CARE HOMES FOR OLDER PEOPLE
Dove Court Kirkgate Street Wisbech Cambridgeshire PE13 3QU Lead Inspector
Lesley Richardson Unannounced Inspection 19th December 2005 10:50 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 Dove Court DS0000065318.V263133.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dove Court DS0000065318.V263133.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Dove Court Address Kirkgate Street Wisbech Cambridgeshire PE13 3QU 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) 01945 474746 01945 474846 Ashbourne (Eton) Limited Ms Julie Curtis Care Home 46 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (46), Old age, not falling within any other of places category (6) Dove Court DS0000065318.V263133.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 15th June 2005 Brief Description of the Service: Dove Court is a purpose built residential care home, situated in a residential area on the outskirts of Wisbech. It is now owned by Ashbourne Care Homes and provides care and support for up to 46 residents over the age of 65 with dementia. The home has 46 single rooms, all with en suite facilities. In addition to the en suite facilities there are 5 bathrooms and one shower, all with toilet facilities. Resident accommodation is on two floors, the upper floor being accessible by stairs or lift. There is a variety of communal areas available to service users. An enclosed garden is at the rear of the home and provides a safe environment for service users to enjoy the garden features. Dove Court DS0000065318.V263133.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 6½ hours and was carried out as an unannounced inspection on 19th December 2005. It was the second inspection of this home for the 2005-2006 year. Three and a half hours were spent examining records and documents and three hours were spent with service users and staff. A tour of the building was also undertaken during this time. The manager was present during the inspection. Four people who were living at the home and three of the staff on duty were spoken to during the inspection. None of the people who live at the home had the capacity to express their views. What the service does well: What has improved since the last inspection? What they could do better:
There are quite a number of issues the home has to address to make sure they meet the Care Homes Regulations 2001 and the National Minimum Standards
Dove Court DS0000065318.V263133.R01.S.doc Version 5.0 Page 6 for Older People. Two of these issues were also issues raised at the last inspection. There were incidents during the inspection where people living at the home were not able to do what they wanted and were at risk of injury from other people who live there or their environment. Some of these incidents may have been avoided or minimised if there were more staff on duty. Staff rotas show there is a high level of sick leave, with an average of the equivalent of nearly four full time staff a week. Staffing levels must improve if people are to be able to have some choice in their lives and are to be able to live safely. Care plans and care records must show how the home plans to meet changes in a person’s needs and they must also be reviewed regularly. Health needs that are identified by care staff and then treated should be recorded to show if there has been any change after the treatment. There are ongoing issues with medication administration, although concerns at the last inspection about training have improved. Recording of medication administration has to be more accurate to prevent medication mistakes. There have been two adult protection issues at the home in the last year. The home referred one incident to the Adult Protection Officer as a precautionary measure, and both issues were unsubstantiated, although good practice recommendations were made. Checks that are required before staff can work at the home are not always made, and this puts people who live at the home at risk. All the required checks must be carried out. People who live at the home must be given the opportunity to say how they feel about the home. The home does not seek the views of the people who live there and the views of relatives and visitors to the home is obtained if they complete a form but is not actively sought. A system must be developed to monitor opinions and use this information in improving the home. There is little evidence to show staff members have the opportunity to discuss concerns or their career paths. It also means there is little confidential opportunity for senior members of staff to discuss care practice with carers. There was a smell of urine in the main corridor on the ground floor and in the lounge area. The cause of this must be identified and resolved. The fire equipment must also be serviced as this has not been done since September 2004. 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. Dove Court DS0000065318.V263133.R01.S.doc Version 5.0 Page 7 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 Dove Court DS0000065318.V263133.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Pre-admission assessments of prospective service users ensure the home is able to meet service users needs. EVIDENCE: Pre-admission assessments are completed by the manager or deputy manager to ensure new service users needs are properly assessed and planned for. Assessments of need are also obtained from healthcare professionals and social service departments. This gathers as much information as possible about each person before they enter the home and ensures their needs can be met. However, one service user’s file did not have a copy of the pre-admission assessment on file and this could not be found. Both the manager and the deputy manager said a pre-admission assessment had been completed for the service user but that it may have become separated when the service user’s file was updated. In view of this, a recommendation only will be made advising that pre-admission assessments should be kept with care records.
