Inspection on 03/09/08 for Dorset House

This inspection was carried out on 3rd September 2008.

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

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 04/09/07

Dorset House 17/11/06

Dorset House 04/01/06

Dorset House 20/05/05

Dorset House 17/11/04

Dorset House 03/08/04

Dorset House 15/03/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 26/11/2008.

CARE HOMES FOR OLDER PEOPLE Dorset House Off Station Road Wallsend Tyne & Wear NE28 8EN Lead Inspector Glynis Gaffney Key Unannounced Inspection 3rd September 2008 09:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Dorset House DS0000033104.V371222.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dorset House DS0000033104.V371222.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dorset House Address Off Station Road Wallsend Tyne & Wear NE28 8EN Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) 0191 643 7750 0191 2007155 anne.steele@northtyneside.gov.uk North Tyneside Council Vacant (Anne Steele has been appointed as the manager and is in the process of submitting an application to register) Care Home 41 Type of registration No. of places registered (if applicable) Category(ies) of Dementia (12), Old age, not falling within any registration, with number other category (26), Sensory impairment (3) of places Dorset House DS0000033104.V371222.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia - Code DE, maximum number of places: 12 Old age, not falling within any other category - Code OP, maximum number of places: 26 2. Sensory Impairment - Code SI, maximum number of places: 3 The maximum number of service users who can be accommodated is: 41 4th September 2007 Date of last inspection Brief Description of the Service: Dorset House Resource Centre is a North Tyneside Council service registered to provide up to 41 places for older people with a range of needs. The centre is a single storey building situated in a residential area of Wallsend. A bus route, pub, and local shops are within easy walking distance. Off street parking is available. The centre consists of four units all of which have their own lounge and dining area, bathing facilities and laundry. The Balmoral and Oakwood units offer a total of 21 short break beds for people with a diagnosis of dementia. The Kensington unit has 11 places for older people who need respite care and the Sandringham unit provides nine beds for older people who need to recuperate following a hospital admission. In addition, 20 day care places are provided seven days a week for people with dementia. The service is currently undergoing refurbishment to improve the standard of accommodation offered. The fees paid by people using the service varies according to their individual financial circumstances. The Council carries out an assessment to determine people’s eligibility to access its services and receive financial support. Information about how people’s financial circumstances will be assessed is included in the home’s service user guide/statement of purpose. A copy of the Dorset House DS0000033104.V371222.R02.S.doc Version 5.2 Page 5 most recent inspection report is available on request at Dorset House. Dorset House DS0000033104.V371222.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. At the time of the visit, work to improve the standard of the accommodation was underway. Because of this, the Commission has made a decision to review compliance with premises related requirements following completion of the works. This applies to Requirements 4 and 5 as stipulated in the inspection report issued following an inspection carried out in November 2007. In addition, because the home has changed its remit, Requirement 2 has been changed into a recommendation. How the inspection was carried out: Before the visit: We looked at: • • • • • Information we have received since the last key inspection visit on the 04 September 2007; How the service dealt with any complaints and concerns since the last visit; Any changes to how the home is run; The manager’s view of how well they care for people. We also interviewed three people who use the service and three staff; The views of relatives, other professionals and staff. The Visit: An unannounced visit was made on the 03 September 2008. inspection we: • • • During the Talked with the assistant managers on duty; Looked at information about the people who use the service and how well their needs are met; Looked at other records which must be kept; DS0000033104.V371222.R02.S.doc Version 5.2 Page 7 Dorset House Checked that staff have the knowledge, skills and training to meet the needs of the people they care for; • Looked around the building to make sure it was clean, safe and comfortable; Checked what improvements have been made since the last visit. • What the service does well: An ‘Open Day’ was held at Dorset House to inform people and their families, and professionals who have contact with the home, of the improvements the Council intended to make. The management team felt that this enabled them to listen to people’s views and provide them with information about the planned changes. Throughout the home’s refurbishment, Dorset House has continued to operate and provide people with services that meet their needs. The newly formed management team have amalgamated 66 staff from three homes and worked with them to create one team with the skills and knowledge required to deliver a complex range of services. The Dorset House staff team have adapted to new ways of working that take account of the home’s changed remit and their new roles and