Inspection on 29/04/09 for Dorset House

This inspection was carried out on 29th April 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Dorset House 06/08/09

Dorset House 21/04/08

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

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Aston Court Nursing Home

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Bank House

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Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Dorset House Blackfriars Avenue Droitwich Spa Worcestershire WR9 8DR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Andrew Spearing-Brown     Date: 1 5 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Dorset House Blackfriars Avenue Droitwich Spa Worcestershire WR9 8DR 01905772710 01905771476 dorset@agecare.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Royal Surgical Aid Society Name of registered manager (if applicable) Mrs Emma Miles Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 42 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 42 Old age, not falling within any other category (OP) 42 Date of last inspection Brief description of the care home 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. The home Care Homes for Older People Page 4 of 32 care home 42 Over 65 0 42 42 0 Brief description of the care 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. Car parking is available in the grounds of the home. For up to date information regarding fees the reader should ontact the service directly. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection at Dorset House was carried out during April 2008.This inspection was unannounced therefore nobody within the home knew we were going to visit. The inspection was carried out by 1 regulation inspector. A pharmacy inspector joined the regulation inspector for part of the second day of this inspection. The focus of our inspections is upon the outcomes for people who live in the care home and includes peoples views of the service provided. The process we use considers the homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of the service that need further development. Prior to our visit we looked at the information that we have received since our last Care Homes for Older People Page 6 of 32 inspection. We requested an Annual Quality Assurance Assessment (AQAA) from the home prior to our visit. The AQAA is a document completed by the service and provides us with information about the home and how they believe they are meeting the needs of people living there. We sent out some questionnaires to a sample number of people living in the home . We also sent questionnaires to some members of staff and some health professionals. Prior to the inspection we received 12 surveys back from residents which was a response rate of 100 . We received 9 back from members of staff and 1 from a health professional. We looked around the home. We viewed records in relation to some people living in the home such as care records, risk assessments and medication records. We also viewed records relating to some members of staff and others regarding health and safety matters. We checked that requirements from the last inspection had been addressed. We spoke to the manager designate, the lead nurse as well as other nursing staff, some care staff and some people living in the home. Since we did our inspection but prior to preparing this report the manager designate has become registered with us. As a result of this registration her name now appears within this report in her capacity of registered manager. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available to help people make a choice about whether they would like to live at Dorset House. The needs of people who may use the service are assessed so that individuals and their relatives can be assured that care needs are able to be met. Evidence: The home has a Statement of Purpose available for people who either use the service or may wish to do so in the future. This document was available in the reception area of the home with other information including a leaflet about Dorset House and the last inspection report. Although these documents were not studied in any detail we observed that they were recently reviewed and up dated. Before we carried out this inspection we sent out some questionnaires to people living in the home. All of these were returned to us and everybody confirmed that they had received enough information about the home before they moved in. Having sufficient Care Homes for Older People Page 10 of 32 Evidence: information about the service can help people decide whether the home is the right place for them. One person wrote Everybody was very helpful when we enquired about Dorset House. I was given a well informed folder of documentation on the home. Any questions I asked were answered fully and promptly. Emma the manager is very very helpful in the arrangements for new residents. The AQAA states that prospective residents are encouraged to visit the home if possible prior to admission so that they can have an active part in the decision making process. Within the Annual Quality Assurance Assessment we were told that the contract used between the home and people wishing to live at the home was recently reviewed. We were told that this document is explained to people. We saw evidence of a contract on the file of somebody recently admitted into the home. The contact we saw contained a breakdown of the fees to be charged. People confirmed that they had received a contract. We viewed the assessment carried out by the manager regarding a person prior to their admission into the home. The assessment was sufficiently detailed to enable an initial care plan to be completed. We saw evidence that following an assessment the home confirms in writing that they are able to meet the identified care needs. Care Homes for Older People Page 11 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health