Inspection on 17/11/06 for Dorset House

This inspection was carried out on 17th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Dorset House 03/09/08

Dorset House 04/09/07

Dorset House 04/01/06

Dorset House 20/05/05

Dorset House 17/11/04

Dorset House 03/08/04

Dorset House 15/03/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

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

CARE HOMES FOR OLDER PEOPLE Dorset House Off Station Road Wallsend Tyne & Wear NE28 8EN Lead Inspector Glynis Gaffney Key Unannounced Inspection 17, 18 and 22 November 2006 14:30 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 Dorset House DS0000033104.V314237.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. Dorset House DS0000033104.V314237.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dorset House Address Off Station Road Wallsend Tyne & Wear NE28 8EN 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) 0191 200 7155 0191 200 7156 pat.golder@northtyneside.gov.uk North Tyneside Council Mrs Patricia Golder Care Home 41 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (26) of places Dorset House DS0000033104.V314237.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Dorset House may also accommodate one identified service user for rehabilitation who is under 65 years of age. The Commission must be notified should this service user leave. 4th January 2006 Date of last inspection Brief Description of the Service: Dorset House is a residential care home for older people run by North Tyneside Council. The Home provides residential care for up to 41 people living in four units known as the Lakes, Ashwood, Oakwood and Rosewood. Six residents are currently cared for on a long term basis at the Home. Dorset House is a single storey building set in the residential area of Wallsend. A eighteen place day care service is provided five days a week. The Home has a central kitchen, a laundry, a large lounge and a dining area. Each unit has its own kitchen, dining and bathing facilities. Toilets are situated close to residents bedrooms and the lounge and dining areas. There are 41 single bedrooms, two of which have en-suite facilities. A bus route, pub and local shops are within easy walking distance. Off street parking is available. The current charge for a place is £295. Extra charges are made for hairdressing, private chiropody services, newspapers, toiletries, purchases made at the on-site shop and the provision of day and respite care. The most recent inspection report was available to residents, visitors and staff in the main reception area. Dorset House DS0000033104.V314237.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced, took place over 10 hours and involved one inspector. A tour of the premises was undertaken and a sample of records was examined. A number of residents, a senior officer overseeing the Home in the absence of the manager, an assistant manager and three care officers were interviewed. Residents, their families and visitors were surveyed as part of the inspection. A summary of the comments received has been included throughout this report. The staff team at Dorset House provided every assistance during the inspection. Since the last inspection, a decision had been made by North Tyneside Council to review the purpose and role played by Dorset House in its services for older people. As part of this review, Ashwood Unit had been closed on a temporary basis and the Home was no longer providing intermediate care for older people recovering from serious illnesses or accidents. What the service does well: A selection of comments from quality questionnaires sent out by the Home to residents’ relatives is detailed below: “I felt quite confident about leaving (mum) in their care and if the need for further respite care arises I would be happy for her to return to Dorset House.” “(Mum) said what a wonderful time she had. I can’t thank you enough. makes such a difference to me to know that my Mum is safe and happy.” “Staff were, without exception, extremely kind and caring.” These are some of the comments made by residents, relatives and professional visitors to the Home, in the surveys sent out by the Commission: “ I was not made aware of a contract…I find this unacceptable.” “The standard of care for my mother is very high…my mother has nothing but praise for the staff in this respect.” “I am very satisfied with the care my mum receives at Dorset House. Staff are very understanding and caring. No complaints whatsoever.” It Dorset House DS0000033104.V314237.R01.S.doc Version 5.2 Page 6 The Home’s menus cater for residents with a wide range of nutritional care needs. Dorset House had a small group of staff that had worked at the Home for a long time. The staff on duty at the time of the inspection were kind, considerate and appeared to have developed warm and caring relationships with the people in their care. Residents were satisfied with the care and support provided at the Home. Dorset House was generally well maintained and attractively decorated Over 90 of the staff team had obtained a relevant qualification in care. One of the units visited provided orientation notice boards for people with