Key inspection report
Care homes for older people
Name: Address: Dunollie Care Home 31 Filey Road Dunollie Nursing Home Scarborough North Yorkshire YO11 2TP The quality rating for this care home is:
zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Pauline ORourke
Date: 1 5 0 1 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People
Page 2 of 23 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. Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 23 Information about the care home
Name of care home: Address: Dunollie Care Home 31 Filey Road Dunollie Nursing Home Scarborough North Yorkshire YO11 2TP 01723372836 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): DNeuropeancare@aol.com www.europeancare.co.uk European Care (SW) Ltd Name of registered manager (if applicable) Manager post vacant Type of registration: Number of places registered: care home 58 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 58 The registered person may provide the following category of service only: Care home with nursing - Code N 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, maximum number of places 58 Physical Disability - Code PD, maximum number of places 58 Date of last inspection Brief description of the care home 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 Care Homes for Older People
Page 4 of 23 Over 65 58 0 0 58 Brief description of the care home 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 personal care needs only. People are provided with information about the service in the form of a service user guide. The most recent inspection report from the Care Quality Commission is available in the home. The current scale of charges range from £344.45 to £771.22 per week. Additional charges are made for hairdressing, chiropody and newspapers. This information was provided at the January 2010 inspection. The home should be contacted directly for up to date information about charges. Care Homes for Older People Page 5 of 23 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 0 Star. This means the people who use this service experience poor quality outcomes. The Care Quality Commission inspects services at a frequency determined by how the service has been risk assessed. The inspection process has now become a cycle of activity rather than a series of oneoff 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.cqc.org.uk We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is Care Homes for Older People
Page 6 of 23 considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The key inspection has used information from different sources to provide evidence for this report. These sources include: Reviewing information that has been received about the service since the last inspection. Information provided by the registered person in an Annual Quality Assurance Assessment form (AQAA) Information provided by European Care in the form of an Improvement Plan A visit to the service by two inspectors that lasted for six hours. The Programme Manager and Manager were available for feedback at the close. Care Homes for Older People Page 7 of 23 What the care home does well: What has improved since the last inspection? Since the last inspection in September 2009 the service provided at Dunollie has improved. There has been some improvement in the care plans, there has been a push to make them more person-centred and some of the information in them is now descriptive and detailed. Many of the plans now have associated risk assessments in place and these are reviewed more regularly but this is an area still needs more work as detailed below. People now have their pressure areas properly dressed in line with their care plans. The management of the home is much better at identifying and reporting incidents that could be safeguarding. They have worked closely with the Local Authority to ensure incidents are reported in a timely fashion. Staff have also received training in safeguarding and so are better placed to identify and respond appropriately to incidents that could be described as safeguarding. The handling of medication has improved although there were areas of concern as highlighted below. The care staff at the Lodge have all received training in the safe handling of medicines and they have to complete in-house competency training before they can administer medication alone. The staffing levels are appropriate for the current occupancy of the home. Staff are provided with training in areas relating to their work. This is provided through organised training sessions relating to one matter and further training is provided in professional development sessions at team meetings. The manager who has now been in post for four months and the appointment of a deputy manager has brought some cohesion to the management structure at Dunollie. There is also a full compliment of care staff and this has brought some stability and consistency to the care and support provided. There is now a regular auditing of the quality assurance systems and evidence was seen to show these take place. Staff spoken with said: Care Homes for Older People Page 8 of 23 She is a good manager, very approachable and will deal with any issues raised and if she is unable to do anything she will tell you Both the manager and deputy manager are helpful and approachable Things are getting more efficient here, the training has improved and she is a good manager A relative said: There has been a big improvement since the last inspection, I now have confidence my relative will get the support he needs if I am not here What they could