Inspection on 01/06/06 for Douglas House Cheshire Home

This inspection was carried out on 1st June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Douglas House Cheshire Home 14/03/06

Douglas House Cheshire Home 09/08/05

Douglas House Cheshire Home 22/02/05

Douglas House Cheshire Home 13/07/04

Douglas House Cheshire Home 18/02/04

Similar services:

The Vicarage

7 Hyde Road

5 Seafield Road

Trevaylor Manor

12 Orchard Mews

Stallcombe House

Stepping Stones

Cornerstones

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

CARE HOME ADULTS 18-65 Douglas House Cheshire Home Leonard Cheshire Foundation Services Douglas Avenue Brixham Devon TQ5 9EL Lead Inspector Doug Endean Unannounced Inspection 1st June 2006 10:00 Douglas House Cheshire Home DS0000028666.V298326.R01.S.doc Version 5.2 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 Douglas House Cheshire Home DS0000028666.V298326.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 Adults 18-65. 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. Douglas House Cheshire Home DS0000028666.V298326.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Douglas House Cheshire Home Address Leonard Cheshire Foundation Services Douglas Avenue Brixham Devon TQ5 9EL 01803 856333 01803 859503 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) www.leonard-cheshire.org.uk Leonard Cheshire Miss Kay Louise Taylor Care Home 29 Category(ies) of Physical disability (29), Physical disability over registration, with number 65 years of age (29) of places Douglas House Cheshire Home DS0000028666.V298326.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. physically disabled - 29 nursing beds elderly physically disabled - 6 residential beds physically disabled - 6 residential beds A named first level Registered General Nurse with experience in the Younger Physically disabled field must be appointed to support the Manager 14th March 2006 Date of last inspection Brief Description of the Service: Douglas House is a purpose built care home for the disabled and first opened in 1973. It is one of the Leonard Cheshire Homes, a Charity Provider of services for disabled people in the UK, and is located on the outskirts of Brixham in Devon having some superb views from the first floor across the sea that is just a short distance away. The home is registered for up to 29 physically disabled service users from 20 years old onwards who require nursing care. The home may also provide residential care if the need arises. There is always a registered nurse on duty who is supported by a team of health care assistants and others skilled in physiotherapy and activities that are therapeutic and entertaining. The Douglas House staff team are committed to enabling service users to live in dignity and encourage them to develop their own individuality. The home is been recently refurbished and bathrooms have received attention to update their facilities and décor. All service users accommodation is provided in the form of single rooms, some of which have en suite facilities. All the service users rooms have access to hoists, most of which are overhead track hoists. There are spacious communal rooms and wide corridors allowing easy manoeuvrability for wheelchair users throughout the home. This purposebuilt accommodation also provides environmental aids and computer equipment for those who need it. Douglas House also has a respite/holiday room for service users wanting short-term care only. Emphasis is put on helping people to achieve their greatest potential level of independence and thus improving their quality of life. Douglas House also has a day-care service for local service users and can do provide suitable transport. Douglas House Cheshire Home DS0000028666.V298326.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first Key inspection carried out on Douglas House. It was unannounced and began at 10:00 hours on the morning of the 1st June 2006. The Inspector was assisted by the Management team and others, including the service users and their relatives during the unannounced inspection. This was the inspectors first contact with the home for several years. The inspection took place over a six hour period and included a full tour of the home and its facilities. During the tour the inspector took the opportunity to talk with several of the service users in their rooms and in the communal areas such as the dining room during the main meal of the day to obtain their view and opinions on the subjects being inspected. When in service users bedrooms the inspector looked at a total of 6 care plans and established how certain aspects of the care was delivered and also received. The inspector spoke to many of the service users and several staff members both whilst touring the home or when focusing on certain areas of the inspection. When in the offices the inspector read 3 staff files and other records kept by the home such as the servicing and maintenance of equipment and the fabric of the home. He also looked at policies and procedures both in the office and whilst touring the home as several are displayed such as the complaints procedure whilst medication related information was in the medication room. Following the inspection the views of 6 service users, 2 relatives, General Practitioners and Social Care professionals were obtained in writing and verbally about the service. What the service does well: What has improved since the last inspection? The inspector noted that the last report made comment about some of the toilet and bathing facilities at the home not being suitably presentable and in Douglas House Cheshire Home DS0000028666.V298326.R01.S.doc Version 5.2 Page 6 need of improvement. There has been a complete refurbishment program directed at these facilities that are now providing the most up to date facilities inside rooms that have been retiled to look clean and achieving a modern décor that is attractive. This has also addressed the infection control comments that were also made as a result of damaged tiles. 