dementia. The information contained on these notice boards helped residents to know where they were, what day it was and who was on duty. A range of specialist aids and adaptations were available within the Home. The staff at Dorset House provided services that assisted and enabled older people to remain living in their own homes after serious illnesses or accidents. Dorset House provided a responsive service which was able to meet older peoples’ needs in a variety of ways. For example, it provided services such as: residential care; a short break service; over night stays to support carers; a day care service. Staff at Dorset House were proud of their success rate in supporting older people to return back to their homes as quickly as possible. Home care staff were able to use the laundry facilities at Dorset House for older people living in the community who were unable to do their own laundry. The manager and team leaders were in the process of completing their management training. The Home’s management team try to be responsive to staffs’ needs by implementing the Council’s new work life balance policy. What has improved since the last inspection? The Adult Services Directorate had introduced new assessment and care plan paperwork for use across all Care Management, residential and day care services. New bathrooms had been fitted in each unit. Dorset House DS0000033104.V314237.R01.S.doc Version 5.2 Page 7 New carpets had been fitted in the front entrance and main dining room. New disability signs had been fitted both within and outside the building. Improvements had been made to the way in which medication is administered within the Home. Dorset House staff had also completed the Commission’s checklist for improving medication practices within homes. What they could do better: Ensure that the Registered Manager, and her senior staff, are clear about the minimum information that must be obtained in the event of an emergency admission into the Home. This will help ensure that the needs of any person admitted into the Home fall within the Home’s Categories of Registration. Ensure that a service plan and recommended preventative risk assessments are put in place for each resident admitted into the Home. This will help ensure that staff are clear about how to meet the needs of any resident admitted into the Home. Develop person-centred activity plans for residents living at the Home on a longer-term basis. Ensure that the Home’s rotas allow staff sufficient time to meet residents’ needs for stimulation and meaningful activity. Ensure that radiators in the conservatory are guarded. This will help prevent residents seriously injuring themselves on unguarded hot surfaces. Ensure that all staff receive regular refresher training in key areas. This will help ensure that staff have the skills and knowledge needed to care for residents in a safe and competent manner. Ensure that staff receive formal supervision at least six times a year. This will help ensure that staff are clear about the standards to which they are expected to work. Ensure that the owner of the Home, or their representative, carries out monitoring visits. This will help ensure that the Home continues to be run in the best interests of the residents. Ensure that staff receive fire prevention training from a ‘competent person’. This will help ensure that staff are clear about what to do in the event of a fire. Prepare an Annual Development Plan for the Home. This will help ensure that residents are able to see that there is a written programme that sets out how the Home’s furnishings, fittings and fabric of the building are to be renewed, repaired and improved. They will also be able to see how staff intend to improve the care and services provided at the Home. Dorset House DS0000033104.V314237.R01.S.doc Version 5.2 Page 8 Ensure that staff files contain the required information. This will help protect residents from staff that are not suitable or competent to care for residents accommodated at the Home. An application must be made to register a manager with the Commission. This will help ensure that the Home is run and managed by a person who is fit to do so. 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. Dorset House DS0000033104.V314237.R01.S.doc Version 5.2 Page 9 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 DS0000033104.V314237.R01.S.doc Version 5.2 Page 10 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): 1 and 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Home had a satisfactory Statement of Purpose and Service User Guide that helped prospective residents to make an informed decision about whether to live at, or visit, Dorset House. Satisfactory arrangements were not in place to ensure that the senior officer responsible for making decisions about who should be admitted into the Home had access to the information they needed to enable them to make an informed decision. In one case this resulted in a resident having to be moved to another home because the placement was not appropriate. EVIDENCE: Dorset House DS0000033104.V314237.R01.S.doc Version 5.2 Page 11 The purpose and role of the Home was under review to ensure that