CARE HOMES FOR OLDER PEOPLE
Dovehaven Nursing Home 9 - 11 Alexandra Road Southport Merseyside PR9 0NB Lead Inspector
Mrs Claire Lee Unannounced Inspection 30 September 2005
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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 Nursing Home DS0000017231.V248974.R01.S.doc Version 5.0 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 Nursing Home DS0000017231.V248974.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Dovehaven Nursing Home Address 9 - 11 Alexandra Road Southport Merseyside PR9 0NB 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) 01704 530121 Mr Mark J Gilbert Mrs Wendy J Gilbert Mrs Joanne Elizabeth Hart Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Dovehaven Nursing Home DS0000017231.V248974.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service users to include up to 40 OP 1 named out of category service user under pensionable age Date of last inspection 11th January 2005 Brief Description of the Service: Dovehaven is a Care Home providing nursing care and accommodation for 40 older residents. The home comprises of 2 large houses that have been joined together and converted in to a care home. It is situated in a residential area of Southport close to local amenities and public transport. Mr and Mrs Mark Gilbert are the registered providers and the registered manager is Mrs Joanne Hart. There are 25 single rooms and 4 double rooms; a double room was recently converted in to 2 single rooms. A number of bedrooms have an ensuite facility and the home is equipped with bathing aids to assist those residents who are less independent. The home has 4 bedrooms situated on a mezzanine level (a floor not accessible by passenger lift) and therefore a detailed assessment of need is undertaken by the home prior to placing residents in these rooms. One mezzanine level has the use of a chair lift and all other areas are accessed by stairs or passenger lift. Residents have the use of 2 dining rooms, a lounge and conservatory; these rooms are pleasantly decorated with comfortable furniture. The conservatory overlooks a spacious landscaped rear garden and there is ample car parking space to the front. Ramps are available for wheelchair access. Dovehaven Nursing Home DS0000017231.V248974.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 7 hours. It was an unannounced visit and conducted as part of the regulatory requirement for care homes to be inspected at least twice a year. Visits have been conducted earlier this year in response to several complaints received. A partial tour of the premises took place and a number of care, staff and general nursing home files were seen. The manager, 3 staff members, 6 of the 36 residents and 1 relative were spoken with during the visit and their views obtained of the home. Satisfaction cards were also left to enable residents and relatives to comment on the service provided. What the service does well:
Residents and relatives spoken with were complimentary regarding the home and the caring approach by staff. Residents felt that staff were concerned about their welfare and the manager led a good team of staff. Residents appeared comfortable and were receiving a good standard of personal care. Staff were seen offering assistance to residents in a polite manner and also spending time with visitors. A resident reported, “The staff are very good, they do look after you.” The home had a friendly atmosphere and residents confirmed that they could choose what time to get up or retire at night. The routine is based around the resident’s needs and wishes. The manager completes assessments prior to residents arriving at the home and this information assists staff when drawing up the plan of care. Care files identified health needs and there was good evidence of residents being referred to outside health professionals when needed. The standard of meals in the home was generally reckoned to be good and residents spoken with were pleased with the presentation and choice of food. Colour schemes throughout the building are attractive and bathrooms have a good standard of equipment to assist residents who are less independent. A resident said, “I think the home is beautiful, I love it here.” Dovehaven Nursing Home DS0000017231.V248974.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
Menus should provide details of the choice of meals available for residents and should be extended to cover a 3-4 week period to provide less repetition. The chef should complete risk assessments for the control and management of food in the home. Details of care practices should be recorded in care files only and not be displayed in residents’ rooms as this has the potential to comprise residents’ privacy and dignity. General cleaning and some maintenance work is required to ensure the environment is kept comfortable and safe for the residents. The requirements are listed in the main report. Appropriate storage space must also be found for wheelchairs as these are currently being stored in bathrooms. Dovehaven Nursing Home DS0000017231.V248974.R01.S.doc Version 5.0 Page 7 With regards to recruitment, 4 new staff have commenced work without being cleared in terms of the required check that must be made by home to ensure that staff are fit and safe. An Immediate Requirement notice was made that all staff must not commence work without a clear check being received from the Protection Of Vulnerable Adults register (POVA). A CRB (Criminal Record Bureau) disclosure is also required for staff. The home has an ongoing training programme however this must include all areas of safe working practice to ensure staff are competent in their role. 