Inspection on 09/08/07 for Dothan House

This inspection was carried out on 9th August 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

Dothan House 29/04/08

Dothan House 02/03/07

Dothan House 24/02/06

Dothan House 19/10/05

Dothan House 06/12/04

Dothan House 23/06/04

Dothan House 10/05/04

Dothan House 27/02/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Dothan House 458 Upper Brentwood Road Gidea Park Romford Essex RM2 6JB Lead Inspector Jackie Date Unannounced Inspection 12:30 9 August to14 September 2007 th th 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.V348093.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. Dothan House DS0000027859.V348093.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dothan House Address 458 Upper Brentwood Road Gidea Park Romford Essex RM2 6JB 01708 761647 01708 761647 dothan@tiscali.co.uk 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 vacant post Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Dothan House DS0000027859.V348093.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd March 2007 Brief Description of the Service: Dothan House is a registered care home for 19 people aged 65 and over. The home is situated in a residential area of Gidea Park and there is parking at the rear of the property. The home is a large two storey detached house with extensions. There is a passenger lift to the first floor. There is a combined lounge/dining area on the ground floor and another smaller lounge on the first floor. There are 17 single bedrooms and one double bedroom. Nine of the bedrooms have en-suite facilities. There is shower room and a bathroom. Personal care is provided on a 24- hour basis, with health care needs being provided by health professionals such as GPs and community nurses. The charge per week for each resident is between £404-00 & £440-00. This information was provided by the proprietor at the time of the inspection. The fees charged were also in a copy of the contract in residents’ files. Information about the service provided is contained in the service users guide Dothan House DS0000027859.V348093.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and started at 12.30pm on the first day. In total 6 visits were made to the home over a period of 5 weeks. Four of these were unannounced and two by arrangement to meet the proprietor, who is now managing the service. The additional unannounced visits were to check concerns received by the inspector as part of the feedback process and also to monitor the situation at the home at specific times of the day. Therefore one short visit was at 8am and another at 6pm. Where appropriate, references are made about these visits in relevant sections of this report. This was a key inspection and all of the key inspection standards were tested. Staff were asked about the care that residents receive, and were also observed carrying out their duties. Where possible residents were asked to give their views on the service and their experience of living in the home. All of the shared areas and some bedrooms were seen. Staff, care and other records were checked. Relatives, social workers and healthcare professionals were contacted and asked for their opinions of the service. At the time of writing this report feedback had been received from 7 relatives, 1 GP and the local authority. In addition feedback surveys were also received from 10 staff and 7 residents. Any feedback subsequently received will be taken into account for future inspections. The last key inspection was in March 2007. In June 2007 a short random unannounced inspection was carried out. The purpose of this was to check out concerns that have been raised anonymously with the Commission. As a result of that visit a meeting was held with Bis Oozageer, proprietor, to discuss concerns from the visit and also to check staff records. Where appropriate references are made about this inspection in relevant sections of this report. Subsequent to this inspection a meeting was held with the proprietor to discuss the concerns that have arisen during the course of this inspection and also the number of requirements from previous inspections that have not been adequately addressed. Services are now required to complete an AQAA (Annual Quality Assurance Assessment) and the completed form was received on 17th August 2007. Information provided in this document also formed part of the overall inspection. The inspector would like to thank the residents and staff for their input during the inspection. Dothan House DS0000027859.V348093.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The provider is now managing the home and has applied to be registered with the Commission. New carpets have been fitted throughout the home and internal decorating has started. Dothan House DS0000027859.V348093.R01.S.doc Version 5.2 Page 7 Staff are receiving more training to enable them to meet residents’ needs as safely as possible. The hoist has been serviced and is now available for use. What they could do better: 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. Dothan House DS0000027859.V348093.R01.S.doc Version 5.2 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.V348093.