the building and its facilities are used in the best way possible. Once the review has been completed, the Home’s Statement of Purpose and Service User Guide will be amended to reflect any changes agreed. Both documents had previously been judged as satisfactory. Generally, there was evidence that new residents had received a comprehensive assessment of their needs before admission into Dorset House. Information completed by Care Management was available in most of the care records examined. But recently, a decision had been made to admit a resident with complex care needs into the Home on an emergency basis with only limited verbal information. Following the admission, the Home insisted on receiving the required documentation which, when sent, was 14 months old. Within a very short period of time, it became clear that the resident had been inappropriately admitted, and had needs that could not be met by the Home. A Planning Meeting to consider an alternative placement for this individual, although requested as a matter of priority by the Home, was not held until 11 days after the admission. Dorset House DS0000033104.V314237.R01.S.doc Version 5.2 Page 12 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): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The newly introduced assessment and service plan documentation was comprehensive and easy to use. But, satisfactory arrangements were not in place to ensure that a completed service plan and preventative risk assessments were in place for each resident. This meant that staff might not have had access to all of the information they needed to safely meet residents’ needs. The health care needs of residents living at the Home had been satisfactorily met allowing them to lead healthy and comfortable lives. The systems in place to support the safe administration, storage and disposal of medication were generally satisfactory in promoting residents’ good health. Residents were treated with respect and dignity when receiving personal care and their right to privacy was protected. Dorset House DS0000033104.V314237.R01.S.doc Version 5.2 Page 13 EVIDENCE: Staff said that within the last six weeks, new assessment and care plan paperwork had been introduced for use within the Home. For most of the residents living at, or visiting the Home, a service plan had been prepared by Dorset House staff. Some of the plans included detailed information about residents’ needs and how they were to be met. But, in some of the plans examined, staff had not completed all of the required information. Also, following the recent emergency admission of a resident with complex care needs, a senior member of staff confirmed that a service plan had not been put in place. It was also confirmed that a moving and handling risk assessment had not been completed despite the fact that this individual needed significant assistance to mobilise. Information included on their falls risk assessment advised care staff to place a chair against their bed to minimise the risk of falling. An occupational therapist informed staff that this was unacceptable and so the chair was removed. But, the risk assessment had not been updated to take account of this guidance. There was evidence that one resident’s service plan had not been evaluated on a monthly basis. Another resident’s service plan had not been updated to include information about changes in their assessed needs. The falls risk assessment for this person had not been fully completed. There was evidence that residents living at the Home on a longer term basis had been given access to community health care facilities such as GPs, the community nursing service, chiropody, dental and optical healthcare. Preventative health care risk assessments had only been completed where the resident’s Care Manager had identified concerns at the point of admission or where staff had identified potential risks after admission. None of the risk assessments examined had been signed by either the resident or their representative. Also, a risk assessment completed for one person considered to be at risk of leaving the Home unsupervised, did not refer to the main exit door out of the unit being locked to secure their protection. There was no policy in place to advise staff about when to use the keypad to ensure residents’ safety and well-being. The Home’s Medication Policy included the required information and a copy was available in the main office. The medication arrangements on one of the units were examined. The medication trolley was clean and appropriately secured. The large cupboard in which the medication trolley was housed was dusty and untidy. Prescribed creams were stored with other items of medication. Lockable facilities for the safe storage of medication were available in all bedrooms. Photos to identify each resident were in their Dorset House DS0000033104.V314237.R01.S.doc Version 5.2 Page 14 medication records. Hand wash facilities were available in the main treatment room and in the kitchens on individual units. There were records covering medications received and administered within the Home. With one exception, certificates confirming that relevant staff had