Inspection on 21/04/08 for Dorset House

This inspection was carried out on 21st April 2008.

CSCI found this care home to be providing an Adequate service.

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 06/08/09

Dorset House 29/04/09

Dorset House 26/06/07

Dorset House 21/10/05

Dorset House 18/04/05

Dorset House 13/12/04

Dorset House 12/05/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Dorset House Blackfriars Avenue Droitwich Spa Worcestershire WR9 8DR Lead Inspector Andrew Spearing-Brown Key Unannounced Inspection 21st April 2008 07:50 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 DS0000018648.V362694.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 DS0000018648.V362694.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dorset House Address Blackfriars Avenue Droitwich Spa Worcestershire WR9 8DR 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) 01905 772710 01905 771476 dorset@agecare.org.uk www.agecare.org.uk Royal Surgical Aid Society Vacant Care Home 42 Category(ies) of Dementia - over 65 years of age (42), Old age, registration, with number not falling within any other category (42), of places Physical disability over 65 years of age (42) Dorset House DS0000018648.V362694.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate 23 service users under the category `Nursing` (N) with bedrooms currently numbered 7-10, 11-12, 14-17, 18-22 (including 20A) and 23-29 26th June 2007 Date of last inspection Brief Description of the Service: Dorset House is a large attractive building, set within its own gardens near to Droitwich town centre. The older part of the building was built in 1928. There are currently 40 single rooms that measure at least 10 square metres, all of which have en-suite facilities. There is one double room currently occupied by a single occupant. Two shaft lifts are available to enable people with mobility concerns to move easily between floors, a stair lift is also provided on a small flight of stairs on the first floor. A service is offered to a maximum of 42 people over the age of 65 years who may have needs associated with age and physical disabilities. Following a change in the home’s categories of registration Dorset House is also able to accommodate a maximum of 23 people who require nursing care. The home is one of several care homes for older people run by Age Care, a charity formed in 1862 as the Royal Surgical Aid Society. The information regarding fees available within the Statement of Purpose seen during this inspection was dated April 2007 therefore the reader may wish to obtain more up to date information from the care service. Dorset House DS0000018648.V362694.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We, the commission carried out this inspection without any prior notice This inspection was undertaken over a period of three days. A pharmacist inspector joined us for part of this inspection. The final visit was primarily to give us the opportunity to discuss matters with the homes Director of Care who was visiting from London. Shortly before this inspection the registered manager resigned and had left her employment within the home. As a result the senior nurse was acting up as manager. This inspection takes into account information we have received since the last inspection as well as the visits to the home. Prior to this inspection an Annual Quality Assurance Assessment (AQAA) document was sent to the home for completion. The AQAA is a selfassessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for providers to share with us areas where they believe they are doing well. This document was returned to us as required. A number of questionnaires were sent to a sample number of people using the service and members of staff after the inspection. At the time of completing this report we had not received any back. Any comments from these will therefore be taken into account as part of future inspection activity. During the inspection discussions were held with the acting manager, a number of staff members and some people using the service. We had a look around the home and observed what was happening. In addition we viewed the care documents regarding some people using the service such as care plans, risk assessments and daily records. In addition we viewed medication records and staff training records. What the service does well: The home is well maintained, warm, clean and has a welcoming atmosphere. Communal areas are homely and comfortable. The dining room has a restaurant appearance to it. Information is available to potential users to Dorset House DS0000018648.V362694.R01.S.doc Version 5.2 Page 6 assist them decide whether they wish to use the service. Staff carry out a needs assessment prior to an admission to ensure that identified care needs are able to be met. Care staff are able to join people using the service at lunchtime. People are able to enjoy a choice of menu and eat in an unhurried and relaxed manner. Staff were seen to be polite and respectful to people residing within the home. There are daily activities on offered and a monthly schedule is provided. A part time activities coordinator is now employed within the home. People told us that the home celebrates special occasions such as birthdays and St Georges Day. A complaints procedure is available and people are aware of how to complain about the service. The number of carers who hold an NVQ (National Vocational Qualification) has just exceeded the National Minimum Standard. Further staff are currently undertaking this training which will result in a higher level of qualified staff. The records and certificates regarding the servicing and testing of equipment and systems were found to be in good order and up to date. What has improved since the last inspection? What they could do better: We recently became aware of some concerns regarding care planning and the delivery of nursing care from another professional. We found some serious shortfalls in care documentation and some evidence that identified care needs were not met or medical needs not always fully followed up. Improvements are required in risk assessment processes and up dating them in line with identified care needs. Dorset House DS0000018648.V362694.R01.S.doc Version 5.2 Page 7 Some further improvements are necessary regarding the administration and management of medication including matters regarding people receiving respite care and people self medicating. The procedure regarding safeguarding people needs to be revised and up dated. Information no longer current needs to be removed and links to local arrangement need to be made. Staff training in safeguarding takes place however staff have concerns regarding the number of subjects covered in one day. It was of concern that at times shifts are not covered therefore reducing the number of people on duty to meet peoples care needs and ensure the health safety and welfare of people using the service. Management systems are insufficient in some areas of the home for example regarding care planning, risk assessing and ensuring that people always receive suitable care and attention. We have recently received some complaints and other comments regarding a range of issues at Dorset House. Although we have received suitable responses to investigations the reasons for the number of complaints needs addressing. The recent vacancy for a home manager needs to be addressed without delay. 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 DS0000018648.V362694.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 Dorset House DS0000018648.V362694.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): Standards 1, 2, 3 and 5. Standard 6 is not applicable. Quality in this outcome area is good Information is available for potential users of the service. An assessment of care needs carried out prior to an individual’s admission helps to ensure that care needs can at that time be identified and assessed as able to be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A Statement of Purpose and Service Users Guide (Welcome Pack) was available in the reception area of the home. The welcome pack was dated September 2004 with the exception of the results of a satisfaction survey from January 2005. Also in the reception area we saw a supply of colour leaflets entitled ‘Welcome to Dorset House’. A copy of our previous inspection report was also available for people to read. Dorset House DS0000018648.V362694.R01.S.doc Version 5.2 Page 10 We were later given a copy of a Statement of Purpose within a colour folder. Although the document was not dated it did contain clear information about the service provided. Some details do however need to be updated for example the information regarding assessment fees was dated April 1st 2007. The final page of the pack gave some additional information regarding Dorset House as well as a couple of quotes including ‘ Dorset House, we have always recognised, is with-out equal.’ There was no indication as to when these quotes were taken. The information pack is not available in any other format. Although one person we spoke to was not aware of any information regarding the home we did nevertheless see a copy of the Statement of Purpose within her bedroom. We viewed the assessment of a recently admitted person using the service. The assessment was carried out by an experienced member of staff and covered a range of care needs. The assessment was not signed by the person receiving the service however the person concerned confirmed that she had visited the home before the start of the care package. The person concerned told us that ‘everything is good’ and referring to staff said that ‘nothing too much trouble for them.’ It was reported that the contract regarding the fees payable by a recently admitted person was with the family concerned. We did however see another contract. The contract seen gave details of the weekly charge and how it was broken down in relation to assessment fee, hotel charge and room charge. The information regarding complaints within this document needed amending; we were told that this has taken place. Dorset House DS0000018648.V362694.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): Standards 7, 8 and 9. Quality in this outcome area is adequate The health and personal care needs of people using the services are not always being met placing people at risk. Written documentation regarding people’s care needs to be improved to ensure that care needs are met consistently. Further improvements are needed regarding the management of medication especially in relation to self-administration to ensure people are safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During previous inspections we have had some concerns regarding care planning within Dorset House. We are aware of some concerns from other professionals regarding care planning and whether staff have at all times ensured that prompt medical attention is sought as necessary. Each person did have a care plan and on initial viewing they would appear to be suitable to meet care needs. It was of concern however to find that care Dorset House DS0000018648.V362694.R01.S.doc Version 5.2 Page 12 plans were not always either an accurate or an up to date reflection of peoples needs. The care plan regarding a respite user stated that the person concerned required the assistance of one carer for washing and dressing and that the person was able to perform minor activities like washing her face and hands. On looking over the daily records it was evident that the person was in fact self-caring. Both the individual herself and carers