CARE HOMES FOR OLDER PEOPLE
Dorset House Coles Avenue Hamworthy Poole BH15 4HL Lead Inspector
Trevor Julian Unannounced 1,3 and 5th July 2005 13:30 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. Dorset House D55 S4044 Dorset House V229063 010705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Dorset House Address Coles Avenue, Hamworthy, Poole, Dorset, BH15 4HL 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) 01202 672427 01202 673239 dorsethouse.thedorsettrust@virgin.net The Dorset Trust Care Home 52 Category(ies) of OP - 44 registration, with number MD(E) - 8 of places DE(E) - 8 Dorset House D55 S4044 Dorset House V229063 010705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Being 52 in the category OP (Old Age) including up to 8 in the categories DE(E) and/or MD(E). Date of last inspection 17 January 2005 Brief Description of the Service: Dorset House is a residential care home registered with the Commission for Social Care Inspection to accommodate a maximum of 52 people (44 old age 8 specialist places). The home is located in Hamworthy and is close to local shops libraries and churches. Local bus services operate from outside the home into the centre of Poole. The home offers accommodation on the ground and first floors, a passenger lift is available for people with mobility problems. Three bedrooms on the first floor offer en-suite toilets, there are two double rooms on the first floor the remaining 33 rooms are single. The other 15 bedrooms are on the ground floor. Communal lounges and dining areas are provided on both floors, as are specialist baths. Dorset House is part of Care South, a not for profit organisation, providing independent care services across Dorset. Dorset House D55 S4044 Dorset House V229063 010705 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on: 1st July 2005 13:30-17:10. 3rd July 2005 13:30-15:50. 5th July 2005 09:30-12:00. The time taken for the report process including travelling time, preparation, site visit and report writing totalled 21 hours. During the visit information was gathered through discussion with the manager, residents, staff and visitors. Further evidence was obtained through a tour of the premises and a review of records and procedures. Since the last inspection the organisation had rearranged the management of several homes, as a result the home’s manager had moved to another home and the manager Joan Nickson had moved to fill the vacancy. For the purpose of this report the terms resident and service user are interchangeable. What the service does well:
New residents were admitted only after staff had carried out an assessment to ensure that all needs could be met. This was confirmed by records, residents and visitors. Care plans were developed from the initial assessment and subsequent reviews. The home worked closely with the local GP practice and staff had a good relationship with the community nurses visiting the home. Medication was safely stored and distributed to the residents. People living at Dorset House said the staff were kind, supportive and dedicated. Several members of staff were in the home on their day off to help with the preparations for the annual fete. Residents said there was plenty to do in the home and they often had visiting entertainers. Excursions took place during the warmer weather for those who wished to go out. Several people were able to go out independently and others enjoyed trips out with their family. During the inspection one resident was off to watch tennis with her daughter. Residents said they were encouraged to join in activities but that there was no compulsion.
Dorset House D55 S4044 Dorset House V229063 010705 Stage 4.doc Version 1.30 Page 6 Several visitors said they often visited the home and they were always made welcome at any time, most added that they were frequently offered refreshments if drinks were being served when they visited. Residents said the quality and variety of food was very good. Meals were served in the dining room or in the individuals’ own room on request. During the afternoon several people were in the dining room meeting with visitors and enjoying the quietness of the room. Records showed that the staff monitor nutritional intake if they notice a problem. The home had a complaint’s procedure which was posted in the main hallway on the ground floor. Residents and visitors said they were able to raise concerns with the staff and management. One person said she had discussed some care issues with the deputy manager and that had helped to resolve her concern. Staff were trained in how to respond to Adult Protection concerns. Those spoken to during the visit were aware of their responsibilities. The rooms at the home were of a variety of sizes. The home was well maintained. Rooms had been personalised by the occupants. The home had its own laundry with commercial washing and drying equipment staff had been trained in infection control. Staffing levels were appropriate to the care needs of the residents. There had been an increased reliance on agency staff to cover vacant shifts. What has improved since the last inspection? 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.
