Inspection on 29/05/08 for Dove House

This inspection was carried out on 29th May 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Dove House 01/06/07

Dove House 18/04/06

Dove House 19/12/05

Dove House 20/06/05

Dove House 14/10/04

Dove House 08/06/04

Dove House 21/01/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Dove House Sudbury Nr Ashbourne Derbyshire DE6 5GX Lead Inspector Rachel Davis Key Unannounced Inspection 29th May 2008 09:30 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.V365057.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 House DS0000044218.V365057.R01.S.doc Version 5.2 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.V365057.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 1st June 2007 Brief Description of the Service: Dove House is a care home registered to provide residential care for 42 older people. On the day of inspection there were 23 people living at Dove House. The needs of the people who may wish to live at Dove House may range from mental health, dementia and/or physical disabilities. The home can accommodate 25 people with dementia and staff are trained in all areas of need, other professionals such as district nurses and community mental health nurses visit the home regularly and offer continued advice and support. The inspection confirmed the home is able to meet the needs of the people who presently use the service. The registered provider is Midland Healthcare Ltd who has overall responsibility for the home; the registered manager is Karen Betts. Information about the fees for this service were not available as needed, fees must be recorded in the service user guide but presently people will need to enquire directly to the home to obtain this information. 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 attractive grounds with adequate parking facilities. Gardens were well maintained and a patio area with seating is available and easily approached. The home also has two large conservatories offering substantial views of the gardens and countryside. The majority of bedrooms are single and meet the required sizes set out by the national minimum standards; these are equipped with adequate fixtures and fittings. Twenty-seven of the thirty-six single rooms have en suite facilities. Communal bathrooms and toilets are well located and offer appropriate equipment. Dove House DS0000044218.V365057.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 people who use this service experience adequate outcomes. This unannounced inspection took place over 7.5 hours; it was carried out by one inspector who used the National Minimum Standards for Older People as the basis for the inspection. This was a ‘Key’ inspection; during a ‘Key’ all the core standards are assessed. A quality rating is provided throughout the report based on each outcome area for the people who use the service. These ratings are described as excellent, good, adequate or poor based on findings of the inspection. The last ‘Key’ inspection took place in June 2007. Since June, and following identified areas of concern we have visited the service twice completing random inspections, once in January 2008 and once in April 2008. During the random inspection in January we evidenced poor record keeping, a lack of sufficient detail in dealing with complex care needs and insufficient staffing levels to meet the needs of the people who use the service. Because of these concerns and previous information provided by other professionals the Health and Social Care Directorate have not been placing any people at Dove House since February 2008. In January the number of staff on duty had to be increased by one person per shift with immediate effect and this increase remains in place. In April we revisited the home and were satisfied with the progress being made, the home has introduced a number of new systems to improve the outcomes for the people who use the service. Prior to visiting the home on this inspection, survey information was completed and returned to us by people who use the service, their relatives, and the staff, their comments are anonymously included within this report. During this ‘Key’ inspection we looked at the life people are able to lead and whether their health and personal care needs are being met. We also looked around the home to see the standard of the accommodation. We looked to see whether people who use the service are being protected and the arrangements the service has for listening to what people think about Dove House. Dove House DS0000044218.V365057.R01.S.doc Version 5.2 Page 6 During the visit we met and spoke to a number of people living in the home, two visitors and five members of staff. Observations were made of staff and resident interaction around non-personal care tasks, around lunchtime and whilst activities were taking place. A pharmacist inspector also visited the home and carried out an inspection of the medicines management systems being practiced within the home. The inspection comprised of examining the medication storage areas, examining the records kept, and having discussions with the manager and care staff. His findings are recorded within the inspection report under Health and Personal Care, in the body of this report. Our inspection reports can be obtained directly from the provider or are available on our website at www.csci.org.uk What the service does well: What has improved since the last inspection? Since January 2008 the staffing levels have been increased by one person on each shift, meaning there are now five care staff in the morning, four in the Dove House DS0000044218.V365057.R01.S.doc Version 5.2 Page 7 afternoon and three at night. This has had a positive outcome for the people who use the service. Staff confirmed they can spend more time with people and do not feel guilty when