoration and refurbishment has greatly improved the appearance of the communal areas and residents were delighted with the changes. There is access to safe garden areas, which have views across the harbour and bay. All of the lounges and the dining room have been decorated and refurbished and there is now smoke free environment.
Dolphin View DS0000000510.V266442.R01.S.doc Version 5.0 Page 15 Many of the double-glazing seals have worn resulting in condensation forming which is starting to obscure views from the windows. The glass in one door is broken and currently covered with protective covering. There is some water damage to the ceiling in the dining room. Many of the bathrooms are out of use and staff are currently taking residents from upstairs downstairs to have a bath, as there is no assisted bath on the first floor. There have been problems with the shower rooms and “pooling” of water. Towels have to be used to stop the water from the shower draining out of the shower areas. One shower chair is broken and staff are using a commode chair, or taking the shower chair to the different areas as necessary. The grouting around the tiling is loose and the wooden boxing around the pipes is worn and the flooring is not easily cleanable. The residents all have single rooms, which vary in size. The vanity units and other bedroom furniture are showing signs of wear and tear. There remains a problem with the residents having access to suitable bedside lights, as this is dependent on where the bed is placed in the room. There remains a problem with residents’ toiletries being left in bathrooms; bins not having lids and two toilet bowls remain heavily lime scaled. The sluices were not locked and although a sluice disinfector has been provided it has still not been fitted. Staff are manually sluicing and cleaning soiled commode pots. There are no liquid soap and hand towels in all resident areas including bedrooms for staff to effectively wash their hands. There has been ongoing problems with the size of the laundry which is very small becomes extremely hot especially as the extractor fan was out of use. Attempts to ease the problems have been taken at home level with a bedroom being converted into a clean laundry area. Dolphin View DS0000000510.V266442.R01.S.doc Version 5.0 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): 27,29,30 The home is adequately staffed with qualified nurses and care staff given the current numbers of residents. The recruitment and selection procedures ensure residents are protected from harm. The induction and ongoing training ensures that there is consistent care provided by an enthusiastic workforce. EVIDENCE: There has been a reduction in the staffing levels by the Company. The current levels are: 1 5 5 2 qualified nurse at all times care staff in the morning care staff in the afternoon and evening care staff overnight. The registered manager “staggers” the shift timing to meet residents’ needs especially in the mornings. There is adequate domestic, laundry, maintenance, administration and activities staff employed. There are no kitchen staff available from mid afternoon to prepare or serve and evening meal. A random check of staff files found that the recruitment policies are followed.
Dolphin View DS0000000510.V266442.R01.S.doc Version 5.0 Page 17 There was evidence of two references, Criminal Record Bureau checks, medical checks, proof of identity and qualifications. The files also showed evidence of induction and orientation for new staff. Staff have a training file and there is a training and development programme. The staff have received statutory training, training in dealing with the emotional needs of residents and have taken part in a falls prevention programme. Dolphin View DS0000000510.V266442.R01.S.doc Version 5.0 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): 33,35,38 The home seeks the views of residents, staff and relatives to improve the service provided. The residents’ personal finances were being satisfactorily managed and safeguarded. There are outstanding health and safety issues, which pose hazards and risks to residents, staff and visitors. EVIDENCE: The home carries out surveys about the service provided and also holds regular meeting which have the minutes recorded. Any action needed is taken at home level. Residents said they are as involved as much as they wish and always know what is happening in the home.
Dolphin View DS0000000510.V266442.R01.S.doc Version 5.0 Page 19 The home has a central non-interest bearing account for residents’ personal allowances. There are plans to ensure that any interest is awarded to individual accounts as necessary. The home keeps separate account sheets for each resident with details of all transactions available. Receipts are available and can be cross-referenced to any expenditure. There are regular audits and monthly checks made on the accounts. The staff have had training in moving and handling, infection control, first aid and fire. Fire risk assessments have been updated and are now available. Accident recording and monthly analysis of all accidents and incidents are recorded to a satisfactory standard. The maintenance records were up to date .The records show that there are faults with the thermostatic mixing valves in some areas. Many of the bedroom doors were held open by wooden chocks, chairs, footstools and bespoke metal door holders. Dolphin View DS0000000510.V266442.R01.S.doc Version 5.0 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 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 2 2 X 2 X 1 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 2 Dolphin View DS0000000510.V266442.R01.S.doc Version 5.0 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 OP9 Regulation 12,13 Requirement The home must ensure that all handwritten entries are signed, witnessed and abbreviations must not be used. The home must ensure that the teatime menu provides in adequate quantities suitable, wholesome and nutritious food, which is varied and properly prepared and available at such time as may reasonably be required by the residents. The home must replace the broken glass door. The home must affect repairs to double-glazing. The problems with water ingress to the dining room ceiling must be repaired The home must clean or replace the two identified toilet bowls. An appropriate shower chair must be provided for the second shower. TIMESCALE OF 01/09/05 NOT MET There must be sufficient bathing and shower facilities on each floor to meet residents assessed
DS0000000510.V266442.R01.S.doc Timescale for action 01/03/06 2. OP15 12(2)(3) 16 (2)(4) 01/03/06 3 OP19 13,23 01/03/06 4. OP21 23 01/03/06 5. OP22OP21 16,23 01/03/06 Dolphin View Version 5.0 Page 22 6. OP25OP24 16,23 7. OP26 13,16 8. OP26 13,16 9. OP38 13,16,23 10. OP38 13,23 needs.1: 8 ratios. The home must resolve the problems with the drainage from the shower rooms and repair damaged tiles and flooring. The home must provide suitable bedside lighting. The home must provide in detail the programme of replacement and upgrade of bedroom furniture. OUTSTANDING 19/02/03 The sluices must be kept locked when not in use. The home must remove bar soap from use and provide suitable storage for toilet rolls and continence products. All bathrooms and toilets must be provided with suitable bins with lids. TIMESCALE OF 01/09/05 NOT MET. The home must ensure that liquid soap and paper towels are available in all resident areas to enable effective hand washing. The Commission for Social Care Inspection must be consulted prior to any structural work being undertaken in regard to improvements to the laundry facilities and advise how working conditions in the laundry will be improved. OUTSTANDING 10/03/04 The home must ensure that the thermostatic mixing valves are repaired. The home must follow advice of the Fire Prevention Officer regarding the use of wooden chocks in bedroom doors. 01/03/06 01/03/06 01/03/06 01/03/06 01/03/06 Dolphin View DS0000000510.V266442.R01.S.doc Version 5.0 Page 23 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. 3. Refer to Standard OP27 OP28 OP36 Good Practice Recommendations The home should review the deployment of kitchen staff in the afternoons and evening. The home should continue with NVQ level 2 training to ensure the 50 target is met. The manager should consider delegating some of the supervision sessions to other senior staff. Dolphin View DS0000000510.V266442.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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. Extracts may not be used or reproduced without the express permission of CSCI Dolphin View DS0000000510.V266442.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