Dove Court DS0000065318.V263133.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Systems are in place for referring service users to health care professionals, but poor recording is such that it cannot ensure personal and health care needs are met. EVIDENCE: Risk assessments and care plans are available for each service user to ensure personal and health care needs are identified and met in the most appropriate way. Although plans were written to show how care needs should be met, one service user’s mental health needs had changed but the plan had not been changed to reflect the change. Not all plans had been reviewed on a monthly basis. Daily care records did not show effects of medication prescribed to resolve particular health issues and were not detailed enough to identify triggers or particular behaviour. For example, records frequently state a person may have become agitated or aggressive, but rarely describe the behaviour. Referrals are made to healthcare professionals, although care records do not always document service users response to intervention given. The records of one service user given medication to treat a physical problem did not show
Dove Court DS0000065318.V263133.R01.S.doc Version 5.0 Page 10 whether the treatment was effective or not. As care staff had identified the problem it is not unreasonable for them to record if the problem had been resolved or the effect of the treatment. Medication is administered by senior staff members to service users who are unable to or do not wish to administer their own medication. Medication held in the home is stored correctly. Medication administration records are maintained with recording for medications given and not given, although some missed entries in recording were noted. One medication had been continued on the next line but had not been written in the prescription box for that line, effectively showing staff members had been giving a medication but not which one. As the medication was the only one recorded on that medication administration record (MAR) sheet the deputy manager was told this must be corrected immediately. The controlled drug register is completed but does not include the address of the pharmacy supplying to and receiving controlled drugs from the home. There were a number of errors in recording controlled drugs administered to service users, which had occurred in 2004. Although there had been improvement in the 2005 records, the name of the controlled drug being administered was not written on the top of one page and entries were made advising service users had refused the medication even though the medication had not been dispensed. Although staff members are polite to service users there is concern that care given to them is reactionary and does not always take service users wishes into account. The inspector observed a carer telling one service user to put his shoes on, although he said he wanted to talk to his wife. The carer persisted in telling the service user to put his shoes on, although these directions were ignored and the service user spoke briefly to a female service user. He then left the lounge with the carer. The carer did not acknowledge the service user’s wish to talk to another service user in any way or suggest alternative ways in which to get her task of putting his shoes on completed. Dove Court DS0000065318.V263133.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 Systems in place do not ensure service users are able to exercise choice in their lives. EVIDENCE: The manager said service users are able to get up and go to bed when they wish. However, the incident described on the previous page shows not all staff members give service users choice about what and when they do things. Given the staff numbers on duty on the day of inspection it is difficult to understand how staff members can enable choice if they are to give appropriate care. This is of most concern in the high dependency unit where there is a greater degree of challenging behaviour and physical dependency. Dove Court DS0000065318.V263133.R01.S.doc Version 5.0 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The home has systems in place for the protection of vulnerable adults, ensuring staff have appropriate guidance. EVIDENCE: The home has received one written complaint since the last inspection, details were kept of the complaint and how the home responded. However, as the manager’s response is sent to the provider’s head office this may not be the letter sent to the complainant. The response kept on file in the complaint log did not show how the complaint was investigated and only gave vague actions on how to prevent recurrence of the issue. The home has Adult Protection and Whistle Blowing policies and procedures that enable staff to appropriately manage concerning situations. There have been two situations requiring the involvement of the local Protection of Vulnerable Adults team in the last year. Both were found to be largely unsubstantiated although recommendations for good practice were made to the home regarding recording of care and ensuring service users had access to healthcare professionals. The manager said protection from abuse training is incorporated within in house resident welfare training, although this doesn’t include local guidelines. It is recommended therefore that the home either incorporates these into the training or has staff members attend local protection from abuse training. Dove Court DS0000065318.V263133.