Inspection on 07/02/06 for Dowty House

This inspection was carried out on 7th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 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 Unannounced Inspection 7th February 2006 10:20 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.V277643.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. Dowty House DS0000016424.V277643.R01.S.doc Version 5.1 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.V277643.R01.S.doc Version 5.1 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. 10th August 2005 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. 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 home provides the appropriate equipment required for moving and handling of the service users. A shower is situated on the ground 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 DS0000016424.V277643.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 5 hours on one day in February 2006. Six service users and one visitor were spoken with to gain their views on the home and the Registered Manager and members of staff were 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, care plans, menus, maintenance and personnel files of new staff were inspected. A partial 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. A number of recommendations have been made at previous inspections to assist the home in meeting the standards, to date these have not been addressed and have been repeated again. Service users and a relative all spoke highly of the home and they enjoy living and visiting there. What the service does well: Continued investment in the home is greatly improving the appearance of this home creating a comfortable and safe environment for those living there and visiting. The home has a core group of staff that have worked at the home for a number of years resulting in continuity of care for service users and the enthusiastic workforce works positively with service users to improve all aspects of their lives. The Registered Manager is supported well by her senior staff in providing clear leadership throughout the home with all staff demonstrating an awareness of their roles and responsibilities. Dowty House DS0000016424.V277643.R01.S.doc Version 5.1 Page 6 Arrangements are in place to ensure service users are not admitted to the home without first having their needs assessed. A relative said that she was able to view the home at any time without making an appointment prior to a decision being made in about their relative moving in. Dietary needs of service users are well catered for with a balanced and varied selection of food available that meets service users tastes and choices. What has improved since the last inspection? 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 DS0000016424.V277643.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 Dowty House DS0000016424.V277643.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): 3&5 Arrangements are in place to ensure prospective service users and their family/representatives can feel confident that the needs of the service user will be met on admission to the home. EVIDENCE: Two pre admission assessments of recently admitted service users were examined. Both contained an assessment of their needs and any problems were identified. Copies of the Social Services assessments were also seen. Both these assessment were undertaken prior to the service users being admitted to the home. One service user and a relative confirmed they had visited the home prior to moving in. The relative said she felt very confident in the home saying that when she rang enquiring about vacancies the Registered Manager invited them to visit the home when it was convenient to them. Dowty House DS0000016424.V277643.R01.S.doc Version 5.1 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 the following standard(s): 7, 8 & 9 There is a clear and consistent care planning system in place, however they are not always updated therefore staff are not receiving the appropriate information to meet the needs of the service users. Health services are accessed for service users as required. The home has made limited progress with regard to the arrangements for administration of medication, which can potentially place service users at risk. EVIDENCE: Three service users had their care examined in detail but the inspector was not able to speak to one service user, as they were involved in activities. All had a pre admission assessment. An assessment of needs was in place for all three-service users and evidence was seen of ongoing reviews. From this, care plans are devised and again ongoing reviews are in place. The two recently admitted service users care plans were up to date with their current care needs. The third service user has been at the home for nearly two years. This service user has been identified as being at risk of falls especially at night. A more detailed risk assessment is needed as this service user does not sleep in her room and needs constant supervision. Her assessment of her needs does not indicate this and must be updated even though ongoing reviews of Dowty House DS0000016424.V277643.R01.S.doc Version 5.1 Page 10 this assessment are taking place. This service user is also taking analgesia due to her pain and a care plan is needed for this and for the other medication that is helping with their anxiety. All three care plans had a moving and handling assessment, ongoing weight monitoring and ongoing records that detail health professional visits. A Community nurse was visiting the home during the inspection. Each service user has a ‘keyworker’ and records were seen relating to this. Risk assessments are in place for falls, fire and hot water. The Registered Manager and a member of staff spoken to demonstrated a good awareness of the needs of the service users that were examined in detail. Medication was not examined in detail only the requirements and recommendations made at the last inspection. The controlled medication register was examined. The home maintains the appropriate records of this type of medication. However it is recommended that for ease each service user has their own page for each controlled medication they take. The requirement for the home to ensure the safety of the medication during administration has been addressed. The Registered Manager said that none of the service users self-medicates their medication, however it was noted that one service user administers their insulin and another their prescribed creams. A risk assessment must be completed to ensure their safety. This requirement remains outstanding. The Registered Manager did say that service users do sign a consent form. Of the six recommendations made at the last inspection, two of these have been addressed; the remaining ones have been repeated. Dowty House DS0000016424.V277643.R01.S.doc Version 5.1 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 the following standard(s): 15 Dietary needs of service users are well catered for with a balanced and varied selection of food available that meets service users tastes and choices. EVIDENCE: The kitchen was not examined in detail as the home has recently had an Environmental Health visit and they were awarded the ‘Spa award’ again. Menus were looked at and the Registered Manager said the Cook devises them and then the Management Committee