Inspection on 26/04/06 for Dugdale House

This inspection was carried out on 26th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Dugdale House 18/04/07

Dugdale House 24/11/05

Dugdale House 08/04/05

Dugdale House 21/10/04

Dugdale House 17/05/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Dugdale House 1 Santers Lane Potters Bar Hertfordshire EN6 2BZ Lead Inspector Angela Dalton Unannounced Inspection 26th April 2006 10:45 Dugdale House DS0000019329.V291608.R01.S.doc Version 5.1 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 Dugdale House DS0000019329.V291608.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. Dugdale House DS0000019329.V291608.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Dugdale House Address 1 Santers Lane Potters Bar Hertfordshire EN6 2BZ 01707 642541 01707 643653 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) Caretech Community Services Limited Care Home 8 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (2) of places Dugdale House DS0000019329.V291608.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th November 2005 Brief Description of the Service: Dugdale House, located near the town of Potters bar, is one of the care homes provided by CareTech Community Services Limited. The home provides full care services for eight service users with learning disability. The two storey detached house was converted into a care home in 1998. There is a front driveway and parking facilities. The ground floor comprises the office, lounge, dinning room, kitchen and two bedrooms with en-suite facilities. The other six bedrooms are on the first floor. These have no en-suite facilities. The toilet and bathroom facilities are nearby. The building itself is surrounded by spacious ground that is mainly laid to lawn with mature trees and shrubs. The patio and garden are accessible to wheelchair users. Dugdale House DS0000019329.V291608.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection consisted of an unannounced site visit, which was conducted by one Inspector on 26th April 2006. It took place between 10.45 am and 6.20pm. As the manager was on sick leave a Senior Home Manager was invited by the staff team to be present for the latter part of the inspection. Some requirements have been made with regard to the safety of service users. Amounts of controlled drugs were not accurate and door wedges were in use. It was a fair inspection and staff have a good knowledge of the needs of service users. The Inspector spent a large proportion of time with four service users who were at home: service users communicate in a variety of ways: some verbally others with Makaton (sign language) or body language. The Inspector toured the environment and inspected paperwork to ensure accurate records were in place. There are areas of the home, which require cleaning and minor decoration. No soap or hand towels were available throughout the home and this compromises infection control. The scale of charges were not available at this inspection. What the service does well: What has improved since the last inspection? What they could do better: Some good interaction between staff and service users was observed but staff must be mindful that at times service users are being told what to do instead of asked what to do. Staff were observed to be doing things for service users but not informing them of what they were doing e.g. moving a recliner chair without talking to the service user. The dignity of service users needs to be given a higher priority: ice cream tubs were in bathrooms (to wash service users’ hair) and bibs were in use but being placed onto the table with plates on them. Safety of service users is not currently assured as fire doors are wedged open and controlled drugs could not be accounted for. If fire doors were held open with appropriate devices this would enable staff and service users to observe what was happening in other rooms and reduce feelings of isolation. Dugdale House DS0000019329.V291608.R01.S.doc Version 5.1 Page 6 Rooms are currently closed off as doors are shut at all times. The service users do not have access to a computer as stated in the National Minimum Standards. Person Centred Planning has not recommenced in the home and this current philosophy and practice has been introduced to ensure that people with a learning disability enjoy the opportunity to aim fulfil their aspirations. 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. Dugdale House DS0000019329.V291608.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dugdale House DS0000019329.V291608.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 3 The statement of purpose requires review. Although a thorough assessment process is in place some service users’ needs are unmet. . EVIDENCE: The statement of purpose must be reviewed to ensure all required information about the home is current and accurate. It was unclear when the last review had taken place and staffing information was not updated. No new service users have been admitted since the previous inspection but there is currently a vacancy. An assessment process is in place and this provides the foundation for care plans to be written. One service user who recently moved to the home has demonstrated that they have challenging needs. Their bedroom is not of the same standard as other service users as furniture has been damaged. If the home is to accommodate service users with specialist needs then the environment must be suitable. Furniture and fittings must be provided which are appropriate and safe. Damaged fittings in the bedroom and bathroom have not been replaced and this practise does not ensure the dignity of service users is observed. Dugdale House DS0000019329.V291608.