Inspection on 07/12/06 for Dudwell St Mary Care Home

This inspection was carried out on 7th December 2006.

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 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 27/06/08

Dudwell St Mary Care Home 27/06/07

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Dudwell St Mary New Building Etchingham Road Burwash East Sussex TN19 7BE Lead Inspector Jane Jewell Key Unannounced Inspection 10:00 7th December 2006 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.V321681.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.V321681.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 www.barchester.com/oulton Barchester Healthcare Homes Limited Alan Risk 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.V321681.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. NA Date of last inspection Brief Description of the Service: Dudswell 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 range from £850 to £1,100 per week, depending on the services and facilities provided. Extras such as community fee of £3,000 are charged prior to admission, newspapers, hairdressing, chiropody, toiletries are also additional costs. Dudwell St Mary New Building DS0000067584.V321681.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The information contained in this report has been comprised from an unannounced inspection undertaken over 7 ½ hours and information gathered about the home. This includes: residents and relatives survey questionnaires, discussion with stakeholders involved in resident’s care and records submitted to the Commission for Social Care inspection (CSCI), including a Pre-inspection questionnaire. The inspection was undertaken with Alan Risk (Registered Manager) and Joy Seymour (Clinical Development Nurse). The site inspection involved a tour of the premises, examination of the home’s records, discussion with staff, relatives and residents. The focus of the inspection was to look at the experiences of life at the home for people living there. This is the first inspection by CSCI of the home, since it opened in May 2006. The Inspector would like to thank the residents, staff and management for their assistance and hospitality during the visit. As part of this unannounced inspection the quality of information given to people about the care home was looked at. People who use services and their relatives were also spoken to, to see if they could understand this information and how it helped them to make choices. The information included the service users guide statement of terms and terms and conditions of residency and the complaints procedure. These findings will be used as part of a wider study that CSCI are carrying out about the information that receive get about care homes for older people. This report will be published in May 2007. Further information on this can be found on our website www.csci.org.uk. What the service does well: Dudswell St Mary’s is a purpose built nursing home completed to a very high specification. One relative said that it was the best premises they had seen in all of the homes they had looked at. The premises are specious light and airy with much thought having gone into providing domestic style décor and furnishings. There are large grounds in which to view or to walk within. Residents looked relaxed in staff company, with staff often using humour as a method of communication. Much good practice was evident in the care of residents who require general nursing care. Nursing staff demonstrated a comprehensive knowledge of residents needs. A sample of comments about staff includes: “Staff excellent”; “very kind”; “staff are very caring”; “very caring nurses” and “generally doing a good job”. Dudwell St Mary New Building DS0000067584.V321681.R01.S.doc Version 5.2 Page 6 Relatives comments included:“A well run, very homely home” and “care wonderful. Many meaningful activities and opportunities for stimulation are made available to promote residents quality of life. Dietary needs of residents are well catered for with a balanced and varied selection of food available. 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. The summary of this inspection report can be made available in other formats on request. Dudwell St Mary New Building DS0000067584.V321681.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dudwell St Mary New Building DS0000067584.V321681.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 2 3 4 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents are provided with information about the homes services and facilities. However this needs to accurately reflect current services and charges to ensure that residents have the information necessary to make an informed choices. Residents only move into the home following an assessment of their needs. Resident’s and their relatives felt that their experiences at the home are in the main positive. However, further work is needed for the home to be able to evidence that it meets most residents assessed needs. EVIDENCE: Information about the home and the services it provides, is presented in a statement of purpose and service user guide. Dudwell St Mary New Building DS0000067584.V321681.R01.S.doc Version 5.2 Page 9 This is displayed at the home and the manager reported that copies are provided in resident’s rooms when they are first admitted. Three out of four residents representatives consulted on this matter said that they were not aware of either of these documents. These documents need further work in order to ensure that residents and their representatives have the information they need to make an informed choice about whether to