received accredited medication training were in place. Some staff had not updated their medication training since 2003. Although staff administering medication did so in a safe and professional manner during the visit, four incidents involving residents receiving the wrong medication had been reported to the Commission since the last inspection. The Home had recently been inspected by their local pharmacist who had only made one recommendation following his visit. The temperature of the medication fridge had not been monitored on a daily basis. Staff were aware of the need to treat residents with respect and dignity when providing personal care. Residents said that they were happy with the way that staff cared for them. Dorset House DS0000033104.V314237.R01.S.doc Version 5.2 Page 15 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): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Satisfactory arrangements were not in place to provide residents with opportunities to participate in social activities. This may mean that residents do not have sufficient opportunities to participate in recreational activities. Suitable arrangements were in place to support residents to maintain contact with their families and friends. EVIDENCE: A programme of weekly activities was posted on notice boards throughout the Home. The programme included activities such as bowls and chair aerobics. Residents were also invited to attend activities arranged for people attending the day care service. Staff interviewed said that it was very difficult to provide activities when there was only one member of staff on the unit caring for ten people with a range of needs, some of which might be very complex or Dorset House DS0000033104.V314237.R01.S.doc Version 5.2 Page 16 challenging. Although a carer said that she never had any time to provide the activities included on the weekly activities programme, she tried to do simple things with residents such as listening and talking, and simple household tasks. But, residents said they were pleased with the range of activities provided. One resident said ‘staff are always very busy seeing to me and the others. They are so rushed off their feet. I watch TV or just spend time in my bedroom.’ In one resident’s service plan there was very little information about their preferred routines and personal preferences regarding how their care should be provided. Although their social care needs had been identified, it was not clearly stated how they should be met. Of the two residents who completed surveys, both said that suitable activities were usually provided. Residents spoken with confirmed that the Home always made families and friends feel welcome. Residents said that visitors could be seen in private or join residents in the lounges and dining areas. There was a policy outlining the Home’s approach to enabling residents to maintain contact with family and residents. None of the residents spoken with could recall the Home placing any restrictions upon their visitors. Wherever possible, it is the Home’s policy to support residents to maintain control of their own financial affairs. Safekeeping facilities, and day-to-day support with managing personal monies and valuables, is provided where a need to do so is identified. Residents had been supported to bring their own personal possessions with them when they moved into Dorset House. Staff were observed providing residents with opportunities to make everyday decisions. The food in the Home was of a good quality, well presented and met the dietary needs of residents. Information about a resident’s special dietary needs had been made available to catering staff. Residents had recently been consulted about the introduction of seasonal menus. Regular drinks and snacks were available throughout the day. Residents were able to eat in their own rooms if they wished. Dining areas were pleasant and had been nicely decorated. Of the two residents who completed surveys: • • One said that they always liked the food served at the Home; One said that they usually did. Dorset House DS0000033104.V314237.R01.S.doc Version 5.2 Page 17 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): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A satisfactory complaints procedure was available. views and opinions were listened to. Residents felt that their Arrangements to protect residents from the potential risk of harm or abuse were satisfactory. This meant that residents could feel safe and protected in their own home. EVIDENCE: The Home’s Adult Protection Policy complied with the relevant guidance and legislation. There had been no adult protection concerns raised with either the Home, or the Commission, since the last inspection visit. All staff had received training in the protection of vulnerable adults. Staff interviewed were able to satisfactorily describe the action they would take to protect residents from potential harm or abuse. Of the two residents who returned surveys, both said that they had been told how to make a complaint. The Home had a detailed complaints procedure, which included the recommended information. Residents spoken with said that they would be Dorset