checks them. They operate on a 4-5 week rolling programme. Lunchtime was observed and found to be a very social event with the majority of service users eating their meals in the dining room. However service users are offered a choice as to where they eat their meals. The meal smelt very appetising. Choices are not offered at lunchtime but if a service user did not like what was on the menu an alternative would be offered. Choices are offered at breakfast and evening meal. Staff were seen to offer assistance discreetly. Service users spoken with all said they enjoyed lunch very much and the majority said the food is very good, but one service user felt the portion sizes are too big for her. One service user confirmed that they are offered drinks through out the day and cold drinks are provided in the main lounge. Dowty House DS0000016424.V277643.R01.S.doc Version 5.1 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The home has arrangements in place for protecting service users from abuse. EVIDENCE: Standard 16 was not assessed in full only the recommendations made at the last inspection; these have not been addressed therefore have been repeated. The home has polices and procedures in relation to vulnerable adults. The Registered Manager said she has not been able to access any training for staff in relation to abuse. A member of staff spoken to said that they had covered this topic in their NVQ 2 training, but if they have any concerns they would go the Registered Manager or Deputy Managers as they always have a Manager on duty. Dowty House DS0000016424.V277643.R01.S.doc Version 5.1 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: No standards were assessed at this inspection, however the home continues with it redecoration programme. The second floor landing has been redecorated and greatly improves the environment for the service users. The home is in the process of decorating the dining room and new furniture has been ordered. Dowty House DS0000016424.V277643.R01.S.doc Version 5.1 Page 14 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): 29 Since the last inspection the standard of vetting and recruitment practices has slightly improved, however not all the appropriate checks are being carried out and this potentially puts service users at risk. EVIDENCE: Standard 29 was not inspected in full only a requirement issued at the last inspection was followed up by looking at four files of staff who had recently been appointed. The home is still not retaining evidence of their identity or obtaining a full employment history so that any gaps can be explored. This must be addressed. Service users and a relative all praised the staff in the home saying they were friendly and helpful, however two service users felt that two members of staff had a different attitude to the other staff. The Registered Manager is aware of this. Dowty House DS0000016424.V277643.R01.S.doc Version 5.1 Page 15 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): 38 The home ensures so far as is reasonably practicable the health, safety and welfare of service users and staff. EVIDENCE: Standard 33 was not examined in detail only the recommendations made at the last inspection. The home is yet to address these and they have been repeated again. Ways of recording monitoring systems was discussed with the Registered Manager. The home has not been sending copies of their unannounced monitoring visits to the Commission for Social Care Inspection. Servicing of equipment was seen to include boilers, the lift, visual inspection of the kitchen utensils and fire equipment was seen. The Registered Manager said the electrical systems have been checked but no evidence was available in the home. Evidence was seen of water temperature checks and the Registered Manager said the showerheads are flushed out monthly but again no records Dowty House DS0000016424.V277643.R01.S.doc Version 5.1 Page 16 are maintained. This will be followed up at the next inspection. The home has a Legionella water test every 6 months but records were not examined at this inspection. The home has health and safety posters in the home and in the dining room a notice is up telling service users where they can get access to the first aid box. Dowty House DS0000016424.V277643.R01.S.doc Version 5.1 Page 17 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 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X X X 2 Dowty House DS0000016424.V277643.R01.S.doc Version 5.1 Page 18 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 OP7 Regulation 14 & 15 Requirement The Registered Person must devise care plans for the service user identified at the inspection in relation to medication and pain. These must also be kept under review. The Registered Person must devise a detailed risk assessment in relation to falls for the service user identified at inspection. The Registered Person must ensure that assessments of needs are updated with any changes in service users care. The Registered Person must complete risk assessments on service users who wish to selfmedicate any medication. This must be kept under review and any changes documented. Timescale of the 30/09/05 was not met. The Registered Person must obtain the following information for all staff prior to them starting work at the care home: 1) Proof of identity. 2) Full employment history DS0000016424.V277643.R01.S.doc Timescale for action 30/03/06 2 OP7 15 30/03/06 3 OP7 14 01/04/06 4 OP9 14 01/04/06 5 OP29 7, 9, 19 & Sch 2 03/03/06 Dowty House Version 5.1 Page 19 6 OP33 26 with satisfactory written explanations of reason for gaps in employment. 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. Timescale of the 1/3/05 and the date of the last inspection (10/8/05) was not met. The Registered Person must send copies of the report of the unannounced visits to the Commission for Social Care Inspection. 30/03/06 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 Refer to Standard OP7 OP9 OP9 OP9 OP9 OP9 Good Practice Recommendations The home should include more personalised detail in service users care plans in relation to personal hygiene. The home should for ease give each service user their own page in the controlled medication register and for each controlled medication they take. 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. DS0000016424.V277643.R01.S.doc Version 5.1 Page 20 Dowty House 7 OP16 8 9 10 11 12 13 14 OP16 OP18 OP29 OP33 OP33 OP33 OP33 The home should remove any reference made to the National Care Standards Commission and replace with the Commission for Social Care Inspection in their complaints policy. The home should display their complaints procedure in the home where it is accessible to service users and visitors. The home should provide training for staff on how to protect vulnerable adults and abuse. The home should request 3 references. The home should maintain records of all monitoring systems used in the home and these should include care documentation 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 as part of their quality assurance procedure. Dowty House DS0000016424.V277643.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Gloucester Office 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 DS0000016424.V277643.R01.S.doc Version 5.1 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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