move to the home. This is with particular reference to including the full terms and conditions of residency and localising these documents to accurately reflect the aims and objectives of the home. This should include information about the admissions criteria used for establishing where residents will be initially accommodated, as this varies according to resident’s level of need, and any criteria used to relocate residents around the home when their needs change. All residents representatives consulted said that they have signed a copy of the terms and conditions of residency, with a relative saying the “contract was very professional”. The organisation has recently introduced an additional fee for all new admissions. Although the contract has been updated to include some information about this payment the manager reported that the contract is in the process of being further updated to provide clearer information as to the nature of this payment. Assessment documentation seen, showed that prospective residents had been assessed by a senior member of staff prior to them moving into the home. The assessment involved discussion with relatives and GP’s, where possible. The assessment is then used to provide the initial guidance to staff on the assessed needs of the resident. The home takes emergency referrals, this practice should be supported by an emergency admission policy, which makes clear the admission criteria for the home. This must also be included in the homes statement of purpose. A resident had recently been admitted outside of the homes registration categories. As a matter of priority the manager agreed to apply for a retrospective variation to their registration in order to continue to care for the resident. The manager felt that this issue had not been picked up at the assessment stage of the resident’s referral and agreed to review the assessment process to ensure that all senior staff that undertake assessments are fully aware of the registration categories of the home. The home accommodates a wide range of residents needs, including some residents who have early stage dementia to some who have advanced stages and some who have complex physical nursing needs. The home helps to manage this by using different floors to accommodate residents in accordance with their needs. Further work is needed in the care planning and staffing levels in one of the dementia care unit in order to evidence that most residents assessed needs are being met. This is discussed under standard 7 and 27. Residents and their representatives consulted were in the main positive about their overall experiences at the home. Dudwell St Mary New Building DS0000067584.V321681.R01.S.doc Version 5.2 Page 10 Their comments included: “The main thing is he likes it and seems quite happy”; “A well run, very homely home”; “Quite happy and they keep the patients clean”; “care wonderful”; I visited with my eldest son and it seemed light and airy” and “Compared with others I visited, about eight, this is by far the best, also most expensive and because of this I expect the higher level of staff and thought that there would have been more staff expertise”. All of the residents and their representatives consulted said that they had been offered the opportunity of visiting the home to help them decide whether the home was suitable. A relative spoke of how helpful staff had been in answering their questions. It was reported that where social services are the placement authority the first four weeks of residency is looked upon as a trial period. This usually culminates in a review with the resident and their representatives to establish that the home can continues to be able to meet their needs. The manager said that in the case of privately funded residents this review is held after a month of their admission. Intermediate care is not offered. Dudwell St Mary New Building DS0000067584.V321681.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all care plans provided adequate information and guidance to staff on the range of residents assessed needs. The health needs of residents are well met with evidence of regular medical input. Medication practices are good. Relatives felt that their relatives were treated with respect and sensitivity. Standard of laundering did not always promote dignity. EVIDENCE: A nurse consultant has been employed to support the induction of care planning documentation since the home opened. It was clear that much work has gone into the development of care plans. The standardised organisation care planning documentation used for all residents has meant that the care plans do not always provided the necessary guidance for staff on the individual and specialist needs of residents. The nurse consulted said that additional dementia care planning documentation has recently been developed by the organisation and they plan to introduce this shortly. Dudwell St Mary New Building DS0000067584.V321681.R01.S.doc Version 5.2 Page 12 In line with good practices in dementia care it was discussed that the care planning documentation should also include the strengths of the individual and be person centred based. Examples were noted in care plans where not all of the residents needs noted by the inspector, had been recorded and the necessary guidance provided for staff. There was a very good standard of recording daily events by the nursing staff. However the care plan needs to be promptly updated with any significant events and observations in order to inform the care staff of changes in needs. Care plans were very lengthy documents and often contained out of date information. It is recommended that a summary