Inspection on 02/08/07 for Dorrington House

This inspection was carried out on 2nd August 2007.

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

Dorrington House 07/08/09

Dorrington House 11/05/09

Dorrington House 16/10/08

Dorrington House 23/05/08

Dorrington House 16/03/07

Dorrington House 16/11/05

Dorrington House 23/06/05

Dorrington House 06/01/05

Dorrington House 10/08/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Dorrington House 73 Norwich Road Watton Thetford Norfolk IP25 6DH Lead Inspector Maggie Prettyman Unannounced Inspection 2nd August 2007 09:00 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 Dorrington House DS0000027516.V348649.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. Dorrington House DS0000027516.V348649.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dorrington House Address 73 Norwich Road Watton Thetford Norfolk IP25 6DH 01953 883882 01953 889035 dhwatton@btinternet.com www.dorrington-house.co.uk Mr Steven Dorrington Mrs Lorraine Dorrington Vacant Post Care Home 52 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) Category(ies) of Dementia - over 65 years of age (52) registration, with number of places Dorrington House DS0000027516.V348649.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Eight (8) Older People who are named in the Commission’s records may be accommodated. One service user under the age of 65 years, with a diagnosis of dementia, may be accommodated. Any new admissions to the home must be in the category of Dementia (over 65 years of age). Maximum number accommodated not to exceed fifty two (52). Date of last inspection 16th March 2007 Brief Description of the Service: Dorrington House is a purpose built care home providing residential care for up to 52 older people including care for older people with dementia. It is situated close to the centre of the town of Watton and within easy reach of its amenities. The home comprises accommodation on two floors serviced by a shaft lift, stair lift and stairs, with 20 bedrooms on the ground and 32 on the first floor. All rooms have en-suite toilet and hand basins in addition to the home’s communal shower and bathrooms. There are other communal areas including lounges and dining rooms that accommodate most service users at meal times. The home is one of two homes in Norfolk owned by the proprietors. The range of weekly fees is £367 - £442 Dorrington House DS0000027516.V348649.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out using information from previous inspections, information from the providers, the residents and their relatives as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the home and current judgements for each outcome group. This inspection took place over the course of 6.5 hours and included a tour of the premises, discussions with residents, visitors and staff and inspection of files and records. The manager’s post is vacant, so a competent deputy manager led the inspection and administrative staff helpfully provided written records. Prior to the inspection the home submitted a detailed Annual Quality Assurance Assessment, (AQAA), which assisted the inspector in preparation in conjunction with other records and past reports held by the Commission. What the service does well: The home has worked hard to provide an informative and accurate “Welcome Pack” and has a detailed and informative website. Families are kept informed about the home and the newsletter and communication books in peoples rooms help in this process People living at the home are treated with dignity and respect. One relative said, “You cannot fault the staff here at all. They care for “x” so well and are very kind, I know that she is as happy here as she can be, and I am so grateful for that” The home is continuing to work to provide a range of activities to meet people’s dementia care needs and aims to provide autonomy and choice. The food is hearty and wholesome and individual likes and dislikes are catered for. One friend said, “It is good to see that “X” has managed to regain some weight and looks so well. She really enjoys the food here.” The premises are well maintained and the home is clean and fresh throughout. Good staffing levels are in place and staff are trained and competent to do their jobs. Dorrington House DS0000027516.V348649.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Dorrington House has had recent management difficulties and currently has a vacant manager post. This is reflected in the number of requirements and recommendations made in this report. These do not necessarily reflect on the general care of the home or the kindness and competence of the staff working there. Requirements and recommendations made are as follows; Requirements • • • • • • • • A more detailed and structured needs assessment procedure must be developed An audit of accidents, occurrences and injuries must be kept to identify and eliminate any potential underlying factors The medication system must be regularly checked and audited Liquid controlled medicines must be properly recorded Several health and safety issues identified must be urgently addressed All staff employed must have references and credentials validated and in place prior to employment A manager must be appointed as soon as possible A full Quality assurance system must be implemented. Recommendations • • Staff training should be further developed in areas of skin care and dementia care Staff training should be audited to identify clearly when update is required DS0000027516.V348649.R01.S.doc Version 5.2 Page 7 Dorrington House • • • • Toiletries belonging to people should be marked with their names Key workers should be given guidance about supporting people to personalise their rooms A system of nutritional assessment should be implemented Complaints and compliments about the service should be audited to identify areas of good practice and where practice can be improved 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. Dorrington House DS0000027516.V348649.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 Dorrington House DS0000027516.V348649.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): Standards 1, 3 and 6 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People have the information they need to make an informed choice about the home. Needs assessments are always undertaken, but the standard of these can be variable. EVIDENCE: The home has a detailed welcome pack and an informative website. People said that the information given matches the service provided by the home. Needs assessments were found in all files inspected. However the detail contained was variable. The deputy manager on duty confirmed that people are always visited by a senior worker from the home before they come to live there. The form used to record this visit lacks detail and should be expanded to Dorrington House DS0000027516.V348649.R01.S.doc Version 5.2 Page 10 ensure that all aspects of need assessment required by the standards are covered. A requirement has been made in this respect. The home does not provide intermediate care. Dorrington House DS0000027516.V348649.