Inspection on 31/07/07 for Dunnington Lodge Nursing Home

This inspection was carried out on 31st July 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Dunnington Lodge Nursing Home 22/07/08

Dunnington Lodge Nursing Home 22/08/06

Dunnington Lodge Nursing Home 31/01/06

Dunnington Lodge Nursing Home 03/05/05

Dunnington Lodge Nursing Home 22/02/05

Dunnington Lodge Nursing Home 08/09/04

Dunnington Lodge Nursing Home 17/03/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Dunnington Lodge Nursing Home 34 Church Street Dunnington York North Yorkshire YO19 5PW Lead Inspector Jean Dobbin Unannounced Inspection 31st July 2007 09:15 31/07/07 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 Dunnington Lodge Nursing Home DS0000028000.V343640.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. Dunnington Lodge Nursing Home DS0000028000.V343640.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dunnington Lodge Nursing Home Address 34 Church Street Dunnington York North Yorkshire YO19 5PW 01904 488676 01904 488513 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) Mr Richard Hugh Richardson Mrs Gill Richardson Not applicable Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19), Terminally ill (4) of places Dunnington Lodge Nursing Home DS0000028000.V343640.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service Users to include up to 19 (OP) and up to no more than 4 (TI) up to a maximum of 19 Service Users. 55 years plus Date of last inspection 22nd August 2006 Brief Description of the Service: Dunnington Lodge is owned by Mr and Mrs Richardson and is registered to provide general nursing care and accommodation for up to 19 service users from the age of 55 years. Dunnington Lodge is a large period building situated in the village of Dunnington on the outskirts of York and the local village amenities are within easy reach of the home. Details provided by the owners in July 2007 state that the current charges are between about £490 and £535 a week. Services like hairdressing and chiropody are included in these fees although outings and individual items, like newspapers, are not. The owners have produced a Statement of Purpose and Service User guide for people who are interested in moving to the home. Recent CSCI reports of the service are also available at the home to look at. Dunnington Lodge Nursing Home DS0000028000.V343640.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is what was used to write this report. • • • Information about the home kept by the Commission for Social Care Inspection. Information asked for, before the inspection. This is called an Annual Quality Assurance Assessment. (AQAA) Information from surveys, which were sent to people who live at Dunnington Lodge, their relatives, and other professional people who visit the home. 10 were sent to people at the home and 5 were returned. 8 were sent to peoples’ relatives and 3 were returned. 6 in total were sent to GPs, Care Managers and healthcare professionals. 2 of these were returned. A visit to the home by one inspector, which lasted about 7.5 hours. This visit included talking to residents and visitors, and to staff and one of the owners about their work and training they had completed. It also included checking some of the records, polices and procedures that the home has to keep. • Information about what was found during the inspection was given to Mrs Richardson at the end of the visit. What the service does well: All people are assessed before they agree to move to the home so that they know that the home will be able to support them properly. People live in a very homely environment with furniture and décor in keeping with the age of the house. There are enough staff on each shift to make sure that peoples’ needs are well met. Staff know about the people they support and the residents spoken with liked them. “The staff are lovely, they are so kind”. Another said they “certainly know what they are doing”. The menu provides traditional meals, which are repeated every four weeks. People spoken with were very complementary about them. Dunnington Lodge Nursing Home DS0000028000.V343640.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The care planning records describing how people are to be supported in the home need to be more individual. This means that they should describe what carers have to do to help people to be as independent as possible and to stay in charge of their own lives as far as possible. Staff should always record their discussions with healthcare professionals in the care plans, to show that the communication took place. Advice from healthcare professionals should always be followed in order to promote people’s health and welfare as much as possible. Medicines belonging to people who no longer live at the home must be got rid of in line with the home’s policy. The home must always have a way that waste drugs can be disposed of safely. People requiring pureed meals because of a swallowing problem should have the different parts of the meal pureed separately so that they provide different tastes and look more appealing. The menu, including pureed alternatives should be displayed so that people can look forward to their favourite dishes. The owners must satisfy themselves that all staff know what to do should they hear or see something that may be an abusive situation, so that people can be protected from harm. The registered owners should continue to encourage and support carers to achieve a National Vocational Qualification Level 2 in Care. People are more Dunnington Lodge Nursing Home DS0000028000.V343640.R01.S.doc Version 5.2 Page 7 likely to receive safe, consistent care from carers who have a good understanding of their work. Staff recruitment files need to be put together in a different way. This is so that authorised people can check that no one starts working at the home until the recruitment process, including police checks have been completed. The owner needs to discuss with prospective employees why they do not want their most recent employers to provide a reference and the reasons need to be written down to show that the owner has seen and explored this. These good practices will show that the owner is protecting people from harm. Records relating to how the home runs must be available for inspection. These include the staff training records, maintenance records and service certificates. This is so that authorised people can look at them to check that things are being done properly. The hot water temperatures of all the taps that people living at the home have access to must be monitored. Records should be kept to show how the risk of people being scalded, from water that is too hot, is minimised. The owners need to make sure the Commission is informed of all events and illnesses, which may seriously affect the well being of people who live at the home. This is so that these events can be monitored. The owners must make sure that bedrails are fitted, checked and maintained properly in order to keep people safe and prevent them coming to harm. 