CARE HOMES FOR OLDER PEOPLE
Dorrington House Residential Home 28 Quebec Road Dereham Norfolk NR19 2DR Lead Inspector
Jerry Crehan Unannounced 19th July 2005 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 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 I55 s15633 dorringtonhouse v240257 190705 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Dorrington House Address 28 Quebec Road, Dereham, Norfolk, NR19 2DR 01362 693070 01362 699464 dorringtonhouse@btopenworld.com Mr Steven Dorrington Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 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 I55 s15633 dorringtonhouse v240257 190705 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 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 then 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 accomodated The total number of service users not to exceed forty-five (45) Date of last inspection 25th January 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 I55 s15633 dorringtonhouse v240257 190705 stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 5 hours. Opportunity was taken to tour the premises, look at care records and policies, and communicate with several of the forty-four service users and staff members in addition to the senior staff on duty. What the service does well: What has improved since the last inspection? What they could do better:
A recommendation has been made in the report that consideration be given to the deployment of care staff during afternoon shifts in order that the activities programme is not compromised. There are adequate staff available to service users in the dementia care unit to make better use of the communal space available. Use of the small lounge area in this part of the home could enable service users to undertake small group or individual activities in a communal area, and at the same time enjoy respite from others.
Dorrington House Residential Home I55 s15633 dorringtonhouse v240257 190705 stage 4.doc Version 1.40 Page 6 As indicated in the report medication records and storage were largely satisfactory, however, further improvement is required in order to assist in the safe administration of medicines. 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 I55 s15633 dorringtonhouse v240257 190705 stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Dorrington House Residential Home I55 s15633 dorringtonhouse v240257 190705 stage 4.doc Version 1.40 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 standard(s) 3 & 5 The admission procedure is adequate, providing prospective service users with the opportunity to visit the home where possible. EVIDENCE: The home has an admission procedure that adequately guides the manager or other senior staff responsible for assessment, as to actions to be taken to ensure service users needs are assessed prior to a move to the home. Evidence of this was seen in files reviewed and confirmed by service users spoken to. Some service users also indicated that they had been provided with the opportunity to visit the home prior to moving in. A service user who had not had this opportunity indicated that his ‘wife had visited the home on his behalf’. Dorrington House Residential Home I55 s15633 dorringtonhouse v240257 190705 stage 4.doc Version 1.40 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 standard(s) 7, 9, 10, 11 The care planning system is clear and adequately provides staff with the information they need to meet the health and care needs of service users. Service users health and personal care needs are well attended to, though medication procedures should be improved. EVIDENCE: Individual care plans were reviewed, these were clearly set out with evidence of regular review. A care plan for a service user with needs arising from dementia and moving and handling showed evidence of up to date review, good care planning with appropriate referral to community professionals and clear information for staff to follow. Medication records and storage were reviewed and found to be largely satisfactory. However, issues concerning the non-removal of discontinued medication from the medication trolley were noted. Discontinued medication should be removed in order to assist in the safe administration of medicines. It is recommended that a clearly identifiable storage area is identified for medications due to be returned to the pharmacy within the treatment room in the dementia care section of the home. Observation during the inspection showed that staff had an understanding of how to promote service users privacy and dignity. Communication between
Dorrington House Residential Home I55 s15633 dorringtonhouse v240257 190705 stage 4.doc Version 1.40 Page 10 staff and service users observed was appropriate to the individual needs of service users. Service users spoken with indicated that staff respond quickly to call bells if used. A slight delay in responding to a call bell during the afternoon was noted. However, it is acknowledged that the staff member most likely to respond was speaking with the inspector. The home have recently offered palliative care to service users at their request. This was clearly carried out with care, as it was evident that one service users condition had stabilised. There was evidence of liaison with appropriate community health professionals to manage the needs of these service users, in addition to monitoring of turning, nutrition and fluid intake. Dorrington House Residential Home I55 s15633 dorringtonhouse v240257 190705 stage 4.doc Version 1.40 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 standard(s) 12 & 13 The home offers a range of options to satisfy service users social and recreational needs, though its provision may be disrupted. Visitors are made welcome. EVIDENCE: There is a published programme of activities provided each week at the home. The programme was displayed at various places around the home, and the programme in the dementia care unit was supported by a pictorial representation of the activity taking place. Service users indicated that they take part in activities in the main part of the home if they wish. The activity indicated on the morning of the inspection was a ‘coffee morning’. One service user spoken to said that his main recreation was watching television though indicated that ‘there is nothing else I want’. The published programme for the afternoon was ‘draughts’ taking place in the main lounge at 3pm. However, there was no evidence of this or a similar activity taking place. It was apparent through discussion with staff that staff sickness that afternoon had prevented the published programme from taking place. A ‘friends of the home’ group also arrange and undertake activities, often in the evenings, with service users. Service users indicated that their visitors were made welcome at the home at a time of their choosing, and that they usually see visitors in the privacy of their own rooms.