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 & 5. Standard 6 does not apply to this home. People using the service experience adequate quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Residents receive an adequate level of care and the home has the capacity to meet the needs of those requiring less specialised support. However, the needs of people requiring higher support have not always been met. Information is obtained to enable the staff team to decide whether or not the home can meet the prospective resident’s needs. Prospective residents and their relatives can spend time in the home to find out what it would be like to live there and to enable the resident to make a choice about living in the home, within their capacity to do so. The home does not offer intermediate care. Dothan House DS0000027859.V348093.R01.S.doc Version 5.2 Page 10 EVIDENCE: Referrals are usually received from the Social Services Department and they provide initial assessment information. This may be from information that they have gathered or from assessments made by hospital staff. The manager then carries out assessments before an individual moves into the home. The files of four of the residents were looked at. These included three of the newest residents. The files contained assessment information from the placing authority but there was not any information with regard to the manager’s assessments. This was discussed with the manager and he said that he did not keep the notes that he made at the time of the assessment but information from this was included in the care plan. The manager was however able to give details about information that he gathered on prospective residents. He was advised that this information should be recorded and kept in the resident’s file and he agreed that he would do this in the future. Details of residents’ needs are obtained before they move into the home. At the time of the last key inspection the manager had accepted residents with dementia even though the service is not registered for this client group. At the time of this visit the manager said that he had not accepted any residents with dementia since the inspection in March 2007. The files examined confirmed this but did contain information that residents admitted recently had no shortterm memory and were confused. In addition there are people at the home who moved in prior to the last inspection who do have dementia. The registered person must be able to demonstrate that the assessed needs of all of the residents are being met and therefore the requirements of the previous inspection, that all staff must receive comprehensive training in caring for people with dementia so that they are able to meet the specialised needs of this client group, is restated. Some staff have now received training on working with people with dementia. The plan is to roll this training out to other staff. Therefore, the timescale to meet this requirement has been extended to allow further training to take place. A random inspection took place on the 14th June 2007 as a result of concerns raised with the Commission about the care of residents. At that time there was a new resident with very high support needs in terms of mobility and moving and handling. Initial information about this persons needs clearly stated that a hoist was required for moving her. However at the time of the inspection that was not happening and staff were transferring this person using other manual handling aids. There was a hoist, but this was not in use. In addition, at that time, only two of the staff team had received moving and handling training. Therefore the home was not in a position to meet this persons needs. As a result of this visit, a meeting was arranged with the manager/provider to discuss the concerns. The hoist was then serviced and was able to be used, and since that inspection four staff have completed a twoday moving in handling course. This lady was only staying for respite and has Dothan House DS0000027859.V348093.R01.S.doc Version 5.2 Page 11 since moved out of home. Please see the section on staffing requirements about staff training. However, feedback from relatives was that residents are well cared for and their needs are met in a caring way. One relative said “great effort is made to keep residents comfortable and happy. I don’t think there is much in the way of improvement that could be made. Another said “dad was happy during his stay, the home seemed very caring”. Residents spoken to also said that the staff looked after them well. One resident said, “ I would like to be in my own home but the staff are all nice”. Feedback from the local authority was that they had recently reviewed all of the residents that they place at the home and felt that they received an adequate level of care. The previous key inspection also required that the registered person must be able to demonstrate that the assessed needs of all of the residents were being met and at the time of this inspection the requirement was not fully met. However, some progress has been made, and therefore the timescale has been extended. During the course of meetings with the proprietor/manager he was advised that unmet requirements impact on the well-being of residents and that ongoing failure to meet these requirements will result in the Commission taking enforcement action. The home does not provide intermediate care. Dothan House DS0000027859.V348093.