Inspection on 10/08/05 for Dowty House

This inspection was carried out on 10th August 2005.

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 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 10/04/08

Dowty House 28/11/06

Dowty House 07/02/06

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 Margarets Road Cheltenham Gloucestershire GL50 4EQ Lead Inspector Sharon Hayward-Wright Unannounced 10 August 2005, 12.00 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. Dowty House D51_D03_S16424_Dowty House_v233805_100805_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Dowty House Address St Margarets Road Cheltenham Gloucestershire GL50 4EQ 01242 520713 01242 530206 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) Coronation Old Peoples Society (Cheltenham) Ltd Mrs Joyce Bourne Care Home 37 Category(ies) of OP Old Age (37) registration, with number of places Dowty House D51_D03_S16424_Dowty House_v233805_100805_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 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. Date of last inspection 27/1/05 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. The home is bordered by a busy road and is sited in an area that is undergoing re-development. 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. Access to this level is achieved through a stair lift. All rooms are single occupancy and have washbasins. Bathrooms and toilets are located on each floor. The communal accommodation consists of two lounges 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 concreted area and parking spaces. CCTV monitors the rear of the property. Dowty House D51_D03_S16424_Dowty House_v233805_100805_Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 3 hours on one day in August 2005. Ten service users and one visitor were spoken with to gain their views on the home and the Registered Manager was also spoken to. Staff were observed going about their duties and interacting with each other and service users. The requirements and recommendations issued at the last inspection were followed up and records relating to medication, duty rotas and personnel files of new staff were inspected. A tour of the home took place with a number of service users rooms inspected. Two requirements remain outstanding since the last inspection and now must be addressed. What the service does well: What has improved since the last inspection? The redecoration programme and replacing of furniture continues providing service users with an attractive and homely place to live. Dowty House D51_D03_S16424_Dowty House_v233805_100805_Stage 4.doc Version 1.30 Page 6 Since the last inspection the home has improved their recruitment practices, however further improvement is needed to meet the Care Homes Regulations. Improvement in the medication system has been made but further improvements are needed to safe guard the medication during administration. 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. Dowty House D51_D03_S16424_Dowty House_v233805_100805_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 Dowty House D51_D03_S16424_Dowty House_v233805_100805_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 & 5 Prospective service users and their relatives/friends are able to visit the home to assess the suitability and facilities offered to assist them in making a decision about moving in. EVIDENCE: Two requirements issued at the last inspection for the home to send copies of their revised Statement of Purpose and Service Users Guide have been addressed. Two service users spoken to confirmed they had visited the home prior to moving in and one was on a waiting a list for a short period. One service user said that when he saw the home he knew this was the place he wanted to live. Dowty House D51_D03_S16424_Dowty House_v233805_100805_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) 9 & 10 Since the last inspection the home has made limited progress with regard to the arrangements for medication, which can potentially put service users at risk. Service users feel their privacy is upheld and they are treated with respect by the staff. EVIDENCE: Service users where able can self-medicate as lockable facilities are provided; however the home does not undertake an assessment of the service user or ask them to sign a disclaimer. The home must complete a risk assessment to determine the risk involved. Records were seen of medications received, administered and returned to the local pharmacy. However the staff are not always recording when prescribed creams are being given even though there is evidence that they are being ordered. The home must devise ways to record when prescribed creams are given and this will also help with auditing of medication. Dowty House D51_D03_S16424_Dowty House_v233805_100805_Stage 4.doc Version 1.30 Page 10 Staff that administer medication have undertaken an accredited training course. At the time of the inspection the home does not have any service users on controlled medication. A requirement issued at the last inspection for the home to obtain a lockable facility to transport medication securely to one part of the home has not been addressed. The home has a lockable trolley to transport medication around the rest of the home. Regular audits of medication are undertaken by the pharmacy used by the home. Service users spoken with confirmed that the staff maintains their privacy and dignity by knocking on their door prior to entering and they receive their post unopened. Service users said they are able to choose how they are addressed by the staff, e.g. by their first name or surname. Dowty House D51_D03_S16424_Dowty House_v233805_100805_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) 12, 13 & 14 Social activities are organised on a planned basis, and links with the local community and service users’ family and friends are encouraged and maintained. Service users where able can exercise choice and control over their lives. EVIDENCE: The home has planned activities that include an outside entertainer who visits the home twice a week. Photographs are on display in the dining room of the recent barbeque held at the home. Recently a number of service users went on a coach trip to a safari park. The Registered Manager said in the warm weather the care staff try to take service users outside and at times in to the local town. At the moment with the surrounding building