Inspection on 06/11/07 for Dorcas House

This inspection was carried out on 6th November 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Dorcas House 03/06/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Dorcas House 56 Fountain Road Edgbaston Birmingham West Midlands B17 8NJ Lead Inspector Kulwant Ghuman Key Unannounced Inspection 6th November 2007 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Dorcas House DS0000016840.V350995.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.V350995.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 F/P 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.V350995.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 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. 2nd May 2007 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. At the rear of the home is a garden. The fees stated by the proprietor at the time of this inspection were between £381 and £440 however the service user guide provided at the inspection indicates a lower fee. The reader may wish to obtain more up to date information from the care service. Dorcas House DS0000016840.V350995.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key, unannounced inspection was carried out by two inspectors over two days during November 2007. During the inspection the inspectors toured the building, sampled the care files of three of the people who lived at the home. The inspectors sampled various health and safety records, the file of one member of staff, the training record of another member of staff and spoke to 4 of the 11 people who lived in the home and one staff member. Prior to the inspection the home had provided the Commission with a completed Annual Quality Assurance Assessment (AQAA) that provided some information about the home. Eleven questionnaires were sent to the home for the people living in the home to complete but none of these were returned to the Commission. The inspector spoke with one relative over the telephone and was informed that they were happy with the service provided in the home. A completed survey from another relative indicated that they were generally happy with the service but communication could be improved. One complaint had been received by the Commission since the last inspection and this had been forwarded to the home to manage. It had been acted on appropriately. No issues of adult protection had arisen at the home. What the service does well: What has improved since the last inspection? Dorcas House DS0000016840.V350995.R01.S.doc Version 5.2 Page 6 Since the last inspection the home had accessed a grant from the local authority that had enabled the carpets to be changed in all the communal areas and some bedrooms. Some double-glazing units had been replaced and some bedroom furniture had been replaced. The home had been repainted internally, the curtains changed and the mini-bus had been re-sprayed. 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 Dorcas House DS0000016840.V350995.R01.S.doc Version 5.2 Page 7 be made available in other formats on request. Dorcas House DS0000016840.V350995.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dorcas House DS0000016840.V350995.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 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. The service user guide needed to be updated to ensure that people had the correct information available to them. EVIDENCE: The inspectors were provided with a service user guide and statement of purpose, which was dated 2004. There was a lot of information available in the statement of purpose that could help people to decide whether they wanted to move into the home or not however the fees stated in the service user guide were not the fees being currently charged by the home. The National Care Standards Commission had been replaced by the Commission for Social Care Inspection but this had not been reflected in the service user guide. Dorcas House DS0000016840.V350995.R01.S.doc Version 5.2 Page 10 None of the three files belonging to people who were living in the home that were sampled during the inspection had a contract available on them. There had been no new admissions to the home since the key inspection of 2nd May 2007. The Annual Quality Assurance Assessment (AQAA) completed by the home prior to the inspection stated that if someone new was admitted ‘This could mean negotiating one of the residents to move to the first floor bedroom to make room for the new resident’. If the person was moving to the first floor because that was what they wanted or that their needs indicated that this was appropriate this would be acceptable. It would not be appropriate to move someone just so that someone else could be admitted. The new individual should not be admitted if the accommodation available is not suitable. Dorcas House DS0000016840.V350995.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The care plans provided little detail of how staff were to provide the people living in the home assistance to meet their needs. There was on occasions conflicting information about how the needs were to be met and risk management plans were poor. The people living in the home were able to receive medical attention when needed but the management of some medicines needed to be improve. There were some issues of dignity that needed to be addressed in the home. EVIDENCE: The home had started to use the QUEST individual assessment system. The three files sampled all had a QUEST assessment in place. This system provided a comprehensive assessment covering issues such as hearing, sight, verbalisation, social interaction, mood, anxiety, foot care, medication and others. This system required the sections to be scored and any score above 2 Dorcas House DS0000016840.V350995.R01.S.doc Version 5.2 Page 12 indicated that a specific care plan to address this issue was required. The areas assessed by the home had been given a scoring but no comments were made about any of the issues and did not identify which care plans were associated with which area of assessed need. This documentation had not been dated or signed