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): Standards 7, 8, 9 and 10 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The health and personal care support that people receive is based on their individual needs. People are treated with dignity and respect. The home can improve its health and personal care standards by auditing incidents and occurrences. EVIDENCE: Service user plans were found in place in all files inspected. These records were complete and up to date and showed evidence of review as well as family involvement. The home has been working to collate life histories for people to support their dementia care needs. Communication books are in place to help families and friends become more involved in people’s care. Evidence of continued healthcare support was seen in people’s personal files. Records of access to external health and specialist services are kept. Records Dorrington House DS0000027516.V348649.R01.S.doc Version 5.2 Page 12 of minor accidents, injuries and occurrences are kept on people’s individual files, but the home does not collate and audit these to determine any underlying group or situational patterns and trends which could enable preventative action can be taken. A requirement has been made in this respect. The storage and recording of medication was inspected. Some errors and omissions were found as follows; • Some signatures were missing • One medication fridge did not have temperature checks • Eye drops were found that were not marked with an opening date or who they were for These errors demonstrated that the medication system is not currently being audited. A requirement has been made in this respect. Inspection of controlled drugs found that accurate records are in place for those in tablet form, however, the liquid medication was not properly recorded. A requirement has been made in this respect. Discussion with people living at the home and their relatives and friends demonstrated that people feel that they are treated with respect and dignity. Observation of care staff and general practice in the home during the inspection supported this. People were seen receiving post unopened, they are addressed by their name of choice and a system of clothes labelling is in place. During the tour of the premises several items of toiletries were found in communal bathrooms unmarked with their owners names. A recommendation has been made in this respect. Dorrington House DS0000027516.V348649.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): Standards 12, 13, 14 and 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home are supported to make choices about their daily lives. A programme of activities is in place and continues to be developed. EVIDENCE: An up to date list of activities was seen displayed around the home. People were seen exercising choice about rising time and where to spend their days. The work being done on life history will help to support people further in enabling them to enjoy activities of their choice. During the tour of the premises one lounge was found to have a radio and TV playing at the same time. This indicates that further training in supporting people with dementia care needs could be undertaken for staff to emphasise environmental influences on quality of life. A recommendation has been made in this respect. Dorrington House DS0000027516.V348649.R01.S.doc Version 5.2 Page 14 One person living at the home maintains full access to the local community. Most other people are helped to maintain contact by community groups visiting the home. Visitors to the home during the inspection confirmed that they are warmly welcomed and supported by the staff at the home. Refreshments and meals are provided to visitors if they wish. The collation of life histories will help support people to have choice and control in their lives. Many people’s rooms were found to have a range of personal possessions. One person had no personalisation of their room despite living at the home for several months. It is important that the key worker system is developed to ensure that support of this nature is given to people if their families are unable to help. A recommendation has been made in this respect. A competent and enthusiastic cook and kitchen team were seen presenting hearty and wholesome food in a careful and professional manner. People said that they like the food and that they are always given generous portions. A list of food preferences is prominently displayed and alternatives are always offered if people do not want the meal provided. The home does not currently use the ‘MUST’ system of nutritional assessment. A recommendation has been made in this respect Dorrington House DS0000027516.V348649.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): Standards 16 and 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. An accessible complaints system is in place so that relatives and service users can raise issues. Staff are trained in Adult Protection which helps protect the people who live at the home. EVIDENCE: The home has dealt with formal complaints according to its policy and procedure since the last inspection. Currently there is no system of auditing complaints. Informal complaints and comments as well as compliments about the service are not recorded centrally or audited. The home would benefit from a system of record and audit so that potential underlying patterns and trends can be identified and addressed. A recommendation has been made in this respect. Staff spoken with understood the principles of adult protection. Training records demonstrated that all staff are trained in this respect. Copies of the whistle blowing procedure are prominently displayed around the home Dorrington House DS0000027516.V348649.R01.S.doc Version 5.2 Page 16 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): Standards 19 and 26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is clean, fresh, well maintained and comfortable so that people have a nice environment in which to live. Some aspects of health and safety provision must be improved. EVIDENCE: A tour of the premises demonstrated that it is well maintained and comfortably furnished. The home is clean and fresh and has a pleasant atmosphere. The home has renewed carpets and flooring in bedrooms, en suites and dining areas. A new fire risk assessment has been undertaken. Some areas of health