Inspection on 29/06/07 for Dresden House Limited

This inspection was carried out on 29th June 2007.

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

Dresden House Limited 04/10/06

Dresden House Limited 04/01/06

Dresden House Limited 15/08/05

Dresden House Limited 23/03/05

Dresden House Limited 09/10/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Dresden House Limited 81 Trentham Road Dresden Stoke-on-Trent Staffordshire ST3 4EE Lead Inspector Mr Peter Dawson Key Unannounced Inspection 29 June 2007 09:00 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 Dresden House Limited DS0000008223.V338070.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. Dresden House Limited DS0000008223.V338070.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dresden House Limited Address 81 Trentham Road Dresden Stoke-on-Trent Staffordshire ST3 4EE 01782 343477 01782 335813 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) Dresden House Limited Miss Lesley Anne Mills Care Home 24 Category(ies) of Dementia - over 65 years of age (7), Mental registration, with number disorder, excluding learning disability or of places dementia (3), Mental Disorder, excluding learning disability or dementia - over 65 years of age (7), Old age, not falling within any other category (24), Physical disability (1), Physical disability over 65 years of age (10) Dresden House Limited DS0000008223.V338070.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. PD minimum age 60 years That the Registered Manager undertakes training in Mental Health Awaress and Dementia Care 4th October 2006 Date of last inspection Brief Description of the Service: Dresden House is a large detached Victorian house located alongside a busy road in Dresden near to shops and community facilities. The town of Longton can be accessed via public transport; parking is at the rear of the home. Bedrooms are for single occupancy, three bedrooms at the time of this report had an en-suite facility; there are plans to increase en-suite facilities in other bedrooms. Bathing and toilets are located throughout the home easily accessed by the residents. Three lounges, one being designated as a smokers lounge provides sufficient space for the residents to wander freely. Considerable building work has been planned and at the time of this report work was advanced in the upgrading of virtually all areas of the ground floor. Later phases of the work will include refurbishment of the first floor and eventually additional en-suite facilities. Dresden house provides care for twenty-four people the majority of whom are elderly. People with mental health care needs or dementia care needs are also accommodated. The fees for care at Dresden House are £344 - £367 per week. Dresden House Limited DS0000008223.V338070.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was carried out by one inspector on one day from 8.30 am – 5.00 pm. The Registered Manager was not on duty and the inspection carried out with assistance from the Deputy Manager and two other care staff on duty. All were helpful and cooperative and had detailed knowledge of the needs of residents and the operation of the home. They were all extremely busy but this did not detract from the contribution they made to the inspection. One of the Directors visiting the home was later spoken to briefly. An Annual Quality Assurance Assessment (AQAA) had been completed by the providers prior to the inspection providing useful and pertinent information about the home and some information is used in this report. There was an inspection of the whole of the physical environment including a sample of bedrooms. Records, reports, documents relating to the inspection process were seen. All residents were seen and many spoken to making a valuable contribution to the inspection and insight into the running of the home. Their information and comments form a basis of description of the service in this report. Two visitors were seen, were warmly welcomed by staff and had a positive, friendly dialogue with them. One visitor expressed a high level of satisfaction in all areas of care of her relative who has lived at the home since it opened. Planned building work was very much in process at the time of the inspection and in the later stages of work which will transform the ground floor area, significantly improving the bedroom and communal areas and the facilities provided. This was being carried out with minimal disruption to residents who commented very favourable about the changes being made and clearly interested in the work being done. What the service does well: Dresden House Limited DS0000008223.V338070.R01.S.doc Version 5.2 Page 6 Residents with mixed/diverse needs are well supported by a very committed staff team. This was confirmed in discussions with several residents. There is a varied programme of activities initiated by staff as part of care provision. Food provision is good with choice of dish at all mealtimes and weekly resident input into menu planning. There is a pro-active approach to healthcare with swift referrals to health care professionals if concerns are identified. The medication system is well documented and safely administered from trained and competent staff. Residents choices and lifestyle are well-documented, known and important to staff who respect and meet those choices. What has improved since the last inspection? There has been ongoing building/renovation work to improve the facilities and environment generally. The renovation and upgrading of the ground floor area is well advanced - The conservatory has been replaced with a newly-built reception area and new kitchen area, which is much needed and will considerably enlarge and improve the previous limited kitchen facilities, new units and equipment is being provided with improved lighting and ventilation. 