CARE HOMES FOR OLDER PEOPLE
Dover Cottage Rest Home Dover Farm Close Stoneydelph Tamworth Staffordshire B77 4AP Lead Inspector
Mrs Wendy Grainger Key Unannounced Inspection 7th June 2007 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 Dover Cottage Rest Home DS0000004934.V338213.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dover Cottage Rest Home DS0000004934.V338213.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Dover Cottage Rest Home Address Dover Farm Close Stoneydelph Tamworth Staffordshire B77 4AP 01827 331116 01827 261569 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) Dr Rais Ahmed Rajput Mrs Glenda Margaret Pollard Care Home 15 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (15) of places Dover Cottage Rest Home DS0000004934.V338213.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 31st May 2006 Brief Description of the Service: Dover Cottage is located on the periphery of an estate outside the town of Tamworth. The home is near to the A5 and M42 but is not within walking distance of any major shops. Public transport is available at the end of the main road. The home is at the end of a cul-de-sac with a small parking area at the front of the home. At the rear of the home is a lawned area with a large weeping-willow tree. The main door is located at the rear of the home. Dover Cottage offers accommodation to fifteen older people whose primary diagnosis was dementia. There were two lounges for the service users. Bedrooms were for single and shared accommodation. Only one of the shared bedrooms has an en-suite facility. Bathing and toilet facilities were available on each floor. The shaft lift or the stairs can access the first floor. From the verbal information provided at the time of the inspection by the retired care manager the current fees were £378. Any additional charges i.e. hairdressing and private chiropody would be the responsibility of the relatives. The home does not handle any finances. Dover Cottage Rest Home DS0000004934.V338213.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced key inspection was carried out on the 7th June 2007 by Wendy Grainger Inspector At the commencement of the inspection two care staff were on duty meeting the early morning needs of the people who use the service. The care manager was contacted and although she was not on duty until the late shift she came to the home to complete the inspection. At the time of this inspection the home had seven residents. One person was in hospital and one person had passed away the previous evening. A discussion with the provider and the care manger to ascertain if the home was marketing the empty beds. During the day the inspector evidenced care records, documents, reports, the care manager accompanied the inspector on a tour of the home, including the laundry in the cellar. A questionnaire sent by the Commission to gather information about the service offered to people who use the service contained somewhat limited information and was part of the inspection. There had been no comment cards sent to the people who use the service or other professionals prior to the inspection. What the service does well: There was evidenced both pictorial and verbally from the people who use the service about the activities they had been involved in. There has been a marked improvement in the provision of activities and social life since the previous inspection. The care manager had invested time in obtaining comments from families and the hairdresser to search out comments about the service. “staff are extremely pleasant to both the residents and us as visitors” “everything has been excellent we are more than happy in the way mum has settled in” “ it’s a nice home to work in all the staff are very friendly” Dover Cottage Rest Home DS0000004934.V338213.R01.S.doc Version 5.2 Page 6 Staff observed during the morning shift demonstrated their skills and commitment to the people who use the service. One person was a concern as she was in their words “very quiet and not very responsive” this was dealt with; the staff ensured that the person had plenty of fluids. At the completion of the inspection the person was with her family and enjoying a yoghurt. The staff in general were sensitive to each individuals needs and addressed them appropriately. The people who use the service were spoken with and observed during the inspection they expressed verbally and by their body language that they were content and satisfied with the “girls” food and home. It was observed that people who use the service were served breakfast at a time they chose to rise. It was pleasing to observe that the dining room was used for all the meals during the day making meals more social. What has improved since the last inspection? What they could do better: Dover Cottage Rest Home DS0000004934.V338213.R01.S.doc Version 5.2 Page 7 The care plans remain an area for discussion, during the day the appropriate care was demonstrated by the staff, ensuring the needs of individuals were being met; the paperwork however did not reflect the care required. . The care manager needs to address the training needs of the staff who continually fail to attend for mandatory training. This was discussed in full during the inspection and advice was provided to resolve the situation. The inspector was concerned that from the fire records seen, one emergency light had been inoperable since 10 April 2007 a further light had been out of order since the 8 May 2007. The first light was at the top of a stairway it is an obvious hazard to staff and possibly people who use the service in the event of a power failure. The problem had been reported to the firm responsible for the system. The care manager told the inspector the system that had to be followed to get a replacement. The problem needs to be dealt with as soon as possible to protect people. Since the last inspection the care manager has retired from her post, she has returned to the position of a part-time carer. The provider has not informed the Commission of this change. The inspector was aware that the provider had advertised for a successor. Advice was provided sometime ago by the inspector to commence advertising prior to the care manager’s retirement to prevent the hiatus of having no manager for the home. The manager was advised to liaise with the fire officer regarding the nature of the fire drills for staff the care manager has received conflicting information because of the resident group. The inspector had concerns as to the actual hands on fire drills, which were not being completed. The records were confusing and discussed with the manager. While other bedrooms had had new bed linen colour co-ordination with other aspects of the rooms were not thought through leaving rooms looking less homely. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Dover Cottage Rest Home DS0000004934.V338213.R01.S.doc Version 5.2 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 Dover Cottage Rest Home DS0000004934.V338213.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. Standards 1,3,4 were reviewed Standard 6 was not relevant to the home. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose remains in the entrance hall, there was a need update the document ensuring the details were current and informative to consider a placement. Assessments were in place but they were not always comprehensive or completed. EVIDENCE: The homes Statement of Purpose was displayed and available to any prospective people who use the service and the families. There were two minor adjustments that were needed.