they have the opportunity to sit and chat. The number of falls has reduced dramatically and documentation such as turning charts, fluid balance charts and daily records are being completed to a good standard. Staff verified the level of care they could now provide was better; they never had to rush people, which they said they sometimes did do before. Three comments offered are as follows: “We were always behind, with more staff on you can get more done and service users are looked after properly, it’s calmer than it was before.” “ Since more staff were required levels are adequate, my fear is when the staff numbers are not enforced we will go minimum staff levels and care is potentially compromised.” “We have more time to sit and talk to service users in the afternoon.” Care plans and risk assessments are being developed for the people who use the service. Plans of care will be person centred and give a picture of the individual, looking at their abilities as well as their needs. Although improving there is still little evidence to confirm people who use the service have had involvement with their own plan of care. The record keeping and documentation in all areas inspected has improved greatly. This means staff have up to date and satisfactory information to support them in meeting the needs of the people who use the service. It also offers the manager a clear audit trail to enable her to follow up any action that may be required. We concluded the people who use the service receive individualised, varied and positive stimulation. The activities are offered on a one to one basis for some individuals if this is more appropriate. We found the staff have been provided with extra training since the random inspections held in January and April 2008. Staff confirmed this has had a positive impact and gives them confidence in the work they undertake. The manager has ensured she keeps a training record and we feel Dove House has the appropriate skill mix, and the staff group have now been suitably trained. What they could do better: The Statement of Purpose and Service User Guide need to give individuals an accurate account of the fees payable. The home may also wish to offer a more “user friendly” version due to the complex needs of the people who are using the service. Dove House DS0000044218.V365057.R01.S.doc Version 5.2 Page 8 The complaints procedure needs to include a timescale, this means people who use the service will know when they can expect a response. Medication systems should be improved upon to ensure the staff always follow good practice and safe practice guidelines. This will mean the people who use the service are fully safeguarded. Although some redecoration has taken place since the last key inspection Dove House is in need of updating throughout, with many areas now looking worn and tired. This is especially pertinent to some of the communal areas, bedroom furniture, carpets, toilets and bathrooms. The programme of redecoration and refurbishment should be implemented quickly in order to improve the appearance and comfort of the environment for the people who live there. Questionnaires returned to us confirmed this: “ The décor of the home needs improving dramatically.” “ There should be more autonomy for the manager to fix décor and sort problems that occur without authorisation from proprietor.” Midland Healthcare Ltd has not met their legal obligation of recording the Regulation 26 visits since January 2008. Not completing these means the company is not able to evidence an opinion of, or show how they monitor the standard of care provided at Dove House. 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 House DS0000044218.V365057.R01.S.doc Version 5.2 Page 9 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.V365057.R01.S.doc Version 5.2 Page 10 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 and 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. More written information is needed to ensure that people who use the service and prospective residents can make an informed choice about the home. Prospective people who use services have a needs assessment carried out before they are admitted to the home. EVIDENCE: The service has a statement of purpose and service user guide, which set out the aims and objectives of the home, and include information about the service. They need to be reviewed and include the fees payable and the staffs’ qualifications. Dove House DS0000044218.V365057.R01.S.doc Version 5.2 Page 11 Dove House should consider developing their statement of purpose and service user’s guide specific to the resident group and consider the different styles of accommodation, support, treatment, philosophies and specialist services required to meet the needs of people who use the service. The information should be in a format suitable for their and their families’ needs, using, for example, appropriate language, pictures or Braille. The home should be as open and transparent as possible and offer diverse information to prospective people about gender (including gender identity), age, sexual orientation, race, religion or belief, and disability. They should also be clear of what is or is not available, an example of this would be to include the fact that the home does not have a pay phone but people who use the service can use the office phone whenever they wish. However, there is no information on what this would cost. Offering such information then enables prospective users the opportunity of making an informed choice as to whether they would be happy with these arrangements The care records for a number of people who use the service were checked and contained the needs assessment as required, pre admission documentation is sound and offers appropriate opportunities for the manager to assess whether Dove House can meet the needs