Inspection on 11/06/09 for Dunedin Residential Care Home

This inspection was carried out on 11th June 2009.

CQC found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Dunedin Residential Care Home 10 Connaught Gardens East Clacton-On-Sea Essex CO15 6HY Lead Inspector Helen Laker Key Unannounced Inspection 10:00 11th June 2009 DS0000072846.V375652.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Dunedin Residential Care Home DS0000072846.V375652.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Dunedin Residential Care Home DS0000072846.V375652.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dunedin Residential Care Home Address 10 Connaught Gardens East Clacton-On-Sea Essex CO15 6HY 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) 01255 476484 dunedinres@tiscali.co.uk Dr Tabraiz Mr Mahmood Hussain Raja, Mr Manilall Rambojun Sandra O`Neil Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Dunedin Residential Care Home DS0000072846.V375652.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home only – Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category – Code OP The maximum number of service users who can be accommodated is 20 Not Applicable 2. Date of last inspection Brief Description of the Service: Dunedin is an established care home, which provides residential care for older people. It is a large detached three-storey property situated in a quiet residential area of Clacton-on-Sea. There is registered accommodation for twenty service users. The home is situated close to the sea front, with local shops, GP surgeries and churches close by. The property has impressive gardens to the front, side and rear of the property, with car parking to the side of the property. The lounge and conservatory overlook the rear garden, which is laid to lawn with fruit trees, a summerhouse and flower borders. Adjoining the lounge there is a dining room. Within the grounds is a privately rented property to the rear of the garden, and access to the property is via the front of the property driveway and side gate. This does not include access to the residential home itself. Accommodation for service users is on the ground, first and second floors, with passenger lift access. The accommodation comprises of one double and eighteen single rooms. Six rooms have en-suite facilities of a toilet and a wash hand basin. Catering and laundry services are in-house. The current range of fees, as at the inspection visit were said to be £398.00 to £450.00 per week with en-suite. Toiletries, newspapers, hairdressing and chiropody are an extra cost. Dunedin Residential Care Home DS0000072846.V375652.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced key inspection was carried out on the 11th June 2009. This home re registered with a provider change in December 2008. An application for the home to provide care for people with dementia is currently being progressed. As part of the inspection we checked information received by Care Quality Commission (CQC), looking at records and documents at the care home and talking to the manager, Mrs Sandra O’Neil, care staff and the people living at the home. In addition the Annual Quality Assurance Assessment (AQAA) completed in April 2009 was considered as part of the inspection process and a tour of the premises was completed at the visit to the care home. The service sent us their Annual Quality Assurance Assessment (AQAA) which is required by law to be completed by the service when we asked for it. This contained information about what they felt they did well. The information was brief and did not always tell us how the service was seeking to improve the outcomes for people living at the service, beyond their present provision. We sent surveys to people living in the home and their relatives. There was a good response and the information contained in these was used to inform us on some of the outcomes for people using the service. The manager, staff and the proprietor assisted the inspector at the site visit. Feedback on findings was given during the visit with the opportunity for discussion or clarification. We would like to thank the proprietor, the manager, the staff team, and people living at the service and their relatives for their help throughout the inspection process. What the service does well: The service aims to inform people considering moving into the home and to understand how they will need to be supported. They complete care plans that set out instructions for staff in meeting people’s needs. There is a greater emphasis on the person as a whole in both the care plans and the staffs recording of their daily lives. Dunedin Residential Care Home DS0000072846.V375652.R01.S.doc Version 5.2 Page 6 Medication management and administration was to a good standard and ensures people are supported and protected by the service. People living at the service enjoy their experience and some comments included “I love this home” and a staff member commented “We thrive on our home and spoil our residents” Additionally one relative survey stated “There is always room for improvement anywhere but my relative is happy here and their care needs are all met, the staff at Dunedin are very good and I have no complaints.” The premises are generally clean and homely. They provide a comfortable environment for the people living there. People are able to personalise their rooms. Staff training and supervision is maintained to a good standard. What has improved since the last inspection? What they could do better: Assessments and care planning do not always reflect everything that is known about the person or sufficient details to provide an improved quality of life for the person. People living at the service should be supported by individual care plans that contain details of how to improve the outcomes in their