Inspection on 17/08/07 for Dorrington House Residential Home

This inspection was carried out on 17th August 2007.

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

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

Other inspections for this house

Dorrington House Residential Home 26/03/07

Dorrington House Residential Home 19/12/05

Dorrington House Residential Home 19/07/05

Dorrington House Residential Home 25/01/05

Dorrington House Residential Home 24/06/04

Dorrington House Residential Home 25/03/04

Similar services:

Claremont House

Firstlings

Fen Road

Dial House Nursing Home

Croxley House

Eversley Nursing Home

Cresta Lodge

Chilton Meadows Residential & Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Dorrington House Residential Home 28 Quebec Road Dereham Norfolk NR19 2DR Lead Inspector Maggie Prettyman Unannounced Inspection 17th August 2007 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 Residential Home DS0000015633.V348999.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 Residential Home DS0000015633.V348999.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dorrington House Residential Home Address 28 Quebec Road Dereham Norfolk NR19 2DR 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) 01362 693070 01362 699464 dorringtonhouse@btopenworld.com www.dorrington-house.co.uk Mr. Steven M Dorrington Mrs Lorraine Dorrington Mrs Lorraine Dorrington Care Home 45 Category(ies) of Dementia - over 65 years of age (45) registration, with number of places Dorrington House Residential Home DS0000015633.V348999.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Fourteen (14) Older People who are named in the Commission’s records 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 forty five (45). Date of last inspection 26th March 2007 Brief Description of the Service: Dorrington House is a care home providing residential care for up to 45 older people including care for up to 16 people with dementia. It is situated close to the centre of the market town of East Dereham. The home comprises purpose built ground floor accommodation in separate wings. Each wing has its own lounge, bathing and toileting facilities. All rooms have en-suite toilet and hand basins. There are two communal dining rooms accommodating most service users at meal times. There are enclosed garden and patio areas that are visible from service user bedrooms. The range of weekly fees is £367 - £442. Dorrington House Residential Home DS0000015633.V348999.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 hours and included a tour of the premises, discussions with residents, visitors and staff and inspection of files and records. The manager was on leave, but a competent deputy manager led the inspection and administrative staff helpfully provided written records. Prior to the inspection the home submitted a detailed AQUAA, 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. People living at the home are treated with dignity and respect. Staff are kind and approachable. One relative said, “They work so hard to make X comfortable here. They have really tried to help her and I am so grateful that they continue to look after her despite her recent significant decline in ability.” One resident said, “It is a real home from home” The home is working to provide a range of activities to meet peoples needs and aims to provide autonomy and choice. Relatives and friends are well supported. The food is good and individual likes and dislikes are catered for. One relative said, “I really appreciate that they give me lunch with my wife on a Sunday. We sit with friends at a small table in a quiet area. It makes a real difference.” 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 Residential Home DS0000015633.V348999.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: During the inspection some matters came to the attention of the inspector that need addressing. Requirements and recommendations made are as follows; Requirements • • • • • A detailed and documented needs assessment must be in place for everyone coming to live at the home An audit of accidents, occurrences and injuries must be kept to identify and eliminate any potential underlying factors 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 full Quality assurance system must be implemented. Recommendations Dorrington House Residential Home DS0000015633.V348999.R01.S.doc Version 5.2 Page 7 • • • • • Omissions in signing for medication in the dementia care unit should be investigated to see if there are underlying training needs or if distraction can be reduced Staff training should be audited to identify clearly when update is required Toiletries belonging to people should be marked with their names 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 Residential Home DS0000015633.V348999.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 Residential Home DS0000015633.V348999.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. Dorrington House Residential Home DS0000015633.V348999.R01.S.doc Version 5.2 Page 10 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 ensure that all aspects of needs assessment required by the standards are covered. A requirement has been made in this respect. The home does not provide intermediate care. Dorrington House Residential Home DS0000015633.V348999.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 good 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. Improvements to care plans required by a previous inspection have been implemented. The home has been working to collate life histories for people to support their dementia care needs. Communication books have been implemented to help families and friends become more involved in peoples care. Dorrington House Residential Home DS0000015633.V348999.R01.S.doc Version 5.2 Page 12 Evidence of continued healthcare support was seen in people’s personal files. Records of access to external health and specialist services are kept so that their access to these services can be monitored. Discussion with a visiting health care professional demonstrated that the home maintains treatment plans well and refers people appropriately for district nursing support. Records of minor accidents, injuries and occurrences are kept on peoples 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, and the senior worker responsible for supervising the system was interviewed. Occasional errors in signing for medication were seen in the dementia care unit. The service would benefit from auditing these omissions to see if they are due to individual training need or to distraction of the staff member during the performance of their duties. A recommendation has been made in this respect. Otherwise the medication system and its administration appear to be well managed, so that people can receive their medication safely and consistently. 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 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. All individual toiletries should be marked with their owner’s names so that they can be sure that other people do not inadvertently use them. A recommendation has been made in this respect. Dorrington House Residential Home DS0000015633.V348999.