CARE HOMES FOR OLDER PEOPLE
Dovehaven Nursing Home 9 - 11 Alexandra Road Southport Merseyside PR9 0NB Lead Inspector
Mrs Margaret Van Schaick Unannounced Inspection 09:30 7 March 2006
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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.V280791.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 Nursing Home DS0000017231.V280791.R01.S.doc Version 5.1 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.V280791.R01.S.doc Version 5.1 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 pension age Date of last inspection 30th September 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 en-suite 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. Stairs or passenger lift accesses other areas. 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.V280791.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over one day and lasted eight hours. This was the second unannounced inspection carried out this year as part of the regulatory requirement for care homes to be inspected at least twice a year. As part of the inspection process some areas of the home were viewed including residents bedrooms. Care records and other nursing home records were inspected. Discussion took place with the registered provider, registered manager, administrator, registered nurse and one to one interviews with one registered nurse, one care staff and one part time chef. Several residents were also spoken with and three relatives. Five residents were interviewed on a one to one basis and their views of how the home is run obtained. Satisfaction cards were left for residents and their relatives to complete. What the service does well:
All of the residents spoken with stated that staff employed at Dovehaven are kind and supportive whilst providing their care. Relatives and residents also felt that their health care needs were well met. Relatives interviewed were complimentary about the staff providing their care and support with comments including “staff are kind, I have no worries about my wife staying here” and residents comments included “It’s very comfortable here, staff are very kind” and “staff are very good, kind and gentle when caring for you”. One registered nurse has been identified to oversee the medication and through discussion was found to be very knowledgeable about the varying medications in use and understood the process of receipt, recording, storage, handling, administration and disposal of medication. The Aberdeen’s (medication) sheets are clear and easy to follow. Storage of medication evidences good housekeeping. The registered provider supports the registered manager on a daily basis either by visiting the home or by telephone contact. The manager works closely with the registered provider, Mr Gilbert, keeping him informed and is able to benefit from his additional support were needed. Relatives interviewed stated, “we see the owner and his wife quite often and are very pleased with how my wife is cared for”. Staff interviewed were very complimentary about the manager’s ability to run the home. Comments included “the manager is very approachable, you can
Dovehaven Nursing Home DS0000017231.V280791.R01.S.doc Version 5.1 Page 6 discuss any worries” and “I am able to chat with matron at any time, I find her very approachable, I have no issues there”. One resident interviewed was equally complimentary commenting, “matron is kind”. The home has been awarded an external Quality Assurance Award. The home has sent out resident and relatives questionnaires to gain their views on how the home is run. The responses were viewed and noted to be generally positive. Results are audited and published. Policies and procedures are in place with the last review in 2005. A training matrix is in place identifying mandatory training for 2006. Residents care files are reviewed monthly. An internal audit has been carried out with long-term plans identified. Monthly risk assessments are carried out and repair and decoration needs are identified. The staffing rota was viewed and evidences satisfactory levels of staff are working to meet the needs of the residents. This includes registered nurses, care assistants, domestics, kitchen staff, maintenance, garden and administrative staff. Staff files evidence new staff have POVA checks in place and CRB (Criminal Record Bureau) enhanced record checks are in place prior to confirmation of post What has improved since the last inspection?