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 Nursing Home DS0000017231.V248974.R01.S.doc Version 5.0 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 Dovehaven Nursing Home DS0000017231.V248974.R01.S.doc Version 5.0 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): 3 Residents’ needs are assessed prior to and during the early stages of admission. This ensures that the home is capable of caring for and meeting their individual needs. EVIDENCE: Assessments are carried out to assess care needs and identify how staff will care for the residents. Assessment documentation was seen for 4 residents; this included assessments for 2 residents who had recently arrived and 2 who had been resident for some time. The information had been completed in good detail and included areas such as nutrition, skin care, previous medical and social history and mobility. One file did not list strength and dosage time of current medicines however this information was evidenced in other care documentation. Assessments from hospital and social services were viewed and the information received had assisted staff with drawing up the plan of care. Dovehaven Nursing Home DS0000017231.V248974.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 and 10 Residents’ health, personal and social care needs are recorded in care plans. This ensures staff can meet their individual needs and provide a good standard of care in the home. General care was provided in a sensitive and respectful manner thus maintaining the privacy and dignity of the residents. EVIDENCE: Residents have an individual plan of care, which is easy to read and understand. Residents and/or a representative are asked for their agreement to their plan of care and this was evidenced in care files seen. This consent had not been obtained for the more recent admissions however the manager was looking to obtain this as soon as possible. Care plans for 4 residents were viewed and these identified individual needs and key areas such as nutrition, mobility, pressure area care, sleep, history of falls, hearing, sight and oral care. The care plans had been reviewed on a regular basis to ensure the information was accurate however one file did not reflect dietary changes that had been noted in the daily report. Information was recorded in good detail regarding assistance with walking/transferring and assessing any areas of the skin that may be at risk. Risk assessments identify any potential risk to the
Dovehaven Nursing Home DS0000017231.V248974.R01.S.doc Version 5.0 Page 11 resident and the use of bed rails is also stated in the plan of care. The home has a good supply of equipment to assist those who are less able, including mattresses, cushions and manual handling hoists. Residents can see their own GP any time and evidence of other health professionals visiting, for example, physiotherapist, chiropodist, speech/language therapist and tissue viability nurse for wound care were recorded. Wound care evidenced current treatments and progress of the affected areas. Staff were observed offering a good level of support to residents with walking and other aspects of personal care. Many residents were being nursed in bed and they appeared very comfortable. Care was seen to be given in a polite and sensitive manner and a male member of staff stated that respect for residents’ individual needs and wishes had been discussed during his induction by the manager. Whilst touring the home it was noted that written instructions to staff regarding certain care practices were evident above residents’ beds. This may compromise the dignity, privacy and confidentiality of residents. Care details should be kept in care files. Residents interviewed were pleased with the standard of care and the general approach by the staff. Comments included, “The staff do look after you”, “I am encouraged to maintain my independence and I try to do as much as I can for myself.” “The staff are very kind and friendly. They always make me feel comfortable when they help me with my personal care.” One resident was concerned regarding transfer procedures carried out by the staff when using the hoist and this was brought to the manager’s attention. It was agreed that the home’s physiotherapist would review the procedure. Senior staff are assigned the role of key worker (a role with extra responsibilities) and through discussion it was evident the good understanding they had of the residents’ care needs. Dovehaven Nursing Home DS0000017231.V248974.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 and 15 The home had a pleasant sociable atmosphere and the routine for the resident is based round individual need and wishes. The menu was nutritious thus ensuring residents receive a well balanced choice of meals. EVIDENCE: The home had a friendly relaxed atmosphere and although many residents require a great deal of assistance due to their frailty the lounge on the first enables resident to get together, watch TV or meet visitors. Activities are arranged on an informal basis however the home does have a minibus for hospital appointments and excursions. Visitors were seen popping in at various times and a relative who visits every day was complimentary regarding the good communication that exists in the home and the very friendly nature of the staff. Another visitor reported, “It is always the same when you come in, the staff are helpful and very kind.” The menu is currently based over 2 weeks and consideration should be given to increasing this to 3-4 weeks to avoid frequent repetition. Residents confirmed that they are offered a choice at mealtimes however this choice should be stated on the menu for residents to see. The kitchen was tidy with evidence of a cleaning rota. It was noted that a fly screen was raised with the kitchen window open, this could present as a health and safety risk in what is a
