Inspection on 11/08/08 for Dunollie Care Home

This inspection was carried out on 11th August 2008.

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

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

Dunollie Care Home 27/04/10

Dunollie Care Home 15/01/10

Dunollie Care Home 26/09/09

Dunollie Care Home 31/03/09

Dunollie Care Home 05/11/07

Dunollie Care Home 21/05/07

Dunollie Care Home 27/11/06

Dunollie Care Home 11/05/06

Dunollie Care Home 07/12/05

Dunollie Care Home 19/05/05

Dunollie Care Home 02/11/04

Dunollie Care Home 13/07/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Dunollie Care Home Dunollie Nursing Home 31 Filey Road Scarborough North Yorkshire YO11 2TP Lead Inspector Jo Bell Key Unannounced Inspection 11th August 2008 10:00 X10029.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Dunollie Care Home DS0000043116.V369952.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 and Care Homes for Adults 18 – 65*. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dunollie Care Home DS0000043116.V369952.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dunollie Care Home Address Dunollie Nursing Home 31 Filey Road Scarborough North Yorkshire YO11 2TP 01723 372836 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) DNeuropeancare@aol.com www.europeancare.co.uk European Care (SW) Ltd Manager post vacant Care Home 58 Category(ies) of Old age, not falling within any other category registration, with number (58), Physical disability (58) of places Dunollie Care Home DS0000043116.V369952.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 with nursing - Code N To services 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 Physical Disability - Code PD of the following age range : 40 years and over The maximum number of service users who can be accommodated is: 58 Service Users to include 58 OP and 58 PD up to a maximum of 58 service users. Service Users in the category PD to be aged 40 years plus and require nursing care. 5th November 2007 2. 3. 4. Date of last inspection Brief Description of the Service: Dunollie Care Home provides nursing care, social care and accommodation for a maximum of 58 people. Some of these people may be admitted from the age of 40 years old and may have a physical disability requiring nursing care. The service consists of the main house that can accommodate 49 people and The Lodge that can accommodate 9 people. The home is owned by European Care (SW) Limited and is located on Filey Road in Scarborough, a seaside resort. It is within walking distance of the local shopping area and close to the Italian gardens and Spa complex. It is about a mile away from the town centre. Access to the home is via a steep driveway with car parking facilities outside the main entrance or via steps for pedestrian access. The home is accessible on a level approach from the car park. It is set in extensive, well maintained, grounds that have several patio areas for residents and visitors to enjoy. These are reached from several points around the home without the need to negotiate any steps. The accommodation in the main house is divided into the garden wing, which is specifically designed for people with a physical disability, and the main house for older people with nursing needs. There is a passenger lift access to all floors in the main house. The lodge is a separate building for older people with Dunollie Care Home DS0000043116.V369952.R01.S.doc Version 5.2 Page 5 personal care needs. People are provided with information about the service in the form of a service user guide. The most recent inspection report from the Commission for Social Care Inspection is made available in the home. The current scale of charges range from £387 -£636 per week. Additional charges are made for hairdressing, chiropody and newspapers. Information about the service is available in the previous inspection report and service users guide. Dunollie Care Home DS0000043116.V369952.R01.S.doc Version 5.2 Page 6 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. The Commission for Social Care Inspection inspects homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.csci.org.uk The key inspection took place on Monday 11th August 2008. This visit took place sooner than planned because of safeguarding issues previously raised and not dealt with effectively by the home or organisation. Prior to the visit the information from the following sources was obtained and considered: The annual quality assurance assessment and a recent improvement plan. This is information, which details how the home hopes to improve and the evidence that shows what has happened during the past 12 months. Six surveys from people using the service, one care manager survey and one health care professional survey. Notifications (Regulation 37) relating to incidents in the home affecting people using the service. Details of complaints and allegations raised by people connected to the service. Progress of the previous requirements and recommendations made at the last site visit. At the site visit one inspector spent 8 hours at the home. An ‘expert by experience’ person also spent time in the home speaking with people using the service and their relatives. This person is a member of the public who has previously been involved with care services. During this time observations of care practices took place. People using the service were spoken with along with some relatives. Discussions with the manager regarding meeting needs, mealtimes, protecting people and the environment took place. The lunchtime meal was observed and time was spent inspecting care plans, looking at individual rooms and reviewing a selection of health and safety information. Staffing and management issues were discussed and feedback was given to the manager and matron at the end of the inspection. Dunollie Care Home DS0000043116.V369952.