The home has made some improvements with regard to the general maintenance of the building therefore improving the comfort of the residents who live there. Room 26 has had the doorframe painted. Room 5’s carpet and armchair have been cleaned. Room 7 appears to have a new carpet. The toilet seat in 6a has been varnished. A recommendation was made with regard to written instructions regarding care practice and this has now been addressed. During the last inspection a resident raised concerns with regard to how they were transferred. The homes physiotherapist has addressed this. The window frames identified as needing replacing on the top floor have been removed and replaced with new double glazed windows. A cleaning rota has not been set up for the shampooing of carpets but the housekeeping team are identifying carpets that require shampooing and then arranging for the cleaning to be done. Carpets viewed during this inspection visit were in satisfactory condition. Dovehaven Nursing Home DS0000017231.V280791.R01.S.doc Version 5.1 Page 7 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 Nursing Home DS0000017231.V280791.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 Dovehaven Nursing Home DS0000017231.V280791.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): EVIDENCE: Dovehaven Nursing Home DS0000017231.V280791.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9,10 Medication systems and storage evidence good practice in most areas with one requirement to ensure all medications administered are signed for at point of administration. This will ensure all residents’ medications are accounted for. EVIDENCE: One registered nurse is responsible for the management of medications in the home and during the inspection process the inspector and nurse met to discuss the medication systems in place. The nurse was knowledgeable about the varying medications in use and understood the process of receipt, recording, storage, handling, administration and disposal of medication. The Aberdeen’s (medication) sheets are clear and easy to follow. Storage of medication shows good housekeeping and medication fridge temperatures are taken and recorded daily. Medications are audited and two signatures of registered nurses are evidenced for pharmacy returns. Policies and procedures are in place and only need updating to include the new disposal of medications procedure. Photographs of residents are in place for easier identification and a list of registered nurses and their signatures/initials are in place. On inspection of Aberdeen’s all medication received into the home is signed in with dates and amounts recorded. One or two registered nurse signatures were missing on
Dovehaven Nursing Home DS0000017231.V280791.R01.S.doc Version 5.1 Page 11 the Aberdeen’s following administration of medication to the resident, therefore this needs to be addressed as discussed. Standard 10 was assessed and met at the previous inspection. A recommendation was made with regard to written instructions regarding care practice and this has now been addressed. During the last inspection a resident raised concerns with regard to how they were transferred. The homes physiotherapist has addressed this. Relatives interviewed were complimentary about the staff providing their care and support with comments including “staff are kind, I have no worries about my wife staying here” and residents comments included “It’s very comfortable here, staff are very kind” and “staff are very good, kind and gentle when caring for you”. Dovehaven Nursing Home DS0000017231.V280791.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14,15 There needs to be consultation between the residents and chef with regard to meals provided, as some of the residents are unhappy with the food served. The chef also needs to prioritise cleaning and hygiene issues rose from this inspection to ensure a safe working environment. EVIDENCE: Residents’ monies are usually held by their relatives. Two of the residents who have no families are receiving assistance and support from a local advocacy group. Residents have been able to personalise their bedrooms by bringing into the home their own belongings including pictures and ornaments. Where agreed relatives of some of the residents have been able to access care files. One relative interviewed stated, “I have read all the care plan and staff always keep me informed”. Some of the residents interviewed were aware that they could access their care files but did not wish to. Recommendations made at the last inspection with regard to food menus have not yet been addressed. Recommendations with regard to risk assessments for the control of food in the home have not been addressed either. Some of the records with regard to ‘catering food hygiene check list’ appear to have been photocopied from October 2005 and therefore not checked and recorded on the dates documented. The environmental health report from January this year identifies some recommendations regarding cleaning of areas, items of
Dovehaven Nursing Home DS0000017231.V280791.R01.S.doc Version 5.1 Page 13 equipment, and defrosting of chest freezers. Staff interviewed commented, “I am concerned about the poor level of cleanliness in the kitchen”. Mixed comments were received from the residents with regard to meals served. Comments included “the food is terrible, sometimes just mashed potatoes and gravy, it could be improved with more fresh fruit and vegetables”, and “the food is good”. One comment received was “it depends on who is cooking”. Dovehaven Nursing Home DS0000017231.V280791.