Inspection on 03/06/08 for Dorcas House

This inspection was carried out on 3rd June 2008.

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

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

Other inspections for this house

Dorcas House 06/11/07

Dorcas House 02/05/07

Dorcas House 21/11/06

Dorcas House 23/05/06

Dorcas House 26/10/05

Dorcas House 19/05/05

Dorcas House 08/09/04

Dorcas House 25/05/04

Dorcas House 24/11/03

Dorcas House 15/07/03

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

CARE HOMES FOR OLDER PEOPLE Dorcas House 56 Fountain Road Edgbaston Birmingham West Midlands B17 8NJ Lead Inspector Jon Potts Unannounced Inspection 3rd June 2008 9:50 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 Dorcas House DS0000016840.V365799.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. Dorcas House DS0000016840.V365799.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dorcas House Address 56 Fountain Road Edgbaston Birmingham West Midlands B17 8NJ 0121 429 4643 0121 429 4643 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) Mrs Kate Danquah Mr Pan Danquah Mrs Kate Danquah Care Home 11 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (11) of places Dorcas House DS0000016840.V365799.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. That four named persons under 65 years of age at the time of admission can continue to be accommodated and cared for in this Home. The home must demonstrate through comprehensive care planning and regular reviews carried out by Social Services that it is able to meet all the needs of each individual. The home must not in future admit any other persons under the age of 65 years. 16th January 2008 3. Date of last inspection Brief Description of the Service: Dorcas House is an adapted domestic property that accommodates 11 people who are users of mental health services. The home has three floors with accommodation for the people who live in the home on two of these. The third floor is for staff use. One lounge has a door out onto the rear garden and contains a large screen television and comfortable seating. Communal space is also provided in the form of a lounge/diner. People who live in the home were seen to sit here to eat, to play games at a dining table and to watch television. The home has both single and shared bedrooms situated on the ground and first floor. A stair lift is available for individuals to access the upper floor. There are shower, toilet and bathing facilities on both floors but none of these provide an assisted bathing facility. Laundry facilities are provided at the neighbouring house owned by the Danquah family. At the front of the home is a steep drive on which three cars can be parked. The side gate to the property permits further parking for up to three vehicles this leading to a rear garden with a private patio area to the side of the home. The current fees stated by the proprietor at the time of this inspection for a new admission were £440. Dorcas House DS0000016840.V365799.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 that use this service experience adequate quality outcomes. The inspection was carried out over two days and focused on the homes compliance with key national minimum standards as well as progress made in addressing requirements previously set by the CSCI. Evidence was drawn through use of various methods including tracking the care provided to three residents, this including examination of care records, discussion with some residents, observation of practices within the home and discussion with staff and management. In addition numerous other records were sampled including staff and management documents. We also toured the premises. What the service does well: What has improved since the last inspection? The home has improved in a number of areas a number summarised below: • Care plans have improved this so that the information within them is more consistent with improved assessment of risks to individuals. • Practices in respect of the handling of medication have improved. • There has been more effort on the part of staff to involve residents in day-to-day activity, with individuals choices as to whether they want to participate recorded. Dorcas House DS0000016840.V365799.R01.S.doc Version 5.2 Page 6 • • • There has been on – going training for staff which has improved their knowledge and has positively impacted on their day to day practice in respect of infection control and assisting residents to move. The induction process for new staff, this providing them with essential knowledge, has improved. There has been some new furniture provided including higher seating for less able residents. There has been some refurbishment of some areas of the home (one example is a new shower seat). The homes practices in respect of safeguarding resident’s finances are not significantly safer with the involvement of others outside the service. 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. The summary of this inspection report can be made available in other formats on request. Dorcas House DS0000016840.V365799.R01.S.doc Version 5.2 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 Dorcas House DS0000016840.V365799.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. The home does not provide intermediate care this meaning assessment of standard 6 was not appropriate. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There was information available in the home that would help people moving into the home to decide if the home was suitable or not, although these are only available in standard written form. The home has appropriate methods in place to assess prospective residents needs. EVIDENCE: Dorcas House was seen to have a statement of purpose, which sets out the aims and objectives of the home, with a separate service user’s guide, which provides basic information about the service and the specialist care the home offers. The guide is made available to individuals (copies seen to be in their rooms) in a standard written format although some consideration needs to be given to this, as not all the residents at the home are able to read it (for Dorcas House DS0000016840.V365799.R01.S.doc Version 5.2 Page 9 example it is not known if some residents can read and cognitive difficulties may hamper other residents understanding of the document). Individuals are also provided with a statement of terms and conditions or a contract, a copy of which is also available to them as was seen to be the case, although issues in respect of its presentation need to be considered as this again is in standard written format. The contract gives basic information on what people who live in the home can expect to receive for the fee they pay, and sets out terms and conditions of occupancy. The contract is normally reviewed when the person’s circumstances change. The home has admitted one new resident since the last inspection and sight of assessment documentation showed this to be extensive and including the formulation of an interim care plan. Discussion with the provider (who carried out the assessment) indicated that this was done pre admission at the persons’ previous home. There was no documentation of this fact, however, which would have been helpful as would the recording of the person’s pre admission visit to the home which the manager stated took place one afternoon. The assessment carried out by the provider was thorough and took account of numerous issues that allowed an overview of the individual’s needs, concerns and anxieties. This was supported by the assessments and care plan the home had obtained from the social worker. Discussion with the provider, who carried out the assessment, indicated that they have the skills necessary to identify issues relevant to the individual beyond what is initially presented, this drawing from their background as a Registered Mental Nurse. Whilst there was evidence of a robust assessment for the new admission to the home the manager and provider were advised that they do need to confirm in writing to any prospective new residents that based on the assessment they carry out they are able to meet their needs at Dorcas House. Dorcas House DS0000016840.V365799.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on individual needs. And care is provided in a way that generally respects the individual’s dignity and privacy, although there are some issues that impact on the these principals. Medication, with the exception of some limited issues, is generally well managed. EVIDENCE: There were care plans in place for all those residents whose care was tracked by us, these signed by the resident or their representative and generally consistent with assessments that were seen to be in place, whether the homes own or those of the funding social services department. Care provided by the home, based on the comments of residents, staff and observation of what was happening in the home during the course of the visit was consistent with these written plans. Dorcas House DS0000016840.V365799.R01.S.doc Version 5.2 Page 11 The care plans covered residents health, social and emotional needs and were supported by a number of risk assessments that considered any risk presented due to individual health and care needs. Plans would still benefit from further development however to make them more person centred, so that they directly reflect the viewpoint of the service user and are also accessible to them, with presentation in appropriate formats. An example of this is where there was a lack of clarity as to whether a resident could read. The care plan was written and they had signed although it would be doubtful they would be able to read it. It was noted however that the assessment the care plan was based on was drawn from discussion with the service user. Care plans are reviewed on a regular basis; the outcomes of these fully documented and reflecting any changes in the individuals needs. Documenting the individual residents involvement with these reviews would also be useful. Based on comments from residents and sight of records service users have access to health care services within the local community. Whilst it was stated by the manager that choice of GP is limited by catchment areas there was evidence that access is maintained with local dentists, opticians and other related community health services. People unable to access local services would be supported by visits to the home by health care professionals. Staff were seen to encourage individuals to be independent, and did not look to take away their responsibility for such things as mobilising themselves, with care plans reflecting how they would take responsibility for such as their own personal hygiene. The home has a medication policy, which is generally acceptable but would benefit from some update to ensure that there is guidance for staff in respect of medication if and when given in error. The Medication records seen were up to date and medicines received, administered and disposed of are recorded. Any handwritten entries on the records were verified with copies of prescriptions from the prescribing G.P. The manager and provider told us that no resident currently self medicates, this due to risk, although there was no documented evidence of residents giving their consent to this, although those residents asked were happy with this arrangement. Systems for the safe administration of medicines were examined and found to be safe with the exception of a prescribed cream in a shared room with was not been kept securely. The manager stated that they would address this issue. Discussion with residents and observation evidenced that people receiving services have a good rapport with staff and are happy with the way that most staff care for them one saying “staff treat me right”. Discussion with staff and management showed that they were aware of how to communicate with residents and had knowledge of how to provide care that respected individuals Dorcas House DS0000016840.V365799.R01.S.doc Version 5.2 Page 12 dignity and choices. Staff were seen on a regular basis to knock doors before entry to residents rooms and shared rooms were fitted with appropriate privacy screens. All rooms are fitted with turn bolt type locks to the doors and the manager stated that keys are available. We were told that no residents however hold keys, this in accordance with their agreement as was borne out by comments from some. There is no record of resident’s agreements however, or risk assessments where there maybe issues in respect of their capacity to safely hold a key. Some of the individuals in the home were incontinent. During a tour of the building beds were seen to have inappropriate coverings on the mattresses to manage incontinence. One bed was seen to have a number of different plastic coverings on it, some of these ripped. This would have been uncomfortable for the individual but the message given to them would not have been a positive one either. The manager needed to access advice from the continence service to enable the appropriate equipment such as Kylie sheets to be accessed. Dorcas House DS0000016840.V365799.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who use services are able to make a degree of choice about their life style, and are offered access to activities that they do not always choose to participate in. Individuals have access to meals which they enjoy and can influence menu planning. EVIDENCE: Discussion with the management and staff showed that they had an awareness of the need to support residents in developing their abilities in respect of such as social, emotional, communication, and independent living skills. There are meetings held where residents are consulted as to their preferred activities and activities are offered on a daily basis, although these are refused by some of the residents, this now documented by the staff on activity records. The manager and staff stated that they do encounter difficulties encouraging some resident’s involvement in activities, whilst others are involved in day centre attendance or going out independently. One resident spoken to stated that activities were available and if he wanted to do something all they had to do was ask staff. It was noted that one resident was a roman catholic (as Dorcas House DS0000016840.V365799.R01.S.doc Version 5.2 Page 14 recorded within their assessment) yet there was no evidence that opportunities to practice their religion had been followed up. The provider stated that he would discuss this with the resident and a catholic priest that already visits to see another resident at the home. The home has a minibus and there have been trips out although again the provider stated that encouraging some of the service users to leave the home environment was difficult due to their choices. Friends and relatives were able to visit when they wanted and could spend time in the lounge areas or the individual’s bedroom. Discussion with management and staff showed they had a basic understanding of human rights and how this impacts on people using the service with some commitment being shown in the areas of respect, dignity and fairness. The provider was aware however that there was a need to improve their knowledge around issues of such as the mental capacity act and how this would influence the homes practices and stated they were to arrange training for staff in this area. Residents are able to move freely at the home and there was little evidence of restriction to their day-to-day choices seen during the course of the inspection although comments in regard to such as key holding and consent to medication should be considered by staff. Opportunities are available for residents to be involved in meetings where menu planning is discussed and there was some evidence that this has influenced the planned menus. It was noted that day to day records of the meal choices people make (although completion of these is inconsistent) showed that they were offered choices above and beyond those recorded in the menu, this reflecting the fact that peoples choices as to preferred diets was respected. The menus seen showed that there were a variety of meals available and there was a four-week rolling menu. The people living in the home were provided with breakfast, lunch, tea and supper. Fresh fruit was available in the kitchen and some individuals bought their own fruit. The individuals spoken with said that they enjoyed the food. The meal seen during the inspection appeared to be nutritious and everyone said they enjoyed it. The food records showed that individuals were able to have choices and there was evidence that on occasions people were given an alternative meal to that identified for the others. Dorcas House DS0000016840.V365799.R01.S.doc Version 5.2 Page 15 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): 16 & 18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People living in the home are listened to and generally safeguarded by the home policies and procedures, although staff knowledge in respect of referring safeguarding alerts to statutory agencies could be better. EVIDENCE: The service has a basic complaints procedure in written format that meets the required standards and regulations, although there was some concern that the phone numbers at the time of the visit were not up to date, although were corrected on the notice displayed near the residents lounge at the time. The manager was advised that phone numbers for the local social services department should also be included and the availability of contact numbers for local advocacy agencies would be beneficial for residents. There have been some