do better: The service at Dunollie has improved. Work should continue to be done to ensure these improvements are sustained and consistent. As part of this inspection information was requested in the form of an Annual Quality Assurance Assessment (AQAA). The information was provided in bullet point form and did not fully detail how people are supported from the first contact, admission and how their changing needs will be met. Each key standard should be detailed enough to allow any inspector to gain an understanding of how the processes work at Dunollie. The manager should apply to be registered with the Commission. During the inspection three care plans for people in the nursing home and two care plans for people in the Lodge were examined and generally improvements have been made to the quality of these. However we found shortfalls in care planning and risk assessments which gives us continued cause for concern. Two of the plans seen contained information about the risk of developing pressure areas, specialist equipment had not been provided to ensure the pressure areas do not develop. Failure to provide proper equipment in such circumstances has been a concern previously and an area where formal action has been taken by the Commission to require improvement. Other plans provided clear instructions for staff to follow when assisting people with their care but staff were seen not to be following them and for one person this could result in them scalding themselves. In one instance staff had not been provided with the records to complete to evidence that someone was drinking what they needed to in accordance with their care plan. Staff were also seen transferring somebody using equipment, when the care plan was seen there was no reference as to how this person should be transfered nor was there an associated risk assessment in place. It is recommended that the manager look at the care plans to ensure only current information is held as this should make them easier for staff to use. There was also evidence that monthly reviews are not consistently being done, again this has been of previous concern to the Commission. The inspector had some concerns regarding two bedrails, these were addressed during the inspection by the manager and programme manager. Whilst some some improvements have been made to the management of medication some inconsistencies were still identified and the manager needs to work with staff to ensure these are addressed. There also appeared to be some lack of consistency with managing unused medication for the period of a hospital admission. Care Homes for Older People Page 9 of 23 The call bell system continues to be inadequate to help people living in the home. It does not allow for remote access so this limits where people can sit in the home, it also means some people are reliant on others to summon assistance for them, this limits their ability to be independent and could compromise their dignity. Whilst the quality assurance system has grown to include audits of systems within the home, the manager is reminded to include feedback from people who live in the home, relatives staff, and other professionals who visit the home. This will give a broader picture of what sort of job the home is perceived to be doing. 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. Care Homes for Older People Page 10 of 23 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 23 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are properly assessed to ensure their needs could be fully met, prior to being offered a permanent placement at the home. Evidence: The care plans we looked at showed that comprehensive pre-admission assessments had been carried out before offering someone a place. This is to make sure that the home can meet the persons needs. A senior member of staff, usually the manager visits the person at home, or in hospital to discuss their care needs. Social Services assessments and Primary Care Trust assessments are also used to determine this as well; these were also available to look at. The embargo on admissions to the home that was in place from the County Council has been lifted The manager confirmed that the home is taking admissions. All of these admissions are staged in order that the manager can manage the admission process. The home does not provide intermediate care.
Care Homes for Older People Page 12 of 23 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst people have a plan of care further detail and review is required to ensure identified care needs are being met fully. Evidence: We looked at four care plans. On the whole they were written with enough detail so that staff were able to give the appropriate care and support people required. Risk assessments had been completed and the plans had been reviewed regularly. One care plan that we looked at gave us some concern. We found that the person was not having enough to drink or eat and that staff had not recognised this. We also saw that some suction equipment that this person would require should they choke was not easily accessible to staff. In addition we had read in the persons initial assessment that they suffered seizures. There was no record instructing staff what to do in the event of this happening. We spoke to the manager about our findings regarding this one person. She immediately took action and located the suction machine in a more accessible place, and the following day we received a telephone call from the manager explaining what further action she had taken in relation to this persons nutritional needs.