confirmed this was the case. The initial assessment also stated that the person could manage along. The assessment stated that the person could not have a bath due to having leg ulcers however the care plan indicated that the person would be able to have a bath. One carer told us that the person using the service would be having a bath on Sunday, as she was a respite user. We saw no care plan regarding the leg ulcers or the involvement of the community nursing service. We saw no mention on the care plan that the person needed a raised toilet seat it only informed carers that they needed to assist with toileting. Although detailed care plans were in place in relation to this person they were incorrect and failed to give an accurate account of the persons care needs and the actions to be taken by carers. The lack of accurate care plans can lead to inconsistence in care or a shortfall in knowledge in areas such as bathing and the leg ulcers. We viewed another care plan, which gave further cause for concern. The care plan in relation to wound care of one foot was insufficient and did not give details of the treatment to be carried out or the frequency. From reading the care plan it was not possible to accurately establish the current situation regarding the wound. Information was contained within the daily notes however these did not evidence the most recently reported change of dressing. We were told that the dressing on the other leg was for protection only however we saw no care plan in relation to this preventive action. We saw a record dated 10/04/08 that stated that the person concerned has a pressure reliving mattress and cushion. On checking we found that the mattress was in place but that the cushion was similar to one used on patio furniture and most certainly was not going to aid pressure relieve. We were told that the person using the service had refused the pressure relieving cushion however this was not documented and was not what was recorded as an agreed action. We saw daily notes indicating that for a period of time the individual had required hoisting, a member of staff who we consulted confirmed this. We saw no mention of hoisting on the moving and handling assessment or on the mobility care plan. We saw evidence that the person using the service had slipped to the ground, however when the assessment on maintaining a safe environment was reviewed 30 days later it made no reference to this incident and stated ‘No falls reported’. A carer confirmed that one person needs to have any letters read to her due to her sight impairment. Although we were later told that the reason she was unable to recognise some information regarding activities was due to not having her glasses with her there was nevertheless no acknowledgement of Dorset House DS0000018648.V362694.R01.S.doc Version 5.2 Page 13 the sight impairment or possible care needs or risks associated with this. The risk of this person falling was assessed as having increased; as a result the risk assessment stated that a short-term care plan was needed. We found no such care plan. Similarly the risk assessment for pressure ulcers was high but no care plan was in place. We were concerned to read of a number of occasions when the person was noted to be either distant or to of collapsed. Medical intervention was sought on one occasion however we could not find any follow up in relation to the treatment suggested by the doctor. In addition we found no evidence that staff had taken into account that the person was diabetic and therefore monitored her blood sugar levels more effectively. The care plan on blood glucose levels said to check on a Sunday morning or when ever necessary. No guidance as to what could constitute the need to carry out this check or guidance for staff about variations in blood sugar levels was recorded. We saw further evidence of concerns expressed regarding foot care, although a chiropodist was seen shortly after the initial concern records did not indicate the outcome of that visit or the current situation. As a result of concerns regarding care planning we were following this inspection provided with a copy of an action plan prepared by Age Care to address the shortfalls. The effectiveness of the action plan and improvements will therefore be assessed as part of future inspection activity within Dorset House. We saw a medication policy produced by Age Care, which meant that trained staff had access to a working medication policy, which helps to ensure that people using the service are safeguarded. There was no procedure available for the safe handling of medication when somebody is admitted for a short respite stay within the service. A person using the service for respite had brought in medication from home, however the medication was not clearly labelled and was not easy to identify. The person concerned was self-medicating; no risk assessment was done until the time of our visit. We were informed a member of the family usually assisted with medication due to the number that needed to be taken. We therefore identified an increased risk of a medication error and staff would not be able to identify the medication if there was a problem. We were informed that staff had undertaken ‘advanced medication training’ provided by a high street pharmacy during January 2008. We were also informed that staff had a two yearly supervision check with the Care Home Manager in October 2007 to ensure the safe handling of medication within the service. We saw medication stored safely in locked cupboards and also within two locked medicine trolleys. It was stored neatly and tidily, which ensured that medication could be easily located. Dorset House DS0000018648.V362694.R01.S.doc Version 5.2 Page 14 The majority of the Medication Administration Record (MAR) sheets seen were