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The standard of the environment within this home is good, providing service users with an attractive and homely place to live. However, there is one area that must be addressed if service users are to live comfortably. EVIDENCE: The home is well decorated and maintained, and all areas that are easily accessible are safe for people who live there. The home has open communal spaces along each corridor where service users can sit and watch television. In the ground floor unit there was a smell of urine in the lounge room and along the main corridor. The smell in the lounge room dissipated somewhat as service users’ toileting needs were attended to before lunch, although there remained a slight odour. Dove Court DS0000065318.V263133.R01.S.doc Version 5.0 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 and 30 Staffing numbers are not sufficient to meet the needs of service users. Vetting and recruitment practices do not ensure that all appropriate checks are carried out, potentially leaving service users at risk. EVIDENCE: Staff numbers on the day of inspection were below those needed to ensure service users were able to be cared for properly. There were two staff members on the first floor in the low dependency unit at the beginning of the inspection and three staff members on the ground floor high dependency unit. Although the deputy manager was also on duty, she was not present for the first 1½ hours of the inspection. Staff members confirmed this was the total number of staff on duty for the morning shift. Service users in the high dependency area leave the unit and walk a short distance to a dining room. During this transfer process one staff member stayed in the dining room, while the other two staff members escorted service users to the dining room. However, this left service users and the staff member in the dining room vulnerable when one service user became tangled in a Christmas tree in the dining room while two other service users walked around. Just prior to this incident staff members remaining in the unit had to resolve a physical dispute between two female service users, while trying to escort several service users at the same time. All three of the care staff on duty were in the dining room during lunch, and although an activities coordinator and a member of the housekeeping staff were on the unit, three
Dove Court DS0000065318.V263133.R01.S.doc Version 5.0 Page 15 service users remained on the unit. This left these service users at risk, as the roles of the staff on the unit during the lunch period was not as carers. One staff member said she felt the situation would be the same regardless of how many staff there were as it was due to challenging behaviour. Staffing rotas show staff scheduled to work at Dove Court and another home adjacent to Dove Court as they are being run as one home, although they are still registered as two separate homes. There is no indication on the rotas of which staff members work in which areas. Therefore staffing levels for Dove Court cannot be determined. However, the staffing rotas do show that for the 11 weeks prior to the inspection there were only 2 weeks when sick leave for care staff was below 100 hours per week, with 2 weeks being over 200 hours and 5 weeks above 150 hours per week. On average there are 155 hours sick leave per week, the equivalent of just less than 4 full time staff each week. This must be addressed as it leaves service users at risk. The files of two recently employed staff members’ shows the home does not always undertake the necessary recruitment checks to ensure the protection of service users. There were two areas of concern that the home must improve to ensure new staff are safe to work with vulnerable adults, and one recommendation for good practice. • The employment history for one staff member did not give any dates. Gaps in employment for this person had not been explored by the home. • One staff member had one verbal reference only. No further checks had been made to verify the accuracy of the reference or obtain further references. Two satisfactory written references must be obtained before staff members are employed. • Enhanced Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (PoVA) checks are applied for but there was no record that PoVA checks had been returned prior to staff members starting work at the home. If the home keeps a record of CRB disclosure numbers only as part of their data protection policy, the return date of the PoVA check should also be kept to show this was returned prior to staff members being employed. A member of the senior care staff has responsibility for ensuring all staff members have mandatory health and safety training. A training matrix showed all staff members had been given required training but did not show when this had been given or when it may be due again. Good practice would be to show the dates when training took place to ensure regular updates are not missed. Certificates of attendance are kept in individual staff files. The manager said protection from abuse training is incorporated within in