of the prospective user. No new admissions have taken place since February 2008. Dove House operates a key worker system to help individuals feel comfortable in their new surroundings, and enables people who use the service to ask any questions about life in the home. It should also encourage and help the staff to develop a person centred approach to care. From speaking with staff it was not clear if staff always understood this role, the manager could revisit this area during one to one supervision or at team meetings. Standard 6 is not relevant to this home and therefore not assessed. Dove House DS0000044218.V365057.R01.S.doc Version 5.2 Page 12 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. This judgement has been made using available evidence including a visit to this service. Staff have a positive attitude to their work and the principles of respect, dignity and privacy are put into practice. EVIDENCE: We looked at three plans of care and spoke to people who use the service, their relatives and staff members. A plan of care had been developed and reviewed for all. There was evidence to confirm one individual had been involved with the development of their new care plan. The manager confirmed this will be the new format for all the people who use the service and they are presently working hard to achieve this goal. New plans contain succinct information around areas of need such as personal care, recreation, nutrition, spiritual needs, sexuality, life skills, hobbies etc. Dove House DS0000044218.V365057.R01.S.doc Version 5.2 Page 13 The plans of care include an assessment of risk for moving and handling and any other identified area of need. The information on how to manage this risk is then recorded on the plan of care and subsequent reviews where necessary. People feel the delivery of personal care is flexible, consistent and reliable. Relatives stated they were always kept informed and communication was “good.” They verified the staff and the manager were approachable and they could talk to them at any time regarding their loved ones. In January, the health and professional diary entries for some individuals were either missing or poorly recorded. We left a requirement for the home to ensure turn charts, fluid, and nutritional intake records were consistently recorded and evaluated, this meant the staff will manage the health care needs of the people who use the service efficiently and effectively. Since then there are noticeable changes in the recording of need for the people who use the service, handovers have been introduced and service users needs are discussed at this time. Other measures such as monitoring charts have been implemented to ensure accountability because previously it was difficult to track whether tasks had or had not been completed. Staff are happy with the implementation of these records and comments include: “I find the handovers useful, it helps me keep track.” “The monitoring charts are useful, if we had a service user fall we didn’t know how long they had been on the floor and now there aren’t as many falls as there used to be. I think that’s because we have more staff and team work is better and with monitoring the lounges and recording on the charts it’s a lot better for the residents.” From observation, it was evident the staff have ensured that individuals are able to receive support to address personal care issues and personal hygiene. One person said: “If I need support another resident will press the call bell for me and staff come very quickly.” Another person confirmed: “ The staff are supportive.” The pharmacist inspector carried out an inspection of the medicines management systems being practiced within the home. The inspection comprised of examining the medication storage area, examining the records Dove House DS0000044218.V365057.R01.S.doc Version 5.2 Page 14 kept and having discussions with the care staff and people who used the service. We found that the policies and procedures document for the handling of medicines did not describe in enough detail how the handling of medication within the home should be safely carried out by the staff. We found that because the home obtained their medication from a dispensing doctor practice the home was having to handwrite their own medication administration record charts. These charts appeared to show that people who use the service were receiving their medication as prescribed by their doctor. Some issues were identified and these included prescribed creams not being entered on to the charts and the handwritten entries not mirroring the information shown on the dispensing labels. In order to ensure that the people who use the service receive their medication as prescribed the home had developed two drug audit sheets. The first sheet is used to record the receipt of medication, what medication was kept in the excess stock cupboard and when the excess stock was transferred to the trolley. The second sheet keeps a running balance of the stock and gives the opportunity for seniors to check that other seniors have administered the medication. The medication administration sheet charts are also being used to record the quantity at the beginning of the month and any receipt during that month, although the date of receipt was not evident on the charts. A number of issues were identified and these included duplication of information, an assumption that stock had not been tampered with, a contradiction of information between sheets and the failing to record the receipt of medication that was not being audited e.g. liquid preparations and some antibiotics. The home was reminded that whatever systems they wished to put in place to ensure the people who use the service received their medication, they must ensure there is an accurate account of the medication present within the