Dovehaven Nursing Home DS0000017231.V248974.R01.S.doc Version 5.0 Page 13 food preparation area. Although meals were served at set times arrangements were flexible to accommodate individual needs. Overall, residents spoken with complimented the quality of the food provided. Comments included, “On the whole the food provided is good. You get a choice for dinner and tea.” “The meals are perfect, you can have what you want.” Residents can have their meals in their room or in the dining room however staff reported that on occasions it is difficult to keep warm due to the layout of the home. Fridge, freezer and hot food temperatures were recorded but there was no risk assessment for control and management of food in the home. Dovehaven Nursing Home DS0000017231.V248974.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The home has a complaint procedure. Complaints are handled properly to provide residents with confidence that their concerns will be listened to, taken seriously and acted upon. EVIDENCE: The complaint procedure states the address of the local Commission office and a summary of the procedure was on display in the home. The Commission have been involved with several complaints following the last inspection in January 2005. An adult protection case has been resolved to the satisfaction of all parties. All complaint are logged and records indicate the outcome of any investigation undertaken by the home. A resident interviewed was unaware of the complaint procedure however reported that if she had a concern her family would bring it to the manager’s attention. Another resident said, “I am aware of how to make a complaint and I am sure they would listen to me if I complained.” Dovehaven Nursing Home DS0000017231.V248974.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21,and 26 Not all areas of the home were found to be maintained to a satisfactory standard and this has a potential for compromising the comfort and safety of some residents. EVIDENCE: Dovehaven is a large care home providing accommodation on 3 floors and 3 mezzanine levels. A partial tour was conducted and the following points were noted: • Room 26 – the door frame requires painting as the paint work is badly chipped • Room 12 – the chest of drawers must be replaced as it is broken. The torn carpet must be repaired or replaced • Room 5 – the carpet and armchair are stained and in need of cleaning • Room 7 – the carpet is stained and in need of cleaning • Toilet 6A – the varnish to the wooden raised toilet seat is badly marked and the seat must be repaired or replaced
Dovehaven Nursing Home DS0000017231.V248974.R01.S.doc Version 5.0 Page 16 • • A number of bathrooms and toilet areas were being used as storage areas for wheelchairs, laundry and commodes. Access for residents was therefore limited and this equipment also poses a trip hazard A number of window frames on the top floor corridor and to Room 26 must be repaired or replaced as the wood is rotten. General maintenance work is needed to rectify the above points to ensure the home is comfortable, clean and safe for the residents. Equipment must be stored in an appropriate place to ensure residents have access to bathrooms and toilet facilities at all times. Many of the vanity units in the bedrooms are also affected by general wear and tear. These should be replaced over a period of time. The carpet edge to the entrance of Room 25 was raised. This was brought to the manager’s attention and rectified at this time. A number of residents reported that their bedrooms were cleaned daily but a comment was also received that carpets are seldom cleaned. A rota for cleaning the carpets would therefore be beneficial. The lounge and dining room were clean and a resident stated that the laundry service was good and the housekeeping team very helpful. The general décor and colour schemes in the home are pleasant. A number of residents stated they were happy with their rooms. Bathrooms have a good standard of equipment including bath chair hoists and one bathroom has a specially adapted bath suitable for residents with very limited mobility. The grounds are spacious, well maintained and accessible for residents. The home has emergency lighting throughout and this is subject to regular by staff and by a qualified engineer. Dovehaven Nursing Home DS0000017231.V248974.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29 and 30 Sufficient numbers of skilled staff are deployed to meet the needs of the residents. The procedures for the recruitment of staff are not robust and do not provide the safeguards to offer protection to people living in the home. Staff require training in a safe working practice area to ensure competency in their role. EVIDENCE: The staffing rota was seen for September 2005 and it was noted that 6 care staff were on duty instead of 7 during the morning of the inspection. This was due to staff sickness and the manager was unable to cover the shift with her own staff or an agency worker. Residents reported that generally the home had sufficient numbers of staff on duty however the home can experience staffing difficulties due to staff changes. The home has now recruited new staff and a key worker stated that “staffing the home is now settling down.” There is no deputy in post however the manager is supported by a senior registered nurse. A resident reported, “The matron and staff are just wonderful.” With regards to recruitment practice 4 staff files of new employees were viewed. An Immediate Requirement notice was issued, as 3 files did not evidence confirmation of a POVA first check being received prior to commencing work at the home. One file did not evidence a CRB disclosure for Dovehaven or Abbenden (a home within the Dovehaven group) where the employee had worked prior to joining the ‘nurse bank’ at Dovehaven.
