Inspection on 23/05/08 for Dorrington House

This inspection was carried out on 23rd May 2008.

CSCI found this care home to be providing an Poor service.

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

Other inspections for this house

Dorrington House 07/08/09

Dorrington House 11/05/09

Dorrington House 16/10/08

Dorrington House 02/08/07

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Dorrington House 73 Norwich Road Watton Thetford Norfolk IP25 6DH Lead Inspector Kim Patience Unannounced Inspection 23rd May 2008 09:30 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 Dorrington House DS0000027516.V365276.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.V365276.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 Position vacant 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.V365276.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 2nd August 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 three homes in Norfolk owned by the proprietors. The range of weekly fees is £367 - £442 Dorrington House DS0000027516.V365276.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. To complete this inspection we looked at information collected since the last inspection. Three inspectors conducted a site visit and we looked at medication, the premises, the records relating to people living in the home and records relating to staff. We talked to residents, visitors and staff. We observed daily life in the home and what was happening for the people who live there. This home is registered for people who have dementia type conditions. This means that many people are not able to verbally express their experience of life in the home. However, we talked to people and observed their responses in order to include the experiences of people living in the home. What the service does well: What has improved since the last inspection? Since the last inspection the home has appointed an acting manager, which has helped in providing some management and leadership in the home. Staff said they felt well supported by the management team. Some new equipment has been purchased and some new good practice policies and procedure have been implemented. The provision of training in specialist areas has increased and will enhance the skills and knowledge of staff. Dorrington House DS0000027516.V365276.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Dorrington House DS0000027516.V365276.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dorrington House DS0000027516.V365276.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good as people who wish to live in the home are provided with information about the service and have their needs assessed to ensure the home has the capacity to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: To assess the homes admission procedures we looked at the records relating to one person recently admitted to the home. Due to the person’s cognitive limitations they were unable to tell us what their experiences of coming to live in the home had been. However, the administrator told us that all people wishing to live at the home are given a brochure and a welcome pack that includes information about the services provided. They were also invited to bring their relatives and look at the accommodation. Dorrington House DS0000027516.V365276.R01.S.doc Version 5.2 Page 9 We looked at the records relating to the person recently admitted. We saw a pre-admission assessment that provided sufficient information for care assistants to meet the persons needs before the full care plans were written. Dorrington House DS0000027516.V365276.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is poor. People living in the home do not experience positive outcomes in this area as their health and care needs are not properly assessed and met. Medication management practices mean that people’s health and welfare is not being safeguarded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the care records relating to seven people who live in the home and compared the records against observations of those individuals. Due to the varying degrees of cognitive impairment it was not always possible for people to tell us what life in the home is like. The care records relating to each resident were kept in separate files locked away in the treatment room in two areas of the home. There are some residents who spend the day in Bluebell Wood, (an area of the home that accommodates people with more severe dementia), but live in the other part of the home. Their records were not kept in Bluebell Wood and, therefore, Dorrington House DS0000027516.V365276.R01.S.doc Version 5.2 Page 11 were not readily available to staff who may need to access information about their assessed needs and how they should be met. The records contained an identifying photo of the resident and some personal information. However, there was a lack of detail relating to people’s personal and social information. For instance, in one case a section titled ‘family’ was followed by ‘they live close by’ and no information about names and relationships. Where it stated ‘activities’ it was followed by ‘likes company’. Each resident has care plans and associated assessments, but the care plans did not necessarily cover all needs. For instance, for one person there was an identified need for nighttime continence support, but no care plan was written as to how staff should assist the person in this area. Staff said the person has continence aids at night, but this was not apparent in the records. Some of the care plans were generic pre printed plans, which means that they are not individualised. In some cases care plans had been evaluated and updated, but in others they had not. For instance, one resident’s needs had changed significantly over the few days before this visit, but the care plans had not been changed to reflect the person’s current needs and how staff should meet them. This resident was observed and needed some support to eat a meal at lunchtime, but the support was not provided and the meal was not eaten. There were some inconsistencies in care planning. For example, information gathered at an earlier stage had not been transferred effectively to new care plans. In one person’s care records an earlier entry said he needed full support