Inspection on 26/06/07 for Dorset House

This inspection was carried out on 26th June 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Dorset House 06/08/09

Dorset House 29/04/09

Dorset House 21/04/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Dorset House Blackfriars Avenue Droitwich Spa Worcestershire WR9 8DR Lead Inspector Andrew Spearing-Brown Key Unannounced Inspection 26th June 2007 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 Dorset House DS0000018648.V337500.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.V337500.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 Mrs Maria Socorro Walker 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.V337500.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 12th December 2006 Date of last inspection Brief Description of the Service: Dorset House is a large attractive building, set within its own gardens on the outskirts of Droitwich. 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 at least 16 square metres in size with en-suite facilities; a single occupant currently uses this room. A new bedroom with en-suite facilities was recently created on the first floor. Provision of this bedroom has not however altered the overall provision as a small room without en-suite was taken out of use as a residents room and is now an office. 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. As a result of a recent 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 fees at Dorset House currently, according to the homes service users guide, range from £471.74 to £655.20 per week. An additional charge of 10 is made in relation to any respite (short stay), which may be available subject to vacancies within the home. Additional charges are made for services such as hairdressing, private chiropody, newspapers and toiletries. Dorset House DS0000018648.V337500.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One regulation inspector based at the Worcester office of the Commission for Social Care Inspection (CSCI) undertook this unannounced key inspection over a number of days. This inspection takes into account any information received by the CSCI in relation to the home since the previous inspection as well as the visits to the home. Since the last key (full) inspection which took place during October 2005 two random visits have taken place at Dorset House, reference to these visits is included within this report. Prior to this inspection a Annual Quality Assurance Assessment (AQAA) document was posted to the home for completion. It is a legal requirement that this form is completed and returned to the commission within a given timescale. This document was returned to the commission and comments from within the document are included as part of this inspection. A number of questionnaires were sent to a sample number of residents, their relatives as well as health and social care professionals. A number of completed questionnaires were returned to the commission. The contents of the completed questionnaires are taken into account as part of this inspection. Since the previous key inspection a couple of significant changes have taken place at Dorset House. Firstly the categories of registration now include (N) nursing care for a maximum of 23 residents. At the time of this inspection a total of 15 residents required nursing care provision with the remaining beds occupied by residents requiring personal care. Secondly the former manager has resigned and a new manager has become registered with the commission. The registered manager was on duty during the vast majority of this inspection. Discussions took place with the registered manager, two visitors, some staff members (qualified nurses, the care coordinator, care assistants, the financial administrator and the maintenance manager ) as well as a number of residents. A partial look around the home took place which included a number of bedrooms as well as communal areas. The care documents of a number of residents were viewed including care plans, daily notes and risk assessments. Other documents seen included medication records, service records, some policies and procedures and staffing records. Dorset House DS0000018648.V337500.R01.S.doc Version 5.2 Page 6 What the service does well: Communal areas at Dorset House are homely and comfortable. The home was clean and tidy throughout with no unpleasant odours detected. All areas of the home are accessible to people with reduced mobility. In the past the grounds and hanging baskets have won awards in the Droitwich in bloom competitions. The home continues to develop community link such as the annual garden fete. Visitors are welcomed into the home. During the inspection a potential resident and her family visited the home. Following this registered manager intended to update the care plan and pre admission assessment. The home has a diverse staff group covering a range of ages, ethnic background and gender. Residents seen looked suitably dressed. Residents sitting in the lounge or in the dining room having lunch appeared relaxed and content. A number of activities are available within the home including bingo and an art group. A computer is available for residents to access the internet. Dorset House has recently acquired a mini bus and outings are anticipated including a visit to a ‘sister’ home. The inclusive atmosphere of staff joining residents for lunch is good and should be commended. A clear and concise complaints procedure is available to residents. The registered manager has recently alerted the commission to matters which were alleged abuse. Age Care provides training for all members of staff. A suitable training room is located on the lower ground floor. Comments received by the commission either before the inspection or as part of the visits to the home included: ‘Always found level of care and standards generally to be excellent’ ‘The staff at Dorset House offer an excellent care service in a kind and considerate way.’ staff are ‘ very helpful’ and ‘ I feel safe’. Dorset House DS0000018648.V337500.