Inspection on 14/03/07 for Dulas Court

This inspection was carried out on 14th March 2007.

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

The inspector 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

Dulas Court 16/03/06

Dulas Court 02/12/05

Dulas Court 22/02/05

Dulas Court 27/07/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Dulas Court Dulas Ewyas Harold Herefordshire HR2 0HL Lead Inspector Julian Mason Unannounced Inspection 10:00 14 March 2007 th 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 Dulas Court DS0000024704.V323528.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. Dulas Court DS0000024704.V323528.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dulas Court Address Dulas Ewyas Harold Herefordshire HR2 0HL 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) 01981 240214 01981 240220 dulas.court@tiscali.co.uk Mr Phillip Raymond Keene Mrs Kathleen Barbara Keene Mrs Elizabeth Anne Blake Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25), Physical disability over 65 years of age of places (25) Dulas Court DS0000024704.V323528.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th March 2006 Brief Description of the Service: The Providers and Manager are registered in respect of Dulas Court to provide personal care to twenty-five older people whose needs arise from the ageing process or through physical disability. The Statement of Purpose produced by the Proprietors describes the primary aim thus: The purpose of this home is to provide continuous and holistic care for elderly people in a Christian environment, enabling and supporting them in their increasing frailty. The Home is located in a lovely rural setting and the house is situated in large grounds several acres of which are accessible to service users with mobility problems. One bedroom is dedicated to the provision of respite care. Dulas Court DS0000024704.V323528.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection that included a visit to the home. The inspection visit started at 10.00am and finished late afternoon on the same day. One inspector visited the home and observed some of the events and routines of the day. Several residents files were examined and a range of records were sampled. A tour of the building was undertaken and the inspector participated in the lunchtime meal. The inspector was able to meet a number staff and residents who were in the home at the time of the visit. The Registered Manager and Proprietor were also available during the inspection and were able to provide a useful range of information about the service. The Registered Manager had completed a pre-inspection questionnaire, which gave some additional information about the home. Fourteen “have your say about…” questionnaires were completed by residents, twenty-two “relatives / visitors comment cards” were also completed and six “…professionals in contact with the care home” comment cards were returned to the Commission. What the service does well: What has improved since the last inspection? What they could do better: Residents care plans should be reviewed and updated every month. Individual medication record sheets need to clearly state if residents have any allergies. Dulas Court DS0000024704.V323528.R01.S.doc Version 5.2 Page 6 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. Dulas Court DS0000024704.V323528.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 Dulas Court DS0000024704.V323528.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service Residents have their needs assessed prior to admission to ensure that the home is able to provide the appropriate care and support required. EVIDENCE: A thorough assessment is completed for all new residents. The Registered Manager carries out this process and the home only accommodates those people whose needs can be met by the service. The home’s assessment of prospective residents is based on a range of information that relates to an individual’s health and social care needs. The assessment also includes gathering information about individual likes and dislikes to ensure the home is fully informed about a person’s needs. Where appropriate, information is also gathered from a range of sources including relevant professionals, family members and previous carers. Dulas Court DS0000024704.V323528.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service Residents care plans must be reviewed and updated monthly. Health care and medication is well managed to promote good health and wellbeing. An individual’s right to privacy and dignity is respected and supported. EVIDENCE: The home uses a care plan format where the needs of each resident were recorded. The plans also outlined how identified needs will be met. Care plans were not routinely update or reviewed, plans did not fully represent the current needs and circumstances of residents. The staff team had a good knowledge and understanding of each residents needs and the home has good handover systems in place to ensure continuity of care is provided between shift teams. Although the home consulted with residents [and where appropriate their representatives] about the plans, most of the documents were not signed by Dulas Court DS0000024704.V323528.R01.S.doc Version 5.2 Page 10 anyone. Residents whenever capable and / or representatives should sign the care plan to indicate their agreement. Out of the fourteen residents questionnaires that were completed, eleven residents said that they “always” received the care and support needed with three stating that this “usually” happens. All twenty-two relatives / visitors comment cards answered, “yes” to the question: “are you satisfied with the overall care provided.” One relative stating: “Dulas Court is an exceptional care home where my mother is very happy with all aspects of her care. As a result we have complete peace of mind regarding her continuing well being.” Residents are registered with a range of local community health services that are appropriate to their needs. Systems are in place to ensure that all health appointments and arrangements are monitored and completed. Liaison between the home’s staff and visiting health and social care professionals is good. One visiting GP stating that: “Dulas Court provides first class care with compassion and sensitivity to individual needs.” Dulas Court promotes joint working with other professionals as part of the home’s aims to achieve the best possible outcomes for residents. All six returned questionnaires from professionals that visit the home answered “yes” to the question “does the home communicate clearly and work in partnership with you”. Another visiting health care professional confirmed that: “I visit Dulas Court monthly and have done so for many years. It is the only home I visit where I feel confident that staff fully cooperate and the user is aware of my attendance on the given date.” All six returned questionnaires from visiting health & social care professionals agreed that: “……staff demonstrate a clear understanding of the care needs of service users.” The Registered Manager