with mobility, then later said no support; another entry said he used a walking stick, but this was not with him when he was walking around and was seen in his room. In another person’s care records, the care plan stated that they needed assistance with personal care then in the care plan summary said the person was independent with personal care. Observations of the person showed that some assistance is needed, but may not always be given. For example, the person appeared as though he had not shave for at least one day and his clothing was soiled. The records looked at contained little information about how to meet people’s individual social and emotional needs. There was a tick list ‘social page’, but was not person-centred and did not show activities based on people’s previous experiences. This is essential in the case of people with dementia who cannot communicate their needs in this respect. During observations many residents were asleep in the lounge and others were walking up and down the corridors in and out of other people’s rooms. Dorrington House DS0000027516.V365276.R01.S.doc Version 5.2 Page 12 People’s weights are being monitored monthly. However the home does not have an effective nutritional needs screening tool in place. Therefore people’s nutritional needs are not being adequately assessed and met. For instance, one resident’s records showed gradual weight loss over several months but there was no action plan or care plan in place to ensure that the weight loss is addressed and nutritional intake is increased. Some risk assessments were seen, but they did not cover all risks. Observations of some residents were completed and risks associated with their behaviours were identified. However, when looking for the risk assessments in the records they could not be found. For instance, a resident was exhibiting behaviour that was disturbing other people but no risk assessment was written here. Another resident was walking into other people’s rooms and taking things out but there was no risk assessment written or care plan as to how staff should protect this person and others. Another resident’s records show that the person has had several falls but there was no falls risk assessment or care plan in place. Staff spoken with said that care plans did not offer guidance as to how people’s needs should be met. They did not feel supported or adequately trained to deal with ‘challenging behaviours’ and very often felt threatened by residents and, therefore some staff are reluctant to offer support to people where needed. Staff also said that people from other parts of the home were brought down to Bluebell Wood to spend the day as their behaviours were not manageable in other parts of the home. This has meant that they have a high concentration of people with behaviours that staff find challenging and have no guidance about how best to support people. The inspection of the medication standard was conducted at the same time by the Commission’s pharmacist inspector. We found there are widespread concerns in the way the home is handling and administering medicines for people who live at the home. When observing medicines being given to people in Bluebell Wood at lunchtime we saw staff following unsafe procedures. In addition, a person living at the home was given a medicine of a potentially sedative nature by a member of staff. The medicine is prescribed for administration to this person at the discretion of staff but there was no apparent need because the person was not exhibiting behavioural disturbance. There was inadequate guidance available for staff to refer to when considering the use of the medicine. Records indicate staff were giving this medicine to the person routinely and not only when needed. There are failings in the home’s medication record-keeping practices with some gaps in records for medicine administration. We also identified discrepancies where records are not showing medicines are being given to people as Dorrington House DS0000027516.V365276.R01.S.doc Version 5.2 Page 13 prescribed. Records showed that some medicines are not being obtained in time to give them to residents as scheduled placing their health and welfare at risk. There are containers of eye drops that were in use longer than their expiry times. Medicines requiring refrigeration are sometimes being stored at temperatures significantly below the accepted temperature range. The cabinet used to store controlled drugs is not compliant with the Misuse of Drugs Regulations. We were told members of staff have received training. The home showed us a computerised record for most, (but not all), staff said to be authorised to handle and administer medicines. However, the home is not able to demonstrate by providing certificates of attendance that members of staff have received training. In addition, the home cannot show that the competence of care staff is being monitored and regularly assessed. A full pharmacy inspection report has been sent separately to the registered provider and is available on request. Dorrington House DS0000027516.V365276.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is poor. People living in the home cannot be assured that lifestyle matches their expectations, social and emotional needs. The home does not demonstrate that choice and control is promoted. This means that people with dementia may not experience fulfilment and a sense of well-being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As mentioned in the health and personal care section, social care plans are not individualised and are not based on people’s previous life experiences. People displayed behaviours that demonstrate there is a lack of occupation and stimulation. For instance, long periods of time asleep, shouting out constantly and walking around the home in and out of other people’s rooms taking their personal items. However, a list of activities was seen on the board and there was some evidence of activities that had taken place such as arts and crafts. But staff need training and guidance as to how they can engage people in meaningful occupation and stimulation as opposed to trying to get people involved in Dorrington House DS0000027516.V365276.R01.S.doc Version 5.2 Page 15 activities that may not be of interest to them. Staff said in