responsibilities. The staff team have helped people using the service to adjust to the changes that have taken place at Dorset House and where appropriate, have assisted people to move onto other more appropriate care settings. Staff have developed caring relationships with the people in their care. Staff are respectful, considerate, understanding and patient. Despite having been through a significant period of change, staff remain enthusiastic and positive about their work and how it helps the people in their care. Staff have completed equality and diversity training. The provider also has a corporate equality and diversity policy which staff are expected to adhere to at all times. Welcome packs have been placed in all bedrooms to provide people using the service with information about how Dorset House operates. The service operates a key worker system that enables staff to deliver more person centred care. People using the service are provided with a copy of the Dorset House complaints procedure. A copy has been placed in each bedroom. All staff have completed training in safeguarding vulnerable adults. This will hep to keep people safe from potential harm. The service has strict financial procedures to protect people from financial abuse. Dorset House DS0000033104.V371222.R02.S.doc Version 5.2 Page 8 The service has devised an annual development plan that sets out the improvements that will be made during 2008. This provides people with the service with information about what improvements are planned and how this will affect the service. What has improved since the last inspection? From April 2008, Dorset House took on a new remit. A range of different services is now provided. These include dementia respite care, a dementia day care service, a rehabilitation service as well as respite care for older people. To reflect the changes that have occurred within the service the size of the staff team has been increased. The service is currently being refurbished and improved. improvements have already been made such as: • • • • • • A range of New fencing has been erected to provide safe and secure garden areas; Garden areas have been re-planted and garden furniture purchased; New flooring has been laid in 20 bedrooms. New furnishings have been provided in some bedrooms and a fire place has been installed in one of the units; New office spaces have been created and computer access is now available; The front entrance has been refurbished creating a warmer and more welcoming space; The previous day care lounge and dining room has been refurbished. Smaller spaces have been created including an activity room, a large conservatory and smaller more domestic lounges and dining area. A new management team has been appointed to deliver the range of services set out in the statement of purpose. Work has commenced to identify the training needs of the new staff team and plans are being put in place to deliver the training that is needed. People and their families are asked to complete personal history information to help staff gain a better understanding of their needs and how to meet them. A new security system has been installed. This enables the service to provide a safe and secure environment for those people who need it. The service has purchased age appropriate activity equipment to enable staff to better meet people’s social care needs. Memory boxes have been introduced to help people with dementia engage in purposeful activities. A more robust approach to managing staff sickness has been introduced and this has already improved staff attendance. Dorset House DS0000033104.V371222.R02.S.doc Version 5.2 Page 9 A new financial system has been introduced to improve the way in which records are kept and to protect people from financial abuse. Improvements have been made to the way in which medication is handled in the home. For example: • • An up to date medicines reference book has been obtained to provide staff with information about the drugs they administer; An audit system has been introduced to ensure that staff are complying with the home’s medication policies and procedures. What they could do better: Ensure that people’s support plans clearly identify their assessed needs and how those needs are to be met. This will help staff to be clear about what action they need to take to meet people’s needs. Please contact the provider for advice of actions taken in response to this Dorset House DS0000033104.V371222.R02.S.doc Version 5.2 Page 10 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Dorset House DS0000033104.V371222.R02.S.doc Version 5.2 Page 11 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dorset House DS0000033104.V371222.R02.S.doc Version 5.2 Page 12 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): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are suitable arrangements for making sure that people’s needs are assessed before they are admitted into the service. This helps to ensure that staff will be able to meet people’s needs on admission. EVIDENCE: Admissions do not take place until a full needs assessment has been carried out by qualified and experienced staff. Where the provider’s care management teams have carried out the assessment, the service ensures it receives a summary of the assessment. Copies of these assessments have been placed in people’s care records. Staff said that they receive enough information to enable them to meet people’s needs on their admission into Dorset House. Dorset House DS0000033104.V371222.R02.