Inspection on 10/04/08 for Dowty House

This inspection was carried out on 10th April 2008.

CSCI found this care home to be providing an Good service.

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

Other inspections for this house

Dowty House 28/11/06

Dowty House 07/02/06

Dowty House 10/08/05

Dowty House 27/01/05

Dowty House 25/08/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

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 Dowty House St Margaret`s Road Cheltenham Glos GL50 4EQ Lead Inspector Sharon Hayward-Wright Key Unannounced Inspection 11:50 10 & 11th April 2008 th 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 Dowty House DS0000016424.V363081.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. Dowty House DS0000016424.V363081.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dowty House Address St Margaret`s Road Cheltenham Glos GL50 4EQ 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) 01242 520713 01242 530206 Coronation Old People’s Housing Society (Cheltenham) Limited Mrs Joyce Bourne Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places Dowty House DS0000016424.V363081.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home can take a maximum of 4 service users between the ages of 55 to 65 years. This number includes 2 named service users under the age of 65. 28th November 2006 Date of last inspection Brief Description of the Service: Dowty House is a Victorian property, which has been adapted and extended; it is situated close to the centre of Cheltenham. Dowty House is a care home for older people. The accommodation is located on three floors; a shaft lift provides access to the second floor but not the first floor, which is at mezzanine level. All rooms are single occupancy and have washbasins. Bathrooms and toilets are located on each floor. The communal accommodation consists of two lounges (one is a smoking room) and a dining room. Access to and from the building is gained through the front and back doors, which are controlled by telephone for security. To the front and side of the property there are well-tended gardens with flowers, shrubs and garden furniture where service users can sit out. To the rear of the home is a conservatory and parking spaces. CCTV monitors the rear of the property. The fee ranges for this home are from £357.90 to £443; per week and extras to the fees include hairdressing, newspapers and chiropody. This information was given to the inspector during the site visit. Copies of the homes Statement of Purpose and Service Users Guide are displayed around the home. Dowty House DS0000016424.V363081.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. One Inspector carried out this inspection over two days in April 2008. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes in to account the views and experiences of people using the service. The Registered Manager was available during the inspection as were other members of the homes team. A total of 25 standards were inspected. The home returned their detailed Annual Quality Assurance Assessment (AQAA) prior to this inspection. Information from this has been used in this report. Where possible, people living at the home were spoken with to ascertain their views on the care and services provided and any visitors to the home. Surveys were sent to the home prior to the inspection for people who use the service, their relatives/representatives and staff. We received five surveys from people who use the service, two from relatives/representatives and four staff surveys. Their responses have been used in this report. Staff were observed interacting with people who use the service. The comments we also received from speaking to people during the inspection have been used in the report. What the service does well: The homes senior staff to include the Registered Manager have worked at the home for number of years and this provides consistency for people who use the service and for other staff members. The home continues to provide a comprehensive training programme for staff to ensure they have the skills and knowledge to care for people who use the service. Dowty House DS0000016424.V363081.R01.S.doc Version 5.2 Page 6 The home has information available to people who use the service and people who are considering moving to the home about the services they provide. People are also able to access their web site. All comments received from people who use the service; staff and visitors to the home all said they are very pleased with the service provided by the home. The continued redecoration and refurbishment of the home has provided people who use the service with a safe, well-maintained and pleasant environment to live in. The home is able to cater for people who wish to smoke as they provide a designated area for this. Feedback received from people who use the service and staff, all said they would approach the Registered Manager if they were unhappy about anything or had a concern or complaint. What has improved since the last inspection? What they could do better: The home needs to write to proposed people following their assessment to confirm they can meet their assessed needs. Dowty House DS0000016424.V363081.R01.S.doc Version 5.2 Page 7 Whilst the home has a new care planning format in place they need to make sure that all the care they are providing is documented along with any risk assessments that are needed. A number of improvements are needed with the medication systems to make sure safe systems are in place that does not place any people who use the service at risk. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Dowty House DS0000016424.V363081.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 Dowty House DS0000016424.V363081.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 5 & 6 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who may use the service have their needs assessed and have access to information needed to choose a home that will meet their needs. EVIDENCE: At the last inspection the home needed to make several additions to their terms and conditions about how people can access additional services not included in the fee and how they pay for these. This was completed following the last inspection and a copy of this was sent to us (The Commission). Copies of the homes Statement of Purpose, Service Users Guide and monthly newsletter are displayed around the home. Dowty House DS0000016424.V363081.R01.S.doc Version 5.2 Page 10 The pre admission assessments of two people who have been admitted into the home since the last inspection were examined. The Registered Manager had completed them both and had taken other members of staff to the assessment for one person. One person was assessed at their home and the other person was in hospital. Both assessments included details about their assessed needs. Community and Adult Care Directorate (CACD) fund the placements of both people and copies of their care plans were present. Both people were not able to remember if they visited the home prior to moving in but one said their family was involved in the decision to move into a care home. From discussions with the Registered Manager both people’s families had viewed the home prior to admission. One person’s pre admission assessment mentions that they wander in the day and at night time and this was observed during the inspection. At the time of the inspection the Registered Manager is confident they are meeting this persons needs and have involved the GP. The home must continue to monitor this to ensure this persons safety. The home needs to confirm in writing to people that following their pre admission assessment they can meet their assessed needs. Comments we received from surveys we sent to the home for people who use the service include “the home was recommended to me”, “good information on their web site” and “ we had a very good report about the home”. Dowty House does not provide intermediate care; therefore Standard 6 is not applicable. Dowty House DS0000016424.V363081.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs, however some improvements are needed with the recording and management of all care records. The principles of respect, dignity and privacy are put into practice the majority of the time. EVIDENCE: Three people had their care examined in detail and this includes examining care records, speaking to the person where able and staff. These three people were chosen at random during the inspection. One person was new to the home, another had been at the home for several months and the third person had been at the home for several years. Since the last inspection the home has changed the format they use for care plans. Each person except the new person as they had only been at the home for a day had a long-term assessment of need in place, however one had not Dowty House DS0000016424.V363081.R01.S.doc Version 5.2 Page 12 been reviewed since October 2006. The home will need to look at reviewing these long-term assessments for each person on a frequent basis to ensure they reflect people’s current needs. The home had started to devise the care plans for the new person and these were examined along with the care plans for the other two people who use the service. The person who has been at the home for several years had a care plan that contained detailed information. The home should consider adding into their personal care plan how often they have a bath or shower and how often they like to shave. The home is still in the assessing process with the new person and the care plans are likely to alter. The person who has been at the home for several months needs some additional information adding to their care plans. This includes in their personal care plan the frequency of bathing, in the diet and weight care plan it needs to mention that they are a diabetic and that they need to leave this person’s food at the table as they tend to wander off. The mobility care plan mentions this person use a Zimmer frame but does not detail that they leave this and tend to walk around unaided. This is vital information that must be added, however the care staff are aware of the care needs of each of these three people. Risk assessments are in place for fire safety and hot water. Moving and handling assessments are also in place but the home needs to consider the frequency of these reviews. All care plans are reviewed monthly. One person had signed their care plan. The person that has a tendency to wander around the home during the day and at night must have a detailed risk assessment and care plan in place to manage this and to ensure their safety at all times. The new care plan format is an improvement to what the home has had at previous inspections but they just need to make sure that all the care they provide is documented. Daily records are maintained by the care staff and each person is allocated a ‘key worker’. The key worker also writes in the care records at least monthly. Evidence was seen in people’s care records that they have access to health professionals