CARE HOMES FOR OLDER PEOPLE
Dorrington House Residential Home 28 Quebec Road Dereham Norfolk NR19 2DR Lead Inspector
Mr Jerry Crehan Announced Inspection 19th December 2005 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.V263998.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V263998.R01.S.doc Version 5.0 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 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 (16), Mental registration, with number disorder, excluding learning disability or of places dementia (1), Old age, not falling within any other category (29) Dorrington House Residential Home DS0000015633.V263998.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. There must be at least 2 staff on duty at all times working with the DE service users who have received Dementia Awareness training within the last 2 years. Within its registered numbers the home may accommodate one person aged less than 65 years with a mental disorder. Up to twenty-nine (29) Older people may be accommodated. Up to sixteen (16) people with dementia over 65 years may be accommodated. The total number of service users not to exceed forty-five (45). 2. 3. 4. 5. Date of last inspection 19th July 2005 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. Dorrington House Residential Home DS0000015633.V263998.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection took place over 8.5 hours. Opportunity was taken to tour the premises, look at care records and policies, and communicate with many of the forty-four service users in addition to care staff, deputy managers and the registered manager. Twenty comment cards were received from service users, ten comment cards from relatives and visitors and three comment cards from health and social care professionals in contact with the care home. These largely expressed satisfaction as to the care provided at the home. Any areas of dissatisfaction were explored within the inspection. What the service does well: What has improved since the last inspection?
Requirements and recommendations made at the last inspection have been fully implemented. Changes to the use of communal space in the area of the home providing care to service users with dementia, has helped to create a choice of space for service users with a different ‘ambience’ (or activity) in each area. The employment of a dedicated activities coordinator at the home has helped improve the variety and availability of activities at the home. This has been acknowledged within the home’s newsletter for service users, families and friends, who have been asked to contribute toward reminiscence sessions with
Dorrington House Residential Home DS0000015633.V263998.R01.S.doc Version 5.0 Page 6 service users. This initiative may be of particular benefit to service users with dementia. 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. Dorrington House Residential Home DS0000015633.V263998.R01.S.doc Version 5.0 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 Residential Home DS0000015633.V263998.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4 & 6 Contracts are provided that adequately reflect services provided by the home. The home provides clear information that would assist service users in making an informed choice as to the home’s ability to meet their needs. EVIDENCE: Contracts signed by either service users or their relatives were evident. These appeared to reflect services provided, including the individual room allocated. The home has clear written information available to prospective service users, which would provide them with a good understanding of the home’s capacity to meet individual need, including needs arising from dementia. The home does not provide intermediate care. Dorrington House Residential Home DS0000015633.V263998.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 9 The care planning system is clear and provides staff with the information they need to meet the health and care needs of service users, though social histories require development with service users and their relatives. EVIDENCE: A sample of service user care plans was reviewed. These set out care requirements clearly and in detail and were evidently reviewed on a regular basis and are an informative tool for care staff in individual care delivery. Though an area for further development is undertaking social histories or ‘life story’ work for service users with dementia. Involving service users and their relatives in the construction of life story information for service users with dementia will further improve the quality of care plans as an informative tool for staff in individual care delivery. A care plan for a service user with behaviour that challenges was sampled. The circumstances surrounding medication intervention to manage behaviour were clearly set out. However these were not supported by non-medication interventions that may have been considered beforehand. Care plans also referred to the involvement of a variety of community health professionals. Comments by service users spoken with supported this
Dorrington House Residential Home DS0000015633.V263998.R01.S.doc Version 5.0 Page 10 confirming that they have access to the GP, District Nurse and other professionals as required. There are currently service users accommodated at the home who take responsibility for administering some of their own medication. Safe storage facilities are provided by the home, which staff have access to. These arrangements are assessed and reviewed on an ongoing basis to support service user responsibility for this aspect of their care. Medication records and storage were reviewed and were found to be satisfactory. Dorrington House Residential Home DS0000015633.V263998.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 & 15 The home offers a range of options to satisfy most service users social and recreational needs. Service users are able to exercise choice and control over their lives. Menus in the home offer choice and variety and are taken in pleasing surroundings. EVIDENCE: The home has appointed a dedicated activities coordinator who publishes a weekly programme of activities, which was in evidence at the home. Care staff have responsibility for implementing the majority of the activities specified, and there was evidence of this at the time of the inspection. The majority of service users spoken to appeared aware of the activities on offer, and felt able to decide whether to participate. Eighteen comment cards were received from service users who expressed an opinion as to whether they felt the home provided suitable activities. Fifteen service users indicated that they felt there are suitable activities, three service users thought either that there were not, or that there were sometimes suitable activities provided. Service users indicated that their visitors were made welcome at the home at any time of their choosing, and that they usually saw visitors in the privacy of their own rooms. It is evident that service users are entitled to bring and to keep personal possessions at the home. The home has promoted the use of