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: While it was evident that pre –admission assessments are carried out one respite residents file was lacking both an up dated assessment and a care plan. This inconsistency was of concern as it could of lead to an inability to recognise and meet care needs. Care plans and risk assessments are insufficient in detail and are not reviewed on a frequent basis to ensure that identified care needs are met. Due to the lack of details carers are not provided with the necessary information to ensure consistency in care provision. As highlighted within the section above some improvement has taken place regarding the management and administration of medication over recent inspection. Despite the earlier concerns including medication errors the required standard and associated regulation is not met and in need of further attention. Comments regarding the food provided at Dorset House varied considerable. The choice of meal on the first day of this inspection was limited and commented upon by a number of residents. Dorset House DS0000018648.V337500.R01.S.doc Version 5.2 Page 8 Some gaps were apparent in the training records including mandatory training such as fire awareness and moving and handling. Redecoration of the corridor in the older part of the home was scheduled to be done before September 2006. This work has not happened. Some communal toilets are functional in appearance and some improvements in infection control are needed. Dorset House is currently using a high number of agency staff. At times agencies and staff already working within the home are unable to cover shifts resulting in the home operating with an unsatisfactory number of carers on duty. The reduced level of staff has the potential to place residents at risk of not having care needs met as well as more serious health and safety risks. Some improvements are needed to ensure fire safety checks take place when people with delegated responsibility are not in the home. Some risk assessments are needed to ensure suitable risk management in a number of areas including windows and one of the lifts. 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.V337500.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 DS0000018648.V337500.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): Standards 1, 2, 3 and 5. Standard 6 is not applicable. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives have information available to them to assist with choosing the home and seeing if their needs can be met. Any inconsistency in having a suitable pre admission assessment and a full contract in place has the potential of the service not having sufficient detail to carry out identified care needs. EVIDENCE: The file of a respite (short stay) resident was viewed and found to continue minimal information. It was evident that the individual resident had attended Dorset House in the past, as some daily records from a previous stay were included within the file. The pre admission assessment was blank with the exception of some personal details. Therefore no documentary evidence was held to establish whether the home was able to meet individual care needs or Dorset House DS0000018648.V337500.R01.S.doc Version 5.2 Page 11 whether these had changed since the previous respite stay. Information regarding the documentation used for recording care plans is included as part of the next section of this report. However the sheets within the file seen were blank, therefore no care plan was in place some 10 days after admission. The registered manager supplied the inspector with a copy of the home’s Service User’s Guide and the current contract used between Age Care and a new resident. These documents were not studied in detail to assess whether all the necessary information, as listed within the National Minimum Standards and recent changes to the Regulations, are in place however they appear comprehensive. A file containing the service users guide was available in the hallway of the home for residents or their representatives to view. The respite resident had signed a one-paged contract on admission to the home. A relative witnessed the signature on the contract however it did not contain a signature from anybody representing the home or Age Care. The file of another recently admitted resident was seen and did contain a preadmission assessment and some risk assessments. The registered manager stated that this was the norm and that the file without the necessary documentation was an isolated case. During this inspection the registered manager met a potential resident and her family who had come to visit the home. The manager stated that she would be up dating the pre admission assessment during the visit. Full and comprehensive assessments are necessary to ensure that care needs can be met in an individualised and person centred style. Dorset House is registered to accommodate up to 42 residents with a dementia type illness. The care of persons with a dementia is specialist and therefore staff need to receive suitable and regular training. The registered manager stated that the majority of carers have received training while others are due to receive training during August 2007. Although Dorset House provides care on a respite basis, when a vacancy exists, this service does not include intermediate care therefore standard 6 of the National Minimum Standards is not applicable. Dorset House DS0000018648.V337500.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): Standards 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. Care plans and risk assessments were not always updated and did not contain sufficient information to provide staff with the necessary information to ensure consistency in care delivery. Care plans need to contain details regarding the principals of privacy, dignity and personal choice. Medication systems are not sufficiently robust to ensure that residents receive their medicines safely. EVIDENCE: As part of this inspection a random sample of residents files were viewed. With the exception of the file described within the previous section each file viewed contained a written care plan. The AQAA (Annual Quality Assurance Assessment) completed by the registered manager stated under the section ‘What we do well’ ‘ comprehensive risk Dorset House DS0000018648.V337500.R01.S.doc Version 5.2 Page 13 assessments’ and ‘monthly evaluation of care plans.’ These statements were not the findings of this inspection. A range of shortfalls were identified. The care plans seen were of the type that allows staff to cross out sections not relevant to the care being provided. They lacked detail and did not provide sufficient information to ensure the correct care is given. Some conflicting information was recorded later within a care plan seen regarding the provision of pressure relieving equipment. Care plans were not always reviewed on at least a monthly basis or more frequently to reflect changes in care need. The home’s service users guide states that care plans will be reviewed monthly. One care plan written on the 2nd February 2007 contained no evidence of any reviews (almost 5 months later) when it was evident from daily notes that changes had taken place. The same care plan failed to give any information regarding visual impairment, a recent angina attack or a piece of equipment with the resident’s bedroom. No risk assessments were included within this file. There was some evidence that residents are consulted and involved in drawing up their care plans. The registered manager stated that some new care plans were in the process of implementation as detailed within the section ‘What we could do better’ of the AQAA. The new care plan format has commenced regarding residents who are currently occupying nursing beds. One of these was written towards the end of May 2007 but had not received any updates up until and including Friday 29th June. These new style care plans also need to have additional detail rather than stating objectives with out specific direction such as ‘observe for signs of hypothermia’. The vast majority of responses received on questionnaires sent to relatives showed that they felt that care needs of their relative are met. Carers consulted were able to give a good verbal account of residents care needs. Although it is acknowledged by the registered manager that improvements in care planning are necessary the overall decline in care plans since the previous inspection is a concern and requires significant input to rectify. A comment was made to the commission regarding the fact that residents only receive one bath per week. One resident also made reference to the frequency of bathing and that during a recent week s/he did not receive a bath due to reported staff shortages. Recording on residents files failed to evidence that frequent bathing was undertaken. Another resident made comments regarding staff shortages and the lack of staff to assist in tasks such as sorting wardrobes. Dorset House DS0000018648.V337500.R01.S.doc Version 5.2 Page 14 The AQAA stated that residents have access to chiropody, opticians and dentists. Evidence of involvement from these services was apparent within the care documents however improvements in the care plans would provide better evidence that these care needs are fully met. One GP (General Practitioner) returned a completed comment card to the commission within which no concerns regarding the service offered were made. One relative stated on a questionnaire returned to the commission ‘offers a home from home environment with all the care required on day to day basis.’ The previous key inspection (October 2005) highlighted some areas of good practice in relation to the management and administration of medication. Although good practices were noted some improvement was however necessary in the recording of medication administration. Since the above key inspection two random inspections have taken place at Dorset House both of which included the assessment of medication management systems. The first random visit (July 2006) was carried out by a pharmacy inspector and took place as a direct result of a medication error within the home. No new requirements were made as a result of the visit by the pharmacy inspector however the following conclusion was recorded: ‘the requirement concerning medication administration records and correct completion at the time of administration will remain and is highlighted as an area of concern for Dorset House.’ The second random visit was undertaken during December 2006 by a regulation inspector and followed correspondence between the registered manager and the commission after further medication error. Although some good practices were noted during the random visit a number of issues were discussed at the time of the inspection and needed attention from the registered manager. The management and administration of medication was assessed during this inspection during which a number of good practices were seen to be in place. A photograph of the individual resident was available with many of the MAR (Medication Administration Record) sheets. A photograph needs to be in place for all residents to ensure recognition of identification especially when agency nurses could be undertaking the administration of medication. The majority of MAR sheets showed any known allergies. The time when medication is prescribed to be administered was highlighted on the MAR sheet although it was 10.45 am when the 8.30 am medication was completed on the first day of this inspection. The qualified nurses stated that they take timeframes such as the late completion of a medication administration into consideration especially if a resident was prescribed further medication at lunchtime. Dorset House DS0000018648.V337500.R01.S.doc Version 5.2 Page 15 The nurse on duty administers medication to all residents receiving nursing care and to residents receiving personal care residing on the ground floor. A senior carer or at times the nurse administers medication to residents receiving personal care on the first floor. The number of drugs held within the controlled drug (CD) cabinet was checked and found to balance with the controlled drugs register. It was queried why one drug which should be regarded as controlled was not booked into the care home until 10 days after the resident was admitted. Some medication belonging to a resident who died in January 2007 was within the CD cabinet. Other medication belonging to another resident who had died remained within the medication trolley. The vast majority of MAR sheets were completed satisfactorily. A small number of gaps where qualified staff had failed to sign for medication or detail