CARE HOMES FOR OLDER PEOPLE
Dove Court Nursing Home Shuttleworth Street Burnley Lancashire BB10 1EN Lead Inspector
Mrs Marie Matthews Key Unannounced Inspection 10th July 2007 10:00 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 Nursing Home DS0000022501.V337297.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 Nursing Home DS0000022501.V337297.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Dove Court Nursing Home Address Shuttleworth Street Burnley Lancashire BB10 1EN 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) 01282 830088 01282 839898 www.bupa.com BUPA Care Homes (CFHCare) Limited Mr Alasdair Swan Care Home 120 Category(ies) of Dementia (10), Dementia - over 65 years of age registration, with number (60), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (20), Old age, not falling within any other category (90), Physical disability (15) Dove Court Nursing Home DS0000022501.V337297.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Staffing for service users requiring nursing care will be accordance with Notice issued 25 May 1999 The home is registered for a maximum of 120 service users to include:A maximum of 90 service users who require nursing care. A maximum of 90 service users who fall into the category of OP. A maximum of 15 service users who fall into the category of PD. A maximum of 20 service users who fall into the category of MD(E) A maximum of 60 service users who fall into the category of DE(E). A maximum of 10 service users who fall into the category of DE. Date of last inspection Brief Description of the Service: Dove Court Nursing and Residential Home is a 120 bedded home situated on the outskirts of Burnley. The home comprises of four units of thirty beds. Robin is an elderly frail nursing unit; Kingfisher and Swallow are dementia units and Nightingale a residential unit. The communal areas on each unit comprise a lounge, dining area, conservatory and smoke room. Swallow also has a snoozalum therapy room. Garden and patio areas surround each unit. There is also a sensory garden and a secure themed garden that provide pleasant, stimulating areas for residents and their visitors. A central administrative block contains the main office, kitchen and laundry areas and a hairdressing salon. Ample parking areas are provided for visitors and staff. Dove Court is located on a main bus route and is close to local amenities, including a Post Office, a Church, Public House, bowling green and local shops. A health centre and public library are also within the locality. Dove Court provides care for up to 120 people, male or female, generally over the age of 65 years. Care can be provided for young adults, who are under pensionable age, who have physical disabilities. The registered provider is Care First Health Care Ltd. A company owned by BUPA.
Dove Court Nursing Home DS0000022501.V337297.R01.S.doc Version 5.2 Page 5 Information about the services offered at Dove Court is provided in the form of a service user guide and is available, with a summary of the most recent inspection report, to existing and prospective residents and their relatives. On the day of the inspection the weekly fees ranged from £319.50 to £578.00. Items not included in the fee include newspapers, toiletries, hairdressing and private chiropody. Dove Court Nursing Home DS0000022501.V337297.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. The key unannounced inspection, including a visit to the home, took place on 10th & 11th June 2007. The inspection process included looking at records, a tour of the home, discussions with the clinical services manager, unit managers, six care staff, six residents and three visitors to the home. Information was also included from survey forms filled in by three visitors and six residents. The inspection also looked at things that should have been done since the last visit and a number of areas that affect people’s lives. There were one hundred and eleven residents living in the home on the day of the inspection. What the service does well:
People were given clear information about services offered by Dove Court to be able to decide whether the place was suitable for them and whether their needs would be met. Residents were admitted only when it was clear their needs could be met by the staff and facilities at Dove Court. The principles of privacy, dignity and respect were put into practice and residents said they were treated ‘very well’ and that staff were ‘polite and friendly’. Residents said they were given choices in many aspects of their day and one resident said she had been asked about her preferences, likes and dislikes. The staff group was balanced in terms of ages, gender and cultures; this allowed residents to have some choice regarding whom they wished to be cared by. Staff were very good at providing activities to suit each resident based on detailed information, provided by residents or their relatives, about hobbies, interests, previous occupations and likes and dislikes. Records showed that a range of activities and entertainments were provided to ensure people’s diverse needs were met. The menu offered a wide choice of meals and records showed that residents were regularly offered meals that were not on the menu. The main menu was supported by a ‘call order’ menu offering other alternatives and a new ‘nite