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. A pleasant enclosed garden area was seen and one person living at the home commented about how much they valued the opportunity to go outside and enjoy the environment and fresh air. Unfortunately, the homes much loved cat has recently passed away. Dorrington House Residential Home DS0000015633.V348999.R01.S.doc Version 5.2 Page 14 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. Of particular note is the support given to partners of people living at the home. Some of them enjoy Sunday lunch with their relative in a smaller, more private dining area. A surprise birthday party was also being planned for one of these regular visitors to the home. A comprehensive newsletter is now being produced to provide information for residents, their relatives and friends. The collation of life histories being worked on by key workers will help support people to have choice and control in their lives. People’s rooms were found to have a range of personal possessions and to be individually furnished and decorated. The kitchen was found to be clean and tidy and the cook on duty was enthusiastic and well informed about peoples individual likes and choices. People said that they like the food and that they are always given generous portions. A list of people’s individual food preferences is prominently displayed in the kitchen, and people confirmed that alternatives are always offered if they do not want the meal provided. The home is to be commended for encouraging at least one resident in helping in the kitchen, and encouraging others to help prepare the dining area for meals if they wish. The homes manager has recently attended a nutrition course, which has led to improvements in diet, nutrition and choice for people living at the home The home does not currently use the MUST system of nutritional assessment. A recommendation has been made in this respect Dorrington House Residential Home DS0000015633.V348999.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 people can express their concerns in a safe and supported way. Staff are trained in Adult Protection so that they can monitor the safety and well being of residents. EVIDENCE: The manager has recently redistributed the homes complaints procedure. 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 to 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 so that people know they can express concerns and be supported in this process. Dorrington House Residential Home DS0000015633.V348999.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. Some aspects of health and safety provision could be improved. Dorrington House Residential Home DS0000015633.V348999.R01.S.doc Version 5.2 Page 17 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. Some areas of health and safety need to be addressed. During the inspection it was seen that; • Output water temperatures are not checked and recorded • Some wheelchairs were found in use without footrests • Spare equipment, including a mattress, was seen in one bathroom making the environment unsafely cluttered and uninviting to use. • The medicines fridge in the dementia care unit temperature is not being checked regularly • The home is in the process of implementing requirements from a recent Health and safety inspection. A requirement has been made in respect of these issues The home has invested significantly in upgrading the dining environment and decoration of other areas recently and is to be commended for this work and effort, in particular the consultation with residents during this process. 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. This matter has been highlighted with residents and their relatives in the most recent newsletter. Inspection of training records and observation of practice during the inspection demonstrated that infection control training and procedures are in place. Dorrington House Residential Home DS0000015633.V348999.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 are consistent, but care needs to be taken that staff supplied by a recruitment agency have their references and qualifications validated. 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 staff are generally recruited and vetted in line with the expectations of the standards. 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 Residential Home DS0000015633.V348999.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 and 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 Residential Home DS0000015633.V348999.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 good quality outcomes in this area This judgement has been made using available evidence including a visit to this service. The home is run by an experienced manager and senior staff team. Quality assurance procedures and some safe working practices could be improved. Dorrington House Residential Home DS0000015633.V348999.R01.S.doc Version 5.2 Page 21 EVIDENCE: The registered manager of the home was on leave when the inspection took place, but made herself available for consultation by telephone during the course of the day. In her absence a team of competent and experienced deputy managers were found to be running the home professionally and in line with its policies and procedures. 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 noted in Requirements elsewhere in this report. Risk assessments were seen in people’s files. Records of accidents, injuries and occurrences are kept but not audited as noted in Requirements elsewhere in this report. Dorrington House Residential Home DS0000015633.V348999.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 3 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 2 18 3 3 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 3 X 2 X N/A X X 3 Dorrington House Residential Home DS0000015633.V348999.R01.S.doc Version 5.2 Page 23 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 OP25 Regulation Requirement Timescale for action 31/10/07 2 OP3 3 OP8 OP38 4 OP19 OP38 Regulation Ongoing Requirement 13(4)(a)(c The registered person must ensure that the ongoing work to provide safety guards for heaters is completed 14 A full and detailed needs 31/10/07 assessment must be conducted and properly recorded for all people before they come to live at the home to ensure that an effective care plan can be drawn up. 13.4(c) The home must record and audit 31/10/07 12.1(a) all major and minor accidents and occurrences so that any potential underlying patterns and trends can be identified and eliminated. 12.1(a) All aspects of health and safety 31/10/07 shortfall identified during the inspection must be addressed and a system put in place so that such matters do not occur in the future. Dorrington House Residential Home DS0000015633.V348999.R01.S.doc Version 5.2 Page 24 5 OP29 19 Schedule 2 6 OP33 24 The home must ensure that validated references and checks are gained on all staff prior to their employment at the home so that service users are fully protected. 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. 31/10/07 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 2 3 4 Refer to Standard OP9 OP10 OP15 OP16 Good Practice Recommendations Signature omission on the medication system should be audited to check for training needs or to identify distractions that can be prevented. All personal toiletries should be marked with the owner’s name so that others do not inadvertently use them. 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 5 OP30 Dorrington House Residential Home DS0000015633.V348999.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 Residential Home DS0000015633.V348999.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!