of needs be developed to provide an overall summary of the assessed needs to aid staff, in particular new and agency staff. Individual risk assessments had been completed on the main risks faced and posed by residents. These included the action needed to manage or reduce any risks. Examples were noted whereby these had not been updated to reflect major changes in needs and provide staff with the necessary information to manage the risks. Staff consulted showed a good working knowledge of how to manage the challenging behaviour of several residents, this was not always recorded in the care plan, as information for the whole of the staff team. Nursing staff consulted were extremely knowledgeable about the assessed needs of residents. However, not all care staff showed the necessary level of knowledge. All residents are registered with a local GP practice. The home has recently introduced a retained GP service, for a trial period which involves a weekly GP surgery being held at the home for none urgent consultations. Staff and relatives all felt that this was now working well with urgent appointments also being promptly made with a relative saying “have always got the GP strait away”. Much evidence was seen as to a good standard of general nursing care being undertaken on the ground floor unit. During the inspection the majority of staff were seen to be respectful and considerate towards residents and visitors an incident where this was not the case was discussed with the manager in order for them to address. All relatives consulted felt that the staff treated residents with dignity and sensitivity. Staff were observed using residents preferred forms of address and knocking on residents bedroom doors prior to entering. The home employs both male and female care assistants. Staff were sensitive to the issues around their gender while undertaking personal care. Some care records stated where a resident or their representative had indicated a gender preference while assisting with personal care and staff reported that this is usually respected where possible. Dudwell St Mary New Building DS0000067584.V321681.R01.S.doc Version 5.2 Page 13 Many residents were observed in clothing that was poorly ironed this was not conducive to preserving their dignity. The manager acknowledged that they were currently experiencing some problems with laundry standards and would be addressing this as a matter of priority. As this is the first inspection of the home, medication practices were inspected by CSCI’s pharmacy inspector. Their comments are as follows: The storage provision for medicines is very good. Only nursing staff deal with medicines. There has been much training and there is evidence of self-audit. Records are made of all medicines received into the home and of any disposal of unwanted medicines is appropriately handled. Medicine administration process was noted to be good by direct observation. It is recommended that: Medication Administration Records record the reasons why medication had not been administered; To indicate the exact amount of medicines administered when prescribed as a variable dose; To have clear, individual guidelines on the criteria of when to give a medicine prescribed on a ‘when required’ basis; The sheets used for recording medicines disposal need to be numbered. Dudwell St Mary New Building DS0000067584.V321681.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Flexible routines are part of daily practice at the home. Social activities are well managed, creative and provide daily variation and interest for people living in the home. Links with families are valued and supported by the home. Dietary needs of residents are well catered for with a balanced and varied selection of food available. EVIDENCE: During the inspection residents were observed to be able to move freely around the particular unit where they lived. Each unit has its own secure door, which prevents free movement around the home and grounds. The Nurse consultant said that locks were necessary to manage risks and that during clement weather residents are supported to go outside or use the balconies with staff. During the inspection several residents were assisted to go to another unit to watch a visiting entertainer. There is an activities co-ordinator who showed much enthusiasm for identifying suitable activities and occupation for both small groups and for individuals. Dudwell St Mary New Building DS0000067584.V321681.R01.S.doc Version 5.2 Page 15 Many activities had been arranged for over the Christmas period. At the time of inspection an external entertainer was visiting. Several residents showed signs that they were enjoying this entertainment, others had indicated that they did not want to be involved and this was respected. Other activities undertaken include motivation exercise, clay making, Christmas card making, craft classes. In addition there were much equipment including puzzles, musical instruments, audio equipment used for in house entertainment. A relative said that residents didn’t go out very much but felt that the purchase of a mini bus would now address this. All relatives consulted spoke of being able to visit at any reasonable time and of being made to feel welcome by offers of hot drinks, invited to stay for meals and use the kitchenettes. A relative said “haven’t been in once without being offered a cup of tea”. Several relatives spoke of how informative a recent relatives evening was about the organisation and the home. Relatives felt that they were regularly kept informed of any major changes in needs and felt at ease to contact the home at any time for updates. Through