Dove Court Nursing Home DS0000022501.V337297.R01.S.doc Version 5.2 Page 7 bite’ menu has been introduced offering snack foods throughout the night. Most residents said they enjoyed the meals and made positive comments including ‘I like the food, there is always something that you like’, ‘very good food and always a choice of at least two things’, ‘the kitchen does lovely puddings and custard’, ‘we get plenty to eat, no one can complain about the food’ and ‘we always get plenty to eat and its always good food’. Residents were protected from abuse by the adult protection policies, procedures and staff awareness. There was a good complaints system and people were happy that their concerns would be listened to and responded to. Complaints were monitored to help them to improve the service. Redecoration and refurbishment was an ongoing process to ensure that the home was safe, comfortable and clean. All areas were bright and comfortable and some of the units had themed areas, one had a therapy room providing a quiet place for residents to relax in. Bedrooms were not en-suite but were spacious and bright; aids and specialised equipment was provided to ensure comfort and safety and to assist with maintaining independence. Residents said they were happy with their bedrooms and most had brought in personal items to make them feel more comfortable and homely. One resident said ‘my room is clean & bright and I can watch people coming and going’. The outside of the home was well maintained and some areas were being improved; residents said they enjoyed the gardens. Secure gardens were provided for residents on the dementia units to ensure they were safe and protected yet able to enjoy the gardens. Comments from residents included ‘I’m well looked after and the staff are very nice’, ‘I only need to press the buzzer and staff come and if you don’t press the buzzer for a while they always check to see if you are alright’. Visitors comments included ‘staff are superb’ and ‘Staff seem to be very busy but are always friendly’. One visitor said ‘I would recommend the home to anyone’. Records showed that staff had received appropriate training to help them to understand the needs of residents in their care. Management regularly consulted with others to determine whether they were meeting people’s needs and expectations. Clear accounting and financial records were maintained; the company regularly monitored these records to ensure residents best interests were protected. Records showed that Dove Court was a safe place for the people who lived, worked and visited the home. Dove Court Nursing Home DS0000022501.V337297.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? What they could do better:
The provision of ‘dementia care’ training could be improved to ensure more staff had up to date skills and knowledge in this area. It was recommended that all staff received adult protection training to ensure their skills and knowledge were up to date and to help them to protect residents from harm. The standard of the environment in some areas needed to be improved to ensure all residents were provided with a well maintained, accessible, safe, clean and comfortable place to live. Survey information indicated that residents and their visitors thought the units were generally clean, however during a tour it was noted, particularly on two units, that some areas needed extra attention to improve the standard of cleanliness. Most people said the staffing numbers were insufficient. Comments included ‘could do with more staff’, ‘not enough staff although staff work hard to make sure everyone is looked after’, ‘there are not enough staff to look after the residents as they need a lot of care and attention’, ‘could improve staff shortages’ and ‘staff are always busy and work very hard’. It was recommended that staffing levels were regularly reviewed on each unit to ensure residents’ needs were met at all times. A safe recruitment procedure had not always been followed and this could put residents at risk of being cared for by unsuitable people. Dove Court Nursing Home DS0000022501.V337297.R01.S.doc Version 5.2 Page 9 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 Nursing Home DS0000022501.V337297.R01.S.doc Version 5.2 Page 10 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 Nursing Home DS0000022501.V337297.R01.S.doc Version 5.2 Page 11 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): 1, 2, 3 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were given clear information about services offered at the home to be able to decide whether it was a suitable place for them and whether their needs would be met. Residents were admitted only when it was clear their needs could be met by the staff and facilities at Dove Court. EVIDENCE: The welcome packs in each bedroom included up to date information about services offered at Dove Court and were located at wheelchair height and therefore easily accessible for people with disabilities. Residents and relatives said they had been given enough information about the services available that would help them to decide whether Dove Court was the right place for them to live. One visitor said he had received enough information and had been able to talk to the staff about the care mum needed. He said ‘I would recommend the home to anyone’.
