Inspection on 02/02/06 for Down House

This inspection was carried out on 2nd February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Down House 13/09/07

Down House 25/10/06

Down House 06/09/05

Down House 22/02/05

Down House 14/07/04

Down House 04/12/03

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Down House Down House 277 Tavistock Road Derriford Plymouth Devon PL6 8AA Lead Inspector Douglas Endean Unannounced Inspection 2nd February 2006 10:30 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 Down House DS0000030358.V269690.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Down House DS0000030358.V269690.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Down House Address Down House 277 Tavistock Road Derriford Plymouth Devon PL6 8AA 01752 789393 01752 769747 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) Mayhaven Healthcare Limited Jacqueline Carol Hunt Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (3), Physical disability over 65 years of age of places (43), Terminally ill (4) Down House DS0000030358.V269690.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users can be admitted over the age of 40 years in relation to the PD category only. 6th September 2005 Date of last inspection Brief Description of the Service: Down House is a Care home which is registered to take 43 clients of either gender, over the age of 65 years, who require nursing care, and a maximum of 3 Service Users who require personal care only. The home is situated in the Derriford area of Plymouth close to Derriford Hospital, and is on a main bus route to Plymouth city centre. It is a large adapted old house with a modern, purpose built, single storey extension. The main house has two floors that have client accommodation with access to the first floor via a stair-lift. The home currently has no passenger lift, but the first stage of the new extension is near completion and this incorporates a shaft lift that will stop at each floor that clients are accommodated on. The home is tastefully decorated and the furnishings are of good quality. There is good provision of equipment for the disabled and those needing support such as a wheel in large shower room, a good sized disabled bathroom, mobile hoists and en-suite facilities to all bedrooms. There is also a well maintained garden area that has a mix of shrubs, paved, and gravel areas with attractive pots for plants. Once the first stage of the extension is complete the garden to the side of the home will be reinstated offering an extensive level lawn area. The Registered Managers post is vacant but the home is being well managed by a very experienced first level nurse whilst the recruitment of a new manager is underway. Down House DS0000030358.V269690.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report should be read along side of the previous report in order to establish the homes performance against the National Minimum Standards during this inspection year. This was the second unannounced inspection of the home within a 12 month period. On this occasion the Registered Person and out going Registered Manager were at the home and were able to spend time with the inspector. The main focus of this inspection was to view the extension that is nearing completion, inspect the function of the home against the core standards that had not been covered on the first occasion and any others that were felt appropriate. The inspector was assisted in his task by the nurse who is providing management support. He saw 3 complete client files that included care plans and risk assessments that are kept in clients rooms. He saw a sample of maintenance records including fire those in the fire log book. During the tour of the home he met and spoke to 7 clients and one relative who was visiting and one who had accompanied a new client to the home for admission. He also spoke to the Administrator, two other registered nurses who were on duty and one care staff member whilst generally observing staff who were engaged in different tasks with the clients. What the service does well: What has improved since the last inspection? Down House DS0000030358.V269690.R01.S.doc Version 5.1 Page 6 The extension is well on the way with the first stage being near completion. It will offer a higher standard of facility to each client then they already experience in the present accommodation. The home continues to meet his aims and objective in an efficient way without care being a mechanical process. The Administrator has made some additions to monitoring processes, such as recruitment, to make them more robust. 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. Down House DS0000030358.V269690.R01.S.doc Version 5.1 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 Down House DS0000030358.V269690.R01.S.doc Version 5.1 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): 1&2 The Statement of Purpose and contract/terms and conditions of residency, have sufficient information to enable a prospective client to make an informed decision about moving into the home. EVIDENCE: The Statement of Purpose offers any prospective client a good level of information that should enable them to make an informed decision about moving to the home. It will also remind those already resident about such things as how to identify different grades of staff by the colour of their uniform, what arrangements there are for activities and how to make a complaint if they feel it necessary. The document also holds colour photographs of several of the staff and how to contact the Registered Person. Finally there is information for the reader on how to contact the Commission for Social Care Inspection for a copies of inspection reports off the Internet or by telephone. The inspector looked at the homes contract/terms and conditions of residency. It is complete and concise and hold information regarding what is being purchased within the agreed price and, where nursing is provided, how this will Down House DS0000030358.V269690.R01.S.doc Version 5.1 Page 9 be funded separately through the Funded Nursing Care system. The fee does not include such things as hairdressing and chiropody. Down House DS0000030358.V269690.