by the staff or the people for whom the assessment was being carried out. All three people had been living in the home at the time of the last key inspection of 2nd May 2007 and all had previous care plans in place. The care plans had not been updated following the implementation of the QUEST assessment. One of the files sampled had also been seen at the last inspection indicated that there continued to be a lack of detail in the care plan. The care plan indicated that the individual suffered from Schizophrenia and anxiety. The goal was to ‘maintain behaviour as predictable as possible’ and the agreed actions included 1 ‘removing agitating and aggravating features to him’ but there were no details about what they were, 2 ‘encourage him to pursue hobbies he enjoys’ but there were no details about what these were and how staff would encourage them, 3 ‘report to the GP if condition deteriorates’ but again there were no details of what symptoms these would include, 4 ‘give medication as prescribed’ . The QUEST assessment for this individual indicated that he needed all his medication to be administered, however a care plan for medication stated that he self medicated and a monthly review of the medication care plan stated that on 7.10.07 he continued to take his own medicines. The key inspection of 2nd May 2007 indicated that the individual needed to be risk assessed to ensure that he could safely manage his own medicines. A response to that inspection from the provider dated 18.6.07 stated that “the risk assessment for the one resident who self- medicate will be reviewed”. The improvement plan following that inspection dated 20.7.07 stated “currently no resident self-medicates”. The QUEST assessment for social interaction indicated a score of 3 and the form stated that a score of 3 or more could indicate depression. It was not clear from the documentation which care plan addressed this issue however two care plans dated 19.4.07 stated that ‘he enjoys his own company and stays in his room’ and that he ‘suffers from Schizophrenia and anxiety’. The first care plan was reviewed until 7.7.07 when it was discontinued because it was felt that there were no issues with him staying in his room for some of the time as he continued to interact with the others in the home. Dorcas House DS0000016840.V350995.R01.S.doc Version 5.2 Page 13 The above shows that the inconsistency showed in documentation at the previous inspection had not been fully addressed and could lead to confusion within the staff group. For another person living in the home there were risk assessments in place for pressure sores and manual handling which placed the individual at risk however there were no corresponding management plans in place. The personal risk assessment indicated that he needed help getting in and out of the bath but no detail about how this help was provided. The third file showed that the individual needed to have the condition of his toes monitored during monthly evaluations. There was no evidence that this was being undertaken. Since the individual had moved into the home during April 2007 he had lost 12 pounds in weight. There was nothing to indicate that the weight loss had been investigated or that there had been a plan to reduce the weight. At the time of this inspection the individual was in hospital. The inspectors had been informed that all the people living in the home had now been registered with the same General Practitioner. The inspectors queried why and were informed that some were already registered with the practice and because the other GP would not visit the home to provide a service for the others they were also registered with the same GP. There was evidence that the people living in the home were receiving medical attention when required. The medication trolley was secured to the wall in the lounge/dining room. Some medicines were provided in weekly blister packs by the pharmacist but some medicines were boxed. As at the last inspection there were still some discrepancies with the boxed painkillers. The manager needed to ensure that individuals were always recording whether one or two tablets were being given. All bedrooms had the appropriate locks in place and keys were available. One person told the inspectors that he did not want a key to his bedroom. There were appropriate privacy curtains in shared rooms and curtains at the windows. 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 three different plastic coverings on it. 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.V350995.R01.S.doc Version 5.2 Page 14 The manager needed to ensure that the dignity of the people was also maintained in other ways which individually appear to be minor but cumulatively add up to be significant. For example, one person had cream put on their scalp due to soreness, the cream had not been properly applied and a white residue made it obvious something had been applied, the individual had been dressed in a jumper but with no shirt on although there was a supply in his wardrobe and the plastic covering on his bed was not appropriate. Dorcas House DS0000016840.V350995.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were some activities available for the more able individuals. Activities suited to the needs of some of the less able people needed to be developed. The home acknowledged that some improvements could be made in this area. The people living in the home appeared to be satisfied with the meals they were receiving and their dietary needs were being met. EVIDENCE: Daily records indicated that there were some activities in the home including dominoes, cards and some throwing/catching of the ball. People living in the home were able to watch the television in the lounges or in their bedrooms if they chose to have one. One of the people living in the home stated that he did go out to the shops and to put a bet on. Another person attended a day centre once a week and there was the occasional mention of one of the women going to the shops for a cup of tea. Dorcas House DS0000016840.V350995.R01.S.doc Version 5.2 Page 16 Since the last inspection