Dove Court Nursing Home DS0000022501.V337297.R01.S.doc Version 5.2 Page 12 Terms and conditions of residency (contracts) had been given out to everyone so that they were aware of their rights. Detailed information regarding the level of care residents needed had been obtained prior to admission. Senior staff had visited people who were thinking of using the service so that they could be sure that the staff and facilities at Dove Court could meet their needs. Assessments from health and social services were also available on residents’ files. Records showed that staff had received appropriate training to help them to meet the needs of residents in their care although the provision of ‘dementia care’ training could be improved to ensure more staff had up to date skills and knowledge in this area. The staff group was balanced in terms of ages, gender and cultures; this allowed residents to have some choice regarding whom they wished to be cared by. Dove Court Nursing Home DS0000022501.V337297.R01.S.doc Version 5.2 Page 13 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that residents receive was based on their individual needs and the principles of privacy, dignity and respect were put into practice. Policies and procedures provided safe guidance for staff in all aspects of management of medicines. EVIDENCE: A new care planning system had been introduced and two care plans on each unit (eight in total) were looked at in detail. The care plans were organised and provided staff with detailed information about the support they needed to provide to meet residents’ health and personal care needs. The care plans contained some good examples of individualised care such as choices and preferences regarding social activities, gender of staff, meals and type of cutlery needed and routines. Dove Court Nursing Home DS0000022501.V337297.R01.S.doc Version 5.2 Page 14 Care plans had been reviewed and updated at least monthly to ensure residents were receiving the right care and attention. There was little evidence to show that residents were involved in the development and review of their care plans although records showed that their relatives had been consulted about care. Six relatives said they were kept up to date and one said ‘staff always let me know what is going on with mum’s care’. Care records now included a ‘relatives expectations’ care plan to ensure relatives were given regular opportunities to be involved in decisions about care. There was evidence that residents had access to healthcare and specialist services and were provided with a range of specialised aids and adaptations to maintain their comfort and safety and to help them to maintain their independence wherever possible. One visitor said staff were ‘good at looking after health needs’. Survey information indicated that residents received the care and medical support they needed; one resident said ‘I only need to press the buzzer and staff come and if you don’t press the buzzer for a while they always check to see if you are alright’. Care staff had received appropriate training to help them to meet resident’s needs. Assessments of any risk to residents had been completed and care plans detailed action to be taken by staff to reduce or eliminate those risks to ensure residents were safe. One relative said ‘ I have no concerns about leaving my wife, I know she will be looked after’. There was evidence that the content of the care plans was regularly monitored to ensure staff were adhering to policies and procedures and meeting residents needs and expectations. The way medicines were managed had improved on all units. There were policies and procedures in place to support staff with safe practice and a number of staff had received medication training to improve their skills and knowledge. Medication storage areas were secure, clean and at the correct temperatures; however the walls and flooring in the treatment room on Swallow unit were in need of attention (see standard 19). There were clear records of order, receipt, administration and disposal although it was recommended that two signatures were obtained when recording medications for disposal to ensure there is no risk of mishandling. Medication Administration Records (MAR) were clear, completed in full and handwritten instructions were double signed to reduce the risk of errors. Medications to be administered ‘as needed’ or ‘PRN’ needed clear protocols to support staff with their decisions to administer or not although some of this information had been included in care plans relating to pain management. Residents who needed to have their blood glucose monitored had their own monitoring devices to reduce the risk of cross infection. Controlled drug records were accurate although a discrepancy on one of the units was identified; management acted immediately to resolve the situation and to ensure Dove Court Nursing Home DS0000022501.V337297.R01.S.doc Version 5.2 Page 15 residents were safe. Records to support that medication systems were monitored were not seen on all units. Staff said they received training on privacy, dignity and respect during their induction training and records supported this. Care plans included references to privacy and dignity and residents said they were treated ‘very well’ and that staff were ‘polite and friendly’. Staff were seen responding to residents in a caring and