CARE HOME ADULTS 18-65
Dorriemay House Dorriemay House 23/27 Eaton Road Margate Kent CT9 1XB Lead Inspector
Clair Brown Announced Inspection 10:00 7 & 8 November 2005
th th Dorriemay House DS0000023391.V253086.R01.S.doc Version 5.0 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 Dorriemay House DS0000023391.V253086.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. Dorriemay House DS0000023391.V253086.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Dorriemay House Address Dorriemay House 23/27 Eaton Road Margate Kent CT9 1XB 01843 292616 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) Mr David Barrie Mirsky Mrs Jacqueline Ann Mirsky Care Home 25 Category(ies) of Learning disability (25) registration, with number of places Dorriemay House DS0000023391.V253086.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 9th May 2005 Brief Description of the Service: Dorriemay House provides residential care to up to 25 people who require varying degrees of assistance as a result of their learning disabilities. The Home comprises three adjoining terraced properties, with a paved garden area, situated close to the sea front in a residential area of Margate. The Home is within a short distance of amenities such as rail and bus services, shops and churches, a library and a concert hall. Staffing comprises of the registered provider, a head of care, care staff and ancillary staff. The premises lack access for people with impaired mobility. Dorriemay House DS0000023391.V253086.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the home’s announced inspection. The inspection was conducted by one inspector and the duration of the inspection was 11 hours over two days. The Home representative was the registered provider. Additional time was spent in planning the inspection and report writing. The inspectors spent time talking to 4 service users, and 5 staff to gain their views. Seven service users and five relatives completed inspection comment cards. A partial tour of the premises was conducted, documents, medication and records were examined and service users files were case tracked. What the service does well: What has improved since the last inspection? What they could do better:
The pre-admission assessments process needs to be improved to ensure prospective service users are within the homes registration and their needs can be met. An application for a variation to the registration needs to be made for those service users admitted over the age of 65 years. Service users care plans needs to clearly identify all aspects of the care needed and provide staff with clear instructions on how to meet those needs. The home needs to write risk assessment for all service users. Each service user needs to have a nutritional assessment. A second hot alternative meal should be offered for the main meal of the day. Medication procedures and practices need to be improved to ensure safe handling and administration of medicines. A new format should be developed for the recording of service users money/financial transactions which shows all service users benefits being recorded, including money taken as top up of fees. The home needs use a two signature procedure for the recording of service users finances. The registered
Dorriemay House DS0000023391.V253086.R01.S.doc Version 5.0 Page 6 provider needs to develop and implement a maintenance programme for the home and keep records of work completed. Infection control procedures need to be reviewed. Staffing levels should be review to ensure sufficient numbers of suitably trained/ experienced staff are provided to meet the needs of the service users, including the weekends. An interview record form needs to be developed for prospective staff and the induction programme revised for new staff, to comply with current training standards. All staff need to receive formal supervision. Those responsible for managing the home need to become more knowledgeable of the National Minimum Standards and Regulations and to implement these fully. An annual quality assurance system must be developed and implemented. The home needs to produce and implement policies and procedures to meet the needs of the home and to comply with current practices. All records should be kept in the registered home and not be destroyed. Environmental health & safety checks should be conducted regularly and environmental risk assessments and fire risk assessment need to be written. 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. Dorriemay House DS0000023391.V253086.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dorriemay House DS0000023391.V253086.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 The statement of purpose does not provide up to date information to enable prospective service users to make an informed decision. The assessment of prospective service users fails to ensure they are not admitted outside of the registration of the home compromising the ability to meet the service users needs. EVIDENCE: The Statement of purpose and service user guide has been produced as one document and does not contain all of the information required by the National Minimum Standards and Regulations. Two service users have been admitted within the last twelve months over the age of 65 years, although over half of the existing service users are now elderly, an application for a variation to the registration to admit these service user should have been made prior to their admission. Dorriemay House DS0000023391.V253086.