there had been no holidays or trips out for the people living in the home. The inspectors were told that some of the people occasionally said that they wanted to go out but when it came to the point of going they refused to go. It is important to record when individuals are offered activities and what their responses are to them. One completed survey from a relative indicated that the home could try to organise more trips out but acknowledged that the home did try on occasions. The individual also indicated that improvements could be made to communications with relatives from the home. Friends and relatives were able to visit when they wanted and could spend time in the lounge areas or the individual’s bedroom. The home acknowledged in the AQAA that they could try to find more day centre placements for some of the people living in the home, organise more social events and visiting entertainers, escort individuals out to places of interest and involve them in simple jobs such as laying the table or polishing furniture. One of the people spoken to confirmed that there were no rigid rules or routines in the home and they were able to get up and go to bed when they wanted. Individuals were seen to be able to go their bedrooms during the day. One of the individuals confirmed that he did not want a key to his bedroom door. The menus seen showed that there were a variety of meal 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.V350995.R01.S.doc Version 5.2 Page 17 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 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There was a basic complaints procedure available to individuals in the service user guide but this needed to be improved. There were adult protection procedures in place but the people were not safeguarded from financial abuse. EVIDENCE: There had been no complaints made to the home directly. One complaint had been received from a person living in the home by the CSCI. The complaint had been forwarded to the proprietors to address as there were some ongoing, long term issues being identified that were indicative of the individual’s mental health status. The home had dealt with the issue appropriately. During the inspection the individual was spoken with and it was evident that the person was still very upset and angry about the issues and the individual’s mental health status needed to be closely monitored. There was a basic complaints procedure in the service user guide but there was no mention of the CSCI. The service user guide needed to be updated to indicate that complaints could be referred directly to the Commission. One of the surveys completed and returned to the Commission indicated that the individual was not aware of the complaints procedure in the home. People living in the home needed to be provided with a complaints procedure in a suitable format and their representatives also needed a copy. Dorcas House DS0000016840.V350995.R01.S.doc Version 5.2 Page 18 The staff had undertaken adult protection and some challenging behaviour training since the last inspection. There were adult protection procedures in place and there had been no protection issues raised about the home since the last inspection. There continued to be some concerns about the home’s ability to protect the people living in the home from financial abuse by the maintenance of robust financial policies and procedures and records (refer to standard 35). Dorcas House DS0000016840.V350995.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,22,24,25 and 26 Quality in this outcome area is poor. 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 current level of adaptations in the home do not make it a home suitable for people with mobility difficulties. EVIDENCE: During the first day of the inspection it was noted that one of the people living in the home was lying on the leather settee in the quiet lounge watching the television. The manager asked the individual to move to the other lounge so that the inspectors could use the lounge. The inspectors were told that no other space was available as the office upstairs was too small. The need for space to be made available for an office was discussed with the manager as it was not appropriate for people living in the home to be moved out of what was their ‘space’. Dorcas House DS0000016840.V350995.R01.S.doc Version 5.2 Page 20 The leather settee, had been acquired for the home since the last inspection however it was noted that the individual asked to move to the other room had great difficulty being able to get up from it due to it being so soft. The manager eventually had to assist the individual to get up. This showed that the settee was not suitable for this person in particular but possibly also for other people living in the home and should be replaced. The individual who used a zimmer frame to mobilise also found it difficult to get through the two doors that were very close to each other between the two lounge areas. This would probably be the same for the doors between his bedroom and the first floor landing. It would be appropriate for the manager to refer the individual to be reassessed and the placement to be reviewed for its suitability. The bath on the first floor did not have a hoist seat and the individual would find it difficult to step in and out of the bath. The individual’s care plan indicated that he would need help in and out of the bath. The shower on the ground floor also had a step up into the shower tray and again would be difficult for the individual to access. The manager needed to look at ways in which access around the home and the bathing facilities could be made appropriate for this individual or review the suitability of the placement for him. During the first day of the inspection the inspectors observed two members of staff walk out into the garden to dispose of used continence pads that were held in the hands of the workers. The pads needed to be put into disposable bags whilst being taken to the clinical waste bin for reasons of cleanliness, infection control and maintaining people’s dignity. The garden area