CARE HOMES FOR OLDER PEOPLE
Doveridge Care Home Doveridge South Street Colyton Devon EX24 6PS Lead Inspector
Teresa Anderson Key Unannounced Inspection 19th September 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 Doveridge Care Home DS0000061662.V306968.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. Doveridge Care Home DS0000061662.V306968.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Doveridge Care Home Address Doveridge South Street Colyton Devon EX24 6PS 01297 552196 01297 552924 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) Doveleigh Care Limited Amy Jane Burt Care Home 20 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (20) of places Doveridge Care Home DS0000061662.V306968.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 16th September 2005 Brief Description of the Service: Doveridge is a detached 2 storey former farmhouse close to the heart of the village of Colyton. It has been extended and adapted for use as a care home. Accommodation and personal care is provided to up to 20 residents who have needs related to old age and/or dementia type illnesses. The home has 18 single and 1 double bedroom on the ground and first floors. There are two floors but these are spread over 3 levels with stair lifts linking all areas. The home has 2 lounge/dining areas, one on each floor and a quiet area on the first floor. In addition there is a conservatory forming the entrance to the home where many residents like to sit. In front of this there is a patio area with seating and a small parking area. Current charges range from £315.00 - £590.00. These fees do not include the cost of bringing in outside entertainers or such things as toiletries, hairdressers or newspapers. Information about this home is available direct from the home. Doveridge Care Home DS0000061662.V306968.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place as part of the normal programme of inspection. The site visit began at 10.00 and finished at 4.30pm. This included a visit to the sister home to inspect staff recruitment records. Prior to the site visit the owner and manager provided information in a preinspection questionnaire. Questionnaires, asking for comments about the home, were sent to 11 residents and 5 were returned and to 12 staff and 8 were returned. Comment cards were sent to and left in the home prior to the site visit for visitors to complete, and 4 were returned. During the visit to the home the inspector saw and/or spoke with all residents. The care and accommodation offered to 3 residents were case tracked (this helps us to understand the experiences of people using the service). The inspector observed the care and attention given to residents by staff. She spoke with 1 visitor, the owner, manager and 4 members of staff. The inspector visited all communal and service areas in the home and saw approximately 10 bedrooms. Records in relation to care assessment, care planning, medication, staff recruitment, residents monies and fire safety were inspected. The inspector appreciated that the manager gave up her day off to help with this inspection, and found staff very helpful on the day. What the service does well:
Before moving into Doveridge all prospective residents are given information about the home and are offered the opportunity to visit and have lunch with other residents if possible. All residents are assessed, ensuring that the home and staff can meet their needs. Each resident has a plan of care, which incorporates their likes, dislikes and preferences. Healthcare needs are well met with evidence of multi-disciplinary working. Comments included ‘my mothers health has greatly improved since going into this home’ and ‘staff are most attentive’. All five residents who responded in surveys said that they always receive the care, support and medical support they need. Medications are handled well and safely. Staff work towards maintaining the privacy and dignity of residents, ensuring that relationships are respectful, that residents receive all personal care in private and ensuring that residents wear their own clothes at all times. Activities at Doveridge are flexible and tend to be spontaneous as opposed to pre-arranged. The manager continues to keep this under review to ensure it
Doveridge Care Home DS0000061662.V306968.R01.S.doc Version 5.2 Page 6 meets the needs of all residents. Some outings take place and the home is currently fund raising for a minibus. There is good contact with the local community and visitors report they are made welcome. The manager has a good understanding of the importance of promoting equal rights for all residents in terms of choice and autonomy. Routines are kept to a minimum as a way of supporting this and care planning is, on the whole, based on the choice of residents. Residents say for example they get up when they like, wear what they like and go to bed when they like. No complaints have been received about this home. Residents report that they know who to speak to if they have a problem, that staff listen to them and that action is taken to overcome any small problems. They also say they feel safe and that staff are kind. Staff all receive training in ‘safeguarding adults’ and demonstrate a good understanding of this and the actions to be taken if needed. Doveridge is described by residents as ‘cosy’ and ‘homely’. They say it is always clean and fresh. Staff describe good infection control procedures and these were observed being put into practice. Staff are highly thought of by residents and visitors. They describe them as ‘lovely’, ‘kind’, ‘cheerful’ and ‘chatty’. The staff group is stable and in surveys demonstrate a commitment to the provision of quality care and team working. The manager is very highly respected by staff and residents. Staff feel well supported and in turn say they want to support her. She has approximately 10 years experience of working in social care and has an open, inclusive and problem solving style of management. Good systems are in place to ensure the home is run in the best interests of residents and to promote their wellbeing and safety. Shortcomings bought to her attention during this inspection are already being addressed. What has improved since the last inspection? What they could do better:
The home has a guide to the home written in a standard format. As this is a home for people with dementia and some residents have other communication problems there should be a guide that is produced in a format that takes these issues into account. Whilst there is a good system of care planning in place, care workers are not always following them. In addition they are not always recording changes.