daily lives. Specifically the service should seek to understand and record how individual conditions can be best supported. Dunedin Residential Care Home DS0000072846.V375652.R01.S.doc Version 5.2 Page 7 Risk assessments should be further developed to reflect the whole risk assessment process and the information translated into the action in care plans. The home needs to develop a system whereby the premises are regularly checked in relation to maintenance and health and safety. This with particular reference to ramps, window restrictors and keypad locks being installed and all being appropriately risk assessed so that service users are safe. The home should finalise the upgrade of the premises in relation to the activities room and garden so that the physical design and layout of the home enables people to live in a safe, well-maintained and comfortable environment, which encourages safe systems and independence. Some furnishings and equipment are unsuitable for the assessed needs of those people using them. This causes damage to the furnishings and does not support people’s dignity. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Dunedin Residential Care Home DS0000072846.V375652.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dunedin Residential Care Home DS0000072846.V375652.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People considering moving into the home can be assured that their needs will be considered before any agreement to their admission. They cannot be fully assured that these needs will always be documented fully. EVIDENCE: The assessment documents of the people who were most recently admitted to the home were considered at this inspection visit. These included the social worker’s initial assessment (COMM 5) of the person that detailed the basic reasons why the person needed to move to a residential care setting and gives some background to their previous history. Dunedin Residential Care Home DS0000072846.V375652.R01.S.doc Version 5.2 Page 10 This information is supported by the service’s own assessment which has been reviewed since the last inspection with new documentation now in place. It is divided into two sections physical health and mental health. This form covers essential ‘admission information’ about the individual and their needs in terms of daily living including such issues as mobility and skin health and the service users own perception of their mental health. In the two records reviewed some areas of the assessment could have been completed with more specific detail. The format used by the service would provide sufficient information to determine the suitability of the person’s admission to the service, although this could be undermined by the lack of consistency in their completion. The manager stated that consistency in documenting care was an area being addressed via training and supervision and the AQAA identifies a need to ‘keep on top of paperwork’. The intention of a full assessment is to ensure that the service is satisfied that they can meet the persons needs, that there are the resources in staff and equipment to support their needs, and where these need to be arranged prior to admission time is given to do so, and that the existing group of people living at the home will not be disadvantaged by the admission. This provides a well-planned and positive admission. However this is reduced where all the information known about the person is not included. The service’s Annual Quality Assurance Assessment says that they provide prospective residents with their colour brochure and encourage people to visit the home to look around and to ask staff any questions they may have. They also encourage people to stay for coffee or lunch to familiarise themselves with the home. They feel they have received positive feedback about their admission processes in the past. The AQAA does not describe the assessment process and how this provides assurances about the quality of the admissions to the home. As part of the inspection process, the Commission sent surveys to people living at the home and their supporters. 5 surveys returned by people living at the home all indicated that they felt they had received enough information about the home before they moved in, and in discussions with people on the day of inspection they said that whilst they mostly had not visited the home prior to moving in, their relative had visited and gained information that they brought back to them. 3 relatives surveys returned indicated differing views with one saying ‘yes’ they did get enough information about the home another saying ‘sometimes’ and another stated ‘usually’. Some people recalled being visited at their previous residence by the manager to discuss how they lived and what they liked and didn’t like. The service does not provide intermediate care. Dunedin Residential Care Home DS0000072846.V375652.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. This is what people staying in this care home experience: 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. People who use the service cannot be confident that all areas of their assessed needs are fully documented and understood by staff. EVIDENCE: The care plans for three people living at the home were considered at this visit and their support was case tracked. The plans demonstrated a response to the assessment documentation seen and contained elements of the individual’s personal, social and health needs of daily living. The plans have all been reviewed with new paperwork in place. We were told they have been made more person centred. The AQAA also states “Person centred care plans are fully updated and all in place to be tried and tested”. Care plans include a short personal overview of the person intended to support Dunedin Residential Care Home