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s care records do not fully cover their assessed need for support with personal, health and social care tasks. This could lead to staff being unclear about how each person’s needs are to be met. However, the manager is taking robust action to ensure that people’s care plans reflect their assessed needs. EVIDENCE: The provider has developed a single assessment and care plan format that is used by all professionals involved with a person to record important information about their needs and how they should be met. When a person is admitted into Dorset House, staff complete the relevant sections of the care record. They are expected to involve the person concerned in its preparation wherever possible. A sample of three people’s care records was looked at. This showed that: Dorset House DS0000033104.V371222.R02.S.doc Version 5.2 Page 14 • • Each person using the service has a service plan that provides staff with information and guidance about how to meet their needs. Service plans address people’s needs in a range of areas such areas as mobility, physical care, sensory impairment and nutrition. Where appropriate, people’s care plans are reviewed on a monthly basis; The home obtains personal information about people’s personal preferences, likes and dislikes and daily routines. However, some people’s service plans did not fully reflect the range of needs identified in their social services assessment. In addition, the needs of some people are not always clearly identified in their service plans and the guidance given to staff about how to care for people is limited. The new manager and her team have identified that improvements need to be made to the way in which service plans are devised and used by staff. Mrs Steel and her senior team hope to tailor the current service plan format to better reflect the needs of respite care service users. Current good practice guidance in the area of dementia care will be used to help inform this piece of work. People using the service said that they are very happy with the care they receive and feel well looked after. On the day of the inspection, people looked well cared for and staff responded to people’s needs promptly and in a caring manner. Two people using the service who returned surveys said that they ‘always’ or ‘usually’ receive the care they need, including medical support. They also said that staff ‘always’ listen to and act upon what they say. A relative said that they felt Dorset House met the needs of their family member. In line with its new remit, Dorset House staff will work in partnership with people using the service, their families and other professionals, to ensure that each individual’s health care needs are satisfactorily met. For example, after being admitted into the home, a respite care user’s health deteriorated. Staff arranged for medical and nursing intervention to stabilise the person’s condition. Appropriate records had been kept of the treatment and support provided. People said that they felt confident that staff would meet their health care needs. Preventative health care risk assessments are carried out. For example, in the three sets of care records checked, nutritional, moving and handling and falls prevention risk assessments had been carried out for each person. Some risk assessments had not been fully completed and this could lead to gaps in staff’s knowledge about how to keep people safe and meet their health care needs. At the time of the inspection, the management team was in the process of establishing what circumstances will lead to specific preventative healthcare risk assessments, such as those referred to above, being carried out. A specialist pharmacy inspector recently carried out an inspection of the centre’s day to day medication arrangements. Although medication Dorset House DS0000033104.V371222.R02.S.doc Version 5.2 Page 15 arrangements were found to be generally satisfactory, one requirement and a number of recommendations were made, all of which have subsequently been addressed. The Dorset House medication policy has been reviewed and updated since the last inspection. The home’s medication records are well completed. Staff now wear a red tabard that identifies that they are in the process of administering medication. This is helping to reduce the amount of distractions that staff administering medication have to contend with. All staff have completed accredited medication training. Arrangements have also been made for all staff to attend extra training provided by the local primary health care trust. Staff were observed supporting people to make choices and decisions about their daily life at Dorset House. This was done in a dignified and respectful manner. For example: • • Staff consult people about their meal choices on a daily basis. People said that staff always ask them about what they want to eat and drink; People are supported to keep up their personal appearance and they look well cared for. Personal support is provided in private. Visiting health care staff are encouraged to attend to people’s healthcare needs in the privacy of their own bedrooms; People said that they had been consulted about when they wanted a bath and what time they preferred to get up and go to bed. • A relative said that Dorset House staff ‘always’ support people to live the life they choose. Dorset House DS0000033104.V371222.R02.