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. Douglas House Cheshire Home DS0000028666.V298326.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Douglas House Cheshire Home DS0000028666.V298326.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The quality in this outcome area is excellent. The homes pre-admission assessment is very comprehensive and gathers enough information for an appropriate decision to be made regarding admission and for a comprehensive care plan to be produced from it. EVIDENCE: The home uses a very comprehensive assessment tool to establish the suitability of every admission to the home. The information that is gathered is also then used to prepare for the admissions that are found to be within the criteria the home uses. The Registered Manager, who is a Registered Nurse, and senior members of the care team are involved in the assessments that can take place in any venue including a National Health Services hospital or the clients home. The areas assessed cover both health and social care needs as well as any psychological issues that may need to be considered. Samples of these assessments were seen in each of the three service users files that were looked at. A personal profile is commenced at the assessment stage that continues to be filled in during a service users stay at the home gathering information on the service users life history and likes and dislikes. Any information already gathered by other health and social care professionals and made available to the assessor will be used to enhance their knowledge of the service user being assessed and copies taken for the file where possible. Douglas House Cheshire Home DS0000028666.V298326.R01.S.doc Version 5.2 Page 9 The initial care plan is designed around the information that has been gathered. The samples of care plans that were seen were very through and covered all the areas of care, physical, psychological and social and include the service users and their advocates where this is possible. The inspector noted that the areas covered included a nutritional assessment and plans. The care plans were reviewed on a regular basis and the review clearly recorded. The home provides a copy of its admission procedure to every potential service user or their advocate in the Statement of Purpose. Douglas House Cheshire Home DS0000028666.V298326.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 and 10. The quality in this outcome area is good. The home has comprehensive care plans for each of the service users and have provided the resources to meet them such as specialist equipment. All the records are securely kept and staff is clear about confidentially of information. EVIDENCE: The home produce very comprehensive care plans from all the information gathered prior to admission that are regularly reviewed and amended where care needs have changed. The service users and their advocates are involved in reviews where this is possible or requested and records of formal reviews were seen. The inspector looked at six care plans whilst touring the home as they are kept in service users bedrooms. The inspector sampled three care plans in detail to formulate the opinion given in this report. The care plans cover equipment and staffing needs to complete identified tasks such as bathing and manual handling or fulfilling a social care need that had been identified and planned for. Douglas House Cheshire Home DS0000028666.V298326.R01.S.doc Version 5.2 Page 11 Where risks are identified and restrictions of choice or movement are made these are documented such as where a service user can smoke and if alcohol consumption should be monitored. The staff do consider the rights of the service users as individuals and also the community when planning restriction. Leonard Cheshire have a document produced for the Disabled Peoples Forum entitled “Service Users Right to Take Risks” that does help in providing some understanding about why a action may carry a risk that is too great for it to be allowed. This is available for all service users. The views of individuals are recorded in their files with regard to likes, dislikes, restrictions, etc. Plans also describe how staff should respond to certain behaviour so as to manage the situation appropriately and in the best interests of the service users in the home and the staff team. This has included leaving the presence of a service user who displays aggression or unacceptable behaviour for a short time to defuse the situation. Where the home has been involved in the finances of a service user records are kept and these were shown to the inspector. Generally service users are responsible for their own finances and this is referred to in the service users guide. The home only allows those with a right to do so to access any of the homes records including those relating to the service users. The records where seen to be securely stored and those held on computer are password protected. Information is only shared in line with the Disclosure of Information Act. The homes policies and procedures are readily available to anyone who wishes to read them with several displayed in the front entrance of the home including the complaints procedure. The Statement of Purpose and service users guide also hold valuable information on the way the home address the issue of privacy and dignity and what the admission procedure involves. Douglas House Cheshire Home DS0000028666.V298326.