home at the start of the month and the receipt of all medication is accurately recorded. It is suggested that in order to simplify the medication systems the home should adopt a 28-day month for the ordering and administration of medication. We found that the care plans were lacking in information about the administration of medication. We found that there was little information for the staff to administer “when required” and variable dosed medication. It was also seen that the administration of some eardrops were being done differently because the exact details for administration had not been written into the care plan. Dove House DS0000044218.V365057.R01.S.doc Version 5.2 Page 15 We found that the home had not obtained written consent from any of the people who use the service for the home to manage and administer their medication. The home was advised to seek written consent from people who use the service for these practices. Some people had been diagnosed with dementia or a mental health problem. As a consequence the home felt that they would not have the ability to consent to the home handling and administering their medication. In light of the Mental Capacity Act, the home needs to instigate mental capacity assessments to confirm whether these people have the ability to consent. If they do not have the ability to consent then the home needs to seek an agreement with the people involved in their care e.g. General Practitioner, social worker and relatives that the home administering the medication was in the best interests for that person. We found the home was storing Controlled Drugs in a wooden cupboard that was located within another wooden cupboard. In light of the amendments made to the Misuse of Drugs (Safe Custody) Regulation in August 2007 the current storage conditions are no longer acceptable. The home must obtain a Controlled Drugs cabinet, secure it to a load-bearing wall with rag bolts and then store all Controlled Drugs within it. We found that the home was using a Controlled Drugs register to record the receipt, administration and disposal of Controlled Drugs prescribed to the residents. On examination of the Controlled Drugs register it appeared that the people who use the service were receiving their medication as prescribed. We found however that some improvements in the recording were needed and these improvements were discussed during the inspection. We found that the temperature of the room where the medication was being stored was rising above the maximum temperature of 25°C. We also found that when medication requiring cold storage conditions was being stored in the designated fridge the temperature of the fridge was not being properly monitored to ensure that the medication remained at a temperature of between 2 and 8°C. The lunchtime administration round was observed and we found on the whole that the practices were being carried out well and followed good practice guidelines. There was however one exception when the medication was prepared in the lounge and then carried in a medicine pot through the home to the persons room. This practice could place other people and relatives at risk if an incident happened between the trolley and the room, therefore when administering to a person in their room the trolley must be taken to the room. We found that the senior staff who were administering the medication had all undertaken training in the safe handling of medicines and had been assessed by the manager as competent to safely handle and administer medication to the people who use the service. Dove House DS0000044218.V365057.R01.S.doc Version 5.2 Page 16 We also found that staff were carrying out blood sugar monitoring on a number of diet and tablet controlled diabetics. Again the staff had received training and had been assessed as competent by a diabetic specialist nurse. Dove House DS0000044218.V365057.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. People who use the service have opportunities for community and family contact . Daily life is geared around meeting the preferences, abilities and needs of the people who live in the home. EVIDENCE: The home has a structured activity programme and offers a variety of activities according to preferences of the people who use the service. The activities co-ordinator is contracted to work 20 hours per week and confirmed the hours were “ flexible.” A discussion was held with the co-ordinator who confirmed activities take place on a one to one basis and in small groups, examples of these included dominoes, reminiscence, crafts, quizzes and crosswords. Where an individual has a particular hobby the staff and activities coordinator will try to ensure appropriate information etc is made available. From discussion with people who use the service, and from observation of practices, individuals are able to retain control of their lives and were given Dove House DS0000044218.V365057.R01.S.doc Version 5.2 Page 18 opportunities to make informed decisions. One person who uses the service stated: “I enjoy all activities within the home and the activities lady is patient with us all and gives us lots of variety, I especially enjoy bingo as we all get prize’s.” Discussion with people who use the service and their visitors confirmed there were no restrictions on visiting from family and friends. They were also happy with the stimulation offered to the people who use the service and spoke highly of the staff and activities co-ordinator. The kitchen is well maintained; it was not fully inspected on this occasion. We are aware that on other visits all the required records have been in place including fridge and freezer temperatures, meat probing and cleaning duties. On this inspection we saw the cook probing food and were able to evidence the kitchen was well maintained and clean and tidy. Food supplies