addition to being concerned about working with people because of their ‘aggressive behaviours’ more often than not there were only 2 members of staff in Bluebell Wood with up to 21 people to care for during the day. On occasions at break times there was only one member of staff so there was little available time to spend with people on one-to-one activities. The home employs a cook and a kitchen assistant who work up until 2.30pm. At teatime meals are prepared by the care assistants who also clear up afterwards. In the main dining room the table were being set at 11.30am, some residents were already seated at the tables having drinks. There were 17 people in this area and no staff were seen other than the cook and kitchen assistant for at least 10 minutes. Tables were being prepared for lunch with placemats and cutlery. The majority of people were sleepy and at least 8 were asleep, this may indicate a lack of stimulation. In Bluebell Wood lunch was being served in the conservatory at approximately 12.30 from a hot trolley. Staff said there was not enough room to seat everyone so some people had to eat in the lounge or in their rooms. The tables in this area were not set prior to lunch and there were no place mats or other dining equipment in place. Lunches were served from the trolley and knives and forks were provided at the same time. The meal served was fish and chips. Some people had mash potato and beans some had scrambled egg. Staff were unable to provide people with drinks during lunch as they did not have enough glasses for everyone. There were a number of people needing assistance with their meals and there were not enough staff to support with this. One member of staff was seen to move between residents offering as much help as she could. People were not being adequately supervised and one resident was observed to take food from another person’s plate. A member of staff saw this happening and approached the resident in a firm manner saying that is ‘naughty’ and tapping her on the hand. Another resident needed assistance and did not get it, therefore went without her meal. Another fell asleep during the meal. People spoken with said they enjoyed the food. On relative spoken with later said the food was not always good. Menu planning is completed by one of the owners. The menus are drawn up from information on people’s likes and dislikes. The home also asks family members what people’s preferences are. There is one meal on the menu each day apart from Tuesday when there are two choices. However, the cook will prepare an alternative when the resident does not want what is on offer. It is not clear how the home ascertains what residents’ want in advance of the meal being served. The teatime list is much more varied and offers choice. Dorrington House DS0000027516.V365276.R01.S.doc Version 5.2 Page 16 The home does not keep dietary intake records for the main meal of the day only for meal choices at teatime. During the visit relatives were seen coming in and out of the home. Some were spoken with and said that their experience of visiting had been good. One person visited everyday and felt the care was good. The only comment to make was that ‘staffing levels were sometimes low’ but staff do the best they can’. It is not clear how choice and autonomy is promoted. There is evidence that choice is not always given such as meals, where people wish to eat and how they would like to spend their day. Dorrington House DS0000027516.V365276.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. People are aware of the systems in place for making complaints and protection. However, adult protection issues have not been reported by the home. This means that people’s health and welfare is being safeguarded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints policy and procedure. A statement referring to this is included in the service users welcome pack. The complaints procedure is displayed in the entrance hall, but needs updating to include the social services access team and the commission’s details. The complaints procedure is not advertised in any other part of the home. Relatives spoken with said they knew who to speak to if they wished to raise a concern. The home has not received any complaints since the last inspection. However, the Commission has been made aware of several concerns that were passed to the home for investigation. The home investigated these in accordance with the complaints procedure, but did not necessarily reach a satisfactory outcome. Dorrington House DS0000027516.V365276.R01.S.doc Version 5.2 Page 18 There has also been one adult protection investigation. The outcome of the investigation showed concerns in relation to the lack of proper care planning, record keeping and assessment of risk. During the visit an adult protection matter was identified. The records relating to one resident showed that there were concerns about the person’s behaviour that placed them and others at risk. The matter was not referred to safeguarding adults and therefore people were being placed at risk. Staff were interviewed about their knowledge of adult protection. All staff have been trained in adult protection and showed some understanding of the issues. Most were provided with refresher training using videos. Some, but not all, were aware of the policy and procedure and where they could locate it if needed. All staff spoken with knew of the whistle-blowing procedure and said they would use it to protect people. Dorrington House DS0000027516.V365276.