Dovehaven Nursing Home DS0000017231.V248974.R01.S.doc Version 5.0 Page 18 A new member of staff can only start work pending receipt of the CRB check if POVA clearance is obtained, a CRB has been applied for and the worker is supervised. The staff files evidenced 2 written references, completed job application forms, health declarations and job descriptions. New staff receive an induction which covers care practice issues and the management of the home. A new employee stated that he had just commenced his induction and was working closely with a senior member of staff. Staff have access to training in safe working practice areas including manual handling and first aid. The home’s training matrix was seen and it was noted that infection control instruction is required. Care staff are not directly involved with food preparation however consideration should be given to including details of basic food hygiene within their induction. Catering staff have completed the appropriate courses. Dovehaven Nursing Home DS0000017231.V248974.R01.S.doc Version 5.0 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 36 and 38 General records viewed for equipment and services to protect the health, safety and welfare of residents and staff were found to be up to date. The manager has commenced formal supervision of the staff. EVIDENCE: The manager now arranges supervisory interviews with the staff on a regular basis and senior members of staff in the kitchen and housekeeping team will also carry out these sessions with their respective staff. Dates for supervision were seen. The fire logbook evidenced testing of fire alarms on a weekly basis and fire prevention equipment is subject to an annual check by a qualified engineer. Staff receive fire prevention awareness training and a new member of staff confirmed that this subject had also been discussed during his induction. Dovehaven Nursing Home DS0000017231.V248974.R01.S.doc Version 5.0 Page 20 Satisfactory safety certificates for the gas, electric, portable appliance testing, lift, manual handling hoists and bath hoists and nurse call systems were seen. Record keeping with regard to this was good. Dovehaven Nursing Home DS0000017231.V248974.R01.S.doc Version 5.0 Page 21 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 3 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 2 x 2 X X X x 3 STAFFING Standard No Score 27 3 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 3 X 3 Dovehaven Nursing Home DS0000017231.V248974.R01.S.doc Version 5.0 Page 22 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 16/23 Requirement To clean bedrooms carpets in Room 5 and 7. To clean the armchair in Room 5. To paint the door frame to Room 26. To repair or replace the wooden toilet seat to toilet 6a. To replace the chest of draws and repair or replace the torn carpet in Room 12 The home must include the repair or replacement of rotten window frames on the top floor corridor and to Room 26 in the maintenance plan Bathrooms and toilet facilities must be accessible for residents All staff must recive POVA first clearence prior to commencing employment in the home. All staff must have a CRB disclosure Staff must receive training in safe working practice areas, including infection control Timescale for action 01/11/05 2 OP19 23 01/01/06 3 4 OP21 OP29 23 19 01/11/05 30/09/05 5 OP30 18 01/01/06 Dovehaven Nursing Home DS0000017231.V248974.R01.S.doc Version 5.0 Page 23 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 5 6 Refer to Standard OP10 OP15 OP15 OP19 OP19 OP30 Good Practice Recommendations Written instructions regarding care practice should not be displayed in resident rooms A 3-4 week menu should be displayed and evidence the choice offered for each meal Risk assessments should be completed for the control of food in the home Vanity units affected by general wear and tear should be replaced over a period of time A cleaning rota for the carpets should be implemented Staff induction should include food hygiene instruction Dovehaven Nursing Home DS0000017231.V248974.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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