Inspection on 11/05/06 for Dovecott Care Home

This inspection was carried out on 11th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Dovecott Care Home 28/05/09

Dovecott Care Home 02/12/08

Dovecott Care Home 12/03/08

Dovecott Care Home 29/01/07

Dovecott Care Home 20/01/06

Dovecott Care Home 23/06/05

Dovecott Care Home 27/01/05

Dovecott Care Home 28/06/04

Dovecott Care Home 11/02/04

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Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Dovecott Care Home 83 Weelsby Road Grimsby North East Lincs DN32 0PY Lead Inspector Theresa Bryson Unannounced Inspection 11th May 2006 09:00 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 Dovecott Care Home DS0000002852.V294903.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. Dovecott Care Home DS0000002852.V294903.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Dovecott Care Home Address 83 Weelsby Road Grimsby North East Lincs DN32 0PY 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) 01472 878133 Mr Stuart Peter Farmery Mrs Rita Ethel Farmery Mrs Rita Ethel Farmery Care Home 20 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (20) of places Dovecott Care Home DS0000002852.V294903.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Care plans and risk assessments must reflect the specific needs of the service users accommodated under the category of registration DE (E) and are maintained up to date. 20th January 2006 Date of last inspection Brief Description of the Service: Dovecott provides care for 20 people in the category of old age and dementia. The accommodation is set over two floors. The home has completed a first floor extension providing a further 7 single ensuite rooms and reconfiguration of an existing double bedroom into a single ensuite bedroom. The extension will also provide an assisted shower and a separate Jacuzzi bath. The home is set close to the centre of Grimsby and local parks and other amenities. There is parking to the rear of the building and in side streets next to the home. The owners are developing the garden area and courtyard for service user use. The home has 3 communal areas including a dining room and service users can smoke in a designated area. There are ample toilet and bathroom facilities. Domestic and kitchen staff and a handyman support the care staff. The manager did not give the fee levels within the home on this occasion. The manager did not give any concrete information on how information about the service is available to prospective and current service users. Dovecott Care Home DS0000002852.V294903.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced key inspection and took place over 2 days in May 2006. Prior to the site visit 6 relative surveys were posted out of which 3 were returned. 3 sets of relatives were seen for face-to-face interviews. 4 health professionals’ surveys were posted and 3 returned.4 health professionals were seen for face-to-face interviews and 2 care managers. The local fire officer and environmental officer also completed visits prior to the site visit at the request of the inspector. 2 district nurses were spoken to on the site visit days, 1 set of relatives, 3 staff and 2 people who live in the home. Due to the severity of the mental conditions of the people living in the home it was not possible to interview any more people who live there. 6 people who live in the home’s care records were tracked during the site visit days and 4 personal files of staff tracked. Events in the home which have occurred since April 2005 have also been considered in this report. The manager, Mrs.R.Farmery was present for both site visit days, the part owner, Mr.S.Farmery was present on the second day for the feedback session. The key inspection process was led by Regulation Inspector Mrs.T.Bryson and she was supported on the first day of the site visit by Regulation Manager Mrs.J.Campbell. What the service does well: The staff are friendly and very open in their approach to visitors, which makes for a welcoming atmosphere for service users. The home keeps legible records on service users personal finances, which are open for their next of kin to see, this makes sure they are accurate and money is used for the benefit of the people it is meant for. Dovecott Care Home DS0000002852.V294903.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: The manager does not make the proper checks on staff before they start working at the home to make sure they are right for the job and safe to work with vulnerable people. Once staff have started work they are not properly guided in the beginning or trained to do their job. As part of monitoring staff the manager is meant to provide them with supervision to make sure they have the skills they need and that they are doing it properly. At least one staff member has not had any supervision since starting in November 2005. The others have had a very poor supervision that looks like it is just done as a paper exercise. This has a serious effect on the quality of the care service users get, especially those who need a lot of care. One person said “ I hear care staff shouting, they need more patience” Service users are not properly assessed before they move into the home and are not consulted about the care they need or how they would like it to be given. To help staff look after service users they have to write a plan which describes how each person needs to be looked after and what they enjoy doing. The plans that the home have written are of poor quality and do not guide staff in what the persons actual needs and desires are and are not accurate. One person on the day of the site visit was very poorly and was prescribed controlled medication for the pain. The staff on duty said that nobody was on controlled medication. The medication record showed this had not been given for 48 hours and it was only when the inspector pointed this out that anything was done. The written plan did not mention anything about