Doveridge Care Home DS0000061662.V306968.R01.S.doc Version 5.2 Page 7 Reviews are taking place, but cannot be meaningful without the input from care workers. The storage of medications that require refrigeration should be more secure and should incorporate a mechanism for recording the storage temperature and ensuring this is appropriate. The manager should continue to keep the activities offered under review to ensure they suit the needs of all residents in particular those with complex communication difficulties. In order to ensure that food is properly stored and handled the temperature of the freezer should be recorded. The manager should check at the coming environmental health assessment as to the appropriateness of uniforms worn by staff during cooking and the placement of the freezer. The area outside the boiler cupboard should be kept free from storage of combustible materials and all fire doors should close properly. The programme of covering radiators to prevent scalding should continue and the order of covering should be based on risk assessments. The home now has 45 of care staff who are trained to NVQ level 2 or above. They should continue to work towards reaching a 50 target. Staff must not take their breaks together leaving no staff inside the home to supervise residents. As the home has a number of people who have communication difficulties staff should receive training in how to help these people to communicate. Records in relation to the handling of residents’ monies should be kept up to date. 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. Doveridge Care Home DS0000061662.V306968.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 Doveridge Care Home DS0000061662.V306968.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. This home does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Assessments of residents prior to admission ensure that staff have enough information in order to know and meet their needs. Residents generally have enough information about the home before they move in. EVIDENCE: In order to help prospective residents to make a decision about where they live, they are, where possible, invited to come and look around the home. One resident said that the manager visited them at home and invited them to lunch at the home. In addition there is a guide to the home detailing the services available and the ethos of the home. This guide contains important information. Three of the five
Doveridge Care Home DS0000061662.V306968.R01.S.doc Version 5.2 Page 10 residents who responded to surveys felt they had enough information before moving in and two did not. Before moving in to the home all prospective residents have their needs assessed to ensure that the home can meet their needs. Information is gathered from the prospective resident, family, and health and social care professionals. The manager described how each new admission to the home is made welcome and helped to settle in. Staff say they have enough information about each new resident and are prepared for their admission. One relative commented that they thought this process could be improved to help overcome the trauma of such a life changing experience. In staff surveys three members of staff said they were always introduced to new residents, one said never and one said sometimes. Doveridge Care Home DS0000061662.V306968.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The arrangements in place for planning resident’s care do not ensure that residents consistently get the care they need in a way that suits them. The healthcare needs of residents are well met with evidence of multidisciplinary involvement. The systems for the management and administration of medications are generally good and largely ensure that residents’ medication needs are met safely. Personal support is offered in such a way as to protect and promote residents’ rights to privacy and dignity. EVIDENCE: The inspector looked at three care plans in depth. They are written in a way that makes them easy for staff to read and understand. Each direction regarding care is generally accompanied by an explanation to help staff understand why they are carrying out care in a certain way. There is evidence that residents are involved in their care planning as they include information about the resident’s preferences, normal routines, likes and dislikes.