Dorrington House Residential Home DS0000015633.V263998.R01.S.doc Version 5.0 Page 12 independent advocates for service users, where necessary, to promote their best interests. Service users gave a good response as to the quality of the food available at the home. A number of service users indicating that there is a good choice and good quality meals available. The meals seen at the time of the inspection looked wholesome and appealing. It was also clear that there were at least two main meal options available at lunchtime. Meals are taken in a variety of communal dining areas or in service users own bedrooms if preferred. There was evidence of the availability of fresh fruit and liquids for service users. It is recommended that this be complemented by the availability of ‘finger foods’ for service users whose mental health needs are such that it is difficult to maintain an adequate diet at designated mealtimes alone. Dorrington House Residential Home DS0000015633.V263998.R01.S.doc Version 5.0 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 & 18 Arrangements at the home for protecting service users legal rights, and for protecting service users from abuse are satisfactory. EVIDENCE: It was apparent that service users have access to relatives or friends, many of whom assist service user in managing their affairs, and that there are no independent advocates currently supporting service users. Service users are able to take part in the political process, voting by postal ballot or in person if preferred. A procedure for responding to allegations of abuse is in place. Staff spoken to appeared aware of the procedure and its function, and had received appropriate training. It is recommended that this procedure is made more readily available for service users and staff at the home. Service users indicated that if they had a concern they would speak to care staff, deputy managers or the manager. Dorrington House Residential Home DS0000015633.V263998.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 21, 22, 23, 25 The home provides a good standard of accommodation with access to appropriate facilities and equipment. EVIDENCE: There are suitable and adequate toilet, shower and bathing facilities. Two minor repairs were noted to these areas, which were otherwise well maintained and clean. There is sufficient equipment available within the home to meet the assessed needs of service users. The practice of assisting service users in wheelchairs without footplates was observed. Wheelchairs should be fitted with footplates unless an appropriate assessment suggests otherwise. Service user own rooms appear to suit the individual needs and preferences of their occupants. Many service users bedrooms were clearly personalised with their own furniture and possessions, creating a homely feel in many rooms. The majority of the bedrooms at the home are designed for single occupancy. Bedrooms are naturally and individually ventilated. All bedrooms and communal areas have natural light with artificial lighting supplementing the
Dorrington House Residential Home DS0000015633.V263998.R01.S.doc Version 5.0 Page 15 available natural light where necessary. An improvement in the way communal areas in the dementia care part of the home are used has helped to create a choice of space for service users with a different ‘ambience’. Christmas decorations throughout the home helped to create a festive atmosphere. Dorrington House Residential Home DS0000015633.V263998.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 & 30 The staff induction and training programme is good and satisfactorily addresses service user needs. The approach of the home toward the training and development of its senior staff is commended. EVIDENCE: Staff files reviewed showed that service users are protected by good recruitment practices and this includes evidence of the carrying out of CRB checks on new staff. Service users are supported by staff access to a good training programme of induction and mandatory training. Competence as to this and other training undertaken is evidently tested in supervision with the manager or supervisor. The manager indicated that deputy managers will be provided with further ‘advanced’ training in dementia care and medication. Senior staff and deputy managers at the home have been supported in undertaking and successfully completing NVQ 3, NVQ 4 and Registered Managers Award training. This, approach, and the approach of the home in general toward training is commended. Dorrington House Residential Home DS0000015633.V263998.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36 & 37 The home is well managed by a competent manager who has the confidence of service users, relatives and staff alike. The home is run in the best interests of service users. EVIDENCE: The registered manager has several years’ management experience and has demonstrated that she is familiar with the conditions associated with old age. She also demonstrates an understanding of the service user group at the care home, and some of the principles underpinning their care. It is apparent through discussion that service users and staff have respect for, and confidence in the manager. There is a clear management infrastructure that supports the registered manager in running the home efficiently. The home employs a variety of measures to systematically monitor quality including monthly staff and service user meetings, a monthly newsletter for service users, relatives and friends of the home, and communication books in
Dorrington House Residential Home DS0000015633.V263998.R01.S.doc Version 5.0 Page 18 every service users bedroom. The manager indicated that she undertakes a daily inspection of the home. Meetings with local surgeries take place on a periodic basis to discuss support and practice issues. Comment cards sent to local GP practices prior to the inspection provided a favourable response. Staff are appropriately supervised and service users further supported by the home’s policies and record keeping. Dorrington House Residential Home DS0000015633.V263998.R01.S.doc Version 5.0 Page 19 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 3 X 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 3 X X 3 2 3 X 3 X STAFFING Standard No Score 27 X 28 X 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 3 X Dorrington House Residential Home DS0000015633.V263998.R01.S.doc Version 5.0 Page 20 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 OP7 Regulation 15(1) Requirement The registered person must ensure that written care plans are prepared with the involvement of service users or their representatives. The registered person must ensure that wheelchairs are maintained in good working order. Timescale for action 19/12/05 2 OP22 23(2)(c) 19/12/05 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 OP15 Good Practice Recommendations It is recommended that ‘finger foods’ are available for service users whose mental health needs are such that it is difficult to maintain an adequate diet at designated mealtimes alone. It is recommended that the ‘whistle blowing’ procedure is made more readily available at the home. It is recommended that the manager consider further personal training and development in dementia care. 2 3 OP18 OP31 Dorrington House Residential Home DS0000015633.V263998.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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