10 bedrooms on the ground floor have been completely refurbished with new flooring, furniture, décor, and lighting. This upgrading extends to the corridor areas accessing those rooms. The improvements are significant. The smoking lounge is being upgraded. The reception area extended and improved and also additional dining space added. The office on the first floor is being relocated to the ground floor – a more appropriate and convenient location for residents, staff and visitors. Wheelchairs and no longer used without footrests to transport residents. This has improved safety. Dresden House Limited DS0000008223.V338070.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Dresden House Limited DS0000008223.V338070.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 Dresden House Limited DS0000008223.V338070.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): Quality in this outcome area is good. Statement of Purpose requires updating. Pre admission assessments and invitations to visit the home are arranged in all instances. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a statement of purpose which is readily available in the home. Some information requires updating. This was identified in the last inspection report but has not been actioned. This must be done. Two care plans of recently admitted residents were inspected. Pre-admission assessments had been carried out prior to admission and also Care Management Assessments obtained. Dresden House Limited DS0000008223.V338070.R01.S.doc Version 5.2 Page 10 It is the homes policy to invite prospective residents for a meal to assist in assessing the suitability of the home, although this may not always be possible, it is the preferred option. Relatives are always invited to spend time in the home before making a judgement about suitability. A resident admitted from hospital one week prior to the inspection said that she had overheard a conversation with a member of Dresden House staff with another patient in the hospital, had made her own approach to the home, visited twice prior to admission and quite satisfied that the care, facilities and service offered by the home match her needs. Dresden House Limited DS0000008223.V338070.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): Quality in this outcome area is good. Care planning information is good, based upon assessed need and clear to staff providing care. Health care needs are clearly identified and referred to health care professionals at an early stage. Some clarification of working with the nursing service is needed. There is a safe system of medication in place. Residents privacy and dignity is promoted and there are detailed plans of actions required in the event of death. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A sample of care plans were seen including recently admitted and also longterm residents. Dresden House Limited DS0000008223.V338070.R01.S.doc Version 5.2 Page 12 The home has a good system in place to establish a care plan from preadmission assessments. This is called the ‘Agreed plan of care’ and contains all required information for staff to provide care to meet assessed needs. Information included, diagnosed conditions, nutritional information including food preferences, continence care, preferred lifestyle, good social history etc. Risk assessments were in place as relevant relating to mobility, moving & handling assessments, risk of pressure ulcers etc. Referrals had been made to specialists including Continence Advisor, District Nurse. Registration had been made with local GP and appointment made for initial health check and review of medication. The plan of a recently admitted resident was impressive with all above information included in the initial plan and signed by the resident. The document was clear and gave adequate required information to support the person. There are daily reports for each resident for each of the 3 staff shifts, reports were clear and concise. There is monthly review by the Key Carer summarising that information. There are 2 people with pressure ulcers at this time although it was not clear whether one had healed following treatment from the District Nursing Service. In this instance the Nursing Service had been visiting over a period of time when the ulcer to sacrum had healed and then broken down again. The last entry on the Nursing Notes stated that spray/creams should be applied and daily bed-rest of 2 hours required in the afternoon. Staff believed the ulcer had healed and that this action was not required. It is important to synchronise care from staff with instructions from the nursing service. This will be clarified with the nursing service. The home report a ‘same day’ response from the District Nursing Service if they have any concerns. Services from health care professionals are in place as required. There are regular optical and dental checks and all are registered with the NHS Chiropody Service. A private Chiropody service is available and some residents choose to supplement the NHS service. A resident with complex medical needs is overseen by the Community Matron. Provision of steroids, anti-biotics, oxygen, inhalers etc being available as needed through that service to sustain the person in the community, avoiding hospital admission. There is clearly a positive working relationship with the homes staff and this is working well. Responses from GPs also reported to be good. A visit requested on day of inspection resulted in examination of person and prescribed medication collected from nearby pharmacy immediately. There was evidence of regular monthly weighing of all residents. Where there are concerns about weight loss weekly weighing is commenced. A resident previously eating well but having weight loss was referred to the GP. Several Dresden House Limited DS0000008223.V338070.R01.S.doc Version 5.2 Page 13 people are on prescribed supplements where nutritional shortfalls are identified. Fluids