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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, 15, 16 and 17. The quality in this outcome area is good. The home provides a good level of physical and psychological support to the service users, which in turn helps to maintain their independence and an appropriate degree of control and choice. EVIDENCE: The service users are supported by the staff to maintain contacts with families, friends and other individuals and groups they were in contact with, or wish to join, who are external to the home. Several service users use the local swimming pool and hydro-therapy pool using the homes transport to travel to and from the facilities. Others attend pottery classes and the home has a number of computers that are connected to the Internet so that they can Surf the net” and make email contact (using their own email addresses) with others. One service user is gainfully employed in the home and also in a local shop part time. The home has its own Activities Coordinator who works 4 days a week and she is helped by two care staff one who also works on the care side of the home. Douglas House Cheshire Home DS0000028666.V298326.R01.S.doc Version 5.2 Page 13 There is a large activities room at her disposal plus an additional room, the quiet room, which also houses the internet linked computers. Both rooms open onto the large balcony at the front of the home that has magnificent past Berry Head to the sea beyond. The service users have received computer training in power point and other programs to make them more computer literate. The local college has tutors attend the home for music and art sessions. They come to the home rather than service users going to the college as it is not particularly well designed for their individual needs. The home also provides day care for individuals in the locality who attend the activities on offer at the home. There are no restrictions to the access that the service users have in the local community and the staff support the service users to attend the cinema, go shopping or just go out for a drive. There are three buses at the home that are used as transport for the service users for both social and domestic purposes. The home has open visiting within reason and service users can see who they wish, wherever they wish within the home but must respect the privacy of other service users. The service users bedrooms have doors that can be locked and all the service users have access to keys. A number of bedrooms have automatic door openers and these are lockable. Staff are aware that they should enter a bedroom only after the service users permission has been given and they were seen to knock before entering bedrooms where service users were inside. The service users have the right to their privacy and do choose to spend time alone in their rooms. However the staff are aware of those service users who may be in need of emotional support or encouragement to join in with other individuals or groups in the home or outside of it. The home rules about smoking and alcohol consumption are clear and are stated in the service users guide. The home has a hotel styled kitchen and employs its own catering staff. Food is prepared fresh and the home now operates a cafeteria style service at present with a selection of food being available each day. The inspector spoke to several of the service users during the mid day meal time and each of them were satisfied with the choice and quality of the food that they had received. Supper can be sandwiches that are pre-prepared for individuals and there is a hot alternative. Fresh fruit was also available and their were jugs of cold drinks seen in the dining area. Cold drinks of apple and cranberry juice were also in the fridge in the dining area for the service users to drink. There is a tuck shop that is located in the old bar at the home that closed due to licensing laws. The inspector discussed how other homes have managed top deal with this problem to the service users benefit. The main meal seemed to be an even with service users sharing tables and enjoying the company of the staff and other service users. Where needed the staff were aiding service users with their chosen meal in a manner that seemed to be acceptable to the service users and did not draw undue attention Douglas House Cheshire Home DS0000028666.V298326.R01.S.doc Version 5.2 Page 14 to individuals. Service users who are artificially fed are continually monitored by the Registered Nurses and the care staff who attend them. All the service users have a nutritional assessment in their file and their choices of meals are monitored so that they do not become nutritionally compromised. The importance of adequate fluids is also something that the inspector was told was an important issue that the staff monitor where this is necessary. The views of those service users who responded to the questionnaire varied but all agreed that the staff treat them well with four feeling they are listened to, one feeling they are not listened to and one did not respond having stated that the staff always treat them well. Douglas House Cheshire Home DS0000028666.V298326.