work the outside grounds can be noisy. Several service users and a visitor confirmed that an outside entertainer visits the home and service users can choose if they wish to participate. The visitor also said that their relative receives the services of a hairdresser and chiropodist. Several service users are able to come and go as they please. Dowty House D51_D03_S16424_Dowty House_v233805_100805_Stage 4.doc Version 1.30 Page 12 Service users and the visitor confirmed that there are no restrictions visiting and a visitor said they are able to take their relative out of the home. Service users’ personal possessions were seen in their rooms during the tour of the home. Service users said they are able to choose how they spend their time each day. The home has recently obtained information about an advocacy service and leaflets are given to all service users. All service users spoken to said the food provided is very good and they enjoy the meals. Dowty House D51_D03_S16424_Dowty House_v233805_100805_Stage 4.doc Version 1.30 Page 13 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 The home has a complaints procedure in place but this procedure has not been used to date. EVIDENCE: The home has not received any complaints since the last inspection and their complaints procedure is as required under the Care Homes Regulations. However the home must remove all references to the National Care Standards Commission and replace with the Commission for Social Care Inspection. The Commission for Social Care Inspection has received one concern. This was investigated and was not upheld. Standard 18 was not inspected, however it is recommended the home provide training for staff about how to protect vulnerable adults and abuse. Dowty House D51_D03_S16424_Dowty House_v233805_100805_Stage 4.doc Version 1.30 Page 14 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, 23 24 & 26 The standard of the environment within this home is good providing service users with an attractive and homely place to live. EVIDENCE: The home continues with their redecoration and new furniture programme that has greatly improved the environment for the service users. Service users were able to choose the colour for their rooms. Service users said they all liked their rooms. A new call bell system has recently been fitted. The next room for redecoration and new furniture is the dining room. The home has also just had a planning application agreed for an extension to the care parking facilities and a conservatory. The conservatory will increase the communal area for service users; at the moment the home has one dining room, 1 large lounge and a smaller lounge for service users that wish to smoke. New seating has been provided along the middle corridor where a number of service users like to sit. Dowty House D51_D03_S16424_Dowty House_v233805_100805_Stage 4.doc Version 1.30 Page 15 The visitor to the home commented on the redecoration saying it had improved the environment and they are very happy with their relative’s room. They had brought in some family photographs and these were going to be put up by the maintenance person. The new assisted baths have improved the bathing facilities for service users and reduce the amount of moving and handling for staff. The home also has two shower rooms and one of these is due to be refurbished. No rooms have en-suite facilities but toilets are in close proximity to service users’ rooms and commodes are provided if needed. Service users with an assessed need have height adjustable beds and hoists available to assist staff in moving of service user. A shaft lift and stair lift are provided for service users to access the upper floor. However service users that live in certain parts of the home must be able to use stairs as the lift does not access this area. Staff were seen to be wearing protective clothing when needed and the home has recently had 4 commode pan washers fitted within the sluicing area which have also been upgraded. The home was clean and odour free on the day of the inspection and service users and the visitor confirmed that the home is always maintained to these high standards. Dowty House D51_D03_S16424_Dowty House_v233805_100805_Stage 4.doc Version 1.30 Page 16 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, 28, 29 &30 The home has an enthusiastic workforce that works positively with service users to improve their whole lives. A comprehensive training programme is provided to ensure the staff are trained and competent to do their jobs. Since the last inspection the standard of vetting and recruitment practices has improved, however not all the appropriate checks are being carried out and potentially this leaves service users at risk. EVIDENCE: The home exceeds the numbers of care staff as required on the staffing notices issued prior to the Care Standards Act, however the Registered Manager feels that due to the care needs of the service users the number of staff they have on duty meets the needs of the service users. Additional staff are on duty to cover ancillary duties. All care staff are over 18 years old. Service users and the visitor all highly praised the staff saying they are friendly and always willing to help them. Service users said they have built good relationships with the staff and the visitor said this is very much a family home. Dowty House D51_D03_S16424_Dowty House_v233805_100805_Stage 4.doc Version 1.30 Page 17 The home actively encourages staff to undertake the NVQ 2 training and they exceed the recommendation of 50 care staff trained in NVQ 2. A number of staff also has NVQ 3. Six new staff have started at the home since the last inspection and their files were inspected. None of the six files had proof of the person identity or full employment history, as the application form does not request it. Two staff did not have references from their last employer or the reason to why they left their last care position in the case of one new staff member. The home must address this to meet the Care Homes Regulations. It is recommended that the home requests three references as other home have found this beneficial. Since the amendments to the Data Protection Act staff CRB disclosures (Criminal Records Bureau) should be stored away from staff personnel files in a secure place. At previous inspection the home has always provided a comprehensive training programme to ensure the staff are