Inspection on 07/04/08 for Donisthorpe Hall

This inspection was carried out on 7th April 2008.

CSCI found this care home to be providing an Adequate service.

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

Donisthorpe Hall 05/12/06

Donisthorpe Hall 07/03/06

Donisthorpe Hall 28/09/05

Donisthorpe Hall 17/01/05

Donisthorpe Hall 22/09/04

Donisthorpe Hall 11/02/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Donisthorpe Hall Shadwell Lane Leeds Yorkshire LS17 6AW Lead Inspector Ann Stoner Key Unannounced Inspection 09:15 7th - 9th April 2008 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 Donisthorpe Hall DS0000001337.V361620.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. Donisthorpe Hall DS0000001337.V361620.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Donisthorpe Hall Address Shadwell Lane Leeds Yorkshire LS17 6AW 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) 0113 2684248 0113 2686079 marialyn@donisthorpehall.org Donisthorpe Hall Company Limited Mrs Maria Lyn Dunderdale Care Home 163 Category(ies) of Dementia - over 65 years of age (45), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (45), Old age, not falling within any other category (163), Terminally ill over 65 years of age (1) Donisthorpe Hall DS0000001337.V361620.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The place for TI(E) is for the named service user only Date of last inspection 5th December 2006 Brief Description of the Service: Donisthorpe Hall is a large care home situated in extensive private grounds in a residential area of Leeds. The home provides residential and nursing care, primarily for Jewish people, but also accommodating the needs of people from a range of cultural and religious backgrounds. The original house was converted in 1956 and extended over time to become what it is today. Building work is taking place to provide additional accommodation for a further 22 people. Communal areas include a Synagogue, cinema (seating capacity for up to forty two), coffee shop and gift shop, reception, physiotherapy area, sensory room and a range of sitting rooms. Two passenger lifts give people access all areas of the home. The area is well served by public transport and there is ample parking for staff and visitors. At the time of this inspection the fees ranged from £402.00 - £725.00 per week. More up to date information about fees should be obtained from the home. Copies of previous inspection reports are available in the home. Donisthorpe Hall DS0000001337.V361620.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes This was an unannounced visit by two inspectors who were at the home from 09.15 until 17.15 on the 7th April 2008, 07.00 until 5.45 on the 8th April and 10.00 until 13.30 on the 9th April 2008. The purpose of the inspection was to make sure the home was operating and being managed for the benefit and well being of the people who live there and in accordance with requirements. Before the inspection accumulated evidence about the home was reviewed. This included looking at any reported incidents, accidents and complaints. This information was used to plan the inspection visit. An annual service review was carried on the 11th March 2008 and information from this was also used in the planning of this inspection. A number of documents were looked at during the visit and some areas of the home used by the people who lived there were visited. This inspection focussed on two main areas of the home, Unit 3, which provides care for people with dementia and the nursing unit of Silver Lodge. Staff working on these units were observed working with people and discussions were held with people living at the home, their relatives, a visiting GP (General Practitioner) as well as with members of the management team, nursing staff and care staff. A Short Observational Framework Inspection (SOFI) was carried out in Unit 3. This provided the opportunity for a 1½ hour period of observation on a small group of people with all interactions recorded within 5 minute timescales. An Annual Quality Assurance Assessment (AQAA) had been completed by the home before the visit to provide additional information. This is a selfassessment of the service provided. What the service does well: This is a large, spacious home that is decorated to a high standard with good on-site facilities that include a cinema, coffee shop selling refreshments and gifts and a Synagogue that holds regular services on Shabbat and other festivals. Although predominantly Jewish the home also meets the needs of all religious denominations. One person living at the home said, “There is a wonderful atmosphere here with all religions. No-one criticises anyone else because of their religion.” The home is set within well maintained grounds with plenty of outdoor seating. Donisthorpe Hall DS0000001337.V361620.R01.S.doc Version 5.2 Page 6 Within the management team people have clear roles and responsibilities. For example the home has a training and development manager and a dedicated finance team. This is useful because visitors know who they need to see if they have specific queries. Some people living at the home enjoy a good lifestyle, are in control of their lives and have plenty of recreational opportunities both inside and outside of the home. One person described the varied activity programme she would be enjoying during the week. This included a shopping trip, art class, exercise class and going to the in-house cinema. People said their religious and cultural needs were met at the home. One person said that, “Staff respect and understand the Jewish people and their culture.” Those who did not follow the Jewish faith said that they were aware, before admission that only kosher food would be served in the dining room. People described the food as being ‘good’ and said, “The food is lovely I couldn’t do better” and “The standard of food is good.” What has improved since the last inspection? What they could do better: The standard of care given to some people should be standard across the board. This visit found that some people living at the home enjoy a flexible lifestyle with a range of stimulating activities to occupy them. In contrast, some people who rely on staff to assist and support them have to wait until staff are available, which at times takes away their choices and flexibility. Some people spoke about waiting for long periods of time for assistance to use the toilet, others spoke about waiting for long periods for staff to respond to the call