House DS0000033104.V314237.R01.S.doc Version 5.2 Page 18 happy to raise any concerns they might have with a member of the staff team. Neither the Home, nor the Commission, had received any complaints since the last inspection visit to the Home. Dorset House DS0000033104.V314237.R01.S.doc Version 5.2 Page 19 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): 19, 21, 22, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The overall quality of décor, furnishings and fittings was satisfactory. This provided residents with a homely and well-maintained place in which to live. Residents’ bedrooms were well-maintained and met their needs. This provided residents with a comfortable private space in which to relax and spend time. Generally the Home’s surroundings were safe, but some radiators remain unguarded and this puts residents at potential risk of serious harm. Dorset House DS0000033104.V314237.R01.S.doc Version 5.2 Page 20 EVIDENCE: On the day of the inspection the Home was clean, tidy and free from offensive odours. Residents spoken with said that Dorset House was always kept in a good condition. The Home’s decoration, furniture and fittings were generally of a good standard, with those exceptions referred to below: • • • The conservatory: there were three unguarded radiators which had very hot surface temperatures; The dining area: the walls around the patio doors had been repaired but not redecorated; some of the dining chairs had a worn appearance; The kitchen: some of the white tiles were chipped and contained holes; the pipe work behind the sinks near the entrance were grimy; the ovens were in a poor condition but were due to be replaced the following day; the paint inside the cooker hood was peeling and could present a potential hazard; the shelves in one of the store cupboards were in a poor condition as the melamine-edging strip had come away in places. Although a recent visit carried out by the Home’s Fire Officer had identified a number of concerns, action had been taken to comply with requirements made following the visit. Residents had access to a range of specialist aids to promote their independence. For example, residents were able to make use of rehabilitation kitchens. Specialist equipment such as grab rails and hoists were available throughout the Home. A senior member of staff felt that the Home had been fitted with the aids and adaptations required to enable staff to safely support those individuals in their care. The laundry on one of the units visited was clean and tidy. The walls and floor were easy to clean. There was only one concern identified. Part of the laundry area was being used as an office base by day centre staff. Dorset House DS0000033104.V314237.R01.S.doc Version 5.2 Page 21 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): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff had been supported to undertake qualifying training, which had provided them with the knowledge and skills they required to care for residents. But, the arrangements for ensuring that staff received regular updates to their training in key areas were inadequate. The failure to ensure that staff personnel records contained the required information placed residents at risk of potential harm. There were sufficient staff to meet the care needs of residents although staff had concerns about the staffing levels which they said made it difficult to provide social activities for the residents. EVIDENCE: There was a rota showing which staff were on duty at the time of the inspection. This included the required information apart from staffs’ job titles. An examination of the Home’s rotas for October 2006 showed that: Dorset House DS0000033104.V314237.R01.S.doc Version 5.2 Page 22 • • • • There was always a minimum of four staff on duty between 8am and 10pm with one of these being a team leader; There was a sufficient cross over of shifts to allow for incoming staff to receive a full handover from outgoing staff; On frequent occasions, there was often more staff on duty than the minimum staffing levels referred to above; Three staff were rostered on duty from 10pm to 8am with one of these being a senior. The Home’s Manager usually worked office hours Monday through to Friday but was off sick at the time of the inspection. Of the two residents who completed surveys: • • One said that they always received the care and support they required. One said that they usually did; Both said that staff were around to help them when they needed it. Staff were concerned about how difficult it was to care for 10 residents on each unit with just one member of staff to cover each unit. They described how if they needed assistance to transfer a resident with complex moving and handling needs, they would either have to leave their unit to get help or, they would use the nurse call system. As a result, this meant that one of the units was left unstaffed whilst the carer responded to a call for help from their colleague. Staff were also concerned about how it was sometimes very difficult to manage new admissions at busy times of the day whilst also: overseeing any discharges; completing Service Plans and risk assessments for