Inspection on 27/06/08 for Dudwell St Mary Care Home

This inspection was carried out on 27th June 2008.

CSCI found this care home to be providing an Good 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

Dudwell St Mary Care Home 27/06/07

Dudwell St Mary Care Home 07/12/06

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Dudwell St Mary New Building Etchingham Road Burwash East Sussex TN19 7BE Lead Inspector Debbie Calveley Unannounced Inspection 09:30 27th June 2008 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 Dudwell St Mary New Building DS0000067584.V365308.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. Dudwell St Mary New Building DS0000067584.V365308.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dudwell St Mary New Building Address Etchingham Road Burwash East Sussex TN19 7BE 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) 01435 883688 01435 883037 dudwell@barchester.com www.barchester.com/oulton Barchester Healthcare Homes Ltd vacant Care Home 43 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (13) of places Dudwell St Mary New Building DS0000067584.V365308.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The maximum number of service users to be accommodated is fortythree (43). Service users must be older people aged sixty-five (65) years or over on admission. The service provides general nursing care to thirteen (13) older people over the age of sixty-five (65), accommodated on the ground floor. Thirty (30) service users with a dementia type illness only to be accommodated on the first and second floors of the building. 27th June 2007 Date of last inspection Brief Description of the Service: Dudwell St Mary’s (New build) was registered with the Commission for Social Care inspection in May 2006 as a care home with nursing. The home was purpose built and is presented across three floors, with level access to all floors. It is registered to provide nursing care to up to 30 people who have a dementia type illness and 13 people who require general nursing care. The ground floor is designated for general nursing care, first floor to residents who have more advance stages of dementia and the top floor to residents who have less complex needs associated with their dementia. The home is owned by Barchester Healthcare Ltd. It is located next door to another nursing home owned by the same organisation and is close to the village of Burwash. Resident’s accommodation consists of forty-three single bedrooms with the provision to convert some to shared accommodation if requested. All bedrooms provide en-suite facilities. Shared space consists of communal kitchenettes, lounges and dining rooms on each floor. The home is set in its own grounds with panoramic views over the nearby countryside. The homes literature states That the aim of the home is to provide a happy, caring, comfortable home from home environment for the service users. The fees for residential care are currently ranged from £850 to £950 per week, depending on the services and facilities provided. Extras such newspapers, hairdressing, chiropody, toiletries are additional costs. Dudwell St Mary New Building DS0000067584.V365308.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 2 stars. This means the people who use this service experience good quality outcomes. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at Dudwell St Mary Phase II will be referred to as ‘residents’. This was a key inspection that included an unannounced visit to the home and follow up contact with resident’s representatives and visiting health and social care professionals. This unannounced inspection was carried out over 6.5 hours on the 27 June 2008. There were forty-one residents living in the home on the day, of which nine were case tracked and spoken with. During the tour of the premises eight other residents both male and female were also spoken with. The purpose of the inspection was to check that the requirements of previous inspections had been met and inspect all other key standards. A tour of the premises was undertaken and a range of documentation was viewed including the Service Users Guide, Statement of Purpose, care plans, medication records and recruitment files. Four members of care staff and the maintenance person were spoken with in addition to discussion with the deputy manager and Regional Operations Director. Telephone contact was made with visiting professionals following the visit and two relatives were spoken with during the inspection visit and one contacted by telephone. The information received verbally has been incorporated into this report. An Annual Quality Assurance Assessment was received from the Regional Manager completed in full prior to this key inspection. What the service does well: There is a comprehensive Statement of Purpose and Service Users Guide that gives prospective residents and relatives the information required enabling them to make an informed choice about where they live. The pre-admission assessments performed prior to admission ensure that the home can meet the identified needs and the family are involved as much as possible. Dudwell St Mary New Building DS0000067584.V365308.R01.S.doc Version 5.2 Page 6 Dudwell St Mary has been specifically designed to provide a spacious, wellequipped and comfortable home for residents that a dementia type illness and those that physically frail. The residents and their families are encouraged and supported to bring in their own small pieces of furniture and personalise their rooms. Robust recruitment practices are followed when selecting staff to work in the home. Systems are in place to regularly consult with residents via service users meetings and surveys. There is an open-house policy, which welcomes visitors at all reasonable times. The facilities for mental stimulation and orientation are well thought out and appropriate to the needs of the residents. There continues to be a varied and nutritious menu provided which allows residents a choice. Drinks and snacks are available at any time. The atmosphere of the home is pleasant with good interaction seen between residents