observation of the daily life at the home and discussion with staff, resident’s individual routines are largely accommodated. This includes varying times for rising and going to bed and able to eat meals at varying times. One relative felt that there was “Very inflexible bath days” this was raised with the manager who said that this was not the case and records are made each time a residents if offered and refuses bathing, which shows that residents are regularly being asked and an alternative provided. All persons consulted regarding the home spoke positively about the food, with comments such as: “food excellent”; “the meals generally are very good”; “5 star” and “meals very good”. The menus showed that a varied diet is offered. Part of the lunchtime was observed with all meals observed presented in an appetising manner. The cook was involved in clearing away the dishes and therefore able to directly observe individual preferences. Staff said that residents choose which meal they would prefer at the time the meal is served and in some cases they have both choices of main meal, but accepted that for some residents supporting them to make an informed choice was difficult. A staff member said that in order to help a resident make a choice they are shown a plate of both choices. They felt that having pictures of the choices on offer would help another resident. This was discussed with the nurse consulted who felt that the ways in which choice was offered could be further improved. Staff did not always show an understanding of good practices in supporting people with dementia to eat, this is necessary to ensure that this is undertaken appropriately and with dignity. Dudwell St Mary New Building DS0000067584.V321681.R01.S.doc Version 5.2 Page 16 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 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a formal complaints system with evidence that the homes complaints procedure is followed. Staff have the guidance necessary to show them what to do if abuse is suspected this needs to be underpinned by all staff receiving training in adult protection guidelines. EVIDENCE: There is an accessible complaints procedure for residents, their representative and staff to follow should they be unhappy with any aspect of the service. One out of three relatives consulted on this issue said that they had been given a copy of the homes complaints procedure through the homes literature when their relative was first admitted. All persons consulted regarding the home said that they felt able to approach any member of senior management with their concerns with a relative saying “Any queries or concerns are always listened to by a very helpful and kind administrator who does his best to sort it out”. Another relative felt that their concerns were not being addressed despite the manager’s assurances. A record of complaints is maintained including the outcome of any investigation and complaints are responded to within agreed timescales. There are written policies covering adult protection and whistle blowing. These make clear the vulnerability of people in residential care, and the duty of staff to report any concerns they may have to a responsible authority for investigation. Not all of the staff have undergone training in adult protection or showed a clear understanding of their roles and responsibilities, this has now been required to be undertaken. Dudwell St Mary New Building DS0000067584.V321681.R01.S.doc Version 5.2 Page 17 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, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is purpose build to a high specification which is spacious homely and comfortable with much attention paid to furnishing detail. Residents have the specialist equipment they require to maximise their independence. Resident’s bedrooms can be personalised to help aid their orientation. Some poor standards of cleanliness and laundering, noted at the inspection, were being addressed. EVIDENCE: The home is in a rural setting located in its own grounds with views across a small woodland park area. The home was build for purpose with much thought having gone into providing domestic, comfortable and suitable aids and adaptations, this is to be commended. Dudwell St Mary New Building DS0000067584.V321681.R01.S.doc Version 5.2 Page 18 The standard of decoration is also extremely high. Many of the people consulted about the home used the words light, airy and spacious when describing the environment. 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. The nurse consulted said that residents on the top floor are supported by staff to access the garden. There is sufficient number of toilets and bathrooms located around the home. all bedrooms have ensuite facilities. There is a range of individual aids and adaptations to assist resident’s mobility and independence, including raised toilet seats, walking aids, hoist ramps, automatic doors, and grab rails. A range of different style assisted baths is available for residents to be able to find a style that they feel most comfortable with. Call points are fitted throughout the home that enable assistance to be summoned and those checked were in working order and promptly answered by staff. A relative said that “ring bell and staff come as soon as they can”. Resident’s private accommodation is decorated and presented to a high standard. Much effort has gone into encouraging, where possible, relatives to be involved in personalising bedrooms to help aid orientation. Feedback from relatives and staff was that standards of cleanliness and hygiene had recently slipped. Upon arrival at inspection one unit was in particularly need of cleaning, this was however addressed by early afternoon. The manager and nurse consultant felt that overall standards had not declined but cleaning had to be undertaken later on during the day due to unexpected staff shortages. Relative’s comments regarding beds not being made until late morning was fedback to the manager, who said that staff’s current priority was to support residents during the early morning period. As previously mentioned the standard of some laundry was poor the manager said that they would be addressing this as a matter of priority. Dudwell St Mary New Building DS0000067584.V321681.