concerns raised by one individual although the home has demonstrated that appropriate action has been taken in this instance, with the resident’s social worker having confirmed this in writing to us. Discussion with one resident indicated that if they had concerns the staff would listen to these and respond with further discussion with staff showing that they were aware of the need to listen to residents, or pick up on behavioural cues in respect of monitoring their satisfaction. Dorcas House DS0000016840.V365799.R01.S.doc Version 5.2 Page 16 The home has policies and procedures available for safeguarding people including the local authorities guidance although discussion with management and staff indicated that there was a lack of clarity as to how they referred safeguarding issues to the local authority. Recent adult protection training, from discussion with staff, was seen to have increased their awareness as to what abuse is but the management need to ensure that staff are familiar with the referral process as outlined in the safeguarding procedure from the local authority. Staff spoken to were however very clear that any bad practice by staff or management would be challenged and they had some awareness of the channels they could use if they choose to ‘whistle blow’. Staff stated they were confident in raising matters with the provider and their ability to question their practice if the need arose. The homes policies highlighted that the use of restraint was a last resort only and observation of practice, discussion with residents and staff indicated that there is little in terms of limitations on the current resident group, for example residents can move freely around the home, they can access the telephone when they wish and if able can go out into the community when they choose, staff accompanying those that need assistance. Concerns that arose at the time of the last inspection in respect of safeguarding residents finances have now been fully addressed. Dorcas House DS0000016840.V365799.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment provides an adequate level of comfort in the home and is suitable for the majority of the people living in the home. The fact that there are ageing residents who are becoming less mobile does mean there is an on going need for the suitability of the building to be kept under review. EVIDENCE: The home provides a physical environment that generally meets the specific needs of the people who live there at present, although we saw that the home had limited adaptation, the owners needing to consider the fact that the residents are in some cases ageing and becoming more frail and they do need to plan for changes in needs, and as a result possible adaptations in respect such of the bathing facilities. It was noted that the provision of a grab rail at the top of the stairs might be beneficial for the one resident as they were seen Dorcas House DS0000016840.V365799.R01.S.doc Version 5.2 Page 18 to be grabbing at boxes on the wall when reaching the end of the stairs handrail. The provider said that this would be addressed. The home is comfortable and a programme to improve the decoration, fixtures and fittings has been supplied to us following the last inspection. There has been some new furniture and some redecoration carried out, this needing to be continued to maintain and improve the environment. The provider spoke to us of some of the planned changes this including the renovation of the patio area so as to provide the residents with an easy to access and private outdoor area. The small size of the building is advantageous in providing a homely environment, and one that is easy to find your way around. During the course of the inspection the quiet lounge was used for discussion with residents, staff and management although it was noted that unlike at the time of the previous inspection residents were not precluded from using the lounge if they wished. Due to the limitations of the building there is not a suitably sized office available and as a result there are filing cabinets in the one lounge, although this does not unduly detract from the ambience of the home and does mean that staff have access to records without having to leave the residents living area. Whilst some of the furniture maybe quite low this is balanced by other seating, which is higher (and has been recently purchased) thus allowing residents a choice. The individual who used a Zimmer frame to mobilise was however seen to still have some difficulty getting through the two doors that were very close to each other between the two lounge areas. This would possibly be the same for the doors between his bedroom and the first floor landing and there is a need for the management to look at how to lessen the affect of these barriers on the individual’s free movement around the home. The home was seen to be generally clean and tidy and there have been no recent outbreaks of infection. Discussion with staff and observation showed that staff have learnt from recent infection control training and this has influenced their practice. Sampling of maintenance records showed that these are up to date although the risk assessments in respect of the premises and infection control would benefit from review so that they are more robust. The provider showed us a quality control tool that when commenced would include a room-by-room audit/risk assessment. The management were also advised to access the department of health document ‘essential steps’ to assist with their management of infection control and risk assessment. Dorcas House DS0000016840.V365799.