Inspection on 04/09/07 for Dorset House

This inspection was carried out on 4th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 03/09/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Dorset House Off Station Road Wallsend Tyne & Wear NE28 8EN Lead Inspector Glynis Gaffney Key Unannounced Inspection 4, 5 and 14 September 2007 14:30 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 DS0000033104.V350429.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 DS0000033104.V350429.R01.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) Type of registration No. of places registered (if applicable) 0191 200 7155 0191 200 7156 john.purdon@northtyneside.gov.uk North Tyneside Council Position Vacant Care Home 41 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.V350429.R01.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 17th November 2006 Date of last inspection Brief Description of the Service: Dorset House is a residential care home for older people run by North Tyneside Council. The home provides residential care for up to 41 people living in four units known as the Lakes, Ashwood, Oakwood and Rosewood. Seven people live at the home on a longer-term basis. Most people accommodated at the time of the inspection were receiving short term respite care. Dorset House is a single storey building situated in a residential area of Wallsend. An eighteen-place day care service is provided five days a week. The home has a central kitchen, a laundry, a large lounge, and a dining area. Each unit has its own kitchen, dining and bathing facilities. Toilets are situated close to peoples bedrooms and the lounge and dining areas. There are 41 single bedrooms, two of which have en-suite facilities. A bus route, pub, and local shops are within easy walking distance. Off street parking is available. The current charge for a residential place is £295 per week. People attending the home for a short break are charged £83.60 per week. Extra charges are made for hairdressing, private chiropody services, newspapers and toiletries. Charges are also made for respite and day care services. Information about fees charged is included in the home’s service user guide. A copy of the most recent inspection report is available in the main reception area. Dorset House DS0000033104.V350429.R01.S.doc Version 5.2 Page 5 Two of the four units are closed while North Tyneside Council undertakes a Value for Money review of the services it offers to older people. The numbers of people using the day care service has also reduced. Dorset House DS0000033104.V350429.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. We looked at: • • • • • Information we have received since the last visit on 17 November 2006; 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; The views of people who use the service and their relatives; Although surveys were issued to a sample of professionals who have contact with the home, none were returned. The Visit: An unannounced visit was made on the 04 September 2007. During the visit we: • • • • • • Talked with people who use the service and the manager; Looked at information about the people who use the service & how well their needs are met; Looked at other records which must be kept; Checked that staff had the knowledge, skills & training to meet the needs of the people they care for; Looked around the building to make sure it was clean, safe & comfortable; Checked what improvements had been made since the last visit. We told the manager what we found. What the service does well: These are comments made by some of the relatives who returned surveys: “The level of care and support exceeds my expectations.” “Care staff are well qualified and skilled in providing a professional level of care.” Dorset House DS0000033104.V350429.R01.S.doc Version 5.2 Page 7 “(Staff) make sure that if they can’t help you, they will quickly get the appropriate help.” “There is a warm and homely atmosphere in Dorset House and I have observed a friendly and caring approach to residents and visitors alike, with staff interacting with residents in social activities.” “They met my mother’s needs and took care of her very well.” “I am very happy with the care my mother is given – she is very well looked after.” “I would like to thank the staff at Dorset House for the care and concern they offer to the residents. They are caring and cheerful whenever I visit and always try to meet the requests of residents. They have allowed me and my family peace of mind and knowing that I can rely on these people has reduced my stress levels immensely. Thank you.” Peoples’ placements are reviewed every six months. A carer’s group run by the local Alzheimer’s Society is held monthly. enables carers to discuss problems and their experiences. This People living and working at the home are asked for their views and opinions about how the service is run. A relative said that the home’s survey questionnaire was not relevant to the needs of people visiting Dorset House for short term care. It has been redesigned to make it more relevant. The Council’s single assessment and care plan requires staff to consider the needs of people with different ethnic and cultural backgrounds. The Council has a corporate equality and diversity policy that staff are expected to follow. Staff are polite, courteous and have developed caring relationships with the people they look after. Day service attendees are able to access a range of activities. People living on the residential units are able to participate in these activities. The home offers a choice of bathing facilities, including a Jacuzzi style bath. People living at the home on a permanent basis have been supported to personalise their bedrooms. 