and staff. The Comments received from residents and families regarding the care received included: What has improved since the last inspection? What they could do better: The medication practices in the home need to be improved to ensure that medications are safely administered at the correct time, and gaps in the records are followed up the staff. Further areas for development include ensuring that identification photographs of residents are updated regularly, and that sample signatures of agency staff are in place for auditing. Dudwell St Mary New Building DS0000067584.V365308.R01.S.doc Version 5.2 Page 7 The home needs to ensure that activities are available for residents that encourage motivation and mental stimulation on a regular basis. The staff need to ensure the care plans and documentation pertaining to residents social and mental well-being are in place and current. The health and safety of residents would be better promoted by ensuring that residents have access to call bell at all times whilst left unattended in communal areas or a monitoring system in place for those residents that do not have the capacity mentally or physically to call for assistance. There are areas of the home that have been identified as having an offensive odour and this needs to be addressed. 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. Dudwell St Mary New Building DS0000067584.V365308.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 Dudwell St Mary New Building DS0000067584.V365308.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): 1, 2, 3, 4 and 5. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides prospective residents and relatives with a good level of information about the home, its facilities, services and the costs involved. The admission procedures allow for the needs of prospective residents to be assessed by a competent person before admission, however little information is documented thus not ensuring their needs can be met. EVIDENCE: There is a Statement of Purpose and Service Users Guide in place, which contains clear information about the home and the services it provides. A copy was provided for the inspector but it was out of date and incorrect, this information needs to be updated. However the brochures and service information in the reception area which are available to visitors were viewed and were up to date, in a format that is easy to read, bright and colourful and contains photographs of the home and grounds. A social care professional that had recently visited the home confirmed that relevant information was provided to a prospective resident. Dudwell St Mary New Building DS0000067584.V365308.R01.S.doc Version 5.2 Page 10 It was confirmed whilst talking to relatives that the contract arrangements were clear and understood. There is a copy of the terms and conditions of residency included in the Service Users brochure that was updated in May 2007. A review of the care documentation confirmed that pre-admission assessments are completed by the deputy manager or a senior nurse. The format of the pre-admission document was seen to be thorough and relevant. The nine assessments seen were in the main completed in full and contained all the information required to ensure that the new admissions to the home were suitable and that the home have the staff and environment to meet the care needs identified. The prospective residents’ are seen either in their home or hospital before admission and the manager confirmed that wherever possible the family or representatives are involved. This was supported by the documentation viewed. The information contained in these assessments is then used to provide the basis of the care documentation in the home. The family of a recent admission to the home said that the staff had been very supportive and kind, and had made the transition easier for all of them. The deputy manager was able to verbally demonstrate her knowledge and awareness of the different specialities required in the home and ensures that the Registered Nurses and carers employed have attended relevant courses to deal with the needs of the elderly and also specialised courses for certain diseases. Trial visits to the home can be arranged. The manager confirmed that residents are invited to a trial period to ensure suitability of the home; this is clearly stated in the Statement of Purpose and in the statement of terms and conditions. Intermediate or rehabilitative care is not provided at Dudwell St Mary phase II Dudwell St Mary New Building DS0000067584.V365308.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): 7, 8, 9 and 10. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans provide a good framework for the delivery of care, which give clear guidance to care staff on all the care needs of all the residents. The home was found to be meeting resident’s health and general needs with accessed additional specialist support when needed. Medication practices at present do not fully protect and promote the residents health needs. EVIDENCE: The residents’ medical, nursing and social needs are recorded in the care plans in sufficient detail, which enables the staff to offer appropriate individual care and support. The care plans clearly identified the specific needs of the residents and demonstrated a person centre approach to meet each need. Staff were able to discuss the care plans, how they assess residents and what additional support may be required, including hoists and pressure relieving Dudwell St Mary New Building DS0000067584.V365308.R01.S.doc Version 5.2 Page 12 mattresses. The care plans identify the hoist to be used and the size of the sling and whether a slide sheet is to be used. Risk assessments are carried out and these include, skin viability, moving and handling and nutritional assessments linked with the monthly weights. The care plans are reviewed on a regular basis and there was evidence that residents’ and relatives are involved in this process at least bi-annually. The staff are recording health changes and changing the care documentation as they occur. There are care plans in plans that identify