care needs are generally met and people feel that they receive appropriate care. However, people can not be confident that all their needs will be met properly or that they will receive medication as prescribed, because suitable systems are not always in place to ensure this. Evidence: As part of this inspection we asked to see the care plans of a number of people residing within the home. A care plan is a document designed to guide staff about the level of care required by each individual to ensure that identified needs are met and people receive the support they require. We have previously had concerns about the care plans at Dorset House as they did not always accurately reflect the needs of people using the service. Following our inspection last year we were supplied with an action plan that stated that care plans would be monitored and reviewed as required. Care Homes for Older People Page 12 of 32 Evidence: The AQAA stated that care plans are comprehensive and include individual tools or risk assessments, care plans are reviewed monthly or as required by the key worker nurse. One care plan gave clear instructions to staff regarding the prevention of pressure sores. The plan stated that staff were to observe for any red marks or breaks in skin and that any such concern should be reported. Pressure relieving equipment was seen to be in use following some reddening. A tissue viability nurse had advised the use of some cream. The lead nurse confirmed that no care plan was in place regarding the use of cream. One person was taking painkillers for her wrist and also wearing a splint. We were informed that the person put the splint on herself however neither the painkillers or the splint were mentioned within the care plan. One person was on a low cholesterol diet. This was not mentioned in his care plan. We did however see a note in the kitchen bringing this dietary need to the attention of catering staff. We saw evidence that the care plans that are in place are reviewed. We saw some risk assessments such as moving and handling which were also reviewed. We consulted staff and found that they had a good knowledge of peoples care needs. Although we found no negative outcome in relation to shortfalls in care planning it is nevertheless important that care plans are up to date and fully reflect current care needs. On the first day of this inspection we found a number of shortfalls with medication. As a result of us having previously made a requirement regarding medication we asked a pharmacy inspector to take part in the second visit to the home. On our first visit we had some concerns about the records of fridge temperatures. The instructions with the new fridge stated that the temperature should be between 2 and 8 degrees. The records showed that the piece of equipment was as high as 11 degrees for a period of 9 days. We viewed the handypersons book to see if anybody had asked him to look at it. We found no request for this to be done. The manager confirmed that no instructions were written down regarding what to do if the fridge was showing too high a temperature. The list of staff able to administer medication was not up to date. Care Homes for Older People Page 13 of 32 Evidence: Some Medication Administration Record (MAR) sheets were viewed. We saw some gaps whereby staff had failed to sign for medication. We were unable to balance some medication against the records held in relation to somebody who had recently gone on social leave. The person concerned was able to confirm that he had received his medication but balancing the number of tablets against records could not be done. In relation to some other medication we were unable to carry out an audit as items was not checked in correctly. We viewed a number of records involving antibiotic medication. One MAR sheet stated course completed however it appeared that the medication was stopped due to side effects. One course of antibiotics balanced correctly however another contained too many signatures for the amount of medication dispensed. The pharmacy inspector also found that the home had failed to keep accurate records in relation to people residing within the home. The MAR sheet for one person failed to give instructions regarding the administration of 1 item. The packaging also failed to give this information. We undertook an audit of this medication and were unable to balance the amount held with the number booked in. We found 4 tablets in an excess stock cabinet belonging to one person. These tablets were not taken into account when the home had receipted other medication into the home. Another audit carried out also found 4 too many tablets remain, our finding was confirmed by the nurse on duty who could not explain the anomaly. We carried out an audit of some medication in sachets and found the stock level to be in excess of what the records suggested. The manager suggested that this discrepancy might be due to some sachets being carried over but not accounted for. We also carried out an audit of some painkillers and found a discrepancy. This discrepancy could not be explained at the time of the inspection. We carried out an audit of another tablet and found that 2 tablets were missing. The nurse on duty could not account for this discrepancy. The records seen showed that staff were not applying a cream to one person with the frequency prescribed. We also saw evidence that the same cream was been applied elsewhere to the location recorded upon the MAR sheet. We found a medicated gel in another persons bathroom. The nurse on duty could not tell us whether whether this gel was being applied to the person concern as no records existed. We saw a record stating that medication was refused on 29 occasions. The manager was unable to find these tablets and no record existed showing the disposal of these Care Homes for Older People Page 14 of 32 Evidence: tablets. The room where medication is held was, according