are taken throughout the 24 hour period – all bedrooms have jugs/glasses to ensure good hydration. Staff understand the importance of this. The medication system is provided in MDS (blister pack) form by local Pharmacy who annually audit the system. Medication records showed good and consistent recording of medication given. It was noted that Haloperidol had been out of stock for 6 days – being dealt with by the Pharmacist/GP due to prescription/dispensing confusion – the home were actively pressing for delivery of the medication. Returns to the pharmacy are countersigned completing the medication audit trail. There is no self-medication in the home at this time. The AQAA states the home promotes self-medication and provides lockable facilities in bedrooms. It was interesting to note that a recently admitted resident who self-administers insulin is not allowed to self administer other medication. A risk assessment may be appropriate in this and other instances, in an effort to promote some self-medication. The last report indicated that residents were being transported without the use of rests on wheelchairs. This practice was not seen during this inspection. Privacy & dignity is promoted – examples were: All female residents are asked if they wish to receive personal care from male carers – one had refused and later changed her mind after establishing positive relationship with the carer. A recently admitted resident who self-injects insulin into her leg, asked if she could administer this in the lounge area where there were other residents and visitors – staff quite rightly said no in order to protect her privacy and dignity. In records seen there were clear instructions of residents wishes in the event of the death of each resident. This information had been obtained from residents/relatives sensitively and included burial/cremation, hymns, donations and funeral directors. This was good. Dresden House Limited DS0000008223.V338070.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is good. A range of activities are provided and residents generally were satisfied with them. Two residents did say they would like to go out more. Family, friends and visitors are made welcome and encouraged to visit regularly. Food provision is good with very positive feedback from residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents spoken to said that they were happy with their life at Dresden House. They enjoyed the activities that were available to them. There is a monthly programme of activities available to all and in pictorial form. There is also a monthly Newsletter. The usual range of indoor activities were spread throughout the month and also included a food meeting, hairdresser and men’s Dresden House Limited DS0000008223.V338070.R01.S.doc Version 5.2 Page 15 and ladies days. Some external visits to local places of interest take place and more planned for the summer. Pastoral care is provided currently to Roman Catholic residents on a weekly basis, no other denominational inputs at this time. There are no specific cultural needs for residents in this home at this time. A resident who previously went out regularly unescorted and no longer able to - confirmed that activities were satisfactory, although he misses the regular external visits. He commented that there needed “more staff on” to assist residents with daily care and to initiate more activity. Staff meeting minutes showed that one member of staff is identified daily to provide 1.5 hours of activities with residents each day, to be spread throughout the day. There were only 3 Care staff (including Deputy Manager) on duty on the day of this inspection – a Trainee (under 18) was not available on this day, putting considerable pressure upon the 3 members of staff to meet the needs of this resident group at the peak morning time. – There are no domestic staff employed – theoretically the Trainees carry out these duties in addition to some non-personal care duties. The reality is that that care staff have some domestic duties –(cleaning rooms, making beds, laundry, feeding residents) and certainly in the absence of Trainees. The planned activity for the day was dominoes which a group of 6-8 residents played with enthusiasm, competition and enjoyment during the morning. It was extremely difficult/impossible for the 3 care staff on duty to meet the needs and demands of residents throughout the morning in particular. Staff on duty did an excellent job – residents were demanding breakfast at 8.30 most having been assisted to rise, wash, dress and waiting for their breakfast in the lounge area. Some residents require individual assistance with feeding, medication was required. Many residents were making other demands upon staff who dealt with the situation very calmly and professionally. Although they were seen to be hard-pressed to meet the needs of all residents, staff showed tolerance and patience in a very demanding situation. The deployment of staff must be reviewed. The allocation of duties to Trainees is good in theory, in practice their duties become the responsibility of care staff in their absence. If Trainees are part of the rota then replacements must be found if they are unable to work, it is not acceptable for carers to take on the duties of trainees also. There are monthly residents meetings and a 2 weekly ‘food’ meeting to discuss menus and general food provision and satisfaction. The menu was posted in the dining area and indicated a good, varied, wholesome diet. There is choice of dish at all mealtimes. Residents spoke very highly of the food provided and Dresden House Limited DS0000008223.V338070.R01.S.doc Version 5.2 Page 16 were clearly satisfied with choice and quality. Staff said the menu was to be provided in larger print. There was a discussion with residents at lunch time about the choices available and not all were aware of them. It may be helpful and a useful point for discussion amongst residents if menus were provided on tables. Major building work was taking place at the time of this inspection, one lounge was closed for a few days as a result, and ground floor bedrooms had been totally refurbished. Staff have taken all possible steps to reduce any inconvenience to residents to a minimum. A resident with oedema of her legs was elevating them on a stool (as directed) in the lounge area. She asked if a stool could be made available in her bedroom for the same purpose. This request was passed to staff who were happy to pursue the matter. Dresden House Limited DS0000008223.V338070.