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9, Care plans fail to identify all of the service users individual needs. Service users are not properly supported to make decision about their own lives. EVIDENCE: Three care plans were cased tracked, these documents main focus was on the service users physical needs, with a lack of detail regarding behavioural and emotional aspects of their care and how they are support to make decisions and choices in about lives. There are insufficient individual risk assessments for those service user who would need them, to add acknowledgment and support from staff when a potential risk has been identified. One service user had a risk assessment for challenging behaviour, which stated they were to be supervised at all times by a designated member of staff, however there was no evidence of this occurring within the daily reports, those written stated the service user spends most of their time in their bedroom. Dorriemay House DS0000023391.V253086.R01.S.doc Version 5.0 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17 The age range of services users influences the activities provided. Links with the local community and activities are limited. Choice is not promoted with meals and there is no process for ensuring service users are not nutritionally at risk. EVIDENCE: Many of the service users attend the homes own daycentre as part of their daily activity. Over half of the service users are now elderly and therefore it would not be essential for those to attend further education. Links with the local community and activities are restricted due to staffing numbers. There is no alternative meal available for the main meal of the day, service users are given the meal that has been cooked. At breakfast time service users can have cereal or a cooked breakfast. The menu is traditional English, meat and two vegetables and some pasta dishes. No form of nutritional assessments are completed for service users. Dorriemay House DS0000023391.V253086.R01.S.doc Version 5.0 Page 11 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20,21 Service users are supported with their health care needs and appropriate action taken when necessary. The home has not acknowledge or prepared for the ageing service user. Medication practices are unsafe. EVIDENCE: Records were kept of attendance to doctors and hospital appointments. Records indicate that staff respond appropriately to illness and health problems. Over half of the service users are aged of 60 years old, at the time of the inspection no preparations have been made to assess the changing needs and to prepare for these. The acting managers confirmed that no plans have been made to adapt the building to enable the home to accommodate these service users. The layout & design of the building is multiple levels and only stair access available to these. A medication audit was conducted and a medication round was observed. Staff did not follow safe procedures, the medication cupboard was left unlocked and unattended. Staff were also second dispensing medication. There is no medication trolley available and the medication cupboard is not an approved medication cupboard. Dorriemay House DS0000023391.V253086.R01.S.doc Version 5.0 Page 12 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 The procedure for the handling of service users finances fails to ensure that their money is protected. EVIDENCE: The records of service users financial transactions fails to record all credits and expenditures. The registered provider is appointee for a number of service users and the quality of records raises questions regarding practices and procedures. Some service users receive benefits, these are not entered on to the records. The inspector was informed that these benefits are taken as part of the service users top up fees for living at the home. Dorriemay House DS0000023391.V253086.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 Changes have been made to the size of bedrooms without notification to the CSCI. Management is slow to respond when furnishing are unsafe and not fit for their purpose. Recent improvements to the communal areas have had a positive impact for the service users. EVIDENCE: Some bedrooms have been made smaller to partition the bedroom and the fire escape route. Although these changes have enhanced service users quality of life by promoting privacy as well as maintaining fire exit routes, these changes should have been discussed with the Commission prior to the work being carried out. A headboard for a bed was found to be broken with screws protruding through, the inspector was informed that this had been like this for several days, but no action had been taken to make it safe or remove it. There are some areas of the home would benefit from some refurbishment, however there was evidence that this has started, with new furniture in the dinning room giving a homely feel. Dorriemay House DS0000023391.V253086.R01.S.doc Version 5.0 Page 14 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36 There are insufficient numbers of care staff provided. Carers have the skills and knowledge to fulfil their roles and responsibilities. Recruitment procedures have improved since the last inspection. Staff are not receiving adequate supervision. EVIDENCE: At the time of the inspection there were 24 service users with mixture of needs and abilities. On Mondays to Saturdays there are only 3 staff on duty with one of these cooking and on Sundays there is only 2 carers on duty with on of these cooking. At the night the there is only one waking night staff and one sleep in staff. It was confirmed that these low staffing numbers impacts on service users abilities to fulfil their wishes, such as going out. Staff are also required to cover some ancillary duties. Over 50 of care staff have now completed the NVQ training. Two staff files were assessed, it was not possible to identify when they started work at the home. The other was the most recently recruited member of staff, the file showed that a thorough procedure was used ensuring that all of the required checks were conducted prior to them started work. Although staff receive some formal supervision it is only 3-4 times a year. Dorriemay House DS0000023391.V253086.R01.S.doc Version 5.0 Page 15 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,41,42,43 The home is without clear lines of leadership and management. There are insufficient and inadequate policies and procedures for the managing of the home. Environmental health & safety checks are not conducted regularly and not all of the homes records are kept within the home. EVIDENCE: The home does not have a registered manager and is currently managed by three different people; the registered provider, their son and a senior carer who has taken on the administrative side of the work. This management team expressed their keenness to be lead by the Commission, with the Commission telling them what to do. This helped demonstrated that they were not proactive in their management approach. The Providers son is working toward the Registered Managers Award with a view to becoming the registered manager, it would be anticipated that the knowledge and skills gained from this training is used effectively. Although the National Minimum Standards contains a whole page of policies and procedures that homes should implement, the home only had six pages in a folder for the entirety of the homes policies and procedures. There are no environmental risk assessments