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Individual needs and risk assessments are reflected within care plans. Informed choice is not always available as staff ‘tell’ rather than ask. EVIDENCE: Care plans reflected the individual needs for each service user. The introduction of Person Centred Planning would further assist in this process. Staff have worked hard to assist the newest service user to settle into the home. The inspector suggested that where success had been achieved through a consistent approach that this was recorded in the care plan. One service user has demonstrated challenging behaviour and the care plan provides details on how to manage this need. It does not provide information on how to ensure a pleasant environment is to be maintained which is linked to requirement cited above. The home manager is exploring the transfer of care plan into pictorial form for those service users who would better understand this format. The Inspector observed service users being told (as opposed to asked) that they were going out for lunch. On speaking to other service users the Inspector confirmed that choices were offered but that some staff needed to consider the way in which they were presented. Individual risk assessments were in place and were frequently reviewed. Dugdale House DS0000019329.V291608.R01.S.doc Version 5.1 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16 and 17 Individual social opportunities are made available. Dignity could be better observed at mealtimes. EVIDENCE: The home has a vehicle, which a number of staff drive and a driver is available each shift. Service users make good use of the local facilities and two service users went out for a pub lunch on the day of inspection. One service use had recently been confirmed with the local Catholic church and clearly valued this opportunity. Most service users attend day care or college but, for those who do not, structured activities take place and professionals conduct sessions within the home. Meals are flexible and choices are available. Service users wear ‘bibs’ which were placed onto the table instead of over the lap and the plate was placed on this. The provision of large napkins or an equivalent is strongly recommended as this would be more dignified and age appropriate. Dietetic guidelines in a care plan outline alternatives available. Dugdale House DS0000019329.V291608.R01.S.doc Version 5.1 Page 11 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 and 21 The dignity of service users is not observed. A safe medication system is not in place and the safety of service users is not assured. EVIDENCE: The dignity of service users must be afforded a higher priority at Dugdale House. As discussed previously staff sometimes fail to consult service users about their choice and perform tasks without informing the individual. A member of staff was observed to be curt and rude to service users at times. A service user was called a liar whilst they were talking to the Inspector and two service users were loudly told to ‘wait’ in a rude manner. These incidents were isolated but they must cease. Ice cream tubs in the bathroom are not necessary as the baths have shower fittings to wash service users hair. If service users do not like this then a more appropriate receptacle is to be used. One service user’s bedroom is dark, as a tree has grown to obscure part of their view. Sinks in bedrooms were crowded with articles leaving little free space. A carrier bag of clothes was on a chest of drawers (for the charity shop it was later discovered). A chart was on one service user’s wall, which had commenced in 1999 and last used in April 2004. Most bedrooms are personalised but one is without pictures and personal effects, the other has a poor standard of furniture. Service users receive professional input where needed to meet their health needs. Dugdale House DS0000019329.V291608.R01.S.doc Version 5.1 Page 12 An immediate requirement was made regarding medication: 12.5 tablets of a controlled drug could not be accounted for and were not stored appropriately. Inaccurate recording processes are in place for controlled drugs, as the missing tablets could not be accounted for. This must be addressed as it could leave service users at risk. Dugdale House DS0000019329.V291608.R01.S.doc Version 5.1 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Service users’ views are obtained and acted upon. An Adult Protection policy is in place. EVIDENCE: Staff received Adult Protection training from the company. A copy of the Local Authority Adult Protection policy is in the home. Service users have one to one time with staff to ensure that any issues of concern can be discussed and addressed. Records of complaints are recorded but are then archived at head office. The home should keep a copy of complaints to evidence the action taken and to monitor the identified issues. It is suggested at least the last 12 months of records should be available for inspection. Dugdale House DS0000019329.V291608.