this pain control being needed. This proves that people are put at risk because their needs are not known by everybody and so are not being given. One service user was seen to hit another one again and again, the member of staff was stood next to them and did nothing. Other examples of poor practice were seen and the manager was told about this. This means people are not protected from abuse and their dignity and respect is not upheld. Service users do not go out in the local community, their social life is poor and only includes things like beauty sessions and entertainers that come in to the home. Nobody is encouraged or takes part in an individual interests or Dovecott Care Home DS0000002852.V294903.R01.S.doc Version 5.1 Page 7 religious activity and we could not find out if people are helped to vote in elections. There is a safe garden for people to use but this does not happen often. The home does not have a formal way of asking the people how they would like the home to be run. At the moment the home seems to run for the convenience of the staff and around the jobs they have to do. One person said “ staff need more time to talk to the people, they are busy concentrating on the jobs they have to do”. All of this means service users become isolated from the local community and are all treated the same. The home that people live in smells unpleasant and is not properly maintained. Some carpets needed replacing because they were so badly stained. Some furniture in the lounges was shabby. The manager could not give us the up to date certificates to prove the environment was safe to live and work in. There are lots of other things that could be done better. We are taking enforcement action. 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. Dovecott Care Home DS0000002852.V294903.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 Dovecott Care Home DS0000002852.V294903.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): 2,3,4 and 6. Quality in the outcome area is poor. This judgment has been made from evidence gathered both during and before the site visit to this service. Service users moving into the home did not have all their needs assessed fully and staff are not properly trained, this could result in people living in the wrong home for their needs. EVIDENCE: It had been confirmed prior to the visit that the local authority of North East Lincs Social Services were funding 16 of the current service users. The manager confirmed that 2 service users were privately funded. Only 1 contract was seen but not all sections had been completed for the privately funded service user. The manager admitted that the second privately funded person’s contract had not been signed. No terms and conditions are given to local authority funded service users. This could result in service users not being fully aware of the provision of care provided and what charges are levied on their care provision. Dovecott Care Home DS0000002852.V294903.R01.S.doc Version 5.1 Page 10 On tracking 6 service users care plans and in discussion prior to the visit with relatives and other health professionals the assessment process had not been fully completed by the home. Sections of the initial assessment tool had not been completed and some relatives stated they were not aware of the actual care being delivered by the home to their loved ones. This has resulted in the home not addressing all the needs of each service user and the inspector having to challenge the care needs of two specific service users. There was insufficient evidence provided to prove that staff have had a broad range of service specific training and this requirement has remained outstanding since the last inspection. Without this training staff will not have the skills to enable them to deliver the correct up to date care methods to service users. The home does not provide intermediate care therefore NMS 6 is not applicable. Dovecott Care Home DS0000002852.V294903.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. Quality in this outcome area is poor. This judgment has been made from evidence gathered both during and before the visit to this service. Service users health and personal care needs are being poorly met as a result of the poor quality of care plans, knowledge and capability of staff.This results in service users being at risk. EVIDENCE: Case Tracking took place for 6 service users. The methodology used was a physical examination of all care plans in the home, written surveys to relatives and health care professionals, discussions with health care professionals, discussions with family members and direct observation on the day and an inspection of each person’s bedroom area. There was a lack of evaluations on most care plan problems seen and the content was difficult to follow and did not on most occasions give a clear instruction to other staff by the writer of the care plan. In most cases the care plan was not being followed by the staff on duty on that day. For example one person was being cared for in bed and we were told by her district nurse that she was prescribed controlled medication for pain relief. When asked staff told the inspector that nobody was on controlled medication and this was not Dovecott Care Home DS0000002852.V294903.R01.S.doc Version 5.1 Page 12 identified on the Medication Administration Record. Examination of the controlled drug book showed the person to have gone 48 hours without this pain relief. The care plan did not identify the pain relief prescribed. Also the care plan did not identify that the person was being nursed in bed, needed frequent turns and an adequate fluid intake. Healthcare professionals have expressed concern that poorly service users may not be getting the fluids they require. The inspector observed on the day that staff were not ensuring the above service user had sufficient fluid intake, despite the district nurse having told us that she had taken a full beaker of juice off her that morning. There was no fluid