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. People using the service experience adequate quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. The health, personal and social care needs of residents are set out in an individual plan of care, which provides staff with the information necessary to meet their basic needs. These plans need to be developed further to ensure that residents’ full needs are identified and that staff have clear information about how to meet these. Personal care is offered in a way that protects residents’ privacy, dignity and promotes their independence. Residents are supported to get the healthcare that they require. Medication is appropriately stored and administered but residents staying for respite cannot be sure that sufficient medication will be available throughout their stay. Dothan House DS0000027859.V348093.R01.S.doc Version 5.2 Page 13 EVIDENCE: All of the residents have plans, which cover the necessary areas and include, mobility, personal care, health, nutrition and orientation. These give information about each persons strengths, needs, likes and dislikes. Therefore there is current information available to enable staff to meet residents’ basic needs. However, as mentioned previously, some of the residents have higher support needs. This can be in terms of their confusion or in some cases their mobility or moving and handling needs. The plans seen do not contain sufficient information or detail to enable staff to safely, or adequately, meet these higher support needs. Comprehensive assessments and care plans must be developed to ensure that residents’ full needs are identified and that staff have sufficient information to meet these needs. They are risk assessments in place. These identify risks for the residents and indicate ways in which the risks can be reduced to enable the residents’ needs to be met as safely as possible. These had been reviewed and were up to date. They had also been signed and agreed by relatives. All of the residents are registered with a local doctor and specialist help is received when needed. Records are kept of medical appointments and these show that residents have checks from the optician, dentist and when needed the chiropodist. The district nurse also visits when required. The nutritional and dietary needs of residents are monitored and residents are weighed regularly, as far as possible, to monitor weight gain or loss. Appropriate referrals are made if necessary. The blood sugar levels of a resident with diabetes are monitored and there are guidelines in place for the action to be taken if she “ has a hypo”. Residents are supported to get the healthcare that they need and to be as healthy as possible. Staff were observed to be polite and respectful to the residents and also to spend time talking to them. One resident said, “ I am happy here, the staff are nice, and they come in and talk to me”. A relative said, “the manager and staff of Dothan house are caring and approachable and make every effort to create an atmosphere of friendliness and warmth”. Medication is stored in an appropriate metal cabinet and trolley that are attached to the wall in the lounge/dining area. Medication is mainly administered by the senior carers. The medication file contained appropriate information and this included photographs of residents and details of any allergies. This is good practice. An audit was undertaken of the management of medicines and a random sample of Medication Administration Record (MAR) charts were examined. Medication records were up to date and all medication was appropriately signed for when administered. However, there were still some handwritten entries on the MAR chart. For accountability hand written entries on MAR charts must be signed and dated by the person making the Dothan House DS0000027859.V348093.R01.S.doc Version 5.2 Page 14 entry. The entry must also include the source of the information. e.g. GP, registered nurse. This was also a requirement of the previous inspection and must be addressed. Some residents receive PRN (as required) medication and protocols/guidelines must be developed for these to ensure that all staff know when to give this medication and for what purpose. The resident with diabetes is insulin dependent. Staff prepare her syringes and she can then administer the injection. Records also showed that a respite resident had not had her medication for several days. This was discussed with the senior on duty and he said that the resident was due to go home and this was changed at the last minute. They were unable to get any further medication for her at short notice. The local authority received a complaint from the daughter of another person who had stayed at the home for two weeks respite care. The complaint was that during this visit he was not given all of his prescribed medication. This resident had been admitted to the home from hospital, and a supply of medication was sent from the hospital. During the course of his stay one of the medications ran out as the home had only received a five-day supply. This was discussed with the senior on duty, and he said that they had difficulties contacting the hospital to confirm details of the medication and that the GP would not prescribe the medication until he had had confirmation from the hospital. Therefore in both these cases the residents had not received their prescribed medication, and this could have had a detrimental affect on their health and well-being. Systems must be in place to ensure the all residents receive