CARE HOMES FOR OLDER PEOPLE
Dorset House Coles Avenue Hamworthy Poole Dorset BH15 4HL Lead Inspector
Trevor Julian Unannounced Inspection 14th November 2005 11:00 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 Dorset House DS0000004044.V265642.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. Dorset House DS0000004044.V265642.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Dorset House Address Coles Avenue Hamworthy Poole Dorset BH15 4HL 01202 672427 01202 673239 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) Care South Mrs Joan Fay Nickson Care Home 52 Category(ies) of Dementia - over 65 years of age (8), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (8), Old age, not falling within any other category (52) Dorset House DS0000004044.V265642.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 52 in the category OP (Old Age) including up to 8 in the categories DE(E) and/or MD(E). 1st July 2005 Date of last inspection 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 the South West. Dorset House DS0000004044.V265642.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on 14th November 2005 between 11:00 and 15:30. Before the inspection comment cards had been returned from residents and visitors to the home. They showed good levels of satisfaction but there remained concerns about staffing levels and concerns about residents dignity both issues were examined during the inspection and the finding included in this report. Information was gathered through discussion with residents, staff and manager, a tour of the premises and inspection of records. This was the second of the two statutory visits for information about key standards not covered in this report please refer to the previous inspection. For the purpose of this report the terms resident and service user are interchangeable. What the service does well:
The home was well maintained warm and comfortable. The rooms seen had been personalised by the occupants. Window restrictors provided in the first floor rooms were operating correctly. Staffing levels were appropriate to the needs of the residents, although there had been an increase in the use of agency carers to cover vacant shifts the home had been successful in a recent recruitment drive so the dependency should start to reduce. The use of agency carers can affect the continuity of care for the residents; in this case the home tries to use the same carers in order to lessen the problem. The staff were well trained, there had been a reduction in the number of staff with NVQ 2 but with the new staff completing their trial period they will complete the award. The home follows the organisation’s recruitment procedure the files seen showed people were only employed once the required references and checks had been completed. The organisation has a contract with supplying staff agencies to only provide temporary staff with the required checks and training. Dorset House DS0000004044.V265642.R01.S.doc Version 5.0 Page 6 The manager had suitable qualification and experience to manage the home. The organisation had a monitoring system which allowed head office staff carry out unannounced visits to check that standards were maintained. Copies of the monthly visits were supplied to the Commission and the home’s manager. The home did not manage the finances for the residents. However, most people deposited cash with the homes staff for personal expenses including hairdressing, chiropody etc. The records seen were up to date and the balances held matched the transaction records. There was evidence of internal checks to ensure errors were promptly corrected. 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 DS0000004044.V265642.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 Dorset House DS0000004044.V265642.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): Not assessed during this inspection please refer to the previous report. Intermediate care is not offered at Dorset House therefore standard 6 is not applicable. EVIDENCE: Dorset House DS0000004044.V265642.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): 9, 10. Medication was well managed in the home, helping to protect residents from errors. Residents were treated well by the staff allowing their basic rights to be respected. EVIDENCE: The medication system was not fully inspected; instead, the focus was on the recording system. The medication records seen showed that amendment and handwritten entries onto the medication records were checked by a second person in order to reduce the risk of transcription errors. The manager was looking to introduce further improvements and was in discussion with the supplying chemist at the time of the visit. A comment card expressed concern about staff respecting residents’ preference for male or female carers giving personal care. Three residents, who were able to express their views, said they had been asked for their preference two said they requested female carers the other did not mind,