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good. The complaints procedure is readily available to all and is satisfactory. Staff have knowledge of abuse procedures and some training has taken place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a complaints procedure in place which is clear and concise. A copy is posted in the home for residents and visitors. There is a copy in the information given in the Service Users Guide to residents. Staff had knowledge of and were aware of the procedures to be followed in the event of any incident indicating possible abuse. Training in Adult Protection has been provided in the past. The number of staff receiving training is not known to the inspector. This was not pursued on this inspection. Some doubts were expressed in the last report relating to the venue and viability of a previous training course in this area. The home should clarify this in writing to the inspector. No complaints have been received by the home or the Commission since the last inspection. Dresden House Limited DS0000008223.V338070.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is adequate There are 2 aspects to the environment at this time – excellent facilities being provided with upgrading of the ground floor area - and poor facilities on the first floor area which require attention to ongoing maintenance and equipment. There are plans to upgrade the first floor. Some action is required to improve hygiene on the first floor. The planned improvements will provide a comfortable and improved environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Dresden House Limited DS0000008223.V338070.R01.S.doc Version 5.2 Page 19 Major building work and improvements are being carried out at this time and are well-advanced. All 10 bedrooms on the ground floor have been completely refurbished including new flooring, new bedroom furniture with added hanging/storage space and drawers, new chairs and other furniture. New blinds, soft furnishings and bedding enhance the appeal of the rooms. The corridor areas to these rooms have also been redecorated and upgraded with new flooring and improved lighting. The results are excellent. Work is also ongoing to re-site the kitchen area, doubling space, replacing all units and equipment and improving natural light. The office is being relocated from the first floor to the ground floor. The conservatory is being re-built to provide a new reception area where residents/visitors can sit. The smoke room/lounge was having the chimney-breast removed on the day of inspection and being completely upgraded. The works will provide much improved facilities when complete, meanwhile there is the inevitable disruption. The ground floor area was tired and worn – the works are transforming the whole of the ground floor area. There has also been considerable work to upgrade the building to increase fire safety. This is complete. The first floor area will also have some upgrading. There were concerns about the standards of hygiene and decoration of areas of the first floor on the last inspection. On this visit 9 bedrooms and bathrooms were inspected on the first floor and there were areas requiring immediate attention. In summary : All bedrooms and bathrooms seen did not have hot water controls on the outlets and all exceeded the required 43C limit. This must be addressed immediately and monitored closely to ensure safety of residents. The over-bed lights in several rooms were not working, in an en-suite room neither the main light nor the over-sink light were working. Furniture in some bedrooms is poor with drawer-fronts missing etc. There were no towel rails in 2 ensuite areas, towels were place on toilet cisterns. There were no toilet rolls in 2 en-suites and toilet bowls were stained requiring deep-cleaning. Some bedrooms needed hovering/cleaning. The carpets in the corridor areas are stained and required hovering/cleaning. Dresden House Limited DS0000008223.V338070.R01.S.doc Version 5.2 Page 20 The inspector is aware that some upgrading is planned for the first floor but many of the matters mentioned above related to ongoing maintenance and cleaning routines – these should be addressed swiftly. The cleanliness of the first floor assisted bathroom which was unsatisfactory on the last inspection was seen and satisfactory on this visit. One bedroom had a strong smell of urine. This was discussed with staff and action is required to improve this room. The curtain track in this room was not in place and no alternative to ensure privacy. All bedrooms have lockable doors and many residents carry keys. Bedrooms seen were well-personalised and reflected individuality. Protective gloves and aprons and alcohol-based hand-washing facilities were readily available throughout the home for staff to ensure good infection control. Dresden House Limited DS0000008223.V338070.