and staff have well-established relationships with a range of visiting healthcare professionals. The home is able to access a range of advice and guidance that may be needed about matters of health and wellbeing. The home has appropriate arrangements and opportunities in place to promote exercise and physical activities. These arrangements were also organised to reflect individual abilities and preferences. Dulas Court has policies and procedures in place for the management of residents medication. Staff who have responsibility for the administration and delivery of medication have completed appropriate training. The home uses pre-printed administration of medication record sheets to ensure prescription and non-prescription drugs were recorded at the point of receipt, administration and disposal. The records demonstrated that the Dulas Court DS0000024704.V323528.R01.S.doc Version 5.2 Page 11 delivery and recording of the administration of medication was being carried out appropriately. The home’s Controlled Drugs Register also indicated that this aspect of practice was being carried out safely. Dulas Court has also undergone an external medication audit, which was carried out by a community pharmacist. The audit indicated that at the time of the visit the home was achieving appropriate standards for the administration of medication. One administration record sheet highlighted the need for the home to ensure that all residents allergies were accurately and clearly recorded on individual medication records. Although the home’s case file included information about an individual resident’s allergies this information was not reflected in medication records. The privacy & dignity of residents was seen to be observed and promoted. Staff knocked on doors before entering rooms and closed doors when assisting with personal care and support needs. All returned questionnaires from relatives and visiting health care professionals confirmed that they were able to see residents in private. Staff were seen to speak to residents with respect and courtesy, the home’s general environment was supportive and caring. Dulas Court DS0000024704.V323528.R01.S.doc Version 5.2 Page 12 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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service The home provides a range of social activities and routines that residents can choose to participate in. Visitors can come to the home at anytime and are always made to feel welcome. Residents receive a healthy, varied diet according to their assessed needs and choices. EVIDENCE: The pre-inspection questionnaire completed by the Registered Manager stated that in-house activities included the mobile library, talks and presentations, religious services, live music and singing, and walks in the grounds. Previous community activities have included lunches and outings, religious services, mini bus outings and shopping trips. The home has its own vehicle to support community access and involvement. Out of the fourteen resident questionnaires that were completed, ten stated that there were “always activities arranged by the home that I can take part in” and four stated that this was “usually” the case. Dulas Court DS0000024704.V323528.R01.S.doc Version 5.2 Page 13 Relatives and friends were able to visit the home at any time and this is confirmed in feedback from the relatives / visitors comment cards. All twentytwo retuned cards stated, “yes” to the question: “do staff welcome you in the home at anytime”. Mealtime arrangements for the home were well organised. Menus rotate on a five-weekly basis and provided a good range of home cooked food. The menus were balanced, nutritious and flexible enough to take account of changing preferences and needs. Kitchen staff were well aware of special dietary requirements and were able to provide a range of food that met with specific needs. Residents likes and dislikes were well known by the cook and care staff and the provision of food was discussed on a weekly basis. Eight returned questionnaires from residents stated “always” to the question “do you like the meals at the home”, with six stating “usually”. The lunchtime meal was unhurried with patient and attentive staff serving individual tables. Dulas Court DS0000024704.V323528.R01.S.doc Version 5.2 Page 14 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service The home has systems and practices in place to ensure residents are protected and safeguarded. EVIDENCE: All new residents and their representatives receive written guidance and information about how to raise a concern about the service. The home’s complaints folder indicated that two complaints had been received about the home since the last inspection. The complaints were both in relation to respite care arrangements; the home investigated the circumstances and provided appropriate responses to the complainants. All residents comment card responses indicated that they knew who to speak to if they wished to make a complaint or raise a concern. Relatives also indicated that they are aware of the home’s complaints procedure and the visiting professionals responses stated that they had not received any complaints about the service. One representative commenting: “I am exceptionally satisfied with quality of care and feel very confident that should any concern arise I am able to speak in person or by phone to the manager or owners.” The home has a policy for the protection of vulnerable adults and holds a copy of Herefordshire’s Multi Agency Procedures for Protection of Vulnerable Adults. Dulas Court DS0000024704.V323528.R01.S.doc Version 5.2 Page 15 The documents provide clear guidance to staff in relation to issues of adult abuse and the reporting of concerns to appropriate agencies. Most staff have received protection of vulnerable adults training and staff spoken to were clear about the action they would take to safeguard the residents in the home. Dulas Court DS0000024704.V323528.R01.S.doc Version 5.2 Page 16 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service Residents live in a clean, comfortable and safe home that meets their needs. Measures are in place to protect residents from infection and reduce risks where possible. EVIDENCE: Dulas Court stands in large spacious well-maintained gardens that provide a pleasant outlook for residents. Day space is provided in a variety of lounges and other areas throughout the home and all the rooms were well furnished. A tour of the building was conducted during which the inspector met residents and staff. Bedrooms appeared comfortable and clean with rooms being personalised with photographs, pictures and ornaments belonging to individual occupants. The home has systems in place to ensure repairs and general health and safety standards were achieved. The Manager highlighted a range of up-grades and improvements that had been completed since the last Dulas Court DS0000024704.V323528.R01.S.doc Version 5.2 Page 17 inspection. Dulas Court is a large building and the process of maintenance and upkeep is on going. Currently, the large