documented with staff signatures to record that medication had been administered to people or a code was recorded to explain why medication had not been administered. For example, we saw that staff recorded whether ‘one or two’ painkillers had been administered. This means that it was possible to check that medication had been administered according to a doctor’s instructions and therefore safeguarding people. Some of the MAR sheets did not always clearly state the directions for administration in English. For example we saw one record with a direction recorded as ‘QDS’, which is the Latin abbreviation for ‘four times a day’. This potential means that there was an increased risk of a medication error. We saw some MAR sheets that did not clearly identify the individual. For example, one medicine record no photograph of the person concerned, no date of birth, no doctor’s name and no indication of any allergies recorded. This means that there was an increased risk of a medication error. We checked some medication to ensure it had been administered correctly. Checks made on medication available in a monthly blister pack labelled with the day of the week were accurate. However not all medication could be accurately checked in this way because some medication was supplied in the original container. We saw boxes of medication that were not dated when they were opened, particularly in the ‘nursing wing’ medicine trolley. There was no evidence to show that the service checked medication. The Acting Manager did inform us that she did check medication balances but there was no documented record of this. This means that accurate checks on medication could not always be made to ensure that medication records for administration were accurate. Everybody seen during the inspection appeared suitably attired taking into account gender and weather conditions. Nobody using the service brought any concerns regarding the level or standard of personal care provided to our attention. One person said ‘I am looked after well and I’m alright.’ While somebody else said ‘ can’t fault it.’ We were told that staff are polite and respectful, we observed staff knocking on bedroom doors and waiting for a reply prior to entering. Dorset House DS0000018648.V362694.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): Standards 12, 13, 14 and 15. Quality in this outcome area is good The introduction of an activities coordinator has increased and improved the range of activities and recreational opportunities available for people. The home is calm and relaxed resulting in people being able to enjoy their day to day lives. People using the service are complimentary about the food served in the home and are given a choice of menu. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Open visiting is in place whereby no restrictions exist. Visitors are able to see their relative / friend either within communal areas or within the individuals own bedroom. Members of staff heard in conversation with people using the service were polite, caring and respectful. Dorset House encourages community involvement putting on events such as garden fetes; the local mayor and other local dignitaries often attend these events. Since are last inspection Age Care have appointed a part time activities coordinator who was working on improving the activities available to people Dorset House DS0000018648.V362694.R01.S.doc Version 5.2 Page 16 using the service. The monthly programme is currently displayed in reception and people are given a copy of the programme. The programme is not currently available in any other format although information in the foyer stated that it was available on audiotape if required. We were told that the newsletter is no longer produced. Events scheduled during April included poetry club, nail care, arts and crafts (making Roman ruins), cheese and wine tasting, flower arranging, quiz and arm chair exercises. We saw a display of pictures painted during a recent arts session. We were told that the activities coordinator ensures that she sees everybody at least once a week to have a general discussion about things and to build upon the programme people want to see in place. Information about social interests and person centred planning within the care plans needs to be further developed. Newspapers are available for people to read in the morning room while other people who have ordered a particular paper have it delivered to their bedroom. Magazines were available within the home. A library is available from which people are able to borrow books. A personal computer is available within the morning room. This machine has internet access should people wish to use such a facility. The keyboard has large characters to assist people with either sight or dexterity difficulties. It was reported to us that following discussions involving people using the service meals have improved. A certificate dated May 2007 awarded by the local District Council was displayed rated the home as ‘Good’ in relation to food hygiene standards. On the 22nd April the mid day meal consisted of Roast Gammon with pineapple and parsley sauce, broccoli and peas or poached salmon or salad of the day. Either Queen of puddings or Artic roll followed the main course. The meat or fish was served ready plated with the vegetables in dishes for people to help themselves. Care staff had their lunch with people using the service. We saw staff assisting people with their meal in a sensitive manner. The mealtime was relaxed and at a leisurely pace. The dining room was decorated for a special celebratory meal on Saint Georges Day. People using the service said that they often have days celebrating events including peoples birthdays. Dorset House DS0000018648.V362694.