Doveridge Care Home DS0000061662.V306968.R01.S.doc Version 5.2 Page 12 Staff report that they have easy access to care plans and that information is given to them during handover. Key workers review the plans regularly and the manager carries out monthly audits. However, staff are not recording or reporting the effect and outcome of the care delivered and staff knowledge about care plans is variable. As a result the quality of care delivered is variable. The care plan of one resident states how this person is to be cared for to ensure that they receive care that prevents deterioration and is given in a way that promotes dignity and choice. Staff describe a different routine to that planned. This resident was found to be unkempt, wearing clothes that were marked, drinking from a glass that did not suit, and they smelt of urine. This was bought to the attention of the manager during the inspection. Another care plan described that a resident should have their legs elevated to help relieve swelling; that the person wears glasses; has a good appetite and does not need help with meals. The inspector met with this person and found that their legs remain swollen and not elevated. The manager reports that this person does not like having their legs elevated. No alternative measures for reducing the swelling have been recorded. This person was not wearing their glasses. They had in front of them a cold and half finished breakfast, a cold cup of tea, a slice of cake from the day before and approximately a quarter full glass of a drink supplement. The care plan indicates that this person was last weighed in July. No review or change to the care plan has taken place and it is therefore not clear that their nutritional needs are being met. The same care plan indicates that this persons overall aim is to improve their mobility and overcome their pain. A plan has been devised to achieve this. A member of staff confirmed, and records show, that painkillers are administered regularly. However staff are not recording if the plan is being followed or if it, and the painkillers, are helping to achieve the residents stated aims. Another care plan indicates that the resident has lost a significant amount of weight over a period of time. No intervention has taken place. In general, care plans do include information about how residents communicate. This is particularly important in a home that cares for people with dementia or with dysphasia (communication difficulties). However, these lack detail and have no input from staff who have come to know residents well and can understand what the resident is trying to communicate. Writing this down ensures that this knowledge is shared amongst all staff. There is good evidence that health and social care professionals are appropriately referred to and involved with residents care; and that residents have their healthcare needs met. This includes involving the chiropodist, dentist, doctor, district nurse and community psychiatric nurse. Care plans show that where therapeutic directions are given, they are followed. One
Doveridge Care Home DS0000061662.V306968.R01.S.doc Version 5.2 Page 13 resident said they had been ill and that staff ‘have looked after me better than my own mother could’. A relative said ‘my mothers health has greatly improved since going into this home’. All five residents who responded in surveys said that they always receive the care, support and medical support they need. One resident said staff are ‘most attentive’. Systems for managing medications are good. There is a system for ordering, receiving, storing and returning medicines, which is well understood by staff and followed to ensure safety. Staff receive training in managing medications and records checked are up to date. During this inspection there were no medications that require refrigeration. The manager has been advised about how these medications should be stored if they have any. Staff demonstrated a good understanding of how they can help residents to maintain dignity and how they can ensure residents have privacy. For example all care is given in private and residents wear their own clothes at all times. ‘ Doveridge Care Home DS0000061662.V306968.R01.S.doc Version 5.2 Page 14 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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Links with the community and visitors are good and residents, on the whole, have their social care needs met. Support is generally offered in a way that promotes choice and flexibility. The meals offered provide choice, variety and meet nutritional needs. EVIDENCE: The care plans looked at do include some life history work, where important information about the resident is collected to help promote an understanding of that person’s life and their interests and to ensure there is some continuity in that person’s life. However, this does not always form the basis for helping to meet social needs. Since the last inspection Doveridge has changed the way social activities are delivered. There used to be a daily programme of activities which residents were invited to attend. However, the manager reports that this system only met the needs of a small number of residents. As a consequence staff now ask residents what they would like to do or wait for residents to ask to do something. This usually takes place in the afternoon. Staff will for example use music as the basis for a quiz and there are a number of board games and craft
Doveridge Care Home DS0000061662.V306968.R01.S.doc Version 5.2 Page 15 activities available. Residents who responded in surveys said that there are usually activities that they can take part in. One said they particularly enjoyed the ‘charabang’ trips. The manager described how relatives of a recently deceased resident had given the home money so that the residents could all go out for a cream tea. To ensure equal access for all residents, the manager has arranged this in three trips. Scones were bought back to the home for those residents who chose not to go. The manager reports that musical entertainment is occasionally bought into the home, which is paid for through donations. Fundraising is currently underway to raise money for a minibus. Residents spoken with said they are not bored and those who are able to express their views and who spend much of their time in their bedrooms said they like their own company. One resident in a survey said ‘I get the attention I need’. However, it is not clear how the social needs of those who are not able to communicate and who spend long periods in their bedrooms are met or how they are stimulated. For example, although staff demonstrate a good knowledge of one residents interests, and there was even more information in the care plan, they said that these interests could not be followed because of the persons disability and because they have dementia. The manager reports this person does not have dementia. There is no evidence to show that attempts have been made to overcome this person’s disability so they can continue to enjoy their preferred interests. The care plan of another resident did not contain any information about their social preferences or a care plan relating to meeting their social needs. One visitor thought that activities could be improved for more able residents. Links with the community are good. Many of the residents are local and know the area and have visitors from the area. The home attempts to join in with local events including the recent carnival. Visitors are free to come and go and describe staff as ‘welcoming’ and say that a cup of tea is always offered. Staff demonstrate a good understanding of paying respect to personal ownership. For example, each bedroom is seen as the residents ‘private domain’, residents wear only their own clothes and staff view resident’s personal belongings as important. One resident described how staff had painstakingly placed all