system. Some staff appeared rushed and flustered, with meal times being a particular area of concern because there was not enough staff to give Donisthorpe Hall DS0000001337.V361620.R01.S.doc Version 5.2 Page 7 people the support they needed. Staffing levels and the deployment of staff must be reviewed to make sure that care is consistent throughout the home and that people’s needs are met. Care records were confusing and conflicting. Computerised versions of people’s care plans did not correspond with paper versions, which creates the potential for people’s needs to be overlooked. Other care records such as food intake charts and fluid intake charts were not filled in properly, so there was no accurate record of food and fluid intake for those people who were most at risk of poor nutrition. Some people had lost significant amounts of weight. There was no evidence in their care records to show what action was being taken to prevent further weight loss. This increases the risk to these vulnerable people. Wound care plans were poor and did not show how often a wound should be re-dressed or the type of dressing needed. Evidence in these records showed that wounds were not being dressed as often as they should. Care records must give staff precise and clear instructions on how to meet each person’s individual care needs. Some poor medication practices were seen, resulting in people not always getting their medication at the time they should. The home must follow guidelines from The Royal Pharmaceutical Society of Great Britain. People on the dementia care unit are not always given proper assistance and support to make sure that they are wearing clothing that belongs to them and which is in a good state of repair. This is undignified and the home must make sure that the dignity of everyone in the home is respected and promoted. Not all staff had a good understanding of the importance of reporting any safeguarding (abuse) issues. This creates the potential to place vulnerable people at risk. Staff must be made aware of the Whistle Blowing policy and of the importance of reporting any safeguarding suspicions or allegations. This inspection visit highlighted a number of serious concerns about the nursing unit of Silver Lodge, some of which the management team of the home were aware of and were addressing. It is a cause of concern that these issues were not identified earlier and dealt with swiftly, particularly as they affect the people living in the unit. Although the management team have quality monitoring systems in place these failed to identify the issues raised at this visit about care records. The effectiveness of the way in which the home is managed is therefore questioned. This is something that the management team must look at. There must be careful monitoring of leadership and supervision of staff in all areas of the home to make sure that care practices are consistent and that the philosophy, policies and procedures of the home are put into practice on a daily basis. Any shortfalls should be identified immediately and addressed. This will make sure that there is a consistent approach in the home and that people receive the care they need. A full list of all the recommendations and requirements made at this inspection can be found at the end of this report. Donisthorpe Hall DS0000001337.V361620.R01.S.doc Version 5.2 Page 8 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. Donisthorpe Hall DS0000001337.V361620.R01.S.doc Version 5.2 Page 9 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 Donisthorpe Hall DS0000001337.V361620.R01.S.doc Version 5.2 Page 10 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): Standards 1, 3, & 5. Standard 6 does not apply to this home. People who use the service experience good quality outcomes in this area. People have the information needed to choose a home that will meet their needs. Not everyone has had a pre-admission assessment prior to moving to the home however. This means that some people’s care needs may not always be able to be met. We have made this judgment using available evidence including a visit to this service. EVIDENCE: The manager described the admission process and said that anyone thinking about moving into the home is invited to visit, stay for a meal and meet with existing people living there and their relatives. People living at the home and their relatives confirmed that they visited the home before making any decisions about moving in. One person said that she had heard about the home by ‘word of mouth’ another said that she knew about the home because of a previous respite stay and a relative said that he visited other homes Donisthorpe Hall DS0000001337.V361620.R01.S.doc Version 5.2 Page 11 before choosing this one on behalf of his wife. Information about the home such as the Statement of Purpose and Service User Guide are available throughout the home. Two people said that they were aware of the contents. Both these documents are available in large print and there are plans for these documents to be made available on audio tape. It is recommended that the home also consider developing a format that is suitable for people with dementia. Before admission people who are self funding are asked for an advance payment. It is recommended that this information be included in all pre-admission information so that people are aware of the terms and conditions of the home. Pre-admission assessment information was sampled on Unit 5, Unit 3 and the nursing unit of Silver Lodge. In some cases the recorded information was limited and did not provide enough information to form the basis of a care plan. There was also no information about where the assessment was completed, who was involved in the process and who provided the information. This means that the home cannot evidence that the assessment process is robust and that all the relevant people have been consulted. There was no pre-admission assessment carried out for a person on Unit 3 who was transferred from another home. The manager of Unit 3 said that the person’s GP was in agreement with the transfer and the person’s relatives had been consulted, but confirmed that a pre-admission assessment was not carried out. Without this assessment the home cannot show it is able to meet people’s needs. Donisthorpe Hall DS0000001337.V361620.R01.S.doc Version 5.2 Page 12 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): Standards 7, 8, 9 & 10. People who use the service experience adequate quality outcomes in this area. The