Dorset House D55 S4044 Dorset House V229063 010705 Stage 4.doc Version 1.30 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 Dorset House D55 S4044 Dorset House V229063 010705 Stage 4.doc Version 1.30 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. Standard 6 Intermediate care was not offered at Dorset House and was therefore not assessed. No one is offered a placement until an assessment of needs had been completed to ensure that those care needs can be met within the home. EVIDENCE: The files of four residents were checked each contained an assessment completed prior to admission. The file for the most recent admission included a pre-admission assessment agreed and signed by the carer. Visitors confirmed that assessments had been carried out before admission and that the home had confirmed that they would be able to meet those care needs. Dorset House D55 S4044 Dorset House V229063 010705 Stage 4.doc Version 1.30 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, 8, 9 and 10 Care plans were in place to inform staff how needs were to be met. Clinical needs were managed with support form the community health team. Medication procedures ensured that items were safely stored and administered. Staff treated residents in such a way as to uphold their basic rights as individuals. EVIDENCE: The files of four residents were checked. Each contained a care plan risk assessments. There was evidence of monthly reviews and there was a short term care plan used to identify any changes in need. The care plans were based on the pre-admission assessment and there was evidence that the residents and their families were involved in the review process. During the visit a community nurse said that her practice held two surgeries in the home each week. This allowed them to be proactive with the healthcare of the residents and they were able to respond quickly to any concerns the staff had about individual residents. She added that she felt the home was very
Dorset House D55 S4044 Dorset House V229063 010705 Stage 4.doc Version 1.30 Page 10 good and communication links between the practice and the staff at Dorset House was very good. She felt that the levels of referral were appropriate. There was evidence that the home referred out for community health support one resident was referred a consultant following a series of falls. Residents and visitors said that the staff arrange for GP visits as needed and a chiropodist visited the home regularly. Medication was safely stored; temperature sensitive items were kept in a lockable fridge with the maximum and minimum temperatures recorded to ensure the fridge was operating correctly. There were photographs on file to aid identification. Only senior staff administered medicine. The records seen were up to date and in good order. It was recommended that when handwritten additions or alterations were made to the records that they should be checked and countersigned to avoid transcription errors. Residents and visitors were satisfied with the medication system one person added that the staff were very thorough when dealing with their medication. The residents and visitors said that the staff were always kind and helpful some said that the emergency bells were answered promptly others had not used the alarm or could not recall using it. Residents felt they were well treated with dignity and respect. During the visit a friendly and supportive atmosphere was observed. Dorset House D55 S4044 Dorset House V229063 010705 Stage 4.doc Version 1.30 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) 12,13,14 and 15. The home’s activity programme allows residents to follow their preferred pastimes. The home encouraged contact with the community, family and friends to help the individuals not to feel isolated. Residents were encouraged to exercise as much choice as their circumstances allow to help them feel valued. Meals were provided in suitable surroundings, the menu offered good levels of choice and the food was appetising to encourage a healthy nutritional intake. EVIDENCE: During the Friday afternoon visit the home was getting ready for it’s annual fete. Residents were helping the activity organiser with the raffle and several staff were in the home on their day off to put the finishing touches. Funds raised were put towards birthdays and Christmas presents and excursions. Residents commented that there was always something going on and that there were visiting entertainers. Several residents were able to go out either independently or others with assistance from friends and families. Records showed that the social preferences were considered during the pre-admission assessment to ensure those could be met. One visitor said the staff tried to
