CARE HOMES FOR OLDER PEOPLE
Dove Court Kirkgate Street Wisbech Cambridgeshire PE13 3QU Lead Inspector
Lesley Richardson Unannounced Inspection 31st July 2008 10:55 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.V369414.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. Dove Court DS0000065318.V369414.R01.S.doc Version 5.2 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 www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Manager post vacant Care Home 76 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (74), Old age, not falling within any other of places category (2) Dove Court DS0000065318.V369414.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Two named service users over 65 years of age (OP) for the duration of their residency only One named service user under the age of 65 years with dementia (DE) already resident in the home Maximum of 74 service users over the age of 65 years with dementia (DE(E)) for the duration of Condition 1 13th May 2008 Date of last inspection 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. Fees for the home range between £415 and £525.25 per week. CSCI inspection reports are available in the office for people to read if they wish. Dove Court DS0000065318.V369414.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes.
This was a key inspection of this service and it took place over 7 hours as an unannounced visit to the premises. It was spent talking to the manager and staff working in the home, talking to people who live there and observing the interaction between them and the staff, and examining records and documents. We completed a Short Observational Framework for Inspection (SOFI) during this inspection, which allowed us to closely watch 5 people for a period of time (1½ hours). Both requirements from the last inspection have been met. There have been three further requirements and two recommendations made as a result of this inspection. Information obtained from the Annual Quality Assurance Assessment was also used in this report. We sent surveys to staff at the home and surveys for relatives and visitors to the home for people to fill in if they wished. We didn’t get any surveys back. What the service does well:
The home is purpose built and provides accommodation for up to 76 people in three separate units. The environment is pleasant and comfortable, and gives people plenty of different areas in which to sit. There is a well-maintained garden that has been designed to simulate a park that people living at the home can go into when they want. The way care plans are written and the information in them is good. We saw that these contain a lot of information about people and how they like to be cared for. When we carried out the SOFI we saw that staff members had positive interactions with people. This meant that there was a calm atmosphere and the limited number of times staff spoke with people had a knock on effect and encouraged them to speak to other people in the room and interact socially a lot more. There are few complaints made to the home. These are looked at and information to show why the home has taken action, if it needed to, is also kept. People who make complaints have a response in the correct timeframe. Staff members have training about safeguarding adults, which means they have a better understanding of abuse and how it can be identified, and what to do if they suspect it has happened. Staff members and management report incidents to the local safeguarding team.
Dove Court DS0000065318.V369414.R01.S.doc Version 5.2 Page 6 Staff members have training in required health and safety areas, and also in areas that improve their understanding of dementia and make them safe to carry out particular tasks, such as safe medication handling. We spoke to staff members who all said they receive a lot of training. The home has an open visiting policy so that people at the home can have visitors at any time. Records are kept to show health and safety checks, equipment maintenance and servicing are carried out at the required intervals. Records are also kept to show money kept by the home on behalf of people living there. This means that there is information to show when money is spent and what it is spent on, so that people can feel safe in having the home take care of it. What has improved since the last inspection? What they could do better:
There hasn’t been a registered manager at the home for over 2 years. The previous manager left the position and another manager was brought in but left after 2 weeks. There is now an acting manager, who is from another home in the same group. Staff members said they want a stable and reliable manager. There is a big division between management and staff in the home that doesn’t give an open and inclusive atmosphere. There are activities available, mostly on a one to one basis with the activities co-ordinators. Although there are records to show what each person takes part in, these are the activities co-ordinators records and don’t form part of the activities care plans. There needs to be more focus to the activities that are
Dove Court DS0000065318.V369414.R01.S.doc Version 5.2 Page 7 available and a wider range, but at present staff do not have access to support organisations. Although we found staff members have received adequate training and there are improvements in medication, we found that staff don’t always follow the guidance they have been given. The records for one person’s medication weren’t kept accurately and didn’t always give a clear indication of when medication had been given. Equipment for moving people wasn’t used on one occasion and the person was physically moved. However, staff told us there isn’t always enough equipment available. A hoist in one part of the home has been broken for some time. Another hoist has been bought but staff said they are still waiting for training to use it. There is only one weigh chair in the entire home. This presented a problem in January 2008 when there was an outbreak of an infectious illness. People in that house were not weighed because staff did not want to spread the illness through the rest of the home. We spoke with the manager about getting another weigh chair, but this has still not happened. At the random inspections in January and May 2008 we looked at staffing numbers in the home. These were acceptable, although in May there were a few staff shortages on night duty. This has not improved and there are more frequent shortages now. Agency staff are employed and new staff are being recruited, but staffing levels are sometimes too low for people to be cared for safely. There needs to be more information in the pre-admission assessment. When needs are identified there should to be information about what is being done about it before the person goes to live at the home. The information that care staff write in the daily notes and reviews of care plans is not in enough detail. For example, one person plan says she prefers showers, but there is nothing about her having showers, baths or washes or how much help she needs with this. This type of detail must be written or no-one knows if the care plan is accurate or if it needs looking at again. 