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): Standard 16 and 18 Quality in this outcome area is adequate People using the service have access to a complaints procedure to assist in the protection of their rights. Although staff have an awareness of safeguarding the training and procedures in place need to be reviewed to ensure that knowledge and procedures are robust in order to protect people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is displayed within the foyer of the home, the procedure was recently up dated to show our new address and contact number. Information regarding the making of complaints is also within the Statement of Purpose and the contract however these documents need to be reviewed to ensure they are also accurate and up to date. Since the last inspection we have received four complaints about the service offered at Dorset House in addition to some other concerns brought to our attention. Complaints and concerns have covered the standard of personal and nursing care delivered to people using the service, medication administration, staffing levels, the loss of personal belongings and management of the standards within the home. As a result of these concerns some multi disciplinary meetings involving the home and Age Care have taken place. We have asked the provider to investigate a number of the complaints Dorset House DS0000018648.V362694.R01.S.doc Version 5.2 Page 18 made. On each occasion a full and detailed report has come back to us following internal investigations regarding how issues were addressed such as reviews of systems and processes. The home generally holds good records regarding concerns or complaints made within the home. In the vast majority of these the records gave details of the immediate response and any subsequent actions. On a smaller number of occasions we were not able to carry out a full audit trail of events or of the actions taken. These seemed to be on occasions when contact was made directly to Age Care rather than to the home. We were also aware of correspondence between the service and a representative, which was not held or fully logged within the file. People using the service told us that they felt safe and that they feel able to complain if a situation arose. We viewed the homes policy and procedures regarding safeguarding. We have previously commented on the fact that the document made reference to Kent joint guidelines and East Sussex multi agency guidelines but not to Worcestershire. We found that the document continues to make reference to the above guidelines but does not to mention Worcestershire. We also saw reference to the former NCSC (National Care Standards Commission – predecessor of the CSCI) and to The Registered Homes Act 1984 (repealed upon implementation of The Care Standards At 2000. The acting manager did have available the guidelines issued by Worcestershire Adult Services and a leaflet for staff was later found within the office. It is important that the guidelines operated by the home are in line with the County Council guidelines and that links to local agencies are known about and included within the procedure in order to safeguard people using the service. Training upon safeguarding is carried out in house. The person carrying out the in house training has not received any formal training herself and told us that the training delivered does not include whistle blowing. Staff consulted told us that they had either had training or were due to undertake training in the near future. As safeguarding training is carried out on the same day as other training (challenging behaviour, infection control and data protection) some staff were concerned about their ability to cover all these areas sufficiently in a short period of time. Staff members believed whistle blowing to be included within the training. Dorset House DS0000018648.V362694.R01.S.doc Version 5.2 Page 19 Dorset House DS0000018648.V362694.R01.S.doc Version 5.2 Page 20 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): Standards 19,20, 23, 24 and 26 Quality in this outcome area is excellent The home enables people who use the service to live in a safe, well-maintained and comfortable environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Dorset House provides a warm, clean and well-maintained environment for people using the service. Communal areas of the home continue to be well maintained, comfortable and attractive. The dining room had a restaurant appearance with well-laid out tables. The tables were particularly attractive for the Saint Georges Day celebration lunch. Numerous pictures and other items such as plates ardour the walls, some of which show either Dorset House or Droitwich Spa. The drawing room contains a large picture as well as two photograph albums of HRH The Duchess of Dorset House DS0000018648.V362694.R01.S.doc Version 5.2 Page 21 Gloucester during her visits to the home in her role as Patron to Age Care. The drawing room is however seldom used except when some people using the service are entertaining visitors. The morning room and conservatory are used on a more regular basis as are the seating areas leading into the newer part of the home. All these areas are bright and welcoming. Carpets throughout the communal areas are in good order with the exception of the main stair carpet, which is showing some signs of wear and tear. Since our last visit the reception area has been redecorated. Handrails are located along corridor areas. The height of the handrail is significantly lower in the older part of the home to the newer part; this needs to be monitored in case it brings about any issues regarding people’s ability to freely move around the home. The home was clean and tidy with no offensive odours. The laundry is appropriately sited and contained suitable equipment including hand-washing facilities. Liquid soap and