61 of staff have obtained a nationally recognised qualification in care. A further six staff are undertaking training leading to a relevant qualification in care. Dorset House DS0000033104.V350429.R01.S.doc Version 5.2 Page 8 There has been no turnover of staff since the last inspection. What has improved since the last inspection? What they could do better: Ensure that peoples’ care plans clearly identify what tasks care staff must carry out to meet peoples’ needs. This will help people to receive more individualised support and care. Ensure that the premise related concerns identified in this report are addressed. This will help to ensure that people live in a building that is well maintained and in a good condition. Ensure that preventative health care risk assessments are carried out to help prevent people from falling or developing pressure sores. Ensure that there is a robust policy providing staff with guidance on how to support people visiting the home to administer their own medication. This will help protect people who are supported to take their own medication. Dorset House DS0000033104.V350429.R01.S.doc Version 5.2 Page 9 Develop person-centred activity plans to make sure that people living at the home are provided with more individualised opportunities for stimulation and fulfilment. Ensure that all staff receive regular refresher training in key areas. This will help ensure that staff have the skills and knowledge needed to care for people in a safe and competent manner. Prepare an annual development plan. This will enable people to see that there is a written programme that sets out how the home’s furnishings, fittings and fabric of the building are to be renewed, repaired and improved. They will also be able to see how staff intend to improve the care and services provided at the home. 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 DS0000033104.V350429.R01.S.doc Version 5.2 Page 10 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.V350429.R01.S.doc Version 5.2 Page 11 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): 1 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Robust arrangements are in place to ensure that peoples’ needs are assessed before they move into, or stay at, the home. People benefit from being cared for by staff who have information about their individual needs and what care and support they require. EVIDENCE: The purpose and role of the home is under review. This is to make sure that the building and its facilities are being used in the best way possible. Once the Council’s Value for Money Review has been completed, the home’s statement of purpose and service user guide will be amended to reflect any changes agreed. Both documents have previously been judged as satisfactory. One Dorset House DS0000033104.V350429.R01.S.doc Version 5.2 Page 12 person using the service who returned a survey said that they had not received any information about the home before moving in. The needs of people using the service are assessed before the home agrees to offer a service. Qualified and experienced social services staff carry out these assessments. Copies of the assessments were in peoples’ care records. Since the last inspection, a policy to provide staff with guidance on how to handle emergency admissions has been drawn up. People are encouraged to visit the home so that they can make an informed decision about whether to accept a service. This also enables the home to decide whether it can meet their assessed needs. There have been no permanent admissions into the home since the last inspection. Dorset House DS0000033104.V350429.R01.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): 6, 7, 8 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans are generally satisfactory but could be improved by including more specific guidance about how peoples’ care needs could be met. This will help make sure that peoples’ individual needs and preferences are catered for. EVIDENCE: The provider has developed a single assessment and care plan document. This is used by all professionals involved with a person to record important information about their needs and how they should be met. On admission to Dorset House, staff are expected to complete the relevant sections of the assessment and care plan document. They are expected to involve the person concerned in its preparation wherever possible. The records of three people were checked and it was found that: Dorset House DS0000033104.V350429.R01.S.doc Version 5.2 Page 14 • • • • • Each person staying at the home had a service plan that provided staff with information and guidance about how to meet their needs. However, some of the care plans did not provide staff with specific guidance on how to meet peoples’ individual needs. For example, when advising staff how to meet one person’s need for support with personal hygiene the care plan said ‘offer the support she requires’; Peoples’ care plans covered such areas as mobility, physical, sensory and dietary care needs, The majority of care plans had been reviewed on a monthly basis; An assessment of peoples’ dependency levels had been carried out; Peoples’ care plans are written in plain language and easy to understand. People visiting the home said that they felt staff listened to them and encouraged them to make decisions about everyday matters such as when to get up, go to bed and take a bath. For example, a bathing preference sheet is completed for each person so that staff are clear about peoples’ personal preferences. People living at the home are supported to access community health care facilities such as GPs, the community nursing service, chiropody, dental and optical