CARE HOMES FOR OLDER PEOPLE
Dove House Sudbury Nr Ashbourne Derbyshire DE6 5GX Lead Inspector
Rachel Davis Unannounced Inspection 19 December 2005 11:30 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 House DS0000044218.V274253.R01.S.doc Version 5.1 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 House DS0000044218.V274253.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Dove House Address Sudbury Nr Ashbourne Derbyshire DE6 5GX 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) 01283 820304 01283 820220 Midland Healthcare Ltd Ms Karen Lesley Betts Care Home 42 Category(ies) of Dementia - over 65 years of age (25), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (5), Old age, not falling within any other category (42), Physical disability (2), Physical disability over 65 years of age (7) Dove House DS0000044218.V274253.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The Registered Manager must complete the Registered Manager’s award within an appropriate timescale. 20th June 2005 Date of last inspection Brief Description of the Service: On the day of inspection there were 35 service users residing at Dove House. Dove House is a residential home set in the countryside near to the Derbyshire village of Sudbury. The two storey Victorian house is registered to provide residential care for forty-two older people. Their needs may range from mental health, dementia and/or physical disabilities. The home has recently had a variation to its registration category and can now accommodate 25 people with dementia. The registered provider is Midland Homes Ltd who has overall responsibility for the home; the registered manager is Karen Betts. Due to the homes position local amenities are limited but the home is well placed for the use of public transport. The premises have been sympathetically extended and have substantial grounds and parking facilities. Gardens were extremely well maintained and a patio area with seating was available and easily approached. Communal areas have been redecorated and are comfortable. The home also has two large conservatories offering substantial views of the gardens and countryside. There is a no smoking policy for service users and staff within the home. The majority of bedrooms were single and met the required sizes set out by the national minimum standards; these were equipped with suitable fixtures and fittings. Twenty-seven of the thirty-six single rooms had en suite facilities. Communal bathrooms and toilets were well-located and offered appropriate equipment and facilities. Adequate parking is available for staff and visitors. Dove House DS0000044218.V274253.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over half a day by one inspector. A brief tour of the home was undertaken; a visiting doctor, service users and the manager were spoken to. Three care plans were examined; information was cross-referenced to reaffirm evidence. Staff practice was observed throughout the inspection. This inspection only covered a small number of the national minimum standards and to ascertain a full picture this report should be read alongside the announced inspection held on 20th June 2005 The inspector has also carried out one additional visit to the home since the last inspection to ensure compliance with regulations and requirements and to discuss the addition of 5 service users to the dementia category of the homes registration. The Commission for Social care Inspection are in the process of investigating one complaint; an outcome has not yet been reached. Eight requirements and five recommendations have been made following this inspection. What the service does well:
The home liaises well with other professionals ensuring appropriate assessments are carried out so that Dove House can meet individual’s ongoing needs. A weekly activities programme is in place and information relating to these is suitably recorded. The activities co-ordinator is motivated and covers a broad range of interesting activities. It was ascertained that service users with complex needs received stimulation on a one to one basis. Service users were watching a pre-recorded pantomime on the day of the inspection. The registered manager has worked hard to ensure the requirements made at the last inspection have been met. The two outstanding requirements are out of her control. Dove House DS0000044218.V274253.R01.S.doc Version 5.1 Page 6 Service users monies were suitably stored and recorded. What has improved since the last inspection? What they could do better:
The medication procedures within the home are still in need improvement, this has been carried over from the last inspection report. The administration procedures within the home are unsafe and potentially leave vulnerable people at real risk. The registered manager needs to ensure that the home’s procedures comply with The British Pharmaceutical Society Guidelines. The registered manager works full time but on many occasions has to work on the floor to cover a shift due to staff annual leave or sickness. This again was highlighted at the last inspection. The manager must be offered the time to fulfil her role and complete the tasks expected of her. The presentation of the main meal of the day needs to be considered, alternative ways of delivering lunch must be thought about, with the emphasis being on individualism and choice. Dove House DS0000044218.V274253.R01.S.doc Version 5.1 Page 7 Discussion with the manager confirmed that all the radiators have now been audited but not necessarily suitably covered for the safety of the service users. It was considered that the overall cleanliness of the home had deteriorated since the last inspection; this does not include the kitchen, which was of a good standard. 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 House DS0000044218.V274253.R01.S.doc Version 5.1 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 House DS0000044218.V274253.