DS0000072846.V375652.R01.S.doc Version 5.2 Page 12 staff in gaining an immediate insight into the person and the issues that affect them. The care plans are then broken down into a list comprising of four sections. These were - Physiological needs - Relationship needs - Looking toward the future - To be accepted and understood as an individual. These care plans were noted to be a generic template specific to residential care and required individualising by adding details of specific conditions that may affect the service user. An example of this was a plan reviewed which made reference to a specific communication problem in the pre admission assessment, but this was not identified within the new care plan as an issue for that individual which would need monitoring. Another two care plans reviewed made reference in one case to the service user being prone to falls and another to smoking but again this was not identified and a risk assessment had not been formulated to support this. Overall the care plans were seen to contain information that gives indications of the person’s abilities and care needs. There was evidence of some areas of their health, personal and social needs being identified and instructions provided to staff in how to support these. There are general considerations made in the plan of how the person’s independence can be supported and the instructions that would provide staff with sufficient information to meet the person’s needs to a safe level. This requires more detail to ensure they are also maximising the person’s abilities. There were also some areas which required further clarification in daily living needs compared to the information gathered during the assessment of needs process or in daily records. This was particularly significant where daily records did not correlate with problems identified from that assessment. Some evaluations were noted to be repetitive and comments such as ‘appears well and content’ and ‘seems fine this am’ did not indicate how the service users overall need is met in an individual way. The service also uses a weekly and monthly summary of the person to review their plan of care. The information needs to be consistently transferred to the care plan to ensure they reflect actual needs and practice. Care plans contained a range of risk assessments relating to the person’s daily living. These include moving and handling and risk of falls. Risk assessments were also on files for safe use of bath and the risk of scalding. The assessment states that staff testing temperatures prior to a person stepping into the bath will reduce the risk. Bathrooms have thermometers and the records of the water temperature recording was generally up to date with a few omissions. The health support provided by medical visits professionals visits were monitored in specific forms for the GP and District Nurse, The forms contained Dunedin Residential Care Home DS0000072846.V375652.R01.S.doc Version 5.2 Page 13 details of the reason for the visit as well as the outcomes. This information was transferred to care plans and medication records where appropriate. People spoken with who lived at the home said that they felt they are well cared for by staff. One person said “I have no complaints they look after me very well” and one relative survey returned stated “They care for my relative very well and all their physical needs are always met”. The AQAA said that the service encourages independence where possible and respects equal opportunities and dignity through the provision of up to date well organised care plans that are reviewed by the manager and deputy. Overall the care plans do provide a level of information to staff in meeting individual’s needs. These are developing in their focus on the person and their abilities, but require more attention to the consistency of information gathered through needs assessments, risk assessments and daily records. People who live at the home do not feel the staff do not support them and this indicates that staff work intuitively in providing support. This will ensure that people’s basic needs are met, but does not demonstrate how they are using information to provide a consistent approach to improving the quality of the care they provide. The medication administration, storage and recording practice of the service was observed during the inspection visit. There was a good application of dispensing undertaken by staff with clear understanding of responsibilities in signing and securing medications. The only minor issue identified related to two signatures not being evident on transcribed medications. This was discussed with the manager and noted. Medication audits may be of benefit in this area to ensure best practice and adherence to the Royal Pharmaceutical Society of Great Britain’s guidance relating to medication. The rapport between staff and people living at the home was good, and throughout the day of the inspection staff were attentive and respectful to peoples needs. They chatted and joked readily with people obviously enjoying their interaction. People spoken with during the inspection spoke fondly of the staff and wanted to tell us how much they appreciated the support they received. Dunedin Residential Care Home DS0000072846.V375652.