healthcare. Preventative health care risk assessments are only completed where the person’s care manager identifies concerns at the point of admission or where staff have identified potential risks after admission. In the three sets of care records checked: • • • • A nutritional risk assessment had been carried out for each person; Pressure area and falls risk assessments had only been completed for one person; There was no evidence that continence care risk assessments had not been reviewed for over a year. Some preventative health care risk assessments had not been updated during the previous 12 months. Of the two people using the service who returned surveys, one person said that they always received the medical support they needed. One person did not answer this question. Of the six relatives who returned surveys: • • • Four indicated that staff ‘always’ gave their relative the care and support they needed; One person said that this ‘usually happened’; One person said that this ‘sometimes happened’. No restrictions have been placed on peoples’ rights to make decisions and choices whilst living at the home. Following the last inspection, guidelines have been drawn up to provide staff with advice about the use of the keypad Dorset House DS0000033104.V350429.R01.S.doc Version 5.2 Page 15 security lock fitted on one of the units. A risk assessment was also completed. The manager said that since he had commenced working at the home it had not been necessary for staff to use the keypad to keep people safe. The home’s medication policy provides staff with guidance on how to handle medication safely. Medication is stored in a central cupboard and in trolleys kept on the units. One of the trolleys was checked. It was clean and secure. Prescribed creams are stored separately from other items of medication. Lockable facilities for the safe storage of medication are available in all bedrooms. Identification photos are attached to medication records. Hand wash facilities are available in the main treatment room and in the kitchens on individual units. Records are kept which cover medications received, administered, and disposed of within the home. Only trained staff administer medication. All staff have updated their medication training during the last 12 months. In August 2006, a trained pharmacist assessed the home’s medication practices and procedures. Although staff administering medication did so safely during the inspection, seven incidents involving the mis-administration of medication have been reported to the Commission since the last inspection. One of these incidents involved a person who administered their own medication. Action has been taken by the home to address the errors that have occurred. For example, the home’s medication policy has been reviewed and some staff have been provided with extra training. The manager is currently working with a primary care trust pharmacist to improve the home’s approach to managing medication. People are treated with respect and dignity when receiving personal care. People interviewed said that they were happy with the way that staff cared for them. Dorset House DS0000033104.V350429.R01.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 good. This judgement has been made using available evidence including a visit to this service. People are supported to exercise choice and control over their lives and to take part in a range of activities that satisfies their social and recreational needs. EVIDENCE: Information about peoples’ social needs is obtained during the pre-admission assessment. Plans of care have been devised to meet peoples’ social needs. Those examined contained general statements advising staff to encourage people to join in activities as well as more specific information about promoting contact with family members. Information about peoples’ individual interests and preferences regarding how they would like to spend their leisure time had been recorded. A programme of weekly activities for day care attendees is posted on the notice board in the central area of the home. The programme includes activities such as bowls and chair aerobics. Since the last inspection, the home has purchased: Dorset House DS0000033104.V350429.R01.S.doc Version 5.2 Page 17 • • • Resources to enable staff to hold reminiscence sessions; Skittles for wheelchair users; A musical bingo set. People living at the home are also able to attend these activities. Due to current staffing levels, unit staff no longer offer a separate programme of social activities. The provision of activities within the home will be reviewed once the provider has made decisions about its future role. People interviewed said that they were pleased with the range of activities provided. Of the two people living at the home who returned surveys, one said that suitable activities were always provided. One person did not provide a reply. Of the six relatives who returned surveys: • • • Three indicated that the home ‘met the needs of different people’; One said that they ‘usually did’; One said that this only happened sometimes. People said that staff always made families and visitors feel welcome. People can see their visitors in private or in any of the home’s lounges and dining areas. There is suitable guidance for staff regarding how they should support people to maintain contact with family and friends. It is the home’s policy to support people to maintain control of their own financial affairs wherever possible. Lockable facilities, and day-to-day support with managing personal money and valuables, are provided where a need to do so is identified. Staff support people to make everyday decisions. For example, a member of staff was observed supporting one person to decide what she wanted to drink and eat during the teatime meal. The central and smaller kitchen areas were clean and tidy. The food cupboard, fridge and freezer were well stocked. Kitchen staff are provided with information about peoples’ 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 meals served looked nutritious and appetising. Of the two people using the service who returned surveys: • • One said that they ‘always’ liked the food served at the home; One said that they ‘usually did’. One relative who returned a survey said that the person they visited was “well fed and offered meals he enjoyed and they are of a suitable quality and quantity.” Dorset House DS0000033104.V350429.R01.