their prescribed medication regularly and safely and that adequate supplies of medication are available. Overall, medication is safely stored and appropriately administered but the systems and arrangements to ensure that residents have adequate amounts of medication for their stay at the home are not robust. Dothan House DS0000027859.V348093.R01.S.doc Version 5.2 Page 15 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 & 15. People using the service experience adequate quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. More activities are needed to ensure that residents’ social needs are satisfied. As far as possible, residents are helped to exercise choice and control over their lives. Visitors are made welcome at the home and are invited to social events. Therefore residents are able to maintain contact with their friends and families. Residents receive adequate meals that in most cases meet their preferences and needs. EVIDENCE: Staff were observed chatting to residents in the lounge and there was a very relaxed and friendly atmosphere. Feedback from a relative was “great effort is made to keep the residents comfortable and happy.” A hairdresser visits each week and some residents have aromatherapy massages from a visiting aromatherapist. The ‘house bound’ library visits and provides a selection of Dothan House DS0000027859.V348093.R01.S.doc Version 5.2 Page 16 books many in large print. Staff also encourage residents to do gentle exercises. However one resident said that she gets bored and feedback from the local authority was that activities are limited. A member of staff said that although they do some activities more is needed and that this needs to be more structured. Activities must be developed that are suitable for the individual needs of people living in the home so that they have as interesting and stimulating time as possible. During one of the later visits one of the residents said “we have started to go out, we are taking turns. I went to the pub and had something to eat.” A resident said, “ it is nice here, staff always help you and the food is good”. Residents also said that they could choose when to go to bed and what to do and that they can spend time in their room or in one of the lounges. One resident said that she prefers to stay in her room but she did go to the barbecue. She also said that she is “happy here, the staff are nice and even the cook comes in to talk to me.” Another resident said that she likes to go to bed late and that this was okay. Records seen contained information about when residents go to bed and reflected the fact that residents go to bed when they are ready. Relatives can visit at any time, as there are no restrictions placed on visiting times. Relatives said that they are always made welcome and are offered refreshments. Staff were observed to take time to chat to relatives. Residents also said that they celebrate birthdays and had birthday cakes. There were some balloons hanging up as part of a resident’s birthday celebrations. An entertainer had visited the home a few days before the inspection and during the course of the inspection members of a local church visited to hold the monthly church service. During the summer a barbecue was held and residents and relatives said that it was very nice and that they all had a good time. Residents’ nutritional needs form part of their care plan. One relative expressed concerns about the quality of the food provided in the home and was concerned that “everything is cheap value food and not good quality”. Inspection of food stocks confirmed that much of the stores were cheaper “value” brands. However the rest of the feedback about food and meals was positive. One resident said, “the food is good and there is plenty of it.” Another said, “the meals are really nice.” The resident that has diabetes does not have sweet things. The inspector visited the home at 8am on one of the days of the inspection and residents were having breakfast. They had a choice of cereals and toast and were offered more toast and more drinks. A newer resident got up later and was asked what she wanted. She chose toast and coffee and staff also offered her eggs, which she was obviously pleased about. Staff spoken to said that 6 or 7 of the residents like tea and toast before they go to bed and there was evidence that they are offered this. At present none of the residents have any specific dietary requirements in relation to their Dothan House DS0000027859.V348093.R01.S.doc Version 5.2 Page 17 cultural or religious needs. Therefore residents receive meals that meet their preferences and needs. Dothan House DS0000027859.V348093.