aggression and behavioural problems, but not all had sufficient guidance in them for staff to deal with the situation safely. Whilst care plans are now more person centred, staff need to ensure that the approach used daily to residents in fulfilling the care plans outcomes is also person centred, on discussion with the management team this has been identified and staff are receiving training and guidance in this area. There was evidence in residents’ rooms of turning charts and fluid charts which are used by staff to ensure the residents’ receive the consistency of care required. Food monitoring charts are in place for those residents who have been assessed as at risk from weight gain or weight loss and it was discussed that it would be beneficial to record simply the residents’ intake at mealtimes, which would then identify appetite traits early and provide an audit trail for staff to follow. This is especially important where residents are not weighed due to physical disabilities/difficulties. The documentation for some residents include the decisions made by their families regarding their end of life treatment and this needs to evidence discussion with the G.P and be reviewed regularly with a multi-agency approach. Some minor areas of care planning were identified as needing improvement and include ensuring that staff complete the risk assessments for nutrition correctly and if the guidance states weekly weighing then this should be carried out or the directives updated. Skin records are in place but need to be dated clearly. Staff spoken with confirmed that they received a full report on each resident daily and read the care documentation that is kept in the main nurses station on each floor. They felt that their views were taken into account when planning resident’s care. Feedback from surveys received and from direct conversation with relatives and residents confirmed that the overall care in the home had improved over the past four months under the guidance of the deputy manager. Direct comments from residents included “ the staff are kind, and look after me well” “everything is okay, I think they are very good here”. Dudwell St Mary New Building DS0000067584.V365308.R01.S.doc Version 5.2 Page 13 Relatives comments included “ have been problems in the earlier part of the year, but things are much better now” “communication with management is now good and any problems raised are dealt with immediately”. Issues raised in the surveys received about the level of personal care given to residents were followed up at this inspection visit and were said to have been resolved. From talking to relatives during this visit no further issues were raised. Two of the three clinical rooms were seen and were found to be clean, tidy and well organised. The systems for recording and checking controlled drugs were found to be thorough and competent. The Medication Administration Charts were found to be competently completed in the main, however a few gaps were identified and it was discussed that these need to be followed up promptly by the staff, residents photographs are in need of updating and dating as some do not bear any resemblance to the respective resident. This was undertaken immediately. There was evidence that if covert medication administration has been identified as required, it is then appropriately risk assessed and discussed within a multi disciplinary team and reviewed on a regular basis. From direct observation the morning medication was prolonged, with the ground floor finishing at 0940 am and the top floor starting at 0940 by the same trained nurse, this practice needs to be reviewed to ensure that medications are administered safely and within the correct time frames. From discussion with the management team, further recruitment of trained staff will address this. Clinical fridges are in place, and used appropriately, records evidenced that the fridge and room temperatures are recorded daily, but the ground floors recording had not been done since 24/06/08. Staff were seen to be respectful and considerate to all residents and visitors. Each of the residents were addressed by their preferred term and dressed appropriately in well-laundered clothing. Dudwell St Mary New Building DS0000067584.V365308.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): 12, 13, 14 and 15. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Meals remain good in respect of both quality and variety that meets the majority of residents’ tastes and choice, however there is little documental evidence to support that the lifestyle experienced by residents at this time matches their expectations, choice or preferences. EVIDENCE: At the present time the activities are not running at their full potential, and this is acknowledged by the management team. From viewing the care plans, the records relating to residents social lives are not up to date and therefore reflect very little interaction. This gave the impression that very few residents have received or taken part in any social event. It would be beneficial if staff were involved especially in the one to one sessions and staffing levels increased to enable all residents the opportunity to participate. The staff in the home could also support the activity co-ordinators by documenting the time they spend interacting positively with the residents, such as visiting the garden, and preparing a cup of tea. Small kitchens are on each floor –known as life Dudwell St Mary New Building DS0000067584.V365308.R01.S.doc Version 5.2 Page 15 kitchens, and these could be used more effectively to encourage residents within a risk assessment framework to undertake simple life tasks. The documentation in care plans needs to improve to demonstrate how their social needs and mental health needs are met and to guide all staff. The AQAA received 25/04/08 stated –direct quote that they had identified that they need to ‘Improve quality of planned activities to provide a more robust offering of daily activities. Improve the quality of our documentation evidencing the activities that residents have participated in’. The feedback from surveys