Inspection on 23/08/06 for Dovercourt House

This inspection was carried out on 23rd August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Dovercourt House 13/07/07

Dovercourt House 13/02/06

Dovercourt House 21/09/05

Dovercourt House 10/02/05

Dovercourt House 21/07/04

Dovercourt House 05/03/04

Similar services:

Claremont House

Chesham House

Argyll House

Firstlings

Dorset Lodge

Fen Road

Acacia House

Falcon House

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

CARE HOMES FOR OLDER PEOPLE Dovercourt House 23 Fronks Road Dovercourt Harwich Essex CO12 3RJ Lead Inspector Jenny Elliott Key Unannounced Inspection 23rd August 2006 10:00 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 Dovercourt House DS0000033764.V309767.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. Dovercourt House DS0000033764.V309767.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dovercourt House Address 23 Fronks Road Dovercourt Harwich Essex CO12 3RJ 01255 506010 01255 553099 miketibbles@fsmail.net 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 Michael Frederick Tibbles Mrs Amanda Jane Tibbles Mrs Amanda Jane Tibbles Care Home 27 Category(ies) of Dementia - over 65 years of age (27), Mental registration, with number disorder, excluding learning disability or of places dementia (1), Mental Disorder, excluding learning disability or dementia - over 65 years of age (4) Dovercourt House DS0000033764.V309767.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Persons of either sex, aged 65 years and over, who only fall within the category of dementia (not to exceed 27 persons) One named person, whose name was made known to the Commission in January 2003, under the age of 65 years, who only falls within the category of mental disorder (not to exceed 1 person) Person of either sex, aged 65 years and over, who only fall within the category of mental disorder (not to exceed 4 persons) The total number of service users accommodated in the home must not exceed 27 persons 13th February 2006 Date of last inspection Brief Description of the Service: Dovercourt House is a large property refurbished from two substantial buildings. The home provides accommodation for older people with varying needs, including some people with behaviours that challenge. The home is located close to local amenities and the sea front, and has good bus routes to other areas. Nearly 70 of the accommodation is available in single rooms, some of which have en-suite facilities. A range of communal space is available which includes gardens to the rear of the property. Dovercourt House DS0000033764.V309767.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Information for this report was gathered from questionnaires sent to users of the service and their relatives, information provided by the home since the last report and a visit to the home on 23rd August 2006. At the visit to the home the premises were inspected, discussions held with people using the service and relatives visiting on that day as well as staff, the registered manager of the service and visiting professionals, in addition a sample of records held by the home were inspected. What the service does well: The service provides a homely and caring environment for people living at the home. Service users, their relatives and visiting professionals spoke very highly of the care provided. One relative said ‘I cannot emphasis how kind the staff and the owners are at Dovercourt House. Nothing is too much trouble, their warmth is genuine and their support is endless.’ Staff working at the home said they felt supported in their day-to-day work and in the development of their care practice through training. Staff gave clear details of the individual needs of people living at the home and how they supported them. The activities that were on offer at the home helped to promote the independence of service users. Where service users needed help and support this was provided in a manner that promoted independence and maintained their dignity. People living at the home spoke highly of the meals provided, and the atmosphere at lunchtime was very relaxed and meals were well presented. The home’s gardens were very well maintained, including a range of seating areas with sea views. Dovercourt House DS0000033764.V309767.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Dovercourt House DS0000033764.V309767.R01.S.doc Version 5.2 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 Dovercourt House DS0000033764.V309767.R01.S.doc Version 5.2 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, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The service provides and obtains sufficient information to ensure that the needs of service users can be met. EVIDENCE: Records belonging to a service user who had moved to the home in the preceding four weeks were inspected. These included an assessment carried out by the person’s social worker and significant additional information about the person’s family history, likes and dislikes provided by their family. From this information the home had produced advice for staff about the person’s night care, daily routines and habits, a full care plan was being developed but not yet available. The records also included a contract setting out the terms and conditions for living at the home. The relative of one service user described how they had visited the home, without an appointment, prior to their relative moving in and found standards of cleanliness and the approach of staff to be good. Dovercourt House DS0000033764.V309767.R01.S.doc Version 5.2 Page 9 Information made available for prospective service users continued to meet minimum standards. Dovercourt House DS0000033764.V309767.R01.S.doc Version 5.2 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, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Most aspects of health and personal care were addressed in a positive and proactive way by the home. The storage and administration of controlled drugs at the home fell significantly short of meeting national minimum standards. EVIDENCE: The manager had developed existing care plans for some service users since the last inspection. There were aspects of these plans that provided clear information for staff about the particular wishes and needs of the service user to whom they related. There were other aspects where advice and guidance for staff was too general, would not necessarily ensure a consistent approach and did not provide a clear basis upon which to review care practice. It was evident that the plans that were in place were being reviewed more regularly than at