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. Dove Court DS0000065318.V369414.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 Dove Court DS0000065318.V369414.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 and 6 Quality in this outcome area is adequate. Not enough information is obtained about people before they live at the home, which means staff may not be able to care for them fully. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An assessment is completed before people move into the home. Further assessments are obtained from health and social care teams and provide additional information so the home is able to say whether it has the staff with the skills and experience to properly care for someone moving in. We looked at the care records for two people who had moved into the home since the last inspection. The pre-admission information for both people showed there was little detail obtained, which would make it difficult for care staff to know how needs were being met and how people like to be cared for. For example, the health assessment information for one person shows there has been a problem with continence. There is no information in the home’s own assessment about how this is managed or equipment and aids the person is using.
Dove Court DS0000065318.V369414.R01.S.doc Version 5.2 Page 10 The home does not provide accommodation specifically for intermediate care or for rehabilitation purposes. Dove Court DS0000065318.V369414.R01.S.doc Version 5.2 Page 11 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 and 10 Quality in this outcome area is good. Care records are completed accurately and in enough detail and staff care for people in a positive way, which ensures the health and welfare of people living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We spoke with the relatives of one person at the home and they said that they are happy with the care and support provided. During this inspection we spent time in one of the units carrying out a SOFI, which let us observe people living at the home and how the staff interact with them. Every time staff members spoke or had contact with people was positive, but it made up only 25 of the time we were there. Three quarters of experiences people had during this time were positive and none were negative. We saw that the way staff interacted with people, although only a small amount, lead to them talking with other people around them. There was very little evidence that people are withdrawn, and although one person was asleep for quite a long period at the start, there was no negative state of being at all.
Dove Court DS0000065318.V369414.R01.S.doc Version 5.2 Page 12 Care plans for five people were looked at as part of this inspection. They show that each person has a plan that gives staff members’ information about what they need to do to meet most of the identified needs. Risk assessments, for things like falls and moving and handling, are completed and reviewed regularly. We found the care plans are well written and give staff members’ clear advice about how to meet people’s needs, and that staff members have a good understanding of the care people want. All the care plans we looked at were written in a style that tells staff how each person likes to be cared for and what their preferences are. For example, we saw one person with a leaf in her mouth who later walked past carrying a chair. After persuading the person to take to leaf out of her mouth and return the chair, staff members explained how they reduce this happening and why they had not taken the chair away from the person immediately. Her care plan tells staff clearly that it is less distressing for the person to do things like return furniture, than for them to take it from her, and one way to prevent this is for her to carry a soft toy that she likes. The person was later seen carrying a large soft toy from her room. We looked at another person’s care plan because of concerns raised by her family about her preference for a shower, rather than a bath. The care plan had been updated to include this information after the person’s relative informed staff of her preference. However, there was no information in the daily records to show whether a shower had been offered, how often this person had been given a shower or whether she frequently refused. We saw this is another person’s plan for activities. That although the plan was well written, there was no information in the daily records about any activities the person had taken part in or declined to take part in. It is important that this type of information is recorded in the daily records, so that staff know whether the care plan is appropriate when they review it. There is information in care records to show health care professionals, such as specialist nurses, opticians and chiropodists, are contacted for advice and treatment. We spoke to a specialist nurse visiting the home during the inspection who said staff listen to what she tells them and she has found her recommendations are usually carried out. We also spoke to a social care professional who works closely with the Community Mental Health Team who report that their working relationship with the home is good and staff follow their guidance. A short inspection was carried out in January 2008 and looked at the information written into care records about recommendations and advice given by specialist nurses and health care professionals to the home. We found that written information had improved at that inspection. During the short inspection in January 2008 we also looked at medication and found that one of the two requirements made at the key inspection in August 2007 had been met. At this inspection we looked at all the medication administration records (MAR) and found most were completed accurately.