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. Dunnington Lodge Nursing Home DS0000028000.V343640.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 Dunnington Lodge Nursing Home DS0000028000.V343640.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People who use this service experience good quality outcomes in this area. All people thinking of moving to the home are assessed prior to the move to make sure that the home can meet all their needs. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: All people who wish to move to the home have an assessment completed before they move there to check that the home can meet their needs. The nurse on duty and the carers confirmed that Mrs Richardson carries out these assessments. However the care plans looked at did not contain this assessment. Both contained comprehensive assessments completed by the care manager. Dunnington Lodge Nursing Home DS0000028000.V343640.R01.S.doc Version 5.2 Page 10 Mrs Richardson explained that she sees prospective residents and creates a plan of care from the notes that she makes at the meeting. She now keeps these records and was able to demonstrate this by showing her notes in a care plan belonging to a person who had moved to the home recently. She sends a brochure to those people expressing an interest to move to the home. A Statement of Purpose and Service User guide is made available for people to read though a copy is not displayed in the entrance hall. People can look around the home and also stay for a trial visit, if they choose, to help them decide whether they want to move there. Staff said that they were always informed when new people were arriving and told about what help they would need so that they would know what to do when the new person arrived. Intermediate care is not provided at Dunnington Lodge Dunnington Lodge Nursing Home DS0000028000.V343640.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use this service experience adequate quality outcomes in this area. Whilst some health and personal care needs are well addressed, the way the home runs does not enable and encourage people to retain some control of their lives. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Two care records were looked at. These should describe the care and support that a person needs in order to still be in charge of their life and be as independent as possible. Whilst carers were generally treating people individually the care plans did not evidence that this was happening. The two people, whose records were looked at, had very different needs but their plans of care were very similar. The care plans describing ‘washing and dressing’ were identical. This did not reflect the people’s individuality. Dunnington Lodge Nursing Home DS0000028000.V343640.R01.S.doc Version 5.2 Page 12 None of the care plans were written in a way that recognised people’s ability to contribute to their care and maintain some control in their lives. There were no care plans to reflect communication difficulties. For example the best way to speak with people who were deaf or poorly sighted was not recorded. There were assessments in place to identify whether someone was at risk of developing bedsores, falling, or becoming malnourished, because of poor appetite or a health problem. Although these were all reviewed there seemed to be no consistency in how frequently this was done. One person’s assessment described them as ‘high risk’ of developing a bedsore and they had developed a skin problem since moving to the home. There had been no change in the equipment provided, though, to prevent a bedsore developing. Whilst the owner said that a discussion had been held with healthcare professionals about this, it had not been recorded. One person wore continence aids all the time, and a carer spoken with said that a toileting programme was therefore not necessary. This does not recognise a person’s dignity. A healthcare professional had written in the care plan that a toileting programme should be set up. This has not been done. Although these records need improving people living at the home looked well cared for. Their clothes were clean and ironed. The carers were observed speaking kindly and gently to the people who live there. One person though was being moved within the home and the staff discussed where the person should sit in the lounge, instead of asking them where they wanted to sit. This too was discussed with the owner. The care plans recorded visits from the GP and chiropodist. The doctor who completed the survey said that the home delivers good one-to-one care to the people who live there. The healthcare professional was also complementary about the care provided. The medication processes were looked at. Nobody looks after their own medicines in the home. The home uses the NOMAD medication system, where tablets are dispensed from a cassette. The record sheets were completed appropriately and all the drugs not stored in the cassette are counted each week to check that the actual number of tablets tallies with the projected number. This is good practice and confirms that drugs are being given and signed for according to the prescription. There were however drugs in the cupboard belonging to people who were no longer at the home. The container for these waste drugs though was full and sealed and so drugs could not be disposed of in line with the home’s policy. This too was discussed with the owner. Dunnington Lodge Nursing Home DS0000028000.V343640.