health and personal care that people receive is not always based on their individual needs. For some people this means that their care needs are not always identified or met. We have made this judgment using available evidence including a visit to this service. EVIDENCE: There were mixed views about whether people’s care needs were met. Two people living on Unit 5 said that they were very happy with the care they received and that staff responded quickly to the call system. A relative of a person living on Unit 3 said that people’s care needs were very well met and said, “I feel I can leave here and feel confident that she will be very well looked after.” Another visitor on this unit said, “The care in the home is excellent” and that his relative, “Couldn’t be better looked after.” A GP (General Practitioner) visiting the home said that he thought people were well Donisthorpe Hall DS0000001337.V361620.R01.S.doc Version 5.2 Page 13 looked after, that staff worked well with other health care professionals and were pro-active in responding to any changes in people’s condition. In the nursing unit of Silver Lodge positive comments included, “They try their best under the circumstances.” “They always try to help me when they can.” There were also negative comments such as, “It takes them a long time to answer the buzzers especially at night.” “ When I need the toilet I really need to go. They take a long time to answer the buzzers. They tell me I will have to wait because they are busy. This upsets me.” There are a lot of people who need the use of a hoist and there is only one on the nursing unit of Silver Lodge. The manager said that another is ordered. This still means that if more than one dependent person needs the hoist for a care need then there is a waiting time. Throughout this inspection staff on this unit were busy and rushed and people who needed their attention were asked to wait on several occasions before they could attend to them. The AQAA (Annual Quality Assurance Assessment) states that documentation has improved in the last twelve months. However, during this visit care records seen were conflicting and confusing. People have two sets of care records, one a paper document and one a computerised document. The computerised records are more up to date than the paper records. This could result in confusion if staff access information from the paper records. The manager of Unit 3 said that staff have PINs (personal identification numbers) to access the computer, but in practice many are reluctant to do so and receive their information verbally. This means that information may be lost in translation, be forgotten or may not be passed on, which in turn may result in people not being given the correct care. A member of staff was unaware why a person on this unit had dressings on his face. She said, “I don’t know I wasn’t on duty yesterday.” The care of five people living in the nursing unit of Silver Lodge was case tracked. Out of these five people, three were able to discuss the care they received. All of the care plans seen were not up to date and did not reflect the care needs of the people at that time. One person living at the home and a relative confirmed that care plans were not accurate. One person said that she was not able to walk without the assistance of at least one person, but her mobility care plan said that she could walk around with the aid of a stick. It also stated in the care plan that she was to use the electric wheelchair to help with mobility. She has not had this wheelchair for some time. With inaccurate information in people’s care records there is a very real risk that people’s needs may be overlooked. Care records showed that risk assessments are not being completed in areas where there is a clear risk. The care records of five people, who were nutritionally at risk in the nursing unit of Silver Lodge, did not include an accurate or up to date risk assessment for poor nutrition. One person’s records showed that her last nutritional assessment was carried out on the Donisthorpe Hall DS0000001337.V361620.R01.S.doc Version 5.2 Page 14 19th July 2007. This person had already lost a significant amount of weight but there was no evidence to show any action had been taken to counteract this. Her care plan stated that she was to receive a pureed diet, but there was no evidence seen in the records to show that an appropriate medical professional had been consulted when taking this decision. Staff could not provide any further information about this when asked. Another person’s nutritional assessment was last reviewed on the 18th August 2007. This person said that she had lost a lot of weight and the care files confirmed that she had lost 6kg in eight months. There was no evidence in the care records to show any action being taken to prevent further weight loss. On Unit 3 a weight chart for one person showed a weight loss of 15kg from October 2007 to March 2008. There were two versions of this person’s nutritional care plan; one paper copy and one computerised copy. These were not identical and contained different information. The paper copy said that this person had a good appetite and could eat independently. The computerised version said that the person had a poor appetite and needed full support with feeding. There was no explanation of what was meant by ‘full support’. There was a dietary intake chart in this person’s room, but there was no reference to this in her care records and no information about when and how this should be monitored and of any subsequent action needed. The recording on the intake chart was poor. On the 5th April there were no entries for dinner, tea or supper, on the 6th April there were no entries for tea and supper and there were no entries made on the 7th and 8th April. There was also a fluid balance chart in place for this person. Again there was no reference to this in her nutritional care plan. Once more recording was poor. On the 26th March this person’s total fluid intake was recorded as 220mls. On the 27th March total intake was 450mls. There were no records for the 28 – 30th March and from the 2nd April – 5th April. Staff on this unit said that charts were completed at the end of a shift. This means that there is no accurate record of food and fluid for people who are at risk and there is a very real risk of people’s needs not being met. The care files on the nursing unit of Silver Lodge showed that all five people were at risk of falls or developing pressure sores. One