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? Care plans are more detailed and relate to specific needs of individuals. These are reviewed regularly with some risk assessments in place. This helps needs to be met. Staff are clearer regarding their roles, and people using the service are more aware of whom the manager, and matron are. One visitor observed “The staff were all friendly and spoke to the residents in a nice polite manner”. People’s personal monies are looked after in a more robust way. Clear records are available regarding transactions made. Regular invoices are sent to people using the service to keep them informed of the amount of money they have available. Staff complete a formalised induction pack when they commence work. This includes care practices and helps them understand how to meet individual needs. Aspects of the medication system have improved. Controlled drugs are correctly recorded and stock balances and regular checks are in place. This helps to identify and reduce errors occurring. People are now given assistance at mealtimes in a manner, which maintains their dignity. This helps improve the dining experience for people. Care staff have received training in First aid, Infection control, Food hygiene and safeguarding adults. This helps to promote people’s safety and makes sure their knowledge is up to date. The home is cleaner and smells fresher; this is a nicer environment for people to live in. People are able to express their views and opinions more readily, and regular visits from the Area Manager identify what improvements are needed. Dunollie Care Home DS0000043116.V369952.R01.S.doc Version 5.2 Page 8 The range of activities provided has improved; money is being raised for a mini-bus, which will mean more trips outside the home, will be available. This will give people a wider variety of activities chose from. What they could do better: 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. Dunollie Care Home DS0000043116.V369952.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Dunollie Care Home DS0000043116.V369952.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): All Key Standards are assessed. People who use this service experience good outcomes in this area. People are effectively assessed prior to admission, which helps to ensure individual needs can be met. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The four pre-admission assessments looked at confirmed that a senior person completes an assessment on potential clients before an individual moves to the home. This is to check what type of care and support the person needs and whether the staff have the skills and knowledge to provide that care if the individual chooses to move there. The process also reassures the individual and their family that they will receive the right support. Dunollie Care Home DS0000043116.V369952.R01.S.doc Version 5.2 Page 11 Assessments are completed if the person has a care manager or is privately funded. These detail health, personal, nursing, social and mental health needs. All the surveys completed by people living there report that people are given enough information about the service and what it provides. This means they can make an informed choice about whether to move there or not. This process has improved with relevant and appropriate staff undertaking assessments. The home offer intermediate care for people who need rehabilitation. This is not always planned but input from the physiotherapist and occupational therapist is available when required. Emergency respite is offered and staff accommodate people when there is a room available. Dunollie Care Home DS0000043116.V369952.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): All Key Standards were assessed. People who use this service experience adequate quality outcomes in this area. People have their health and personal care needs generally met in a dignified manner, though better communication is needed. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Dunollie Care Home DS0000043116.V369952.R01.S.doc Version 5.2 Page 13 Four care plans were looked at during this visit. These describe the care and support people need to stay in charge of their own lives as much as possible. The plans looked at contained a lot of information, so that an unfamiliar carer could look at them and would be able to work out how much support they needed. There were written assessments as to whether people were at risk of developing pressure sores, or losing weight because of poor appetite or a health problem, or needing help with moving and handling. Those identified as ‘at risk’ had a care plan in place describing how that risk was to be managed. The plans have improved since the last visit. Records showed that the home contacts the doctor, wound care specialist, or community mental health team when needed. Though two surveys returned felt that staff could communicate more effectively with health professionals. Some incidents are reported to the Commission but there can be a delay in receiving this information from the home organisation. An audit of the accidents takes place along with medication audits. This helps to identify if there are any patterns to the accidents occurring or if medication systems are working effectively. People looked clean and well cared for. There were comments from a couple of people about having to wait to go to the toilet and another comment about being left in Reception after lunch and being told they are “in a queue for the toilet” A relative spoken to said they were happy with the Home and their only real concern was their relative getting to the toilet when they needed to go. One person spoken with said they did not sleep but when they mentioned this to the staff they said they were imagining things and this made them “despondent”. Staff do need to deal with any issues that arise. Staff were observed speaking to people in a professional manner and privacy was maintained. This was confirmed in the surveys received. One visitor said their relative was afforded privacy and dignity”. One carer had a wonderful rapport with a person at lunchtime and this put the person at ease. The medication system was inspected. Medication charts ere detailed and well maintained. Staff have received medication training and are aware of how to administer, record and dispose of medication. In one of the offices painkillers and constipation medication was kept under the table in a large open box. The door was wide open. This needs to be kept secure to prevent any harm occurring. The controlled drugs were checked and these were accurate and staff were aware of how to keep medication in the fridge. Dunollie Care Home DS0000043116.V369952.