intake chart and the jug of fluid remained full throughout the day. The turn charts had not been completed for a number of weeks. Health professionals interviewed also stated that staff are given instructions which they clearly do not follow and staff appeared not to be able to follow clear instructions for continence control. There was also a lack of follow through on the written care plans. For example a care plan stated that a person had poor mobility and was generally in a poor state of health, a Waterlow risk assessment had been commenced, but had not been re-evaluated for over a year, yet staff and health professionals confirmed that the service user’s health had deteriorated in that year. A bath book was in use and indicated that service users only had one bath each week, yet several service users had incontinence problems, but staff stated they felt this was sufficient. Baths appeared not to be written on the daily report sheet. The manager was asked to speak to certain staff regarding the content of the daily report sheets in the care plans. Some entries appeared to give very accurate information on the service users day, but others were extremely brief. Relatives also stated that they had visited often, yet this was only spasmodically recorded. Some relatives also stated they were not informed of their loved ones condition or when appointments at hospitals took place and events such as falls had occurred. The recording of these events was again spasmodically recorded in the care notes and the accident policy not always followed through in the documentation seen. The inaccurate recording in care plans is an outstanding requirement from previous inspections and has still not been addressed by the manager. In 3 of the 6 care plans the manager had included an audit sheet for her own checking purposes. This was just a list of dates with the manager’s signature. No comments were included. In the care plans seen there were significant errors, so the inspector had to question with the manager and the other part owner the knowledge base of the manager. It was suggested that the manager needed to have some up date training in the writing of care plans to enable her to effectively audit the process. Dovecott Care Home DS0000002852.V294903.R01.S.doc Version 5.1 Page 13 Due to insufficient recorded evidence in the care plans and information described by other health care professionals two service users were referred to the local authority for a reassessment of their needs in this home. It was also necessary during the course of the first day to issue an immediate requirements notice for the maladministration of drugs. The drug administration sheets were incorrectly transcribed and the staff had failed to administer some pain relief to one service user and she had been without suitable medication for over 48hours. This was rectified on the day and the manager asked to conduct an investigation as to how this had happened. On speaking to one senior care staff she did not appear to understand the importance of this and although having completed a safe handling of medicines course this knowledge had not been consumed. The inspector and Regulation manager also directly observed on the day some poor care practises taking place by staff. This included a poorly service user, being cared for in her room in isolation, a care staff member did not speak at all to the service user or offer any words of encouragement to eat her lunch. It appeared to be just a task just to perform. Another situation was observed where one male service user assaulted another disabled service user repeatedly, the senior care staff member was stood next to them and did nothing despite there being a care plan to monitor one persons challenging behaviour. The same member of staff had also had had challenging behaviour and aggression management training. Another health care professional also informed and showed the inspector where dirty dressings had been placed on clean ones in a service users room, which she stated was not the first time she had had to remind staff of this practise. The manager was informed at the feed back session that the care staff need better training and observation of their care practises through direct supervision and that the records need to show that all the care needs of service users were being met. Serious concerns had been raised about two service users. Dovecott Care Home DS0000002852.V294903.R01.S.doc Version 5.1 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Service users social inclusion is limited to basic and repeated activities within the home but on frequent occasion even denies them basic social interaction with staff going about their work. No account is taken of individual preferences. The dietary needs were not being met due to poor menu planning and insufficient training of staff. EVIDENCE: Of the 6 care plans tracked there was insufficient evidence to support that their social needs had been adequately assessed and very little evidence to support what activities had taken place and the service users participation in those events. Activities in the diary kept for that purpose predominately recorded beauty and hairdressing or entertainers. There was little recorded evidence that a good choice of activities were on offer and no physical evidence seen in the home. The manager had admitted at a previous meeting with CSCI officers that she Dovecott Care Home DS0000002852.V294903.R01.S.doc Version 5.1 Page 15 did not understand how to survey the dementia category service users in her home and relatives stated they had not been included in such discussions. One relative was particularly concerned about the level of stimulation in the home for his loved one. The kitchen was only briefly visited as the local Environmental Health Officer had completed a visit prior to the site visit. His comments were fed back to the manager. His concerns were around the cleanliness of the kitchen, which the manager assured the inspector