why it was omitted were noted. There was some evidence to suggest that on occasions qualified staff had signed the MAR sheet prior to administering medication as signatures were over signed by a code meaning that the resident was on leave or out for the day. An audit of one course of antibiotics balanced however a course of liquid antibiotics contained signatures accounting for 250mls of medication when only 200mls were dispensed. A recent visit from the supplying pharmacy documented ‘excellent date of opening’. This statement was not confirmed as part of this inspection as the vast majority of items not included within the MDS (Medication Dispensing System) blister packs had no date of opening recorded upon them. The lack of date recorded upon boxes / bottles makes it difficult to carry out a full drug audit. A fridge is provided for the storage of medication needing such a facility. A record is maintained of the temperature of the fridge however this is not always done with a total of 7 gaps during June noted on the 26th of the month. Inconsistency in recording fridge temperatures also formed part of the last key inspection. Staff consulted commented that one resident preferred to have a female carer to attend to individual personal care tasks. The care plan viewed as part of the inspection process made no reference to this request therefore placing this significant request dependent upon carers knowledge. As Dorset House at times relies on agency staff for a high number of shifts the potential for a unsatisfactory outcome was visible. The AQAA document highlighted a named nurse and keyworker system as a means of ensuring equality and diversity. Having a keyworker system can be beneficial to residents to ensure that Dorset House DS0000018648.V337500.R01.S.doc Version 5.2 Page 16 additional needs are met, however uncertainty regarding who was key worker to who was apparent amongst both staff and residents during this inspection. As a means of providing privacy a ‘Do not disturb’ notice can be displayed on each bedroom door. It is clear within Dorset House that staff observe residents wishes regarding their preferred name with the majority of residents called by their surname. A pay phone is available for residents to use; however this facility is located under the stairs, which could be claustrophobic. A high number of residents have a telephone fitted within their own bedroom therefore providing the privacy to make calls. The registered manager stated that she would obtain a cordless phone which could be used if residents were to receiving in coming calls. Residents seen looked suitably dressed taking into account gender issues and weather conditions. Residents sat within the morning room or having lunch within the dining room seemed relaxed and at ease with staff members. Dorset House DS0000018648.V337500.R01.S.doc Version 5.2 Page 17 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 and15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Stimulation is provided within the home by means of social and recreational activities and religious observance. People using the service are able to maintain contact with family and friends. EVIDENCE: Open visiting is in place whereby no restrictions exist. A number of visitors were seen within the home throughout this inspection, two visitors were consulted. Visitors seemed to be comfortable within the home and were able to see their relative / friend within either communal areas or within the individuals own bedroom. Dorset House encourages community involvement including annual events such as the garden fete. The home produces an in house newsletter to keep residents and their relatives up to date with events held and items of interest such as photographs of a member of staff who recently got married. Dorset House DS0000018648.V337500.R01.S.doc Version 5.2 Page 18 A range of daily newspapers and other publications are situated within the morning room for residents to read and browse. The care coordinator has amongst other duties the role of organising a range of activities within the home. As this member of staff has to undertake other duties such as administering medication, the supervision of staff and hands on care she is unable to devote herself solely to the provision of activities and social stimulation. One relative stated within a questionnaire returned to the commission ‘More recreational periods and possibly trips out’ as an area where the respondent believed improvements could be made. As Dorset House has recently acquired a mini bus an increase in social outings is envisaged. Plans are in hand for residents to visit another home also managed by Age Care in Middlesex in the foreseeable future. A checklist to ensure safety on the minibus was seen, areas for potential improvement to the routine checklist were discussed with the maintenance manager who is currently the only person authorised to drive the vehicle. A schedule of planned activities was on display and the care coordinator was working upon the July programme which will include crosswords, quizzes, armchair exercise, bingo, and the art group. Photographs of the recent fete were on display. The current edition of the home’s newsletter contains photographs of two paintings done by residents as part of the art group. The activities programme includes visits to the home from church ministers. It was stated that some residents attend a nearby church on Sunday’s. Information contained on the AQAA showed that all but two residents who have religious believes are Christian. One resident spoke of how Birthdays are celebrated within the home and was aware of one later in the week. The resident consulted stated that residents receive a cake as part of the celebration. The manager stated that entertainers visit the home on a regular basis. A computer is located within the morning room upon which residents are able to access the internet. The dining room at Dorset House is attractive and was well set out for lunch on the first day of this inspection. The room resembles a restaurant or hotel setting. The weeks menu was on display at the entrance of the dining room however this did not give a full description of the food on offer for example the vegetables are not detailed. It was noted that the choice of menu on the first day was Moroccan (lamb) curry or vegetable curry, therefore a choice between curry or curry. One resident was heard say to other persons on the table that she did not like curry while a resident on another table stated the same when the carer presented him with a plate of curry. An alternative of ham salad was provided to these residents. One person described the food as ‘not brilliant ’ Dorset House DS0000018648.V337500.R01.S.doc Version 5.2 Page 19 however also stated ‘lunch today was nice and was hot.’ Residents are given the opportunity to have a glass of sherry each Sunday with their lunch. During discussions with a number of different people throughout the inspection, including residents, the opinions and viewpoints regarding the food varied considerably. While some people felt that the food was good others believed it to be mixed and stated that the standard had reduced over recent months. The consistency of the soup was mentioned by a couple of residents consulted. It was noted on reading the complaints records that the majority of concerns raised with the manager were regarding food provision. Care staff and managers join residents at lunchtime making the experiences inclusive to those living and working within the home. Not only does this enable staff to encourage residents as necessary with eating but it also provides additional means by which conversation can be encouraged. Where staff assistance was needed this was given discretely. Dorset House DS0000018648.V337500.R01.S.doc Version 5.2 Page 20 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): Standards 16 and 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Policies and procedures are in place to promote the protection of people who live within the home. Staff training is in place to provide additional protection to residents against abusive practices. EVIDENCE: A clear complaints procedure is included within the homes service users guide a copy of which was within the reception hall. The procedure was also displayed in a picture frame near to the main door. The details of the commission are given within this document although the wording upon when an individual can contact the commission is different within the contract issued to new residents. A ‘suggestions’ box is located in reception although it was reported that nobody has ever used this means of making comments regarding the service offered. The homes complaints records were viewed going back a number of months. It needs to be acknowledged that the registered manager has recorded a number of concerns / complaints which could be viewed as ‘minor’ and easy to resolve. It is good practice that these more minor issues are recorded Dorset House DS0000018648.V337500.R01.S.doc Version 5.2 Page 21 although the evidence of actions taken could be enhanced further, as reported ‘action plans’ were not recorded. The commission have not received any complaints regarding Dorset House since the last random inspection in December 2006. The random visit in December was undertaken partly due to concerns raised to the commission regarding recruitment procedures. Policies and procedures regarding safeguarding adults or protecting vulnerable people were briefly viewed on this occasion. The document made reference to Kent joint guidelines and East Sussex multi agency guidelines but not to the Worcestershire guidelines. Over recent months the registered manager has reported a number of concerns regarding potential or actual abuse to the commission as necessary. As part of this inspection a potential concern was brought to the attention of the registered manager who was later able to report that the concerns appeared to be unsubstantiated. Staff training includes sessions regarding the safeguarding of adults. The training covers what constitutes abuse, the reporting of abuse and information about bodies such as the Criminal Records Bureau (CRB) and PoVA (Protection of Vulnerable Adults). As reported elsewhere within this report regular training covering a range of subjects including adult protection (safeguarding) takes place within Dorset House. It was noted that 18 people have attended safeguarding training so far this year. Some staff last undertook training during 2005 while 2 persons have not yet undertaken any training upon safeguarding. Dorset House DS0000018648.V337500.R01.S.doc Version 5.2 Page 22 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, 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. People living within the home are provided with a homely, comfortable and clean environment. The layout of the home encourages residents independence. EVIDENCE: Dorset House provides a warm and clean environment. Communal areas of the home continue to be well maintained, comfortable and attractive. The dining room had a restaurant appearance with well-laid tables. 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 photograph albums of HRH The Duchess of Dorset House DS0000018648.V337500.R01.S.doc Version 5.2 Page 23 Gloucester who is Patron to Age Care, this room seems to be rarely used by residents. The morning room and conservatory are used on a regular basis as are the seating areas leading into the newer part of the home from the older part. 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. The corridor areas within the original part of the home remain in need of decorating, as the current décor is looking dated and fatigued in its appearance. The previous report stated that work was scheduled to take place on the décor during the financial year commencing on the 1st September 2005. This work has not happen. 