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 suitable procedures in place for handling complaints and concerns. This helps to ensure that staff are clear about the steps that must be taken on receipt of a complaint. EVIDENCE: Information about peoples’ social needs is obtained during the pre-admission assessment. Plans of care have been devised to meet peoples’ social needs. Those examined contained general statements advising staff to encourage people to join in activities as well as more specific information about promoting contact with family members. Information about peoples’ individual interests and preferences regarding how they would like to spend their leisure time had been recorded. A programme of weekly activities for day care attendees is posted on the notice board in the central area of the home. The programme includes activities such as bowls and chair aerobics. Since the last inspection, the home has purchased: • • • Resources to enable staff to hold reminiscence sessions; Skittles for wheelchair users; A musical bingo set. DS0000033104.V350429.R01.S.doc Version 5.2 Page 19 Dorset House People living at the home are also able to attend these activities. Due to current staffing levels, unit staff no longer offer a separate programme of social activities. The provision of activities within the home will be reviewed once the provider has made decisions about its future role. People interviewed said that they were pleased with the range of activities provided. Of the two people living at the home who returned surveys, one said that suitable activities were always provided. One person did not provide a reply. Of the six relatives who returned surveys: • • • Three indicated that the home ‘met the needs of different people’; One said that they ‘usually did’; One said that this only happened sometimes. People said that staff always made families and visitors feel welcome. People can see their visitors in private or in any of the home’s lounges and dining areas. There is suitable guidance for staff regarding how they should support people to maintain contact with family and friends. It is the home’s policy to support people to maintain control of their own financial affairs wherever possible. Lockable facilities, and day-to-day support with managing personal money and valuables, are provided where a need to do so is identified. Staff support people to make everyday decisions. For example, a member of staff was observed supporting one person to decide what she wanted to drink and eat during the teatime meal. The central and smaller kitchen areas were clean and tidy. The food cupboard, fridge and freezer were well stocked. Kitchen staff are provided with information about peoples’ 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 meals served looked nutritious and appetising. Of the two people using the service who returned surveys: • • One said that they ‘always’ liked the food served at the home; One said that they ‘usually did’. One relative who returned a survey said that the person they visited was “well fed and offered meals he enjoyed and they are of a suitable quality and quantity.” Dorset House DS0000033104.V350429.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 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. Peoples’ bedrooms are well maintained and meet their needs. People are provided with a comfortable private space in which to relax and spend time. EVIDENCE: The home and bedroom accommodation is clean, tidy, and free from offensive odours. People said that Dorset House is always kept in a good condition. The home’s decoration, furniture and fittings are generally of a good standard. Following the last inspection radiators in the conservatory have been guarded and the walls leading into this area have been repaired and redecorated. The home’s dining furniture has not yet been replaced and refurbished as the Council is in the process of reviewing the future of its residential services for Dorset House DS0000033104.V350429.R01.S.doc Version 5.2 Page 21 older people. inspection: • • • A number of other concerns were identified during this The dining room carpet next to the main kitchen is stained and grimy. The door jambs on the door leading into the kitchen are in a poor decorative condition; The carpet in the central lounge area has cigarette burns and other stains; Some of the lounge armchairs and a small table on Rosewood Unit have a worn appearance and the garden is overgrown and untidy. In the November 2006 inspection report, it was identified that the dining chairs on Ashwood Unit needed to be refurbished or replaced and a requirement was set. However, the unit has remained unoccupied until a decision about the home’s future is made. The requirement has been included in this report and a new timescale set. People living at the home have access to a range of specialist aids that can be used to promote independence. For example, rehabilitation kitchens have been installed to enable staff to support people to maintain and improve their domestic independence skills. Specialist equipment such as grab rails, hoisting equipment and assisted baths have been provided throughout the building. Bedrails have not been used since the last inspection visit to the home. People who require such facilities are referred to other Council services. The home’s laundry areas are clean and tidy. No concerns were identified. Of the two people using the service who returned surveys, one said that the home was always clean and fresh. The other person said that this is ‘usually’ the case. Dorset House DS0000033104.V350429.