were being addressed. Other visitors to the home had stated to the inspector they are frequently offered tea in dirty cups and handed biscuits from someone’s hand. Poor food hygiene practises could lead to service users and visitors being put at risk from infection. The Regulation manager sampled a meal and the inspector a sandwich snack as part of the site visit. The Regulation manager reported to the manager that the meat was fatty and had several bones. The manager reported that this would not have been the case if it had been for a service user. The bread for the sandwiches was very dry. The menus seen are on a cyclical basis, but except breakfast there is little choice during the day. Although the manager stated that after tea the service users have supper of biscuits and horlicks this was not mentioned on the menu planning. Fluids are provided at set times during the day, one service user was heard to ask for a cup of tea and was told he would get one soon as it was nearly time. The concerns regarding the provision of frequent fluids has already been referred to in the previous section. The manager needs to ensure that staff are aware of how to assist service users with their nutritional needs, call on the advice of a dietician and monitor the specific needs of those service users with particular dietary problems to ensure all needs are being met. Dovecott Care Home DS0000002852.V294903.R01.S.doc Version 5.1 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17 and 18. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The home does not have a robust system in place to ensure that service users are protected from abuse and staff fail to deal with abusive situations. EVIDENCE: Relatives and health professionals spoken to prior to the site visit stated they had never seen the complaints procedure. The manager had the complaints procedure on display in her office, but it was partially covered by other material. She stated she could not have this on display due to the nature of some service users taking items off walls. An alternative method was suggested. Since the last inspection one complaint had been received directly to CSCI, which was partially upheld. The local authority protection of vulnerable adults team had also received 3 complaints, which were the subject of on going investigation. All were received within a six-month period. The manager stated she does not keep a complaints log even though several have now been notified to her. Complaints are not received by the home as a learning curve, an opportunity for improvement, their response to the 4 recent complaints was defensive and there was evidence that areas of concern were not being addressed or passed Dovecott Care Home DS0000002852.V294903.R01.S.doc Version 5.1 Page 17 on to staff. This could result in service users being put at risk from mistakes not being rectified. The policy manual regarding the procedure to allow service users to exercise their legal and civic rights had still not been up dated and no evidence was produced to show that all permanent service users are included on the local electoral role. The tracking of 4 staff personal files showed errors which had been made regarding checking their recruitment details. After the last inspection an immediate requirements notice had been issued concerning having Criminal Investigation Bureau checks in place prior to employment. Where convictions/cautions appeared on CRB returns, the manager had failed to take appropriate action to monitor . References are not taken up prior to employment and when they are obtained they are not scrutinised for their authenticity and serious flaws were not identified. Failure to ensure all staff have the correct checks in place prior to employment could put service users at risk from abuse. Dovecott Care Home DS0000002852.V294903.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The home could not produce sufficient evidence to show that the home was being adequately maintained and safe for the use of service users, staff and visitors. EVIDENCE: The manager accompanied the inspector on a tour of the home and the inspector and Regulation manager also toured sections of the home unaccompanied on the first day. Prior to the site visit on a previous meeting with the manager and partial owner a brief renewal and maintenance programme had been submitted. This was re – presented on this site visit and some items had not been completed on schedule and the fuller schedule had not been submitted as promised. This requirement will remain outstanding from the last inspection. Dovecott Care Home DS0000002852.V294903.R01.S.doc Version 5.1 Page 19 The fire officer had completed a major audit prior to this site visit and had issued a default letter for major work, which still needed to be completed. This included the checking of fire doors, a risk assessment in place and an evacuation plan. Most of this work has not been completed which could put service users; staff and visitors at risk from inadequate fire precautions being in place. Health professionals and visitors to the home had stated verbally to the inspector how at times the home smelt of urine. There was a general musty smell on the day of the site visit and one of stale incontinence around the entrance and lounge areas. One carpet had been replaced on one service users room since the last visit. Some verbal comments were also received that at times the home appears dirty and unkempt and staff had opened the door smoking and smoked in the dining area, which potentially was a fire risk and health hazard. The manager has now put a new smoking policy in place, which on the visit days staff appeared to be adhering too. The requirement to combat odorous smells still remains from the previous inspection, there was no evidence to support that polices are in place to ensure staff remain on top of the problem. Radiator covers have now been installed on all unprotected radiators, although still needing painting. The top lift lobby