CARE HOMES FOR OLDER PEOPLE
Dothan House 458 Upper Brentwood Road Gidea Park Romford Essex RM2 6JB Lead Inspector
Ms Rhona Crosse Unannounced Inspection 19 October 2005 11:40 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 Dothan House DS0000027859.V259612.R01.S.doc Version 5.0 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. Dothan House DS0000027859.V259612.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Dothan House Address 458 Upper Brentwood Road Gidea Park Romford Essex RM2 6JB 01708 761647 01708 761647 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) Genesis Residential Homes Limited Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Dothan House DS0000027859.V259612.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 6th December 2004 Brief Description of the Service: Dothan House is a property that has been converted over time to accommodate 19 older people. The home provides 24 hour care. The home is situated in a residential area of Gidea Park, parking is to the rear of the property. There are single and shared bedrooms. Nine of the bedrooms have en-suite facilities. Dothan House DS0000027859.V259612.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced therefore the home did not know the inspector was coming. The inspector arrived at approximately 11.40 the proprietor and the manager were at the home. The cook was preparing lunch. The kitchen was clean and well organised there were no concerns about the way the food preparation was being dealt with. An NVQ Assessor was at the home speaking with staff that are undertaking NVQ level 2 training. One relative was visiting at the time of the inspection and the inspector spoke with the relative to gain views of the service the home provides. The inspector also spoke with service users to gain their views of what it is like living at the home. Music was playing in the downstairs lounge and one service user was dancing to the music. The inspector looked at daily records, GP and health professionals visits, care plans and risk assessments, accident records and also inspected the premises. What the service does well: What has improved since the last inspection?
Dothan House DS0000027859.V259612.R01.S.doc Version 5.0 Page 6 Staff have been provided with NVQ level 2 training. 10 staff are currently taking this course. One staff member holds an NVQ level 3 qualification and another staff member has an NVQ level 2 qualification. There was no mal odours within the home and the home was clean and tidy throughout (at the last inspection one bedroom had an odour control problem this has now been addressed and one bedroom required decorating this has also been achieved). All but one new member of staff has attended training in reporting and recognising suspected abuse. When inspecting care plans it was observed that a service user had signed their care plan to say that they agreed with the assessment. This is seen as good practice. What they could do better:
Each service user who is admitted must have a written assessment carried out prior to admission. For a short stay service user there was only the placing authorities assessment. The manager stated that he always assesses every prospective service user, but there was no record to support this statement. Although there are care plans for all service users these are not being updated on a monthly basis this must be addressed. For one service user there was no risk assessment. One area of the home requires decoration. Part of the downstairs hallway (from bedroom 3 that includes the bathroom and laundry room in this area) requires decoration. This area lets the home down as the rest of the home is well maintained. Although staff training is taking place, one staff member must be provided with training in the protection of vulnerable adults as she missed this course. All staff must undertake basic first aid training. The acting manager must put forward his application to register with the Commission as manager. All health and safety information was available and in order. The accident book was inspected. The entries in this book need to be monitored more closely by the acting manager. One entry did not state the action staff took after a service user had a fall. This information must always be recorded to evidence what action the home took to ensure the ongoing health and welfare of the service user. Dothan House DS0000027859.V259612.R01.S.doc Version 5.0 Page 7 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. Dothan House DS0000027859.V259612.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dothan House DS0000027859.V259612.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 does not apply to this home. The home has not worked in line with the Regulations in this instance and therefore this standard is not met. The home cannot evidence from documentation that they appropriately assessed the needs of the service user prior to admission. This needs to be addressed for the next service user who is accommodated to evidence that the service user is appropriately placed. EVIDENCE: The inspector looked at the file of the most recent service user accommodated. There was no written assessment carried out by the home in the records held for the service user. The manager stated that he always visits any prospective service user and carries out an assessment to ensure the home can meet their needs. It is a requirement that there must be a written assessment held on file. Dothan House DS0000027859.V259612.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 10. Standard 9 will be inspected at further inspections. The information held within the care plans (standard 7) is appropriate, however greater attention is required to ensure that all care plans are updated as changes occur and that the one missing risk assessment is completed to ensure the care needs of all service users are met appropriately. Standard 8 and 10 are well managed, this was confirmed in discussion with service users and from documentation supporting the care the home provides. EVIDENCE: Care plans were written up for all service users and held good information relating to catheter care, diabetes and anxiety guide lines. For a service user who is prescribed ‘Warfarin’ (a blood thinning medication) a risk assessment was written up providing information in the event of any accident where there may be excessive bleeding. For another service user prescribed ‘Warfarin’ there was no risk assessment this should be written up. Health care needs were well documented with information readily available. Visits from the GP, specialist nurses (diabetic), chiropodist, dentist and hospital