to the records, too warm on a number of occasions prior to our visit. Dorset House has a controlled drugs cabinet for the storage of such classed medication. It was found that the cabinet was not Rag Bolted to the wall and therefore was not compliant with the Misuse of Drugs (Safe Custody) Regulations 1973. We saw a copy of a generic homely remedies list. As this was generic it was not individual and did not therefore take into account individual circumstances. As a result of our concerns about medication we served a Statutory Requirement Notice under the provision of Regulation 43(3) of The Care Homes Regulations 2001 to the registered provider. We observed staff and their practice throughout our time in the home. We found staff to be polite and courteous to residents at all times. During our discussions with residents nobody brought to our attention any concerns regarding staff attitude or how people are treated. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service offers people the chance to take part in a range of social and recreational activities reflecting personal preferences. A choice of varied meals are available. Meal times are relaxed and most people like the food that is provided. Evidence: Dorset House employs a full time activities organiser. The vast majority of people told us that activities are arranged in the home that they are able to take part in. One person described the activities organiser as great. Somebody else commented that there are plenty of activities every day. Information was on display about a forthcoming trip to see a play at the local amateur theatre. A number of residents told us about this trip and that they were looking forward to going. Information about activities is available within the home. We saw copies of a weekly schedule as well as details of other events on the notice board. A larger board in the dining room also reminds people of the events that are taking place that day. Forthcoming activities included knitting and cross stitch club, gentle exercises, book Care Homes for Older People Page 16 of 32 Evidence: club, piano recital, quiz and nail care. Since our last inspection changes have taken place to the drawing room making its use as a room for activities more feasible. A new large flat screen television is in place, we noted that a DVD was going to be shown that afternoon. We were told that pop corn and sherry is served during a film. We saw the Spring 2009 edition of the homes newsletter. The newsletter gave details of forthcoming events as well as a brief write up and photographs of past events especially those around last Christmas and an Burns lunch when haggis was served. A survey carried out prior to April 2009 found that 65 of people believed their spiritual needs were been met in the home while 30 said there were not. We discussed this area with the activities coordinator who said that she was looking into asking the Methodist church to return to carry out a service. Other areas of meeting religious needs may need to be considered. We saw a number of people visiting relatives or friends. Visitors were seen to be made welcome within the home. During our visit we took the opportunity to join residents for lunch. The menu was displayed at the entrance to the dining room. The weeks menu has the appearance of a restaurant about it. The days menu is also displayed to make it easier for people to see and associate with. The meal was well prepared and enjoyable. The residents we sat with were complementary about the meal. Dorset House benefits from having dedicated staff to serve meals. As a result care staff are able to sit with resident and have their lunch at the same time. This is good practice as staff are able to assist people with their meal, if needed, in a very discreet and sensitive way. The meal was unhurried and was a social time for both residents and staff. We saw people being offered a choice of meal. Dorset House celebrates birthdays and other events with special meals. During our visit one resident had supplied wine for her fellow residents to celebrate her daughters birthday. We received some written comments about meals meals are always very nice, the food is exceptional and the tables are laid beautifully. We asked people if they liked the meals at the home. A total of 3 people answered always while 7 answered usually and 2 sometimes. Information about peoples dietary needs such as low cholesterol was on a white board in the kitchen. Care Homes for Older People Page 17 of 32 Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be more confident that there complaints will be listened to and that they will receive an appropriate response. Staff have knowledge about safeguarding procedures within the home. Evidence: The complaints procedure was displayed within the foyer of the home, this procedure included details about the Care Quality Commission. We asked people as part of our questionnaire whether they know how to make a complaint. All but one person answered yes. The majority of people indicated that they would know who to speak to if they were unhappy. We also asked staff if they know what to do if a resident or their representative has a concern about the home. Staff confirmed both on the questionnaire and during our visit that they were aware of what to do in these circumstances. Since our last inspection we have received one complaint about the service provided. We asked the provider to investigate these matters and let us know the outcome. We received a prompt and detailed response. We viewed the records of complaints made since the previous inspection. Some correspondence was not available for example when people had written directly to Care Homes for Older People Page 19 of 32 Evidence: head office we could not always find a copy of the letter sent back on behalf of the organisation. Similarly regarding another complaint we could not find a record of the response however the manager assured