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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. Robust pre-employment checks had been carried out on new staff before they started work at the home. This helps ensure that people who might be unsuitable to work with vulnerable adults are not employed at Dorset House. EVIDENCE: The home’s rotas show which staff are on duty and what shifts they are working. There are only two units in operation and the numbers of people attending the day care service has reduced. There are seven people living at the home on a permanent basis. Arrangements are in progress to assess the needs of one person for nursing care. Minimum staffing levels are as follows: • • Four staff on duty between 8am and 10pm, including a senior; Two staff on duty from 10pm to 8am, including a senior. An examination of the rotas indicated that there were often more staff on duty than the minimum staffing levels referred to above. Dorset House DS0000033104.V350429.R01.S.doc Version 5.2 Page 23 The manager normally works between 9am and 5pm and is extra to the shift complement. The manager said that current staffing levels are sufficient to meet the needs of those people living at the home. Of the two people using the service who returned surveys: • • Both said that they always received the care and support they required; One said that staff were always around to help them when they needed it. One said that this was usually the case. Of the six relatives who returned surveys: • • Four said that staff had the right skills and experience to look after people properly; One person said that they ‘sometimes’ did. Over 90 of the care team have a relevant qualification in caring for older people. Generally, the staff whose files were checked had updated their mandatory training. Although: 1. Two staff had not updated their moving and handling training since July 2006; 2. One staff member had not received fire training delivered by a competent person within the last three years; 3. There was no evidence that two staff had completed health and safety and infection control training. The inspector was advised that staff had completed the required training but had not made their certificates available to the home. A comprehensive recruitment and selection policy was in place. A recently appointed member of staff had completed three paid training days in the last 12 months. Each member of care staff had a Personal Development Review file that included details of training completed and required. Staff files held at the home and at the provider’s head office were examined. They contained evidence that the Council’s Occupational Health Department had found prospective applicants fit and healthy before they were allowed to commence work. The required pre-employment checks had been completed for a member of staff appointed after the introduction of the National Minimum Standards. Each file contains an identification photograph. Dorset House DS0000033104.V350429.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager provided a clear sense of leadership, involved staff and people living at the home in the management of Dorset House, and demonstrated a commitment to providing people with good quality care. This meant that people lived in a home which was run and managed by a person who was fit to be in charge, was of good character and able to discharge his responsibilities fully. EVIDENCE: A new manager has been appointed since the last inspection. Mr Purdon has the required qualifications in care and management. He has many years Dorset House DS0000033104.V350429.R01.S.doc Version 5.2 Page 25 experience of working in a residential setting with older people and has previously acted as a registered manager in another of the Council’s care homes. Since the appointment of the new manager, arrangements have been put in place to ensure that staff receive regular supervision. Mr Purdon said that all staff would receive regular supervision at the frequency set out in the National Minimum Standards. All staff have had their performance appraised and monitored during the past 12 months. Arrangements are in place to monitor the quality of care provided in the home. For example: • People using the service and their relatives are invited to complete quality surveys. There was evidence that the home acted on comments made in the returned surveys. One relative had said that the survey they had received was not geared towards the services that her relative received. As a result, the home re-designed its carer’s survey to make it more relevant to the needs of people using the home for short stay breaks; The provider carries out regular monitoring visits. • However, there was no evidence that staff or visiting professionals had been surveyed. The inspector acknowledged that the absence of an annual development plan was linked to uncertainties about the home’s future. The building is safe and hazard free. Independent contractors have regularly checked the home’s water systems for the presence of