area remains bare plaster and has remained in this state for over a year. Some areas of the home are still looking tired and require to be on the maintenance programme. This includes renewal of carpets and some furniture. On the second day of the site visit the electrical cupboard was unlocked, which the fire officer had specifically asked to be kept locked and no adequate explanation could be given. This could put service users at risk of electrocution and is a fire hazard. Dovecott Care Home DS0000002852.V294903.R01.S.doc Version 5.1 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. Quality in this outcome area is poor. This judgment has been made from evidence gathered both during and before the visit to this service. The home does not have a robust recruitment policy in place and there was insufficient evidence to support that staff have been adequately trained. Putting service users at risk from abuse and from ill equipped staff. EVIDENCE: 4 staff personal files were tracked in depth. Errors were found on some records. This could result in staff being employed who are not suitable for working with vulnerable people. After the last inspection an immediate requirements notice was issued concerning the Criminal Investigation Bureau checks of 2 staff which had not been obtained prior to their employment. Where significant issues have arisen on CRB checks the manager had failed to undertake a risk assessment until asked to do so. Despite having a risk assessment which required weekly monitoring, there had been none and induction and supervision had not taken place since the persons start date several months prior. References are not taken up prior to employment and when they are obtained they are not scrutinised for their authenticity and serious flaws were not identified. For example two duplicate references which had been obtained after employment had commenced had starkly different signatures, this had not Dovecott Care Home DS0000002852.V294903.R01.S.doc Version 5.1 Page 21 been noticed by the home manger. Another file contained a copy of a reference “to whom it may concern” which was dated 12th October 2005, the start date of the person was the 5th November 2004. The 2005 date had been typexed and handwritten over and upon close examination of the facts contained within it and of the persons C.V it was clear it had been written when employment ceased in 2001. This had not been noticed by the manager. The training records did not show any recent NVQ training had taken place and that sufficient statutory training and service specific training had been recorded. Some staff spoken to stated they had not had any induction and no further training since being employed. No induction records were on file for newly recruited staff. One staff member when asked to confirm what training they had had in the last twelve months could not offer one suggestion saying “I can’t remember we have so much” This could put service users at risk from inadequately equipped staff trying to attend to their needs. Health professionals have raised concerns about the knowledge base of some staff and their ability to carry out simple clear instructions like not disposing of soiled wound dressings on top of clean dressing packs. Whilst some training has been provided it is of concern that it does not extend into practice, for example the instance of assault described previously. Healthcare professionals have also expressed concern at the number of skin tears they are asked to attend to and that they had observed poor care practices in moving and handling. On the second day of the site visit the inspector was called by the district nurse to look at the legs of one service user which showed an alarming amount of scar tissue resulting from continual skin tears. One of the home owners provides staff with moving and handling training, however there is no evidence that he is trained as a trainer. Staff were observed to wear a lot of jewellery whilst caring for service users. Dovecott Care Home DS0000002852.V294903.R01.S.doc Version 5.1 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36 and 38. Quality in this outcome area is poor. This judgment has been made from evidence gathered both during and before the visit to this service. Service users live in a home where the management and administration systems have raised grave concerns about the ability to care for vulnerable people EVIDENCE: The manager was able to produce a letter to state she has now enrolled on the Registered Manager’s Award, but does not have a start date. There was no evidence to support that she has attended other courses or kept herself up to date in all aspects of running the home. From this inspection it is apparent that the manager is failing to fulfil her responsibilities and appears to not understand what is expected of her. The quality of the care plans, supervision records and recruitment practices have raised grave concerns about her understanding of ensuring service users are looked after and safe. Dovecott Care Home DS0000002852.V294903.R01.S.doc Version 5.1 Page 23 Supervision records were not available for inspection in the home, merely a supervision log. The manager was asked to produce the four records of those staff tracked. One had not had any supervision since starting in November 2005, some were not dated, some dates did not tally with the logs and some did not have an employees signature. In addition the quality of the supervision record was poor providing an average of four hand written lines per supervision. The content of the supervision record did not cover any of the areas identified in the NMS. No evidence was seen that service users are consulted about the home and their needs. Several relatives stated verbally that they are not consulted on daily matters of service users. One couple said they were pleased with the quality of care their mother received. There was no evidence to support that regular staff meetings are held to ensure staff are kept