CARE HOMES FOR OLDER PEOPLE
Drumconner 13 - 21 Brighton Road Lancing West Sussex BN15 8RJ Lead Inspector
Miss Helen Tomlinson Unannounced Inspection 14th January 2006 9.15am 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 Drumconner DS0000024138.V273991.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. Drumconner DS0000024138.V273991.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Drumconner Address 13 - 21 Brighton Road Lancing West Sussex BN15 8RJ 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) 01903 753516 01903 851437 Drumconner Ltd Mr Roger John Kinsman (Jnr) Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48), Physical disability (48), Physical disability of places over 65 years of age (48) Drumconner DS0000024138.V273991.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Only service users over the age of 50 years in the PD category may be admitted. service users over the age of 50 years in the PD category may be admitted. 5th July 2005 Date of last inspection Brief Description of the Service: Drumconnor is a care home registered to provide personal and nursing care for up to 48 people who are over 65 years or people with a physical disability who are over 50 years. The home is a large detached building which has been extended. It stands in its own, well maintained gardens with a car park to the side. It is situated in a residential area on the main coast road from Worthing to Brighton in the village of Lancing. Local shops and other community facilities are close by. It is on a bus route. The accommodation is provided on two floors with a passenger lift allowing access to the top floor. Communal areas include three lounges, a dining room and a lounge/bar area for entertaining. There are 35 single and 6 double bedrooms. A number of rooms have en-suite facilities. Some have a sea view. Drumconner DS0000024138.V273991.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection. The inspector arrived at 9.15am and left the home at 3.30pm. The registered manager, Mr Kinsman (Jnr) was present throughout the inspection. Over the course of the inspection twelve residents, three visitors and five members of staff were spoken with. Staff were observed giving support and assistance. Resident’s files were examined in order to see specific records and other documents were seen as was necessary. A tour of the premises took place. Staff files were examined. A recent adult protection procedure was carried out and this inspection demonstrates that the process has been reviewed and there is an improved understanding of it. Also, as agreed prior to the inspection, a planned meeting will be taking place with the providers, the purpose of which is to ensure that the Commission’s expectations are clear. This will also allow the providers to express their concerns as to the Commission’s role in Adult Protection strategies. Following the last inspection seven requirements and two recommendations were made. At this inspection six of the requirements and all of the recommendations had been met. At this inspection one additional requirement and three recommendations were made. What the service does well:
Residents live in a home that was seen to be clean, tidy, well maintained and free from offensive odours. The home was noted to provide for residents a well decorated environment with the provision of furnishings, fixtures and fittings in the communal areas and bedrooms that were of a high standard. The home was pleasantly decorated. The gardens were well kept with seating areas for the residents. Residents said they had a choice of when to get up, go to bed and where to sit to eat their meals etc. Staff spoke about resident’s choices being respected. Residents said staff were “polite and kind”. One resident described herself as being “spoilt” by the staff who were “so lovely and patient.” Residents said there were plenty of activities available in the home, should they wish to join in. They have entertainment from outside groups, which they said they enjoyed, and trips out take place. Visitors were welcomed into the home at any reasonable time and those spoken with said they were kept informed about their relative or friend. Residents benefit from being cared for by staff who receive appropriate training. At the time of this inspection sufficient numbers of staff, with appropriate experience and skill were on duty, to meet the needs of the residents accommodated at the time. Drumconner DS0000024138.V273991.R01.S.doc Version 5.1 Page 6 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. Drumconner DS0000024138.V273991.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 Drumconner DS0000024138.V273991.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 Residents were not admitted to the home without an assessment of their need having been completed. Standard 6 does not apply as Drumconnor does not provide intermediate care. EVIDENCE: The file of one resident, admitted since the last inspection, was examined. This contained an assessment of need which had been carried out by the manager of the home, prior to that person being accommodated. The manager discussed how he, or another suitably qualified and experienced member of staff, would visit any person wishing to become accommodated in the home. This would take place prior to them coming to the home. Copies of Social services and health assessments would be obtained, if they were available. Drumconner DS0000024138.V273991.