Inspection on 22/01/08 for Drayton House

This inspection was carried out on 22nd January 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Drayton House 02/02/10

Drayton House 17/09/09

Drayton House 15/01/09

Drayton House 16/07/08

Drayton House 17/10/07

Drayton House 19/06/06

Drayton House 23/11/05

Drayton House 09/08/05

Drayton House 13/09/04

Drayton House 13/05/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Drayton House 50 West Allington Bridport Dorset DT6 5BH Lead Inspector John Hurley Key Unannounced Inspection 22nd January 2008 10:00 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 Drayton House DS0000036054.V358521.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. Drayton House DS0000036054.V358521.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Drayton House Address 50 West Allington Bridport Dorset DT6 5BH 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) 01308 422835 01308 422835 Miss Andrea Helen Quirk Mrs Isabella Fitzgerald, Mr John Stanley Pitcher, Mrs Mary Josephine Pitcher Vacant Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Drayton House DS0000036054.V358521.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That four persons may be accommodated within the category DE(E). Date of last inspection 17th October 2007 Brief Description of the Service: Drayton House is registered to provide personal care for a maximum of 19 older people including up to four with dementia. Miss Andrea Quirk is the Responsible Individual; she also owns a number of other registered services, including Glencairn in Dorchester. The accommodation is on the ground and first floors with a small passenger lift serving both floors. 7 of the 13 single bedrooms have en-suite hygiene facilities and there are 3 larger rooms that may be used to accommodate 2 residents who have made a positive choice to share with each other. None of the shared use rooms have en suite facilities; all bedrooms have a wash hand basin. Communal facilities include two lounges, a small dining room and 3 bathrooms including two for assisted use. Drayton House is within walking distance of Bridport town centre with its shops and services. There is space at the front of the house to park two cars; parking is not permitted in the road in front of Drayton House. Behind the house is a steep raised garden accessible only by steps and therefore rarely used by residents of the home. There is a small patio at the side of the house accessible via patio doors from the rear lounge. Laundering of clothing and household linen is carried out at the home and arrangements can be made for chiropodists, opticians and other health and social care professionals to visit individual residents. Fees are charged weekly and at present range between £417 and £450 per person. Drayton House DS0000036054.V358521.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 zero stars. This means that the people who use this service experience poor quality outcomes. This was the third unannounced inspection of Drayton House care home for the inspection year 2007/8 and the second key inspection. The inspection process followed the Commission for Social Care Inspection Inspecting for Better Lives methodology. The registered person has appointed a management company, Personal Care Solutions (PCS), to provide management support for the home. At the time of the inspection this new management structure had been in place for three weeks. The inspector spent some time with representatives of the new management discussing the future plans for the home and the action plan they had put into place. The inspector had a very brief tour of the building and spoke with the residents at the home. The inspector sampled some of the documentation relating to the individuals who reside at the home along with records of staff and other documents required by regulation. This report should be read in conjunction with the other key inspection report carried out on the 17/10/07 as not all of the standards were covered at this inspection. What the service does well: What has improved since the last inspection? Drayton House DS0000036054.V358521.R01.S.doc Version 5.2 Page 6 • • • • • • There have been some improvements to the dinning area which has a better ambience. A number of the policy documents have been updated and now reflect the statutory requirements. In general terms the infection control practises have improved. A number of staff have valid medication administration certificates. A comprehensive action plan is in place to address the shortfalls highlighted in this and previous reports. Accidents are evaluated and risk assessed What they could do better: The responsible individual (proprietor) must ensure that; • There is a recorded rationale and practice guidelines for the administration of medication via the per required needs route in order to protect the people who use the service. All medication records are maintained in good order in order to protect the people who use the service. All people who use the service have a detailed care plan, which accurately reflects the individuals needs and is reviewed on a monthly basis. All environmental risks are assessed and action taken to minimize the risk in order to protect those who reside at the home, staff and visitors. The statement of purpose must be updated to reflect the new management arrangements at the home. That all staff undertake all of the statutory training required. • • • • • 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. Drayton House DS0000036054.V358521.R01.S.doc Version 5.2 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 Drayton House DS0000036054.V358521.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,4, 6 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The statement of purpose needs updating to accurately reflect the management arrangements at the home. EVIDENCE: As there are new management arrangements in place the statement of purpose needs to be updated to reflect this. At the time of the inspection no new people had taken up residence at the home. The inspector looked at the new documentation available to carry out an assessment of need that demonstrated how the service will assess new and prospective residents. If these assessment documents are followed they should provide the basis for a comprehensive assessment. The management informed the inspector that at present there no plans to offer intermediate care. Drayton House DS0000036054.V358521.