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, 25 and 26 Quality in this outcome area is poor. People who live in the home do not have a safe internal and external environment to live in. This means that people’s health and safety is not safeguarded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We completed a tour of the premises. We found that the home has a good range of communal and private accommodation on two floors. Access to the upper floor is via the stairs or by using the lift. People do not have independent access to the upper floor via the stairs but can use the lift if they know how. There are several communal lounges, but most people only use the two main lounges/dining room on the ground floor. Dorrington House DS0000027516.V365276.R01.S.doc Version 5.2 Page 20 The home appeared to be tidy and nicely decorated. There were no unpleasant odours and the home was reasonably clean. However, there were some areas where the cleanliness could have been better. For example, the carpet upstairs that was heavily stained and some of the bathroom floors were soiled. One bathroom entered had fresh blood on the floor and the home had not taken immediate action to remove it in line with safe infection control procedures. At least one bathroom did not have a lock on the door and could be entered easily if someone was inside. There were also some communal toilets that had bolts on the outside and could not be entered if needed. People we spoke to said the home was generally kept clean and tidy. Some of the bathrooms contained unnamed toiletries and products that could place people with dementia at risk. We entered some of the bedrooms and found similar products in people’s ensuites. For instance we saw razors and denture cleaning tablets. There were no risk assessments in place to ensure that steps were taken to protect people from harm. The rooms we entered appeared to be personalised and homely. Some people had televisions and some had music systems. People we spoke to said they liked their room and had everything they needed. The home has some signage to assist people with orientating around the building and some identifying the communal bathrooms. However, there was no signage directing people to their rooms and to the communal lounges. Several people were seen trying to orientate around the building without success. On the day of the visit the clock in the main lounge/dining room was not working and had stopped at 4.10pm. This does not promote time orientation. Some of the resident’s rooms had pictures and names on them but not all and some were not named at all. In Bluebell wood access to the outside is poor. From the conservatory there is a step and people with mobility problems or poor cognition may find it difficult to negotiate this. Once outside the ground is uneven and unsafe. The seating in the garden is not suitable for older people and may place people at risk. On the day of the visit no residents were seen outside and it was a nice sunny day. Dorrington House DS0000027516.V365276.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is poor. People living in the home cannot be assured that their needs will be met by adequate numbers of competent staff. This means that peoples health and welfare is not being promoted and safeguarded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the visit we were informed by the acting manager that there were 49 people living in the home. The home is registered for 52 people with dementia. The manager stated that they assess the dependency levels of people living in the home and decide how many staff are required to meet people’s assessed needs. The home’s target staffing levels were said to be 8 in the mornings, 7 in the afternoons and 4 at night. We assessed the staffing levels by analysis of the home’s staffing rotas for a two week period in May, observations of people living in the home and how their needs are met by staff, what staff told us, what people who live in the home could tell us and what visitors to the home told us. We also considered the layout of the building. The rotas showed that the numbers of staff on duty each shift did not meet the home’s staffing targets on any occasion during the two weeks. 42 of shifts in the morning were covered by 6 staff or less, 35 of the shifts in the afternoon Dorrington House DS0000027516.V365276.R01.S.doc Version 5.2 Page 22 were covered by 5 staff or less and 42 of the night shifts were covered by 3 staff. Staff told us that at times they were unable to meet people’s needs due to the low numbers of staff on duty each shift. They said at times there was only one member of staff on duty in Bluebell to support up to 21 residents with dementia and they found it difficult to cope at these times. One relative spoken with said the staffing levels were low at times and he knew staff found it a challenge to meet people’s needs effectively. We observed people upstairs walking around the corridors, in and out of other people’s rooms and no staff to supervise them. We also observed people upstairs in a state of distress needing support and no staff to attend to their needs. We observed people in other parts of the home who lacked stimulation and occupation resulting in them either being asleep or seeking attention. People were observed to be at risk with no way of contacting staff and no staff to attend to them. Staff are being provided with training in all the key areas such as moving and handling, first aid, infection control and dementia awareness. Senior staff have received training in the Mental Capacity Act, but care staff have not yet undertaken the training. Staff said they were provided with sufficient training, but often found it difficult to translate into practice. For instance, staff have received training in managing challenging behaviour, but are still unable to understand and deal with it. Staff recruitment procedures were checked and found to be satisfactory. Dorrington House DS0000027516.V365276.R01.S.doc Version 5.2 Page 23 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): 31,33,37, and 38 Quality in this outcome area is poor. People living in the home cannot be assured that it is being managed in a way that promotes their health and welfare. This means the service is not currently being managed effectively. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has not had a registered manager since May 2007. However, they do have an acting manager who has not held a registered managers position before. There are also 3.5 deputy managers. People we spoke with said they knew who the manager is and would feel able to approach the management team if they had anything they wished to discuss. There have been concerns about the overall management of the home, which have been discussed with the provider. The Commission has been given Dorrington House DS0000027516.V365276.R01.S.doc Version 5.2 Page 24 assurances that the providers would manage the home to ensure that standards are improved. Despite this the standards at the home have declined. The home’s quality assurance process was not fully assessed on this occasion. However, the home is not completing regulation 26 visits and this system of self-monitoring the quality of the service is not in place on a regular monthly basis. In addition, the home has not met the requirement of the last inspection. Accident records were inspected and we found that the home is recording the incidents, but not following up with an effective action plan to stop further occurrences and protect people from harm. In addition we found that the home has not been reporting serious incidents to the Commission in accordance with regulation 37. The home has completed a fire risk assessment and fire safety checks are being completed. In November 2007, following a complaint, the home was visited by the environmental health inspector who found some concerns in relation to manual handling, stress, inadequate hot water and the lack of proper procedures to prevent the risk of legionella disease. These matters have now been dealt with. A number of health and safety concerns have been highlighted in this report. For instance a lack of risk assessments and products that are potentially hazardous. Dorrington House DS0000027516.V365276.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 2 2 2 3 3 3 2 STAFFING Standard No Score 27 1 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X X X 1 1 Dorrington House DS0000027516.V365276.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation Requirement Timescale for action 31/07/08 2. OP7 3. OP8 4. OP12 5. OP9 15.1, 15.2 People who live in the home (a)(b) must have their needs fully assessed and written into care plans so that staff know how needs should be met. 13.4 (c) People who live in the home must have risks associated with their daily living assessed and written into plans so that action can be taken to minimise or eliminate risks to their health and safety. 12.1(b) People who live in the home 17.1(a) must have their nutritional needs assessed and written into a plan of care so that staff know how to meet peoples nutritional needs. 16.2(m)(n People who live in the home ) must have their social and emotional needs assessed and written into an individualised plan so that staff know how their needs should be met. 13(2) People who live in the home must have their medicines administered safely so that their health and welfare is safeguarded. This requirement made at the inspection DS0000027516.V365276.R01.S.doc 31/07/08 31/07/08 31/07/08 20/06/08 Dorrington House Version 5.2 Page 27 6. OP14 7. OP15 8. OP15 9. OP15 10 11. OP18 OP20 12. OP22 13 OP25 14. OP26 02/08/07 remains unmet. People who live in the home must be offered choices in respect of the way that they live and be encouraged to make decisions about how they wish to conduct their lives. 16.2(i) People who live in the home must be provided with meals in a way that promotes a positive experience of dining so that it encourages good nutritional intake and well-being. 16.2(i) People who live in the home who need assistance to dine must be given support in a sensitive and discrete manner so that their sense of well-being is promoted and good nutritional intake is maintained. 17.2 People who live in the home must have their daily dietary intake recorded so that their daily diet can be monitored and action taken in response to needs. 13.6 People who live in the home must be safeguarded from harm so they are protected. 23.2(o) People who live in the home must have safe access to the outdoors with appropriate seating to meet their needs so that their health and well-being is promoted. 23.2(n) People who live in the home must have an environment that promotes independence so that their health and well-being is enhanced. 13.4(a)(b) People who live in the home must have an environment that is free from hazards to their safety so that they are protected from harm. 16.2(j) People who live in the home must have an environment that is hygienic so that their health 12.2 12.3 DS0000027516.V365276.R01.S.doc 31/07/08 31/07/08 31/07/08 31/07/08 31/07/08 31/07/08 31/07/08 31/07/08 31/07/08 Dorrington House Version 5.2 Page 28 15. OP27 18.1(a) 16. OP31 8.1, 9.1 17. OP33 26 18. OP38 37 19. OP38 13.4 and welfare is safeguarded. People who live in the home must have their needs met by adequate numbers of competent staff so that their health and well-being is promoted. This requirement made at the inspection 02/08/07 remains unmet. People who live in the home must be assured that the home is managed by a person who is competent and fit to do so. So that their health and welfare is safeguarded. This requirement made at the inspection 02/08/07 remains unmet. People who live in the home must be assured that there are systems in place to self-monitor the quality of the service so that their health and well-being is safeguarded. This requirement made at the inspection 02/08/07 remains unmet. People who live in the home must be assured the management will report any serious incidents to the appropriate agency so that their health and welfare is safeguarded. People must be assured that they live in a safe environment and that risks to their safety are eliminated so they are protected. 31/07/08 30/09/08 31/07/08 31/07/08 31/07/08 Dorrington House DS0000027516.V365276.R01.S.doc Version 5.2 Page 29 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. 2. 3. 4. 5. Refer to Standard OP10 OP7 OP15 OP16 OP16 Good Practice Recommendations All personal toiletries should be marked with the owner’s name so that choice and autonomy is promoted. Staff should ensure they have easy access to the records relating to people they are caring for in the various parts of the home The home should find a way of ensuring that people have a meaningful choice of meals that are based on their choices and preferences. The home should update the complaints procedure to include details of other agency people can contact if not satisfied with the outcome of a complaint investigation. The home should advertise the complaints procedure more widely within the home. Dorrington House DS0000027516.V365276.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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.V365276.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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