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. All residents had a plan of care. These documents had been reviewed and changed since the last inspection and now provided more information. Since the last inspection additional assessments for various health needs of the residents had been carried out. These now gave a much more detailed picture of the residents needs. Various risk assessments had been included. The storage of medication was safe. One of the two requirements made at the last inspection, with regard to medication, had been met at this time. Standard 10 was met at the last inspection. EVIDENCE: Since the last inspection the documentation used to record the individual resident’s plan of care had been reviewed. Those seen contained more detailed information than at the last inspection, and this gave a clear picture of the resident’s needs and how staff should meet them. The care plans seen were up to date. The system for review was unclear, as the entire plan would have to be re-written should one issue on a page change. The manager was going to discuss this with the nursing staff and devise a suitable system of review. All plans should be reviewed at least monthly and kept up to date. Drumconner DS0000024138.V273991.R01.S.doc Version 5.1 Page 10 Additional assessments for various health care needs had been added to the plans of care, since the last inspection. These included nutritional assessments, bed rail risk assessments and falls risk assessments. The pressure sore and moving and handling assessments were on file and up to date. These assessments had a subsequent plan of care in place to ensure these needs were met. The Care plans and health assessments had improved since the last inspection, with additional information being present to give a much more thorough and detailed picture of the resident’s overall needs and how these should be met. The requirement made at the last inspection regarding the recording of medication administration had been met. Risk assessments for residents who administered their own medication were still not in place and this requirement is not met. Qualified nurses were observed giving out medication and this practice was in line with their own code of practice. Signage where oxygen was stored was in place. Drumconner DS0000024138.V273991.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): 12,13 and 14. Residents had the opportunity to join in social and recreational activities, should they wish. Residents could maintain contact with their relatives, friends and local community should they wish. Residents were helped to make choices about their lives. These were respected by the staff. Standard 15 was assessed and met at the last inspection. EVIDENCE: A variety of activities were advertised, on the notice board, as taking place in the home. These included movement to music, reflexology, crafts and entertainers coming into the home. Residents said they could join in these activities, should they wish, or remain in their own rooms, whichever they preferred. Those who did attend the activities said they enjoyed them and found them suitable for the audience in the home. A minibus is available, for the residents, to have trips and outings to local shops and places of interest. Residents said they enjoyed this “change of scenery” and those in wheelchairs particularly enjoyed this opportunity. Visitors were present in the home at a variety of time throughout the inspection. They said they could visit whenever they wished, within reason, and stay with their relative for as long as they liked. They said they were always greeted in a friendly manner by the staff, and given information
Drumconner DS0000024138.V273991.R01.S.doc Version 5.1 Page 12 regarding their relative or friend, should there be any changes. Residents could have telephones in their bedrooms in order to keep in contact with friends and family. A religious service took place monthly and other ministers visited the home, as was individual residents preferences. The choices and preferences of the residents were documented on their care plan. These included small details of how the resident would like certain things, which meant their needs were met in line with their wishes. Those spoken with said the staff asked them how they would like things done and respected this choice. They said that although there had to be some routine in the home, there was flexibility within this to allow for individual choices to be accepted. They could choose their own time of rising and retiring, where to eat, where to sit and what to do with their time. Drumconner DS0000024138.V273991.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The procedures for reporting abuse had been reviewed since the last inspection. EVIDENCE: At the last inspection the procedures for reporting any allegations of abuse were not in line with the current guidance. These had been amended at this inspection. As discussed in the summary a meeting was planned, to take place after this inspection, which will allow the commission, provider and the manager to discuss further the processes around adult protection. Drumconner DS0000024138.V273991.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21, 22 and 24 Residents live in a well maintained home. One aspect of fire safety did not meet with current guidance. There is a large amount of varied, suitable and comfortable communal space available. Toilets and bathrooms are conveniently located and accessible to residents. The equipment required to meet the specific needs of the residents was available. Resident’s bedrooms were safe and comfortable. Many had personalised these with their own items. EVIDENCE: Residents live in a home which is maintained to a high standard, with good quality fixtures and fittings in place. Residents said they thought the environment was “very pleasant” and “well kept”. Re-decoration of both bedrooms and communal rooms took place when required. All staff had received fire safety training and a fire drill had taken place recently. Several fire doors, including bedrooms and lounges, were wedged or propped open.