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The care planning documentation is improving and once fully implemented should detail the needs and aspirations of those who use the service. The recording of medication fails to protect those who use the service. EVIDENCE: Through the examination of these files it was reasonably clear that residents have their health care needs met by a number of key professionals such as district nurses and doctors. The inspector looked at four of the resident’s files two had recently been updated. The updated files contained good details with regards the individual stating some personal preferences and routines. The files also contained information relating to people important to them such as relatives and healthcare professionals. These two files also evidence that where possible the residents had been consulted as to the contents of the information held. Whilst Drayton House DS0000036054.V358521.R01.S.doc Version 5.2 Page 10 these files are yet to be fully updated they represent a good start in bringing the care documentation back to the required standard. The two files that had yet to be updated were looked at in conjunction with the medication records and accident book. The accident book evidenced that one resident had had a recent fall. There was no record of this fall in the care files. The inspector discussed this issue with the new deputy manager and operations manager of PSC. They informed them that the resident had now been moved to the ground floor where they could observe the resident better as they (resident) was getting out of bed in the night and falling. There was no recorded reference to the consultation process relating to this move recorded in the documentation. The inspector looked at the medication administration records and found a number of issues that require attention. The inspector was unable to establish a clear audit trail for all medication. A number of hand written entries did not record the amount into the home and in one case the home did not have a recorded rationale for the administration of medication via the per required needs route. As there are new management arrangements in place the inspector would strongly recommend that the management carryout their own audit of medication and record what they are taking responsibility for. Drayton House DS0000036054.V358521.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The pace of life appears to suit the service users expectations and aspirations EVIDENCE: The residents said that that they could spend their time as they want to and that they are given choices. The inspector toured the building and noted that many of their rooms were personalised with their own possessions. The home has employed a dedicated staff member to provide activities to the resident group. They are developing their knowledge of the likes and dislikes of the people living at the home in order to provide meaningful activities. Some of the residents the inspector spoke with confirmed that they had been consulted about what they would like. They further informed the inspector that staff often sit and talk with them and tell them about local events. Some of the residents attended activities away from the home at local day centres and other community groups. Drayton House DS0000036054.V358521.R01.S.doc Version 5.2 Page 12 It was noted that the dining room has had a certain amount of refurbishment and generally looked more welcoming and homely. One resident commented “ it looks more like home now”. They also commented that more people now use the dinning room. Drayton House DS0000036054.V358521.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Updates to policies and procedures should ensure the protection of those who use the service EVIDENCE: The inspector noted that the management has introduced an updated complaints and vulnerable adults procedure in line with the statutory requirements. The vulnerable adults procedure reflects the local authorities procedures with regards to this matter Drayton House DS0000036054.V358521.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,22,23, Quality in this outcome area is adequate . This judgement has been made using available evidence including a visit to this service. The home is generally furnished to an acceptable standard. More needs to be done to ensure that all of the people who use the service can access all areas of the home independently. The storage in the laundry area is inadequate for the purpose. EVIDENCE: At the time of the inspection the inspector only took a brief tour of the building in order to establish that the infection control issues highlighted at the previous inspection had been attended too. The inspector looked in the communal bathrooms and found them to be clean and hygienic. The communal lavatories although in need of some updating were similarly clean and hygienic. Drayton House DS0000036054.V358521.R01.S.doc Version 5.2 Page 15 As mentioned earlier the dinning room has had a certain amount of refurbishment and there are plans to update other areas. The residents own rooms are pleasantly furnished and reflect the individual’s tastes and choice. The laundry area is accommodated in the cellar area. There is a large opening which leads up to the ground level which in previous times may have been a coal shute. It was noted that at the bottom of this area and next to the washing machines debris from above was collecting. It was further noted that there was insufficient shelving or storage arrangements for clean clothes. The management agreed to look at addressing this issue without delay. Whilst the home has retained a certain degree of a domestic nature it still does not contain any visual clues as to where a person may be in the building. As the home has a registration which includes those who suffer from dementia this may mean that they are less confident to move around the building independently. Drayton House DS0000036054.V358521.