previous inspections, the manner of the review was not inspected on this occasion. Dovercourt House DS0000033764.V309767.R01.S.doc Version 5.2 Page 11 Discussions with staff demonstrated a clear understanding of the particular needs of service users and of how those needs are best met, in a manner that supported the dignity of individuals. The promotion of privacy and dignity amongst service users was evidenced in other ways, including how service users were assisted with meals, helped to ensure appropriate appearance and encouraged to maintain their independence about the home. Staff recognised that some people liked time on their own, an important issue in a busy home with a jolly ambience in communal areas. The promotion of health care needs was documented in care plans and supported during the inspection by discussion with two GPs visiting patients living at the home. Both GPs spoke very positively about the home, saying the home did not make excessive requests for medication and contacted health services appropriately and in a timely manner. The majority of medication was stored in an appropriate, locked trolley in the dining area. The administration records in relation to this medication were clear and well maintained. Staff were observed administering medication at lunchtime in an appropriate manner. However it was discovered during the inspection that controlled drugs were not stored in line with the Misuse of Drugs (Safe Custody) Regulations, that they were decanted in advance of administration at night, and that records relating to their administration were inadequate. These practices create an unacceptable risk to service users. The manager and care manager were advised to stop the practice of decanting medication in advance of administration immediately. Advice was sent to the home following the inspection about the administration of drugs in care homes. It was also noted that a white board in the dining room, which could be read by anyone entering or living at the home, contained details of two service users who had been prescribed Warfarin, this did not maintain privacy or dignity for those individuals and portrayed and institutional approach to care. Dovercourt House DS0000033764.V309767.R01.S.doc Version 5.2 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, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home promotes people’s independence and dignity through social contact and activities. People living at the home enjoyed mealtimes. Food was well presented, but of limited variety at tea-time. EVIDENCE: There are some organised activities arranged by the home, including music and keep fit. On the day of the site visit a keep fit session was taking place. The inspector sat in on this session. Fourteen service users were at the session, all joining in to varying degrees, some with the support of staff. Service users appeared to enjoy the session and be familiar with the routines and activities suggesting this was a regular occurrence. Regular visitors to the home included people from a local church who ran a sing-a-long session. There was also evidence (from observation and discussion with staff) that some individual needs were recognised and promoted including supporting one person who was an artist to continue painting and recognising the need of Dovercourt House DS0000033764.V309767.R01.S.doc Version 5.2 Page 13 another to spend time away from group activities. Staff clearly described the individual likes of service users, including the importance of chatting and helping people who were confused to maintain routines, again in a manner that respected their dignity and promoted their independence. Care plans did not always clearly state what action staff should take to help individuals overcome the difficulties they experience due to their dementia and other needs. During a tour of the premises one service user told the inspector they enjoyed reading books. Later on at the site visit the manager of the home was overheard telling this service user that there were some new books available for them to look at. Service users helped to set the table for mealtimes, and the inspector was advised that a rota was now in place, such was the demand from service users to help with this task. The atmosphere at lunchtime was lively with service users being encouraged to sing ‘why are we waiting’ in anticipation of their meal. Meals were presented in an appetising way, and people living at the home spoke positively about the food. Service users were encouraged to eat independently as much as possible. Those that required support were helped in a manner that maintained their dignity. There was a good supply of fresh vegetables and fruit at the home. Although the menu provided by the home did not show that alternatives were routinely offered at lunchtime, service users and relatives said that alternatives were provided for people who did not like the main choice. It was also noted that tea, on the four-week menu provided, was always sandwiches and cakes. The home has a range of seating areas, indoor and out, that service users can make use of. Dovercourt House DS0000033764.V309767.R01.S.doc Version 5.2 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, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home has policies in place to deal with complaints and has responded well to clearly articulated complaints. Staff do not have sufficient training to understand or interpret dissatisfaction expressed in other ways. The home’s policies in respect of recruitment and practice in respect of service users’ finances served to protect people living at the home. EVIDENCE: The inspector was advised that the home had not received any complaints since the last inspection. The Commission has also, not received any complaints about the service since the last inspection. Feedback from people living at the home, their relatives and professionals visiting the home was very positive. Staff had not had training about how to work with people with dementia, and may, therefore experience difficulties dealing with and interpreting more challenging behaviours sometimes associated with this condition. The financial records belonging to three service users were inspected and found to be in order. The systems in place to monitor and check balances and expenditure served to protect service users from financial abuse. There had been no new staff recruited to the home since the last inspection, it was not, therefore, possible to test whether or not the gaps identified in recruitment Dovercourt House DS0000033764.V309767.R01.S.doc Version 5.2 Page 15 checking at previous inspections had been rectified. However the manager was clear in discussion about the checks that would be carried out on new staff. Records relating to two staff were inspected. Both sets of records contained evidence that the staff had undertaken training in respect of the protection of vulnerable adults. Neither member of staff had attended training in respect of dementia, which could limit their understanding in respect of protecting people whose behaviour and understanding could be confused or challenging. Dovercourt House DS0000033764.V309767.