CARE HOMES FOR OLDER PEOPLE
Dovehaven House 58 Moss Road Birkdale Southport Lancashire PR8 4JG Lead Inspector
Val Turley Unannounced Inspection 21st March 2006 10:45 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 Dovehaven House DS0000005973.V279395.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. Dovehaven House DS0000005973.V279395.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Dovehaven House Address 58 Moss Road Birkdale Southport Lancashire PR8 4JG 01704 564259 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) Mr Mark Jonathan Gilbert Mrs Wendy Josephine Gilbert Mr Peter Andrew Brookfield Care Home 40 Category(ies) of Dementia - over 65 years of age (40) registration, with number of places Dovehaven House DS0000005973.V279395.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 16th September 2005 Brief Description of the Service: Dovehaven house is situated in the village of Birkdale with Southport town centre and all its amenities being a short drive away. The home provides 24hour personal care for up to 40 older people who have a dementia related condition. The home has been designed to provide care on two separate units, each of which has its own lounge and dining areas. The home has a passenger lift to the first floor. Single room accommodation is provided for all service users. Of the forty rooms, thirty have en-suite facilities. Security is a prime concern at the home. There is a secure internal courtyard with a lawned area and flowerbeds and a garden area to the rear of the home. Dovehaven House DS0000005973.V279395.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over one day in March 2006 by one regulatory inspector. The inspection involved discussion with and observation of the staff working at the home, an examination of records, policies and procedures and a tour of the premises. What the service does well: What has improved since the last inspection?
Since the last inspection the care plans had been developed to provide a more person centred approach and included the preferred routines, likes and dislikes of the individual service users as well as their interests and hobbies. There had been an increase in the numbers of staff, who were on duty at the weekend to ensure that appropriate medication dosing intervals were maintained.
Dovehaven House DS0000005973.V279395.R01.S.doc Version 5.1 Page 6 The home no longer held any large sums of money on behalf of service users with families or advocates taking on the responsibility of managing service users finances. The policy in respect of the management of challenging behaviour had been reviewed and updated making it clear that a multi-disciplinary approach must be adopted in respect to the use of restraint. Training opportunities for staff had been greatly increased and a large proportion of staff had enrolled on NVQ courses. Staff were also now paid for at least three days of training a year. The recruitment procedures at the home had also improved with all relevant checks being undertaken prior to a member of staff being appointed. The manager had made concerted efforts to ensure that staff received supervision on a one to one basis six times a year. What they could do better: 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. Dovehaven House DS0000005973.V279395.R01.S.doc Version 5.1 Page 7 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 Dovehaven House DS0000005973.V279395.R01.S.doc Version 5.1 Page 8 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): 3 The pre-admission process was in sufficient detail to ensure that prospective service users supports needs are fully assessed before admission. EVIDENCE: The file of one recently admitted service user was examined. A pre-admission assessment covered all of the details as included in the National Minimum Standard and gave a good overview of the service users support needs including the hobbies and interests of the service user and their preferences in food and drinks. A plan of care had been developed based on the information collected during the pre-assessment process and this informed staff of the support the service user needed. Dovehaven House DS0000005973.V279395.R01.S.doc Version 5.1 Page 9 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): 7,9 and 10 Care plans are detailed and personalised to help ensure that staff are able to provide appropriate support to service users. The medication in the home is managed safely for the benefit of the service user EVIDENCE: Standard 7 was partly assessed at this inspection. Recommendations made at the previous inspection had been acted upon. The care plan examined had been reviewed on a monthly basis to ensure that the changing needs of the service user were being addressed. Since the last inspection the plans had become more person centred providing support staff with information of the service users preferred routines and likes and dislikes. Staff had been supported by the senior staff to develop the care plans in the required detail. Standard 9 was also partly assessed. A requirement made at the previous inspection had been acted upon and there was evidence on the staff rotas that there were always sufficient numbers of trained staff on duty to administer the medication and thereby ensure that appropriate medication dosing intervals were maintained. On the day of the inspection support staff were seen to treat service users with respect and to converse with them appropriately. Service users were