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 9 The total care planning process that includes regular assessments and the monitoring of dietary intake is good is the use of other health care professionals in assessing and meeting the needs of the clients at the home. The arrangements for the management of clients medication are satisfactory. EVIDENCE: The care plans are generated from the results of several risk assessments that are undertaken by the registered nurses and other staff both on admission and during the period of time that the clients are resident in the home. The inspector looked at two of the clients files that are kept in the office and then the addition parts of the file and care plans that are kept in each of the clients room for staff to use whilst delivering care. The care plans are clear and offer direction to the care givers. They are regularly reviewed to keep them up to date in line with the changing needs of the clients. The additional information that is gathered includes such things as nutritional assessments the result of which is duplicated and discussed with the cook. Fluid balance chart, Waterlow score, regular weights are some of the ways that the staff monitor the clients and make judgements about future care. These recordings were seen by the inspector in files managed by the nursing staff. All Down House DS0000030358.V269690.R01.S.doc Version 5.1 Page 11 these factors also played a factor in the management of the clients skin integrity especially where they are less mobile. Equipment is available and in use to prevent the formation of a pressure sore and this was seen by the inspector during his tour of the home. The files also hold risk assessments for the use of bed guards and signed agreements regarding their use, or the decision by a client to refuse a bed guard. During the inspection many clients were seen and six were spoken too. All the clients looked comfortable, appropriately dressed and well presented as their general appearance had been looked attended to. All the clients are registered with a General Practitioner. The inspector saw the records made by the teams of nurses when they call upon the General Practitioner or any other health care professional to assist them in meeting the changing care needs of the clients such as the chiropodist, physiotherapy, etc. The home is managed by at least two registered nurses during the day and one registered nurse during the night. They are supported by care staff many of which have a National Vocational Qualification in Care. The home is well equipped with aids such as mobile hoists, stand aid’s, raised toilet seats, disabled bathing, disabled toilets and shower facilities and there are hand rails in appropriate places around the home and in the en-suite and semi en-suite facilities some of which have a domestic bath and floor mounted hoist. The home has secure facilities for the storage of the medicines they are using. There are also good procurement and administration records. The drug reference material includes a British National Formulary dated September 2005 and a new copy of the Plymouth Area Joint Formulary supplied by the National Health Services. Clients have lockable facilities in their rooms should they meet the criteria for self administration of there medication. Down House DS0000030358.V269690.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 & 15 There are suitable activities arranged by the home for clients who can choose to take part or not. The home meets the nutritional needs of the clients in a way that takes their choice and their physical needs into account and produces nicely presented balanced meals. EVIDENCE: The clients who are able to exercise their choice in many ways such as what food they will eat and what they dislike. This information is recorded both in the clients file and in the kitchen where the cook plans and cooks the meals following the menu’s and the registered nurse guidance such as when addition food supplements are indicated due to poor dietary intake and weight loss. Weights are done monthly and the records were seen by the inspector. During the inspection the inspector did see a number of the meals that had been provided. They were well presented, were in suitable portions that looked to be well balanced and had a nice aroma. The clients eating them remarked that they were enjoying them. The clients also choose the clothes they wear, the room they prefer to sit in (i.e. the lounge or their own room) and where they will see a visitor. They may personalise their own rooms and the inspector saw a lot of evidence of this when he toured the home. Down House DS0000030358.V269690.R01.S.doc Version 5.1 Page 13 There are telephone sockets in all the rooms in the new wing and clients can have their own telephone line that is then they are privately billed for its use. If they wish to watch television the home has a large wide screen television in the lounge, and also provides televisions in the bedrooms on request. One client had his own television, video and DVD player that he used to meet his personal choice for entertainment. There is a mini bus that is available, and used, for visits to places and also where possible to attend appointments if a driver is available. The manager told the inspector that several clients did enjoy a trip to see the lights at Torquay over the festive season. The home does have individual entertainers come into the home such as singers and musicians. They also have a therapeutic entertainer who does “Music and Movement” with the clients. Down House DS0000030358.V269690.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: The core standards were reported on during the last inspection and not fully inspected on this occasion. Down House DS0000030358.V269690.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23 & 24 The areas of the home that are set aside for use by the clients are well decorated and maintained and have satisfactory facilities to suit their individual purposes. EVIDENCE: Down House is located in a mainly residential area off a busy main road near a major general hospital in the Derriford area of Plymouth. It is on the bus route to the city of Plymouth and close to the airport. It has a long driveway from the road leading up to the main entrance with parking for cars off the driveway. There are extensive grounds although some areas are not accessible at the moment due to the building work that is at an advanced stage to bring into use new communal areas, new bedrooms, bathrooms, a shaft lift and a new administration office. The home is well maintained by the maintenance man who is assisted by specialists for such things as the hoists that had up to date service dates on them. The inspector saw several bedrooms and they each had levels of personalisation to meet the wishes of the individuals who are resident in them. Down House DS0000030358.V269690.R01.S.doc Version 5.1 Page 16 All were of good shape and size and offered the ability to nurse a client from both sides of the bed if necessary. The single rooms had either en-suites with disabled toilet facilities and wash hand basins or were shared between two single bedrooms and had a toilet, wash hand basin and a domestic style bath with a floor mounted hoist with a integral bath chair. The rooms also had appropriate beds, a nurse call systems and heating that did not pose a risk to clients from hot surfaces. The only bedrooms without en-suites are the double bedrooms. At present there is a lounge room that is of reasonable size and offers clean comfortable and attractive communal space for the clients who use it. Several clients were seated in the lounge and each appeared to be happy with the level of comfort they were experiencing. The room is well lit naturally and has adequate provision of artificial lighting. A new dining room is part of the new build that is underway. Near the lounge there are two toilets for general use plus a further two, one in the large bathroom and one in the wheel in shower room. These bathing facilities provide good facilities for those clients that need a greater level of assistance or supervision whilst bathing. The inspector was told that the carpet in the corridor will be replaced as part of the upgrading that is underway in the home. Down House DS0000030358.V269690.