Dorset House DS0000004044.V265642.R01.S.doc Version 5.0 Page 10 those views had been respected, they were not able to answer for other residents. Staff said that most residents were female and they preferred personal care carried out by females, there were no male carers, except for the deputy manager, on the Dorset House staff but sometimes agency carers were male. The matter was discussed with the manager who was aware of previous problems which had resulted from two agency workers supplied for one shift both being male. The manager had taken action to prevent further problems. During the visit it was noted that there was a good rapport between residents and staff. People said they were well treated. Call alarms were being answered promptly. Residents said this was normally the case but sometimes during busier parts of the day there could be delays. Dorset House DS0000004044.V265642.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): Not assessed during this inspection please refer to the previous report. EVIDENCE: Dorset House DS0000004044.V265642.R01.S.doc Version 5.0 Page 12 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): Not assessed during this inspection please refer to the previous report. EVIDENCE: Dorset House DS0000004044.V265642.R01.S.doc Version 5.0 Page 13 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): 25 The home was well maintained and generally provides a safe environment for the residents and staff. However, there remains a risk of burns from hot water pipes and radiators in residents’ bedrooms. EVIDENCE: The rooms visited had been personalised by the occupants with pictures, photographs and some had brought in items of furniture from their own homes’. The bedrooms on the first floor had window restrictors, those seen operated correctly. The home is heated by radiators fed by hot water pipes at low level around each of the bedrooms. Risk assessments were in place but did not include the topics as recommended by the Health and Safety Executive. Dorset House DS0000004044.V265642.R01.S.doc Version 5.0 Page 14 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): 27, 28, 29, 30 The home was adequately staffed, the staff were recruited and trained to a good standard allowing the residents to have confidence in their abilities. EVIDENCE: There had been a further rise in the homes reliance on agency staff to cover vacant care shifts. In July 10 of care hours were covered by agency staff in October that had risen to 15 . This can result problems of continuity of care but the home does try to use the same members of agency staff to reduce disruption. The manager had recently had success in recruiting three new staff with a further two posts being offered these appointments will reduce the home’s reliance on agency carers. The home’s care staff were encouraged to complete NVQ level 2 in care. There had been a turnover of care staff leaving 17 with the award and another 2 part way through. The three new members of staff were to be nominated once they had completed their trial period. In addition to the NVQ the care staff had taken specialist courses in medication, residents’ rights, dementia etc. Senior staff were being trained to respond to allegations of abuse. New staff were given induction and foundation training during their trial period. The organisation’s recruitment procedure was being followed in the home. A sample of three files were checked, all were in order.
Dorset House DS0000004044.V265642.R01.S.doc Version 5.0 Page 15 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, 33, 35, 38 The home was well managed, checks were in place to ensure the home remained at a good standard. Residents’ views were being sought to ensure the home was run in their best interest. The home operated procedures to ensure that the residents were protected from the risk of financial abuse while in the home. Health and safely was generally well managed although there were areas for improvement. Dorset House DS0000004044.V265642.R01.S.doc Version 5.0 Page 16 EVIDENCE: The homes manager had appropriate levels of experience and qualifications. The organisation had a programme of monthly visits by head office staff to carry out monitoring checks of the home, to ensure that standards in the home were being maintained. Copies of the reports were provided to the Commission and the home’s manager. The organisation had completed a quality survey in February 2005 this had involved the residents, their family and friends, staff and community healthcare professionals. There was no formal improvement plan based on the findings of the survey. The home did not manage the finances for any of the residents although most people deposited an allowance with the office staff for personal purchases including hairdressing, chiropody etc. A sample showed the balances held matched transaction records and receipts. The transaction records showed that staff carried out internal checks to ensure that the recording was accurate. The staff said they receive safety training in safe moving and handling, fire safety etc. Staff records were in place to show training courses completed and nominated. Fire safety systems were regularly checked by the staff and were up to date any defects were recorded and actioned. It was noted that the annual fire fighting equipment servicing was overdue. The matter was being addressed. Dorset House DS0000004044.V265642.R01.S.doc Version 5.0 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X 2 X STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Dorset House DS0000004044.V265642.R01.S.doc Version 5.0 Page 18 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 OP38 Regulation 23 (4) c Requirement The organisation must arrange for annual checks and servicing of fire fighting equipment. Timescale for action 31/12/05 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. 2 Refer to Standard OP9 OP33 Good Practice Recommendations Hand written amendments to the medication administration record should be checked and countersigned by a second person. A quality improvement plan should be produced annually based on the findings of the quality survey. Dorset House DS0000004044.V265642.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Poole Office 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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