CARE HOMES FOR OLDER PEOPLE
Dorset House Coles Avenue Hamworthy Poole Dorset BH15 4HL Lead Inspector
Amanda Porter Key Unannounced Inspection 17th October 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000004044.V315516.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. DS0000004044.V315516.R01.S.doc Version 5.2 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) www.care-south.co.uk 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) DS0000004044.V315516.R01.S.doc Version 5.2 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). 14th November 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. Weekly fees range from £425 to £ 515. DS0000004044.V315516.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 16th October 2006 and took approximately five hours. The purpose of the inspection was to assess all of the key standards and the requirement and recommendations made in the last report. The registered manager, Mrs Nickson, and her staff were on hand to aid the inspection process. Information gathered for this report came from several sources including: • Reports made to the Commission for Social Care Inspection by the home. • A pre-inspection questionnaire completed by the registered manager. • 28 comment cards completed by residents, 29 from relatives/visitors, 5 from GPs; 3 from health and social care professionals and 1 from a care manager. • Tour of the premises. • Review of a variety of documentation including care records, staff records, maintenance records, policies and procedures. • Discussion with residents, visitors and staff. Five residents, one visitor and six members of staff were spoken with and asked their views on the service provided at Dorset House. Comments received in comment cards and through discussion included: “Could not wish for better care for my Mother, the staff at Dorset House are truly dedicated.” “The staff are very supportive and caring towards my Mother.” “When I visit my Father he unfailingly tells me how he couldn’t “be anywhere better” and how “the staff make it.” “Dorset House has a very friendly, caring atmosphere.” “I am generally content and feel well looked after.” “We are very pleased with the standard of care received at Dorset House.” “Mum couldn’t be better placed. She is very happy and settled.” “I feel the home manages and supports all my mother’s needs.” “It is a good place to work.” All the staff and residents were welcoming and helpful. DS0000004044.V315516.R01.S.doc Version 5.2 Page 6 What the service does well:
Dorset House is well managed by Mrs Nickson and she is supported by very competent and committed staff who ensure the home is run in the best interests of the residents living there. The home carries out thorough assessments prior to residents moving in and this includes finding out about social interests, hobbies as well as health and personal needs. Assurances are given that individual needs can be met. Residents’ health needs are generally well met by the home and community health professionals. The activities arranged within the home meet the expectations of the residents living there. Residents are encouraged to maintain their links with friends and family and all visitors are made welcome. Residents are helped to exercise choice and control over their lives as far as possible. Meals are wholesome and nutritious and planned around the likes and dislikes of residents. The complaints procedure reassures residents that their views are important to the home and that any complaints they raise will be properly investigated. The house and gardens are well maintained which provides residents with a comfortable place to live. Residents are encouraged to personalise their rooms with small items of furniture, pictures and a variety of mementos. The home protects the residents from abuse by ensuring robust policies and procedures are in place, which staff find easy to follow. Sufficient numbers of staff are on duty throughout the day and night to be able to meet the needs of the residents. A thorough recruitment process is followed when employing staff, which ensures that residents are protected from risk. Dorset House has an ongoing training programme for staff, which means that residents will be cared for by skilled staff. Financial procedures within the home also ensure that residents’ interests are protected. The health and safety of the residents and staff are protected by the policies and procedures that the staff follow at Dorset House. DS0000004044.V315516.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. DS0000004044.V315516.R01.S.doc Version 5.2 Page 8 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 DS0000004044.V315516.R01.S.doc Version 5.2 Page 9 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): Standard 3. Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New residents move into the home having had their needs assessed and been assured that these needs will be met. EVIDENCE: Care files for four residents were seen and each contained a pre-admission assessment, which provided sufficient information so that a plan of care could be drawn up. Residents and relatives confirmed that they were invited to view the home before making a decision about admission and given information about the home. Twenty-seven residents responded to the question “Did you receive enough information about this home before you moved in so you could decide if it was the right place for you?” twenty-six said, “Yes” and one said “No”. DS0000004044.V315516.R01.S.doc Version 5.2 Page 10 Comments received included: “My sister and I visited several homes and wanted our Mother to go to Dorset House.” “My Mother had stayed at Dorset House for respite care and we knew this would be the right home for both her and us.” “We had a conducted tour prior to placing my Mother at Dorset House and the staff were so helpful.” “Visited Dorset House and the staff were cheerful and friendly.” DS0000004044.V315516.R01.S.doc Version 5.2 Page 11 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 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Dorset House has a good care planning system in