and these include the Chiropodist, GP, Optician and Community Nurses. The Registered Manager said that people who use the service are able to have a GP of their choice provided they are within the catchment area of the surgery. The home monitors the weights of people who use the service on a monthly basis and records are maintained of this. Four People who use the service said in their surveys that they ‘always’ receive the care and support they need and one person said ‘usually’. Four people also said that they ‘always’ receive the medical support they need and one person said ‘usually’. Dowty House DS0000016424.V363081.R01.S.doc Version 5.2 Page 13 Two relatives/representatives were asked in their survey if they feel the home meets the needs of their friend/relative and one said ‘always’ and one said ‘usually’. The medication systems used by the home were examined. Three boxes of medication were left on the table in the office and the door was not locked. The Registered Manager explained that they belonged to the new person who had been admitted, however as the home has people who wander it is paramount that medication is stored securely at all times. All Medication Administration Records (MAR) were examined and no gaps in the recording were found, which is good practice. However one person is receiving insulin injections but the care staff are not documenting that the afternoon dose has been given. Other areas that need attention with the MAR are the use of ‘as directed’ instructions as care staff must have clear directions to follow to ensure consistency. One person had written that they must not have their Zopiclone every night but care staff were administering it every night. The Registered Manager said that prior to admission this person was having it every night. This person’s GP must be contacted to review their medication. Records were seen for medication received into the home, administered (except for the insulin as mentioned above) and returned to the pharmacy when needed. The Registered Manager confirmed that care plans are not in place for all people that receive ‘as and when required’ medication and this will need to be addressed. The home should also consider that following the implementation of the Mental Capacity Act, asking people where they would like to have their medication administered and record this in their care plans. Dates of opening were found on randomly selected boxed and liquid medication. The home has secure facilities for transferring medication around the home. One medication round was observed and the member of care staff followed the correct procedure. Several people who use the service are taking controlled medication and the appropriate records are in place. An audit of this medication took place, which includes counting the medication and checking the records, and all was correct. The home must start to audit this medication on at least a monthly basis and maintain records of this. The Registered Manager said the home is looking to obtain a more up to date medication reference book as the one they have is dated March 2007. Secure facilities are in place for the storage of all medication and an air conditioning unit is in the room to make sure the medications are stored at the manufacturers recommended temperature. A medication fridge is also in place and records were seen of staff monitoring the temperature. The Registered Manager and care staff spoken with confirmed that prior to them a administering medication they undertake an accredited medication course and records were seen of care staff receiving an up date in medication training. Dowty House DS0000016424.V363081.R01.S.doc Version 5.2 Page 14 Staff were observed treating people who use the service with respect and knocking on their door prior to entering. People who were spoken with did not express any concerns about how the staff treated them as they all felt the staff are very good. Again no concerns were expressed in the surveys we received from people who use the service and their relatives/representatives. One issue was identified that related to one person’s dignity and this is discussed further in the next outcome group. Dowty House DS0000016424.V363081.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are able to make choices about their life style. A range of activities is provided to help meet peoples recreational interests. EVIDENCE: Since the last inspection the home has worked hard to improve the recreational activities they provide for people who use the service. As well as the care staff providing activities, they have a volunteer who visits the home weekly and undertakes a variety of activities. An outside entertainer visits the home twice weekly and were at the home during the inspection. At weekends someone comes to play a musical instrument. One of the care staff that works at weekends is also a trained activities coordinator and provides activities but no records are maintained of this. The homes monthly newsletter lists the activities they have planned and last year in the warmer weather trips out took place. The AQAA mentions that the home has access to a volunteer bus, which they can use to take people who use the service out. People who use the service that were spoken with during the inspection had different views of the activities provided as some said they join in where as Dowty House DS0000016424.V363081.R01.S.doc Version 5.2 Page 16 other said they chose to undertake their own activities. The Registered Manager said that people