are plentiful and fresh fruit and vegetables are available. We noted the people who use the service are offered an alternative meal at lunchtime and at tea. The daily meal is written on the notice board and at lunchtime it was seen to be as recorded. We spoke to staff who confirmed liquidized meals are being provided to people who require a soft diet, we were told the cook liquidizes all parts of the meal separately. This is considered good practice because it enables people to experience a variety of taste, texture, colour and visual stimulation. Dove House DS0000044218.V365057.R01.S.doc Version 5.2 Page 19 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. People who use the service feel safe, secure and are confident their welfare and safety needs are promoted. EVIDENCE: We have received one formal complaint about the home since the last key inspection held in June 2007. The information received by us has been investigated under the safeguarding of adults policy, this means that a number of professional bodies have been involved in the investigation including the Primary Care Trust (PCT) and the Social Care and Health Directorate (Social services). This investigation has been ongoing since January, but it is near completion. Dove House have received two complaints and these are recorded within the logbook. Previously we had advised the manager to ensure these logs offer date, investigation and outcome to ascertain if an outcome had been reached. From the records we saw it was clear that this action has been taken. The complaints procedure offers clear information but must also include a timescale. Questionnaires confirmed people who use the service knew how to complain and when we talked to people they confirmed they would feel comfortable in approaching the manager, should the need arise. Dove House DS0000044218.V365057.R01.S.doc Version 5.2 Page 20 The complaints procedure is available in the service user guide (all people who use the service have a copy of this) and by the homes’ notice board near the office. Dove House also has an informal ‘comments and compliments’ book, it is available by the visitors signing in book. People who use the service and their relatives are free to write their comments at any time, we saw some very positive comments from people who thanked the staff for their “compassion, sensitivity, flexibility and good care.” This open approach shows the home is happy to look at areas of improvement and good practice recommendations in a transparent way. From the records available on the day of inspection it was clear all the staff are trained to recognise the signs and symptoms of adult abuse. The manager confirmed this training was part of the mandatory programme and all staff have received this training. One vulnerable adult referral has been made since the last inspection and this was dealt with by the manager as required in a multi disciplinary way. As recommended during the last inspection the home has obtained a copy of the Safeguarding of Adults policy and protocol to ensure they are up to date with new procedures. Dove House DS0000044218.V365057.R01.S.doc Version 5.2 Page 21 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 adequate. This judgement has been made using available evidence including a visit to this service. Refurbishment is needed but the home does provide a physical environment that is appropriate to the specific needs of the people who live there. EVIDENCE: Dove House is clean and comfortable and has a homely feel however; some communal areas, toilets and bathrooms, carpets, curtains and fittings are in need of upgrading. For example, a number of wardrobe doors don’t close properly and some wardrobes were not attached to the wall. There are not any fans available for when it is very hot or stuffy, and some bathrooms are without blinds or curtains, some paintwork is chipped and some carpets are in need of replacement. Dove House DS0000044218.V365057.R01.S.doc Version 5.2 Page 22 At the last key inspection the safety of the unguarded radiators and exposed pipework needed to be assessed for the risk they presented to the people who use the service. On speaking with the manager she confirmed all radiators are low surface temperature and risk assessments have been completed. We found one radiator that did not meet with this statement and was dangerously hot. We asked for this to be dealt with straight away because it was a potential risk to the people who use the service. The manager locked the bathroom immediately and informed us it was out of bounds. We saw the exposed pipework around the home has been boxed in where it presented a risk. The home has a designated laundry and this area is well organised, all clothing is individually returned to avoid misplacement. Laundry is being washed at the required temperature and dealt with correctly. We saw that red alginate bags are used and placed on a sluice cycle where people are incontinent to ensure infection control standards are met. Infection control measures are in place, examples of this include: Ozone initialising machines to destroy Methicillin Resistant Staphylococcus Aureus (MRSA) and Clostridium Difficile (C Dif), paper towels, liquid soap, hand sanitizer and personal protective clothing are in place as standard. Staff questionnaires revealed they also considered improvements are needed: “ Maintain the building and equipment to better standards, the owner doesn’t seem to want to spend money in these things.” “ We need new beds, carpets, etc, we need more wheelchairs as we do not have enough for our clients needs.” Dove House DS0000044218.V365057.R01.S.doc Version 5.2 Page 23 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 good. This judgement has been made using available evidence including a visit to this service. Recruitment procedures follow