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is adequate The numbers and skill mix of staff should be reviewed to ensure residents needs can be met at all times. Training is good but with a shortfall in dementia and mental health training. Recruitment procedures ensure protection for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Concerns about staffing levels on the day of this inspection are mentioned previously in this report. The home does not have domestic/laundry staff, this work is undertaken by care staff. In particular Trainees (under 18 years and unable to engage in person care) appear to carry out the majority of domestic duties, although some also rest with other care staff. Trainees are employed under the Modern Apprentice training scheme. The problem is that when Trainees are not on duty the total responsibility for domestic duties remains with care staff in addition to their priority to provide resident care. Dresden House Limited DS0000008223.V338070.R01.S.doc Version 5.2 Page 22 There is a mixture of categories at this home, including older people, people with dementia and some with mental health needs. The physical dependency levels of some residents is high requiring assistance with most personal tasks. Some need a high level of support with daily living including emotional and social care needs. Additional pressures of domestic tasks are not feasible. Staff on duty on the day of inspection were seen to provide a high level of personal care to residents, the added pressure of domestic tasks were inappropriate. Staff were seen to provide the necessary time and support to 2 residents who were emotionally upset (one tearful) and needing 1:1 time and support to talk them through their concerns and reassure them. They did this in a skilful and natural way. The home should review and maintain staffing levels in the light of the additional duties outlined above. If Trainees are deployed they must be part of the total staffing rota and replacements found if unable to work in the same way as care staff. Domestic, care or agency staff should replace them. There has been staff training in the following areas in the past 6 months: 10 staff have had medication training. 6 have had Food Hygiene training, most have had fire training. NVQ training continues, the home having previously met the prescribed 50 of staff trained to NVQ level. A requirement of the last report to provide dementia care training for staff has not be actioned. It is further required that staff should be given training in dementia care and also in mental health needs to ensure they can meet the needs of residents in these 2 categories. A sample of staff files were seen and contained all required documentation under Schedule 2. All checks and references had been obtained prior to employment including POVA/CRB checks. Staff meetings are held approximately 3 monthly. Minutes of the last meeting on 16/06/07 were seen. Staff showed a high level of competency, skill and professionalism during this inspection. Dresden House Limited DS0000008223.V338070.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is good. The home is well run and managed and in the best interests of residents. There is good support, training and supervision for staff ensuring the health, safety and welfare of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager was not on duty during this inspection. She has been Managing the home for the past 2 years in a competent way and takes a positive lead in the home. She was due to complete the Registered Managers award by December 2006 but due to change in the emphasis of the training Dresden House Limited DS0000008223.V338070.R01.S.doc Version 5.2 Page 24 and the ongoing building works at Dresden House the anticipated completion date for the course will be December 2007. The Deputy Manager was involved in the inspection and demonstrated a thorough knowledge of the needs of residents and able to assist positively and totally in the inspection process. There was evidence of teamwork amongst the 3 carers on duty. Tasks were completed with ongoing consultation and a close working relationship between all staff. The priority was to meet residents needs with some prioritising of tasks and this worked extremely well. There is a close working relationship between the Registered Manager and the 2 Directors of the Company. Weekly management reports are compiled for Directors who closely monitor progress and support the Manager. Surveys are sent to gain feedback from residents, relatives and professionals, these were not inspected on this visit but generally made available with the Statement of Purpose/Service and included in Newsletters. All staff recieve 2 monthly progress reviews and annual appraisals. Policies/procedures are in place and recording was generally to good professional standards. Dresden House Limited DS0000008223.V338070.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 2 3 3 2 3 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 3 3 Dresden House Limited DS0000008223.V338070.R01.S.doc Version 5.2 Page 26 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 OP8 Regulation 12(1) Requirement Care staff must follow instructions from the Nursing Service and clarification sought where confusion exists. All equipment provided/used in bedrooms & bathrooms must be maintained in good working order. To ensure safety of residents steps must be taken immediately to ensure hot water supplies to resident areas do not exceed 43C Take steps to control mal-odour in bedroom identified Review staffing levels in the light of additional domestic duties required of care staff. Training is required for staff in dementia care and mental health needs. Previous timescale not met. Timescale for action 30/06/07 2. OP19 23(2)(c ) & (d) 13(4)(a) 14/07/07 3. OP25 29/06/07 4 5 6 OP26 OP27 OP30 16(2)(k) 18(1)(a) 18(c) (i) 30/06/07 07/07/07 14/08/07 Dresden House Limited DS0000008223.V338070.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Dresden House Limited DS0000008223.V338070.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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 Dresden House Limited DS0000008223.V338070.R01.S.doc Version 5.2 Page 29 - 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!