could choose whether or not to participate in the activities. The AQAA mentions that people who use the service can visit local Churches or places they choose to meet their spiritualist needs or they can have someone visit the home. Four people who use the service who returned their surveys said that the home ‘always’ arranges activities for them to take part in and one person said ‘usually’. A comment received said, “Much enjoyed by all”. Some people who use the service are able to go out and about independently and staff are also able to take people out. One person was away on a holiday during the inspection, which they had booked with the help of the home. Another person has undertaken a college course. Visiting to the home is not restricted. People are able to make choices about their life style. Staff were observed offering people choices and assisting those people that require more assistance. People who were spoken with also confirmed that they are able to make choices. People’s personal belonging are on display in their rooms and one person said they have been able to bring in items of furniture. The home has information about advocacy services available to people and their representatives if it is needed. Records were seen relating to one person whose family have Power of Attorney. The menus were examined and the head cook devises these on a four-week rotation. People who use the service are asked for their input into the meals provided. There are plans to review the menus shortly. A full inspection of the kitchen did not take place as they have recently had an Environmental Health Department visit. Records relating to health and safety checks were in place and these include fridge and freezer temperatures and food probing. People who use the service confirmed they are able to choose where they eat their meals as some people have them in the dining room and other in their room. Each day the menu board in the dining is completed with the food and choices that are offered for each meal. The inspector joined people for breakfast and lunch on one of the days of the inspection and observed people being offered choices and found the food to be very tasty. Staff offered people assistance discreetly, however to make sure people’s dignity is respected staff should be seated when assisting people to eat. People who were spoken with all said they enjoyed the food provided and that choices are always available. The results in the surveys we received said that three people ‘always’ enjoy the food provided and two people said ‘usually’. Comments include “excellent food” and “ I enjoy the good plain food like meat and vegetables. I am not keen on the more spicy or continental food”. Dowty House DS0000016424.V363081.R01.S.doc Version 5.2 Page 17 Cold drinks are available in the communal areas and hot drinks are provided frequently throughout the day. The homes AQAA list what they have in place to improve the meal provision for people who use the service and these are: A visiting nutritionist provides the home with special high calorie drinks, and dietary ideas are given to the catering staff. A suggestion box is sited in the Dining Room where any ideas, suggestions can be placed, and will be taken into consideration when changing the menus. The Registered Manager confirmed that one person had put a suggestion in for more ‘egg and chips’. Dowty House DS0000016424.V363081.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, and have access to the complaints procedure. The home has systems in place to help protect people from the risk of abuse or harm. EVIDENCE: The Registered Manager confirmed that the home has not had any complaints since the last inspection. As part of the admission process people who use the service are given a Service Users Guide that contains the homes complaints procedure. Copies of this guide and the homes complaints policy are displayed around the home. The home’s AQAA and the Registered Manager confirmed they operate an ‘open door’ policy and staff who were spoken with confirmed this. People spoken with during the inspection all said they were happy with the care they received. In the surveys four people said they ‘always’ know who to speak to if they are unhappy and one person said ‘usually’. All five people in their surveys said they know how to make a complaint. Both relatives/representative surveys said that they know how to make a complaint and one person said the home ‘always’ responds to concerns appropriately and the other person said ‘usually’. The Registered Manager, training records and certificates confirmed that all staff have received training in safeguarding people provided by the local Dowty House DS0000016424.V363081.R01.S.doc Version 5.2 Page 19 council. The Registered Manager is going to book any new staff onto this training. Staff spoken with also confirmed that they had done this training. The home has policies in place for abuse, managing aggression and whistle blowing. A selection of personnel files for staff that have been appointed since the last inspection had evidence that POVA first’s and Criminal Records Bureau Disclosures (CRB) had been obtained Dowty House DS0000016424.V363081.