place, but more attention to detail must be taken to ensure that staff always have the information they need to meet the needs of residents. The health needs of the residents are generally well met with evidence of good support from community health professionals. The medication at this home is well managed promoting the good health and well being of residents. Residents are treated with respect and their right to privacy upheld. DS0000004044.V315516.R01.S.doc Version 5.2 Page 12 EVIDENCE: The care files for four residents were reviewed. They were based upon information provided from pre-admission assessments. In general, care plans are well laid out and well maintained. Residents and/or their relative were involved in drawing up and reviewing care plans wherever possible. Occasionally there were omissions and some care plans had not been updated to reflect the current needs of the resident. Daily records were maintained, however gaps were left between some entries, which should be avoided so that records could not be added to at a later date. At the time of inspection the home was not keeping a record of any nutritional monitoring for each resident. The Registered Manager confirmed that she was about to introduce a new nutritional monitoring tool and this will be assessed at the next inspection. Discussions with staff demonstrated that they had a good knowledge of residents’ individual care needs. The home has systems in place for managing medicines. Examination of the records indicates that medicines are given as prescribed, to ensure the protection of residents. Staff were seen to offer and administer personal care discreetly. Staff interacted with residents in a friendly and caring manner. It was clear from the time spent with residents that they felt comfortable and at ease with staff. Staff were seen throughout the inspection to be treating residents with courtesy, kindness and respect. 28 residents responded to the question “Do you receive the care and support you need?” and 20 said “Always” and 8 said “Usually”. 27 residents responded to the question “Do the staff listen and act on what you say?” they all said “Yes”. DS0000004044.V315516.R01.S.doc Version 5.2 Page 13 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 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social, cultural and leisure activities provided by the home are consistent with the resident’s abilities to engage. Residents are supported in maintaining contact with their friends and family and in making decisions about their lives in the home and it was evident that a caring staff group provided choices in daily routine and level of activity. Residents are provided with a variety of meals that generally meet their individual tastes and dietary requirements. EVIDENCE: A written schedule of activities was reviewed and included: • Hand and nail care • Gentle exercise • Visits from outside entertainers • Reminiscence therapy • Music • Cooking • Arts and crafts.
DS0000004044.V315516.R01.S.doc Version 5.2 Page 14 Records demonstrated the extent to which residents engage in social or leisure activity in the home and with visits from friends and families. Some residents have varying degrees of dependency and complex needs and many are unable to make decisions and choices about their daily lives although it was apparent that staff provide choices with regard to daily routine and level of activity. Residents were observed in the lounge area and with a staff presence there was a supportive, relaxed and friendly atmosphere. 24 residents responded to the question “Are there activities arranged by the home that you can take part in?” 8 said “Always”; 10 said “Usually” and 6 said “Sometimes”. Relatives confirmed via comment cards that they were made welcome when visiting and visits could take place in private. The registered manager confirmed that the home was without a permanent chef and she was in the process of filling this vacancy. However residents generally felt the food was acceptable and staff were aware of residents’ preferences and made every effort to meet their individual needs. 21 residents responded to the question “Do you like the meals at the home?” 7 said “Always”; 12 said “Usually” and 2 said “Sometimes”. DS0000004044.V315516.R01.S.doc Version 5.2 Page 15 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 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A system is in place to deal with any complaints that might be made by residents. The home’s adult protection policy demonstrates an understanding of abuse and of how to protect residents from it. EVIDENCE: Dorset House has a clear complaints procedure available to everyone. The home had received two complaints in the last year, which were dealt with promptly and were partially substantiated. Residents spoken with during the inspection said that if they had any concerns they would feel confident about talking to the staff, knowing that they would listen to them. The home has a robust policy and procedure to respond to suspicion or evidence of abuse or neglect. Staff had received training on abuse. DS0000004044.V315516.R01.S.doc Version 5.2 Page 16 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 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment within Dorset House is good providing residents with an attractive, homely and safe place to live. The home is kept clean and smells pleasant thereby making daily life for all in the home more pleasurable. EVIDENCE: The home is well maintained both inside and out. The gardens are attractive, safe and easily accessible for residents. The building complies with the requirements of the local fire service and environmental health department. During the inspection some redecoration was in progress, which involved the painting of handrails in the main corridor on the ground floor and staircase leading to the first floor. This caused a certain amount of disruption and may