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. The quality in this outcome area is good. All the staff at the home has a supportive role in meeting the holistic needs of the service users and they carry this out very well whilst promoting independence as much as is possible and involving other health and social care professionals when necessary. EVIDENCE: The staff plan the care to be provided in collaboration with those service users who can, and wish to take part. Formal reviews are recorded in the case files and each of the service users, and their advocates, may take part in these reviews. Evidence of this was found both in the case files and verbally when in discussion with the service users and staff employed at the home. Risk assessments are used and were seen in service users records to establish the safety of any plans or requests for activities by individuals. The remarks obtained in the questionnaires that were returned would suggest that not all the service users agree with the outcome of the risk assessments. The care plans reflect the information obtained in many ways and includes the likes and dislikes of service users including their preferred time of getting up and going to bed, the food they will and will not eat and what their preferences Douglas House Cheshire Home DS0000028666.V298326.R01.S.doc Version 5.2 Page 16 are in social activities. The service users will make their choice of personal clothing and hairstyle known to staff at the appropriate time. The gender of staff to provide care is also agreed upon with service users as well as preferred staff to provide care when possible and appropriate. This agreement was seen to be recorded in the sample of service users case files read by the inspector. The home has registered nurses on duty to plan and deliver nursing care. Where their ongoing monitoring and assessment raises the need for other health and social care involvement this is arranged. Specialist assessment and care is provided in house such as physiotherapy. The community services are accessed, sometimes through General Practitioner referral, where not provided within the home, to meet the service users needs such as occupational therapy assessments, care management services and health care professional advice and support such as speech therapy. Transport is available at the home to take service users to any health care appointment that has been made by them or the home and includes visits to their dentist of choice. The home is suitably equipped and prepared to provide good care to any service users who are reaching the end of their life. This is done both in a professional and emotional sensitive way including and supporting those individuals that are to be a part of the final caring experience. They will receive this care in the privacy of their own room unless it is not medically possible. The arrangements for the supply, storage, administration, and disposal of medication was inspected and found to be satisfactory. The medication storage room is air conditioned to maintain a correct storage environment for some medications that do not require to be refrigerated. The Registered Nurse on duty is always responsible for the administration of medication to the service users. The administration records were looked at and found to be satisfactory and the reference material held at the home about medications was sufficiently up to date. Where it has been requested service users can self medicate providing the homes risk assessment finds this to be a safe arrangement. There is suitable storage in service users rooms where this is an acceptable arrangement. Douglas House Cheshire Home DS0000028666.V298326.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. The quality in this outcome area is excellent. There are satisfactory arrangements in place for service users to raise complaints and have them addressed and for the protection of service users from abuse. EVIDENCE: The home has many ways of informing the service users of their rights including their right to complain. The information on how to do this is held in the complaints procedure that is displayed in the entrance of the home and also held in documentation such as the Residents Guide and Statement of Purpose. IN addition to this there are professionally printed leaflets that are in the front lobby entitled “Have your say” regarding complaints, “Protecting Vulnerable Adults” guidance for service users, and “Whistle Blowing” for staff who want to raise issues of bad practice. Further to this the service users can become a member of the “Disabled Peoples Forum” where they can discuss issues that might include them dealt with by these standards. The inspector saw records of the complaints that have been handled at home level and the outcomes. There are procedures in place to protect the service users from abuse that include the vetting of staff and also any contractor who work at the home and evidence of the Criminal Records Bureau checks on all these personnel were seen by the inspector. The staff files provided evidence of Adult Protection training having taken place for staff employed at the home. This training is supported by the homes policies and procedures on Adult Protection that included the Joint Pan Devon Alerters Guide. Douglas House Cheshire Home DS0000028666.V298326.R01.S.doc Version 5.2 Page 18 Douglas House Cheshire Home DS0000028666.V298326.