person, who had a history of falls, had no evidence of a falls risk assessment in her care plan. Another person who was totally dependent on staff had no evidence in her care plans to show that she had been assessed as being at risk of developing a pressure sore. She did have a turn chart in place that said she was to be turned every three hours, but there were significant gaps identified in these records. On Unit 3 the Tissue Viability Nurse visited one person who had developed pressure ulcers on her heels. An entry in this person’s records on the 31st December 2007 showed that she was reluctant to move or change her position. Turn charts were in place in this person’s room, but there were none for the 1st and 2nd March, 7 & 8th March, 10 – 13th March, 16 & 17th March and 4th – 7th April. On the 26th March no turns were recorded from 7pm – 8am the Donisthorpe Hall DS0000001337.V361620.R01.S.doc Version 5.2 Page 15 following morning. On the 28th March no turns were recorded from 6pm – 9am the following morning. This is unacceptable. Wound care plans on the nursing unit of Silver Lodge were reviewed randomly. The care plans were poor and did not always show how often the wound should be dressed or the type of dressing needed. One person’s care plan stated that a wound was to be redressed on 22nd January 2008 but the records showed that it was not redressed until the 26th January. Another stated that a wound was to be redressed on 3rd April but this had still not been redressed on the 8th April. Care records on the nursing unit of Silver Lodge showed that reassessments do not always take place as people’s care needs change. For example, one person was terminally ill and as a result some of her needs had changed. There had been no reassessment of this person’s needs and some were clearly not being met. Another person’s relative said that the care plans in place did not reflect her mother’s needs. Once again after looking at this person’s records it was clear that a full reassessment was needed. Information supplied by the home in the AQAA states that management of medication is robust with training that includes annual assessment of competencies, administration, ordering, destruction, storage, controlled drugs, self-medication, monitoring and auditing of medication. During our visit a number of issues about medication were raised. A random selection of medication administration records (MAR) was looked at on the nursing unit of Silver Lodge. These showed a significant number of unexplained gaps relating to the administration of medication. This suggests that medication is either not given or not recorded at the time that it is given. The MAR for one person, included controlled medication, this had not been signed for by the nurse on duty the previous night. One person on this unit said that she often got her tablets at irregular times and not at the times they should be given. She said that she had not received her morning medication. This person’s MAR showed that the nurse on duty had signed to say that the medication had been given, but it was actually still in the blister pack. This is extremely poor practice. The same nurse was seen giving medication at 5pm that according to the MAR should be given at 10pm. The nurse said that she was following GPs (General Practitioner) instructions, but had no evidence to support this. A selection of MARs was sampled on Unit 5. Handwritten entries made by staff were not signed and dated by the person making the entry and were not checked and countersigned by a second person. Pharmacy labels had been attached to the MAR. These practices increase the risk of errors and do not follow the guidelines of The Royal Pharmaceutical Society of Great Britain. Donisthorpe Hall DS0000001337.V361620.R01.S.doc Version 5.2 Page 16 Overall people who live in the nursing unit of Silver Lodge and their relatives said that staff respected people’s privacy and dignity. However, one person was in bed during the afternoon and was clearly distressed because she was uncovered and wanted assistance to get up. Although she was able to use the emergency call system it was not within her reach. The staff member who came to assist did not appear to recognise the importance of this. The AQAA completed by the home states that a high standard of privacy and dignity is provided to everyone living there. The registered manager, in association with the Care Homes Association, is a member of a working party looking at ways of developing a toolkit for privacy and dignity for use in all homes in the area. On Unit 3 one visitor raised some concerns affecting the dignity of people living on this unit. She said that her relative was wearing a cardigan that did not belong to him, the zip on his trousers was broken and it was almost 5pm and he had not had a shave. She found this distressing because she said that he always took care with his appearance. She said that often staff did not make sure that her relative was wearing a vest and when she visited the previous week he had no buttons on his trousers. Staff on this unit described the ways that they protect the privacy and dignity of people by knocking on doors before entering, closing curtains, doors and windows when giving personal care, but also confirmed that because they are busy they do not assist people to shave in the morning, instead they leave this task for later in the day. The manager of the unit was unaware of this undignified practice. The home has an on-site laundry. Some people spoke about the length of time it takes for their laundry to be returned to them. Two people on Unit 5 said that their clothing was not ironed or pressed to the standard that they would like, but they felt that they have to accept this given the size of the home. A person visiting Unit 3 said that his relative always looked smart. He had brought her some new clothes the previous day and staff had already labelled them and they were ready for use in her wardrobe. Another visitor described the laundry service as ‘poor’. She said that her relative has 8 pairs of good trousers, none of which were in his wardrobe. Donisthorpe Hall DS0000001337.V361620.R01.S.doc Version 5.2 Page 17 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): Standards12, 13, 14 & 15. People who use the service experience adequate quality outcomes in this area. Some people living at the home are able to make choices about their lifestyle and have recreational activities that meet their needs. Others however, who are more dependent