Dover Cottage Rest Home DS0000004934.V338213.R01.S.doc Version 5.2 Page 10 Each person would be given a copy of this and the Service Users Guide, maintained in their rooms depending on the capacity of the individual. Evidenced in the sample of care plans was the pre admission assessment, there was a need to complete this document in full prior to the prospective person coming to the home for the day. The care manager produced a copy of the letter sent to confirm the placement, this was part of the previous inspection discussions. Contracts had been provided to people who use the service; there was a need to maintain a copy within the home, not the office that dealt with the paperwork and available to the Commission. Dover Cottage Rest Home DS0000004934.V338213.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate Standards 7,8,9,10 were reviewed. This judgement has been made using available evidence including a visit to this service. The standard of the care plans could be improved upon to include all the elements to meet individuals’ needs. Arrangements were in place for the continued health care of the people who use the service. People who use the service were treated with respect, kindness and understanding, their right to dignity was acknowledged by the staff. EVIDENCE: While the care plans had continued to be formulated they required more pertinent details of how the care was to be provided. The manager needs to review the plans ensuring that the details recorded were an identified problem. The content of the document used for any person taking a calculated risk was
Dover Cottage Rest Home DS0000004934.V338213.R01.S.doc Version 5.2 Page 12 part of the inspection. The plans were reviewed monthly and signed by management. The home had commenced a nutritional and food intake for all the people who use the service this record was current and available. This practice was combined with regularly taking the weights of individuals. One district nurse visited the home, she expressed that she was satisfied with the care provided at the home. During the inspection concerns by the staff for one person resulted in requesting a general practitioner. The staff attended this resident during the day, they ensured that her needs were met and fluids administered. At the conclusion of the inspection the individual was taking fluids and a yoghurt independently. The medication system was observed, the person in charge administered medicines appropriately. Taking the trolley into the small lounge would be a major hazard to the people who use the service and walk freely. The member of staff takes the cassette instead and administers the medication. Records were current as were the records for the controlled medication. It was recommended that the book used for the controlled medication had the pages numbered. The locked box, used should solely be for the purpose of storing controlled medication; the other items in this box should be secured elsewhere. Staff who were responsible for administering medication had received medication training. A recommendation was made to create a protocol for any individual that was prescribed a PRN (as required) medication. Dover Cottage Rest Home DS0000004934.V338213.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good Standards 12,14,15, were reviewed. This judgement has been made using available evidence including a visit to this service. The home’s social and activity programme had been extended to include a fuller social life for the people who use the service. The daily routines of the home were relaxed, people who use the service maintained contact with their families and friends. Individuals commented favourably on the food served today. EVIDENCE: Following the last inspection the manager and staff have invested their time in extending the social life and entertainment for the people who use the service. This has been much appreciated according to the comments made. Individuals were quick to tell the inspector about their time out at the music hall, and to the local club. “we had a good time” “ the music was very good and the costumes”
Dover Cottage Rest Home DS0000004934.V338213.R01.S.doc Version 5.2 Page 14 Each day activities were displayed on the door, on the day of the inspection it was to be basketball, which was duly played much to the enjoyment of the individuals that took part. During the day one visitor came to the home she expressed her satisfaction with the care and staff and the manner in which she was made welcome. The meal of the day was lamb with an alternative of faggots, the inspector observed staff ask people who use the service prior to the meal being plated and served. There were ample portions well presented and to suit individuals needs. The menus were to be updated to combine lighter summer recipes, based on individual’s likes and dislikes. Dover Cottage Rest Home DS0000004934.V338213.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good Standards 16,18 were reviewed. This judgement has been made using available evidence including a visit to this service. Staff were aware of the issues of abuse enabling them to ensure the people who use the service were protected. The homes complaint process was displayed in the front entrance hall. EVIDENCE: Staff spoken with confirmed that they were aware of the “whistle blowing” procedure for the home, they had received training in how they would deal with any form of suspected abuse. The complaints process was displayed in the entrance hall, it was discussed with the care manager that the telephone number of the Commission should be added to the notice. The Commission or care manager had received no complaints since the previous inspection From training provided in house, the staff had awareness of the homes registration category for older people with dementia. Dover Cottage Rest Home DS0000004934.V338213.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good Standards 19 20 23 24 25 26 were reviewed. This judgement has been made using available evidence including a visit to this service. The home meets the needs of the people who use the service. It was well maintained, with a programme of upgrading and decoration. EVIDENCE: Located at the end of a cul-de-sac Dover Cottage operates to offer accommodation to older people with a dementia. Corridors and rooms were safe for people to walk around freely. People who use the service were provided, with the exception of one bedroom, an odour free environment. The inspector was satisfied that all steps to maintain a good standard in this one room were on going. Professional advice