friendly manner. Personal care and visits from GPs were provided in the privacy of residents’ own bedrooms. There were clear procedures to support staff with the care of residents who were dying. ‘End of life’ care plans had been introduced and showed that staff had discussed some residents and relatives wishes regarding arrangements to be followed after death. One plan detailed the hymns to be included as chosen by the resident. Dove Court Nursing Home DS0000022501.V337297.R01.S.doc Version 5.2 Page 16 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 excellent. This judgement has been made using available evidence including a visit to this service. Staff met residents individual and diverse needs, expectations and preferences and helped them to maintain contact with friends and family. Residents were offered a wholesome, varied and appealing diet. EVIDENCE: Residents said they were given choices in many aspects of their day; they could get up and go to bed when they wanted and spend time in their rooms or in the lounges. The care plans contained useful information about residents’ likes, dislikes and preferences which would help staff to make the right choices for some residents who were unable to make decisions for themselves; one resident said she was asked about her choices and preferences. Some residents had people who were able to act in their best interests called ‘advocates’; the contact details of the advocates were recorded on the care records. The information in the care plans referred to ‘supporting’ and ‘helping’ residents to be independent and included their religious and cultural needs. One resident said staff had arranged for her to receive weekly communion which was very important to her.
Dove Court Nursing Home DS0000022501.V337297.R01.S.doc Version 5.2 Page 17 A range of suitable activities and entertainments were available that met residents diverse needs, preferences and expectations. Residents said they could choose whether to participate in the activities, some of which took place on other units. One resident said ‘activities are available and are often on other units but I prefer to stay here’. Activity records were seen on residents’ care plans and showed what activities they had been involved in and whether they had enjoyed it. Some records were clearer than others as for some residents the information was included in the daily record and was more difficult to access. Activities staff were employed and each resident had a key worker to help develop closer friendships between staff and residents. The staff group was balanced to allow residents to choose male or female staff of various ages to assist them with personal care There was an open visiting policy and visitors said they were made to feel welcome; one visitor said he visited everyday and ‘I can come and go as I please’. The menu offered a choice of meals and records of meals served showed that residents were regularly offered meals that were not on the menu. The main menu was supported by a ‘call order’ or alternatives menu offering other alternatives such as fish, omelettes, jacket potatoes, sandwiches, salmon and a new ‘nite bite’ menu has been introduced offering snacks foods such as beans/ spaghetti on toast, cakes, sandwiches, yoghurts, cheese and biscuits throughout the night. Most residents said they enjoyed the meals and made positive comments including ‘I like the food, there is always something that you like’, ‘very good food and always a choice of at least two things’, ‘the kitchen does lovely puddings and custard’, ‘we get plenty to eat, no one can complain about the food’ and ‘we always get plenty to eat and its always good food’. The chef was aware of resident’s likes and dislikes and dietary needs; she visited the units every week to talk to residents about the meals and attended residents and relatives meetings. Residents could choose where they wanted to dine and staff provided supervision and assistance where needed. The chef said that everything is home made and fresh foods are used to ensure residents get a nutritious, healthy and appetising diet. Dove Court Nursing Home DS0000022501.V337297.R01.S.doc Version 5.2 Page 18 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were protected from abuse by the policies and procedures. There was a good complaints system and people were happy their concerns would be listened to and responded to. EVIDENCE: The complaints procedure was clear and accessible; it was included in the information pack in resident’s bedrooms and on display in large print on each unit. From survey information and discussion with residents and their visitors it was clear they knew how to complain, whom to complain to and were satisfied that their complaint would be dealt with appropriately. One visitor said he had discussed his concerns with the manager and had received a prompt and appropriate response. Complaints were monitored to help them to improve the service. The adult protection procedure was clear and provided staff with appropriate guidance to help them to protect residents. All staff spoken to were aware of action to be taken if they suspected abuse and some had received training to help them to recognise abuse. It was recommended that all staff received adult protection training to ensure their skills and knowledge were up to date to help them to protect residents from harm.