safe practice and support the need to protect vulnerable adults. EVIDENCE: Two staff files examined demonstrated that a thorough recruitment practice is now in place, this includes two written references, criminal records bureau checks, application forms that cover gaps in employment history and the required identification certificates, health declaration and photograph. Male staff are also recruited to the home, which promotes equality and choice. In January 2008 we noted on six separate occasions people who use the service were left unsupervised in the lounge areas, we were also aware there had been a high number of falls. The team manager for the Social Care and Health Directorate stated that an increase in staffing was necessary. The commission left an immediate requirement to this effect. In April and on this inspection we checked the rotas and are happy that these new levels of staffing have remained in place. We are also confident that it has had a positive outcome for the people who use the service. During the time we spent at Dove House we spoke to a number of staff and observed them supporting people. We found there were positive and engaging interactions between those people living at Dove House and the staff members. Dove House DS0000044218.V365057.R01.S.doc Version 5.2 Page 24 Staff reported: “I think that things have improved because we have more staff and better team work and with monitoring charts it’s a lot easier.” “ The new shifts work better and the handovers are very good.” “ Since more staff were required levels are adequate, my fear is when the staff numbers are not enforced we will go minimum staff levels and care is potentially compromised.” “I really enjoy it in the afternoons because during the afternoon drinks round we have chance to sit with service users and spend time with them which we didn’t before.” Staff also felt positive around the training offered to them they commented: “ Training is wide ranging and effective.” “ In house training is very good.” All staff receive relevant training that is focussed on delivering improved outcomes for the people who use the service. The home has put a high level of importance on training and staff report that they are supported to meet the individual needs of people who use the service. To further this, the home should consider offering staff training in equality and diversity. Dove House DS0000044218.V365057.R01.S.doc Version 5.2 Page 25 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, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home must continue to evidence that it is run in the best interests of the people who use the service. EVIDENCE: The annual quality assurance assessment (AQAA) is a legal document that all services have to complete on a yearly basis. All sections of the AQAA were completed and the information gave us a reasonable picture of the situation within the service. The evidence to support the comments made is satisfactory, although there are areas where more supporting evidence would have been useful to illustrate what the service has done or how it is planning to improve. The AQAA only gave us limited detail about the areas where they still need to improve and the ways that they were Dove House DS0000044218.V365057.R01.S.doc Version 5.2 Page 26 planning to achieve this are only briefly explained. Some of the information contained within the Annual Quality Assurance Assessment could not be evidenced during the inspection examples include: The Annual Quality Assurance Assessment read‘Monthly visits are carried out by the quality assurance manager and can be found at the home and a copy sent to Commission for Social Care Inspection’ We could not find any evidence to corroborate this statement. When we asked for the Regulation 26 visits there were no reports available in the home since January 2008.We have made a requirement about this. The Annual Quality Assurance Assessment also recorded‘The home is visited by a Director at least twice weekly who will not only give advice and support to the Manager but will discuss issues or concerns with residents, relatives and staff.’ When we spoke with some staff and visitors they said they had not seen the director and questionnaires reflected their views on this: “We need better support from senior management.” “ Support from immediate manager, but no support from senior management.” “ The manager works very hard to keep the home going without the support of higher managers.” “ Senior management need to visit the home more often and take more responsibility.” “ Karen keeps me well informed and supports myself and others, senior management however do not.” The director should seriously consider these views and look at ways to improve communication. It is also still apparent that Karen Betts works on shift alongside care staff and is not afforded the time to complete her managerial duties. On the last few visits we have asked Midland Healthcare to evaluate whether the manager has the time to complete the required managerial tasks, we have had no response. It is again strongly recommended the manager has the necessary time available to fulfil her managerial role. This has been raised on numerous inspection reports but has not been implemented by the director. Dove House DS0000044218.V365057.R01.S.doc Version 5.2 Page 27 The manager is suitably qualified and has nearly completed the Registered Managers Award; this is a qualification all managers in social care need to obtain. The manager now needs to concentrate on person centred planning, evidence still needs to be improved upon around the translating of this theory into practice this will ensure a continual improvement in the outcomes for the people who use the service. The manager ensures there is suitable training available to develop the staff team. Overall staff are