CARE HOMES FOR OLDER PEOPLE
Duncote Hall Nursing Home Duncote Towcester Northants NN12 8AQ
Lead Inspector Linda Preen Unannounced 9th May 2005 @ 10:00 A.M. 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 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. Duncote Hall Nursing Home Version 1.10 Page 3 SERVICE INFORMATION
Name of service Duncote Hall Address Duncot Towcester Northants NN12 8AQ 01327 352 277 01327 359 168 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Dove Care Homes Limited Holdsworth House 4th Floor, 65-73 Staines Road, Hounslow, Middlesex TW3 3HW Mr Darren Lee Peter McGregor Care Home 41 Category(ies) of DE (E) Dementia - over 65 (10) registration, with number OP Old Age - 41 of places Duncote Hall Nursing Home Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: The total number of service users in the home must not exceed 41 No one falling into the category of Dementia over 65 years of age may be admitted into the home where there are 10 persons with Dementia over 65 years of age already accommodated in the home. Date of last inspection 1/11/04 Brief Description of the Service: Duncote Hall is set in 8 acres of grounds in a small village. Accommodation is in a mixture of single and double rooms, all of which have en-suite facilities. There are 3 general sitting rooms, a dining room and conservatory as well as extensive gardens. A mixed client group is accommodated and includes the elderly frail as well as mentally frail clients. Duncote Hall Nursing Home Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over a period of three and a half hours as part of the statutory inspection programme. Two residents were chosen in order that their experience in the home could be monitored. This included looking at their records, talking to them and also to the staff concerning the care received. In addition to this Fire records, Complaints and accident records were seen. A limited tour of the home was undertaken. What the service does well: What has improved since the last inspection?
The new Registered Manager has worked hard to improve the standard of record keeping in the home and to ensure that staff are trained to meet resident’s needs.
Duncote Hall Nursing Home Version 1.10 Page 6 First Aid training has been provided to ensure that a qualified first aider is on duty at all times in case of accident. Food hygiene training has been provided for all staff who handle or serve food, in order to protect residents from infection. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Duncote Hall Nursing Home Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Duncote Hall Nursing Home Version 1.10 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3 and 4 Residents have the information required to enable them to make an informed choice concerning admission to the home. EVIDENCE: A new Statement of Purpose has been provided since the last inspection. Resident files seen demonstrated that comprehensive assessments are undertaken prior to residents being admitted to the home. Duncote Hall Nursing Home Version 1.10 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 10 Staff do not always have the information required to ensure that all resident needs are met. Residents are treated with dignity and respect. EVIDENCE: It is acknowledged that considerable improvements have been made to care planning in the home, and these plans are regularly reviewed, but the sample of resident records seen demonstrated that the information required to provide care was not always completed or was contradictory. For example: One resident had two different pressure risk scores on file and another had no care plan for prevention of pressure ulcers or for the treatment of those already identified. Another resident, who was reported to be refusing medication and diet, was found to have an ulcerated tongue, which staff in the home were unaware of. A requirement was made in this respect. The resident or their representative as well as staff in the home signed these plans. Staff were observed to be treating residents with respect and with due regard to their privacy.