their treasured ornaments in a display cabinet. In surveys all residents said that always like the meals served at the home; two residents and one visitor spoken with during the inspection thought that the quality of food could be improved. Doveridge Care Home DS0000061662.V306968.R01.S.doc Version 5.2 Page 16 Doveridge does not have a dedicated cook. Instead carers share the responsibility for cooking and have designated days on which they cook. Two members of staff in surveys mentioned that they would prefer the home to have a cook. The kitchen is clean and, apart from checking and recording the temperature of freezers, checks are in place to ensure food is stored safely. Doveridge Care Home DS0000061662.V306968.R01.S.doc Version 5.2 Page 17 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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has a satisfactory complaints system that residents feel confident in using if they need to. Residents feel safe and well cared for and staff’s knowledge of adult protection ensures that residents live in an environment where they are protected from abuse. EVIDENCE: The formal complaints policy is contained within the guide to the home provided in all bedrooms. There have been no complaints made to the home or to the commission since the last inspection. Residents report that they can express any ‘little niggles’ to the carers or manager and, on the whole, feel confident these will be dealt with. In surveys residents indicate that they know who to speak to if they are not happy and that they always or usually know who to make a complaint to. The inspector heard many comments between residents and staff during the day indicating that relationships are relaxed and residents are listened to. Staff receive training in the protection of vulnerable adults and demonstrate a good knowledge of abuse and what to do if this were alleged or witnessed. Staff surveys indicate that all staff that responded are aware of adult protection procedures. Residents say they feel safe and, based upon observations made by the inspector, clearly have relaxed relationships with the staff.
Doveridge Care Home DS0000061662.V306968.R01.S.doc Version 5.2 Page 18 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, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The environment of this home provides residents with a homely and clean place to live. Failure to follow fire prevention and protection guidelines is placing residents at risk. EVIDENCE: In surveys residents said that the home is always clean and fresh. And the inspector found the home this way on the day of inspection. The home does not have a designated cleaner, instead staff share the cleaning. Two members of staff in surveys suggested that having a designated cleaner would free up more time for staff to spend with residents. The manager reports that the home is due to have a routine assessment by an environmental health officer. The inspector suggested that the manager discuss with this person the suitability of the uniforms worn when staff are working in the kitchen and the positioning of the freezer in the laundry.
Doveridge Care Home DS0000061662.V306968.R01.S.doc Version 5.2 Page 19 Not all rooms have liquid soap dispensers and paper towels. However, staff described the procedures that are in place to overcome this and to prevent the spread of infection. The inspector observed that these procedures are being put into practice. The home has a number of communal areas but residents tend to sit in the lounge and conservatory on the ground floor. One visitor commented that the conservatory could become busy because it is a walkthrough area, another that it could become noisy because of its close vicinity to the kitchen. Visitors thought the consequences of this are that residents might not be able to ‘nod off comfortably’ and that encouraging residents’ mobility in such a busy area could be difficult. During the tour of the home the inspector noted that a large amount of combustible materials are being stored near to an area that is potentially a high fire risk (the boiler). In addition, one of the bedroom doors adjacent to this area (a fire door) does not close properly increasing the risk of the spread of a fire. This was bought to the attention of the manager and owner during the inspection. Residents are protected from hot water scalds through the fitting of thermostatic valves to hot water outlets. The owner is continuing with a programme of covering radiators to prevent scalds based on risk assessments. The manager ensures these are up to date. Doveridge Care Home DS0000061662.V306968.R01.S.doc Version 5.2 Page 20 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 quality outcome in this area is adequate. This judgement has been made using available evidence including a site visit. Staff receive appropriate training to provide residents with the support and care they need. They are employed in sufficient numbers but, on occasion, are putting residents at significant risk of harm. The recruitment procedures designed to protect residents are followed, ensuring residents’ safety. EVIDENCE: The inspector arrived at Doveridge at 10.00am. At that time all the staff on duty were sitting outside having their break. The senior carer on duty confirmed that every member of staff on duty was outside and that there were no staff in the home. The inspector informed the manager and owner that this is unacceptable and is placing residents at significant risk of harm or injury. The manager and owner report that this is not normal practice. In surveys returned by residents all said that they get the care and support they need. The majority said that staff are always available when needed, although one resident said that they are sometimes asked to wait 2 minutes, which can turn into 20 minutes. Comments about the staff are very positive and include ‘the efforts of the staff have made my life very happy’; they are ‘lovely’, ‘kind’, ‘helpful’ and ‘friendly’. In surveys staff said they are never asked to care for people outside their area of expertise, that they feel they are well trained and supported to carry out
Doveridge Care Home DS0000061662.V306968.R01.S.doc Version 5.2 Page 21 their role and that they have enough time to provide the care required. Approximately 45 of care staff are trained to NVQ level 2 or above and specialist training is provided. The inspector noted that some residents have dysphasia, a problem with communication. One member of staff thought that a resident with dysphasia had dementia and none of the staff have received training in how to help people with this condition to communicate. The recruitment files of two members of staff were inspected. These contain all the appropriate checks to promote the safeguarding of residents. The manager reports that when the last carer was recruited, she informally met with and was interviewed by two of the residents. Doveridge Care Home DS0000061662.V306968.R01.S.doc Version 5.2 Page 22 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 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a site visit. The management systems in place help to ensure residents live in a wellmanaged, safe environment where they are protected. EVIDENCE: The manager of Doveridge has approximately 10 years experience of working in social care. She holds the Registered Manager’s award and consistently demonstrates that she keeps up to date with current practice. Her style is open, honest and problem solving. Staff describe her as ‘supportive’, and as ‘bringing the home up to date’. Staff report that the atmosphere at the home is very good and as a ‘pleasure to work in’. One member of staff said that the staff work hard to support the manager because she works hard to support them. The manager demonstrates a good understanding of equality issues and works hard to promote choice and equality for all the residents.