dinning room was in the process of being upgraded and decorated. Dulas Court has received a recent visit from the local Environmental Health Officer and the home has incorporated the recommendations made as a result of the visit. The returned resident comment card stated that the home is “always” clean and fresh. The tour of the home confirmed this feedback, everywhere was clean and tidy and there were no bad smells or odours. Policies and procedures for infection control were in place and some staff have completed training in this area. Dulas Court DS0000024704.V323528.R01.S.doc Version 5.2 Page 18 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service The staff team have the appropriate skills, knowledge and experience to provide care and support to meet residents need. The vetting of staff is completed to the required standards to ensure individuals are suitable to work with vulnerable adults. All staff receive training appropriate to their role and responsibilities. EVIDENCE: The pre-inspection questionnaire indicated that there are twenty seven care staff, eight ancillary staff and 2 catering staff employed in the home. Fourteen of the care staff held a National Vocational Qualification (NVQ) to Level 2 or above. This meets the 50 required by the National Minimum Standards. In the resident comment card responses to the question: “Are staff available when you need them”, eight answered “always” and six answered “usually”. A number of residents made additional comments in response to the question: “Sometimes very busy, but I do not have to wait long”. And “Press the bell and get a speedy answer”. The relative / visitor comment cards were unanimous regarding the question: “In your opinion are there always sufficient numbers of staff on duty”, all twenty-two answered “yes”. The Registered Manager and Proprietor were free Dulas Court DS0000024704.V323528.R01.S.doc Version 5.2 Page 19 from the home’s staff rota and were able to provide additional support to the team at peak times of activity and need. Staff were confident and knowledgeable about the needs of individual residents, many had worked in the home for a considerable number of years. New staff were supported, mentored and coached to become competent members of the team. A new member of staff was in the process of completing a nationally recognised induction programme. The recruitment and selection processes at the home follow an established procedure. Staff personnel files were appropriately stored and secured in the manager’s office. A sample of personnel files for staff working at the home was made available to the inspector. The files demonstrated that appropriate checks were being undertaken in relation to an individual’s employment and the role to be undertaken. The home was able to provide a profile of all training events and development activities that the staff team had attended. The profile demonstrated that a wide range of training and learning opportunities had been organised and delivered. Managers were well aware of individual staff training and learning needs and were in the process of identifying forthcoming events to ensure these needs were met. Dulas Court DS0000024704.V323528.R01.S.doc Version 5.2 Page 20 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 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service The home is managed by a competent and experienced manager. Systems are in place to ensure residents financial interests are safeguarded. The home continues to develop ways of gathering information to ensure services are meeting residents needs. Appropriate standards of health and safety are being maintained. EVIDENCE: The management arrangements in the home remain unchanged since the last inspection. The Owners of the home also continue to take an active role in the delivery of care and overall management of the service. The Registered Manager has the necessary skills and experience to carry out the role and responsibilities. The Manager placed a strong emphasis on being Dulas Court DS0000024704.V323528.R01.S.doc Version 5.2 Page 21 involved in the day-to-day operations of the home and being available to residents and staff to ensure services achieved the required standards. Dulas Court consults with residents and families about the day-to-day running of the home. Views and opinions were considered about the range of care and support provided. Managers have started to use more formal quality assurance systems to help them identify what the home does well and what could be improved. Systems and processes continue to be developed to ensure quality assurance activities were effective and appropriate. There were policies and procedures in place in respect of managing residents money, valuables and finances. Residents or their representatives were encouraged to manage their own finances except where they stated that they did not wish to or lacked the capacity to do so. In such instances there were safeguards in place to protect the interests of residents. The home carries out small financial transactions for general needs such as hairdressing, personal needs newspapers etc and these transactions were being appropriately managed, monitored and recorded. The home has a range of policies and procedures to cover the necessary areas of health, safety and welfare of residents, visitors and staff. Staff were receiving a range of training relating to areas of health and safety such as fire prevention and evacuation, first aid, food hygiene and moving and handling. Fire drills were taking place with the frequency required. Testing of emergency lighting, fire alarms and fire fighting equipment was also taking place within appropriate timescales. The pre-inspection information completed by the Registered Manager confirmed that fire, gas, electrical, heating, and water systems in the home were being maintained and equipment was being serviced. The home’s records demonstrated that a range of risk assessments were in place, which were regularly reviewed and updated. Dulas Court DS0000024704.V323528.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 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 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Dulas Court DS0000024704.V323528.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 15 Requirement The Registered Manager must ensure that all care plans are reviewed and updated on a monthly basis. The Registered Manager must ensure that residents whenever capable and / or representatives sign individual care plans to indicate their agreement. The Registered Manager must ensure that all the home’s administration of medication record sheets for residents include information about known allergies. Timescale for action 31/05/07 2. OP7 15 31/05/07 3. OP18 13(6) 31/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Dulas Court DS0000024704.V323528.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Dulas Court DS0000024704.V323528.R01.S.doc Version 5.2 Page 25 - 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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