paper towels were in place at wash hand basins throughout the home in line with infection control procedures. Toilet facilities within the older part of the home are functional in appearance. Toilets and bathrooms within the newer part of the home are larger and therefore more suitable for persons with reduced mobility. Dorset House provides single bedroom accommodation all of which have ensuite facilities. People using the service are able to personalise their bedrooms. We saw a number of rooms whereby people had brought in items of furniture and other personal belongs. We were told that nobody had a key to his or her bedroom; one person stated that s/he was not offered one. There was no evidence within care plans that people are offered a key to their bedroom and a key to a lockable space within their room. All areas of the home are easily accessible to persons with reduced mobility due to the provision of passenger lifts and a stair lift. The grounds around Dorset House, which are also easily assessible, were in good order considering the time of year and weather conditions. Recently a number of raised flowerbeds have been added near to a large patio area. Seating is available not only near to the patio area but also at frequent locations around the garden footpath therefore providing people with places to sit and relax. Shading from the sun can be obtained by using umbrellas and awning. During this inspection we saw a number of people sat outside enjoying the spring sunshine. Dorset House DS0000018648.V362694.R01.S.doc Version 5.2 Page 22 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): Standards 27, 28, 29 and 30. Quality in this outcome area is adequate Usually enough staff are on duty to meet the identified care needs of people using the service. Training is provided to enable carers fulfil their duties; gaps in training are known about in order that these gaps are filled. The time spent covering elements of training needs to be reviewed to ensure it is sufficient. The number of staff undertaking training towards a recognised qualification should assist in improving service delivery. The recruitment procedures are sufficiently robust in order to safeguard people using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the last inspection we highlighted a serious shortfall in staffing levels at certain times. As a result of our findings a requirement to have sufficient and suitably experienced staff on duty at all times was made. People using the service were generally happy with staffing levels within the home. Most people stated that staff are willing to help but some commented that at times you have to wait or that you don’t see staff very often. Dorset House DS0000018648.V362694.R01.S.doc Version 5.2 Page 23 The number of staff on duty is usually satisfactory however we identified times when staffing levels were unsatisfactory and could be insufficient to meet peoples care needs especially taking into account the lay out of the home. We previously reported that six carers are on duty during the morning shift and five during the afternoon. Three carers cover the night shift. One qualified member of staff is on duty at all times. We have recently received an anonymous concern regarding a possible reduction in night staffing. We were informed that a decision is yet to be reached regarding this matter as a full review of staffing is taking place within Age Care. It would however be of concern were staffing levels to be reduced. We received conflicting information regarding whether agency staff could be used to cover shifts when necessary. We were also told that the situation had improved from the time of our last visit and that some of the morning staff were working some night shifts. We did however note a number of occasions when staffing levels were not acceptable. Some of the shortfalls had occurred when staff were on planned holiday therefore the management of the home would have had sufficient time to arrange cover. The organisation provides staff training. There were some gaps in the training programme however the training manager had plans to deal with this. Some catering assistants have not done basic food hygiene. We queried the content of some of the training and the time dedicated to provide/ receive the training. Staff told us that they find the training to be too much in a day. Other than NVQ (National Vocational Qualification) training the vast majority of training provided is associated with either health and safety or protection. There is a need to provide training in other areas such as care planning and person centred care to ensure that staff have the knowledge and the skills to carry out these functions and safeguard people. We were told that twenty-four carers are currently employed within Dorset House. Out of this number fourteen people hold an NVQ (National Vocational Qualification) level 2. One of these people has also obtained a level3. In addition two staff are currently undertaking level 3 and eight are undertaking level 2. The service has systems in place regarding recruitment. Practice carried out helps to provider a safer system and one which protects people against the potential of abuse. The recording thought the recruitment process was acceptable although improvements could be made such as the notes made during the interview. We viewed a small number of staff files relating to new members of staff. The files seen contained the necessary CRB information Dorset House DS0000018648.V362694.