Dove Court Nursing Home DS0000022501.V337297.R01.S.doc Version 5.2 Page 19 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, 22, 24 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of the environment in some areas needed to be improved to ensure all residents were provided with a well maintained, accessible, safe, clean and comfortable place to live. EVIDENCE: Redecoration and refurbishment of the units was an ongoing process to ensure that the environment was safe and comfortable. However during a tour of each unit it was clear that a number of areas, particularly on two of the units, required attention. Areas identified included damage to walls and woodwork, splashes and stains to walls, a broken valance rail, a toilet door that would not close and was unsafe, chipped paint, a hole in a dining room wall where a ventilation fan was awaiting replacement and inappropriate storage of boxes in a quiet lounge area. The maintenance records on each unit showed that requests for repairs were noted in the book and were attended to promptly although the areas listed above had not been recorded. It was recommended that audits were undertaken regularly to ensure that areas in need of minor repair and redecoration were identified promptly.
Dove Court Nursing Home DS0000022501.V337297.R01.S.doc Version 5.2 Page 20 One of the units was due to be refurbished and the residents needs in terms of colour schemes were being taken into consideration prior to this. The home met the requirements of the Disability Discrimination Act and the layout and design was suitable for the people who lived there. All areas were bright and comfortable. Some of the units had themed areas and one had a therapy room providing a quiet place for residents to relax in. Boxes were provided outside residents rooms on the dementia units; these contained personal items and photographs of the resident, family, friends and pets to help them to recognise their room. All bedrooms were provided with lockable storage and most with locks to doors; risk assessments in respect of non provision of keys were included as part of the care plan in most cases. Not all rooms were carpeted but this was discussed with relatives and residents prior to admission to ascertain their wishes. Call bells were supplied in all areas to enable residents to summon assistance from staff and risk assessments were seen to support non-provision. Residents said they were happy with their bedrooms and most had brought in personal items to make them feel more comfortable and homely. One resident said ‘my room is clean & bright and I can watch people coming and going’. A range of equipment was available and this was generally clean and in a good state of repair; staff confirmed they were given training in the use of the equipment to ensure they used them safely. The outside of the home was well maintained and residents said they enjoyed the gardens. Secure gardens were provided for residents on the dementia units to ensure they were safe and protected yet able to enjoy the gardens. A range of seating was provided and also bird tables and bird feeders were placed in the gardens and outside bedrooms for residents to enjoy watching the wildlife. There were plans to improve the gardens, walkways and seating areas this year and work had already commenced. The laundry was clean and organised and residents were well dressed in clean and matching clothes. Survey information indicated that residents and their visitors thought the home was generally clean although one commented that ‘sometimes surfaces were left unwiped and dirty’. During a tour it was noted, particularly on two units, that some areas needed extra attention including debris behind the handrails, dust on high shelves, sticky and marked vinyl flooring in residents rooms, stained fire extinguisher covers, dusty desk and extractor fans and mouldy seals around a shower base; also the flooring in one treatment room and one of the dining areas needed to be cleaned or replaced. All other areas were clean and bright and one visitor had commented that carpets were cleaned ‘regularly’ however one of the units had an unpleasant odour. Staff were observed wearing protective clothing to reduce the risk of cross infection.
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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. This judgement has been made using available evidence including a visit to this service. Staffing levels did not meet everyone’s needs and recruitment procedures did not completely safeguard people using the service. Staff were competent and skilled to meet residents needs and expectations. EVIDENCE: Most people said the staffing numbers were insufficient. Comments included ‘could do with more staff’, ‘not enough staff although staff work hard to make sure everyone is looked after’, ‘there are not enough staff to look after the residents as they need a lot of care and attention’, ‘could improve staff shortages’ and ‘staff are always busy and work very hard’. One resident commented that ‘staffing shortages mean that full attention is not always available’ and ‘staffing shortages mean that they are not always able to act quickly enough when requiring the toilet’. A number of staff commented that they are always very busy but always ensure that the residents are safe and comfortable; one staff said ‘the care is good but we could do much more if we had more staff’. On one unit it was noted that twenty-one residents needed assistance at mealtimes and staffing levels did not take this into account although extra staff had been provided for a resident on another unit with challenging behaviour.