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All Key standards were assessed. People who use this service experience adequate quality outcomes in this area. People participate in a range of activities and the dining experience is pleasant for people. Though staff need to encourage more autonomy and choice. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: A range of information was obtained from the Expert by Experience regarding activities. She stated “On the day I visited there was a fundraiser in the Home who was spending time with the residents in the main lounge – with a singalong and clap-along. She told me they were trying to raise money for a bus Dunollie Care Home DS0000043116.V369952.R01.S.doc Version 5.2 Page 15 for the home”. The Manager confirmed that an activities organiser has recently been appointed. There was a list of activities on a wall in the lift and staff keep people informed. One person said “the activities organiser spends time with them on a one to one basis and had taken them to Scarborough though they would like to go out more and had made suggestions for other trips”. Another comment was that one resident did not get too much stimulation and would like to be taken to other parts of the building. Another person said they go to a Day Centre, which is enjoyable, and they go Christmas Shopping. This person had been to see Status Quo, which had been organised by the home. A comment from a visitor was that the activities seemed to be more entertainment rather than hands on activities for example they used to do painting and make Christmas decorations and a person commented that if the activities organiser takes people out she doesn’t leave anything for the others to do. The activities organiser was not available at the visit though activities appeared to be for both younger adults and older people. A communion service is held once a month in a resident’s room. This seems to be arranged by one person’s family but others could attend and there were two other residents who had attended that afternoon. The Activities Organiser would take people to Church if they asked and the Home would arrange for a person’s own vicar/minister to visit if asked. People’s religious needs are recorded in the care plans and each person has a social history. Visitors were observed being welcomed into the home and positive comments were recently received from an ambulance crew who had visited the home, who were made to feel very welcome. The surveys returned and comments from people were mixed regarding the choices people have on a daily basis. One person felt they go to bed when it suits the staff and one commented bath time is sometimes gets forgotten and they are offered a shower when they would prefer a bath but is told they are short staffed. However another person said they could have an extra bath when they wanted. Mealtimes were discussed and the lunchtime meal was observed with the Expert by Experience. The carers go round in the morning with a menu and ask people using the service what they would like to eat that day. There is a choice and the staff say they could have something else if nothing on the Menu suited. It seemed to take a while to get everyone at the table and one or two seemed to be sitting there a while before the others came in. Staff seemed to be trying to find a wheelchair for one person. One or two people sat at the dining table in their wheelchairs. However the tables were nicely set with napkins Dunollie Care Home DS0000043116.V369952.R01.S.doc Version 5.2 Page 16 and condiments. There was a choice of fruit juices or water to drink. The meals looked very nice and everyone said they enjoyed them and said they were hot (although one person said they didn’t like the soup that day). The meals were served from a serving trolley and taken to people on plates with lids on. Staff came round and politely asked people if they would like help in cutting up their meat. One person was assisted at the table by a member of staff who sat with them at the table and talked to them and the other people on the table. Another person who needed assistance had their meal in the lounge. They were being assisted by a carer who sat with them throughout the meal. There seemed to be sufficient staff on duty at lunchtime. For those people on diets staff said this would be recorded in the Care Plans and passed to the Kitchen. People who were in their bedrooms all had jugs of water with glasses or other appropriate drinking cups. There were no jugs of water or juice in the Main Lounge but two people in the Main Lounge had drinks on nearby tables and well within reach and there was a water cooler in the Reception Area. There was a coffee maker with coffee made up in the Quiet Lounge, which was for the visitors and was complimentary. One visitor spoken with had been given a cup of tea served nicely on a tray whilst waiting for their relative to finish lunch. Cups of tea are made on each floor and taken by the staff to each person. A comment was made that on a couple of occasions tea in the afternoon had been missed and one person mentioned the tea was always cold. Dunollie Care Home DS0000043116.V369952.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All the Key Standards People who use this service experience adequate quality outcomes in this area. People sometimes have their concerns listened to, but improvements are needed to ensure people are safe and protected from harm. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The home has a complaints procedure in place. Mixed information was received from surveys and speaking to people about how concerns and complaints are dealt with at Dunollie. Some people said they would speak to the manager whilst others said they would prefer to say nothing. Two people were not aware of the formal procedure though this is available in the home. The Annual Quality Assurance Assessment states that three complaints have been made, one was upheld and a safeguarding referral has been made which was inconclusive. Previous discussions have taken place via the telephone and face to face regarding reporting of abuse. There is a procedure in place, which covers Whistle Blowing and gives staff advice on the action needed when making an allegation of abuse. The manager and the organisation did not respond appropriately to an allegation of abuse relating to a number of people using the service three months ago. Due to the time gap between the alleged Dunollie Care Home DS0000043116.V369952.R01.S.doc Version 5.2 Page 18 incident, and it being reported, it was difficult to determine whether the incident had happened or not. The outcome was therefore inconclusive. Evidence of staff receiving safeguarding training was in place though the correct action was not taken subsequent to the training. Lengthy discussions have taken place with Social Services, the police and the manager to progress these issues. The organisation need to be satisfied that staff employed are very clear about their immediate responsibilities should they see or hear something inappropriate. Staff spoken to confirmed they had received further training since the first allegation and were aware of the different types of abuse. People must communicate more effectively and feel confident that issues raised will be dealt with appropriately. Since the site visit a further allegation of abuse has been made, and the member of staff to whom this was reported failed to pass this information on to the person in charge or to the manager. Dunollie Care Home DS0000043116.V369952.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards were assessed and 22. People who use this service experience adequate quality outcomes in this area. People live in a comfortable and clean environment, though the call bell system is not maintained effectively which makes the entrance area noisy and unpleasant to spend time in. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Dunollie Care Home DS0000043116.V369952.R01.S.doc Version 5.2 Page 20 The home is divided into The Lodge area for people with personal care needs only, the Garden Wing for younger adults and the Main House for people with nursing needs. The communal areas are spacious, and some people have wonderful views across Scarborough from their rooms. Areas are accessible for people in wheelchairs and there are assisted baths for people to use. There is a range of moving and handling equipment, which helps when mobilising people. The grounds are landscaped and colourful. There was a table with a parasol and chairs on a patio for people using the service. There was a main lounge with a TV and music; there was also a quiet lounge. There were two bedrooms which did smell of urine and which were discussed with the Matron, these were due to be cleaned. Staff do have infection control training, and during the day staff were observed wearing protective clothing, and using hand-washing techniques. There was antiseptic hand wash alongside the signing in book in the Foyer. More domestic staff have now been employed which helps to maintain the cleanliness of the home. Whilst the environment was generally pleasant it was evident throughout the visit that call bells were continually ringing. This was extremely loud in the foyer area. Comments included “ the call system is not very good and staff are a long time coming”; “seems as if it rings and rings and rings and no one answers” “staff always say its broken down” “buzzers seem to ring a long while”. The manager stated that there have been a range of faults with the system and sometimes bells ring for no reason. Some people did have to wait for assistance. Visitors commented on the continual noise and the concern is that staff do not answer call bells if they think the system is faulty. This must be addressed to ensure people get the assistance when they need it, and the reduction in noise will improve the environment for people. The large dining area whilst pleasant and calm did have tables and chairs which were old, worn and in need of repair. The manager confirmed that she was aware of this and action will be taken to address this. Dunollie Care Home DS0000043116.V369952.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All Key standards were assessed. People who use this service experience adequate quality outcomes in this area. People are cared for by staff who are trained in meeting needs, but need to be recruited more effectively. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The home supports people with complex nursing and personal needs who is either under or over 65, and some with physical disabilities. Male and female staff are employed and a mix of nurses and carers look after people. How teams are organised has been reviewed to ensure people know who to go to. Whilst this has improved, staff do need to communicate more effectively with people using the service. The Expert by Experience discussed staffing issues with people and mixed comments were made. For example “staff are prompt” “night staff very good at promptness”; “if I want an extra bath I can have one”, “the staff are very Dunollie Care Home DS0000043116.V369952.R01.S.doc Version 5.2 Page 22 good like that”; “some staff alright, some aren’t - all respectful” “one member of staff very good to me – the others alright” “the staff are lovely – very good” “I get on well with the staff” “I get on well with the Manager”. Other comments were made by both people living there and visitors about staff changes that had taken place and people full stop Some felt that staffing levels seemed to be lower at weekends. One person stated, “I have to wait to go to the toilet - staff say “too busy”, or “on my own”, and “never seems to be anyone around when you want them”. The surveys returned also had mixed views regarding the availability of staff. This needs to be reviewed by the manager. It was noted that there has been a lot of staff sickness in July and August and whilst agency staff can be used this does depend on their availability. Over 50 of staff have completed an NVQ Level 2 in Care, and a detailed induction programme is in place. This is equivalent to Skills for Care and covers care practices and how to deal with people’s needs. This helps staff understand how to look after people more effectively and this promotes good standards of care. Recruitment files were inspected. The manager was aware that references and a police check need to be in place prior to a person starting employment along with a protection of vulnerable adults check. However, the records that were viewed did not have all the checks in place. The files were disorganised, and it was unclear if two written references were in place or if police checks had been received. If there are good recruitment practices then this all helps to protect people from harm Dunollie Care Home DS0000043116.V369952.