Drumconner DS0000024138.V273991.R01.S.doc Version 5.1 Page 15 This practice should cease and fire doors should only be held open using a device which meets the approval of the fire service. There was a large amount of varied communal space available to the residents. This included a large lounge, with smaller lounge leading off it, to the front of the house, a conservatory style lounge to the rear, a large open space for activities, which was situated off the spacious dining room. Residents said they could choose where to sit during the day, or eat their meals. The garden to the rear of the premises, provided a pleasant seating area for residents, in the good weather. Some bedrooms had a patio door leading to this garden. There was an adequate number of toilets and bathrooms available, close to the resident’s bedrooms and the communal areas. At the last inspection one toilet, close to the lounge, had a large number of wheelchairs stored. These presented a hazard to any resident using this room. At this inspection these had been moved and no items were stored so as to cause a hazard. Some bedrooms had en-suite facilities, for those without a commode was provided. All bedrooms had a hand wash basin. The bathrooms seen were tidy, with appropriate bath hoists, raised toilet seats, grab rails and other equipment provided. Portable hoists, other moving and handling equipment, handrails and pressure relieving equipment was in place. Not all bedrooms were seen during this inspection. Those seen were tidy, clean and well maintained. Residents had personalised their rooms with photographs, pictures, furniture and other items, as they wished. They said they had been able to bring these items from home, provided they did not overcrowd the bedroom for safety reasons. Personal entertainment equipment and telephones were present, should the resident want these. Adequate furniture for the resident to sit comfortably and safely out of bed was provided. Drumconner DS0000024138.V273991.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 At the time of the inspection the numbers and skill mix of staff was adequate to meet the needs of the residents accommodated. Residents benefit from staff who have received appropriate training. The recruitment procedures had improved and protected the residents. EVIDENCE: This inspection was conducted on a Saturday due to written comments received, prior to the last inspection, that the numbers of staff was less and inadequate at the weekend. At the time of this visit the number of staff on duty was the same as that during the week. The duty rota examined did not indicate that less staff were on duty at the weekends. Residents spoken with said there was usually adequate staff on duty, though they were “very busy in the mornings”. Staff spoken with said, although the dependency of the residents was high, they thought they could meet the resident’s needs with the staff numbers on duty. It was discussed with the registered manager that the number and skill mix of staff on duty should be kept under review. This should be done preferably using a recognised assessment tool, to make sure staff could meet the dependency of the residents accommodated. Staff training consisted of induction training, which was documented as meeting the current guidelines, and ongoing specific training for the needs of the residents accommodated. Statutory training was completed and kept up to date for all staff. Some staff members had completed their NVQ 2 and others were on the course. The manager was aware that the aim was for fifty per cent of staff to have completed their NVQ level 2.
Drumconner DS0000024138.V273991.R01.S.doc Version 5.1 Page 17 Two staff files were examined, for staff who had been employed since the last inspection. The recruitment procedure had improved since the last inspection and the necessary Criminal Record Bureau and Protection of Vulnerable adult checks had been completed, prior to them starting work. Two written references were on file. The application for one staff member was not present. For neither person was a full employment history recorded. This should be obtained for all staff members, as part of the pre-employment checks. Drumconner DS0000024138.V273991.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33 and 35 The home is managed by a suitably experienced and qualified person. The home is run in the best interests of the residents. The resident’s financial interests are safeguarded by the practices of the staff at the home. EVIDENCE: The registered manager had been in post for over six years. He is a Registered General Nurse with experience in emergency surgery, prior to working with older people. He up dates his practice by attending training courses and reading the latest research etc. He has not completed a qualification in management and it is recommended he does so. The registered manager said there was ongoing review of the quality of care provided in the home. This was done on an informal basis with the registered manager and the responsible individual being present in the home on most days and talking to the residents and visitors about the quality of service provided. Some questionnaires had been completed to formalise some aspects
Drumconner DS0000024138.V273991.R01.S.doc Version 5.1 Page 19 of the quality review. It is recommended a more comprehensive system of review is undertaken, which includes review, implementation and evaluation of the service provided. This should be recorded. The practices and procedures for managing resident’s money safeguarded their interests. Secure storage was available and records of all transactions, including receipts, were kept. Drumconner DS0000024138.V273991.R01.S.doc Version 5.1 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 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 2 3 3 3 x 3 x x STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x x Drumconner DS0000024138.V273991.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(4)(b) Requirement All residents who administer their own medication must have a risk assessment completed. This requirement remains unmet since the inspection of5/7/05. The timescale given of 31/7/05 has expired All fire doors must be kept closed, unless held open by a device which meets the guidance of the fire service. Timescale for action 31/07/05 2 OP19 23(4) 31/01/06 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 Refer to Standard OP29 OP31 OP33 Good Practice Recommendations A full employment history should be obtained, prior to the person starting work, for all staff members. The registered manager should obtain an appropriate management qualification. A more comprehensive system of review of the quality of service provided in the home should be implemented and recorded.
DS0000024138.V273991.R01.S.doc Version 5.1 Page 22 Drumconner Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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