was a basic lawned area that could be accessed by people with full mobility but not easily accessed by those with limited mobility. Also during the day the fire exit door from the lounge was found to be sticking. This issue had been identified at the last inspection. At the time that the inspectors left the home on the first day of the inspection the front door to the home could not be opened and the inspectors were told the lock had been sticking. The inspectors left by a side door and they were assured that someone would be called in to attend to it as an emergency. The inspectors returned to complete the inspection on 8.11.07 and were let in through the front door but the work was not fully completed on that door. The fire exit door from the lounge had not been attended to. Dorcas House DS0000016840.V350995.R01.S.doc Version 5.2 Page 21 A letter was sent to the home on 9.11.07 requiring the door to be repaired and the Commission to be informed of the actions taken by the home by 12.11.07. At the time of writing this report the Commission had received no information about the actions taken by the home. The home had been successful in obtaining a grant from the local authority that had enabled the carpets to be replaced, some furniture and a new television to be purchased, the home to be repainted, some double glazing units to be replaced and curtains to be replaced. The inspectors activated the nurse call system from the bathroom and staff turned it off from downstairs. The alarm was activated again and the staff came to attend. Had someone who was living in the home been in the bathroom at that time they could have been at risk of being left unattended by staff when they turned off the call system from downstairs. In some bedrooms head boards were detached from the beds, window latches and door handles were broken, bedside cupboard drawers were broken, bed bases were worn and bed side lamps were needed. Much of the bedroom furniture in the home needed to be replaced as part of a refurbishment programme. This has been an outstanding requirement since December 2005. During this inspection the proprietors indicated that they were unable to replace this furniture as they did not have enough funds and that the improvements made to the home recently were only possible because of the grant obtained. This calls into question the financial viability of the business. One of the wash hand basins in the bedrooms was blocked and needed attention. There was no bedside lamp available and the bed base was worn and the furniture old. In another bedroom the mattress was covered with 3 plastic covers none of which were of the right size fro the bed. Privacy curtains were in place in shared bedrooms and some bedrooms had had new carpet and some of the bedroom furniture replaced. During a tour of the building the inspectors noted that the bath mat in the bath on the first floor was very dirty with mould on the underside. There was a bar of soap in the bathroom that was removed by the manager. Management of infection control needed to be improved. In the kitchen a dessert was found to be past its use by date, cups were chipped, the lock on the kitchen door leading to the dining room was broken, some vegetables found in the chiller section of the fridge had gone black, sauces were not being dated when opened, food debris was found in the fridge seals, the microwave needed cleaning, the electrical socket by the microwave Dorcas House DS0000016840.V350995.R01.S.doc Version 5.2 Page 22 was very dirty, food debris was stuck in the seals in the work surface and a pedal bin was needed. The water temperature from the shower was tested and found to be restricted to a suitable temperature. The shower head holder was broken, the door to the shower unit was broken and the shower chair needed cleaning. The toilet paper was of very poor quality. Dorcas House DS0000016840.V350995.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels in the home were adequate and the recruitment process was satisfactory. Work practices needed to be monitored and improved. EVIDENCE: The staffing rota identified that there were sufficient people working in the home to meet the needs of the people living there. In addition to the manager there is always another worker on duty with an additional worker on duty for part of the day. There is one waking night staff on duty and the provider is available on sleeping in duty. The recruitment file of one member of staff was sampled and it was found to have all the required employment checks in place. The induction training consisted of a check list and the proprietor stated he was aware it was not suitable and he had accessed the Skills for Care package which they would be using. Examination of the training matrix indicated that none of the staff had completed there NVQ level 2 training however, in discussions it was determined that two people had completed this training. Dorcas House DS0000016840.V350995.R01.S.doc Version 5.2 Page 24 There had been some training since the last inspection including challenging behaviour and adult protection. Moving and handling training had been undertaken in 2005 and needed to be updated. No dates were available for infection control training. The inspectors were informed that some of this training would have been covered in the NVQ level 2 training but there were no certificates available to evidence that this had taken place. The owners also stated that they were going to have some training through a consortium as their prices were lower but because they were not registered with them they had been unable to benefit from it. The training provided by other organisations was too expensive for the home. Some training costs were currently shared between them and another local home. The group of people currently living in the home were either 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. The staff needed to be mindful of issues of infection control for example, transporting of soiled continence pads, cleanliness in the kitchen and removing bars of soap from communal washing areas and that they did not switch off the nurse call system before attending to someone as this could lead to the potential risk of someone not being attended to. Dorcas House DS0000016840.V350995.