Inspection on 11/02/10 for Donnington House

This inspection was carried out on 11th February 2010.

CQC found this care home to be providing an Poor 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

Donnington House 14/12/09

Donnington House 18/11/09

Donnington House 21/08/07

Donnington House 26/06/06

Donnington House 21/09/05

Donnington House 03/05/05

Donnington House 14/10/04

Donnington House 09/06/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 10/04/2010.

Random inspection report Care homes for older people Name: Address: Donnington House 47 Atlantic Way Westward Ho! Bideford Devon EX39 1JD zero star poor service 19/11/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Teresa Anderson Date: 1 1 0 2 2 0 1 0 Information about the care home Name of care home: Address: Donnington House 47 Atlantic Way Westward Ho! Bideford Devon EX39 1JD 01237475001 01237424540 donnington@stone-haven.co.uk WWW.stone-haven.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Stonehaven (Healthcare) Ltd care home 36 Number of places (if applicable): Under 65 Over 65 0 36 0 dementia old age, not falling within any other category physical disability Conditions of registration: 36 0 36 The maximum number of service users who can be accommodated is 36. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: DementiaCode DE- maximum of 36 places Physical disability- Code PD- maximum of 36 places Old age, not falling within any other category- Code OP- maximum of 36 places Date of last inspection Brief description of the care home Donnington House is a large detached property situated in the seaside resort of Westward Ho! It has recently been extended and has increased its registration to 36 Care Homes for Older People Page 2 of 13 1 9 1 1 2 0 0 9 Brief description of the care home older adults who may also have dementia or physical disability. The accommodation is on three floors. There is access between the floors by stairs, chairlift and a passenger lift. The majority of residents are accommodated in single occupancy rooms but there are two bedrooms which have shared occupancy. Fees charged ranged from £467.50 to £582.25 per week. Additional charges are made for chiropody, hairdressing, newspapers, private telephone lines and are variable according to individual needs. Care Homes for Older People Page 3 of 13 What we found: We (the Commission) carried out this unannounced inspection to check that the Statutory Requirement Notice issued on 11th January 2010 had been complied with. The Notice stated that the service was failing to comply with a Care Home Regulation (2001). It gave notice to the Registered Persons (the owners) that if the service failed to comply with the notice that the Commission could prosecute the owners. The Notice was issued as a result of an inspection following an allegation that peoples care needs in relation to the prevention of pressure sores were not being addressed in a safe way. The inspection was carried out as part of a multi agency safeguarding strategy. The inspection demonstrated that people were at risk of developing pressure sores and that sufficient actions had not been taken to address those risks, and to prevent people from developing pressure sores. We visited this home spefically to check that this service had acheived compliance with the notice. We did not inspect any of the outstanding requirements made at the key inspection. The timescale for compliance was set at January 31st 2010. We visited the service on 11th February 2010. The Notice stated that the service must put effective measures in place, including the use of equipment/aids, to ensure that service users are not put at risk of pressure sores. In order to check that measures had been put in place and that outcomes had improved for people living here, we used a method called casetracking. That is, we looked closely at the care offered to some people living here. We looked at their care records including risk assessments, we observed their care and comfort, the equipment being used to prevent them developing pressure sores and we spoke with staff about their care and how risks are managed. We found that no one living at this home has a pressure sore. We casetracked 3 people who were frail and had reduced mobility and who therefore could be at risk of developing pressure sores. We found that written records are kept which identify if the person is at risk of developing pressure sores, and that this includes nutritional assessments which are important when assessing this type of risk. We found that where risk had been identified that the District Nurse had been contacted for advice. Those people identified as being at risk were cared for on appropriate pressure relieving mattresses and cushions. We spoke with staff about their knowledge of risks and how they are managed. Staff demonstrate a real commitment to providing good care and to preventing pressure sores. However, they also demonstrate that they do not have full knowledge of how to manage risks. Although staff complete risk assessments, we noticed that records do not contain a Care Homes for Older People Page 4 of 13 record of the recommendations that are linked to each level of risk. We asked staff about this and they were unaware that these recommendations existed. We showed staff a copy of the recommendations, and they told us they had not seen this. We asked staff, in the absence of these recommendations, how they decide what actions to take if they identify risk. They told us they would call the District Nurse. This is good practice. We could see from care records that District Nurses are contacted in a timely fashion by staff. However, we also saw that there is sometimes a time delay of days before the District Nurse can respond to the referral, and therefore before appropriate actions to manage the risk identified can be taken. We asked staff if there is a stock of pressure relieving equipment in the home for them to use if they identify that someone needs this. They were not sure. One member of staff was aware that there is an agreement that all care homes, where people are at risk of developing pressure sores, keep a supply of appropriate pressure relieving equipment, but did not know if this home has enough equipment. We looked at how staff calculate risks. We found that one person had been assessed as being at medium risk of developing pressure sores. However, when we calculated the risk using the same assessment, the outcome was that this person was at high risk. This is because staff had not fully taken into acccount this persons lack of mobility, chronic medical condition and nutritional status. This means that people might be at higher risk of developing pressure sores than is recognised. We also found that some risk assessments associated with malnutrition might be inaccurate. The assessment used calculates risk according to Body Mass Index (BMI) and weight loss. When this person was assessed as having a higher BMI and