indicated that relatives are concerned that their relatives are not being mentally stimulated and this is an area that needs improving. Residents said that they are able to choose what they want to do and take part in activities if they wish. The home has been planned to provide an interesting and stimulating environment for the people who live in the home. The lounge areas contain music centres with a variety of well known songs, books and cassettes are also readily available to the residents. The corridors are used as sensory awareness tools, with textured pictures and interesting memorabilia in the form of clothing and shoes. The lounge areas lead in to safe balconies with tables and chairs, which are used under supervision and there are plants and pots that residents care for. There is also a walled garden with a fountain, which is accessible to all residents. Again it was noted that these were not used effectively at this time. Visitors are welcome at any time, those spoken with said they feel comfortable visiting their relatives and friends. Relatives now feel that they can talk to the staff if they want to know anything or have any concerns. One relative commented ‘the staff are approachable and willing to chat’. A health care professional commented’ I was impressed with the staff I recently met and their understanding of the care needed’. The staff confirmed that residents are encouraged make choices about all aspects of their day to day lives, and a number of residents said they are able to choose how they spend their time, in their own room or in one of the lounges, and the staff are there to help them if they need it. However this needs to extend to residents wishes regarding the time they are got up in the morning and where they are left whilst staff are assisting other residents. One resident was left alone sitting at a breakfast table for a considerable length of time without any interaction or cup of tea offered. That resident had no way of calling for assistance if required. The meals provided continue to be nutritious, well balanced and varied with an emphasis on home cooking and fresh ingredients. Residents were able to have their meals where they wanted to and to have extra portions if they so wish. Menus are displayed in the dining areas and evidenced a varied and well balanced diet with choices available. There are kitchenettes on each of the Dudwell St Mary New Building DS0000067584.V365308.R01.S.doc Version 5.2 Page 16 units with hot trolleys, which ensure that the food is hot and that the residents can choose again from the choices available. Staff serve the food individually after asking the resident how much they want. The dining areas are pleasantly furnished and decorated, providing residents with a relaxing and positive environment to eat their meals. Staff were observed assisting residents in a respectful manner and maintaining their dignity. The feedback from family and residents regarding breakfast and the midday meal was positive and included ‘ excellent food’ ‘always tasty’ ‘ plenty of choice’. The supper meal did not receive the same positive feedback and this was discussed with the deputy manager and will be reviewed. The use of relative and resident surveys would be beneficial to get a feedback of the supper menus and what the residents would like. Dudwell St Mary New Building DS0000067584.V365308.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): 16 and 18. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a formal complaints system with evidence that residents feel that their views are listened to and acted upon. Staff receive training to protect residents from abuse. EVIDENCE: The complaint policy and procedure is clear and uncomplicated and a copy of this is readily available in the home and the Service Users Guide. A system of recording complaints was demonstrated to the inspector during her visit to the home. The home has received 11 complaints since the last inspection, and from information received all have been responded to within the time frames set. Relatives and residents spoken with confirmed that they were now confident that any complaints or concerns that they had would be listened to and responded to effectively. Due to management changes the beginning of the year was unsettled and this did affect the running of the home. However the feedback from relatives and staff was positive on the inspection visit in the management structures now implemented. Follow up telephone calls with health professionals and residents were positive regarding contact with the home whilst dealing with Safeguarding Vulnerable Adults issues. Dudwell St Mary New Building DS0000067584.V365308.R01.S.doc Version 5.2 Page 18 The home has relevant guidelines on the protection of vulnerable adults and staff have received appropriate training. The management team has a clear understanding of adult protection guidelines and are aware of how to initiate an investigation if required. Dudwell St Mary New Building DS0000067584.V365308.R01.S.doc Version 5.2 Page 19 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, 20, 21, 22, 23, 24, 25 and 26. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable, clean and safe environment for those living there and visiting. Residents are enabled and encouraged to personalise their bedroom, and rooms are furnished and decorated to a high standard yet remain homely and reflect the resident’s personalities and interests. There is specialist equipment in the home for residents’ use to maximise their independence. EVIDENCE: The home was purpose built to provide a safe, comfortable and homely environment for residents with nursing needs and for those suffering from a dementia type illness. The home has the necessary adaptations and aids to enable and promote independence. The home operates a door key system to Dudwell St Mary New Building DS0000067584.V365308.R01.S.doc Version 5.2 Page 20 each floor, which ensures the residents safety when wandering and also ensures that staff are aware of who is in the building. The home is decorated and furnished to a high standard. The relatives were very