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. This is what people staying in this care home experience: 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. People in the care home can expect that the daily routine and activities in the home are flexible and optional to suit their individual needs and wishes and they are encouraged to make choices with regard to their social, cultural, religious and leisure activities. EVIDENCE: The people living at the home spoke to us about the way in which they made choices and filled their day. They told us that they have their own routine of activities that they enjoy such as watching TV, knitting and gardening. One person grows tomatoes and others in particular four ladies, enjoyed watching all murder mystery programmes. In addition some people continue to attend outside clubs such as Clacton Family Support and a reflexologist visits the home. The weekly activities programme posted in the home and all care plans included daily walks, watching TV, bingo, ball games, darts and armchair exercise which related to individual’s needs and wishes. Dunedin Residential Care Home DS0000072846.V375652.R01.S.doc Version 5.2 Page 15 The service’s AQAA states they plan to “Have the new activities centre being built in the grounds ready for use and employ an activities co – ordinator.” The home obtained a grant to do this and this was noted to still be under construction on the day of inspection. The manager also stated “We also ask our residents what they would like to do as they have choices. We like to take them out when we can and have external entertainers in for birthdays etc”. A lady comes in from Age Concern every Thursday who chats with the residents and Holy Communion is held twice a month. The services provide a choice for people with different beliefs. People living at the home were generally satisfied with the opportunities on offer for engagement and occupation. They had good relations with each other and readily joined in discussions with each other and staff. At the time of this inspection there were only eight residents in house although the home’s AQAA refers to occupancy being only eleven residents and the home is registered for twenty people. The manager stated that staff have more time to spend with residents and this enhances care delivery. One person spoken with stated “They always stop and chat and I like that”. Social care plans are now included in person centred care plans and detail how the service promotes an individual approach to meeting people’s social needs. The quality of meals was not commented on in the surveys returned to the Commission by people who lived at the home. However those spoken with on the day of inspection had no undue complaints. The service operates a fourweek planned menu with a minimum of two choices on offer at each main meal. Food was home cooked and presented in an appetising way. Dietary requirements and preferences were catered for and records of these are kept in the kitchen. Nutritional records are also in all care plans. Staff were observed asking people for their choices and demonstrated a knowledge of the individuals preferences and needs when doing so. Dunedin Residential Care Home DS0000072846.V375652.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at the care home can expect that they will be listened to through the home’s complaints and safeguarding adults systems and their concerns acted on EVIDENCE: All the staff have undertaken training in the safeguarding of adults from abuse The last POVA course attended by staff was in November 2008. Staff spoken with during the inspection were able to give a good account of the safeguarding process both in the home and the responsibilities of other organisations. The service has a policy relating to the reporting of abuse and protecting staff that whistle blow. Both documents meet the expectation of the local guidance and the National Minimum Standards for Care Homes 2001. There have not been any reported safeguarding issues for this service in the last twelve months. The complaints procedures are publicised in the home and people spoken with were clear that they had the right to bring up matters that concerned them with the manager. The service maintains a complaints log that details the issue under consideration and its outcome. Dunedin Residential Care Home DS0000072846.V375652.R01.S.doc Version 5.2 Page 17 The AQAA details that the home has received no complaints since the last inspection and states “We have an open door policy and we are approachable” Dunedin Residential Care Home DS0000072846.V375652.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the service can expect the premises to meet their needs and expectations overall. Some people cannot expect the equipment and furnishings to be suitable for their assessed needs. EVIDENCE: A tour of the premises was conducted and all communal areas, the laundry, kitchen, sleep-in room, bathrooms and some bedrooms were visited. Since the last inspection some carpets have been replaced, all bedrooms have been redecorated and six new beds have been purchased to enable the hoist facility to go under the bed when moving and handling residents. Dunedin Residential Care Home DS0000072846.V375652.R01.S.doc Version 5.2 Page 19 At the time of this inspection there were only eight residents in house although the home’s AQAA refers to occupancy being only eleven residents and the manager stated that as rooms were vacated these were being decorated in a systematic way A number of other improvements were noted in the home’s AQAA which included “A new wet room, secure fencing and a wall erected outside. A new hoist to the top upstairs bathroom and new toilets by the laundry room. The downstairs shower room has been retiled and a new security light fitted in the front porch.” We were informed that as the home is considering varying its’ conditions of registration to include provision for dementia that keypad locks are being installed in areas such as the front and back door and stairwell door areas. On some doors seen there were double chubb locks insitu as the proprietor thought ‘these would be an adequate alternative to keypads’. Chubb locks only allowed access one way therefore restricting service users. The proprietor was informed that these should be removed and an adequate non restrictive alternative used. Another