weighing more, they were assessed as being at a higher risk of malnutrition than when they had a lower BMI and had lost weight. This shows that staff might not fully understand how to calculate this assessment, and shows that staff are not always taking appropriate actions due to this lack of understanding. In addition to the above, two of the care plans we looked at did not record what actions staff should take to prevent the development of pressure sores. However, when we spoke with staff about this, they demonstrated a good knowledge of what to do. One of the people we casetracked had been admitted to hospital following a significant decline in their health. We looked at their care leading up to that admission to hospital. We found that records show that this person had been assessed as being at high risk of developing pressure sores. Records also show that appropriate pressure relieving equipment was being used to manage this risk. Records also contained evidence that advice had been sought from the District Nursing Service in a timely fashion, as soon as this persons health started to decline. The District Nurses visited this person regularly from the time of referral. In addition, staff contacted the GP for advice on two occasions over a period of approximately one month. Records also show that this person was at risk of becoming malnourished and dehydrated. Records show that appropriate measures were put in place to manage these risks, and the risks and care delivered were frequently reviewed by staff. We talked with the District Nurse about this persons care. They told us that this person Care Homes for Older People Page 5 of 13 was appropriately and well cared for. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 3 14 Assessments must consider 08/01/2010 whether or not a person has the mental capacity to make specific decisions. This will ensure that that decisions for people who do not have the capacity are always in their best interest. 2 3 14 People must not be admitted 08/01/2010 to this home unless their needs have been assessed by a suitable person. This assessment must include health and social care assessments and take account of information provided by professionals, if the placement takes place through health or social care services. This will help to ensure that each persons needs are identified and can be met. 3 7 15 The registered person must 08/01/2010 ensure that care plans provide clear and up to date instructions on how each persons care needs are to be met, recorded and monitored. Information recorded in care plans must be relevant and appropriate Page 7 of 13 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action and updated as needs change. This will ensure that staff will have the information they need to ensure that peoples needs are better understood and met. 4 8 12 The registered person must 08/01/2010 ensure that there is a system in place to ensure staff are aware of and are up to date with peoples health and welfare needs. A system must also be in place that monitors the health and welfare needs of people and that actions are taken and recorded when appropriate. This will help to ensure that peoples needs are met in the most effective way. 5 10 12 The registered person must ensure that the home is conducted in a way that ensures people are treated with respect and in a dignified way. This will help to ensure that people are treated appropriately with dignity and respect. 6 15 16 People must be offered drinks, meals and supplements regularly. The registered person must ensure that people who lack capacity are encouraged to eat by offering them a 31/12/2009 08/01/2010 Care Homes for Older People Page 8 of 13 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action variety of foods and supplements that suit their needs and preferences. This will help to ensure that people are supported to remain healthy. 7 18 13 The registered person must 08/01/2010 ensure that people are not the subject to physical restraint, for example certain medication, unless it is is the only practicable means of securing the welfare of the individual. And must ensure that where a person lacks capacity a referral for a best interest assessment is made. This will ensure that decisions are always made in the best interests of the person and therefore safeguards them from potential harm. 8 18 13 The registered person must ensure that unnecessary risks to the health or safety of people living in the home are identified and so far as possible eliminated. In paricular, staff should have the knowledge and skills to diffuse potentially abusive situations that may put vulnerable people at risk of harm. This will ensure that people are safeguarded from potential harm. Care Homes for Older People Page 9 of 13 31/01/2010 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 9 26 13 The registered person must ensure that adequate infection control procedures are in place. This will help to ensure that people are protected from the spread of any infections as far as possible. 08/01/2010 10 27 18 The registered person must 31/12/2009 ensure that there are always enough suitably qualified and skilled staff on duty. This will help to ensure that peoples needs can be met. 11 29 19 The registered person must ensure that recruitment procedures are robust. This will help to ensure that people are cared for by appropriate staff. 31/12/2009 12 31 8 The registered person must ensure that an application is submitted to register a manager for this home. This will help to ensure that people benefit from living in a home that is managed by a suitable person that oversees management systems that help to ensure peoples safety and well being. 31/01/2010 13 32 37 The registered person must ensure that the Commission is notified about any event that affects the health or welfare of people. 31/12/2009 Care Homes for Older People Page 10 of 13 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action This will ensure that procedures are properly followed and people are protected as a result of this. 14 37 17 The registered person must ensure that all records relating to people living in the home are up to date, meet and kept securely. This is to ensure that information kept about people is accurate and their rights of confidentiality are maintained. 15 38 13 The registered person must 31/12/2009 ensure that risks to people living at Donnington House, in respect of the risk of falling, use of equipment and other environmental hazards be identified and as far as possible should be eliminated. This will help to ensure that people are kept safe 16 38 13 The registered person must 08/01/2010 ensure that equipment provided at the home for use by people living here is maintained in good working order. This will help to ensure that people are kept safe 31/12/2009 Care Homes for Older People Page 11 of 13 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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