Dove Court DS0000065318.V369414.R01.S.doc Version 5.2 Page 13 However, one medication on one person’s MAR shows that medication had been given, although there was still medication in the blister pack, medication had been refused, but was missing from the blister pack. When we talked to a senior carer she told us that medication is taken from other parts of the blister pack. This is not acceptable practice as it does not then give an accurate record of medication that may or may not have been taken. As it was the only MAR and blister pack not to tally a requirement will not be made, but the home is expected to manage this, including refresher training for those staff members involved. Care records show there is clear guidance for staff when they have to give PRN (as required) medication. Medication with variable doses has the dose staff gave written on the MAR. Records for medication storage room and fridge temperatures are kept and are within acceptable limits. We talked to staff about taking the room temperature at the hottest time of day as the room was warm during our visit and almost at the maximum recommended by drug manufacturers. We also talked to them about resetting the fridge thermometer each day and why this is important. Dove Court DS0000065318.V369414.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. Staff members have a good understanding of peoples needs, and care records need to also show how people are supported to live as they would like. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has two activities co-ordinators who arrange activities and events in the home. We spoke to the activities co-ordinators and discussed the variety of projects that have been created in the home and gardens. One co-ordinator said often activities are given on a one to one basis, so that they are individual, but also because of the time it takes to keep people’s attention. We suggested that a membership to NAPA might be beneficial to extend the range of activities for residents with dementia care needs. Records are kept by the co-ordinators to show the time they spend with people and what activities people take part in. Although there are activities care plans, care staff don’t record anything about this in the daily records, which may mean that they don’t see it as part of their role. Staff involvement with people during the SOFI (see previous section) was positive and one staff member sat with one person for a short period and talked about the weather. However, the only
Dove Court DS0000065318.V369414.R01.S.doc Version 5.2 Page 15 other activity available to most people was the television that was turned on, but difficult to watch from some chairs that were turned away. It was also suggested that contact with dementia care professionals would also enhance the understanding of how certain activities and aids would benefit residents in the home. Both co-ordinators commented that previously used Montessori activities had been very helpful with some residents but this had been discontinued with little explanation from the management. The previous manager said this had been explained to the activities staff and that a psychologist working with the organisation had advised there was little evidence to support the Montessori theory and it was likely to be the amount of one to one time spent with people that made the difference. The home has an open visiting policy and people can have visitors at any time of the day. We spoke with visitors during the inspection who said that the staff are helpful and friendly and that they are always made to feel welcome when they visit. People are able to make everyday choices about when to get up and go to bed, how to spend their days, whether that is in their own room, in the main lounge/dining area. During the SOFI we saw and listened to how staff members interact with people and found they ask what people would like and how they would like it rather than telling people or giving limited options. Staff members were asking people if they would like a drink and offering different cold drinks, as it was a warm day. One person asked for a cup of tea and this was immediately made for that person. As described in the previous section care plans contain information that is personal to each person, how they want to be cared for and their preferences. Staff members we spoke to know the people they care for and were able to tell us their preferences. The main meal is served at lunchtime and there is a choice of two hot meals every day. We saw lunch being served in the dining room in one unit. Food was served appropriately in a relaxed and unhurried way, staff members asked people which meal they would like and showed them the plated meals if they needed this to make a choice. Drinks were offered throughout the meal. One staff member had sat with a table before lunch was served, talking to them and others while waiting for lunch. This made going to the dining room feel like a social event and got people talking, including one person who had spent quite some time before lunch sleeping. Dove Court DS0000065318.V369414.R01.S.doc Version 5.2 Page 16 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. Staff know what to do if there is a safeguarding issue, which means incidents of possible abuse is dealt with properly. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure and keeps a complaint log to show how they have looked at and the outcome of complaints that have been made. CSCI has been told about two complaints and concerns that have been made to the home since the last key inspection, and we have been given information from six other people, who have not contacted the home. Five of these concerns were about staffing levels in the home. Six of the people making complaints have either been anonymous or asked to remain anonymous. Information provided before the inspection shows the home has received 4 complaints in the last 12 months. 3 of these were looked at and responded to within 28 days. These 3 complaints were all found to be true. Staff files and training records show that staff members have received training in safeguarding (adult protection) people. We spoke to staff members who said they had received this training. There have been 7 safeguarding referrals and 7 investigations in the last year. We spoke with the local authority safeguarding lead practitioner before this inspection who is happy with how the home are managing these issues. She thinks they are referring issues properly and take any action that is recommended.