newly admitted residents; meeting the needs of other residents already on their units; serving meals and administering medication. Staff also said that social activities were not provided because of all the demands placed upon their time. Residents spoke very highly about staff and said they went out of their way to meet their needs. Staff said that the Home’s management team did their best to support them but that they also struggled with the difficulties presented by their only being one member of staff per unit. But, in spite of this, no concerns about the care received by residents were identified. In recent months, the Home had experienced staffing difficulties in the central kitchen due to short-term sickness and a vacant post. Members of the Home’s kitchen staff team and staff from other local authority services had covered the shortfall in hours. At the time of the inspection, action was being taken to address staffing problems in the kitchen. Staff said that the Manager’s illness and absence from work, the uncertain future of the Home and various temporary managers placed at the Home had resulted in staff morale being at a very low point. Over 90 of the care team had obtained a relevant care based qualification. But, in the four staff files examined, there was evidence that: Dorset House DS0000033104.V314237.R01.S.doc Version 5.2 Page 23 1. None of the staff had updated their moving and handling training or received fire training delivered by a ‘competent’ person in over 12 months; 2. One staff member had not updated their first aid training since 2000; 3. Three staff had not updated their basic food hygiene training in over five years; 4. A senior member of staff had not completed health and safety training; 5. A staff member had not completed infection control training. A comprehensive Recruitment and Selection Policy was in place. A recently appointed member of staff had completed three paid training days in the last 12 months. Each member of care staff had a Personal Development Review file that included details of training completed and required. Staff personnel records contained the required information with the following exceptions: 1. A description of staffs’ experience and qualifications; 2. An identification photograph; 3. A full employment history and written evidence confirming that gaps in employment had been explored; 4. There was no written evidence confirming that staff had been asked to declare any criminal convictions; 5. There was no written evidence that staff had been asked to declare that they were physically and mentally fit to do the job they were expected to perform in the Home. Dorset House DS0000033104.V314237.R01.S.doc Version 5.2 Page 24 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): 31, 33, 35, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were suitable arrangements in place for consulting with residents and their families about the care and support provided at Dorset House. But, a suitable plan for developing the service at Dorset House had not been prepared. The arrangements for regularly monitoring the Home were not satisfactory. This meant that the service at Dorset House was not being regularly reviewed to ensure that it continued to meet the needs of the people who lived there. The arrangements for carrying out formal staff supervision were not satisfactory. This meant that staff were not receiving a good enough level of support and guidance in meeting the needs of residents living at the Home. Dorset House DS0000033104.V314237.R01.S.doc Version 5.2 Page 25 EVIDENCE: Due to the absence of the Registered Manager, alternative arrangements were being made for the management of the Home during the course of the inspection. A senior member of staff said that they were clear about the standards of care that they were expected to work to. This person was able to clearly describe the purpose, aims and objectives of the Home. All staff interviewed felt able to raise any matters of concern with the management team. Balances of money held on behalf of residents were checked and found to match the Home’s records. Residents’ monies were securely stored. Regular audits of the Home’s financial records had been completed. Two staff signatures had been obtained for all transactions involving the use of residents’ monies. None of the staff whose files were examined had received formal supervision at the frequency set out in the National Minimum Standards. Records of supervision contained little information about what had been discussed and what had been agreed. Two staff had not had a Personal Development Review during the last 12 months. Internal systems had been developed to monitor the quality of care provided in the Home. For example, residents’ relatives had been sent quality assurance questionnaires. Those returned were generally very complimentary about the care and support provided at the Home. Where a concern had been identified in one of the questionnaires returned, the Home had taken immediate action to resolve the issue raised. There was no evidence that staff, or professional visitors to the Home, had been surveyed. An annual development plan had not been prepared