on staff for their needs, are more restricted in the choices they make and the manner in which care is given. This creates a system where more dependent people are given a lesser service than others who are more able. We have made this judgment using available evidence including a visit to this service. EVIDENCE: There were mixed views about the experiences of people living at the home. The AQAA states that there are two full-time activities co-ordinators employed along with volunteers who assist in co-ordinating and supporting activities in the home. A varied activity plan includes an in-house cinema showing 6 different films each week, art and computer classes and reminiscence sessions. One person living on the residential unit of Silver Lodge described a range of activities she attends on a weekly basis. On the week of this visit she had Donisthorpe Hall DS0000001337.V361620.R01.S.doc Version 5.2 Page 18 been on a shopping outing, was attending an exercise class, an art class and watching a film in the cinema. She described how her religious and cultural needs would be met during Passover and said, “There is a wonderful atmosphere here with all religions. No-one criticises anyone else because of their religion.” She also said that staff respect and understand the needs of Jewish people and their culture. The AQAA states that people have access to the Synagogue on site and people who are non-Jewish have access to their own ministers. Three people from different units in the home said that their cultural needs were met. The AQAA also states that people are encouraged to exercise choice and control over their lives. This was confirmed by one person on the nursing unit of Silver Lodge who said, “The staff are very kind and help me live the way I want.” On the nursing unit of Silver Lodge two people said they were able to go out with their relatives when they visited and they looked forward to that. Three people said they didn’t get involved in any activities. One person said that there was an outing planned on one of the inspection days. Staff assisted her to get ready but when she arrived in the foyer she was told there was no room for her to go. There were no activities seen on this unit during the inspection. People were sitting in the lounge area, the television was on but some people were asleep. The only time that staff visited the lounge was at times when care was given. Two people said they preferred to stay in their rooms because they could not interact with those in the lounge due to communication problems. Other comments made by people on this unit include: “I spend my days in my room, it’s very boring.” “I did do the flower arranging. I thought there were classes to teach us but I just sat there sticking flowers in a vase. I didn’t go back.” “I haven’t been out of this home for two years. I’m bored stiff. I feel like a lonely old woman with no family.” “I usually use the TV for my entertainment. They were taking people out today but I wasn’t asked.” “If I was given the opportunity to go around the grounds in a wheelchair I would love to. I haven’t been out since I was here.” On Unit 3 a SOFI (Short Observational Framework Inspection) was carried out. This included observing 5 people for a 1½ period and noting all interactions and behaviours within 5 minute timescales. Overall staff were kind, patient and worked at the pace and level of each individual. Staff made time to sit down and chat to people but also gave people the opportunity to wander about. Three people who were not part of the observation were enjoying playing a game of bingo but others sitting in the lounge were either asleep or Donisthorpe Hall DS0000001337.V361620.R01.S.doc Version 5.2 Page 19 looking into space while a video of ‘Riverdance’ was playing. Four people. who were sitting in a small lounge at the end of one corridor, were all asleep. The TV was on but there was no sound, the radio was also switched on and was playing ‘pop’ music. This is unacceptable. A visitor felt that there was not enough stimulation for people on this unit and said that she has to ask for her relative to be included in outings and be taken to concerts. Another visitor to this unit said that the activities provided were ‘OK’ but some people were incapable of joining in. He described the home as being ‘brilliant’ and said that staff often worked on an individual basis with people. Visitors were made welcome throughout this inspection visit and people living at the home said that their visitors could visit at anytime throughout the day. Some people living at the home spoke about flexibility particularly around times for going to bed and getting up in the morning. The manager and some staff on Unit 3 confirmed this and spoke about people making choices. Other staff on this unit were less sure and described an inflexible system where people are assisted to get up in the morning at 5.30am and assisted back to bed for the night at 5.15pm. One night worker said that if someone is in bed and asleep when she gives out suppertime drinks she will not disturb them. Potentially, this means that some people may have their last drink of the day before 5pm. The registered manager and the training co-ordinator both said that rights and choices are integral to the philosophy of the home and are discussed with staff from the point of induction. They both agreed to address this issue further with staff teams. The main dining room on the ground floor was attractive, with fresh flowers on the dining tables. People eating in this area were complimentary about the food, as were some people on the nursing unit of Silver Lodge. Comments included, “The food is lovely. I couldn’t do better.” “The standard of the food is good.” However, the majority of people spoken to on the nursing unit of Silver lodge were not happy about the temperature of the food served. The food is brought from the kitchen and served from hot trolleys. People said the vegetables were often lukewarm. On both Unit 3 and the nursing unit of Silver Lodge not everyone received assistance with their meals in a dignified and courteous manner. Some staff were very rushed and disorganised. On the nursing unit of Silver Lodge one person assisted three people to eat their food at the same time. One person would receive a few mouthfuls of food and then they were left whilst the staff member moved on to the next. This was observed at all meal times on this Donisthorpe Hall DS0000001337.V361620.R01.S.doc Version 5.2 Page 20 unit and is poor