Dothan House DS0000027859.V259612.R01.S.doc Version 5.0 Page 11 appointments were all well documented showing health care needs are acted upon appropriately. Although there is a mix of gender within the staff group no male carers give personal care to female service users. Dothan House DS0000027859.V259612.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 From discussion with service users and relatives it appears that the home offers as much choice as possible in all aspects of daily life. Documentation also supported comments made to the inspector. These standards are well managed. EVIDENCE: The home offers a range of activities. Not all service users wish to join in and their choice is respected. Music features highly and birthdays are celebrated if this is the choice of the service user. Entertainers are usually brought into the home for birthday celebrations. The ‘house bound’ library visits and provides a selection of books many in large print. Requests for specific books can be made to the ‘house bound’ library staff who will make arrangements to get that particular book. The talking newspaper has also been arranged for one service user. A barbeque took place on the 14/8/05 and this was said to be enjoyed by many service users, relatives participated in the organising of this event. Links with the local community are encouraged. Relatives can visit at any time as there are no restrictions placed on visiting times. One service user regularly goes out to a ‘tea’ dance in the afternoon with a friend who visits. One relative was visiting at the time of the inspection and stated that his mother is well
Dothan House DS0000027859.V259612.R01.S.doc Version 5.0 Page 13 cared for. A service users spoken with said “ we can choose when we get up and when we go to bed” “they ask us what we want to eat at meal times and you get a choice , but I can’t remember what I chose today, that’s age for you”. Another service user who chooses to relax in her room said “ they have to help me get washed and dressed, they give me a choice of what to wear, I can get up when I want, sometimes I have a lie in if I’m tired”. Dothan House DS0000027859.V259612.R01.S.doc Version 5.0 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18 The home works within the policies and procedures for the protection of service users from abuse. From discussion with service users and relatives they stated that any complaints are acted upon. These standards are well managed. EVIDENCE: The home has policies and procedures for the protection of service users from abuse. All but one new member of staff have received training in the detection and reporting of abuse. In discussions with staff they were clear what forms abuse took and were able to inform the inspector of the action they should take if any suspected abuse was witnessed. A complaint was raised with the Commission about staff shouting at service users. Service users, staff and management were interviewed. Service users spoken with stated that “staff are kind and talk to them in a nice manner”. “ The staff are nice here nothing is too much trouble”. “The staff have to speak loudly to the ones that are deaf and have hearing aids. “I think they sometimes turn them off and they can’t hear what is being said” “they are all nice girls”. “Sometimes it is difficult to understand their accents but they just have to repeat it again.” Relatives spoken with stated “The staff seem to enjoy their jobs they are very enthusiastic.”” Mum has lots of visitors so I am sure if anything was heard or seen that was not appropriate about the care of any of the service users I would have been informed as the family all visit at different times”.
Dothan House DS0000027859.V259612.R01.S.doc Version 5.0 Page 15 From the interviews there was no evidence to suggest that any inappropriate shouting had taken place. The inspector was unable to uphold this part of the complaint. Some service users show an interest in voting and are assisted to go out to the local poling station at election times. Any new service users are placed on the electoral role. A further complaint was raised with the Commission about the way the food was prepared in the kitchen. On the day of inspection the inspector went straight to the kitchen and food was being appropriately prepared on that day, the kitchen was clean and well organised. It was established that the cook does not hold a current food hygiene certificate this part of the complaint was upheld. Staff training will be discussed in the relevant standard. Dothan House DS0000027859.V259612.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 The home is well maintained. However one area within the home requires attention as this lets the standard of the home down. Redecoration of this area would improve the facilities for service users. EVIDENCE: The home is well maintained. However the decoration of one part of the hallway from bedroom 3, also incorporating the bathroom and laundry area needs attention. The walls and woodwork require painting. Bedrooms and other areas of the home were inspected. All were clean and free from odours. All bedrooms were individually decorated and lots of personal possessions were on display making the rooms look homely. There are sufficient bathrooms and W.C.’s for the needs of service users. Specialist equipment is provided in bathrooms and W.C.’s. Dothan House DS0000027859.V259612.R01.S.doc Version 5.0 Page 17 The garden is accessible from the back door of the home and service users regularly walk in the garden. A comment made by two service users was, “ what’s it like out today? We usually go for a walk around the garden.” “I hope we can get out later as I like a walk around the garden, we don’t go if it’s cold or windy”. The kitchen was clean and tidy. The kitchen units are very old and shabby and require replacing as the doors do not close properly. The proprietor stated that the kitchen units are to be part of the next refurbishment carried out to the home. Dothan House DS0000027859.V259612.