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The needs of residents who have dementia where not always able to be met due to the staffing levels and skill mix of staff. Staff need to have the range of training necessary in order to work safely and competently with residents and for the home to meet its aims and objectives. EVIDENCE: The vast majority of interactions between staff and residents, observed during the inspection, were courteous and respectful. Some examples were noted of good practices in the care of people who have dementia, for example time being taken to orientate a resident to their current location and residents being supported to walk around independently. Residents appeared relaxed in staff company, with humour being used, where appropriate, to lighten situations. A sample of relative’s comments regarding care is: “Staff excellent”; “very kind”; “staff are very caring”; “very caring nurses” and “generally doing a good job”. Much comment was received by the inspector from both staff and relatives regarding insufficient staffing levels on one of the floors. Dudwell St Mary New Building DS0000067584.V321681.R01.S.doc Version 5.2 Page 20 A sample of comments received were: “some times there seems to be a shortage of carers”; “it is sometimes hard to find a member of staff”; “Love my job but very stressful due to the lack of staff”; “Not able to spend enough quality time with residents” and “What staff there are are always friendly and cooperative but I think they cannot spare the time to give anything but superficial attention” Three relatives said that shortages of staff resulted in them having to undertake personal care tasks that they felt should be undertaken by the staff. There was evidence to confirm that additional staffing were needed at peak times, on one of the floors, in order to meet the assessed needs of residents. This evidence was discussed with the manager and nurse consultant who agreed to provide additional staffing immediately and review the deployment of staff to identify what level of additional staffing would now be needed. Staff and relatives raised issues regarding the staff on duty not always having the experience and specialist knowledge to provide the appropriate support to residents on one of the floors. This is with particular reference to shifts being made up of newly appointed staff and staff undergoing induction not being supernumerary to minimum staffing levels. The manager and nurse consultant said that they were already addressing this issue through a review of the deployment of staff and monitoring of the skill mix of staffing rosters to ensure that these situations do not occur again in the future. The manager reported that 9 out of 24 care staff have obtained a National Vocational Qualification. Although this is below the recommended level of 50 of care staff having such qualifications. Plans are in place to meet this minimum target in the near future. Through unforeseen circumstances staff files could not be accessed at inspection, instead the manager subsequently confirmed the training undertaken by staff selected by the inspector. This showed that not all of the staff had completed the mandatory training necessary to undertake their roles safely and competently. This includes such areas as health and safety, food hygiene and adult protection. Training in dementia care is provided by the nurse consultant and the staff selected had completed a one day dementia course. As previously noted staff need to undergo training in supporting people to eat that have dementia. The majority of training undertaken by staff is computer-based where staff work through a program developed by the organisation. To help underpin this knowledge it was reported that training topics such as manual handling are also supported by trained trainers who also work at the home. There is a mentoring system in place, a staff member who is a mentor demonstrated a sound knowledge of good practice issues in the care of people who have dementia. Dudwell St Mary New Building DS0000067584.V321681.R01.S.doc Version 5.2 Page 21 The nurse consultant said they plan to undertake many areas of specialist training in the near future. Including such areas as palliative care and continence. Currently there is no on- going training and development plan which identifies the training necessary in order for the home to meet its statement of purpose, service aims and residents assessed needs. This has been recommended in order to assist in the overall managing of training. As staff files could not be accessed on this occasion the organisations Regional manager (Ann Saunders) confirmed that they had audited five staff files and found that all of the necessary recruitment documentation had been obtained in order to safeguard residents. Dudwell St Mary New Building DS0000067584.V321681.R01.S.doc Version 5.2 Page 22 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 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Additional management is needed