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,34,35,37 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of documentation in the home is poor. People living in the home are not safeguarded in respect of monies and there are some concerns regarding the financial viability of the home. EVIDENCE: The manager had been managing the home for many years. She had achieved her Registered Managers Award. Issues with respect to the financial viability of the home were raised as the provider has stated that they have only been able to replace carpets and some windows because of a grant obtained from the local authority and that the home was unable to replace some bedroom furniture for the people living in Dorcas House DS0000016840.V350995.R01.S.doc Version 5.2 Page 26 the home. This is reflected in the fact that the requirement for replacing furniture has been an ongoing issue in the home with little progress having been made. Other areas that continue to be of concern are the development of adequate care plans and risk assessments, the safeguarding of the people living in the home through the provision of adequate policies and procedures and records showing the management of their monies. The proprietor and manager of the home are in place to safeguard the people living in the home however their abilities to be proactive are called into question by statements in the AQAA such as ‘ Financial interests of residents are safeguarded. Where this hasn’t been the case this is put right once we are aware of it’. It has been evidenced over the past inspections that even when it has been brought to their attention that the records are not satisfactory they have not been ‘put right’. During this inspection it was again difficult to audit the monies of the individuals as the records had not been maintained adequately. The record of expenses for one individual showed that purchases were being made and receipts obtained however, a mistake had been made in the calculations resulting in the balance being short £2. This may not be a large amount and it was replaced during the inspection however, had there been adequate checks in place this would have been identified earlier and rectified. Another person was going with a member of staff to withdraw money from their account and there was no risk assessment or procedure in place to ensure that they were being safeguarded. There were discussions regarding another person living in the home for whom it was identified that the provider had been deducting too much money towards fees. The manager contacted the Department of Works and Pensions who confirmed the individuals contributions to the fees and that the remainder of the money was the applicants. There were no records to show how many giros had been cashed, how much had been received or how much had been given to the individual. It could not be determined how much this individual was owed due to the lack of records. Another individual’s monies were managed by a solicitor and the solicitor had agreed that the individual could purchase bedroom furniture from their own funds. It was concerning that the suggestion to purchase bedroom furniture came from the manager especially as the proprietor stated that the individual’s chair needed replacing and the home could not afford to replace the furniture. It is the responsibility of a care home provider to provide adequate, homely furniture that is fit for purpose in the home and only if this is not too the liking of the individual should there be a need for them to purchase it from their own funds. Dorcas House DS0000016840.V350995.R01.S.doc Version 5.2 Page 27 For another individual who was having money paid into bank accounts it was not possible to audit the income and expenditure adequately as there were some bank statements missing. This had been the case at the last inspection. When this was raised with the proprietors they stated that all the records were available. The inspectors requested records from 2006 until the present showing income and expenditure but this could not be provided in full. These records are still unacceptable and need to clearly show when money has been received and for what period they relate to and when new benefits have been claimed from. Enforcement action is being considered by the Commission in respect of the poor record keeping for finances in the home. There was no quality assurance system in place that monitored the services provided and that took into account the views of the people who lived in the home and other people with an interest in the home. Staff supervision was taking place but it was not up to the required levels. The Commission had received no regulation 37 notifications from the home since the last inspection. One of the people living in the home had been admitted to hospital and no notification had been forwarded to the CSCI. Maintenance of equipment in the home was generally well managed including servicing of fire extinguishers and gas equipment. The 5 yearly electrical hard wiring inspection had been undertaken and the fire alarm and emergency lighting tests were up to date. A fire drill had taken place in May 07. The medication system in the home was adequate but some audits did not tally. The manager needed to take a proactive approach to ensure that health and safety issues were attended to such as ensuring all exit routes were easily exited, that premises risk assessments were updated and that good infection control practices were carried out in the home. Dorcas House DS0000016840.V350995.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 1 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X 2 2 X 2 2 1 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 2 1 2 1 2 Dorcas House DS0000016840.V350995.R01.S.doc Version 5.2 Page 29 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 OP8 Regulation 13(4)(c) Requirement Risk assessments for the people living at the home must be holistic and identify how the risks are to be managed. This will ensure people living at the home will be protected from risk. (Previous timescale of 01/08/05, 01/12/05, 14/08/06 and 01/02/07 and 01/07/07 not met.). 