house resident welfare training, although this doesn’t include local guidelines. Dove Court DS0000065318.V263133.R01.S.doc Version 5.0 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35, 36, 37 and 38 The systems for service user consultation are limited with little evidence that service user views are sought and acted upon within the home. The arrangements for the supervision of staff are poor with little evidence that staff members are supported. EVIDENCE: The home leaves comment forms for relatives and visitors to the home to complete if they wish. These are sent to the provider’s head office and returned to the home in the form of complaint if there is negative feedback. The manager said the home receives no feedback regarding positive comments and there is no annual survey or other mechanism for finding out service users views. Records are kept for all money held on service users behalf, credits and debits, together with receipts are documented and the person performing the
Dove Court DS0000065318.V263133.R01.S.doc Version 5.0 Page 17 transaction signs to show who is responsible. Records were seen for four service users, which were in order. However, credits and debits were recorded in the wrong columns and there was only one staff signature for debits. It was recommended to the administrator that money coming in to the home for service users is written into the credit column and money going out is written into the debit column. A recommendation will also be made for good practice that two staff members sign each debit; although receipts are available this ensures further accountability and reduces the risk of errors. Supervision records showed staff members had not had regular one to one supervision, although the manager said clinical supervision, which was not recorded had been given. Staff members must be given the opportunity to discuss working practice, concerns and career development regularly. This ensures both the home and the staff member are able to air views and raise concerns in a confidential environment. Checks are completed to ensure the health and safety of service users and the results of these are recorded. The fire safety policy and procedure is comprehensive and contains information on fire drills, fire prevention, escape routes, equipment testing and what to do in the event of a fire. Records were seen for fire safety, hot water temperatures, chlorination and portable appliance testing. These were all recorded as acceptable. However, fire equipment had not been serviced since September 2004. The manager felt this may have been a result of changing provider. Dove Court DS0000065318.V263133.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 1 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X 2 1 3 2 Dove Court DS0000065318.V263133.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1), (2)(b) Requirement The registered person must prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. The plan must be kept under review. Arrangements must be made for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. (Previous timescale of 31st July 2005 not met.) The registered person must ascertain and taken into account service users wishes and feelings. The registered person must keep the care home free from offensive odours. The registered person must ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. (Previous timescale of 31st July 2005 not met.)
DS0000065318.V263133.R01.S.doc Timescale for action 31/01/06 2 OP9 13(2) 31/01/06 3 OP14 12(3) 20/01/06 4 5 OP26 OP27 16(2)(k) 18(1)(a) 31/01/06 20/01/06 Dove Court Version 5.0 Page 20 6 OP29 19(1)(b) 7 OP33 24(1)(a), (b), (3) 8 OP36 18(2) 9 OP38 23(4)(c) (iv) The registered person must not employ a person to work at the care home unless he has obtained in respect of that person the information and documents specified in Schedule 2. The registered person must establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the care home. The system must provide for consultation with service users and their representatives. The registered person must ensure that persons working at the care home are appropriately supervised. The registered person must make adequate arrangements for the maintenance of all fire equipment. 20/01/06 28/02/06 15/02/06 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 5 6 Refer to Standard OP3 OP8 OP10 OP18 OP27 OP30 OP35 Good Practice Recommendations Pre-admission assessments should be kept with care records. Care records should show if treatment from a health care professional has had any effect. Service users should be treated with respect at all times. Protection from abuse training should also include local PoVA guidelines. Dates of PoVA returns should be kept to show this is before the staff member starts working at the home. Training matrix should show dates of training undertaken. Two staff signatures should accompany debits to financial accounts kept on service users behalf.
DS0000065318.V263133.R01.S.doc Version 5.0 Page 21 Dove Court Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB1 5XE 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. Extracts may not be used or reproduced without the express permission of CSCI Dove Court DS0000065318.V263133.R01.S.doc Version 5.0 Page 22 - 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!