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Policies and procedures are in place to safeguard residents’ finances. EVIDENCE: The new sefton adult protection procedure is not yet in place. The inspector has advised the appropriate authority so that the home receives their copy. POVA (Protection of Vulnerable Adults) checks are in place with documented evidence viewed on file. Elder abuse training has been attended by many of the staff at the home as evidenced in staff files and confirmed by staff interviewed. The POVA training has not been attended yet. The home has policies and procedures in place to safeguard residents including ‘whistle blowing’, abuse policy and bullying. Witnessing of wills is discussed with staff during their induction period. One or two of the residents have a lockable bedroom door. Any new resident is to be approached and asked if they require this facility. Risk assessments would then be in place to ensure they are capable of using it. Financial records evidence an allowance is brought in by residents’ relatives that, enables payment of items such as chiropody and hairdressing. One of the residents condition has deteriorated and is now unable to sign for their pension therefore a local advocacy service has been accessed to assist them with their finances otherwise relatives are responsible and assist with residents pension money. Dovehaven Nursing Home DS0000017231.V280791.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,26 The home has made some improvements with regard to the general maintenance of the building therefore improving the comfort of the residents who live there. Further thought needs to be given to providing storage areas for equipment as discussed in this and the previous report to ensure safe access to bathrooms for residents. EVIDENCE: Standard 19, 21 and 26 were assessed at the previous inspection with requirements and recommendations made. Recommendations and requirements made include replacing vanity units. These have not been replaced but repairs have included the ‘trim’ being replaced/repaired where needed. One set of drawers has been repaired in bedroom 12 but appear to be unstable therefore need replacing. Room 26 has had the doorframe painted. Room 5’s carpet and armchair have been cleaned. Room 7 appears to have a new carpet. The toilet seat in 6a has been varnished. The home still has a problem with storage of wheelchairs and commodes in the bathrooms. The window frames identified as needing replacing on the top floor have been
Dovehaven Nursing Home DS0000017231.V280791.R01.S.doc Version 5.1 Page 16 removed and replaced with new double glazed windows. A cleaning rota has not been set up for the shampooing of carpets but the housekeeping team are identifying carpets that require shampooing and then arranging for the cleaning to be done. Carpets viewed during this inspection visit were in satisfactory condition. One of the residents interviewed stated, “I find it very comfortable living here”. Dovehaven Nursing Home DS0000017231.V280791.R01.S.doc Version 5.1 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The home provides regular mandatory and other training but this needs evidencing in staff files. Staff files need to be audited to ensure all pre employment reference checks are in place to safeguard the residents who live there. EVIDENCE: The staffing rota was viewed and evidences satisfactory levels of staff are working to meet the needs of the residents. This includes registered nurses, care assistants, domestics, kitchen staff, maintenance, garden and administrative staff. Staff interviewed about staffing levels stated, “we are not short staffed and I feel the care provided to the residents is good” and “we get agency staff in if we are short staffed”. The registered provider supports the registered manager on a daily basis either by visiting the home or by telephone contact. Nineteen care staff are employed at the home with one carer qualified to NVQ Level 3. Six care staff are at present training to Level 2 NVQ and six staff are awaiting funding therefore at present the home does not meet the minimum requirement to have a minimum of 50 care staff to have the NVQ qualification. Staff files evidence new staff have POVA checks in place and CRB (Criminal Record Bureau) enhanced record checks are in place prior to confirmation of post. One registered nurse file showed one reference was satisfactory with the other reference unsatisfactory as it was a copy of a reference dated 1999, which is approximately five years out of date. The other registered nurse file
Dovehaven Nursing Home DS0000017231.V280791.R01.S.doc Version 5.1 Page 18 checked evidenced one satisfactory reference with one unsatisfactory also as it was undated. The home needs to ensure all references are authentic, dated and both registered nurse references are professional references. With all references one must be from their most recent employer. Terms and conditions are not evidenced in two of the staff files checked. Staff induction is evidenced in the four staff files checked. Mandatory staff training is evidenced in some of the staff files with one having no evidence at all despite the staff member being employed approximately two years. One of the care staff has attended basic food hygiene training, which, was raised as a recommendation at the previous inspection. This needs to be included for more staff to attend in the planned staff training. The training matrix was on display showing the mandatory training set up for this year. Some of the staff interviewed confirmed they had attended mandatory and other training whilst employed at Dovehaven. Dovehaven Nursing Home DS0000017231.V280791.R01.S.doc Version 5.1 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 The home canvasses the opinions of residents and their relatives to gain feedback on how the home is meeting the residents’ needs. Results are published, which ensures residents views are available to others. Some of the residents, relatives and staff who were interviewed feel their views are valued. EVIDENCE: The registered manager has gained many years experience at a senior level in the nursing home sector. Mrs Hart has been in post 8 years and has gained the Registered Managers Award in September 2005. Mrs Hart has also attended additional training including mandatory to enable her to keep up to date with good practice and is also enrolled in a Learning and Development Award at Level 5. Staff interviewed were very complimentary about the Manager’s ability to run the home. Comments included “the Manager is very approachable, you can discuss any worries” and “I am able to chat with matron at any time, I find her very approachable, I have no issues there”. One resident interviewed was equally complimentary commenting, “matron is kind”.