Dorriemay House DS0000023391.V253086.R01.S.doc Version 5.0 Page 16 and no fire risk assessment. Many of the environmental certificates were in date, however there was some confusion as to the last fire engineer checks were done. Some of the confusion was caused by not all of the paperwork being held at the home. Dorriemay House DS0000023391.V253086.R01.S.doc Version 5.0 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 2 2 X X Standard No 22 23 Score 2 1 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 2 2 x Standard No 24 25 26 27 28 29 30
STAFFING Score 2 2 2 2 2 2 2 LIFESTYLES Standard No Score 11 2 12 2 13 2 14 2 15 2 16 2 17 Standard No 31 32 33 34 35 36 Score 2 2 2 3 3 2 CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Dorriemay House Score 2 3 1 1 Standard No 37 38 39 40 41 42 43 Score 1 2 1 1 2 2 2 DS0000023391.V253086.R01.S.doc Version 5.0 Page 18 yes Are there any outstanding requirements from the last inspection? 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. Standard 1 YA1 Regulation 4 5 sch 1 Requirement The statement of purpose and service user guide must be updated in accordance with the National Minimum Standards and the Regulations, to be produced as two separate documents and copies to be sent to the CSCI within 28 days of any amendments made. 1) Detailed pre-admission assessments must be conducted to ensure prospective service users are within the homes registration and their needs can be met. 2) An application for a variation to the registration must be made for those service users admitted over the age of 65 years. 1) Service users care plans must clearly identify all aspects of the care needed (not just physical needs) and provide staff with clear instructions on how to meet those needs. 2) Risk assessment should be produced for all service users, where appropriate. 1) Each service user must have a nutritional assessment completed
DS0000023391.V253086.R01.S.doc Version 5.0 Timescale for action 08/01/06 2 YA2YA3 12 14 15 18 31/01/06 3 YA6YA7YA8Y A9 12 - 17 31/03/06 4 YA17 12 - 17 31/03/06 Dorriemay House Page 19 5 YA20 12-14 16 17 23 sch 3 6 YA22 17 22 sch 4 12 17 20 23 sch 4 7 YA23 8 YA24YA25YA 28YA29 12 13 14 16 23 and regularly reviewed. 2) A second hot option for the main meal of the day must be available/offered. 3) A record of all meals provided must be kept for each service user. 1) Medication procedures must be reviewed. 2) Records must be kept of all medication received in to the home. 3) Staff must ensure safe practices for the handling of medicines and must not second dispense medicine. 4) The home should obtain a current copy of the BNF. The area office address & telephone number of the commission must be included in the complaints procedure. 1) A new format should be developed for the recording of service users money/financial transactions. 2) All service users benefits to be recorded in the records, including money taken as top up of fees. 3) To use a two signature procedure. Previous timescale: 30.05.05 Any changes to the environment must be approved by the Commission prior to work being carried out. 1)The registered provider must develop and implement a maintenance programme and keep records of work completed. 2) To inform the Commission of proposals of work for damp wall at the bottom of the stairway in the basement. 1)All infection control procedures must be reviewed. 2) To determine if alginate bags
DS0000023391.V253086.R01.S.doc Version 5.0 31/01/06 31/03/06 31/01/06 31/01/06 9 YA24YA25YA 26YA27YA28 YA29 12 13 14 16 23 31/03/06 10 YA30 12 13 16 23 31/03/06 Dorriemay House Page 20 11 YA33 18 12 13 YA34 YA35 7 9 19 sch 2 12 13 18 14 15 YA36 YA37YA38 18 19 5 7 9 10 12 18 21 24 16 YA39 10 12 15 24 17 YA40 10 12 15 17 18 YA41 10 12 15 17 13 16 17 23 sch 1-4 19 YA42 can be used in the current washing machines and to review procedure for the handling and transporting of soiled linen. The registered person must review the current staffing levels and ensure sufficient numbers of suitably trained/experienced staff are provided to meet the needs of the service users, including the weekends. To develop & implement an interview record form for prospective staff. To revise the induction programme for new staff, to be in accordance with the Sector Skills Council. All staff must receive formal 1:1 supervision 6 times a year. The registered person and the acting managers must become more knowledgeable of the National Minimum Standards and Regulations and to implement these fully. An annual quality assurance system must be developed and implemented. The report of the collated information to be sent to the CSCI To produce and implement policies and procedures as per Appendix 3, plus any others relevant to the needs of the home. All records must be kept in the registered home and must not be destroyed for a minimum of 3 years from the last date of entry. 1) Hot water must be tested on both baths and hand wash basins. 2) Quarterly fire inspections to be conducted by a specialist contractor and all fire checks to be done in accordance with legislation and recorded in the fire log book.
DS0000023391.V253086.R01.S.doc Version 5.0 31/03/06 31/01/06 31/03/06 30/06/06 31/03/06 05/07/06 05/07/06 31/01/06 31/03/06 Dorriemay House Page 21 20 YA42 13 16 17 23 sch 1-4 12 13 16 17 12 13 15 17 21 22 YA42YA19 YA6 1)To produce and implement environmental risk assessments. 2) To produce and implement a fire risk assessment. For the correct blood glucose testing needles devices to be used by staff. All individual confidential information to be recorded in the individual service users file. Previous timescale: 30.05.05 31/03/06 31/03/06 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Dorriemay House DS0000023391.V253086.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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