Dove Court Nursing Home DS0000022501.V337297.R01.S.doc Version 5.2 Page 23 It was recommended that staffing levels were regularly reviewed on each unit to ensure residents’ needs were met at all times. Comments from residents included ‘I’m well looked after and the staff are very nice’, ‘I only need to press the buzzer and staff come and if you don’t press the buzzer for a while they always check to see if you are alright’. Visitors comments included ‘staff are superb’ and ‘Staff seem to be very busy but are always friendly’. Four staff employment files were looked at in detail. Two of the staff files did not have evidence to support that a safe recruitment procedure had been followed and this could put residents at risk of being cared for by unsuitable people. Records showed that staff had received appropriate training to help them to understand the needs of residents in their care. It was suggested that the training records could be improved to show an overall training matrix available for inspection. Dove Court Nursing Home DS0000022501.V337297.R01.S.doc Version 5.2 Page 24 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was run in the best interests of the people living there. EVIDENCE: The service did not have a registered manager in post at the time of the inspection visit; a number of applicants had been interviewed and short listed for the post. The clinical service manager who normally shared responsibility for monitoring and improving the standards of care in the home was temporarily responsible for the day-to-day management of the home supported by the senior management team. Each unit and other departments in the home had an identified manager who was involved in the development of the service.
Dove Court Nursing Home DS0000022501.V337297.R01.S.doc Version 5.2 Page 25 There were a number of systems in place to monitor whether the service was meeting people’s needs and expectations and to determine whether the service could be improved. Annual surveys were sent out to residents and their relatives and the results of these were available. There were internal audits to monitor whether staff were following policies and procedures regarding care planning, medication, finances and complaints. Regular meetings were held with staff and residents and their relatives and people said they were able to voice their opinions about the service. Clear accounting and financial records were maintained; the company audited these records to ensure residents best interests were protected. Records supplied by the registered manager prior to the inspection and those viewed during the inspection showed that health and safety records had been properly maintained and systems protected residents, staff and visitors to the home. There had been a health and safety inspection last month and action had been taken to respond to any areas of concern to ensure residents were protected from harm. Dove Court Nursing Home DS0000022501.V337297.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 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 3 3 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X 3 X 3 X 2 STAFFING Standard No Score 27 2 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 4 X 3 X X 3 Dove Court Nursing Home DS0000022501.V337297.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. 1. 2. Standard OP9 OP29 Regulation 13 19 Requirement Staff must follow procedures in relation to controlled medicines at all times. In order to ensure that new staff are fit to work with vulnerable people the registered person must complete all preemployment checks before a member of staff commences work at the home. Timescale for action 20/08/07 20/08/07 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. Refer to Standard OP4 OP9 Good Practice Recommendations All staff caring for people with a dementia should be provided with appropriate training to meet their specialised needs. The records of medicines for disposal should be signed by two staff to prevent any mishandling. Protocols to support ‘as needed’ and ‘PRN’ medicines should be developed. Staff should have training in safeguarding adults to assist them to recognise and deal with suspected abuse.
DS0000022501.V337297.R01.S.doc Version 5.2 Page 28 3. OP18 Dove Court Nursing Home 4. OP19 5. 6. OP26 OP27 An regular audit of all areas should be undertaken to identify areas in need of repair, re decoration or replacement and appropriate action taken to ensure residents were provided with a safe and pleasant environment to live in. All areas should be clean and free from offensive odours. Staffing levels throughout the home should be reviewed to ensure that there are sufficient staff on duty at all times to meet the needs of people using the service. There should be a manager to take day-to-day control of the home that is registered with Commission for Social Care Inspection. 7. OP31 Dove Court Nursing Home DS0000022501.V337297.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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
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