and safety need to be addressed. During the inspection it was seen that; Dorrington House DS0000027516.V348649.R01.S.doc Version 5.2 Page 17 • • • • • • • A Some fire doors were kept propped open by chairs Output water temperatures are not checked and recorded Wheelchair battery chargers were left in close proximity to a sink in an area where people with dementia care needs may not always be supervised Some wheelchairs were found in use without footrests The laundry door does not have a notice reminding staff to lock it A broken shower chair was in use A broken hoist was not marked as unsuitable for use until repaired requirement has been made in respect of these issues Laundry facilities are good and a system of sorting clothes and labelling are in place. The home demonstrated that it works hard to ensure people’s clothes are cared for and returned to their owners. Inspection of training records and observation of practice during the inspection demonstrated that infection control training and procedures are in place Dorrington House DS0000027516.V348649.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained and skilled and in sufficient numbers to support the people who live there. The standards of recruitment and vetting at the home have not always been consistent. EVIDENCE: Observation of the home during the inspection as well as discussion with staff and examination of rotas demonstrated that the home is well staffed. Training records demonstrated that the home has a good percentage of staff that have gained their NVQ level 2 in care or above. Examination of staff files demonstrated that two references were not always in place, and that references and checks given by an agency providing permanent staff are not validated as being copies of original material gained. A copy of “Safe and Sound” was left at the home to provide guidance for future vetting of staff. A requirement has been made in this respect Dorrington House DS0000027516.V348649.R01.S.doc Version 5.2 Page 19 Examination of staff records and discussion with staff during the inspection demonstrated that a good system of training is in place. It was difficult from records to identify what training is in need of renewal. A recommendation has been made in this respect. Dorrington House DS0000027516.V348649.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38 People who use the service experience adequate quality outcomes in this area This judgement has been made using available evidence including a visit to this service. The manager’s post is currently vacant. Quality assurance procedures could be improved. Safe working practices could be improved. EVIDENCE: The manager’s post is currently vacant and is in the process of being advertised. During the inspection a competent and confident deputy manager demonstrated that the home is being carefully run on a daily basis in the interim. However overall management systems of audit and control are not Dorrington House DS0000027516.V348649.R01.S.doc Version 5.2 Page 21 always being implemented. The new manager will need to address these issues when appointed. A requirement has been made in this respect. Some quality assurance procedures are being adopted by the home. These currently do not mean that a full system of quality assurance is in place. A requirement has been made in this respect. Administrative staff on duty stated that no money is held or managed on people’s behalf by the home. Training records demonstrated that staff are given mandatory training in health and safety matters. Records demonstrating up to date compliance with Health and Safety regulations were seen. Some aspects of daily health and safety need to be addressed as stated elsewhere in this report. Risk assessments were seen in people’s files. Records of accidents, injuries and occurrences are kept, but not audited as addressed elsewhere in this report. Dorrington House DS0000027516.V348649.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X N/A X X 3 Dorrington House DS0000027516.V348649.R01.S.doc Version 5.2 Page 23 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 OP3 Regulation 14 Requirement A comprehensive and structured needs assessment process that meets the standards must be developed and implemented by the home The home must record and audit all major and minor accidents and occurrences so that any potential underlying patterns and trends can be identified and eliminated. The system of medication in the home must be regularly checked to ensure that medicines are being dispensed safely and consistently. All controlled liquid medication must be accurately recorded and accounted for to ensure that the system is not open to abuse. All aspects of health and safety shortfall identified during the inspection must be addressed and a system put in place so that such matters do not occur in the future. The home must ensure that validated references and checks are gained on all staff prior to DS0000027516.V348649.R01.S.doc Timescale for action 30/09/07 2 OP8 OP38 13.4(c) 12.1(a) 30/09/07 3 OP9 13.2 30/09/07 4 OP9 13.2 30/09/07 5 OP19 OP38 12.1 (a) 30/09/07 6 OP29 19 Schedule2 30/09/07 Dorrington House Version 5.2 Page 24 7 OP31 8 8 OP33 24 their employment at the home so that service users are fully protected. A manager must be appointed as soon as possible so that the home has consistent overall management. The home must implement an overall system of quality assurance so that current and prospective service users can have information about how well the home is performing. 30/12/07 31/03/08 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 OP30 Good Practice Recommendations Ongoing recommendation Further staff training is recommended in the following ‘specialist’ areas: Skin care, particularly in moving and handling and the prevention of pressure sores. Continuing to review staff training needs for those people for whom English is a second language. Further training for all staff in ‘quality of life’ issues, particularly around choice and environmental influences on dementia care. All personal toiletries should be marked with the owner’s name. Key workers should be given guidance about how and when to assist people with personalising their rooms. The home should introduce a system of nutritional assessment. A record and audit of complaints comments and compliments about the service should be kept to identify patterns and trends as well as areas of good practice at the home. An audit of training should be kept so that training update need is clearly and easily identified 2 3 4 5 OP10 OP14 OP15 OP16 6 OP30 Dorrington House DS0000027516.V348649.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Dorrington House DS0000027516.V348649.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!