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service live in a well-maintained, safe and comfortable environment. EVIDENCE: A tour of parts of the environment took place with a number of rooms belonging to people that use the service being seen. The home is continuing with the redecoration and refurbishment. Since the last inspection a new shaft lift has been provided which is much easier for people who use the service to use. The main communal lounge has been redecorated and new televisions have been provided, which has greatly improved this room and people said it is a pleasure to sit in there. A new lift in the lounge has been provided which enables people who use a wheelchair to access all parts of the ground floor. A Dowty House DS0000016424.V363081.R01.S.doc Version 5.2 Page 21 number of shower rooms have been refitted and again these have improved the facilities for people. The home has plans to refurbish the downstairs shower room. All rooms belonging to people have been redecorated and at the last inspection people said they were able to choose the colour. None of the room have en-suite facilities but bathroom and toilets are in close proximity, and the home has chosen to separate male and female toilets. People are able to have a commode in their rooms if they wish. The outside gardens are kept tidy and well presented. The AQAA states that the home has an ongoing redecoration programme and further plans are in place to continue to improve the environment for the benefit of people who use the service. In room 105 a tear was found in the carpet by the door and this must be repaired to prevent any risks to that person. The standard of the cleanliness within the home is very good and no odours were found. People in their surveys that were returned to us said that the home is ‘always’ clean and fresh. Staff have access to protective clothing and alcohol hand gel if needed. All staff receive infection control training. The laundry was not examined at this inspection as the washing machines were new at the last inspection and have the required sluicing programmes. The AQAA lists the procedure for managing soiled linen. No concerns were expressed by people who use the service about the laundry and one person said they are very happy with the standard of their clothes. Dowty House DS0000016424.V363081.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support people who use the service. EVIDENCE: The duty rotas were examined. The staffing numbers have not changed since the previous inspections. The Registered Manager has appointed a ‘general assistant’ to work from 9am – 1pm to help with bed making and giving out hot drinks each morning to reduce the burden on the care staff. Ancillary staff are also employed to assist in caring for people who use the service. Staff spoken with and from the surveys returned all said it was a nice place to work and they receive excellent support from the management team. Three out of the four staff surveys we received said that they ‘usually’ have enough staff on duty to meet the needs of people and one said ‘always’. People who use the service were asked in their survey if staff are available when they need them and two said ‘always’ and three said ‘usually’. All comments received about the staff both in the surveys and during the inspection were very complimentary. Comments included “caring and helpful staff” and “the staff are always very friendly and always welcome you”. One person had also written “ I am pleased to be in a warm comfortable home and feel well looked Dowty House DS0000016424.V363081.R01.S.doc Version 5.2 Page 23 after”. People who use the service who were spoken with during the inspection all felt they are well looked after. The home does not use agency staff. The home exceeds the 50 of staff trained in NVQ 2 and above in health and social care. At the time of the inspection 12 care staff have NVQ 2, eight have NVQ 3 and one care staff has NVQ 4 and four are undertaking NVQ 4. The home actively encourages staff to undertake this training and staff confirmed this. The personnel files of four staff appointed since the last inspection were examined. All had the required checks in place prior to starting at the home. The home’s induction programme was examined. Since the last inspection the booklets have been reviewed and separate ones issued for care and ancillary staff. The home is not registered with Skills for Care and is going to look into doing this. Each new member of staff is allocated a supervisor and is supervised for up to three months. Induction records were seen in staff personnel files. The home has a good training programme for staff that includes the NVQ training. The home has a training matrix in place that lists all training undertaken by staff and when it is due again. This ensures that all staff are up to date with mandatory subjects and additional training is also offered. Staff spoken with and from the surveys sent all said they are offered training. The staff surveys said that they have all been given training that is relevant to their roles and helps them to understand the individual needs of people that use the service. Six members of staff are booked on to training about the Mental Capacity Act and following this the home is going to plan training for all staff. Dowty House DS0000016424.V363081.