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29,30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The management need to ensure that all staff have received their statutory training to ensure the protection of those who use the service. There is evidence that new staff receive a structured recorded induction into the care home so as to meet the needs of those who use the service. EVIDENCE: At the time of the inspection the new management company informed the inspector of the plans to carryout a full skills audit of the staff group. Once this audit is complete and the competencies of the staff have been evaluated the management have committed themselves to ensuring all mandatory training will be completed in the very near future. The inspector sampled the recruitment records of those staff who have recently taken up employment at the home. These were found to be comprehensive and in good order. New staff confirmed that they have undergone a thorough recruitment and selection process by way of a formal interview and statutory checks to establish their suitability to work in the home. Drayton House DS0000036054.V358521.R01.S.doc Version 5.2 Page 17 The inspector spoke with staff who confirmed that they had received an induction into the care home where the needs of the resident group were explained. The residents informed the inspector that staff are always around to help if required. Drayton House DS0000036054.V358521.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management structure in the home should be able to re-establish the National Minimum Standards and provide effective leadership to the staff team once it has had time to settle in. EVIDENCE: Prior to this inspection the responsible individual had addressed a number of requirements set at previous inspections. In order to maintain this momentum the responsible individual has decided to employ the help of a management company (PCS) to assist in the running of the home. At the time of the inspection PCS had developed an action plan to address issues of concern and had began work on addressing them. As a result a number of procedural documents have been reviewed or introduced. Drayton House DS0000036054.V358521.R01.S.doc Version 5.2 Page 19 It is hoped that given further time to address the previous requirements set the new management arrangements will have a positive impact on the home and the National Minimum Standards will be re established and maintained in all areas. A new deputy manager is undergoing a comprehensive induction supported by an operations manager from PCS. Whilst all of these changes are taking place the staff group appear to be offering a consistent service to the residents. Those residents the inspector spoke with confirmed that they had not been affected by the changes and appeared to be going about their personal routines as before. It was noted at this inspection that all substances hazardous to health were stored correctly and health and safety procedures followed. Drayton House DS0000036054.V358521.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x 3 2 3 x x x STAFFING Standard No Score 27 2 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x x x x x x x Drayton House DS0000036054.V358521.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP30 Regulation 18(c)(1) Requirement The registered person must ensure that the persons working at the home receive training appropriate to the needs of the people living at the home. Whilst there are plans in place to address this requirement it has yet to be achieved. The previous timescale for meeting this requirement was 01/01/08 3. OP1 17(2) The registered person must update the statement of purpose to accurately reflect the services on offer at the home so that people can make an informed choice. The registered person must ensure that all individuals have an appropriate risk assessment that identifies that action to be taken to minimise the risk. Whilst there are plans in place to address this requirement it has yet to be achieved. The previous timescale for meeting this requirement was 25/01/08 Drayton House DS0000036054.V358521.R01.S.doc Version 5.2 Page 22 Timescale for action 01/04/08 01/03/08 5. OP7 13 (4) 01/03/08 12. OP38 13(4) The registered person must ensure that there is a fire evacuation plan in place. 21/02/08 15. OP9 13 (2) The registered person shall make 21/02/08 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received in the care home including: must ensure that staff that administers medication have been suitable trained and hold the appropriate certificates relating to their competence Recording the rationale for administering Per required needs’ administration of medication. To ensure that all returned, disposed of or medication given to others is robustly accounted for. The previous timescale for meeting this requirement was 01/11/07 16. OP7 15(1)(2) The registered person must ensure that the residents care records include an action plan with sufficient detail to provide clear guidance to staff on the actions to be taken to meet all their identified needs. The resident or their representative must be consulted when preparing the care plan and sign the plan to evidence they agree with actions taken on their behalf. Whilst there are plans in place to address this requirement it has 25/03/08 Drayton House DS0000036054.V358521.R01.S.doc Version 5.2 Page 23 yet to be achieved. The previous timescale for meeting this requirement was 20/11/07 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. Refer to Standard OP2 OP19 Good Practice Recommendations It is recommended that all residents be reissued with their up to date contract. It is recommended that the signage within the home is improved in order to assist people who live in the home to access all areas as independently as possible. It is recommended that the storage of clean laundry is evaluated and action taken to address any issues identified. 3. OP26 Drayton House DS0000036054.V358521.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South West Regional Office 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. Extracts may not be used or reproduced without the express permission of CSCI Drayton House DS0000036054.V358521.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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