area of concern was a metal ramp that had been installed by the proprietor himself a couple of days prior to the inspection. The gradient was very steep and it consisted of a metal construction and was not non slip and posed a potential serious health and safety hazard. Upon discussion with the proprietor it was proposed that this would aid wheelchair use to that area and or help service users who may have a ‘shuffling gait’. The ramp area was not big enough to facilitate safe wheelchair use and turning and a service user would only have to catch their heel on the ramp to sustain a fall. The proprietor agreed he would review this option and remove the unsafe ramp. He also agreed to renew the window restrictors on all the upstairs windows as they consisted of a weak piece of chain which could easily be broken and some already had. The home prior to the new registration had a maintenance man and this changed when the new registration was progressed. A discussion was held with the proprietor with regard to the need for adequate and safe maintenance throughout the home and that the availability of permanent maintenance man and or qualified professional external contractors would be of benefit to the home. The home should have a system that ensures maintenance matters are managed and dealt with appropriately. The home’s AQAA also identifies a need to “employ a maintenance man” Overall the home is reasonably maintained and the décor was neutral and fresh. The manager said that other areas that require attention were to be included in the annual renewal plans over the coming year. Communal areas were light and spacious with comfortable furnishings with no noticeable odours. Overall the impression is of a homely environment where people are comfortable. In general the service does need to ensure that its choice of furnishings are appropriate to the assessed needs of people living at the home. One example seen was that of the dining room which had two large tables in a small area. As the home is making an application for dementia category which would Dunedin Residential Care Home DS0000072846.V375652.R01.S.doc Version 5.2 Page 20 increase their service user base, the design of this would not facilitate twenty people and smaller tables should be considered. Also it was noted that the pale cloth seats on dining chairs that had plastic bags covering them in order to protect them from discolouration, do not promote dignity for the individuals concerned. The manager told us that twenty new chairs had been ordered with tables but were yet to be delivered. The service’s AQAA states they plan to “Have the new activities centre being built in the grounds ready for use.” The home obtained a grant to do this and this was noted to still be under construction on the day of inspection. Following the inspection we were notified by the proprietor of the home that they had addressed the issues raised and this will be followed up at the homes next inspection. Dunedin Residential Care Home DS0000072846.V375652.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the service can expect that there would be sufficient staff available to meet their needs. They can expect to be supported by staff that have the knowledge and skills required to meet their needs. EVIDENCE: The staff arrangements and numbers are two care staff, and the manager on duty during the waking day, with support from catering and housekeeping staff. There is two staff on duty overnight one awake and one sleeping in. The service was not fully occupied at the time of the inspection and the numbers on duty appeared to provide sufficient time for staff to spend with people living at the home. This was confirmed by discussions with people at the inspection and in all five residents surveys returned prior to the inspection. People said that they ‘always’ received the care and support they needed and one survey stated “ they (staff) are always friendly welcoming and see to my needs” and “ I love this home” Dunedin Residential Care Home DS0000072846.V375652.R01.S.doc Version 5.2 Page 22 The manager and staff spoken with outlined the daily routine of the home and identified periods within their shifts where there was time allowed to spend time with people in activities either in or outside the home. They felt they had sufficient staff cover to meet their needs without rushing. A discussion was held with the manager regarding the dementia category application and the need to increase staff in line with dependencies and occupancy. The staff training programme and matrix demonstrated that staff undertook a variety of courses pertinent to their work including skin care, medication, dementia, Safeguarding, falls prevention, infection control, fire safety, food hygiene, first aid, moving and handling and funeral awareness. Other areas relating to the assessed needs of people living at the home, such as Parkinson’s disease, advanced dementia and risk assessments and care planning would be beneficial. The manager stated that this was already underway and staff had already started basic and in depth dementia training and were attending deprivation of liberty workshops. All other courses are planned for this year. All but one of the staff had completed their (National Vocational Qualification) NVQ level 2 and five staff are now undertaking their NVQ level 3. This maintains the services to over 50 compliance with the standard relating to a national qualification for its care staff. In addition staff are and have taken NVQ 2 in cooking and NVQ in COSHH (Control of substances hazardous to health). Staff files were examined to determine how the service carried out its recruitment process. The documents on the files seen demonstrated a robust approach with checks made on the person’s Criminal Records check prior to employment and the Department of Health Safeguarding list, as well as two written references, and proof of the persons identity. These with the completed application form assist the service to determine whether the person is of a suitable background to work with vulnerable people. Dunedin Residential Care Home DS0000072846.V375652.