DS0000004044.V315516.R01.S.doc Version 5.2 Page 17 have been better undertaken at night when the residents’ use of this area was minimal. All areas of the home were clean and there were no unpleasant odours. Twenty-seven residents responded to the question “ Is the home fresh and clean?” and eighteen said “Always”; eight said “Usually” and one said “Sometimes”. The laundry was well managed and adequate supplies of clean linen were seen to be available. DS0000004044.V315516.R01.S.doc Version 5.2 Page 18 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 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The deployment and number of available staff is sufficient to meet the needs of the residents. Robust recruitment procedures are in place to protect residents from the risk of unsuitable staff working at the home. Staff are well trained and experienced and residents could be confident they would be well looked after. EVIDENCE: Staff rosters demonstrated that there are sufficient staff on duty at all times. Twenty-seven residents responded to the question “Are staff available when you need them?” twelve said “Always”; fourteen said “Usually” and one said “Sometimes”. The home has an ongoing training programme, which includes NVQ level 2 and 3 in care. At the time of inspection approximately 63 of care staff held at least one of these awards. DS0000004044.V315516.R01.S.doc Version 5.2 Page 19 Four staff recruitment files were reviewed. Both files were well ordered and contained all the information required by law including – • • • • • • Completed application forms Two written references Enhanced CRB and POVA First checks Terms and conditions of employments Documentary evidence of any relevant qualifications Proof of identity. Training files demonstrated that healthcare assistants were receiving the appropriate training, which included: • Induction • Moving and handling • Health and safety • Dementia awareness • Dementia Care (5 days) • Fire safety. DS0000004044.V315516.R01.S.doc Version 5.2 Page 20 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 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run by a committed and competent manager, who creates an open and positive atmosphere, which supports good care practices for residents. The home regularly reviews aspects of its performance through a programme of self-review and consultations, which include seeking the views of residents and relatives. Residents are assured of sound management of their financial interests. The health and safety of the service users and staff are protected by the policies and procedures followed at Dorset House. DS0000004044.V315516.R01.S.doc Version 5.2 Page 21 EVIDENCE: Mrs Nickson, who is supported by a loyal staff, manages the home well. Residents and staff said that all the management team were very approachable and if they had any concerns they would be happy to talk to them knowing that they would be listened to. A condition of registration for Dorset House is that they have eight beds available for residents with mental health needs and this included those residents suffering with dementia. In the pre-inspection questionnaire completed by Mrs Nickson she confirmed that the home was accommodating more than eight people with dementia. All of these residents appeared very well cared for. However, to ensure that Dorset House operates within the conditions of its registration Mrs Nickson should apply to vary the condition so that the number of residents with dementia is accurate. The home takes steps to review its performance regularly and resident surveys are conducted and results analysed. Since the last inspection satisfaction questionnaires had been sent out to residents, relatives, staff and stakeholders in the community, eg GPs. Topics covered in the survey included: • Catering and food. • Personal care and support. • Daily living. • Premises and facilities. • Staff. The results had been analysed by an independent consultant and a report was available at the home. It showed a high degree of satisfaction from residents and staff and stated, “The management and staff of Dorset House can take pride in the overwhelming number of satisfied responses to these questionnaires... Of particular note is the evident appreciation for the warmth, kindness, approachability and friendliness of the staff team and their efforts to create a good atmosphere in the home” The quality of facilities and services provided at Dorset House are also monitored through internal audits; visits and reports made by senior managers for Care South; feedback through residents and staff meetings and through staff supervision. Residents confirmed that they either deal with their own finances or have appointed a responsible representative to do so. This is frequently another family member. The home does hold a small amount of money for some residents at their request. All monetary transactions were recorded and seen to be accurate.
DS0000004044.V315516.R01.S.doc Version 5.2 Page 22 Records showed that staff had received recent training in fire safety and moving and handling updates. Fire fighting equipment had been checked and serviced within the last year. Substances hazardous to health were seen to be stored securely. Records showed that equipment had been serviced regularly. Accidents were recorded, analysed by the manager and appropriate action was taken as necessary. DS0000004044.V315516.R01.S.doc Version 5.2 Page 23 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 3 X X N/A 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 DS0000004044.V315516.R01.S.doc Version 5.2 Page 24 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. 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 OP7 Good Practice Recommendations Care staff should ensure that all care documentation is completed and up to date so that clear details of how residents’ needs are to be met are available to staff. Nutritional assessments should be undertaken with each resident. The registered person should apply to vary the condition of registration for the home when it accommodates more than eight residents suffering with dementia. 2. 3. OP8 OP31 DS0000004044.V315516.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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
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