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards & 37 were assessed. People who use this service experience adequate quality outcomes in this area. The home is sometimes run in the best interests of the people using the service. Though more openness and transparency is needed so the home can progress further. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Dunollie Care Home DS0000043116.V369952.R01.S.doc Version 5.2 Page 24 An extremely experienced nurse who has worked in the Health and Social Care setting for many years manages the home. She needs to become registered with the Commission which will help her understand more fully the role and responsibilities of being the registered manager. The manager has implemented many positive changes and improvements during the past twelve months. A review of the staff roles has taken place and a clear management structure has been developed with designated teams of staff. It is evident from previous discussions and incidents that have taken place that the manager needs to foster a more open and transparent culture, where people using the service, their relatives and staff feel comfortable in expressing their views and opinions. This will help to improve the service. A quality assurance system is available and more residents and relatives meetings are in place. The minutes of these were evident on the notice board. Surveys will be sent out in November 2008 for people using the service. Though only a small amount of detail regarding the quality assurance system was discussed in the annual quality assurance assessment. The home can look after people’s personal monies. This system has improved greatly and now accurate records are kept and people are invoiced for chiropody, newspapers and toiletries. People spoken with confirmed that they can access this Monday to Friday. Three records were inspected and the amount recorded tallied with the amount of money available. The Annual Quality Assurance states “ The home manages Residents monies and personal belongings safely making sure that on a 3mthly basis a print out of the account is sent to the named representative for those Residents.” This was confirmed at the visit. Record keeping was discussed. Staff files need to be better maintained, and the manager needs to ensure Regulation 37 notifications are sent to the Commission in a timely fashion. These details any incidents which affect people’s well-being. Health and safety was discussed and staff have undertaken a range of mandatory training. This has improved since the last visit. Some staff confirmed they have attended fire training, moving and handling and first aid. Certificates were available in training records to establish this. Emergency lighting, a fire risk assessment and fire alarm testing were all in place. Water temperatures are within the expected range and a sample of these were taken. Staff were observed moving and handling people in the correct manner and policies relating to health and safety are in place. Dunollie Care Home DS0000043116.V369952.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 x 2 x 3 3 4 x 5 x 6 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 1 ENVIRONMENT Standard No Score 19 2 20 x 21 x 22 1 23 x 24 x 25 x 26 3 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 x 33 2 34 x 35 3 36 x 37 1 38 3 Dunollie Care Home DS0000043116.V369952.R01.S.doc Version 5.2 Page 26 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 OP16 / OP18 Regulation 13 Requirement The manager must foster an open culture so people feel confident in raising their concerns, and any allegations of abuse are dealt with appropriately and in a timely fashion. This will help protect people from harm Medication must be stored in a locked area and not left on the floor. This will help reduce the risk of harm to people. The call bell system must be in good working order at all times. This helps ensure people are given assistance when needed. Records relating to recruitment must be complete and well maintained; this is to clearly demonstrate that all checks have been made prior to a person being employed. Previous timescale 05/12/07 not met. Regulation 37 notifications must be sent to the Commission without delay and appropriate action taken. Timescale for action 18/08/08 2. OP9 13 11/09/08 3. OP22 12 11/10/08 4. OP29 19 11/09/08 5. OP37 37 18/08/08 Dunollie Care Home DS0000043116.V369952.R01.S.doc Version 5.2 Page 27 6. OP37 17 Records in respect of people using the service must be kept up to date and be accurate. 18/08/08 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. 3. 4. Refer to Standard OP8 OP14 OP19 OP27 Good Practice Recommendations Staff must seek medical attention fore people when needed and clearly record accidents and injuries in a timely fashion. Staff need to ensure daily routines are for the benefit of the person using the service and not the staff. The worn tables and chairs in the dining room should be replaced. A review of the staffing levels should take place. Dunollie Care Home DS0000043116.V369952.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. Dunollie Care Home DS0000043116.V369952.R01.S.doc Version 5.2 Page 29 - 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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