Dorrington House Residential Home I55 s15633 dorringtonhouse v240257 190705 stage 4.doc Version 1.40 Page 12 Dorrington House Residential Home I55 s15633 dorringtonhouse v240257 190705 stage 4.doc Version 1.40 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 standard(s) 16 Arrangements for dealing with complaints are satisfactory. EVIDENCE: Service users spoken to indicate that they would speak with the manager or with their carers if they had a complaint or concern, and that they felt they would be listened to. Information about complaints is readily available within the home and issued to every service user. The home keeps a record of complaints, which was reviewed at the inspection. Records seen indicate a description of the complaint and action taken as a consequence. It was apparent that responses are provided within 28 days according to the homes procedure. Dorrington House Residential Home I55 s15633 dorringtonhouse v240257 190705 stage 4.doc Version 1.40 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 standard(s) 19, 20, 26 Service users live in a well-maintained and safe environment. The homes varied communal facilities could be further promoted. EVIDENCE: The home appears safe, well maintained and suitable to meet the needs of service users. At the time of the inspection it was evident that appropriate fire and health and safety practices were being observed. Service users have access to a range of indoor and outdoor communal facilities, including an enclosed garden area with a patio. It was apparent that one of the communal areas (with a dining and lounge area) within the dementia care unit is seldom used by service users other than for dining. It is recommended that this area be promoted as an alternative to the main lounge area for service users. Particularly in circumstances where service users in the main lounge area suffering with levels of agitation. The home appeared clean and hygienic throughout. Dorrington House Residential Home I55 s15633 dorringtonhouse v240257 190705 stage 4.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 30 Staff at the home were employed in sufficient numbers to adequately meet service users needs, though deployment of staff in the afternoons requires attention to ensure that the full range of activities can take place. Staff have a very good understanding of service users support needs, and maintain positive relationships with service users. EVIDENCE: There were six members of care staff supporting the forty-four service users living at the home during the afternoon of the inspection, providing a staffing level above the minimum standard required. However, due to unforeseen staff sickness care staff had taken on other duties normally undertaken by absent colleagues. Consequently, it appeared that staff were stretched in their attempts to meet service user need, and as already indicated in this report this had an impact on the availability of the activities programme in the afternoon. Staff rotas seen indicated the allocation of five care staff to support the fortyfour service users for some forthcoming afternoon shifts at the home. This would evidently not be sufficient to meet the level of need of the service users at the home, and it is recommended that consideration be given to the deployment of care staff during afternoon shifts in order that the activities programme is not compromised. However, it is recognised that the rota may not yet be complete. Service users spoken to indicated that they felt they were well looked after and were in safe hands. A good staff training programme of induction, mandatory and other training supports this. There are seventeen care staff who have achieved NVQ 2 training (or above), which comfortably exceeds the 50
Dorrington House Residential Home I55 s15633 dorringtonhouse v240257 190705 stage 4.doc Version 1.40 Page 16 requirement. The home is commended on its efforts to achieve NVQ training for its staff group. Dorrington House Residential Home I55 s15633 dorringtonhouse v240257 190705 stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35, 38 The financial interests of service users are safeguarded by the home’s policy and practice. EVIDENCE: Service users financial interests are safeguarded by others not associated with the home, as the home takes no responsibility for service user monies. Bills for expenditure for hairdressing, chiropody and other services are sent direct to service users. The home seeks to promote the health, safety and welfare of service users, though the matter identified in this report concerning medication removal may compromise this. Dorrington House Residential Home I55 s15633 dorringtonhouse v240257 190705 stage 4.doc Version 1.40 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x
COMPLAINTS AND PROTECTION 3 3 x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x 3 x x 2 Dorrington House Residential Home I55 s15633 dorringtonhouse v240257 190705 stage 4.doc Version 1.40 Page 19 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13(2) Requirement The registered person must take steps to ensure medicines no longer in use are promptly removed in order to assist in the safe administration of medicines. Timescale for action Immediate and Ongoing 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 9 Good Practice Recommendations It is recommended that a clearly identifiable storage area is identified for medications due to be returned to the pharmacy within the treatment room in the dementia care section of the home. It is recommended that the small lounge area within the dementia unit be promoted as an alternative to the main lounge area for service users. It is recommended that consideration be given to the deployment of care staff during afternoon shifts in order that the activities programme is not compromised. 2. 3. 20 27 Dorrington House Residential Home I55 s15633 dorringtonhouse v240257 190705 stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection 3rd Floor, Cavell House St Cripins 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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