us that the matter was now resolved. he records regarding more recent complaints were more detailed and showed the outcome of the investigation. Since our last inspection the home has made an appropriate referral to the local authority following an alleged incident between two residents. We saw a copy of a booklet issued by Worcestershire Adult Services on safeguarding within the office for staff to refer to if needed. We have previously highlighted that the homes policy and procedure upon safeguarding makes reference to Kent joint guidelines and East Sussex multi agency guidelines but made no reference to Worcestershire. These documents were reviewed earlier this year when changes were made about a previous commission to the former one. A further review of this document is needed to ensure it fully reflects the Worcestershire protocol and the most recent change regarding regulator. Training for staff is provided by the in house trainer. We were told that 17 members of staff have so far undertaken this training during 2009, other staff last received the training last year with the exception of 2 bank carers who were to due to do the training in the near future. Staff consulted confirmed that they have received training and that they are aware of the actions needed in the event of actual or potential abuse taking place within the service. We were told that both the manager and the senior nurse have attended training regarding the local Deprivation of Liberty Standards. We saw a referral under these procedures while we were in the home. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Dorset House do so in a well maintained, clean and comfortable environment. Evidence: Dorset House continues to provide a clean and well maintained environment for people who live there. The communal areas are attractive and comfortable. The dining room has he appearance of a restaurant. The tables are set out nicely ready for people to enjoy their meals. We were informed that the curtains within this area are new. Some new pictures are on display however some others are becoming faded. Numerous pictures and other items such as plates are on the walls, some of which show either Dorset House or Droitwich Spa. A digital photoframe is in place in the reception area which shows a varity of pictures of residents undertaking activities. The reception are has a display cabinet. At the time of our visit the theme was May Day. Toilet facilities within the older part of the home are functional in appearance. The toilets and bathrooms in the newer build are larger and are more modern. Care Homes for Older People Page 21 of 32 Evidence: Since our last visit the drawing room has undergone some changes. In the past this room seemed to be seldom used. Following receiving some funding from a local trust a new wide screen television has been purchased and the room is now used for some activities. During our visit we observed the activities coordinator preparing the room with a jigsaw puzzle and plans were in hand for the showing of a film later that day. Dorset House provides single accommodation and all bedrooms have en-suite facilities. We saw a number of bedrooms where people had brought in items of furniture and other personal belongings. We noticed a free standing wardrobe that was not secured to the wall, we brought this to the attention of the lead nurse. Bedroom doors are lockable and we were told that people are asked upon admission whether they wish to have a key. The manager told us of her plans to enable a redecoration programme of bedrooms to continue. In addition the manager hopes to be able to replace the carpet in the reception area and on the main staircase. All areas of the home are easily accessible to people with reduced mobility due to the provision of passenger lifts and a stair lift. The grounds surrounding the home are easily assessable and were at the time of our visit in good order. We were told of plans to purchase two greenhouses to be used by the gardening club. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are trained staff on duty to meet the the needs of people using the service. People can have confidence in the homes recruitment processes. Evidence: We were told that currently staffing levels consist of six care assistants in the morning and five each afternoon. Three carers work each night. A trained nurse is on duty 24 hours per day. The rota showed any gaps that needed to be covered by other staff. We were told that staffing in the afternoon was recently increased back to its former level following a period when it was reduced. People commented that staff on the whole listen and act upon what they say however we received mixed comments regarding whether staff are available when needed. staff are very helpful and act very quickly, sometimes it has been necessary to repeat requests. We asked staff for their opinion regarding whether enough staff are available to meet care needs. We received a range of responses from always to sometimes. Dorset House has a complement of trained nurses, a care coordinator, a senior carer, 6 night carers and 14 day carers. Care Homes for Older People Page 23 of 32 Evidence: Since our previous inspection the home has built up its own supply of bank / relief staff therefore placing less dependency on the use of agency staff to cover any shortfalls. At the time of the inspection the home had a total of 6 bank staff available to cover the rota as needed. We looked over the files of two recently appointed members of staff. We found evidence that references are obtained and checks carried out to ensure that potential employees are suitable to be working in the home. The files contained copies of peoples contract of employment. During our inspection we were told that 75 of care staff now hold a level 2 NVQ (National Vocational Qualification). Three members of staff hold a level 3 qualification. These figures are a slight increase from those given within the AQAA and demonstrate on going improvement in this area, which already exceeds the National Minimum Standard. The records seen showed an improvement in training provided since our last inspection. A considerable amount of training is carried out by the homes in house trainer. We were informed that Age Care are currently providing specialist training in dementia although this has not yet happened at Dorset House. As the home is registered to care for people with a dementia type illness it is important that staff receive regular and appropriate training. However we did not witness any inappropriate practices during our visit to the service. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is managed in the best interests of people living there. Improvements in some systems and record keeping could ensure that people are safer. Evidence: Since our inspection the managers application to CQC for registration has been approved. The manager started working at Dorset House in September 2008. She informed us that she has a diploma in nursing and holds the Registered Managers Award (RMA)which is a level 4 NVQ in management. The manager was not present in the care home when we visited for the second time. We were wanting to see some records which need to be readily available for us. These records were however held in a locked cabinet, the only key was with the manager who was not on duty and not in a position to attend the home. Arrangements were made for us to obtain the key but showed the importance of having certain records available at all times. Care Homes for Older People Page 25 of 32 Evidence: The manager is now using the office near to the main entrance of the home in order to improve her availability to people living in the home and visitors. As indicated earlier within this inspection report we found that some areas of management especially in relation to medication systems and care plans need improvement. Regular heads of department meetings are held in order to discuss issues within the home. We were able to evidence that a representative from Age Care visits the home on a regular basis. Regular Regulation 26 reports are written up following visits. The report from April stated that feedback from residents was all positive. Following a customer satisfaction survey on activities carried out by Age Care the findings, dated April 2009, were available in the reception area. A total of 41 surveys were sent out and 23 were returned. An action plan with suitable timescales was devised as a result of the findings. The manager and senior staff at the home have in the past informed us of incidents or happenings within the home as necessary. Age Care has a wide range of quality auditing tools which are used. These documents were not viewed in any detail as part of this visit to the service. People living within the home are able to deposit small amounts of money into safekeeping. We viewed records and found that on one, although only incorrect by a relatively small amount, a number of mistakes were apparent. Systems therefore need to be in place to ensure the accuracy of these records to ensure peoples money is kept safely. Staff confirmed that they have received formal supervision in line with the associated National Minimum Standard. The supervision planner showed that staff had received at least two sessions during 2009 up to the date of our visit. The manager told us that she planned to carry out appraisals during June and July as she was aware that these had not happened for some time. We viewed a small number of service records. We have in the past find these to be in good order at Dorset House. The records on hoists showed that they were last serviced during March 2009, the handyperson carries out a monthly visual check. We did not Care Homes for Older People Page 26 of 32 Evidence: view records on window restrictors on this occasion. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 (1) Ensure each service user has 30/06/2008 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. 2 7 15 (2) Review care plans at regular intervals and where necessary update plans to reflect changing needs and current objectives for health and personal care. 30/06/2008 Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Regulation 13 (2) Make arrangements to secure the Controlled Drugs cabinet as is require by the Misuse of Drugs Act (Safe Custody) Regs 1973. To ensure the health and well being of people using the service. This requirement is subject to a Statutory Requiement Notice. 20/07/2009 2 9 13 Regulation 13 (2) Ensure that the care plan for each person using the service has a list of the homely remedies that can be safely administered to them alongside their prescribed medications. To ensure the health and well being of people using the service. 20/07/2009 Care Homes for Older People Page 29 of 32 This requirement is subject to a Statutory Requiement Notice. 3 9 13 Regulation 13 (2) Put a procedure in place to ensure effective arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. To ensure the health and well being of people using the service. This requirement is subject to a Statutory Requiement Notice. 4 9 13 Regulation 13 (2) Make arrangements to ensure that medication administration records are accurately maintained including all records of the disposal of medicines refused at the time to be administered by people using the service. To ensure the health and well being of people using the service. This requirement is subject to a Statutory Requiement Notice. 20/07/2009 20/07/2009 Recommendations These recommendations are taken from the best practice described in the National Care Homes for Older People Page 30 of 32 Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 18 The homes procedures in safeguarding should reflect those devised by Worcestershire Adult Service. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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