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use this service experience good quality outcomes in this area. Whilst people enjoy their life at Dunnington Lodge some people’s dining experience needs improving. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Those people spoken with said they were very happy living at Dunnington Lodge. They said that they choose when to get up and go to bed. One person said they normally went to bed about seven but sometimes they were tired and then they were helped to go to bed earlier. Two from the three responses said that staff helped people living there to live the life they choose. Visitors are welcomed at any time and the visitor’s book confirmed this. Some people were sitting in their room, others in the lounge or dining room. One person sat outside and had their lunch in the garden. One visitor though Dunnington Lodge Nursing Home DS0000028000.V343640.R01.S.doc Version 5.2 Page 14 said that their relative had a shared bedroom and talking to them there was not very private. There is no activities person employed at the home however one or two carers have protected time once a week to organise some type of activity, like bingo or quizzes. One person said they really enjoyed these. The home also has small trips out, when they hire a wheelchair-adapted minibus. There has been a recent trip to a local garden centre for lunch. Outside entertainers visit each month and visitors are allowed to bring dogs into the home. The home tries to integrate within the village community. The vicar gives communion at the home every six weeks and people sometimes attend the service at the village church. The dining room would not be big enough if all the people living there wanted to eat there. The tables are attractively presented with cloth table covers and cloth serviettes. The lunch was shepherd’s pie, cauliflower and carrots and looked very appetising. There was apple crumble for dessert. There was no alternative meal. One person said in their survey that they wished there was an alternative menu. Those people spoken with were very complementary about the meals. One person said “it’s marvellous here: The food and everything”. The menu was not displayed and this would be good practice, as it would allow people to ‘look forward’ to a favourite meal. Those spoken with did not know what was for lunch. There were enough staff to assist people in a discreet way, however those people requiring pureed meals because of swallowing difficulties, did not have the different foods prepared separately. The meal looked very unappetising and different meals would look very similar if they are all prepared in this way. The presentation of meals to encourage appetite and maintain nutrition is just as important for people with a swallowing problem and this area of care was discussed with the manager. Dunnington Lodge Nursing Home DS0000028000.V343640.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use this service experience good quality outcomes in this area. Complaints are well managed, however all staff who work at the home need to understand their responsibilities to report possible abuse, to protect people from harm. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The complaints policy is displayed in the entrance hall. There have been no complaints to either the owners or to the Commission in the last year. All the surveys completed by people who live at the home said that they knew who to complain to if they were unhappy. Two people spoken with said they knew who was in charge of the home and would say if they were unhappy about something. However one person spoken with said they would not tell anyone if someone had been horrid to them. The manager needs to promote an open culture where people feel comfortable telling someone their concerns. Two of the three relatives who responded, however, said they did not know how to complain. The manager needs to be confident that everyone has this information so that they can comment if necessary. Dunnington Lodge Nursing Home DS0000028000.V343640.R01.S.doc Version 5.2 Page 16 An adult protection policy is in place and staff attend safeguarding adults training. Two carers spoken with confirmed they had attended training this year and one said they had had this training when they first started working at the home. Whilst two staff members were very clear about their responsibilities should they hear or see something that concerns them, one person when questioned was not sure what they would do in that situation. The manager needs to be confident that all staff understand the need to report any possible abusive situation immediately. There has been one safeguarding adults referral since the last inspection and the owner and staff cooperated in the investigation. The outcome of this could not be determined. There are no advocacy leaflets available at the home and this was discussed with the manager. Two recruitment files looked at both contained police checks to show that prospective employees were not barred from working in a care service because of a previous offence. These systems are in place to protect people from harm. (See Standards 27 – 30). Dunnington Lodge Nursing Home DS0000028000.V343640.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use this service experience adequate quality outcomes in this area. People accept the less than ideal layout in order to live in an old house, which is comfortable and clean. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Dunnington Lodge is a very attractive rambling old house in the centre of the village. A tour of the home showed it to be warm, clean and comfortable with no unpleasant odours. Some parts of the home though look quite worn and the owner is slowly addressing these. The dining room, sitting room and one bedroom have been redecorated since the last inspection. The downstairs Dunnington Lodge Nursing Home DS0000028000.V343640.R01.S.doc Version 5.2 Page 18 carpets are to be replaced later this year and were being cleaned by a contractor on the day of the site visit. The gardens also are very attractive. Two people were sat out there on the day of the visit. The access though is gravel and this means it is difficult to push people in wheelchairs. One carer said “you have to have good muscles”. This may discourage some visitors and staff from taking people outside. There is also a rather uneven slope up to the house from the pavement and one visitor said this made it quite hard to go into the village with someone in a wheelchair. Portable ramps are used to get in and out of the building. There are five shared bedrooms and three more people share one room. One person spoken with said they didn’t mind sharing and said that staff always used a screen when helping someone to ensure their privacy. This was also noted on the site visit. There are bedrooms on three floors and stair lifts aid access. The age and design of the house though means that there are small flights of stairs to reach different areas within each floor. This means that many of the people are restricted as to where they can go because of their mobility. There is a lounge and dining room on the ground floor. The dining room though is a throughway to other rooms and the office. Because people often have a shared bedroom this can mean there is limited space for people to talk in private. Four sound activated door closures have been bought since the last inspection so that fire doors can be held open by these authorised means. One person who uses an electric wheelchair said it was now easier to get in and out of their room. Whilst the owner kept her office door wedged open, when she was there, no other doors were seen wedged open. There are adequate assisted bathing facilities and the manager hopes to redecorate some of these later this year. The home though has no sluicing disinfector to enable commode pots to be cleaned effectively. This means that the pots cannot be effectively and safely cleaned and the registered owners should gain advice about the best way to protect people’s health and safety without this facility. The home has a number of moving aids but there is insufficient storage space for these and the wheelchairs. The laundry room is well equipped. Staff were seen wearing plastic aprons and gloves when carrying out personal care. This good practice provides protection from the spread of any possible infection. Dunnington Lodge Nursing Home DS0000028000.V343640.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use this service experience good quality outcomes in this area. There are adequate numbers of staff with the skills to care for people but recruitment processes need to be more robust. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The staffing levels are satisfactory at the home. There is a trained nurse at the home at all times and there are four carers in the morning, three in the evening, and one carer at night. The rota confirmed this. The owner is not included in these numbers. There is a domestic each day, and whilst the cook does not work after 2pm, a carer starts work at 4pm and goes straight into the kitchen. This person does not provide any personal care until after the meal. The manager said that some carers have a food hygiene certificate and where possible those are the ones that carry out the kitchen duties. The staff spoken with said they felt there were enough carers and people spoken with, who live at the home, agreed. One person said their call bell was Dunnington Lodge Nursing Home DS0000028000.V343640.R01.S.doc Version 5.2 Page 20 always answered, though said they sometimes had to wait because they were seeing to someone else. One person said in their survey that, “the carers are very caring”. Another commented. “The staff are lovely, they are so kind. There isn’t one I don’t like”. The staff training records were not available for inspection. One carer spoken with said that they had attended training in moving and handling, fire safety and abuse awareness earlier this year. This could not be confirmed. Another carer had not worked at the home for very long. She said that when she started working she had several days where she shadowed another carer so that she could learn good practice from her. The carers said that the trained nurses at the home were very supportive and enjoyed teaching them new skills and knowledge. They felt supported and felt everyone worked well as a team. About 25 of care staff have a National Vocational Qualification Level 2 in Care. The owners need to encourage and enable staff to attain this award, as people are more likely to be cared for in a safe, consistent way if carers have knowledge and understanding about their role. The staff files for two recently employed staff were examined. Whilst both had Criminal Records Bureau checks to make sure they were not barred from working in a caring environment, the records did not say when they started work. It was therefore not possible to say whether these police checks were completed before they started work. Old rotas were not available to check. One person had worked at two care homes prior to working at Dunnington Lodge. Whilst two references were obtained neither were from these homes. There was no explanation as to why these were not sought. Recruitment processes need to be more robust to keep people safe. Dunnington Lodge Nursing Home DS0000028000.V343640.R01.S.doc Version 5.2 Page 21 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 and 38 People who use this service experience adequate quality outcomes in this area. Whilst the welfare of people and staff are seen as very important there are shortfalls, which may be putting people at risk. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The two owners share the management of the home. Mr Richardson oversees the finances, record-keeping and maintaining service records to ensure the health and safety of the people and staff at the home. Mrs Richardson is responsible for the day-to-day running of the home and the care provision. Dunnington Lodge Nursing Home DS0000028000.V343640.R01.S.doc Version 5.2 Page 22 Mrs Richardson has managed the home for nearly twenty years. She is an experienced nurse who has a good understanding of the needs of the people at the home. People spoken with know who she is and say they see her around the home. Staff said she was very approachable and would be happy to speak with her if they had any concerns. Mrs Richardson is developing systems in the home to show that they are monitoring how they operate so that they and the people who use the service can say what areas need improving. Questionnaires