Dorset House D55 S4044 Dorset House V229063 010705 Stage 4.doc Version 1.30 Page 12 encourage residents to join in with activities but felt there should be more compulsion to reduce the risk of isolation, the resident said she preferred her own company and was happy to know there were things going on if she wanted. The home had well maintained gardens with seating areas, these were being enjoyed by several residents and visitors during the inspection. During the visit there was lots of visitors coming and going. All said that they were always made welcome and the staff and management were approachable. The home did not manage the finances for any of the residents although they did hold personal allowances for most of the residents. One family said they checked the personal allowance records from time to time and they were always in order. An audit of four allowances showed the balances held matched with the transaction records and receipts. The home had internal procedures to carry out their own checks. None of the residents used external advocacy but information was available in the home and previous residents had accessed the service. The residents said the variety and quality of food was very good and on the occasions when it wasn’t up to standard they could let the chef know. There was always a good choice of main meal and on the Sunday all had enjoyed a roast. Special diets were not considered at this inspection although a relative did say that dietary needs were discussed before admission. The files examined showed the staff had been monitoring one person’s fluid and nutritional intake. During the visit the staff were seen regularly distributing drinks. The topic of food was discussed with the staff one person said she regularly takes meals in the home and that the quality and choice was very good. Dorset House D55 S4044 Dorset House V229063 010705 Stage 4.doc Version 1.30 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 & 18 The organisation’s complaint procedure allowed residents and visitors to raise concerns. Adult protection systems were in place to help keep residents safe. EVIDENCE: Visitors said they were able to raise concerns with the staff. One person said there was no need for any issue to be unresolved. Information on the complaints procedure was held in the information pack and also on display in the hallway. One carer said she had been worried about some care issues, she was able to talk to the deputy manager and the situation was resolved to her satisfaction. Others commented that if they had problems clothing returns from the in-house laundry they were soon sorted by the staff once they had been informed. Adult protection was discussed with several of the staff. They were clear about their responsibilities and had access to the procedure to be followed and the topic was included in the initial training and then periodically as a revision exercise. Dorset House D55 S4044 Dorset House V229063 010705 Stage 4.doc Version 1.30 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 and 26 The home was clean and well-maintained providing residents with a safe and hygienic environment. EVIDENCE: The home is located in a residential area close to local shops and other amenities; several residents manage to use the shops independently. The ground floor offices were being re-decorated at the time of the visit as part of the organisation’s maintenance schedule. The secluded garden at the rear had several features and provides a pleasant area for residents and visitors. There was a lift breakdown during the visit. The staff were familiar with the problem which was rectified immediately. During the tour of the premises the rooms visited had been personalised by the occupants some had brought in items of furniture, an inventory was seen on the files. Dorset House D55 S4044 Dorset House V229063 010705 Stage 4.doc Version 1.30 Page 15 The laundry was sited away from the food preparation and storage areas. The laundry was equipped with commercial washers and dryers. Staff were trained in infection control and procedure were available for reference. Dorset House D55 S4044 Dorset House V229063 010705 Stage 4.doc Version 1.30 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 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. The home was staffed appropriately to meet the needs of the residents. EVIDENCE: During the Sunday afternoon visit there were six care staff including one from an agency, one care team manager and a shift leader. There had been an increased reliance on agency staff since the last inspection rising to 10 of day care hours. There had be no night agency carers. The staff group were dedicated to their role, many seen during the visit had worked in the home for some time including several for over 10 years. When agency hours were needed they tried to use the same staff to aid continuity. The resulting staff vacancies had led to difficulties with the key worker system and the deputy manager was aware and actively working to resolve the problem. During the visit the inspector observed a resident calling for assistance using the call bell, the response time was very prompt. Dorset House D55 S4044 Dorset House V229063 010705 Stage 4.doc Version 1.30 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) Not assessed during this inspection. EVIDENCE: A completed registered manager application form was awaited from the new manager. Dorset House D55 S4044 Dorset House V229063 010705 Stage 4.doc Version 1.30 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 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x x Dorset House D55 S4044 Dorset House V229063 010705 Stage 4.doc Version 1.30 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 Regulation Requirement Timescale for action 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 OP9 Good Practice Recommendations Hand written amendments to the medication administration record should be checked and countersigned by a second person. Dorset House D55 S4044 Dorset House V229063 010705 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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