Care Homes for Older People Page 13 of 23 Evidence: We looked at how peoples medication was managed by the home. A requirement had been made at the previous inspection regarding how prescribed creams and lotions are administered and recorded. The manager told us that the recording had improved and that care staff were clear on what creams and lotions they were responsible for and what must be administered by atrained nurse. All of the medication records that we looked at were completed properly. In one persons room we saw three tubs of cream, however the medication record sheet only had one of the creams entered on it. In the persons care plan it did not make reference to any cream application. We spoke to the member of staff on duty who informed us that the cream on the medication record was the cream that they were administering. She then went on to say that she would alter the persons care plan to include this information. Care Homes for Older People Page 14 of 23 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recreational and social needs of people are well catered for which enables them to make daily choices and maintain Independence. Evidence: Most people told us that they determined their own routines at the home. One person said that they got up and went to bed when they liked. During the inspection people were settled and occupying themselves. One person was doing a crossword, and another was reading the daily newspaper, several people were sat in their own rooms watching television or reading. Some peopel were sat outside in the grounds of the home enjoying the sunshine. Staff made sure that they were supplied with cool drinks and sunhats as the day was very hot. Some people told us that they went out with their family and some people told us that staff took therm out on trips. There was a varied activites program for people to join in with if they wanted to. People told us the food was very nice. One person said the food is lovely better that I would cook at home, I watch what I eat and the cook knows what I like. The lunch looked and smelt lovely and people told us that they really enjoyed it. Care Homes for Older People Page 15 of 23 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confidant that their concerns and complaints are dealt with appropriately and that safeguards are in place to protect them from abuse. Evidence: There are adequate written policies and procedures in place to deal with complaints and the care staff spoken to confirmed they were aware of these proceedures. Staff knowledge of these help ensure that they were able to address any issues or anxieties of the residents, relatives and visitors to the home. People who live at the home told us they would speak to any of the staff if they had any concerns or complaints. The complaints record was inspected. Complaints had been dealt with properly and to the satisfaction of the complainants. Staff told us that training has taken place in the protection of vulnerable adults . They were clear on what to do if they suspected a person was at harm or at risk of abuse. We looked at three personnel files and found that staff recruitment procedures were adequate and staff were employed and deployed following appropriate checks. Care Homes for Older People Page 16 of 23 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe, clean and comfortable home. Evidence: The home was clean and comfortable. People are encouraged to bring into the home some of their own personal belongings and small items of furniture. Some of the carpets on the main stair case and outside the lify area in the Garden wing are worn and will need to be replaced in time before they become a tripping hazard. There is an infection control policy and proceedure that staff adhere to minimise the spread of infeection. The laundry equiptment is suitable for the size of the home and the laundry on the day of inspection was clean, tidy and well organised. Care Homes for Older People Page 17 of 23 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that staff are trained and on duty in sufficient numbers to meet their assessed needs Evidence: The rotas and staff numbers suggest that there are enough staff on duty at all times to meet the needs of the people who live at the home. The manager told us that htere are seven care staff and three trained nurses on duty all day and one trained nurse and three care staff on duty during the night. The manager works supernumary and the team are also supported by an administrator and ancillary staff. The manager makes sure that staff have the necessary training to help them do their work as well as possible. There is a wide range of courses available and the records confirmed that the staff are allowed the time to attend. Records demonstrated that staff had been recruited properly and appropriate checks had taken place before they were accepted to work at the home. Staff said they enjoyed the training and found it very helpful when dealing with older people. They said that if they expressed an interest in a certain area the manager would identify courses or training sessions to develop their interest and knowledge. Care Homes for Older People Page 18 of 23 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems have been introduced to ensure peoples health and safety needs are met however the quality assurance system needs developing to better identify areas for improvement. Evidence: The manager at the home is a trained first level nurse and has experience at managing a home. She is supported in her role by a deputy manager, an administrator and by a Programme Manager. In addition the manager also told us that she get peer support from other managers within the company on a regular basis. We saw that there was a quality assurance system within the home. Weekly and monthly audits are carried out on a variety of systems such as care plans, pressure sores, laundry, kitchen, wheelchairs, and medication. The Programme Manager also does a regulation 26 report each month. From the evidence we saw in one persons care plan it is evident that these audits are not as robust as they should be in order to keep peoples health and welfare safe. Care Homes for Older People Page 19 of 23 Evidence: Personal money is held for people in the home and the records seen were accurate and up to date. The records showed what money was coming in and going out and receipts were kept and the cash and records tallied. The health and safety records were checked and all were found to be up to date. Risk assessments for fire, the environment, and COSHH are in place. All accidents and incidents are now recorded and when necessary they are reported to the Commission. Care Homes for Older People Page 20 of 23 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 21 of 23 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 19 It is recommended that the manager plans the replacement of the worn carpets on the stairway and corridor into the refurbishment plan for the home, nd that it is replaced before it becomes a trip hazard. Care Homes for Older People Page 22 of 23 Helpline: Telephone: 03000 616161 Email: enquiries@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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 23 of 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