Duncote Hall Nursing Home Version 1.10 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 Social activities and meals are well managed, creative and provide daily variation and interest for people living in the home. EVIDENCE: The home employs a dedicated activities co-ordinator who has devised an interesting programme according to resident’s requirements. The programme on display advertised such things as a Gardening club, French club and Culture club as well as current affairs discussions and quizzes. Themed days have been organised. For example an Italian day included Lasagne for lunch, which the residents had enjoyed. During the inspection, a group of residents were reading the paper together and discussing articles from the news. The activities co-ordinator ensured that all of the group were included in this discussion. This newspaper discussion was followed by a crossword and then a quiz. Records of preferred activities were available on individual files. Residents are allowed pets where they are able to take care of them, and one lady had a small dog as her companion. Residents spoken to cofirmed that they were able to choose whether or not to take part in any activity provided and that they were given choice as to where they spent their day. Duncote Hall Nursing Home Version 1.10 Page 11 Lunch was served in an attractive dining room and both looked and smelled appetising. Those residents, who required assistance to eat, were given this on an individual basis by a dedicated member of staff. Residents were given choice concerning the quantity of lunch served and of gravy and condiments. There is a set menu at the main meal but alternatives are provided on request. Residents spoken to stated that the food was good except one lady who complained about some of the meat being tough sometimes. The Registered manager stated that an alternative supplier was being investigated in order to address this problem. A gentleman spoken to in the conservatory was enthusiastic about his cooked breakfast. Satisfactory levels of food stocks were seen and the relief cook stated that there were two deliveries of fresh food per week. Petty cash is available to purchase any items, which are needed in between deliveries. Duncote Hall Nursing Home Version 1.10 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 17 Residents may be confident that their concerns will be addressed and that they will be protected from abuse. EVIDENCE: A complaints procedure is available for guidance. There have been no recorded complaints in the home since the last inspection. Staff spoken to were aware of the potential forms of abuse and their responsibilities in reporting any actual or suspected instances. A Copy of the Northamptonshire Protection of Vulnerable Adults guidance document is available for reference. Duncote Hall Nursing Home Version 1.10 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 23, 24, 25 and 26 Residents live in homely surroundings, which are well maintained and clean. EVIDENCE: A limited tour of the environment was undertaken. This demonstrated that all communal areas of the home were comfortable and decorated to a good standard. Resident rooms seen had evidence of personalisation in the form of ornaments, photographs and small pieces of furniture. The home was bright and airy, with a very pleasant atmosphere. In addition to a variety of lounge areas, there is a pleasant dining room and extensive grounds, which may be enjoyed when the weather permits. Some food was found to be uncovered and unlabelled in the refrigerators and a large, open, bag of salt was being used to prop open the door of the overflow food store. This was brought to the attention of the Registered Manager, and a requirement has been made in this respect. Duncote Hall Nursing Home Version 1.10 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 30 Staff training and development is encouraged in the home. EVIDENCE: Two staff members hold a National Vocational Qualification certificate at present with two more awaiting accreditation. Six further care staff are working towards this qualification at present. A new induction procedure and records have been introduced and excellent records were available to demonstrate that this was being undertaken. Staff spoken to confirmed that in addition to statutory training, training in the care of those residents with a diagnosis of dementia had been provided. An additional Registered Nurse has been recruited recently in order to facilitate training in the home. Duncote Hall Nursing Home Version 1.10 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36 and 38 The Registered Manager ensures that the home is run efficiently, in a way that serves the best interests of the residents. EVIDENCE: The Registered Manager is a first level Registered Nurse with several years experience of managing a care home. Relationships between him and the residents and staff were observed to be relaxed and friendly. Staff spoken to confirmed that they are offered regular supervision in order to perform to their best ability, and felt well supported by the Manager. Records of testing the fire alarms and emergency lighting were seen and found to be satisfactory. Radiators in the home have been covered to reduce the risk of burning. The inspector was informed that all hot water outlets in service user areas have the temperature thermostatically controlled.
Duncote Hall Nursing Home Version 1.10 Page 16 Moving and handling assessments had been carried out on service users chosen to track, and staff seen demonstrated that they had undertaken moving and handling training. A number of staff have undergone 1st Aid training since the last inspection in order to meet the requirement that a qualified 1st Aider is on duty at all times. Duncote Hall Nursing Home Version 1.10 Page 17 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 x x 3 3 3 3 STAFFING Standard No Score 27 x 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 x x 3 x 3 Duncote Hall Nursing Home Version 1.10 Page 18 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 7 Regulation 15(2)(b) Requirement Resident care plans must be reviewed to ensure that instruction are clear and not contradictory and that all needs are identified. Food must be stored in line with environmental health guidelines. Timescale for action 1/7/05 2. 38 16(2)(g) 1/6/05 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. Refer to Standard 15 Good Practice Recommendations Action should be taken to address the problem of tough meat in the home. Duncote Hall Nursing Home Version 1.10 Page 19 Commission for Social Care Inspection 1st Floor, Newland House Campbell Square Northampton NN1 3EB 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 Duncote Hall Nursing Home Version 1.10 Page 20 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