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A qualified and competent manager undertakes the management and administration of the home. Effective quality assurance systems are in place to ensure the home is run in the best interests of people who use the service. EVIDENCE: The Registered Manager has been working at the home for 30 years and has been the Registered Manager for a number of years. She has completed the NVQ 4 and undertakes all training provided. She has been nominated for the ‘Pride of Gloucestershire’ award by the home for her service. The home has three deputy managers and since the last inspection one has retired and a new member of staff appointed to this role from within the home. Dowty House DS0000016424.V363081.R01.S.doc Version 5.2 Page 25 Staff spoken with all praised the Registered Manager saying she was approachable and would always listen to any concerns they might have. The home last undertook a quality assurance review of the service they offer in September 2007. This involves obtaining the views of people who use the service, their relatives/representatives and staff. From this the home has devised an action plan to address any areas highlighted. The home should consider updating the action plan once an action has been completed. Monitoring systems are in place and these include weekly fire safety checks, housekeeping checks, catering, food tasting and entertainment. Monthly check monitoring checks include, water temperatures, medication, accident auditing and wheelchair maintenance. The home is in the process of writing a business plan as part of their quality assurance procedure. The home has obtained our guidance about ‘Putting People First Equality and Diversity Matters’. From this they have issued each member of staff with an anonymous questionnaire and when they have the results they will devise an action plan if needed. The home has a secure facility to store people’s monies. Two were selected at random for auditing which includes checking the money against the records. Both were correct. Receipts as well as ongoing records are maintained and two staff members sign any money in and out. Since the last inspection the Registered Manager has reviewed how staff supervision takes place. Care staff that are doing NVQ 4 training are now supervising staff. Consideration should be given to these staff having training in supervision skills. Supervised practice of care staff is part of their supervision. Each member of staff has a yearly appraisal that includes them filling in the form and the Registered Manager discussing it with them. The home is working towards the six times per year for care staff. Ancillary staff also receive supervision sessions. In the staff surveys two said they meet ‘regularly’ with the manager for support and to discuss how they are working and two said ‘often’. The homes AQAA contains details about servicing of equipment. The home has had new boilers fitted and these are not due for a service. Monthly checks are undertaken on water temperatures and these were all within safe limits. Following the Environmental Health Department visit the home needs to undertake further tests in relation to Legionella and they have plans in place to address this. The home has also had a Fire inspection by the local Fire Service recently and the letter was seen that detailed some changes needed. The Registered Manager said they are working their way through these. As part of their fire risk assessment the home needs to identify which people will require help from staff to evacuate the premises if a fire was to break out. Records were seen of fire checks and training. Dowty House DS0000016424.V363081.R01.S.doc Version 5.2 Page 26 Dowty House DS0000016424.V363081.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 3 X 3 Dowty House DS0000016424.V363081.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(1d) Requirement The home must make sure that they confirm in writing to the proposed person that they can meet their assessed needs. Timescale for action 30/05/08 2. OP7 15 3. OP9 13(2) 4. OP9 13(2) The home must make sure that 30/05/08 peoples current care needs are documented in their care plans and that any risk assessments are completed and kept under review. This will make sure that staff have up to date information available to them to care for people who use the service. The Registered Person shall 15/06/08 make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. (This relates to care plans for ‘as and when needed medication’ and handwritten entries.) This requirement has been partly met since the last inspection; timescale of the 30/01/07 was not met in full. To make sure the home has safe 30/05/08 DS0000016424.V363081.R01.S.doc Version 5.2 Page 29 Dowty House systems in place for administration of medication; they must record when insulin has been administered, amend any ‘as directed’ instructions with clear directions for care staff to follow and to ask the GP to review the Medication Admisntration Records highlighted at the inspection. 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. 4. 5. 6. Refer to Standard OP7 OP9 OP9 OP18 OP38 Good Practice Recommendations The home should document the times people wish to get up and go to bed in their care plans. The home should ask people where they would like their medication administered and record this in their care records. Review the medicine policy as advised by the pharmacist inspector in line with latest legislation and the guidance provided by us. This guidance is available on our web site. The Registered Manager and Deputy Managers should consider undertaking the enhanced safe guarding training provided by the local council. As part of the fire risk assessment the home should identify people who use the service that would need help to evacuate the building if a fire was to break out. Dowty House DS0000016424.V363081.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Contact Team Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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