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Staff are benefiting from continuing training, and are able to apply their learning so as to improve outcomes for residents by such as making them safer and recognising the importance of such as promoting independence. Staff are available in sufficient numbers to meet the current needs of the resident group. EVIDENCE: We sampled the homes staffing rota, which we saw was consistent with the staff on duty. Based on the needs of the residents there are sufficient staff available. Whilst the staff are multiskilled and carry out domestic duties around the home they are supported by the manager (whose core hours are identified on the rota). There is one waking night staff on duty and the provider is available on sleeping in duty. We sampled the staff files for two members of staff employed since the time of the last inspection and these showed that the home follows safe recruitment practice, with staff not commencing work until they have been suitably vetted to make sure they are safe to work with vulnerable adults. The only omission was the lack of a questionnaires relating to a staff members physical and Dorcas House DS0000016840.V365799.R01.S.doc Version 5.2 Page 20 mental health, these to evidence that they are fit for the duties that are consumerate with the post. The home was seen to employ a brief initial induction check list (that covered such as the essential knowledge a staff member needed to know when first commencing work) this now supplemented by an induction package that is consistent with the skills for care package. Sampling of the work staff had done within these induction packages showed that answers covered essential areas and the provider stated that staff were supported with this, with him devoting time to discuss the induction packs contents with them. Examination of the training matrix indicated that a number of staff have completed their NVQ level 2 training and others were in the process of doing so. It was also noted that other staff have training that is comparable or in excess the NVQ level 2 qualification (for example one was stated to have a professional social work qualification). There are some training needs (as identified elsewhere in this report), although it is acknowledged that the training provided since the last inspection has reflected areas identified within our last report. Staff training has continued since the time of the last inspection this including infection control, first aid, moving and handling and adult abuse, this in cases verified by certificates we saw, or discussion with staff that had undertaken said training and who were able to recount significant learning points from the same. (Particular examples included description of how staff transferred residents, which was consistent with practices seen in the home and identification of hazards from an infection control perspective). The group of people currently living in the home were mostly of English or Irish background. The staff group did not reflect this in their background. It was important for the home to remain mindful of this and make efforts to employ a more diverse staff group to ensure that all the needs of the people living in the home can be met, although it was noted that there are male staff working at the home, this significant as there are a number of male residents. . Discussion with staff showed that they were motivated and interested in their work this seen to be reflected in their interaction with residents. Comments about the staff made to us by residents were positive and we saw a positive rapport between staff and residents. Dorcas House DS0000016840.V365799.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The management of the home have demonstrated since the last key inspection that they have a desire to improve the service and have improved the management of the service in some key areas, this improving the protection of such as resident’s finances. There is still scope for a more pro-active approach to the management of the home however. EVIDENCE: The joint providers of which one is the manager have been running Dorcas house for many years within which time the manager has obtained her Registered Managers Award. The joint provider is also a registered mental nurse and provides the manager support in running the home. Dorcas House DS0000016840.V365799.R01.S.doc Version 5.2 Page 22 There was evidence to show that the management have worked hard to address deficiencies identified at the time of the last inspection this with the result that all the requirements previously identified have been met and the home rating is now improved. There are still areas where improvement is needed, and management need to be proactive in ensuring they keep themselves abreast of national developments that impact on the successfully running of a care home, but it was noted that there was a willingness on the managements part to work with us to further improve the service offered, and ultimately improve outcomes for service users in their care. A significant area where the home needs to improve is in robustly monitoring the quality of the service available. The provider showed us a copy of a quality management audit system that he is looking to introduce over the coming months. The use of this in conjunction with such as the annual quality assurance assessment (AQAA) that we require annually, with account taken of the views of the people who lived in the home and other people with an interest in the home should provide a benchmark for the management to measure their success in providing a quality service. It was noted that residents are consulted through regular residents meetings although there was no evidence of recent consultation through questionnaires with residents, their relatives or other stakeholders (for example visiting health professionals, social workers etc). There was noted to be consultation with staff through meetings and supervision, the latter seen to be recorded in staff files. Staff also stated that the manager and provider were approachable and supportive and they were aware of how to access the homes policies and procedures. We