Inspection on 26/04/05 for Doveridge Care Home

This inspection was carried out on 26th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Doveridge Care Home 31/05/07

Doveridge Care Home 19/09/06

Doveridge Care Home 16/09/05

Doveridge Care Home 26/10/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Doveridge Care Home Doveridge South Street Colyton EX24 6PS Lead Inspector Teresa Anderson Announced 26 April 2005 10:00 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 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 D54 D06_S61662_Doveridge_V213822_260405 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Doveridge Care Home Address Doveridge South Street Colyton Devon EX24 6PS 01297 552196 01297 551493 Telephone number Fax number Email 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 Mrs Elizabeth Mills Care Home 20 Category(ies) of DE(E) Dementia - over 65 (20) registration, with number OP Old age (20) of places Doveridge Care Home D54 D06_S61662_Doveridge_V213822_260405 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 26 October 2004 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. Accomodation 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 room bedroom on the ground and first floors. The home has 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 large conservatory forming the entrance to the home where many residents like to sit. To the front of the house is a patio area with seating and a small parking area. Doveridge Care Home D54 D06_S61662_Doveridge_V213822_260405 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced and arranged with the owners and manager as part of the normal programme of inspection. It took place over 6 hours, between 10.00am and 4.00pm. The inspector spoke with or met all the residents and spoke with the manager, the deputy manager, four members of staff and the administrator. She looked around the entire inside of the home and looked at paperwork in relation to care planning, staff recruitment, training and safe working practices. The owner of the home, prior to the inspection, had completed a pre-inspection questionnaire and six comments cards from relatives and residents were received by CSCI. What the service does well: What has improved since the last inspection? Doveridge continues to work towards move away from a communal living environment towards supporting individuals to live in a communal setting. The manager continues to work with and act as a role model for staff to help develop their skills in this area. Recommendations previously made in relation to the management of medication and the resurfacing of the laundry floor have been acted upon. Books and activities have been placed in a more prominent place to encourage their use and the manager has compiled a library of relevant information and leaflets for residents on many social and health care issues. Doveridge Care Home D54 D06_S61662_Doveridge_V213822_260405 stage 4.doc Version 1.30 Page 6 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. Doveridge Care Home D54 D06_S61662_Doveridge_V213822_260405 stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Doveridge Care Home D54 D06_S61662_Doveridge_V213822_260405 stage 4.doc Version 1.30 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 standard(s) 1 and 3. Residents are able to make an informed choice about where they live. Comprehensive pre-admission assessments ensure, as far as is possible, that the home can meet the needs of potential residents. EVIDENCE: Information, both written and verbal, relating to the services offered at Doveridge is available to all potential and current residents. Copies of this information are kept at the entrance to the home together with a welcome guide for visitors. This describes the valuable contribution visitors can make to the quality of residents lives. Three recently admitted residents said that they had met with the manager prior to admission to Doveridge and that they had received sufficient information on which to base their choice of home. The manager had asked them lots of questions about their health and interests. They had also been asked what they wanted to gain from living at Doveridge. One resident has decided he would like to learn to play a musical instrument. All had visited or arranged for someone to visit the home on their behalf before deciding to move in. Doveridge Care Home D54 D06_S61662_Doveridge_V213822_260405 stage 4.doc Version 1.30 Page 9 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 standard(s) 7, 8, 9, 10 and 11. The health and personal care needs of residents are identified and met. The homes arrangements for the management of medicines are robust. Privacy and respect for residents is given a high priority. Arrangements for caring for people who are dying are good and continue to improve. EVIDENCE: All aspects of residents’ health, personal and social care needs are identified and planned for in care plans. Staff have a sound knowledge of the individual needs and preferences of residents. Plans are kept up to date and are reviewed frequently with the resident and with family members if appropriate. Residents said that care staff support them to be’ healthy and happy’. Staff at the home and the primary care team have an excellent relationship as identified by the staff at the home, district nurses and the hospital liaison nurse. Risk assessments are comprehensive and actions to minimise risk are clearly identified and acted upon. During the last few months and weeks staff have worked closely with the primary care team and the hospice nurses to achieve a ‘good’ death, as defined by the resident concerned. Staff felt they had really helped this resident and documentation confirmed this. Approximately 8 members of staff Doveridge Care Home D54 D06_S61662_Doveridge_V213822_260405 stage 4.doc Version 1.30 Page 10 are now undertaking training in ‘Foundations in Palliative Care’. The manager and staff are commended for their hard work and commitment. Since the last inspection the arrangements for storing and receiving medications has been improved as recommended. This system is robust. Training is on-going. Residents said that staff worked hard to ensure their privacy and that they are always treated with respect. The inspector saw some lovely (and very discreet) examples of this throughout the inspection. Doveridge Care Home D54 D06_S61662_Doveridge_V213822_260405 stage 4.doc Version 1.30 Page 11 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 standard(s) These standards were not inspected. EVIDENCE: Doveridge Care Home D54 D06_S61662_Doveridge_V213822_260405 stage 4.doc Version 1.30 Page 12 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 standard(s) 16 and 18. The home has a robust complaints procedure and residents are confident that all complaints and suggestions will be taken seriously and acted upon. Residents are protected by the adult protection procedures in place. EVIDENCE: Doveridge have not received any complaints since the last inspection. During the inspection a number of residents confidently made suggestions to the manager on how improvements could be made. Suggestions