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the respite care services experience a lifestyle that matches their expectations and preferences. However, there are limited opportunities for people to benefit from individual and group social activities. Because of this, people’s social, cultural and recreational needs and interests may not be met. EVIDENCE: Staff obtain information about people’s social needs from the assessment carried out by social services. Plans of care are then devised by Dorset House staff setting out how people’s social needs are to be met. Those checked contained general statements advising staff to encourage people to join in activities. However, person centred activity plans have not been devised for people with dementia who are using the service. The management team are in the process of reviewing how social activities are provided to people receiving respite care. A life history checklist has been devised to help Dorset House staff collect important which will assist them to provide social care that meets people’s expressed needs, preferences and wishes. Dorset House DS0000033104.V371222.R02.S.doc Version 5.2 Page 17 A varied programme of weekly activities for day care attendees has been devised. The programme has been produced in a pictorial format to help people understand what activities are being offered at the centre. Activities offered range from salt dough art and craft sessions to prize bingo. Information about what activities work best is available to carers. Staff also have access to more specialist resources, which enables them to hold reminiscence sessions and undertake ‘memory box’ work with people with dementia. In one of the dementia units, historical photographs have been placed on corridor walls to provide points of interest and opportunities for conversation. There is an orientation board outside of the lounge area that includes details of the names of staff on duty. Large photographs have been placed outside of toilets and bathroom to indicate the purpose of the room. Some ‘way-finding’ markers have been placed on corridor walls to help people find their way around the unit they are staying on. People using the respite care services are able to attend day care centre activities. Social activities are also provided in the respite care units. Staff working on the Oakwood unit had kept a record, which showed that the over the course of one-week activities such as bingo, skittles, and target practice had been arranged. However, the record also showed that on five of the seven days, no activities were provided and in most cases, no reason was given. Two people using the service who returned surveys said that social activities were either ‘always’ or ‘sometimes’ arranged by the home. Although one person’s family said that they would like to see more outings arranged, they also said that Dorset House staff provide their relative with opportunities to remain physically and mentally active. Staff support people using the service to keep up relationships with family, carers and friends. Visitors are welcomed into the centre and are made to feel comfortable. The unit kitchen areas are kept clean and tidy. Care staff said that kitchen staff are given information about people’s special dietary needs. Regular drinks and snacks are available throughout the day. People are able to eat in their own rooms if they wish. The inspector joined people for their lunchtime meal. It was nutritious, appetising and nicely presented. The meal was nicely served by attentive staff in a pleasant dining room. People said that they enjoyed the meals served at Dorset House and always received enough to eat and drink. Two people who returned surveys said that they ‘usually’ liked the food served at the home. The new management team have piloted the use of photo menus to help people with dementia make more informed choices about the food they want to eat. Dorset House DS0000033104.V371222.R02.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good arrangements for keeping people safe and for ensuring that complaints are responded to appropriately. This means that people can be confident that they will be protected from harm, and that their views will be listened to and their concerns acted upon. EVIDENCE: People using the service said that they are encouraged to express their views and concerns. They also said that they are happy with the support they receive, and that they feel safe and well supported by the staff at Dorset House. Two people who returned surveys said that they ‘always’ or ‘usually’ know who to speak to if they are not happy. A relative said that Dorset House staff ‘always’ respond appropriately if they raise any concerns about their family member. Dorset House has a complaints procedure that is clearly written and easy to understand. It is available on request in a number of formats to help anyone living at, or involved with, the service to complain or make suggestions for improvement. Dorset House DS0000033104.V371222.R02.S.doc Version 5.2 Page 19 A copy of the complaints procedure has been placed in each bedroom. This means that people can read the procedure at their own pace. Dorset House has received one complaint during the last 12 months. The manager prepared a written response to the concerns raised and the provider forwarded a response letter to the complainant. However, a copy of this letter was not available at the home. The centre has policies and procedures for keeping people safe. They provide staff with clear guidance for handling safeguarding concerns. Staff are clear about their responsibilities in this area. No formal safeguarding concerns have been referred to the Commission since the last inspection. However, the home has acted to protect people and keep them safe following two incidents that occurred involving three people who use the service. People’s families and social services were consulted and the home established that the concerns would not be dealt with under the Council’s safeguarding procedures. Staff interviewed confirmed that they had received training in safeguarding vulnerable adults. Dorset House DS0000033104.V371222.R02.