complimentary regarding the homes décor and maintenance. ‘Its so spacious and light’ ‘ a beautiful building that really makes it a home’. A great deal of thought has gone in to the décor and fixture and fittings of the home. Each floor is individualized and has followed themes to encourage recognition and interest. There are textile pictures for residents to touch and one floor has a range of evening shoes and boas, whilst another has old sewing machines and a dress making bust. The communal space consists of a combined lounge dining room and kitchenette on each of the three floors. There are well maintained grounds in which there are pathways and various patios with eating areas. There is a balcony on the first floor, which residents can access independently and tend to pots of flowers. The balcony also has high Perspex clear walls to protect residents from cold winds, so they can continue to enjoy the fresh air. Residents that live on the top floor are supported by staff to access the walled, well maintained gardens. All bedrooms have an ensuite shower room and there are a sufficient number of separate toilets and bathrooms located around the home. Resident’s bedrooms are well furnished with high profile nursing beds and aids to enable them to be as independent as possible. Residents and their families are encouraged to personalise their rooms and also bring in small bits of furniture. There is a range of individual aids and adaptations to assist resident’s mobility and independence, this includes raised toilet seats, walking aids, hoist ramps, automatic doors, and grab rails. A range of different style assisted baths are available for residents differing needs. There is resident call system in the home and call points are fitted throughout the home that enables assistance to be summoned. The residents in the dining areas and lounge areas did not have access to a call bell, those residents that can’t physically ring for help, need to have an appropriate risk assessment in place and a plan of action/monitoring to ensure their safety and comfort. This was identified at the last inspection and was to have been addressed therefore it is now a requirement. The lighting in the home is of domestic quality and there are above bed lights as well as the main ceiling lights. Water temperatures are controlled and monitored monthly and a record kept. Random temperatures were taken and were of the recommended level. There are systems in place for monitoring safety issues such as fire checks, fire drills, PAT testing, electrical tests and gas and boiler checks and all the rooms are routinely checked for safety and maintenance issues. The records in the home confirmed they were up to date. The tour of the home confirmed that Dudwell St Mary New Building DS0000067584.V365308.R01.S.doc Version 5.2 Page 21 staff are aware of the fire safety policies, no doors were found inappropriately wedged open. Polices and procedures for infection control are in place and are updated regularly. The home was clean, however there are areas of the home that have an odour, this has been identified by the home, but not yet eliminated. Surveys received from relatives all mentioned at times that there is at times an unpleasant smell in certain areas of the home. Good practice was observed throughout the inspection in respect of infection control measures. All sluices were found in good working order and all associated equipment was found clean and of a good standard. The laundry area was clean and well organised and the standard of the laundry was seen to be good. The facility is small and is under review for enlargement. Dudwell St Mary New Building DS0000067584.V365308.R01.S.doc Version 5.2 Page 22 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, 28, 29 and 30. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Robust recruitment procedures are in place to protect residents, and staff training ensures they are aware of their roles and are able to provide the support and care the resident’s need. EVIDENCE: The staffing rota was viewed and the staffing levels were seen to be sufficient to meet the care needs of the residents at this time, it was however noted that the staffing levels do not allow much interaction at key times of the day, this is especially important as there are no activity co-ordinators working at this time. Care staff spoken with said that the levels of staff on duty were sometimes insufficient to give the care required; they also said that the trained staff were too busy to help out. Feedback from residents, relatives and staff indicate that there are times when more staff would be beneficial for positive outcomes for the residents and therefore staffing levels need to be reviewed regularly and adjusted accordingly. It was confirmed that new staff had recently been recruited and this would be benefit the staffing levels and minimise the use of agency staff, therefore this has not been made a requirement at this time but will be assessed at the next key inspection. A selection of staff recruitment files were viewed and demonstrate that a robust recruitment process has been maintained to protect residents and Dudwell St Mary New Building DS0000067584.V365308.R01.S.doc Version 5.2 Page 23 contained all the relevant information required. There was evidence of health questionnaires, Criminal Record Bureau checks, two references, a resume of previous employment and work permits where necessary. All the paperwork is kept within a locked room. Staff receive a comprehensive induction programme in accordance with Skills for Care and the organisations policies and protocols. Files seen confirmed this. Staff spoken with said that training opportunities at the home are good and they are well supported by the senior staff and the deputy manager. Staff and the training list seen confirmed that compulsory training such as manual handling, adult protection, first aid and fire safety are being undertaken on a regular basis. The home use a CD Rom training programme for health and safety, food hygiene, POVA and customer care. Staff confirmed that they receive training in dementia care, challenging behaviour, diabetes and other specific resident related diseases. There is a training matrix, which tracks the training needs of staff and identifies the need for updates of training. National Vocational Qualification training is encouraged, but at present the amount of staff enrolled or who have enrolled on a course is low. Dudwell St Mary New Building DS0000067584.V365308.R01.S.doc Version 5.2 Page 24 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, 33, 35, 36, 37 and 38. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The overall management of this home is good with effective systems in place to protect residents and promote their health, safety and well being EVIDENCE: In the past year there have been changes to the management of the home that had impacted negatively on the smooth running of the home. However since February 2008 the deputy manager has stepped in to managers’ role and the feedback from residents, staff and relatives was that she has made a difference and standards of care and communication have improved. Residents and staff feel more supported and relatives feel that they now can approach her and feel listened to. Dudwell St Mary New Building DS0000067584.V365308.R01.S.doc Version 5.2 Page 25 6 of the 8 surveys received from relatives and staff mentioned the unstable management structure in the latter part of 2007 and early 2008. The senior management team of Barchester Health Care are supporting the deputy manager and have kept the CSCI informed of all changes to the home management team by Regulation 37 notifications. The standard is not met as the home has been without a registered manager for a long period of time, however as there are systems in place to ensure the home has a plan in place to address this a requirement has not been made at this time, but there is an expectation that this situation will be addressed in the near future. The formal quality assurance and quality monitoring systems enable the management to objectively evaluate the service and ensure it is run in resident’s best interests. Questionnaires are made freely available and sent directly to head office where the results are analysed. Relative and resident meetings take place three monthly, staff meetings take place for carers three monthly and head of department meetings take place three times a week. Residents are encouraged to retain control of their own finances for as long as they are able to do so and if unable then this responsibility is taken on by a relative or another responsible persons external to the home. Residents are safeguarded by the robust accounting and financial procedures in the home. Staff spoken with confirmed that they receive supervision with a senior member of staff, but it is not regular at present. The deputy manager stated regular supervision is an area that is being developed and this was confirmed by the AQAA - direct quote ‘To continue to improve the quality of support and supervision of staff’. Records were available to demonstrate that fire alarms, water temperatures and emergency lighting systems are regularly tested and fire drills undertaken. Testing of portable electrical appliances has been carried out. Certificates to demonstrate that bath hoists, gas appliances, electrical systems and appliances are safe re confirmed as being in place. Policies and procedures are available in relation to health and safety and good practice was evident in the management of records relating to accidents, servicing and repair of equipment. Training required by legislation, including moving and handling, fire training and infection control is being provided for all staff to protect the health and safety of residents. The Regional Manager confirmed that an audit is performed on all accidents and incidents that occur in the home and appropriate action is then taken. Good practice was observed throughout the inspection in respect of promoting the safety and well being of the residents. Dudwell St Mary New Building DS0000067584.V365308.R01.S.doc Version 5.2 Page 26 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 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 4 2 4 4 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 3 3 3 3 3 Dudwell St Mary New Building DS0000067584.V365308.R01.S.doc Version 5.2 Page 27 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 OP9 Regulation 13 (2) Requirement That the registered person ensures that medication administration procedures are safe. • Medicines are administered at the prescribed times. • That identification photographs of service users are current and signed and dated. • That all gaps are identified and tracked. • That fridge and room temperatures are recorded. • That agency staff that administer medication have sample signatures available for auditing. That the registered person ensures that the routines of daily living and activities made available are flexible and varied to suit service users expectations, preferences and capabilities. • That activities are available for service users that encourage motivation and Version 5.2 Page 28 Timescale for action 27/08/08 2. OP12 16(2m) 23(2h) 12(4b) 27/08/08 Dudwell St Mary New Building DS0000067584.V365308.R01.S.doc mental stimulation. That the care plans and documentation pertaining to service users social and mental well being are in place and current. That the registered person ensures that all service users are enabled to make their own choices regarding their daily lives. That the registered person ensures that service users have access to call bell at all times whilst left unattended in communal areas. That a system is devised for those service users that do not the capacity mentally or physically to call for assistance. That the registered person ensures that the home is free from offensive odours at all times. • 3. OP14 12 (2)(3) 27/08/08 4. OP22 23 (2) (n) 27/08/08 5. OP26 16 (2) (k) 27/08/08 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 Dudwell St Mary New Building DS0000067584.V365308.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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