included the use of china cups, hotter tea, an alternative placement for a clock, the clipping of a hedge and a request that fresh fruit be offered (this is currently available but not necessarily offered). The manager and staff demonstrated a strong commitment to making changes in line with resident preferences, and flexibility when residents changed their minds about their preferences. Residents said that they are always treated well and with kindness. They obviously had confidence and were relaxed in the company of the manager and staff. Good procedures are in place to ensure that proper actions would be taken if allegations of abuse were made. Staff receive training in the protection of vulnerable adults and confirmed they understood these. Doveridge Care Home D54 D06_S61662_Doveridge_V213822_260405 stage 4.doc Version 1.30 Page 13 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 standard(s) 19, 20, 21, 22, 25 and 26 Residents live in a safe, comfortable and clean environment that is well maintained. They have good access to appropriate facilities and the promotion of independence is treated as a priority. EVIDENCE: Residents at Doveridge can choose where they spend their time. Bedrooms are comfortable, well furnished and personalised. Communal areas are inviting and relaxing or noisy and busy depending on what residents are doing. The upstairs lounge has recently been reorganised and now includes a number of intimate seating areas, together with a TV, a piano and a dining area. The conservatory, at the entrance to the house, is currently the most popular area in the home where residents congregate to listen to or sing along with music, read or rest and where they can generally keep an eye on activities. Since the last inspection clear signage has been added to toilets and bathrooms, which has helped new residents to orientate to the home, and helps to promote continence and independence. Doveridge Care Home D54 D06_S61662_Doveridge_V213822_260405 stage 4.doc Version 1.30 Page 14 The independence and maintenance of abilities of residents is strongly emphasised at Doveridge. For example the handyman is currently looking to adapt the flushing system of one toilet to allow a resident to be completely independent. Whilst the laundry is small, good management procedures are in place to prevent cross infection. The floor has been resurfaced to ensure it is impermeable to water as recommended at the last inspection. Many residents commented that their clothes are well cared for. Many of the radiators have no protective guards and this poses a potential risk to residents. The owner has agreed to guard all un-protected radiators by 2007. Risk assessments determine the order in which covers are provided. Doveridge Care Home D54 D06_S61662_Doveridge_V213822_260405 stage 4.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30. Residents are protected by the home’s recruitment policies and procedures. Staff numbers and skills suit residents. Staff are well trained, supervised and are competent EVIDENCE: Residents describe the staff at Doveridge as ‘excellent’, ‘darlings’, ‘always there to help and they never complain’ and ‘kind’. They are obviously relaxed in their company and showed a large degree of confidence in and respect for the staff. Staffing numbers are sufficient to meet the health, personal and social care needs of the residents as demonstrated in care plans, referrals made, training records, staff knowledge, interactions and by residents comments. Staff, without fail, commented on how much they enjoy working at Doveridge. They feel they are well supported, have good training and that there is a good team spirit. There is no doubt this has been helped along by the ‘Champagne and Pampering team building day’ organised and financed by the owners of Doveridge. Recruitment files demonstrate that robust procedures are in place to ensure that appropriate checks are carried out on all staff. Training files, discussion with staff and observation of practices and interactions demonstrate that staff receive comprehensive and appropriate training suited to caring for people with problems related to old age and dementia. Doveridge Care Home D54 D06_S61662_Doveridge_V213822_260405 stage 4.doc Version 1.30 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 35 and 38. Doveridge benefits from strong leadership and direction for staff, which in turn promotes and safeguards the health, safety and welfare of residents. Two members of staff have not attended mandatory fire training. EVIDENCE: Doveridge has an experienced care manager, Amy Burt, who has worked at the home for approximately 3 years. She is currently applying to become the Registered Manager. The owners, one of whom is a registered nurse, are clear about roles and responsibilities and about their own and others limitations. Amy is also supported by a very well respected deputy who has worked at Doveridge for more than 20 years and who continually updates her skills and builds upon and shares her vast experience. The staff team are committed and understand the ethos of the home and work hard to ensure that the home is run for the benefit of service users. Doveridge Care Home D54 D06_S61662_Doveridge_V213822_260405 stage 4.doc Version 1.30 Page 17 Safe working practices are followed which include mandatory training, maintenance and checks. It was identified during the inspection that two members of night staff had not attended the mandatory three monthly fire training. Systems for storing and managing service users monies are good. However, it is recommended that more detailed records of monies spent be kept to ensure clear audit trails. Doveridge Care Home D54 D06_S61662_Doveridge_V213822_260405 stage 4.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION 3 3 3 3 3 3 2 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 4 x 3 3 3 x x 2 x x 2 Doveridge Care Home D54 D06_S61662_Doveridge_V213822_260405 stage 4.doc Version 1.30 Page 19 no Are there any outstanding requirements from the last inspection? 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 25 Regulation 13(4) Requirement The registered person 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). The registered person must make arrangements for persons working at the care home to receive suitable training in fire prevention (in relation to 2 members of night staff who have not attended the mandatory 3 monthly training). Timescale for action 31/12/07 2. 38 23(4)(d) 30/05/05 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 35 Good Practice Recommendations The registered person should ensure that there is a clear audit trail in relation to service users monies (including receipts detailing monies spent). Doveridge Care Home D54 D06_S61662_Doveridge_V213822_260405 stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection 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 © 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 Doveridge Care Home D54 D06_S61662_Doveridge_V213822_260405 stage 4.doc Version 1.30 Page 21 - 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. 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