practice. Similarly, on Unit 3 a member of staff was rushed and said to one person, “If you don’t eat this soup it will go cold.” This felt as though he was putting pressure on the person to eat quickly, which resulted in her having a ‘fit’ of coughing. This member of staff then worked between three people assisting them to eat their meal all at the same time. There was no interaction other than “Open your mouth wide, let’s get the food in” “Open your mouth, eat your dinner” and “Open your mouth”, which all felt like an order. There was no explanation of what food was being offered or any interaction about tastes or flavours. A senior care worker on this unit said that people are offered a choice of food and that picture menu cards are used to help people with communication difficulties. This is good practice in dementia care. However, two care workers said that the menu is in written form only and that picture menus are not used. Peoples’ religious and cultural needs were respected with regards to providing food. This has been an area where the home has worked very hard. Similarly some good practice in dementia care was seen on Unit 3 when a senior care worker was giving out morning drinks. She gave one person who was wandering about 2 pieces of cake to eat and when she noticed the person had finished her cup of tea she offered a refill. This care worker later explained that the person often refused to sit down and eat a meal so it was important to offer as many calories and fluids as possible when the person was willing to eat and drink. Donisthorpe Hall DS0000001337.V361620.R01.S.doc Version 5.2 Page 21 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): Standards16 & 18. People who use the service experience adequate quality outcomes in this area. People are able to express their concerns but safeguarding issues are not always identified and not all staff are aware of the importance of prompt reporting. This has the potential to put people living at the home at risk. We have made this judgment using available evidence including a visit to this service. EVIDENCE: Information about how to complain is available throughout the home and is available in large print. The manager said that a version on audio-tape is being developed. This would be good practice, as would developing a format suitable for people with dementia. People spoken to throughout the home said that they would complain if necessary but some relatives raised concerns about the way that the home investigates complaints. One person said that when she complained about the laundry nothing was done about it and another described feeling bullied and intimidated by members of the management team. The home keeps a log of all complaints with details of any investigation and the outcome. The management team said that if a complaint is serious complainants are invited to the home to discuss the issues. During the feedback session a discussion took place as to whether these meetings may be the cause of people feeling intimated. Donisthorpe Hall DS0000001337.V361620.R01.S.doc Version 5.2 Page 22 On both the nursing unit of Silver Lodge and on Unit 3 staff knew about the different types of abuse and most said that they would report any safeguarding suspicions or allegations. Concern was raised however, when one person on Unit 3 said that she would not report a colleague because it felt like ‘telling tales in the playground’, and that said that she wouldn’t report any safeguarding suspicions about the manager because she was not confident that senior managers would believe her word against that of the unit manager. This person said that she was not aware of the ‘Whistle Blowing policy’. On the nursing unit of Silver Lodge an agency worker lacked any awareness of safeguarding issues and had not had any training. These means that there is a risk that not all safeguarding issues will be reported and people will not be protected. During the inspection visit a number of safeguarding issues were identified in the nursing unit of Silver Lodge. These were passed on to the management team. Some concerns were identified about how safeguarding issues are managed within the service. Donisthorpe Hall DS0000001337.V361620.R01.S.doc Version 5.2 Page 23 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): Standards19 & 26 People who use the service experience good quality outcomes in this area. The environment is safe, comfortable, well maintained and meets the needs of people living at the home. We have made this judgment using available evidence including a visit to this service. EVIDENCE: The home is spacious, maintained to a high standard and provides a comfortable environment for people living there. There is a coffee shop in the foyer where people living at the home and their visitors can enjoy an informal chat, a drink and buy cards and gifts. Many people were seen taking advantage of this facility. Other facilities include a spacious fully equipped cinema and a Synagogue that holds regular services on Shabbat and other festivals. People living at the home and their visitors can attend. The grounds are well maintained and provide plenty of outdoor seating. Donisthorpe Hall DS0000001337.V361620.R01.S.doc Version 5.2 Page 24 One dining area in Unit 3 had an excellent mural and reminiscence material suited to the needs of people with dementia. Sadly, this unit has not made good use of colour to help orientate people, which is recommended when caring for people with dementia. The registered manager said that building work is taking place to provide accommodation for a further 22 people and care is being taken to make sure that the environment follows good practice guidelines in dementia care. Two people had ‘child-type’ gates at the entrance to their bedroom. The unit manager said that the people in these rooms were vulnerable because they remained in their rooms and were unable to shout for assistance if other people wandered in. He said that the gates had been fitted within a risk assessment framework. Such measures could be viewed as a means of restraint and the home must monitor this carefully. If people in their rooms are vulnerable there should be sufficient staff on duty to protect them. The home has an on-site laundry, which has recently been refurbished and upgraded. Unfortunately teething problems, which the management team are aware of, are still being experienced. A relative said that a lot of money has been spent on the laundry but the service has not improved. Good standards of