looked at the homes policies and procedures in respect of the handling of resident’s finances and handling of their valuables. There was seen to have been significant improvement in this area with the management now only holding small amounts of monies in safe keeping for some residents, these when checked recorded appropriately and balancing with recorded amounts. The home does maintain inventories of residents property and valuables, although it was noted out of three case files, there was one not completed. Maintenance of equipment in the home was generally well managed including servicing of fire and gas equipment. The management were advised that they do need to review and expand risk assessments related to safe working practices, in particular the homes fire risk assessment and the safer food, better business pack the home was stated to have received from Environmental services. Dorcas House DS0000016840.V365799.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X 2 X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 3 X 2 Dorcas House DS0000016840.V365799.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement The registered manager must ensure that all prescribed creams are stored safely and appropriately. This is to ensure that access is restricted to these by the person using (if self medicating) or the member of staff administering. The registered providers need to review the premises in respect of its on going suitability for an ageing resident group through a robust risk assessment process, this to identify adaptations /changes that will benefit residents independence as they arise, such as provision of handrails on the landing and so on. Timescale for action 05/07/08 2. OP22 23(2) 31/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Dorcas House DS0000016840.V365799.R01.S.doc Version 5.2 Page 25 No. 1. Refer to Standard OP1 Good Practice Recommendations The registered persons should consider the review of the homes service users guide and contract so that it is available in formats that are understandable for all the residents (for example a resident that is unable to read may need it in audio/pictorial format). This will ensure that people moving into the home have information that will enable them to make an informed choice about whether to move into the home. The registered persons should ensure they confirm in writing to a prospective resident that, based on any assessment carried out, they are able to fully meet their needs. This will ensure that any prospective resident is confident that they have chosen an appropriate service. The registered manager/provider should ensure that the homes medication policy carries reference to the action staff should take if medication is given in error. The registered manager should ensure that residents consent to medication been held by the home is documented, or if when they wish to self medicate, but lack capacity there is a risk assessment in place that demonstrates why they are not able to do so. The registered manager/provider should ensure that all beds are fitted with appropriate protection that is comfortable and also best meets the needs of the residents in terms of continence promotion. The registered manager/provider should ensure that where residents do not hold keys to their bedroom door or a lockable area in their room this agreement is recorded, or when they wish to but lack capacity there is a risk assessment in place that demonstrates why they are not provided with keys. The registered providers should ensure that the people living in the home and their representatives have access to contact numbers for the local social services department and advocacy services. This will ensure that everyone will be aware of how a complaint about the service can be made. The registered providers should ensure that they and the staff are aware of the local authorities safeguarding procedure and how to refer safe guarding alerts should this be necessary. DS0000016840.V365799.R01.S.doc Version 5.2 Page 26 2. OP3 3. 4. OP9 OP9 5. OP10 6. OP10 7. OP16 8. OP18 Dorcas House 9. OP19 The registered providers should continue to update the furnishings and decor throughout the home in accordance with the plans submitted to CSCI. This will ensure that people who live in the home are provided with an environment that is homely, comfortable and will ensure that the people living in the home also feel comfortable and valued. The registered providers should access and use advice from the department of health document ‘essential steps’ to assist with risk assessments in respect of infection control, this to ensure that any potential infection related hazards are pro actively managed. The registered providers should ensure that all they are able to verify that staff are physically and mentally fit to carry out their duties as detailed with their job description, this through use of such as health questionnaires that staff complete and sign. The registered providers should introduce a system that routinely monitors the quality of the service and as part of this regularly takes the views of those living in the home and all stakeholders into account. This will ensure the people living in the home will receive a service that is delivered around set quality outcomes in care. The registered providers should ensure that inventories of resident’s property are consistently completed so that it is clear what property the resident has at the home. The registered providers should review the homes risk assessments in respect of fire and food safety. Advice in respect of the completion of these can be obtained from the appropriate statutory agencies, i.e. West Midlands Fire Service and Environmental Health. 10. OP26 11. OP29 12. OP33 13. 14. OP35 OP38 Dorcas House DS0000016840.V365799.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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