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the service can expect to be supported by leadership who have demonstrated their suitability for the role and their health and welfare maintained. EVIDENCE: The manager has completed her fitness interview with the Commission to become a registered manager. They have been working at the home and for a number of years in other posts and know the service and the people living there well. Dunedin Residential Care Home DS0000072846.V375652.R01.S.doc Version 5.2 Page 24 The proprietor reported that a specialist company had been contracted to carry out quality assurance training and implement a quality assurance model to help the service to move forward. This had not been achieved at the time of inspection and there was not any formal quality assurance system in place. Staff supervision was discussed with the manager and staff and records examined in staff files. Staff were clear that they received regular supervision and outlined the agenda that these followed, which included discussion of training needs. The deputy manager and manager undertake all supervision of staff and direct training in supervision which may prove useful in their development. The completion of the AQAA was noted to be brief and non specific in areas, and included repetitive statements such as ‘To maintain standards’. Although it showed an understanding of the home a much more detailed completion is required and would have clarified the home’s development and progress. The proprietor and manager are reminded that there is an expectation that the AQAA is an up to date audit tool for the home required by law, and should identify how the home plans to develop and ensure positive outcomes for residents. Records required for the protection of service users and for the efficient and effective running of the care home were inspected and reviewed during this inspection. We were informed that all the home’s policies and procedures have been renewed in January 2009 and upon review these were noted to be appropriate and up to date. Schedule 2 records, Information and Documentation in Respect of Persons Carrying on, Managing or Working at a Care Home, were generally found to be in good order. There are systems in place to maintain the health and safety of the home, and a clear policy statement of the arrangements to maintain health and safety in the home, including employer and employee responsibilities, however this should be addressed with regard to recent maintenance tasks undertaken within the home detailed earlier in this report. Staff training records showed that staff had received training in relevant health and safety topics, including the moving and handling of people. The home maintains records to show that equipment and utilities are regularly serviced, and that appropriate internal checks are carried out. Records relating to the fire safety checks were in place and regular fire drills and checks on equipment were recorded. Dunedin Residential Care Home DS0000072846.V375652.R01.S.doc Version 5.2 Page 25 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 2 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 2 x x x x x 2 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 x 3 2 2 Dunedin Residential Care Home DS0000072846.V375652.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Not applicable? 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 OP19 Regulation 13 Requirement The home needs to develop a system whereby the premises are regularly checked in relation to maintenance and health and safety. This with particular reference to ramps, window restrictors and keypad locks being installed and all being appropriately risk assessed so that service users are safe. And upgrade the premises in relation to the activities room and garden so that the physical design and layout of the home enables people to live in a safe, well-maintained and comfortable environment, which encourages safe systems and independence. Timescale for action 30/09/09 Dunedin Residential Care Home DS0000072846.V375652.R01.S.doc Version 5.2 Page 27 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 OP3 Good Practice Recommendations People moving into the service should have all their needs, strengths and aspirations documented. This will ensure that the service is fully aware of these and how they will support them before they agree to the admission. People living at the service should be supported by individual care plans that contain details of how to improve the outcomes in their daily lives. Specifically the service should seek to understand and record how individual conditions can be best supported holistically as described in the case of Ataxia not evidenced on the day of inspection. The employment of maintenance personnel would be of benefit as this would ensure service users live in a safe well maintained environment. The quality of information provided to the Commission in the Annual Quality Assurance Assessment should support the understanding of how the service is complying with their responsibilities under the Care Standards Act 2000 and what steps they are taking in order to improve the outcomes for people living at the service. 2 OP7 3 4 OP25 OP37 Dunedin Residential Care Home DS0000072846.V375652.R01.S.doc Version 5.2 Page 28 Care Quality Commission Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.eastern@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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