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 & 18. People using the service experience adequate quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Although positive feedback has been received about how residents are treated by staff and how complaints/concerns are dealt with there have been concerns raised that have indicated that residents have not been adequately safeguarded by the systems and practices in the home. EVIDENCE: The home does have a complaints procedure that is used in the event of a complaint being made. A resident said, “if I make a complaint Bis takes action immediately, and I am happy.” Feedback written by a family member on behalf of a resident said, “I do not have any outstanding issues. Any problems are dealt with and many people take care of my well-being”. The home has policies and procedures for the protection of residents from abuse. Staff have received training in what constitutes abuse and how to report it. Feedback from staff was mostly that residents were well cared for and that they did not have any concerns about the way that residents were treated. However the Commission and the local authority have received complaints and concerns about the way that residents are cared for. As a result of these concerns a random inspection visit took place on 14th June 2007. At that time Dothan House DS0000027859.V348093.R01.S.doc Version 5.2 Page 19 one of the newer residents had high support needs in terms of her mobility and moving and handling. This resident was admitted as an emergency. Information obtained about this person’s needs clearly stated that a hoist was required for moving her. However at the time of the inspection this was not happening and two staff were transferring this person using other manual handling aids. I was informed at the time that the hoist was not in use. The manager/proprietor subsequently confirmed that the hoist had ‘expired’ in terms of servicing and could not be used. He also said that 1 or 2 staff had raised the issue but that he did not see it as a difficulty as the home has transfer boards and sheets. In addition there was not any risk assessment with regard to moving and handling this person and there was not any care plan or guidance with regard to how these needs must be met. This resident did say that she was not always changed quickly enough when she had been incontinent and that sometimes it hurt her when she was being put into the wheelchair. At that time only 2 staff have received moving and handling training. This situation was totally unacceptable and placed both staff and residents at risk. As a result of this random inspection an urgent meeting was held with the manager/proprietor and he was advised that this must be addressed as a matter of urgency. The resident’s care plan was subsequently updated and the hoist was to be serviced. The resident concerned has since moved out of the home and therefore it was not possible to have further discussions with her. Please see the section on staffing for further details with regard to staff training. Other concerns were raised about how residents had been treated and the safeguarding adults team has investigated these. Because of the nature of the concerns and initial observations by staff from the local authority they reviewed the care of all of the residents that they placed at the home. The overall conclusion was that residents are receiving adequate care from the home. At the time of writing this report the report into the safeguarding adults issues had not been received from the investigating officer. However verbal feedback from the investigating officer indicated that no further action will be taken in line with safeguarding adults but the report will contain recommendations that the service will need to address. The registered person must make arrangements, by training staff or other measures, to prevent residents being harmed or suffering abuse or being placed at risk of harm or abuse. There has been a lot of positive feedback about the care that residents receive and staff being caring and friendly but the concerns raised have been serious and have not been without substance, for example, issues regarding medication and moving and handling, which place the people who use the service at risk of harm. As a result of this another meeting has been held with the proprietor/manager to discuss these and to emphasize the concerns that the Commission has. The proprietor/manager has taken these issues on board and indicated his commitment to work to improve matters. He has outlined his Dothan House DS0000027859.V348093.R01.S.doc Version 5.2 Page 20 plans for improvement and the Commission will continue to monitor this service. Dothan House DS0000027859.V348093.R01.S.doc Version 5.2 Page 21 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, 20, 21, 22, 23, 24, 25 & 26. People using the service experience adequate quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. The residents live in a clean home that is suitable for their needs. Ongoing improvements are making the environment brighter and more homely. However repairs are not always dealt with promptly and this can affect the quality of the service that residents receive. EVIDENCE: The home is situated in a residential area of Gidea Park and there is parking at the rear of the property. The home is a large two storey detached house with extensions. There is a passenger lift to the first floor. There is a combined lounge/dining area on the ground floor and another smaller lounge on the first floor. There are 17 single bedrooms and one double bedroom. Nine of the bedrooms have en-suite facilities. There is a shower room and a bathroom. Since the last inspection the home has been recarpeted throughout and at the Dothan House DS0000027859.V348093.R01.S.doc Version 5.2 Page 22 time of the visits the flooring was also being replaced in the en suite facilities and the shower and bathroom. In addition internal and external redecoration has started. When this is completed it will make the home much brighter and also improve the personal and communal areas for residents. The kitchen