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. The home was noted to be 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. Notices on sluice doors state ‘In the interest of infection control this door should be shut after you at all times’. Despite the notice doors were found to be left open therefore not only failing to uphold the guidance upon infection control but also not safeguarding residents against items within these areas. Toilet facilities within the older part of the home are functional in appearance. One toilet has carpet flooring which is not ideal due to infection control procedures. Toilets and bathrooms within the newer part of the home are larger and therefore more suitable for persons with reduced mobility. The home was clean and tidy. No offensive odours were noted at anytime throughout this inspection. Bedrooms seen contained residents own personal belongings. An emergency call system is in place. All areas of the home including the grounds are easily accessible to persons with reduced mobility due to the provision of passenger lifts and a stair lift. An additional comment regarding one of the passenger lifts is included later within this report. The grounds around Dorset House have in the past being noted as well maintained. In recent years the home has entered the Droitwich in Bloom competition and has won in the best communal garden category and come second in the hanging basket and window box category. More recently a number of raised flowerbeds have been added near to a large patio area. Dorset House DS0000018648.V337500.R01.S.doc Version 5.2 Page 24 Seating is available not only near to the patio area but also at frequent locations around the garden footpath therefore providing residents with places to sit and relax. Shading from the sun can be obtained by using umbrellas and awning. Although acknowledged that the area has recently experienced heavy rainfall the grounds were not looking at their best on this occasion with both long grass and weeds. One resident made a comment upon the grounds and the need for a gardener. A new gardener commenced work at the home on the last day of this inspection. Dorset House DS0000018648.V337500.R01.S.doc Version 5.2 Page 25 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 poor This judgement has been made using available evidence including a visit to this service. The lack of care staff on certain days is of serious concern due to the potential risks posed to people living within the home in that care needs may not be met. Training is provided however some staff have not undertaken recent up dates to ensure the needs of residents can be fully met. Improvements in the homes recruitment procedures provide safeguards for residents against potential harm. EVIDENCE: It was 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. The registered manager is in addition to the above staff. Due to recruitment difficulties Age Care have over recent years recruited a number of persons from overseas. The staff group is diverse with staff covering a range of ages. Both male and female staff are employed although carers and qualified nurses are predominately female. One relative stated on a residents questionnaire ‘Attentive staff – all areas. Caring attitude.’ Other comments were Dorset House DS0000018648.V337500.R01.S.doc Version 5.2 Page 26 ‘The staff are very caring and very willing and friendly.’ and ‘The staff at Dorset House offer an excellent care service in a kind and considerate way.’ During the actual inspection residents made positive comments regarding the majority of staff members similar to the comments recorded above. One resident stated that the staff are ‘ very helpful’ and ‘ I feel safe’. Time is built into the rota for the purpose of handover from one shift to the next. Staff are allocated certain residents to assist each morning on a daily basis, therefore ensuring each member of staff has a knowledge of all areas of the home. However during the visits to the home a number of comments were made regarding staff shortages. Both staff and residents made comments regarding shortages. Over recent months a number of staff have left Dorset House to pursue other opportunities therefore creating a number of shifts that need covering. To cover these shifts some staff work overtime while other shifts are covered by the deployment of either bank or agency staff. The use of agency staff is high. It was evident that some shifts remained uncovered due to the unavailability of agency staff or the home’s own staff leaving the home understaffed. Prior to the weekend Saturday 30th June and Sunday 1st July the rota showed uncovered shifts. A qualified member of staff was asked to contact another agency in order to cover these shifts. However after the weekend it was apparent that shifts were not covered by the agency therefore serious shortfalls were evident. On Saturday 30th the home operated with two carers short for a period of three hours. On Monday 2nd July carers were working with one carer short. A small number of rotas from previous weeks were viewed (some of the more recent rotas were not available) these also showed a considerable number of shifts which needed to be covered and some which were not covered. The commission were not informed of any uncovered shifts under Regulation 37 of the Care Homes Regulations. A lack of sufficient staff on duty to meet the needs of residents is of serious concern and appropriate action must take place to ensure that suitably qualified and experienced staff cover the rota. In addition to care staff are a number of staff undertaking different roles. Waiters / waitress are provided to serve the mid day meal. Domestic staff are also employed, including weekends. The laundry is staffed until 3.00 pm each day, after which care staff undertake some laundry duties. Dorset House DS0000018648.V337500.R01.S.doc Version 5.2 Page 27 The previous key inspection report (October 2005) stated that 50 of carers were qualified to NVQ (National Vocational Qualification) level 2 or above. This level of qualified staff was consistent to the target set within the National Minimum Standards. A document seen during this inspection stated that 88 of carers hold an NVQ, although this was not checked against any other records including information regarding staff who have terminated their employment or new starts. The above level of qualified staff differed with information within the summer edition of Dorset House’s newsletter which states ‘Presently we have 50 of care staff already qualified.’ Both the previous random inspection (December 2006) and the previous key inspection (October 2005) highlighted some serious concerns regarding recruitment procedures within Dorset House. As a result of these earlier concerns an immediate requirement notice was issued during December 2006 requiring an improvement in line with the associated regulations. A couple of new starters files were viewed as part of this inspection. Generally they were found to be in satisfactory order although a few further improvements could be implemented. It was noted that interview notes were held which is good practice. In addition it was evident that a full-enhanced CRB (Criminal Records Bureau) disclosure was obtained prior to the commencement of employment. Staff contracts were not sought on this occasion. Training records for 2006 and 2007 were viewed as well as some other documentation. These documents as well as discussions with staff evidenced that regular training is provided in house for staff to attend. However despite the training provided a number of gaps were identified including moving and handling and fire safety these were discussed with the registered manager at the time. Staff induction was not assessed however it was evident that newly recruited staff were undertaking some training within the home’s training room during this inspection. Dorset House DS0000018648.V337500.R01.S.doc Version 5.2 Page 28 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 This judgement has been made using available evidence including a visit to this service. An experienced manager manages Dorset House. Monitoring systems are in place covering a range of areas including some quality assurance matters and health and safety. Risk assessments are held. Some of these need to be reviewed to ensure that people living within the home are not placed at potential risk. EVIDENCE: Since the last key inspection the original manager has left Dorset House. The current manager made an application to the commission for registration which was approved. The registered manager who is experienced in managing care Dorset House DS0000018648.V337500.R01.S.doc Version 5.2 Page 29 services is a Registered General Nurse and has successfully completed the Registered Managers Award (RMA) which is a level 4 NVQ (National Vocational Qualification) in management. Documents regarding a formal quality assurance system dated February 2005 are in place. The procedures contain no amendments and no monitoring has taken place since June 2006. The records regarding quality monitoring using the system were insufficient and need to be improved. Clinical governance audit forms were seen showing the number of incidents which have occurred within the home such as falls. Surveys were issued to residents during the summer of 2006 and the result grouped together into one document. The vast majority of responses were reported to be either ‘excellent’ or ‘good’. No action plan was seen in relation to the areas where the feedback was not as favourable. Residents meetings are held regularly in which residents have the opportunity to discuss their views of the home and the services offered. A representative from Age Care head office visits the home on a regular basis and prepares a report upon the finds regarding the conduct of the home. Dorset House has facilities for the safekeeping of small amounts of money on behalf of residents. Since the last key inspection a number of changes have taken place regarding staff with responsibility for ensuring safe systems are in place regarding residents money. A small sample of residents monies were checked and found to balance. Although the actual balances held were correct it was evident that improvements to systems are needed to safeguard both residents and staff against possible abuse or allegation of abuse. The fire records kept by the maintenance manager were in good order. It was evident that when he is away from the home such as on annual leave checks and testing of the system do not take place. Suitable arrangements to cover periods of holiday need to be addressed. A revised risk assessment taking into account the Fire Safety Order needs to be drawn up. Evacuation chairs are available in case of needing to move persons down the stairs in the event of a fire or other emergency when the lift could be out of action. Fire extinguishers are serviced on an annual basis. Details of the location of emergency stops and taps were displayed within the home, which is good practice. The registered manager is currently updating the home’s disaster contingency plan. Records regarding the checking of water temperatures were in place and well maintained. Small kitchenettes are located around the home therefore enabling residents or visitors access to facilities to make drinks. A fridge is situated within each of these areas; the records within the kitchenette regarding temperature records were not completed on a daily basis with a number of gaps noted. On one Dorset House DS0000018648.V337500.R01.S.doc Version 5.2 Page 30 occasion it was noted that a reading of 9 °C was recorded. Cleaning materials are stored in cupboards within the kitchenettes; although these cupboards are secured the suitability of the pad lock should be re-assessed. The registered manager must ensure that the health and safety of residents is assured and any risks identified need to be either reduced or eliminated. Temperature records regarding fridges, freezers and hot food were generally in place although some gaps were evident when agency staff had covered and not completed the documentation. Catering staff have not implemented the introduction of the Food Safety Agency document on better business safer food. Some concern regarding either the lack of window restrictors in some places or the suitability of restrictors was discussed with the registered manager and the health and safety coordinator. A number of windows above waist height had no restrictors fitted and therefore could pose a potential risk to residents failing either accidentally or intentionally. A risk assessment was in place dated 24th May 2005 (therefore over 2 years ago) the recorded action to be taken to reduce the risk stated ‘Restrictors to be fitted to all windows or replacement windows’. It was therefore evident that despite identifying measures to reduce potential risk action had not happened. The majority of windows checked including those within bedrooms did have a means of restricting opening, although this was not the case in one bedroom. No systems were in place to check the existence of or suitability