Dove Court DS0000065318.V369414.R01.S.doc Version 5.2 Page 17 We were told about one issue involving an agency staff member that had not been referred to the safeguarding team. The previous manager said staff had told her they had informed a manager and written statements but none of the managers had any recollection of this, and therefore the incident was not reported. An investigation has begun into where the system fell down. Dove Court DS0000065318.V369414.R01.S.doc Version 5.2 Page 18 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 and 26 Quality in this outcome area is good. The home offers people a pleasant environment in which to live, but there is not always enough equipment available to make sure adequate care can be given. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are many positive aspects in the design and environment of the home’s dementia care units. There are a number of orientation aids in place to help residents find their way. People have pictures of themselves and their names in large and colourful print on their bedroom doors, which helps them identify which bedroom is theirs. There are pictorial representations of toilets on toilet doors. ‘Fiddle Boards’ are hung along long corridors to offer stimulation and interest to people as they walk along corridors. There is a well-planned garden that gives people the opportunity for reminiscence and a safe place to walk outside.
Dove Court DS0000065318.V369414.R01.S.doc Version 5.2 Page 19 We were told during a complaint that lifting equipment in one part of the home was not always available, and one hoist had been out of action for some time. We asked staff members about this and they said that one of the hoists had been broken for some time but it had recently been changed and they were waiting for training before they could use it safely. We looked at how many weigh chairs there are in the home, as people in one unit had not been weighed during an outbreak of an infectious illness. During the short inspection in January 2008 we talked to the manager about obtaining more chairs, as having only one is not enough when issues like this happen. At that time the manager said further weigh chairs had been requested. Staff told us at this inspection there is still only one weigh chair for the whole home. Another complaint mentions “a very strong stench of urine” when the person walks in the door. We walked around the building and noticed a smell of urine at the entrance to one house, although that had lessened later in the day. There were no unpleasant odours in the rest of the home. Dove Court DS0000065318.V369414.R01.S.doc Version 5.2 Page 20 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. Staff are recruited and trained so they are safe to work with people, but not all staff members follow safe practice procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at recruitment records for five staff members employed since the last inspection and they all contained the appropriate recruitment documents including references, application forms, and POVA/CRB checks. Gaps in employment histories are checked by the home and on one person’s file the applicant had also recorded reasons for a gap in their employment. The administrator makes sure that files are kept accurately. We also looked at recruitment checks during the short inspection in January ’08 and found these were completed before people start working for the home at that inspection. The previous manager confirmed new staff members are given induction training, which includes mandatory health and safety training. We spoke to four staff members who told us they received lots of training including PoVA, NVQ, moving and handling, food hygiene, infection control, fire safety, dementia and medication. Records in the training and staff files in the home confirmed this. Information provided before the inspection shows 40 of staff members have a NVQ at level 2 or above. However, the home told us about an incident where two staff members were seen transferring a person by
Dove Court DS0000065318.V369414.R01.S.doc Version 5.2 Page 21 manually lifting them. The home took disciplinary action for this. As described in the section on Health and Personal Care one staff member described how she and other staff administer medication from parts of a medication blister pack not relevant to the day or time in question, without recording what or why they have done this. The staff member had received training in the safe administration of medication, although this is not safe practice. All staff commented on how staff shortages had affected them and had been stressful over the last week. Staff stated that there had often only been 2 staff on each shift, which had caused a number of problems i.e. when giving medication leaving one staff member on the floor for periods of up to 40 minutes. The previous manager said the home is in the process of recruiting new staff members. Staffing levels were looked at during the short inspections in January and May 2008. In January staff member said levels were satisfactory and there was a lower use of agency staff. In the May inspection staffing levels were still satisfactory but levels were starting to drop at night and on one unit there was occasionally only one person working at night. The manager said at that time that staffing levels are based on how many people live at the home, not