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 and 30. The quality in this outcome area is good. The environment is both practical and homely despite the high level of equipment that is in place to meet the needs of the service users. There are good arrangements in place to keep the home clean and well maintained. EVIDENCE: The home was purpose built by Leonard Cheshire in 1971 to care for Young Physically disabled. It has been up graded and further adapted since that time and was registered to provide nursing care July 1997. It has good access for wheel chair users and the disabled from the large car park at the front of the home and a slowly rising ramp up a small gradient to the front automatic door. It has a functional floor design having wide corridors, automatic doors in the corridor, large bathrooms with suitable hoisting and bathing equipment particularly since they have just been completely refurbished. One bathroom on the first floor that has a Parker bath installed also has hairdressing facilities and facilities to allow chiropody to take place in the room. Despite its functional design the environment has been decorated to make it feel comfortable and homely. The service users donated money for the purchase of pictures that they chose and are displayed in the main corridors. Douglas House Cheshire Home DS0000028666.V298326.R01.S.doc Version 5.2 Page 20 There are up to date disabled toilet facilities off the main corridors and three bedrooms have their own en-suite facilities. The service users all have single bedrooms that were seen to be personalised by the occupants who also have a nurse call system, ceiling track hoists and wash hand basins in a vanity unit some of which are height adjustable and a large mirror that tilts to provide a suitable reflection for the user. There are shaver points and light switches in the units and the water temperature is controlled by thermostatic mixer valves. Most beds are electrically operated for height and position and the power points are in at a suitable height for wheel chair users. The bedrooms are generally large and doors can be locked with the service users having a choice of being a key holder. Each room has a large double glazed window area covering the full length of one wall that offer a view from either a seated position in a chair or from the bed. Ways of improving the alarm that is part of the nurse call system are been looked into to reduce the need for a tone that presently is heard 24 hours a day when the system is activated. All the doors are linked into the fire alarm system so that the self closures are activated in the case of a fire be detected. There is a computer/quiet room for the service users and they have their own email addresses that are used to keep in contact with friends world wide. One service user did have his own Internet linked computer in his room and has his own contract with the supplier and telephone line. Private telephone lines can be installed in the bedrooms at the service users own expense and there is a private phone booth with wheelchair access in the dining/lounge area. The lounge diner has a tuck shop that was once a bar. There is a 13 man lift that stops on each floor of the home. The home also employs a full time maintenance man who has his own workshop and is conversant with the home and the equipment. He provided the inspector with information about the maintenance of the home and its grounds and keeps good records of the planned and unplanned work that he does. The records of work carried out by outside contractors were looked at during the inspection and all was found to be up to date. The two disinfecting sluices, one on each floor, are new and still within there warranty period. The homes fire risk assessment was seen and this had been recently up dated to keep it current. The outdoor space includes a level garden area to the side of the home with disabled access and a balcony leading off the activities and quiet room that provides beautiful views over undeveloped land to the sea beyond. There is a complete laundry service at the home that is housed in a suitably designed room that has 2 washing machines, one of which has a sluicing cycle, and 2 commercial dryers. Appropriate infection control procedures are in place through out the home and not just in the laundry room. Douglas House Cheshire Home DS0000028666.V298326.R01.S.doc Version 5.2 Page 21 Douglas House Cheshire Home DS0000028666.V298326.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. The quality in this outcome area is good. The home has good recruitment procedures. The standard of induction training is very good the service user specific training that follows is excellent. EVIDENCE: The staff group were seen to communicate with the service users in a manner that appeared to be acceptable to the individual service users and also over came the difficulties that some of the service users had as a result of their disability. Time was seen to be spent with a person who had recently been admitted and was not communicating well so as to develop a relationship and understanding of his communication skills. The staff group collectively hold a wide variety of skills and qualifications that are drawn on to provide care to the service users to meet their physical, psychological and social needs. Among the staff are people with skills in nursing, physiotherapy, care, and activities. The induction training covers five mandatory areas, manual handling, food hygiene, fire, infection control and Health & Safety. Evidence of this training was seen in the 3 staff files that were used as a sample group by the inspector. All grades of staff including volunteers, care and ancillary, undergo the same induction. The home then provide for further training that is appropriate to the role of individual workers and 33 of those presently employed in care have at least an National Vocational Qualification in care at level 2 or above. Other Douglas House Cheshire