Dover Cottage Rest Home DS0000004934.V338213.R01.S.doc Version 5.2 Page 17 had been sort; it may be that the carpet will have to be changed and the floor beneath treated before new carpet is fitted. Since the previous inspection two of the shared bedrooms had been divided creating two singles. There remained one shared and one en-suite bedroom. New armchairs had been purchased for one of the lounges, they were tasteful and appeared practicable to meet individuals needs. From the evidence during the tour of the home it was obvious that people who use the service were encouraged to personalise their bedrooms. The blend of colours in a minimum of bedrooms could be more co-ordinated. The new bedroom furniture purchased for the divided bedrooms had considered a persons safety with having all rounded edges. At the side of the home were tomato and bean plants put there by a relative to give the residents an interest. The rear of the garden was lawned, while at the front is the car park and small seating area. There was a need to continue to monitor the large holly tree to ensure it did not encroach into the space detracting the light from bedrooms. The laundry was located in the cellar it is an extremely small area but appears to manage the homes and personal laundry. Notices in respect of COSHH were located on the door, risk assessments were in place for the use of chemicals. Dover Cottage Rest Home DS0000004934.V338213.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate, Standards 27,28,29,30 This judgement has been made using available evidence including a visit to this service. People who use the service had their needs met by experienced staff. Recruitment procedures and induction training protected the people who use the service EVIDENCE: From the evidence in the returned Aqaa staffing levels were adequate, at the time of this inspection the home had two staff vacancies. Adverts had been placed locally. The care manager spoke highly of her staff as they continue to cover the shifts when the bank staff were unavailable. The Aqaa records identified that over 50 of the staff had a qualification in NVQ in Care. Training in this area is ongoing one new member of staff told the inspector “I am looking forward to starting my NVQ, we are just waiting for the funding later in the year” Staff on the morning shift confirmed and from records evidenced that induction into care had been completed. There were some minimal gaps in the training records; the gaps were identified as the night staff. It is important that they complete any mandatory training. The provider reimburses staff when training in house was provided.
Dover Cottage Rest Home DS0000004934.V338213.R01.S.doc Version 5.2 Page 19 The care manager had not completed the Registered Mangers Award due to her retirement. A sample of three staff records identified that the manager had carried out robust recruitment, which included an application form, CRB (police check) references and other relevant documents with the exception of a personal photograph, which will be addressed. Dover Cottage Rest Home DS0000004934.V338213.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate Standards 31.33.35.38 were reviewed. This judgement has been made using available evidence including a visit to this service. A capable manager had managed the home until the time of her retirement and this inspection. The home continued to be operated in the best interest of the people who use the service by all the staff. EVIDENCE: The manager had addressed all the requirements made during the previous inspection.
Dover Cottage Rest Home DS0000004934.V338213.R01.S.doc Version 5.2 Page 21 At the time of this inspection Dover Cottage was without a registered care manager although she remains on the staff with the deputy to assist in operating the home. The provider told the inspector that he had advertised and hopefully will be interviewing soon. A definite improvement had been made in obtaining feedback from the relatives and other interested parties for the home. This was evidenced from the survey results “glad we made the choice of this home” “ the staff are exceptional and always friendly” these were made available to the inspector. Staff confirmed that they received supervision, this was evidenced from the records located in the staff records. An inspection of the fire records identified that the home had not completed a fire risk audit or completed the contingency plans in the event of an emergency. The inspector had concerns that one emergency light had been out of order since April 2006 another was found out of order in May this problem had not been addressed following notifying the professional firm responsible. This action could put people who use the service and staff at risk in the event of a power failure. There was a need for the provider to ensure by professional testing that the water system was free from Legionalla. An inspection of the homes insurance policy was found to be current until August 2007. An inspection of the hot water testing, potable equipment testing, and the lift servicing were evidenced and found satisfactory. The home has on call a person who completes any decoration of the home; Dover Cottage is too small to employ a permanent maintenance person Dover Cottage Rest Home DS0000004934.V338213.R01.S.doc Version 5.2 Page 22 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X N/A 3 X 2 Dover Cottage Rest Home DS0000004934.V338213.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 15 Requirement Care plans should contain relevant detailed information to enable any carer to provide the appropriate care at all times included should be comprehensive risk assessments People who use the service should be kept safe at all times by providing the appropriate lighting Timescale for action 07/06/07 2 OP38 23 07/06/07 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 OP1 Good Practice Recommendations To ensure that the Statement of Purpose was current with the commissions telephone number and correct staffing information. Dover Cottage Rest Home DS0000004934.V338213.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Birmingham Local Office 1st Floor Ladywood House 45-56 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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