and monitoring visits carried out on behalf of the Provider had not taken place on a regular basis. Service contracts and maintenance reports relating to such matters as gas and electrical safety, and the safe disposal of hazardous waste, were up to date and available for inspection. A record had been kept all of accidents occurring within the Home. The Home’s Accident Record was generally well completed. A tour of the premises revealed no health and safety concerns. An up to date fire risk assessment was in place. Weekly checks of the Home’s fire alarm systems and monthly visual checks of the emergency lighting had been completed. Ten fire drills had been held in the last 12 months. But, the following concerns were noted: Dorset House DS0000033104.V314237.R01.S.doc Version 5.2 Page 26 • • • • Service reports confirming that hoisting equipment had been serviced at the required frequency were not available within the Home; A notifiable accident had not been reported to the correct authority; Monthly visual inspections of the Home’s fire extinguishers had not been carried out in line with guidance issued by the Fire Service; There was no written record confirming that checks of the temperature of hot water supplied to residents’ bathing facilities on the Lake Unit between January and November 2006 had been carried out. Dorset House DS0000033104.V314237.R01.S.doc Version 5.2 Page 27 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 2 X 2 X X x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 3 3 X 3 2 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Dorset House DS0000033104.V314237.R01.S.doc Version 5.2 Page 28 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 OP1 Regulation 4&5 Timescale for action The Registered Provider must 01/06/07 ensure that the Home’s Statement of Purpose and Service User Guide reflect any changes made to the role of Dorset House following the Council’s review of residential services for older people. The Registered ensure that: • Provider must 15/01/07 Requirement 2. OP3 14 • In the event of an emergency admission, senior staff have written guidance on the minimum information that must be made available to enable them to make an informed decision about whether a prospective resident’s needs can be met at Dorset House; Where it has been decided that the Home cannot meet the needs of a resident admitted into Dorset House on an emergency basis, a planning meeting is held Version 5.2 Page 29 Dorset House DS0000033104.V314237.R01.S.doc within five working days to identify a more appropriate placement. 3. OP7 15 The Registered ensure that: Provider must 01/01/07 1. Using the information supplied by Care Management, a Service Plan is prepared for each resident; 2. Residents’ service plans are reviewed on a monthly basis and updated to reflect changing needs; 3. Standardised falls risk assessments also include, as appropriate, information about residents’ individual needs and are updated as and when assessed needs change. 4. OP7 15 The Registered ensure that: • Provider must 01/02/07 • A moving and handling risk assessment is completed for each resident who needs assistance to mobilise; Moving and handling risk assessments include details of the actual techniques to be used when moving and transferring residents. Provider must 15/01/07 5. OP8 13(4) The Registered ensure that: • A policy is put in place which sets out the circumstances in which the keypad lock located on one of the units is used to prevent residents Version 5.2 Page 30 Dorset House DS0000033104.V314237.R01.S.doc • considered to be at risk of harm from leaving the Home unsupervised; Completed risk assessments refer to the use of keypad locks as a means of keeping a resident safe. 6. OP8 13(4) The Registered Provider must 15/01/07 ensure that where it is identified that a resident is at risk of falling, the latest guidance issued by the Medicines and Healthcare Products Regulatory Agency regarding the use of bedside rails is followed. The Registered Provider must: • Carry out a review of the arrangements that are in place to provide social activities within the Home; Develop a person-centred activity plan for each resident with dementia care needs that takes into account their strengths, interests and abilities. Ensure that the provision of activities within the Home is checked as part of the Provider’s monitoring visits. Provider must 01/03/07 on re01/03/07 7. OP12 16(2) • • 8. OP19 23(2) The Registered ensure that: • The dining chairs Ashwood Unit are varnished; (The timescale for this requirement expired on the 1 June 2006. Ashwood Unit was closed at the time of the Dorset House DS0000033104.V314237.R01.S.doc Version 5.2 Page 31 inspection) • The kitchen: the white tiles are repaired; the pipe work behind the sinks near the entrance is cleaned; the internal surface of the cooker hood is repainted; the shelves in one of the food store cupboards is replaced or resurfaced. 