Doveridge Care Home DS0000061662.V306968.R01.S.doc Version 5.2 Page 23 The manager reports that she tries to run the home in a way that suits residents. Routines are flexible and individual preferences are taken into account. She says she finds informal feedback a useful means of improving services although more formal questionnaires are undertaken. The management team hold frequent staff and resident meetings where suggestions and ideas are aired. In surveys and during interviews residents could not suggest anything that would improve the home. The monies held on behalf of two residents were checked. The system used is secure, clear and auditable. For that reason it was easy to see that the account of one resident is not completely in order. Whilst there is no suggestion that there is any wrongdoing (the amount of money held exceeds the amount recorded) it does show that the system designed to protect residents from financial abuse is not being used properly. Prior to the inspection the owner and manager of Doveridge provided the commission with information about their policies and maintenance checks and controls. These appear to be in order. The fire logbook was inspected and this shows that training, drills and appropriate checks are undertaken and that remedial action is taken as necessary. Mandatory training, including first aid, food hygiene and manual handling is provided for all staff, as is some specialist training as required. One member of staff commented how good the manual handling training is. Doveridge Care Home DS0000061662.V306968.R01.S.doc Version 5.2 Page 24 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 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x 2 3 STAFFING Standard No Score 27 1 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 2 x x 3 Doveridge Care Home DS0000061662.V306968.R01.S.doc Version 5.2 Page 25 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(2) Requirement You must keep each residents plan under review and ensure that revisions to the plan are appropriately made. You must ensure that adequate precautions against the risk of fire are taken. (This relates to the storage of items adjacent to the boiler and to one bedroom door, a fire door, in the same vicinity not closing properly). You must ensure that necessary risks to the safety of service users are, so far as possible eliminated. (This refers to the need to cover all hot surface temperature radiators). Timescale for action 30/11/06 2. OP19 23(4)(a) 30/10/06 3. OP25 13(4) 31/12/07 4. OP27 18(1)(a) You must ensure that at all times 30/10/06 there are enough staff working at the care home. (This relates to all staff taking their break at the same time leaving no one in the home to supervise residents). Doveridge Care Home DS0000061662.V306968.R01.S.doc Version 5.2 Page 26 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. Refer to Standard OP7 OP9 OP12 OP15 Good Practice Recommendations You should ensure that care staff update care plans to reflect changing needs and current objectives for health and personal care, and that appropriate action is taken. You should ensure that when medications stored in the home need refrigeration, that such storage is safe. You should continue to review the activities offered to ensure they are suited to the needs, preferences and capacities of all residents. You should ensure that all food is stored safely by testing and recording the temperature in the freezer and by checking with the environmental health officer (during the assessment visit) that the freezer is located in an appropriate place. You should also check that the uniforms worn by staff during cooking is suitable. You should ensure that you continue to work towards ensuring that at least 50 of care staff are trained to NVQ level 2 or above. You should ensure that staff have the skills to meet the specific needs of residents. In this case this relates to meeting the needs of those residents with dysphasia (communication difficulties). You should ensure that written records of all transactions are made in relation to residents monies. 5. 6. OP28 OP30 7. OP35 Doveridge Care Home DS0000061662.V306968.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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