Dovehaven Nursing Home DS0000017231.V280791.R01.S.doc Version 5.1 Page 20 The manager works closely with the registered provider, Mr Gilbert, keeping him informed and is able to benefit from his additional support were needed. Relatives interviewed stated, “we see the owner and his wife quite often and are very pleased with how my wife is cared for”. The home has been awarded an external Quality Assurance Award. The home has sent out resident and relatives questionnaires to gain their views on how the home is run. The responses were viewed and noted to be generally positive. Results are audited and published. Policies and procedures are in place with the last review in 2005. A training matrix is in place identifying mandatory training for 2006. Residents care files are reviewed monthly. An internal audit has been carried out with long-term plans identified. Monthly risk assessments are carried out and repair and decoration needs are identified. The relatives generally hold residents’ monies. A local advocacy agency is at present providing assistance and support for two of the residents with regard to their finances. Individual financial records are held for residents and their signatures are recorded where able. A safe facility is available for residents use with records kept and viewed during the inspection. Dovehaven Nursing Home DS0000017231.V280791.R01.S.doc Version 5.1 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 X 2 X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X X Dovehaven Nursing Home DS0000017231.V280791.R01.S.doc Version 5.1 Page 22 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 OP9 OP15 Regulation 13 (2) 16 (2i) Requirement Timescale for action 03/04/06 3. OP19 16 (2c) 4. OP21 13 (4a) The registered provider must ensure all staff sign for administration of medications. The registered provider must 02/05/06 ensure the chef meets with the residents to ensure food served is suited to their needs. The registered provider must 02/05/06 ensure the set of drawers in bedroom 12 are replaced, as the ones in present use are unstable. This was a requirement at the last inspection. The registered provider must 02/05/06 ensure that the bathrooms remain clutter free to provide safe access to residents who live in the home. This was a requirement at the last inspection. The registered provider must ensure that a minimum 50 care staff is trained to NVQ Level 2. The registered person must ensure two written references provided for each staff member are authentic.
DS0000017231.V280791.R01.S.doc 5. OP28 18 (1c i) 04/09/06 6. OP29 19 (1c) 02/05/06 Dovehaven Nursing Home Version 5.1 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. Refer to Standard OP9 OP15 Good Practice Recommendations The inspector recommends that the new procedure for disposal of medication is included in the homes policies and procedures. A four-week menu should be displayed and evidence the choices offered for each meal. This was a recommendation at the previous inspection. The inspector strongly recommends that risk assessments be completed for the control of food in the home. This was a recommendation at the last inspection. The inspector strongly recommends that all staff training be evidenced in staff files so that any training/certificates gained can be viewed. This would clarify the individual staff members up to date training/study. 3. OP15 4. OP30 Dovehaven Nursing Home DS0000017231.V280791.R01.S.doc Version 5.1 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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