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected on this occasion; please refer to the inspection held in June 2005 for relevant information on this section of the report. EVIDENCE: Dove House DS0000044218.V274253.R01.S.doc Version 5.1 Page 10 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 and 9. Standard 10 was assessed at the last inspection. The care planning processes within the home were clear providing adequate information for staff to meet the needs of the service users; care plans risk assessments are reviewed. The systems for the administration of medication were poor and potentially place service users at risk. EVIDENCE: Care plans were in place for all of the service users, three files were checked on this occasion, they contain all of the information listed in National Minimum Standard 3.3. The care plans were reviewed monthly and risk assessments were undertaken. The health care section of the care plan evidenced that needs were closely monitored and medical professionals contacted when necessary, suitable recording of body weight and nutritional needs were in place. The inspector was able to talk with the visiting doctor who confirmed that the home referred appropriately and liaised with the surgery and the district nurses as required. It was verified that the staff at Dove House would escort the doctor to the
Dove House DS0000044218.V274253.R01.S.doc Version 5.1 Page 11 service users room and fully informed him of their needs, when instructions by the GP were left it was verified that these would be followed through. “ Karen uses us appropriately, she does an excellent job, we have a good relationship” were a few of the positive comments passed onto the inspector by the doctor. Suitable policies on the receiving, admissions and safe handling of medications are in place. The ‘as and when required’ medication records were checked on this visit and evidenced that a safe recording system was now in place. Policies and procedures are available to guide staff to assist service users with their medication but irregularities were apparent. The senior staff on duty was observed administering medication, it was noted that the process was poor. Medications were signed off as being taken without the senior member of staff not knowing if this was so, two members of staff touched medications in all instances, this should not occur. Medication was placed in a pot with a piece of paper with the service users name on it and then dispensed by another member of staff, secondary dispensing is not permissible. Staff must ensure the correct recording of all medicines received and administered for the protection of the service users. It was recommended that designated staff undertook refresher training in all aspects of medication. The controlled drugs checked were stored appropriately; the systems used at Dove House in relation to controlled drugs were safe. Dove House DS0000044218.V274253.R01.S.doc Version 5.1 Page 12 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): 15. Standards 12, 13 and 14 were assessed at the last inspection. Although individual routines were evident in the home, the manager was asked to investigate further ways of offering preferences during lunchtime. EVIDENCE: Lunch was observed, it was noted that service users were seated at the table for approximately half an hour before the meal was served. This did cause some agitation for people with complex needs. Five service users remained in their wheelchairs throughout the meal, it was revealed that more suitable dining chairs were on order. Two service users received liquidized meals; these were poorly presented in a bowl with all parts of the meal blended together, this does not offer people any variety of taste, texture, colour or visual stimulation. Meals were served from a heated trolley all meals were identical in size and delivery, an example of improvement may be providing gravy in a jug/gravy boat, rather than it being put straight on the plate. The availability, quality and style of presentation of food, along with the way in which staff assist service users at mealtimes are crucial in ensuring service users receive a wholesome, appealing and nutritious diet.
Dove House DS0000044218.V274253.R01.S.doc Version 5.1 Page 13 Individuals’ food preferences, both personal and cultural/religious are part of their individual identity and should always be observed. The manager confirmed that a buffet tea was now offered and has proved successful; this style of meal ensured the service users had a greater choice and as they were not overfaced they would invariably have a second helping. The kitchen was inspected on this visit; all the required records were in place. Fresh meat, fruits and vegetables were delivered and the dry stores were well stocked. All areas of the kitchen were clean and well presented; crockery and cutlery were of a good standard. Dove House DS0000044218.V274253.R01.S.doc Version 5.1 Page 14 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): 18. Standard 16 was assessed at the last inspection. The home has the required information and knowledge relating to abuse procedures and Whistleblowing. EVIDENCE: Discussions with the manager revealed that the staff had recently read the ‘recognition of abuse’ policy and procedure. Training is on the agenda for staff next year, which will further improve their knowledge base. All relevant up to date information provided to the home by Social Services was in place. The manager confirmed she is aware of the vulnerable adults referral process. Dove House DS0000044218.V274253.R01.S.doc Version 5.1 Page 15 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, 22, 25 and 26. The standard of the environment within this home is satisfactory; the home was not as clean as it was on the last inspection. EVIDENCE: A partial tour of the environment was undertaken during this inspection of all of the communal areas, bathrooms, the laundry and the kitchen area. Most areas are in a satisfactory state of repair, the proprietor may wish to consider replacing the flooring in the toilets and bathrooms in the future and the small conservatory carpet would benefit from attention. The wheelchairs seen were not in a good state of repair. Three of the five had flat tyres, none were particularly clean