hygiene were seen throughout the home. Donisthorpe Hall DS0000001337.V361620.R01.S.doc Version 5.2 Page 25 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): Standards 27, 28, 29 & 30. People who use the service experience adequate quality outcomes in this area. Staffing levels do not always meet the needs of the people living at the home. This means that there are some times when people have to wait for staff to attend to their care needs. We have made this judgment using available evidence including a visit to this service. EVIDENCE: People living in the nursing unit of Silver Lodge and their relatives spoke about inadequate staffing levels on this unit. They said that the staff try to do their best but there simply aren’t enough of them. Two people said, “When you ask for help you are always told, ‘ wait a minute’ but it never is a minute.” Other comments include: • • “The staff try their best but there simply isn’t enough of them.” “There isn’t enough staff on duty.” Staff said they were very busy the majority of days. One person said, “The dependency levels of residents has risen on the unit and the work is much Donisthorpe Hall DS0000001337.V361620.R01.S.doc Version 5.2 Page 26 harder. We don’t have enough staff to manage.” Throughout the inspection staff were very busy, very rushed and some appeared flustered. The staffing rota for this unit showed that there were several shifts when the correct staffing levels had not been met. The manager of this unit confirmed this. The management team are aware of this and have been trying to employ carers in an attempt to resolve the issue. Agency and bank staff are used whenever possible. On the first day of this inspection the unit was short by one carer. This shift was not covered. Throughout the inspection there were sufficient numbers of staff on Unit 3, but a relative said that this was not always the case. She said that some practices are for the benefit of staff rather than the people living in the unit. For example her father wears a continence pad but she felt that he knew when he wanted to go to the toilet and if taken in sufficient time would be continent. Some staff described rigid routines, which were for the benefit of staff on the next shift. The AQAA shows that there is a training development plan for all staff and a robust induction programme for new staff that is monitored by the home’s training and development manager. 38 of staff at the home have a National Vocational Qualification (NVQ) and a further 5 are currently being assessed. Training records and discussions with staff confirmed that there are good opportunities to attend various training sessions within the home. The recruitment records of two staff members were sampled. Appropriate recruitment checks had taken place but in both cases there was only 1 written reference held on file and it was thought that the home had accepted a telephone reference from the second referee. To make sure that people are suitable to work with vulnerable people two written references must be obtained before the start of employment. Donisthorpe Hall DS0000001337.V361620.R01.S.doc Version 5.2 Page 27 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): Standards 31, 33, 35 & 38. People who use the service experience adequate quality outcomes in this area. Whilst there are robust management systems in place, when issues are identified they are not always acted upon in a timely way. This means that some people living at the home are at risk of not having their care needs met. We have made this judgment using available evidence including a visit to this service. EVIDENCE: The registered manager has a wealth of experience in the care of older people and is involved in various internal and external projects. Some staff said that they felt comfortable discussing any issues with the management team. Some relatives have confidence in the management team, others less so. A relative Donisthorpe Hall DS0000001337.V361620.R01.S.doc Version 5.2 Page 28 of a person on Unit 3 said that he felt the management team were open to suggestions and respond well. He gave an example of how the team had responded to a room being made available for visitors. Other relatives were less sure about the effectiveness of the team. One visitor on Unit 3 was unhappy about certain issues in the home and described the staff as being ‘brilliant’ but said issues were more about the management of the home. This was a view reflected by visitors on the nursing unit of Silver Lodge. Many of the more serious issues found at this inspection relate to this unit on Silver Lodge. There are robust management systems in place and the management team said that they are aware of some of the issues and have started to deal with them. It is however, a cause of concern that the situation has been allowed to continue as the standard of care to people living there is affected. It is the responsibility of the manager to make sure that staff follow the policies and procedures of the home. Although members of the management team said that random checks have taken place these have failed to identify the issues raised at this inspection and the validity of the checks is therefore questioned. On a positive note the management team responded well to feedback from this inspection and spoke about plans for improvement that would focus particularly on the nursing unit of Silver Lodge and that would involve and include relatives and people living there. The registered manager explained the home’s quality assurance mechanisms and said that satisfaction surveys are being revised to make them easier to understand and complete and so that the home receives the information it needs. She said results from completed surveys are analysed and an action plan is formulated. Regular meetings are held with various staff groups, people living at the home and their relatives. Quality assurrance systems however, have failed to identify issues raised in this report. The home has a dedicated finance team who manage the finances for a small number of people living there. Records of all transactions are made and are up to date. The AQAA shows that servicing of equipment and regular maintenance work takes place as required. Donisthorpe Hall DS0000001337.V361620.R01.S.doc Version 5.2 Page 29 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 3 X 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 4 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Donisthorpe Hall DS0000001337.V361620.R01.S.doc Version 5.2 