up to date on the running of the home however one staff member did say they had had one in the last five months. The manager stated she has not commenced a quality assurance programme so there were no records to check against NMS 32 and 33. The requirements will remain outstanding from the last inspection. A bank manager’s letter had been received by the inspector stating the home is financially sound. The owners/manager have yet to submit a new business plan and initial financial plan. Concerns were raised by one of the owners that due to the Local Authority blocking placements and the effect of the recent complaints on the homes reputation that this could result in financial uncertainty. A folder of maintenance certificates was provided, however a number of these were old and did not accurately compare with the dates on some equipment. The personal allowance records were checked of the service users recorded tracked in other parts of this report. A small discrepancy was found on 2, which was found before the end of the visit. The manager was reminded that accurate records must always be kept. The policy manual was checked and still does not cover all aspects of running the home or give clear instruction to staff over some issues. Failure to complete this record of evidence could result in service users being put at risk from a poorly run home, which is not safe to live and work in. The part owner, Mr.S.Farmery was present for the feedback session on the second visit day; he appeared to have a better understanding of the running of the home and was very co-operative to the inspector. He also made some positive suggestions to move the home forward. Dovecott Care Home DS0000002852.V294903.R01.S.doc Version 5.1 Page 24 Dovecott Care Home DS0000002852.V294903.R01.S.doc Version 5.1 Page 25 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 1 1 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 1 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 1 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 2 3 1 X 1 Dovecott Care Home DS0000002852.V294903.R01.S.doc Version 5.1 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2 Standard OP2 OP7 Regulation 5.1.c. 13.1.b and 15.2. Requirement The registered person must ensure that all service users have a valid contract in place. The registered person must ensure that all care plans show accurate recording, where advice has been sought from other health professionals and are audited by the manager. (Previous time scale of 28/02/06 not met). The registered person must ensure that all drug administration records are accurate and all medication is given as prescribed. The registered person must ensure that all staff have been trained to show dignity and respect to service users. The registered person must ensure that all service users have adequate social needs assessments completed and there is evidence to support what social activities have taken place. The registered person must DS0000002852.V294903.R01.S.doc Timescale for action 25/08/06 25/08/06 3. OP9 13.2. 25/08/06 4. OP10 12.4.a.. 08/09/06 5. OP12 16.2.m.n. and 16.3. 25/08/06 6. OP13 16.2.m.n. 25/08/06 Page 27 Dovecott Care Home Version 5.1 and 16.3. 7. OP16 22.1. 8. OP17 16.2.m. ensure that all service users have access to community services and activities and this can be evidenced. The registered person must ensure that the complaints procedure is on display and all parties using the home are aware of its content. The registered person must ensure that service users can exercise their legal and civic rights and the correct polices are in place. (Previous time scale of 30/03/06 not met). 08/09/06 25/08/06 9. OP19 23.2.b. The registered person must 08/09/06 produce a planned programme of maintenance and renewal. This to include replacement carpets and furniture. (Previous time scale of 28/02/06 not met). The registered person must ensure that the home is free from odorous smells and put a system in place to combat problem areas. (Previous time scale of 30/03/06 not met). The registered person must provide evidence of the consultations with the service users and staff on the development of the home and the services provided. (Previous time scale of 01/05/05 not met and 30/03/06 not met). The registered person must develop a system to monitor the quality of care provided and provide a report to service users DS0000002852.V294903.R01.S.doc 10. OP26 16.2.k. 08/09/06 11. OP32 21.1. 08/09/06 12. OP33 24.1.a, b. 08/09/06 Dovecott Care Home Version 5.1 Page 28 and the CSCI. (Previous time scale of 01/05/05 not met and 30/03/06 not met). 13. OP34 25.1. The registered person must complete a business and financial plan, which is open for inspection. (Previous time scale of 01/05/05 and 20/01/06 and 28/02/06 not met). The registered person must develop and review all policies and procedures relating to safe working practises in line with relevant legislation particularly food hygiene. (Previous timescale of 01/04/05 not met and 30/03/06 not met). The registered person must ensure that all adequate fire precautions are maintained through out the home. (Previous time scale of 28/02/06 not met). The registered person must ensure that all accident records are correctly recorded and audited on a regular basis and assistance sought from other health professionals where necessary. (Previous time scale of 28/02/06 not met). The registered person must ensure that all certificates for equipment and maintenance of the building are in place and open for inspection. DS0000002852.V294903.R01.S.doc 08/09/06 14. OP38 12.1.a, b. 08/09/06 15. OP38 23.4.a. 08/09/06 16. OP38 13.1.b. and 13.6. 25/08/06 17. OP38 23.2.a. 08/09/06 Dovecott Care Home Version 5.1 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP28 Good Practice Recommendations The manager must pursue NVQ level 2 training for care staff. Dovecott Care Home DS0000002852.V294903.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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