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 The arrangements for staffing of the home to meet the nursing needs of the clients is very good with at least two registered nurses on duty during each day. The recruitment and training arrangements for staff is good and should make clients feel secure that the carers are well prepared to do the duties required of them. EVIDENCE: The home employ 25 care staff of which 11 presently have a National Vocational Qualification at level 2 or above and two other staff are presently studying for their National Vocational Qualification at level 2. The staff duty roster showed that the home does employ a very satisfactory number of nurses and care staff on duty each shift to meet the needs of the clients. There is always a minimum of two registered nurses on duty during the day and one at night supported by adequate numbers of care staff. On the day of this unannounced inspection there were three registered nurses on duty. The skill mix at the home includes registered nurses from both the fields of general nursing and psychiatry. The homes recruitment policy and procedure was looked at and found to be satisfactory. Three staff records were also viewed by the inspector and these were complete, well constructed and showed that the recruitment procedure is robust. The nurses that have been recruited from overseas have police checks in their files from their country of origin and also have Criminal Records Bureau checks. The inspector was shown evidence that all the staff have a Criminal Records Bureau except one new member of staff for which their was evidence that one had been applied for. Down House DS0000030358.V269690.R01.S.doc Version 5.1 Page 18 The administrator demonstrated how she audits staff files using her check list that identifies all the items that are required by the home before a file is complete. The home has an induction process that is monitored and records kept of each item that staff become competent at. Copies of these are held in the training file in the administrators office. In addition there is evidence of the training that staff have undertaken that is in excess of the three days of paid training per year stated in the National Minimum Standards. This includes manual handling, fire, adult protection, and infection control as well as the National Vocational Qualification training already mentioned. Down House DS0000030358.V269690.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 The home is well managed by the team of nurses who are on duty each day and staff training is sufficient to prepare the registered nurses and care staff for the work that they undertake. There is clear evidence of good maintenance at the home supported by records from external contractors. EVIDENCE: The Registered Managers post is presently vacant however the previous Registered Manager still works at the home and is overseeing its functions until a newly appointed Manager is found and takes up the position. The home is functioning very well under this arrangement. The inspector saw that there are quality assurance systems in place that do include the comments, in writing, from clients, their relatives or advocates and also visiting professionals to the home. In addition to this there are other measures that audit such things as staff files and training in place that identify the level of achievement for each item. The home also uses the Commission Down House DS0000030358.V269690.R01.S.doc Version 5.1 Page 20 for Social Care Inspection report as a measure of their success at meeting the National Minimum Standards and Care Homes Regulations. The home does not manage the financial affairs of any of the clients. Where purchases have been made on behalf of the individual clients their financial advocate is invoiced for the items and evidence of this process was provided. There are also lockable draws in each of the clients bedrooms for them to store any valuables. There were records in clients files of property that was brought into the home on admission and the inspector saw that a newly admitted patients (during the inspection) had a property sheet completed by the staff member dealing with the process. There was evidence that good maintenance has taken place at the home either by the maintenance man or by an outside contractor. Dates that hoists and fire equipment had been serviced were clearly recorded and the fire log book showed that the smoke alarm system is tested according to requirements. The home has 1st level registered general nurses on duty over the 24 hour day and this satisfies the Health & Safety Executive requirements for first aid. All accidents and incidents are recorded and where necessary the Commission for Social Care Inspection has received a Regulation 37 notice. Clients files hold risk assessments for such things as manual handling for which appropriate training and equipment is provided. Also the need for bed guards is risk assessed and these are provided unless a clients strongly objects to their use. Should this be the case the home does ask the clients to sign a notice to that effect. Down House DS0000030358.V269690.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 3 3 X 3 3 X X STAFFING Standard No Score 27 4 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Down House DS0000030358.V269690.R01.S.doc Version 5.1 Page 22 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. Standard Regulation Requirement Timescale for action 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 OP19 Good Practice Recommendations The carpet in the main corridor by clients rooms needs attention to remove any trip hazard. Down House DS0000030358.V269690.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Down House DS0000030358.V269690.R01.S.doc Version 5.1 Page 24 - 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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