Page 30 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 (1) (2) (a) (b) (c) (d) Requirement People living at the home must have a care plan that gives staff clear instructions on how to meet all aspects of the person’s needs. The care plan must be kept under review and wherever possible people must be involved and included in the review process. This will make sure that all aspects of people’s needs are met. 2 OP8 12 (1) (a) Nutritional risk assessments must be completed on admission and in place for everyone who is at risk of poor nutrition. A falls risk assessment must be completed on admission and in place for everyone who has a history or is at risk of falling. This will make sure that people at risk are accurately identified and that appropriate action is taken. Donisthorpe Hall DS0000001337.V361620.R01.S.doc Version 5.2 Page 31 Timescale for action 31/07/08 30/06/08 3 OP8 12 (1) (a) Food and fluid charts must be accurately recorded. Where people living in the home have a significant weigh loss the home must seek advice from the GP and dietician. This will prevent further risk of poor nutrition. Turn charts must be accurately recorded. This will prevent people being at risk of developing a pressure sore. Wound care plans must show how often the wound is to be dressed and what type of dressing is needed. This will make sure that people receive the correct treatment and care required. People must receive their medication at the time stated on their Medication Administration Record. Medication Administration Records must be completed at the time that the medication is given. People must not wear clothing belonging to anyone else. Care must be taken to make sure that people’s clothing is in a good state of repair. This will make sure that people’s dignity is respected and promoted. The social, leisure and activity programme must be reviewed to make sure that activities on offer meet the needs of everyone DS0000001337.V361620.R01.S.doc 01/06/08 4 OP8 12 (1) (a) 01/06/08 5 OP9 13 (2) 30/04/08 6 OP10 12 (4) (a) 30/04/08 7 OP12 16 (2) (m) 31/07/08 Donisthorpe Hall Version 5.2 Page 32 living at the home. Opportunities must be given to everyone to join in activities both inside and outside of the home. This will prevent people feeling bored and isolated. Routines and practices in the home must be reviewed to make sure that they are in the best interests of people living at the home rather than for staff. This will make sure that the rights and choices of people living at the home are taken into account and wherever possible respected. Staff must work at the pace and level of each individual and follow good practice guidelines when working with people with dementia. This will make sure that people are treated with dignity and respect. All staff must be made aware of the Whistle Blowing policy and of the importance of reporting safeguarding issues. All safeguarding issues must be dealt with by following local safeguarding procedures. This will make sure vulnerable people are protected. There must be enough staff on duty at all times in all parts of the home. This will make sure that there are enough staff on duty to meet people’s needs. Two written references must be received before new employees DS0000001337.V361620.R01.S.doc 8 OP12OP27 12 (3) 12 (4) (a) 31/07/08 9 OP15OP10 12 (1) (a) 12 (4) (a) 31/05/08 10 OP18 13 (6) 31/05/08 11 OP27 18 (1) (a) 15/05/08 12 OP29 19 (1) (b) 30/04/08 Page 33 Donisthorpe Hall Version 5.2 are allowed to start work. This will make sure that people are safe and suitable to work with vulnerable people. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 OP16 Good Practice Recommendations Information such as the Service User Guide and Complaint procedure should be developed in a format suited to the needs of people with dementia. The home should consider using simplified language and pictures to reduce any communication barriers. This will make sure that people with dementia have the same access to information as anyone else. The Statement of Purpose should include all pre-admission information, including fees and any initial payments required. This will make sure that people are aware of the terms and conditions of the home. Pre-admission assessments should have sufficient information to form the basis of a care plan. Information such as the people who were involved in the assessment process, who provided the information and where the assessment took place should be recorded. This will make sure that the home can show that the assessment has taken into account the views of all concerned and that it can meet people’s needs. When people’s needs change there should be a reassessment of their needs. This will make sure that people receive the care they need. Staff must be able to access accurate and up to date information in care plans. If care plans are computerised staff must be able to access and use the home’s IT equipment. DS0000001337.V361620.R01.S.doc Version 5.2 Page 34 2 OP1 3 OP3 4 OP7 Donisthorpe Hall 5 OP9 This will make sure that staff have the most recent and up to date information about the people they are caring for and to prevent needs from being overlooked. Handwritten entries on Medication Administration Records should be signed and dated by the person making the entry and checked and countersigned by a second person. Pharmacy labels should not be attached to Medication Administration Records. 6 OP10 This will prevent the risk of mistakes. The home should find an alternative to using plastic aprons to protect people’s clothing when eating. The laundry service in the home should be monitored to make sure that it is effective and that clothing is returned to people living there as quickly as possible. 7 8 OP15 OP31 This will make sure that people’s dignity is promoted. The home should review the meal service to make sure that hot meals in all parts of the home remain hot when served. The management team should carefully monitor the leadership and supervision of staff, staffing levels and care practices in all of the units and make sure that the philosophy, policies and procedures of the home are implemented. Any shortfalls should be identified immediately and addressed. This will make sure that there is a consistent approach in the home and that people receive they care they need. Donisthorpe Hall DS0000001337.V361620.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Donisthorpe Hall DS0000001337.V361620.R01.S.doc Version 5.2 Page 36 - 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!