have been sent out to all relatives. Information from these, need to be sorted and displayed. The owners need to decide what action they will take as a result. The home also needs to determine ways that people living at the home can be consulted so that they can influence how the home runs too. Peoples’ personal monies are stored in a safe and the home has lockable boxes which can be given to people, so that items can be kept locked in their rooms. Some health and safety records were checked, but not all were available. The fixed wiring certificate was seen, but the gas safety certificate and service records for the stair lifts were still not available for inspection. These records were not seen at the last inspection and a requirement was made. PAT testing records and fire appliance checks were satisfactory. The fire risk assessment, fire training records and emergency lighting checks were also requested to show that the owners are protecting the health and safety of people and staff. These were sent to the Commission in the days following the visit. The service record for the stair lifts is still outstanding. Random temperature checks on two hot water taps showed that they were close to the recommended temperature. Records of hot water monitoring are not kept however and the owners need to demonstrate that checks are routinely carried out at the home to minimise the risk of people getting scalded. This was discussed with Mr Richardson. The owners are required to notify the Commission of potentially serious events and illnesses that may affect the residents at the home so that they can be monitored. This was not always happening and was discussed with Mrs Richardson. The management of bedrails also needs to be made much more robust. One person had trapped their hand between the bed and the bedrail, causing swelling and bruising. This had been recorded on their care plan. When checked though their bedrail was still positioned incorrectly with the risk of entrapment. They had not had an assessment for using rails on their bed. On touring the home at least three bed rails were seen incorrectly fitted. All were fitted too far from the head of the bed. This poses a risk of people trapping their head and coming to serious harm. Mrs Richardson was shown these Dunnington Lodge Nursing Home DS0000028000.V343640.R01.S.doc Version 5.2 Page 23 bedrails and she immediately corrected them and checked the rest of the rails that were in use. The owner needs to be sure that bedrails are fitted correctly and regularly checked to make sure they remain in the right position in order to protect people from harm. Dunnington Lodge Nursing Home DS0000028000.V343640.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 1 Dunnington Lodge Nursing Home DS0000028000.V343640.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes 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 OP8 Regulation 12(1) Requirement Records should be kept of communications with healthcare professionals to show that these conversations took place. The owners must satisfy themselves that all staff working at the home know they need to report any potential abusive situation promptly. Health and safety service checks need to be available for inspection to confirm that the welfare of the residents and staff is being protected. Previous timescale not met. People requiring bedrails must have a clear assessment identifying need and consent and they should be fitted to the bed, checked and maintained according to MRHA (Medicines and Healthcare products regulatory Agency) guidelines, in order to keep people safe. Timescale for action 31/07/07 2. OP18 12(1) 31/08/07 3. OP38 13(4) 31/08/07 4. OP38 13(4) 31/07/07 Dunnington Lodge Nursing Home DS0000028000.V343640.R01.S.doc Version 5.2 Page 26 5. OP38 13(4) The hot water temperatures of all taps to which people living at the home have access, should be monitored in such a way that the risk of people getting scalded is minimised. 31/08/07 7 OP38 Reg 37 The Commission must be notified 31/07/07 of all serious events and illnesses affecting people who live at the home so that these can be monitored. Dunnington Lodge Nursing Home DS0000028000.V343640.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. 2 Refer to Standard OP7 OP9 Good Practice Recommendations The plans of care should be written to reflect a person’s individuality and how their independence and control of their life can be encouraged. Drugs belonging to people who no longer live at the home should be disposed of in line with the home’s policy and equipment should be available to allow staff to follow that policy. It would be good practice for the daily menu to be displayed so that people can look forward to their meals. This should also include pureed alternatives. People requiring pureed meals should have the different parts of the meal pureed separately so that people can enjoy different tastes, textures and colours. The registered owners should have a planned refurbishment programme so that they can advise people when particular areas are likely to be re decorated. It is recommended that the owners take advice from the Environmental Health department about the lack of a sluicing disinfector at the home, so that the risk of a spread of infection is minimised and people’s health and welfare are protected. It is recommended that the home work towards 50 of care staff achieving an NVQ Level 2 or above to make sure care is provided in a safe, consistent way. It would be good practice for references to be obtained from recent employers and if this is not possible then the reasons should be recorded. The staff files should record the date they started work so that people can check that all the recruitment checks are carried out before that date. It would be good practice for the owners to display the results of the questionnaire and to inform people what they are going to do with this information. The owners should also look at ways of making sure the people living at the home can influence how the home runs. 3. 4. 5. 6. OP15 OP15 OP19 OP26 7. 8. OP28 OP29 9. OP33 Dunnington Lodge Nursing Home DS0000028000.V343640.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 - 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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