Dovehaven House DS0000005973.V279395.R01.S.doc Version 5.1 Page 10 comfortable in the presence of the staff and were observed to approach them for support and guidance. A relative of a service user wrote that the staff treated her father as an individual and with respect. Dovehaven House DS0000005973.V279395.R01.S.doc Version 5.1 Page 11 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, 14 and 15 The routines within the home were flexible and took into account the service users preferred routines and individual choices. EVIDENCE: Routines within the home were flexible with service user being supported to make decisions as to how they wished to spend their day. The care plans also contained detail as to the service users preferred routines in terms of their daily routines. There was evidence within the home that trips out were arranged for the service users. Information regarding these was made available for visitors giving them an opportunity to discuss the outings with service users. The interests and hobbies of service users were recorded within the care plans allowing staff to support them to follow these. Discussion took place with the manager regarding the challenge of providing suitable activities for all of the service users and the work his staff undertook to organise activities. Service users bedrooms were personalised with belongings the service users had brought into the home with them. None of the service users managed their own finances and apart from the home holding small amounts of money for each of the service users, the responsibility for managing the finances of the service users was left with relatives. The manager stated that one manager had the services of an advocate to provide support with financial matters. Information regarding the local advocacy service was available within the home within the service users guide and on the notice board.
Dovehaven House DS0000005973.V279395.R01.S.doc Version 5.1 Page 12 Discussion with the cook at the home indicated that the preferences of the service users were taken into account when deciding upon menus. The cook stated that she was personally aware of each of the service users likes and dislikes and that if ever she was not on duty then another member of staff with the same knowledge would take on the responsibility of providing meals. A record was kept of any specific dietary requirements the service users had. Care plans included details of any specific support the service users may need at meal times. A record of service users weights was kept and used as a means of monitoring the general health of the service users. Dovehaven House DS0000005973.V279395.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The home had good policies and procedures in place in order to protect service users. EVIDENCE: Standard 18 was partly assessed at this inspection. A recommendation made at the last inspection had been acted upon. The homes policy that addressed the management of challenging behaviour had been amended and now included additional guidance for staff regarding the needs to adopt a multi disciplinary approach in respect to the use of restraint. This standard has now been fully met. Dovehaven House DS0000005973.V279395.R01.S.doc Version 5.1 Page 14 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 The home was clean and comfortable and provided a pleasant environment for both the service users and support staff. Some work was required to ensure the safety of the service users in terms of fire prevention. EVIDENCE: The home was well maintained providing service users with a comfortable and homely environment. The home employed a maintenance man and this ensured that any minor repairs could be attended to quickly. The home was in the process of being redecorated at the time of the inspection. A recent visit by the fire service had identified some work the home needed to undertake to ensure the safety of the service user in terms of fire prevention. There was evidence that these issues were being addressed. The manager was required to inform the Commission for Social Care Inspection in writing when the required work was completed Dovehaven House DS0000005973.V279395.R01.S.doc Version 5.1 Page 15 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 The staff team were provided with a range of training opportunities enabling them to extend their skills and knowledge. The staffing levels at night needed to be reviewed to ensure the safety of the service users. The home recruitment policy and procedure was generally robust, with a view to protecting service users, although some improvements could be made to protect service users further still. EVIDENCE: The staffing levels at the home were discussed with the manager. In general terms the manager felt that there were sufficient numbers of staff on duty during the day. He also had the authority to increase the staff numbers when the needs of the service users increased. The inspector noted that there were only three members of staff on waking watch at night. Bearing in mind the numbers and needs of the service users plus the lay out of the building there was concern that the safety and well being of the service users may be at risk at night. It was required that the manager review the staffing levels at night based on the likely needs of the service users resident at the home. Since the last inspection there had been an improvement in the training opportunities offered to staff and although the home was still working towards 50 of the staff team achieving a relevant care qualification, over 75 of the staff had been enrolled on an NVQ course. Additionally the home had signed up to a staff-training programme, which provided additional training opportunities including mandatory training. There was evidence that staff had signed up for these. Staff received at least three days training a year for which they were paid.