competent and knowledgeable to care for the people who use the service. The manager understands the need to focus on the individual, taking account equality and diversity issues, and working in partnership with professionals, families or close friends, as appropriate. The home has a statement of purpose that sets out the aims and objectives of the service. The manager is improving and developing systems that monitor practice and compliance with the care plans and policies and procedures of the home. More work is needed in this area. Staff files and discussions also confirmed supervision is regular. The manger must ensure however they follow their own decision processes, in this instance some staff were not being supervised at the stated required frequencies. We did not need to inspect the finances of the people who use the service because the Annual Quality Assurance Assessment states: “ The majority of services users have their finances managed by their families or by Solicitors etc. Staff do not manage the finances or hold for safe keeping any service users money.” Dove House has recorded individual risk assessments in relation to fire evacuation for all the people who use the service and it includes an emergency contingency plan. Dove House has developed a plan for ultimate evacuation to a place of safety and considered the needs of the people who use the service and the staffing levels. Due consideration has been given to access alternative accommodation and emergency contact numbers. This plan should be reviewed regularly and updated to reflect any changes. Dove House DS0000044218.V365057.R01.S.doc Version 5.2 Page 28 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 2 X 3 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 2 X 2 Dove House DS0000044218.V365057.R01.S.doc Version 5.2 Page 29 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 OP1 Regulation 5)(1)(bb) (bc)(c) Requirement The fees must be included within the Service User Guide so people who use the service know the appropriate cost and what is and isn’t included. The Statement of Purpose needs to include information on the staffs qualifications to offer awareness to people who use the service and prospective users on the training offered by the service. Appropriate information relating to medication must be kept, for example, in risk assessments and care plans to ensure that staff know how to use and monitor all medication including “when required” and “variable dosed” medication to ensure that all medication is administered safely, correctly and as intended by the prescriber to meet individual health needs. Controlled Drugs must be stored in a cabinet that complies with the Misuse of Drugs (Safe Custody) Regulations. The complaints procedure must DS0000044218.V365057.R01.S.doc Timescale for action 18/07/08 2 OP1 4(1)(c) 18/07/08 3 OP9 13(2) 29/07/08 4 OP9 13(2) 29/08/08 5 OP16 22(4) 18/07/08 Page 30 Dove House Version 5.2 6 OP19 23(2) (b)(d) 7 OP33 26(3)(4) offer a timescale so the people who use the service know when to expect a response. Modernisation and decoration of the home is required to provide more suitable and attractive surroundings for the people who use the service. Midland Healthcare Ltd must undertake monthly unannounced Regulation 26 visits. Not completing these means the company is not able to evidence an opinion of, or show how they monitor the standard of care provided at Dove House. 01/09/08 30/06/08 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 OP1 OP9 OP9 OP9 Good Practice Recommendations The home should develop a more user friendly Statement of Purpose and Service User Guide to assist people who use the service with diverse and/or complex needs. The policy and procedures for the handling and administration of medicines are update to include a procedure for all tasks undertaken within the home. The handwritten Medicine Administration Record (MAR) charts mirror the information displayed on the dispensing labels. The receipt of all medication is recorded and the total quantity for each medicine present within the home at the beginning of the month is also recorded prior to the start of the new month. The home should adopt a 28-day month for the ordering, recording and administration of medicines. Written consent to handle and administer medication on the residents’ behalf is obtained for each resident. Where consent is not possible because of lacking capacity, records must be made of the agreement that the way in which medicines are administered is in the best interests DS0000044218.V365057.R01.S.doc Version 5.2 Page 31 5 6 OP9 OP9 Dove House 7 OP9 8 OP9 9 10 11 12 13 OP30 OP33 OP33 OP36 OP38 of that particular person. The temperature of the room where the medication is stored is monitored on a daily basis and if the temperature rises above 25°C appropriate action is taken to prevent this happening. The fridge temperatures are monitored on a daily basis using a maximum and minimum thermometer to ensure that the fridge temperature is maintained at between 2 and 8°C when medication is being stored in the fridge. The home should consider offering staff training in equality and diversity. The home should continue to consider ways in evidencing equality and diversity within their service. The director should seriously consider the views of the staff team and consider ways of improving communication. The manager should ensure they follow their own decision making processes and records when supervising staff. It is again strongly recommended the manager be given the necessary time to fulfil their managerial role. Dove House DS0000044218.V365057.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 House DS0000044218.V365057.R01.S.doc Version 5.2 Page 33 - 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. 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