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): Standards 31, 33, 35 and 38. Quality in this outcome area is adequate The registered provider needs to ensure that a suitably qualified and competent manager is appointed in order to improve the quality of the service provided and ensure that suitable systems for monitoring outcomes are in place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Shortly before this inspection a representative of Age Care informed us verbally that the registered manager had tended her resignation and was no longer working within the home. Prior to writing this report we had not received confirmation of the resignation or the short term or long term plans Dorset House DS0000018648.V362694.R01.S.doc Version 5.2 Page 25 regarding the post of manager. At the time of our visit the senior nurse was acting as manager with support from within Age Care. The Annual Quality Assurance Assessment (AQAA) was returned to us by the date requested. All the sections of the form were filled in. Some of the information given or the evidence to support the claims or statements was minimal. A representative of Age Care makes regular visits to the home and completes a report following the visit as required. Copies of these reports were available for us to view within the home. Information following the most recent survey carried out seeking the views of people using the service was not available within the home when we visited. This information was however obtained from the homes head office for our attention. The results from the surveys returned by 12 people in October 2007 showed that overall 3 people were very satisfied, 7 were satisfied and 2 were not very satisfied. Nobody indicated that they were not at all satisfied. We did see a small number of survey forms completed by people who had used the service for a period of respite these did not show any concerns regarding the care provided. Dorset House has facilities for the safekeeping of small amounts of money on behalf of people using the service. A small sample of monies were checked and found to balance. The fire records were briefly seen and found to be in good order. We also viewed a small sample of certificates and records regarding the servicing and the maintenance of equipment. All the records viewed were found to be in good order. Since our last visit new door closures have been fitted to fire doors. One person told us that she was now unable to open her bedroom door independently and therefore felt trapped in her room. The Director of Care was aware of this problem and was arranging for action to take place to remedy the situation. Staff at Dorset House receive training in areas such as moving and handling however comments about this training are recorded elsewhere within this report. Our concerns regarding the need to ensure that risk assessments are both in place and up to date in areas around moving and handling and hoisting are also included earlier within this report. Dorset House DS0000018648.V362694.R01.S.doc Version 5.2 Page 26 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 2 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 4 4 X X 3 2 X 4 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Dorset House DS0000018648.V362694.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 15 (1) Requirement Ensure each service user has a written care plan that sets out in detail the action, which needs to be taken by care staff to ensure that all aspects of their health and personal care needs of the service user are met. Review care plans at regular intervals and where necessary update plans to reflect changing needs and current objectives for health and personal care. Appropriate risk assessments, which are in line with identified care needs must be in place. Risk assessments must be regularly reviewed to ensure the health safety and welfare of people using the service. Medicine records for the administration of medication must be clear and accurate showing that people using the service have received medication as prescribed in order to ensure DS0000018648.V362694.R01.S.doc Timescale for action 30/06/08 2 OP7 15 (2) 30/06/08 3 OP8 13 (4) (c) 30/06/08 4 OP9 13 (2) 21/04/08 Dorset House Version 5.2 Page 28 that people are safeguarded. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations A system should be introduced to ensure that accurate medicine audits can be done and check that people who use the service have been administered medication according to the directions of a General Practitioner. The medicine policy should be reviewed and updated in order to ensure it is specific to the service, particularly with regard to short respite stays to ensure that the health and welfare of residents taking medication are safeguarded. The wishes of residents, or with their consent their relatives, should be sought regarding their end of life care and death so that they can receive the care they want. A review of different versions of the complaints procedure should take place to ensure consistent guidance regarding people’s rights is given. The training given to staff regarding safeguarding should be reviewed to ensure it is sufficient and contains all necessary areas such as whistle blowing. The procedure regarding safeguarding should be reviewed to ensure it is in line with guidance issued by Worcestershire County Council. Care plans should indicate whether people were offered keys to their bedroom and lockable space within their bedroom. Staffing levels should be maintained to ensure that sufficient staff are on duty at all times. Additional staff should be deployed in order to meet identified care needs as necessary. DS0000018648.V362694.R01.S.doc Version 5.2 Page 29 2 OP9 3 OP11 4 5 OP16 OP18 6 OP18 7 8 OP24 OP27 Dorset House 9 OP30 Staff should receive training appropriate to the work they perform this should include for example care planning and person centred care. Dorset House DS0000018648.V362694.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 DS0000018648.V362694.R01.S.doc Version 5.2 Page 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!