on the level of their needs. We saw during the SOFI that staff members were with people for less than 20 minutes in more than the hour and a half of the observation. The SOFI was carried out, late morning and lunchtime, during a period of time that is usually quieter than first thing in the morning. The previous manager said that the positive effect gained by activities that are no longer permitted was not as a result of the activity, but of time spent with individual people. However, current staffing levels do not give staff members the opportunity to spend time with people. Dove Court DS0000065318.V369414.R01.S.doc Version 5.2 Page 22 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, 32, 33, 35, 36 and 38 Quality in this outcome area is adequate. There is not a stable management and staff do not get adequate support, which affects the service given to people living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There has been another change of manager since the last key inspection. The manager at the last inspection is no longer in the position, although she still works for the organisation. Another manager was employed, but was only in the post for two weeks. A senior staff member from another home in the same group of homes started in the managerial position as a temporary measure on the day of this inspection. Dove Court DS0000065318.V369414.R01.S.doc Version 5.2 Page 23 There have been a number of managers over the last 2 years, which has caused a lack of stability, and the staff all commented that a good and reliable manager is needed. We spoke to staff members who all said that they were a good team but there seemed to be a divide between management and care staff and a lack of understanding about the pressures this causes. During the inspection we saw the new acting manager walking around the home. He had been in the building since mid morning but none of the care staff, until mid afternoon, knew who he was or had been introduced to him. The previous manager said staff had been informed he would be starting in the role at a meeting the previous week, but he had not been at the meeting. Activities staff told us they had not been given an explanation about why Montessori activities can no longer be used, although the previous manager said this had been explained to them. The Commission for Social Care Inspection has been informed of 8 complaints and concerns since January 2008. Six of the people making complaints have either been anonymous or asked to be anonymous. None of the examples above show there is an open and inclusive atmosphere in the home. An annual quality assurance survey has been carried out by the home since the last inspection. The previous manager said issues that had been identified include problems with lost laundry and staff being moved to work in other areas of the home. The issue about staff movement was treated as a complaint and letters have been written to explain the reason for this. We looked at staff supervision records, which show these sessions have been infrequent. In most cases only one session had been recorded this year. One staff member said that she had only had 3 supervision sessions in the last 3 years. Other staff members were not aware how often they should receive supervision sessions. Fire testing and water temperature records are up to date. Regular checks of the call system, window restrictors, extractor fans, fire doors and wheelchairs are also carried out. Food temperatures and fridge/freezer temperatures are recorded on a daily basis. There are service contracts in place for the maintenance of services and equipment in the home and information provided before the inspection shows these have been completed within the required time frames. A sample of residents’ fee payments and cash sheets were viewed. Good written records for all transactions undertaken on behalf of residents were maintained, as were receipts. Dove Court DS0000065318.V369414.R01.S.doc Version 5.2 Page 24 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 3 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 3 3 X X 1 X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 1 3 X 3 1 X 3 Dove Court DS0000065318.V369414.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP22 Regulation 23(2)(n) Requirement Timescale for action 30/09/08 2 OP32 12(5)(a) 3 OP36 18(2)(a) There must be enough equipment in all areas of the home so that people do not have to go without the use of equipment. There must be the opportunity 30/09/08 for staff and other people to question actions in the home and receive clear reasons for them. So that the home runs in an open and inclusive way. All staff must receive regular and 30/09/08 frequent supervision, so they have adequate support to do perform their work. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP3 Good Practice Recommendations Pre-admission assessments should have details of how needs are met, so that staff are able to easily and correctly care for people when they first live at the home.
DS0000065318.V369414.R01.S.doc Version 5.2 Page 26 Dove Court 2 OP7 Information in daily notes should be in enough detail so that care plans can be reviewed easily from them. Dove Court DS0000065318.V369414.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Dove Court DS0000065318.V369414.R01.S.doc Version 5.2 Page 28 - 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!