was clean and tidy. There were doors that were not working properly and the cupboard under the sink is damaged. The kitchen needs to be upgraded/replaced to ensure that it of a satisfactory standard. The proprietor stated that he was aware that a new kitchen was needed and that this would be done by the end of the year. The timescale for completion of this task has been extended by three months to allow for this work to be carried out. A sample of bedrooms 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. Bedrooms have recently been recarpeted and the proprietor/manager said that bedrooms would be decorated as they become vacant. There are sufficient bathrooms and W.C.’s and these are suitable for the needs of residents. The toilet in the upstairs bathroom is not easily accessible due to its close proximity to the door. There are plans to refurbish this bathroom early next year and therefore no requirement has been made at this time. Suitable laundry facilities are available so that residents’ clothing, bedding and any soiled items can be washed appropriately. There is a small garden, which has some garden furniture and also sheds for storage. At the time of the inspection there was a lot of rubbish stored in the gardens and in the sheds. This included some discarded soft furnishings. The manager was advised that this rubbish must be removed as soon as possible as it was unsightly and presented a health and safety risk. At the time of one of the visits there was not a toilet seat on the downstairs toilet. It had been broken a few days previously and as it was a risk to residents (one resident had almost fallen) a representative of the local authority had advised that it should be taken off. The inspector issued an immediate requirement notice and the toilet seat was replaced the same day. However it is not acceptable that this should have taken so long or that residents should have had to use a toilet with a broken seat or no seat at all. Earlier in this report there is information about the hoist, which was not in working order when needed and was serviced after the Commission had raised the issue. It is not acceptable that facilities and equipment for use by and with residents are not kept in good working order or that there is a delay in repairs/replacements. This affects the health, well-being and safety of residents. A system must be in place to ensure that any repairs or breakages are noted and reported and that repairs are actioned in a timely fashion. This Dothan House DS0000027859.V348093.R01.S.doc Version 5.2 Page 23 will ensure that the environment is safe for all that use the home and that equipment is in good working order. This requirement also relates to Standard 28. At the time of the random inspection in June 2007 it was found that the call bell for one resident was not plugged in. At the time of this visit call bells seen were in reach of residents and were plugged in. Therefore residents that were able to could summon assistance when required. Prior to the inspection concerns were raised with the inspector that CCTV cameras were in operation in the home. This was discussed with the manager/proprietor and he confirmed that there were cameras in the entrance hall, the lounge, the corridors and at the back door. He was informed that this was not acceptable as it breached residents’ privacy and was asked to stop using these immediately. At a subsequent meeting he confirmed that the cameras had been removed. At the time of the random inspection in June 2007 poor practice was observed in terms of infection control. A requirement was made that all staff must receive infection control training so that they are aware of the required practice and so that that good infection control is practised within the home. In view of the fact that staff have been booked to do this course with the local authority the timescale for compliance has been extended. Dothan House DS0000027859.V348093.R01.S.doc Version 5.2 Page 24 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 & 30. People using the service experience adequate quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Staffing levels are not always sufficient to meet residents’ needs. Residents and their relatives say that the staff are kind and caring but all staff need to receive training that will equip them to meet residents’ needs as safely as possible and in line with best practice. EVIDENCE: The usual staffing complement is 1 senior carer and 2 carers in the morning, 2 carers in the afternoon and 2 carers at night. Sometimes there is a third member of staff until 5pm. There is a cook from 9am to 2pm each day and some domestic support. From discussions with staff and from information about residents’ needs the staffing level in the morning is adequate but not for the late shift. In addition to caring for residents, staff on the late shift need to prepare the evening tea and clear up. In the completed AQAA the proprietor/manager acknowledged the need for increased staffing in the afternoon. As a result of this he has been recruiting some staff and said that he attends to introduce an additional split shift from 7.30- 10 in the morning and from 4 –7 in the evening. He had not been able to cover these shifts consistently but the rota did show an additional person working some Dothan House DS0000027859.V348093.R01.S.doc Version 5.2 Page 25 afternoons. There is a