2. OP26 13(3) The staff in the home must ensure that work practices in the home are in line with good infection control practices. This will ensure that the people living in the home are safeguarded from cross infections. 3. OP30 13(4) At least one member of staff on each shift must have first aid training. DS0000016840.V350995.R01.S.doc Timescale for action 08/11/07 01/12/07 01/02/08 Dorcas House Version 5.2 Page 30 All staff must receive training in manual handling. This will ensure that the people living in the home are safe. Previous timescale given 01/09/07 There must be a business and financial plan for the establishment, open to inspection and reviewed annually. A system must be implemented to ensure that the financial interests of the people living in the home are safeguarded. This will ensure that the people living in the home are safeguarded from financial losses. (Previous timescale of 01/08/06 and 01/01/07 not met.) 6. OP38 23(4)(b) People living, working or visiting the home must be able to exit the home via the identified fire exit doors. This will ensure that everyone can safely exit the home in the event of an emergency. Previous timescale given 01/06/07 12/11/07 4. OP34 25 01/02/08 5. OP35 17(2)Sch 4(9)13(6) 08/11/07 Dorcas House DS0000016840.V350995.R01.S.doc Version 5.2 Page 31 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 Good Practice Recommendations There must be up to date information available for people who may move into the home that includes the range of fees charged by the home. 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. 2. OP2 Contracts and the terms of conditions of residence at the home must be discussed with the people who live in the home at the time they move into the home. Contracts and terms of conditions of residence must be in place for all the people living in the home. This will ensure that people moving into the home are aware of the terms and conditions of moving into the home. 3. OP7 The care plans of the people living in the home must clearly show all the needs of each person and how the staff are to meet the identified needs. Care plans must include strategies for dealing with difficult and challenging behaviour. This will ensure that the needs of the people living in the home are met in a consistent way by the staff. 4. OP7 Care plans should include consistent information to prevent confusion within the staff group. This will ensure that the people living in the home receive a consistent service from the staff. 5. OP9 Staff must record the number of tablets given where there is a choice. This will ensure that all staff are aware of what medicines Dorcas House DS0000016840.V350995.R01.S.doc Version 5.2 Page 32 6. OP10 have been given and safeguard the people living in the home from experiencing unnecessary pain or being given too much medication. The home should ensure that the dignity of the people living in the home is preserved when dealing with incontinence and personal appearance. This will ensure that the people in the home are comfortable and their dignity is maintained. The home should try to organise more trips and outings and entertainments in the home. This will ensure that the people living in the home enjoy fulfilled lives. The home should ensure that the people living in the home and their representatives have a copy of an updated complaints procedure. This will ensure that everyone will be aware of how a complaint about the service can be made. The furnishings and decor throughout the home must be updated and suitable for the use of the people living in the home. This will ensure that people who live in the home are provided with an environment that is homely, comfortable and inviting. 7. OP12 8. OP16 9. OP19 10. OP19 The home should look into the provision of alternative space that could be used as office space. This will ensure that the people living in the home do not have to vacate their lounge when the manager needs it. The garden area should provide an accessible and safe space to all the people living in the home regardless of physical, sensory or cognitive impairments. This will mean that all the people living in the home will have access to safe and pleasant outdoor space in which to sit and walk. 11. OP20 12. OP22 The placement should be reviewed for its suitability for the person with reduced mobility in the home and either a suitable placement sought or adaptations made to bathrooms. This will ensure that the individuals needs continue to be met. Dorcas House DS0000016840.V350995.R01.S.doc Version 5.2 Page 33 13. OP22 Staff must not cancel the emergency call system before attending the point of call. This will ensure that the people living in the home are not left unattended. The registered person must ensure that the bedrooms occupied by the people living in the home are furnished with furniture and fittings that are suitable and provide a comfortable and homely accommodation. This will ensure that the people living in the home are comfortable and feel cared for. At least 50 of the care staff are qualified to NVQ level 2 or equivalent. This will ensure that the people living in the home are cared for by staff with the appropriate knowledge and skills. 14. OP24 15. OP28 16. OP30 New staff should undertake induction training in line with Skills for Care. This will ensure that the people living in the home are assured that only people who have the appropriate skills and knowledge are caring for them. 17. OP33 A system should be implemented to take the views of those living in the home into account. This will ensure the that people living in the home will receive person centred care. Dorcas House DS0000016840.V350995.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Dorcas House DS0000016840.V350995.R01.S.doc Version 5.2 Page 35 - 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. 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