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of accommodation is satisfactory and work is underway to make the environment more appropriate for the needs of those people who now use the service. EVIDENCE: Dorset House is currently being refurbished. This is to help improve the physical environment so that it meets the specific needs of people who access the new services. For example, the large day facility has been partitioned into two separate areas to provide a safer environment for people with dementia care needs. Whilst the refurbishment works are taking place, staff are making sure that the home is safe, comfortable, clean and tidy. All radiators are Dorset House DS0000033104.V371222.R02.S.doc Version 5.2 Page 21 guarded and low surface temperature heaters have been installed in some areas. The fire service has recently carried out an inspection of the premises. A number of requirements were made and all of these have subsequently been addressed. Each unit has its own dining and lounge area, kitchen and laundry facilities. Dividing the home into units enables staff to deliver more person centred and homely care. No health and safety concerns were identified and the standard of accommodation is generally satisfactory. People using the service have access to a range of specialist aids that can be used to promote independence. For example, staff support people to maintain and improve their domestic independence skills using the rehabilitation kitchen areas. Specialist equipment such as grab rails, hoisting equipment and assisted baths have been provided throughout the building. The home’s laundries are clean and tidy. Dorset House DS0000033104.V371222.R02.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can feel confident that their needs will be met by professionally qualified staff that are able to provide good quality care. EVIDENCE: The Dorset House rotas show which staff are on duty and what shifts they are working. The service employs 19 full times, and 26 part time, care staff. Eighteen ancillary staff also work at the home. Agency staff have not been used within recent months. Generally, a minimum of eight care staff is rostered on duty between 8am and 10pm each day. In addition, there are usually two care officers on duty as well as members of the management team. The manager has allocated management hours, which enables them to carry out the duties associated with their post. The numbers of staff on duty can vary to take account of the numbers of people using the service and the complexity of their needs. Dorset House DS0000033104.V371222.R02.S.doc Version 5.2 Page 23 Staff did not raise any concerns about staffing levels but did say that there were often times when they were extremely busy and had to make choices about what work they prioritised. No concerns were identified that suggested people’s needs had not been met. Staff spoke about helping colleagues out when their unit was busier than their own. The manager said that current staffing levels are sufficient to meet the needs of the people using the service. Two people using the service who returned surveys said that staff were ‘always’ or ‘usually’ available when they needed them. A relative said that they felt staff had the ‘right skills and experience’ to look after people properly. 35 staff have obtained a National Vocational Qualification in care at Level 2 or above and a further 15 staff are working towards obtaining such a qualification. This means that the service has exceeded the National Minimum Standard in this area. A range of pre-employment checks is carried out before staff can commence work at the service. For example: there was evidence in two of the staff files checked that Criminal Records Bureau Disclosures had been obtained; the staff’s identities had been verified and two written references had been obtained for each person. However, for a third member of staff there was no documentary evidence of their employment history or qualifications. The new management team are in the process of identifying each staff member’s training needs. Staff are provided with opportunities to complete and update their mandatory training. For example, two of the staff whose files were checked had completed training in moving and handling, first aid, fire safety and health and safety. However, there was no documentary evidence that one of these staff had completed training in food hygiene awareness or that the second person had undertaken training in infection control. For a third member of staff there was only documentary evidence that they had completed training in first aid. Action is being taken by the management team to ensure that the home holds documentary evidence of all training completed by staff. Arrangements are in place to ensure that new starters have access to training that covers the ‘Skills for Care’ induction standards. Staff are also given opportunities to attend training that is more related to the needs of the people they look after. For example, some staff have completed Mental Capacity Act, risk assessment and equality and diversity training. All staff working on the dementia care unit have completed awareness training using the ‘Yesterday, Today and Tomorrow’ training package. To help staff carry out their new roles and responsibilities, arrangements were made for some people to shadow hospital based staff working in the dementia rehabilitation ward. In addition, the Dorset House manager has agreed to attend regular multi-disciplinary meetings with other professionals involved in the care of people with dementia. Mrs Steele hopes that this initiative will foster good working relationships and create a better understanding of people’s professional roles. Dorset House DS0000033104.V371222.R02.S.doc Version 5.2 Page 24 Dorset House DS0000033104.V371222.R02.