member of staff that is employed to carry out some domestic duties and also care duties but the inspector received differing information about how this works and was not satisfied this arrangement is robust. The rota must clearly indicate who is on duty and in what capacity. It must be clear when the individual is working as a carer and when as a domestic. It must also clearly indicate if another carer is covering domestic duties as opposed to caring for residents. This requirement remains outstanding from the previous inspection and must be addressed. As a result of the progress that has been made the timescale for meeting the requirement that staffing levels must be reviewed to ensure that they are sufficient staff on duty to meet residents’ needs appropriately and safely has been extended. Unmet requirement impact on residents’ welfare and ongoing failure to meet requirements will result in the Commission considering enforcement action. From discussions with staff and from checking staff records it is evident that staff receive training, including induction, to give them the skills and knowledge that they need to provide an appropriate and safe service for the residents. In addition some staff have achieved NVQ qualifications. However, as stated previously in this report some residents do have dementia and not all staff have received training in this area to enable them to work appropriately with these residents. A requirement has been made in Standard 4 in relation to this. At the random inspection in June 2007 the need for staff to receive moving and handling and also infection control training was also identified. These requirements have not been fully met but there has been some progress and there was also evidence that staff have been booked to attend courses run by the local authority. One member of staff said that she had completed a lot of training in the year that she had been employed at the home. This had included food hygiene, fire safety, manual handling, living with sight loss and adult protection. She had also started NVQ level 2. Therefore the date for the completion of this requirement has been extended to allow for the courses to take place. This requirement also relates to Standard 28. A selection of staff files were examined and this included the file of the newest employee. The file of the newest employee contained a copy of the application form, new staff questionnaire, references, confirmation of identity, CRB (Criminal Records Bureau) check from the persons last employer and other required details. There was also an application for a CRB taken by Dothan House. The proprietor manager was able to provide evidence that a POVAfirst (Protection of Vulnerable Adults) check was carried out before this person started working at the home. Other files examined also contained appropriate information. Details in another file showed that a member of staff started work on the basis of a CRB check undertaken by a previous employer. The manager said that a previous inspector had said this was acceptable at that time. This cannot be confirmed but the manager is now clear as to the required process and in future recruitment should be robust. Therefore a requirement has not been made in relation to this. Dothan House DS0000027859.V348093.R01.S.doc Version 5.2 Page 26 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 & 38. People using the service experience adequate quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. The home is now being managed by a qualified and experienced manager but there is still a lot of work to be done to ensure that the service meets minimum requirements and that residents are safeguarded by the practices in the home. EVIDENCE: Although there have been some managers in post, the home has not had a registered manager for several years. The last manager employed left in February this year. Initially the proprietor was overseeing the home whilst he recruited a new manager. Subsequently the proprietor has decided that he will manage the home and has made an application to the Commission’s registration unit. He has previously been the registered manager and Dothan House DS0000027859.V348093.R01.S.doc Version 5.2 Page 27 therefore was deemed to have the necessary experience and qualifications to manage the home. Staff said that he is at the home a lot and that he assists residents and works in the home. The previous manager had completed a quality assurance survey. The results of this were available at the home and this confirmed that residents and relatives had been asked to comment on the service provided. Staff spoken to said that they had been receiving supervision and that staff meetings were being held. This gives staff the opportunity both collectively and individually to discuss work practice, any concerns and the development of the service. Staff also said that they can talk to the proprietor or the senior carer and that they get advice and support from them. The home’s insurance policy is current. The proprietor does not deal with residents’ overall finances, but for some residents has small cash amounts in safekeeping. Residents’ money held in safekeeping and used on their behalf for purchases or services from the chiropodist, hairdresser and aromatherapist were found to be in order. The cash held for three residents was checked and amounts recorded tallied with cash held. All entries