Dovehaven House DS0000005973.V279395.R01.S.doc Version 5.1 Page 16 A relative of s service user wrote that that the staff were professional and provided an excellent standard of care. Another relative wrote that the staff did a great job. The files of two members of staff were examined and it was noted that the home had robust recruitment policies and procedures in place with the relevant checks being undertaken, ensuring as far as possible the safety of the service users at the home. It was however required that the home obtain references directly from referees to guarantee their authenticity. Dovehaven House DS0000005973.V279395.R01.S.doc Version 5.1 Page 17 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, 33, 35, 36 and 38 The manager was experienced and qualified and was able to ensure that the home was well maintained and that staff had received appropriate training to maintain the health, safety and welfare of the service users. Further efforts should be made to ensure that staff receive training in specific areas and receive appropriate supervision. The homes quality assurance processes should be extended to ensure as far as possible that the home is run in the best interest of the service users. EVIDENCE: The registered manager at the home had been in post for seven years and has achieved an NVQ 4 in care and management. There was evidence available to indicate that he had undertaken and planned to undertake additional training to update his skills. The home had a number of quality monitoring systems in place to ensure that the service provided met the needs of the service users. The home had achieved a four star Residential and Domiciliary Benchmark rating which is a quality assurance award accredited by an outside body. The senior staff in the
Dovehaven House DS0000005973.V279395.R01.S.doc Version 5.1 Page 18 home undertook a number of audits within the home including monthly checks on care plans and a monthly medication audit. Policies and procedures were updated as necessary and any requirements and recommendations made through the inspection process are acted upon. At the time of the inspection the home was in the process of canvassing the views of service users families and friends in respect of the service provided by the home. The manager stated that it was his intention to display the results of the survey on the homes notice board once it is completed. It was recommended that the views of professionals involved in the service are also sought with a view to acting on any issues raised. Standard 35 was partly assessed at this inspection. A requirement made at the previous inspection had been acted upon. The manager stated that the home no longer held large sums of monies on behalf of service users and that the responsibility of managing service users monies now rested with families. A requirement was made at the last inspection with regard to the supervision of staff. There was evidence in place to indicate that the manager had made concerted efforts to ensure that the staff team received supervision on a one to one basis six times a year from either himself or the deputy manager. Supervision sessions had been arranged for the year and there was evidence on staff files that some of these had taken place. The manager stated that he found the supervision process to be positive but had found it very difficult to ensure that supervision was undertaken as planned because of the constraints on his and the deputy managers time. Other options regarding the supervision of staff were discussed although the manager considered that they were limited at this point in time and that he preferred to persevere with the current approach. Records in relation to safe working practices and the maintenance of the home were examined. Relevant training in health and safety matters were provided for all staff although there was a need to ensure that first aid training was updated for some staff. Risk assessments had been updated as required. Equipment and systems were serviced at appropriate intervals and the security of the home was maintained taking into consideration the needs of the service users. All accidents and incidents were recorded appropriately. Dovehaven House DS0000005973.V279395.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 X X X X X X X STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 Dovehaven House DS0000005973.V279395.R01.S.doc Version 5.1 Page 20 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 OP19 Regulation 23(4)(a) Requirement The registered manager must forward evidence to the Commission for Social Care Inspection that indicates that the issues identified by the fire service have been addressed appropriately. The registered person must ensure that there are sufficient numbers of suitably qualified staff on duty during the night The registered must ensure as far as possible that references for prospective employees are authentic. The registered person must continue to work towards providing appropriate supervision for all staff working at the home. The registered person must ensure that suitable arrangements are made for refresher training for staff in first aid. Timescale for action 30/06/06 2 OP27 18(a) 31/05/06 3. OP29 19(4)(c) 30/04/06 4. OP36 18(2) 30/06/06 5. OP38 13(4) 30/06/06 Dovehaven House DS0000005973.V279395.R01.S.doc Version 5.1 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP28 OP33 Good Practice Recommendations The home should continue working towards 50 of its staff achieve a relevant qualification in care. The views of health and social care professionals involved in the home should be sought. Dovehaven House DS0000005973.V279395.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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