9. OP20 23(2) The Registered Provider must 01/03/07 ensure that the walls around the patio doors in the large dining room are redecorated. Where necessary, the dining chairs should be either replaced or refurbished. The Registered Provider must 01/03/07 ensure that the radiators in the conservatory are guarded. Whilst this work is being carried out, risk assessments must be completed to ensure that vulnerable residents are properly protected. The Registered Provider must 15/01/07 contact the Local Health Protection Unit and take advice about day centre staff using part of one of the Home’s laundries as an office area. The Registered Provider must 01/06/07 ensure that staff receive regular updates to their training in the following areas: moving and handling; first aid; basic food hygiene; health and safety and infection control. The Registered Provider must 01/03/07 ensure that the following information is available within the Home: DS0000033104.V314237.R01.S.doc Version 5.2 Page 32 10. OP25 16(2) 11. OP26 13(3) 12. OP28 13(4) & 18 13. OP29 18 Dorset House • • • • • A description of staffs’ experience and qualifications; An identification photograph; A full employment history and written evidence confirming that gaps in employment have been explored; Written evidence confirming that staff have been asked to declare whether they have any criminal convictions; Written evidence confirming that staff have been asked to declare that they are physically and mentally fit to do the job to which they have been appointed. 14. OP31 9 The Registered Provider must 01/03/07 arrange for an application to be made to register a Manager with the Commission. The Registered Provider must 01/02/07 make application to vary the Home’s Conditions of Registration to bring it in line with what the service is currently providing. The Registered ensure that: • • Provider must 01/03/07 15. OP31 9 16. OP33 26 An annual development plan is prepared for the Home; Staff and professional visitors to the Home are surveyed as part of the quality assurance process. Registered Provider must 01/02/07 Version 5.2 Page 33 17. OP33 24 The Dorset House DS0000033104.V314237.R01.S.doc ensure that he, or his representative, visits the Home at least once a month unannounced to: • Interview residents, their representatives and staff working at the Home to form an opinion of the standard of care being provided; Inspect the premises and its records, including the complaints record. • The Registered Provider must prepare a written report on the conduct of the care home and supply the Commission with a copy. 18. OP36 18 The Registered Provider must 01/06/07 ensure that staff receive supervision at least six times a year and a written record kept clearly detailing what has been discussed and agreed. The Registered ensure that: • Provider must 01/02/07 19. OP38 13(4) • • Reports confirming that the Home’s hoisting equipment has been serviced on a six monthly basis are available at Dorset House; Notifiable accidents are reported to the Health and Safety Executive; Records of checks conducted to test the temperature of the hot water supplied to residents’ bathing areas are kept up to date. Registered Provider must 01/03/07 Version 5.2 Page 34 20. OP38 23(4) The Dorset House DS0000033104.V314237.R01.S.doc ensure that: • Staff receive fire prevention training delivered by a ‘competent’ person at least once a year; A visual inspection of the Home’s fire extinguishers is carried out on a monthly basis and a written record kept. • 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 OP7 Good Practice Recommendations The Registered Provider should ensure that: • • Preventative risk assessments covering the following areas are carried out for each resident – skin care; ‘falls’ prevention; continence care; nutritional care; Either the resident, or their representative, are provided with an opportunity to sign any of the risk assessments that have been completed. the the The the 2. OP7 The Registered Provider should ensure that dependency levels of people living at, or visiting Home, are assessed and updated on a regular basis. information obtained should be used to confirm that required staffing levels are in place. The Registered Provider should ensure that: • • • 3. OP9 All relevant staff up date their medication training at least annually; Creams are kept separate from medicines prescribed for internal use; The cupboards in which medication are kept are both clean and tidy. DS0000033104.V314237.R01.S.doc Version 5.2 Page 35 Dorset House 4. OP27 The Registered Provider should ensure that: • • The Home’s rota is amended to include details of staffs’ job titles; As part of the review of the services provided at Dorset House, a review of staffing levels in the Home is carried out to take into consideration the concerns expressed by staff during the inspection. 5. OP35 The Registered Provider should ensure that residents are encouraged to sign their financial records when money is debited from their accounts. The Registered Provider should ensure that staff receive a performance appraisal at least once a year. 6. OP36 Dorset House DS0000033104.V314237.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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 Dorset House DS0000033104.V314237.R01.S.doc Version 5.2 Page 37 - 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. 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