Home DS0000028666.V298326.R01.S.doc Version 5.2 Page 23 staff are presently either doing their National Vocational Qualification training or have National Vocational Qualification training planned for a future date as part of their development. The additional training received by staff, for which evidence was provided in staff files is such things as attitudes towards service users, working with relatives, first aid, and vulnerable adults training. The inspector noted that there was a good mix of staff on duty during the inspection such as trained nurses, care staff, someone skilled in physiotherapy and also an activities organiser. The duty rosters provided evidence that the home always plan for adequate numbers of staff on duty with the appropriate skills. The home does have overseas volunteers work at the home from time to time who are university students on a gap year. Each volunteer is fully vetted by GAP, who organise the placement, including police checks and they also have to complete the same induction training that all other staff are given. Accommodation is provided for these volunteers in the flats at the rear of the home being part of the original Douglas House. There were no volunteers working at the home at the time of this inspection. The staff records seen by the inspector revealed that the home does follow their recruitment procedure and obtain a completed application form, references, proof of identity and a Criminal Records Bureau on all staff that they employ. They also insist on a Criminal Records Bureau being completed on any outside contractor who works at the home and evidence of this happening was available. The home employs a motivated staff team who appear to work well together whatever their role in the home. The staff who were spoken to by the inspector each felt satisfied in their employment and that their training had prepared them for the role they had at the home. Evidence of staff supervision and appraisal taking place on a regular basis were seen by the inspector during the vetting of records. They also felt supported by the management at the home. One staff member responded with a completed questionnaire. They felt that the training was excellent and they were kept up to date with any changes. They pointed out that in the home it is their care supervisor the nurse in charge of a shift that keep them up to date with information about service users and support them whilst on duty and not directly the home manager. The questionnaire is possibly not totally suitable for the management structure of homes like Douglas House. Of six service user replies there was a mixed response about staff “listening to service users” from excellent from one, usually from most and never from one. Douglas House Cheshire Home DS0000028666.V298326.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. The quality in this outcome area is good. The management of the home is good and supported externally by the organisation who is the registered person. There are satisfactory arrangements at the home for risk assessments that meet the Health & Safety of the clients and staff who work at the home. EVIDENCE: The home is managed by a Registered Nurse with several years experience who also has the appropriate management skills. She is fully conversant with the aims and objectives of the home and the wider organisation and manages the homes recourses in order to achieve them. She uses the organisations quality assurance system to establish the level of performance in any given area against their own standards. Evidence of a satisfactory quality assurance system was seen by the inspector and this includes the regulation 26 that is Douglas House Cheshire Home DS0000028666.V298326.R01.S.doc Version 5.2 Page 25 received by the Commission for Social Care Inspection monthly. The system does include the views of the service users. The inspector obtained the views of service users, relatives, General Practitioner and people from care management who collectively have reported that the home does achieve a good standard of care from each of their prospective. The organisation monitors and reviews policy and procedures as it is necessary to do so and there was evidence of this having happened in the appropriate file. The Registered Manager, as part of the induction of all staff ensures that staff are correctly prepared for the duties that are expected of them and this includes handling and fire training. In addition to this all the service users have their manual handling needs risk assessed by a suitably trained assessor and the appropriate equipment provided. The staff are trained to use all the lifting aids that are in use such as over head track hoists and stand aids. There was a fully fire risk assessment of the home that had been completed recently and evidence of staff fire training, alarm tests and fire equipment servicing. Douglas House Cheshire Home DS0000028666.V298326.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 4 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 4 33 3 34 3 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 4 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Douglas House Cheshire Home DS0000028666.V298326.R01.S.doc Version 5.2 Page 27 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. Standard Regulation Requirement Timescale for action 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 Douglas House Cheshire Home DS0000028666.V298326.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 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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