and the footplates would not lock into place. A requirement to ensure equipment operates correctly to ensure the safety of service users has been made. Dove House DS0000044218.V274253.R01.S.doc Version 5.1 Page 16 Not all radiators are guarded as required, one service user was seen using an unguarded radiator as a walking aid, this is a serious concern and must be guarded as a matter of urgency. Toilets and bathrooms are well situated; requirements from the last inspection have been met relating to locks, toilet roll holders, lighting and floor sealant. Hoists were serviced 6 monthly as required; this ensures service users are not placed at harm or at risk. The laundry area was visited on this occasion, two new ‘sluice facility’ washing machines have been purchased, the inspector was advised that an ozone 3 system was also in place which means bacteria and super bugs such as MRSA are eliminated on a 30 degree cycle. Dove House DS0000044218.V274253.R01.S.doc Version 5.1 Page 17 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 and 30. Standards 28 and 29 were assessed at the last inspection. The manager must ensure that the home is staffed at all times by a sufficient number of personnel. EVIDENCE: Competent, well trained managers and staff are fundamental in achieving good quality care for service users, The registered manager, Karen Betts continues with the Registered Managers Award which is a requirement for this position. Karen is a fairly new manager and has worked alongside the Commission for Social Care Inspection to meet and improve the standard of care offered at Dove House. Other professionals speak well of her and through discussions and observing her practice it was evident that she has the service users’ at the heart of her decision making. It was concerning however that since her appointment Karen has nor received any formal supervision, infact, her last recorded supervision session was 23/2/04. This was a requirement of the last inspection and has not been met. It was again evident that Karen works on care for 2 /3 days per week, this does not always offer her the time or the opportunity to meet the roles and responsibilities of her managerial position efficiently or effectively. Again, this requirement is unmet.
Dove House DS0000044218.V274253.R01.S.doc Version 5.1 Page 18 Through discussion it was ascertained that 37 domestic hours per week were not being covered, this was reflected in the standard of cleanliness within the home, a requirement has been made to cover these hours where possible. The training of staff is still high on Karen’s agenda; this will be fully inspected on the next visit, there was proof that staff were being formally supervised but it was hard to evidence if the outcomes of these sessions were met or followed through. Senior staff providing supervision need to be trained to do so. Dove House DS0000044218.V274253.R01.S.doc Version 5.1 Page 19 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 and 35. Standards 31 and 38 were assessed at the last inspection. The health, safety and welfare of the service users and staff were promoted and protected as far as reasonably practicable. EVIDENCE: There is continuous self monitoring within the home and the required regulation 26 visits are undertaken on a monthly basis. A quality assurance system is in place within the home, and the findings were available on the homes’ notice board. Service users’ financial interests were safeguarded; service users were encouraged to look after their own financial affairs with the support of their families or representative. Where the home did have responsibility the correct procedures were used. A recommendation to sign for the receiving of cheques was made. Dove House DS0000044218.V274253.R01.S.doc Version 5.1 Page 20 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X 2 3 STAFFING Standard No Score 27 2 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X X Dove House DS0000044218.V274253.R01.S.doc Version 5.1 Page 21 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. Standard OP7 1 2 OP9 13(2) Regulation 17(1)(b) Requirement The registered person must ensure individuals’ records are not stored communally. The registered person shall make suitable arrangements for the recording and safe administration of all medicines. Previous requirement. Not met. The registered person must ensure the wheelchairs operate efficiently and are kept in a good state of repair. All radiators within the home where service users have access must be guarded, priority must be given to those risk assessed as high risk. The registered person shall ensure vacant domestic hours are covered where possible. The registered person shall ensure senior staff required to supervise staf are trained to do so. The registered manager must be offered the required time to fulfil the responsibilities of her role. Previous requirement. Not
DS0000044218.V274253.R01.S.doc Timescale for action 01/01/06 01/01/06 3. OP22 23(2)(c) 19/01/06 4. OP25 13(4)(a) 19/01/06 5. 6. OP27 OP30 18(1)(a) 18(1)(c i) 01/01/06 19/02/06 7. OP31 18(1)(a) 19/01/06 Dove House Version 5.1 Page 22 8. OP31 18(2) met. It was noted that the registered manager has not been in receipt of supervision and this is a requirement of the inspection. Previous requirement. Not met. 19/01/06 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 Refer to Standard OP9 OP15 OP19 OP20 Good Practice Recommendations The home should seriously consider undertaking refresher training in medication The cook should liquidise all parts of a meal individually The responsible individual should consider adding a second banister rail on the back stairs following the risk assessment. The home should consider the appropriateness of service users sitting in a wheelchair at mealtimes. Assessments should be undertaken with these individuals to ascertain if there are suitable double armed dining chairs available. The manager should consider signing against receiving a cheque. 5. OP35 Dove House DS0000044218.V274253.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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