equipped to meet the needs of the service users. For any staff new to care a foundation course is provided and then they go onto NVQ 2. The home provides mandatory training to include first aid, moving and handling and infection control. All new staff are supervised by senior care staff for their induction programme. All the Deputy Managers have NVQ 3 and three senior carers. Several senior carers have undertaken a supervisory course. The Registered Manager is always looking for new courses and it is recommended that training is provided for the protection of vulnerable adults and abuse (see standard 18). Dowty House D51_D03_S16424_Dowty House_v233805_100805_Stage 4.doc Version 1.30 Page 18 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 & 33 The service users feel the Registered Manager provides them with leadership, guidance and they feel she is fit to be in charge of the home. There is verbal evidence that service users’ views are listened to and acted upon but documentation is missing. EVIDENCE: The Registered Manager has NVQ 4 and had been running this home for a number of years. She undertakes all the same training as the other staff. Service users and the visitor all said they find the Registered Manager approachable and friendly. From observation the Registered Manager relates very well to the staff, service users and visitors. Dowty House D51_D03_S16424_Dowty House_v233805_100805_Stage 4.doc Version 1.30 Page 19 Recommendations issued in relation to quality assurance and monitoring have not been addressed. However it was evident from discussions with the Registered Manager that service users’ views are being acted upon but records are not being maintained. The home needs to devise ways of recording their monitoring systems and service users’ views. Dowty House D51_D03_S16424_Dowty House_v233805_100805_Stage 4.doc Version 1.30 Page 20 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 x x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION 3 3 3 3 3 3 x 3 STAFFING Standard No Score 27 4 28 4 29 2 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 3 2 x x x x x Dowty House D51_D03_S16424_Dowty House_v233805_100805_Stage 4.doc Version 1.30 Page 21 yes 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 9 Regulation 13(2) Requirement The Registered Person must ensure that medication is stored securely at all times during the adminstration process. A lockable facility must be purchased for the areas in the home that are not accessible to the medication trolley. Timescale of the 30/3/05 was not met. The Registered Person must complete a risk assessment on all service users that wish to self medicate. This must also be kept under review and changes documented. The Registered Person must ensure that records are maintained to provide evidence that prescribed creams are being given. Since the introduction of the POVA scheme, and the amendments to the Care Home Regulations on the 26/7/04 for pre-employment checks on staff, the Home must obtain the following for future recruited staff: 1) Proof of indentity. 2) Two written references, Timescale for action 21/9/05 2. 9 14 30/9/05 3. 9 13(2) 21/9/05 4. 29 7, 9, 19 & Schedule 2 immediate and ongoing Dowty House D51_D03_S16424_Dowty House_v233805_100805_Stage 4.doc Version 1.30 Page 22 including, where applicable a reference relating to the person’s last period of employment, which involved work with vulnerable adults, of not less than 3 months duration. 3) Where a person has previously worked in a position which involved contact with children or vulnerable adults, written verification of the reason why the person ceased to work in their last position unless it is not reasonably practicable to obtain such verification. 4) Full employment history with satisfactory written explanation of reasons for gaps in employment. Timescale of the 1/3/05 was not met. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. 8. Refer to Standard 1 9 9 9 9 9 9 9 Good Practice Recommendations The home should add a diagram of the organisational structure of the home to their Statement of Purpose. The home should date all medication that is not used each month to assist with their stock control and auditing. The home should obtain an up to date BNF drug reference book. The home should ask service users who wish to self medicate to sign a disclaimer/agreement form. Where an amendment to the MAR sheet has been requested by a GP the staff should PP the hand written entry indicating which GP has made this request. Handwritten entries should be checked and signed by another member of staff for safety reasons. The home should maintain records of the room temperature. The home should ensure the allergy box is filled in on all service users MAR sheets for their safety. D51_D03_S16424_Dowty House_v233805_100805_Stage 4.doc Version 1.30 Page 23 Dowty House 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 16 16 18 29 29 32 33 33 33 33 The home should remove any reference made to the National Care Standards Commission with the Commission for Social Care Inspection in their complaints procedure. The home should display their complaints procedure in home where it is accessible to service users and visitors. The home should provide training for staff on how to care for vulnerable adults and abuse. The home should request 3 references for new staff. Since the amendments to the Data Protection Act the home should store CRB disclosures away from staff personnel files but in a secure place. The home should discuss at their next staff meeting the General Social Care Council code of practice and conduct to check staff understand the meaning of this. The home should maintain records of all monitoring systems used in the home and these should include care plans and MAR sheets. The home should collate the results from the quality assurance questionnaires sent out and display them in the home. The home should send out questionnaires to other stakeholders in the community. The home should look at ways of recording service users views and monitoring systems as part of their quality assurance procedure. Dowty House D51_D03_S16424_Dowty House_v233805_100805_Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester GL3 4AB 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 Dowty House D51_D03_S16424_Dowty House_v233805_100805_Stage 4.doc Version 1.30 Page 25 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!