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is generally well managed and run in the best interests of the people using the service. This means that people can feel confident that their health, welfare and safety will be promoted and protected. EVIDENCE: Although a new manager has been appointed since the last inspection, this person is not yet registered with the Commission. The new manager has considerable experience in working with older people in a residential setting and has managed other local authority services. Mrs Steele is a qualified social Dorset House DS0000033104.V371222.R02.S.doc Version 5.2 Page 26 worker and has obtained a NVQ at Level 4 in Care as well as the Registered Manager’s Award. Staff receive regular supervision in line with the National Minimum Standards. There is a set proforma for recording staff supervision outcomes. In the three staff files checked, only one contained evidence that the person’s performance had been appraised during the last 12 months. However, a new system of performance management is currently being introduced within the home to ensure that staff performance is regularly appraised. Arrangements are in place to monitor the quality of the service. For example: • Unannounced monitoring visits are carried out by the provider. During the visit, the premises are checked and a sample of the home’s records are examined. Some of the people using the service are spoken to as well as some of the staff; An annual development plan has been devised setting out what the service intends to achieve in 2008. • As the service has recently changed its remit, a full quality audit of the services and facilities being provided has not yet taken place. The new manager intends to introduce quality assurance processes to enable this to happen. However, the manager has already issued surveys to the day centre service users and obtained feedback on the day to day performance of the centre. The responses have been collated and the outcomes made known to the Commission. North Tyneside Council has a comprehensive health and safety policy which staff are expected to adhere to at all times. Of the three files looked at, there was documentary evidence that two staff had completed health and safety training. The third member of staff said that they had completed the training but there was documentary evidence to support this. The home’s electrical appliances and hoisting equipment have been tested within the last 12 months. The home has a current gas safety record. The corridors and people’s bedrooms were free of obstacles that could cause injuries. Dorset House DS0000033104.V371222.R02.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X 3 X 3 Dorset House DS0000033104.V371222.R02.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes Refer to Report Summary STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Ensure that: • The plans of intervention put in place to meet peoples’ needs clearly describe the tasks that care staff are expected to carry out. This will help to ensure that staff are meeting peoples’ assessed needs; People’s service plans fully address the needs referred to in their social services assessment and care plan. Timescale for action 01/04/09 • This will help staff to be clear about what help and support people require and how this is to be done. 2. OP29 Schedule 4 Ensure that there documentary evidence in home confirming: • • Dorset House is 01/01/09 the The qualifications that staff have obtained; Staff’s employment history. Version 5.2 Page 29 DS0000033104.V371222.R02.S.doc This will help ensure that people are not cared for by unsuitable individuals who might cause them harm. 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 OP8 Good Practice Recommendations Ensure that: • • • People’s continence care needs and their susceptibility to developing pressure sores are assessed; Preventative health care risk assessments are signed and dated; Preventative health care risk assessments are carried out to prevent the development of pressure sores. 2. OP12 Consideration should be given to: • • • Increasing the number of ‘way-finding’ markers in the dementia care units and day care facility; Agreeing how colours will be used to help people with dementia make sense of their environment; Providing key staff with training in delivering individual and social activities to people with dementia. The orientation boards in the dementia unit should be kept up to date, possibly including photographs of staff. Simple and deliverable dementia activity plans should be devised for each person using the service. (This is a Dorset House DS0000033104.V371222.R02.S.doc Version 5.2 Page 30 repeat recommendation) 3. 4. OP16 OP31 Ensure that a full record of the way in which complaints have been addressed is kept at the home. Submit an application to register the home’s manager. Dorset House DS0000033104.V371222.R02.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Dorset House DS0000033104.V371222.R02.S.doc Version 5.2 Page 32 - 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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