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29 and 30 Attention is needed to the maintenance and cleanliness of the home. Good practise regarding hygiene and infection control is not observed. EVIDENCE: The home was odour free and mostly clean – some decoration is needed in bedroom corridors and areas where the paintwork is marked. The grounds were neat and spring flowers were displayed in containers giving a homely feel to Dugdale House. Windows throughout the home are dirty and lampshades had dead insects collected within them. Windows are covered with Perspex to offer double glazing and dirt is between this covering and the glass. As discussed earlier one bedroom visited by the Inspector does not fully meet the needs of the service user. It has poor furnishings compared to the other rooms that were seen and the dado rail had been removed. The bathroom opposite has no mirror or toilet roll holder. Plugs were attached with string and a lampshade was missing in a bedroom corridor. Bathrooms and toilets did not lock either because the lock was broken or ill fitting. No bathroom or toilet had soap or hand towels available and this poses a risk to infection control. A computer should be available for service users to use. Dugdale House DS0000019329.V291608.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Appropriately trained staff are employed. EVIDENCE: Service users needs are known by staff and good communication between team members was observed. Staff receive an ongoing programme of training, which is updated as necessary. No new staff have been appointed since the previous inspection and a permanent staff team is employed. Dugdale House DS0000019329.V291608.R01.S.doc Version 5.1 Page 16 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 A quality assurance procedure policy is in place. The safety of service users is not assured and the manager is unregistered with the Commission. EVIDENCE: Due to personal circumstances the manager has been impeded in their progress to register with the Commission for Social Care Inspection. They are currently on sick leave but plan to return in the near future. A requirement has been made to ensure registration occurs. CareTech has recently conducted a quality assurance audit of Dugdale House and a commendable score of 91 was achieved. Doors must not be wedged open by devices other than those approved by the fire authority. The practice of wedging open doors may present a risk to both service users and staff. An immediate requirement has been made to ensure that a safe and suitable alternative to door wedges is implemented. The home needs to have something in place to ensure that observation can occur and to ease the mobility of service users from one room to another. Dugdale House DS0000019329.V291608.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 3 3 2 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 1 25 3 26 2 27 1 28 3 29 2 30 1 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 3 1 3 1 X 3 X X 1 X Dugdale House DS0000019329.V291608.R01.S.doc Version 5.1 Page 18 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 6(a)Sch 2 Requirement The Statement of Purpose must current and reviewed regularly. It must reflect the content cited in Schedule 2. The assessed needs of service users must be met. Service users must be enabled to make informed choices. Service users must be treated and cared for with dignity. A safe medication system must be in place – controlled drugs require specific attention. The home must be clean and well maintained. Bedroom fittings and furnishings must be suitable for the needs of service users. Bathrooms must lock and appropriate fixtures and fittings be in place. Soap and hand towels must be made available to observe infection control. The manager must register with the Commission for Social Care inspection. Fire doors must not be wedged open and a safe and suitable alternative employed. Timescale for action 30/06/06 2 3 4 5 6 7 8 9 10 11 YA3 YA7 YA18YA17 YA20 YA24 YA26 YA27 YA30 YA37 YA42 12(1) 12(2)&(3) 12(4)(a) 13(2) 23(2)(d) 16(2)(c) 23(2)(j) 13(3) 8(1)(a) 13(4)(c) 31/05/06 31/05/06 31/05/06 26/04/06 31/05/06 31/05/06 31/05/06 31/05/06 30/06/06 26/04/06 Dugdale House DS0000019329.V291608.R01.S.doc Version 5.1 Page 19 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA22 YA29 Good Practice Recommendations The home should keep a tracking record of complaints made one archived. A computer should be in place for service users’ use Dugdale House DS0000019329.V291608.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 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 Dugdale House DS0000019329.V291608.R01.S.doc Version 5.1 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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