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The premises continue to meet national minimum standards. EVIDENCE: A tour of the premises was undertaken during the visit to the home with the help of a service user. The premises were clean and tidy throughout, with no unpleasant odours noted. The home is decorated and furnished in a homely style. Some bathrooms were a little tired looking, but remained functional. The kitchen was awaiting refurbishment, it was anticipated that this would be completed within the next two months. One room had an en-suite toilet that was also accessible from the hallway. The service should review the appropriateness of this in a home that accommodates people who are easily and often confused about their whereabouts. Dovercourt House DS0000033764.V309767.R01.S.doc Version 5.2 Page 17 The gardens to the home were well-maintained and included areas laid to lawn, flower beds and patio with a range of seating. Records were kept of regular checks undertaken to ensure safe hot water temperatures were maintained. Dovercourt House DS0000033764.V309767.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The service does not have a clear training plan or programme in place that meets the needs of people living in the home. EVIDENCE: Staffing levels remained as at the last inspection and felt to meet National Minimum Standards. A rota was in place showing which staff were on duty at all times and in what capacity. It was also noted that a white board in the dining area, which gave the date and heading ‘staff’ stated ‘as per rosta’, which was not considered helpful to people living at the home. Included in the information provided to the Commission by the home was that 65 of staff held National Vocational Qualification (level 2) in Care, this exceeds the level recommended by NMS. In discussion, staff said that the manager of the home was very supportive about staff accessing training as well as providing better equipment and furnishings that made it easier to care for people. The staff records seen as part of this site visit demonstrated that whilst staff had attended training in the last twelve months, not all mandatory training, or training related to the needs of people living in the home was up to date for all staff. This included fire safety, basic food hygiene, manual handling or dementia care. The manager had taken steps to provide fire safety training on a rolling basis for all staff, but this had not yet been Dovercourt House DS0000033764.V309767.R01.S.doc Version 5.2 Page 19 completed. The manager also advised that staff would be undertaking specialist training in respect of caring for people with dementia, but dates had not yet been set. Dovercourt House DS0000033764.V309767.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The manager communicates a clear sense of leadership and direction. The support and direction provided to care staff, and assessment of the service provision was not structured and did not feed directly into the quality of care provided. EVIDENCE: The manager of the home has recently completed an appropriate qualification at NVQ level 4 (subject to external verification) and has a suitable level of experience in managing care services. The manager of the home is also (jointly) registered as proprietor of the home. There were clear lines of Dovercourt House DS0000033764.V309767.R01.S.doc Version 5.2 Page 21 accountability within the home, understood by people living and working there. Service users, relatives and staff spoke highly of the manager describing her as approachable and a positive influence. The service did not have a comprehensive quality assurance programme. Questionnaires had been sent to people living at the home and professional visitors to the home, but these had not been used to inform a cycle of planning – action – review in respect of the service provided. Some time was spent discussing this with proprietors and in particular the need for a more open and analytical review of the service provided that would ensure continuing improvement. Records relating to service users’ money were well maintained and regularly checked. Staff reported good relationships with the registered manager and senior staff, but regular 1:1 supervision that covered practice, the philosophy of the home and career development needs were not in place. Records relating to the maintenance and safety of equipment and services were in order. Dovercourt House DS0000033764.V309767.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 3 Dovercourt House DS0000033764.V309767.R01.S.doc Version 5.2 Page 23 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. Standard OP7 Regulation 15 Requirement The registered person must continue to develop service users’ care plans to ensure they are all person centred and contain adequate directions to inform staff how identified needs should be met. The registered person must ensure that medication is stored, administered and recorded in line with legal requirements and good practice. The registered person must provide suitable, wholesome and nutritious food which is varied. This refers specifically to food provided at tea-time. The registered person must ensure that staff receive training and supervision to enable them to carry out their duties and protect vulnerable adults. The registered person must ensure further development of the home’s quality assurance process. Previous timescale of 30.04.06 not met. Timescale for action 31/10/06 2. OP9 13 31/10/06 3. OP15 16 31/10/06 4. OP16 OP18 OP30 18 31/12/06 4. OP36 OP33 24 30/11/06 Dovercourt House DS0000033764.V309767.R01.S.doc Version 5.2 Page 24 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 OP30 Good Practice Recommendations The registered person should ensure that each staff member has an individual training record. Dovercourt House DS0000033764.V309767.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Dovercourt House DS0000033764.V309767.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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