were recorded and receipts were kept to evidence any expenditure. For other residents the proprietor keeps a record of money spent and then sends invoices to relatives. Therefore residents’ finances are appropriately dealt with. All of the necessary health safety checks are carried out but if problems arise they are not always dealt with quickly. For example the water temperature in the bathroom was too high. This was addressed during the course of the inspection but once again this was actioned after the inspector had raised the issue. A system must be in place to ensure that any repairs or breakages are noted and reported and that repairs are actioned in a timely fashion. This will ensure that the environment is safe for all that use the home and that equipment is in good working order. This requirement was made in the section on the environment earlier in this report. Subsequent to this inspection a meeting was held with the proprietor to discuss the concerns that have arisen during the course of this inspection and also the number of requirements from previous inspections that have not been adequately addressed. He acknowledged that there was a lot of work to be done and gave details of the action that he is taking to rectify the situation. He also agreed to provide an action plan and said that he will send regular updates to the Commission. Dothan House DS0000027859.V348093.R01.S.doc Version 5.2 Page 28 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 Dothan House DS0000027859.V348093.R01.S.doc Version 5.2 Page 29 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 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 3 17 X 18 2 2 3 3 2 3 3 3 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Dothan House DS0000027859.V348093.R01.S.doc Version 5.2 Page 30 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 OP3 Regulation 14 Requirement The registered person must be able to demonstrate that the assessed needs of all of the residents are being met. (Previous date for compliance 30/06/07 not met). Staff must receive comprehensive training in caring for people with dementia. (Previous date for compliance 30/06/07 not met). Comprehensive assessments and care plans must be developed to ensure that each resident’s full needs are identified and that staff have sufficient information to meet these needs. For accountability hand written entries on MAR charts must be signed and dated by the person making the entry. The entry must also include the source of the information. e.g. GP, registered nurse. (Previous date for compliance 30/06/07 not met). DS0000027859.V348093.R01.S.doc Timescale for action 31/12/07 2. OP4 18 31/12/07 3. OP7 15 30/11/07 4. OP9 13 15/10/07 Dothan House Version 5.2 Page 31 5. OP9 13 6. OP9 13 7. OP12 12 8. OP18 13 9. OP19 16 10. OP19 23 11. OP19 23 12. OP26 12, 13 & 16. Some residents receive PRN (as required) medication and protocols/guidelines must be developed for these to ensure that all staff know when to give this medication and for what purpose. Systems must be in place to ensure the all residents receive their prescribed medication regularly and safely and that adequate supplies of medication are available. Activities must be developed that are suitable for the individual needs of people living in the home so that they have as interesting and stimulating time as possible. The registered person must make arrangements, by training staff or other measures, to prevent residents being harmed or suffering abuse or being placed at risk of harm or abuse. The kitchen must be upgraded/replaced. (Previous date for compliance 30/06/07 not met). A system must be in place to ensure that any repairs or breakages are noted and reported and that repairs are actioned in a timely fashion. This will ensure that the environment is safe for all that use the home and that equipment is in good working order. This requirement also relates to standard 22 Excess rubbish must be cleared from the garden as this presents a health and safety risk and is unsightly. All staff must receive infection control training so that they are DS0000027859.V348093.R01.S.doc 31/10/07 31/10/07 31/12/07 31/12/07 31/12/07 30/11/07 31/10/07 31/12/07 Page 32 Dothan House Version 5.2 13. OP27 18 14. OP27 18 15. OP30 18 aware of the required practice and the registered person must ensure that good infection control is practised within the home. (Previous date for compliance 15/08/07 not met). The rota must clearly indicate 31/10/07 who is on duty and in what capacity. (Previous date for compliance 15/06/07 not met). Staffing levels must be reviewed 15/11/07 to ensure that there are sufficient staff on duty at all times to meet residents’ needs appropriately and safely. (Previous date for compliance 31/07/07 not met). All staff must have the necessary 31/12/07 training to meet residents’ needs, specifically all staff must receive moving and handling training to ensure that they know how to appropriately and safely transfer and assist residents. (Previous date for compliance 31/07/07 not met). This requirement also relates to standard 28. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Dothan House DS0000027859.V348093.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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 Dothan House DS0000027859.V348093.R01.S.doc Version 5.2 Page 34 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!