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 30. Standards 28 and 29 will be inspected at further Training is ongoing, however all staff must have attended a basic first aid course to ensure the safety of all service users and ensure that all staff take the appropriate action after any accidents. EVIDENCE: Staff training is provided. 10 staff are undertaking the NVQ level 2 training course. On the day of the inspection the NVQ assessor was at the home and the inspector spoke with him about the progress of the staff team. One staff member holds the NVQ level 3 qualification and another staff member holds NVQ level 2 qualification. Medication training took place on the 14/10/05 and an in-depth dementia training course is to take place for the acting manager who will then be able to train staff to care for people with dementia. Dental hygiene training took place at the home on the 23/9/05. On the 6/10/05 equal opportunities training took place and COSHH (control of substances hazardous to health) took place on the 18/10/05. All staff must undertake basic first aid. The home must make arrangements for this training to take place and also training for the one member of staff who has not undertaken the protection of vulnerable adults training, this must also be arranged. Dothan House DS0000027859.V259612.R01.S.doc Version 5.0 Page 19 The current cook has not undertaken a course in food hygiene this must be addressed with urgency. However the kitchen was clean and food preparation was underway when the inspector arrived (the inspector went straight to the kitchen) there were no concerns about the way the food was being prepared on the day of inspection. There is a gender mix within the staff group. No male staff carryout personal care for female service users. Dothan House DS0000027859.V259612.R01.S.doc Version 5.0 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32 and 38. 33 and 35 will be inspected at further inspections. The acting manager has been in post for some time now and must put forward an application to register with the Commission by 26/10/05. This has been raised with both the proprietor and the acting manager. Health and safety was well managed apart from closer monitoring of accident reports. This must be carried out to confirm that staff have taken the appropriate action after an accident to ensure the wellbeing of service users. EVIDENCE: The acting manager has been employed now for some time and must put forward an application for registration to the Commission by the 26/10/05. If the Commission do not receive this application then an Immediate Requirement Notice will be served on the home to ensure that this takes place. Dothan House DS0000027859.V259612.R01.S.doc Version 5.0 Page 21 The manager has greatly improved the care provided in the home. This has been stated by visiting professionals, as well as service users and relatives. The acting manager is currently undertaking his Registered Managers Award training. Health and safety documentation was up to date. The fire alarms were serviced along with the emergency lighting system on the 13/5/05. Staff fire drills have taken place on 7/3/05 and 4/7/05 the home is aware that 4 drill per year should take place. The fire extinguishers received their annual check on the 17/12/04 and weekly fire alarm tests are taking place and are recorded. The annual Gas safety certificate is dated 10/5/05, the lift was serviced on the 3/1/05. The annual portable electrical appliance test was carried out on the 27/7/05. The 5 year electrical safety certificate was dated 7/6/05. The Legionella test was carried out on the water storage on the 10/10/05. Staff had placed several walking frames by a fire door, these were restricting the closure of a door that is a fire door. The manager moved the frames immediately they were seen. Staff must take responsibility for the safety of service users and themselves and pay greater care when placing walking frames near fire doors. The accident book was inspected. All accidents when cross referenced corresponded with entries in the daily records. Although the accidents were recorded the information about the action taken by staff after the accident was not recorded on one form. All information must be appropriately recorded to enable the home to evidence the action they took. The manager must monitor this recording more closely. Dothan House DS0000027859.V259612.R01.S.doc Version 5.0 Page 22 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 2 x x X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 x x X x X 2 Dothan House DS0000027859.V259612.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP14 Regulation 14 Requirement A written assessment must be carried out for any new service users prior to admission this must be held on file. Care plans must be updated as changes occur Risk assessments must be completed where there is an identified risk and updated along with care plans as changes occur. Hallway (from room 3 down to the blue corridor) requires the woodwork and the walls decorating. Food hygiene training must be provided for the current cook. The one staff who has not attended protection of vulnerable adult training must do so. All staff must have basic first aid training. Managers application for registration must be sent to the Commission. Staff must ensure that walking frames do not restrict the closing of the fire door in the hallway at any time.
DS0000027859.V259612.R01.S.doc Timescale for action 30/10/05 2 3 OP15 OP8 15(1) & (2) 13(4)(c) 30/12/05 30/12/05 4 OP19 23(2)(d) 30/12/05 5 6 7 8 9 OP30 OP30 OP30 OP31 OP38 18(1)(c) (i) 13(6) 13(4)(c) 9(1) 13(4)(c) 30/12/05 30/12/05 10/02/05 26/10/05 21/10/05 Dothan House Version 5.0 Page 24 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 OP38 Good Practice Recommendations The manager must monitor the accident forms more closely. Dothan House DS0000027859.V259612.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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