of these restrictors. In one bedroom screws were used to restrict the window which was showing signs of becoming an unsafe method. The registered manager undertook to take suitable action in response to the shortfalls identified. Radiators seen throughout the home are covered to prevent accidental scalding. Some pipe work is boxed in while other pipe work is not. Staff consulted within the home were confident that the exposed pipe work does not carry hot water therefore no potential risk of harm existed. It was stated that this statement would be checked out and suitable risk assessments carried out. It was evident from discussions during the inspection and by means of labelling on equipment that the maintenance manager tests portable electrical appliances on a regular basis. One resident was heard making a request to staff within the office to have a new lamp tested in order that she could use it. It was reported that the home was awaiting a report following a recent electrical test. Records are not maintained to evidence the safe functioning of bedrails. Wheelchairs seen throughout this inspection all had footrests in place as needed to safeguard residents against a potential risk of injury. Identification attached to portable hoisting equipment evidenced that items were recently tested in line with the associated regulations. The actual documents regarding Dorset House DS0000018648.V337500.R01.S.doc Version 5.2 Page 31 portable hoisting equipment, the lifts and stair lift were not viewed. A potential risk was identified regarding one of the passenger lifts as part of the last key inspection. A risk assessment was needed and suitable action if identified to reduce any risks. Although a risk assessment was in place it did not cover the actual area of concern and therefore needs to be reviewed. Details of first aiders were displayed showing a total of five register nurses and ten carers with a certificate. Dorset House DS0000018648.V337500.R01.S.doc Version 5.2 Page 32 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 3 2 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X 3 X 3 3 2 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 3 X 2 X 3 X X 2 Dorset House DS0000018648.V337500.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? Yes 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 OP2 Regulation 5 Requirement Residents must be provided with full and accurate information regarding the fees they are to be charged and what is included within the charge. Care plans accurately covering in detail all identified care needs including emotional and social needs, must be in place and updated at least monthly or when any significant changes become apparent. The above requirement replaces a similar requirement with a timescale of 12/12/06 which was unmet. This requirement must be met within the revised timescale. 3 OP8 13 Risk assessments must be in place and regularly reviewed to ensure the health safety and welfare of residents. Risk assessments must be in line with the care needs as identified within the care plan. DS0000018648.V337500.R01.S.doc Timescale for action 15/07/07 2 OP7 15 31/08/07 31/08/07 Dorset House Version 5.2 Page 34 4 OP9 13 (2) Ensure that records and other items regarding medication and its administration and storage are clear, accurate and up to date to ensure that residents receive items as prescribed and therefore ensuring the health, safety and welfare of residents. Systems in place must be able to be audited and monitored. The above requirement replaces a number of similar requirements with varying timescale one dating back to 21/10/05 were unmet. This requirement must be met within the revised timescale. 02/07/07 5 OP19 23 (2) (b) All areas of the home must be well maintained including décor. The above requirement replaces a similar requirement with a timescale dating back to 31/03/06 was unmet. 30/10/07 6 OP28 18(1) Sufficient suitably experienced 02/07/07 staff must be on duty at all times to ensure that the identified care needs of people living within the home can be met as well as the ability to safeguard their health, safety and welfare. Staff must receive the training necessary to enable them to carry out their duties in a safe and competent manner. A suitable and revised risk assessment must be undertaken in relation to the location of the sensor beam on the passenger lift and that appropriate action is taken. 31/08/07 7 OP30 18 (1) (c) 8 OP38 13 07/07/07 Dorset House DS0000018648.V337500.R01.S.doc Version 5.2 Page 35 9 OP38 13 (4) The above requirement replaces a similar requirement with a timescale dating back to 12/12/06 was not fully met. Windows within the home must be assessed for the risk they present to the people within the home and action taken to minimise any identified risk. A fire safety risk assessment in line with the Fire Safety Order must be in place. 15/07/07 10 OP38 23 31/07/07 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 Consideration should be given regarding the obtaining of written confirmation (such as via a fax) of any changes or amendments to residents prescribed medication. (This recommendation was not re assessed as part of this inspection. The wording is amended slightly.) 2 OP11 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 the choice of meals provided should be undertaken to ensure that residents dietary wishes and needs are addressed. Information upon the menu board should include additional detail such as the vegetables due to be served. The current practices regarding the administration of residents money should be reviewed. 3 OP15 4 OP35 Dorset House DS0000018648.V337500.R01.S.doc Version 5.2 Page 36 5 6 OP38 OP38 The current arrangements for securing chemicals should be reviewed. It is strongly recommended that the former guidance issued by Hereford and Worcester fire authority is adhered to. The pre journey safety check for the mini bus should be expanded and more detailed regarding the checks made. 7 OP38 Dorset House DS0000018648.V337500.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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.V337500.R01.S.doc Version 5.2 Page 38 - 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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