Legionella. An assessment addressing potential risks in this area had been carried out in 2001 and is due for review in 2008. Information about hazardous materials used within the building is kept to ensure that they are safely used. Checks are carried out to ensure that the home’s electrical systems and gas appliances are safe. For example, all electrical equipment had been recently checked and the home had an up to date gas safety certificate. Risks within the workplace are assessed. For example, the risks posed to staff working in the kitchen and laundry areas had been assessed. The home has an up to date fire risk assessment. Regular checks of the home’s fire alarm systems and emergency lighting are carried out. For example, in August 2007, the fire alarms had been checked each week. The home’s mobile hoist is serviced on a regular basis. However, there is no maintenance contract for one of the bath hoists. The manager said that action had already been undertaken to address this shortfall. Moving and handling risk assessments are completed by staff where a person needs assistance to mobilise. In two of the care files examined, moving and Dorset House DS0000033104.V350429.R01.S.doc Version 5.2 Page 26 handling risk assessments had been completed. However, the actual techniques to be used by staff when moving and handling people had not been detailed. Dorset House DS0000033104.V350429.R01.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 3 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 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 3 17 X 18 3 2 2 X 3 X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X X X 3 Dorset House DS0000033104.V350429.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 15 Requirement Ensure that: • Peoples’ care plans are reviewed each month. This will help to ensure that care plans are updated as peoples’ needs and circumstances change. Timescale for action 01/01/08 (The timescale for complying with this requirement expired in 01/01/07) • 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. 2. OP8 12, 13 & 15 Ensure that preventative health 01/01/08 care risk assessments are carried out to prevent people falling and developing pressure sores. This will help people to remain healthy and safe whilst living at DS0000033104.V350429.R01.S.doc Version 5.2 Page 29 Dorset House the home. 3. OP9 13(2) Ensure that there is a robust 01/12/07 policy that provides staff with clear guidance on how to support people who administer their own medication. This will help people to retain control over their own medication with the right level of staff support and guidance. Ensure that: • The dining chairs on Ashwood Unit are revarnished to improve their overall appearance. 01/01/08 4. OP19 23(2) (Previous timescales of 01/06/06 and 01/03/07 have not been complied with) • • The dining room carpet next to the main kitchen is either cleaned or replaced; The door jambs on the door leading into the kitchen are repaired and redecorated; The damaged carpet in the central lounge area is replaced. The dining room area carpet is cleaned; The Rosewood Unit lounge armchairs and a small table are replaced; The Rosewood Unit garden area is tidied. • • • By complying with this requirement people will be able to live in a home which is in a good condition and wellmaintained. 5. OP20 23(2) Where necessary, ensure that 01/01/08 the dining chairs in the main lounge are either replaced or DS0000033104.V350429.R01.S.doc Version 5.2 Page 30 Dorset House refurbished. This will mean that people will be able to live in a home which is in a good condition and well-maintained. (Previous timescale of 01/03/07 has not been complied with) 6. OP30 13 & 18 Ensure that: • Staff involved in the regular moving and handling of people update their training every 12 months. 01/01/08 (The timescale for complying with this requirement expired on the 01/06/07) • • Staff receive fire training from a competent person every three years; Documentary evidence confirming that staff have received training in health and safety and infection control is available at the home. By ensuring that staff regularly update their mandatory training people can be sure that a professional and well-trained workforce is caring them for. 7. OP33 26 Ensure that: • • An annual development plan is prepared; Staff and professional visitors to the home are surveyed as part of the quality assurance process. 01/01/08 Compliance with this requirement will enable people Dorset House DS0000033104.V350429.R01.S.doc Version 5.2 Page 31 to see that there is a written programme that sets out how the home’s furnishings, fittings and fabric of the building are to be renewed, repaired and improved. People living at, and visiting the home, will be able to see how staff intend to improve the service. 8. OP38 13 Ensure that moving and handling 01/01/08 risk assessments include details of the actual techniques to be used when moving and transferring people. This will help to ensure that staff are clear about how to move people safely. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Ensure that: • • A preventative continence care risk assessment is completed for each person; Preventative health care risk assessments are reviewed every six months, or more often where circumstances indicate that this is necessary. 2. OP12 Ensure that: • • A person centred activity plan is prepared for each individual; A separate programme of activities is provided for permanent residents. Dorset House DS0000033104.V350429.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection North Eastern 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. 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