to help improve the effectiveness of the management team at the home. Staff must to be appropriately supervised to ensure good care practices are consistent throughout. The health, safety and welfare of residents and staff is being promoted and protected. EVIDENCE: The manager Alan Risk, has been in post since the home opened in May 2006 and is a qualified nurse and has undertaken a management module as part of his nursing degree. Dudwell St Mary New Building DS0000067584.V321681.R01.S.doc Version 5.2 Page 23 He is the registered manager in respect of both homes and demonstrated a good working knowledge of the running of a service for older people. The manager said that they undertaken regular training, it was discussed that this should also include adult protection training for managers and providers. A sample of comments received about the manage includes: “if I have a problem I can go to Alan”; “very supportive of personal matters” and “Alan best manager I have had”. The current management structure is for the manager to be supported by two senior nursing staff, with one in the process of being promoted to this position. In addition the nurse consultant works at the home several days a week. The organisation had already identified that there needed to be additional management support and a matron was due to start in the immediate future. Feedback questionnaires are available for residents and their representatives to comment on regarding the homes services and facilities. Any completed forms are sent directly to head office where the results are analysed. Surveys for relatives and visiting professionals are in the process of being developed. The organisation has procedures for the self-assessment and auditing of the home’s services and practices. These have not yet been fully implemented until practices become established. However, monthly visits by a representative from the organisations undertakes an audit of some of the homes services and facilities and looks at issues around service development. 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. Staff consulted said they felt well supported from their colleagues but did not all have regular supervision with their line manager. Consistency of standards would be improved by increased direct supervision of staff. This was discussed with the manager and nurse consultant who said that nursing staff have recently undergone training in supervision and are also due to undertake assertiveness training in the near future. The role of the matron would also be to provide direct daily supervision of staff. Written guidance is available on issues related to health and safety. Records submitted by the manager prior to the inspection stated that all of the necessary servicing and testing of health and safety equipment has been undertaken. Systems to support fire safety are in place including the completion of a fire risk assessment. Dudwell St Mary New Building DS0000067584.V321681.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 3 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 x 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 x 18 2 3 3 4 3 x 3 4 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 2 x 3 Dudwell St Mary New Building DS0000067584.V321681.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NA 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 OP1 Regulation 5(1)(abd) 4(1)(a) 4(1)(b) 4(1)(c) Sch 1(8) Requirement That the Service User Guide includes the terms and condition of residency for the home. Timescale for action 28/02/07 2 OP1 3 OP6 15(1) 4 5 OP18 18(1)(c) (i) 18(1)(a) That a Statement of Purpose is 28/02/07 updated to reflect the aims and objectives of the home, services and facilities and any criteria used for admission, which includes the homes policy and procedures on emergency admissions. That care plans provide clear 30/03/07 guidance for staff on all aspects of the health, personal and social care needs of service users and which make explicit the actions needed to meet these needs and which are reviewed regularly. That staff undergo training on 28/02/07 Adult Protection guidelines. That there are adequate staffing levels at peak times as is appropriate for the health and welfare of service users. That staff undergo training necessary to undertake their work. This must include all DS0000067584.V321681.R01.S.doc OP27 30/01/07 6 OP30 18(1)(c) (i) 30/03/07 Dudwell St Mary New Building Version 5.2 Page 26 7 OP36 18(2) mandatory areas of training. That persons working at the home are appropriately supervised. 30/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 7 Refer to Standard OP3 OP7 Good Practice Recommendations That an emergency admissions procedure be developed implemented and reviewed regularly. That a summary of residents needs be developed which provides an overview of residents assessed needs. To indicate the exact amount of medicines administered when prescribed as a variable dose To number the pages in the disposals of medicines record To have clear, individual guidelines on the criteria of when to give a medicine prescribed on a ‘when required’ basis. To have clear recorded reason for non administered medicines. That a training and development plan be developed, which identifies the training necessary to meet the homes Statement of Purpose, service aims and service users needs and individual plans. OP9 OP9 OP9 OP9 OP30 Dudwell St Mary New Building DS0000067584.V321681.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 Dudwell St Mary New Building DS0000067584.V321681.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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