This inspection was carried out on 19th May 2005.
CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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.
CARE HOMES FOR OLDER PEOPLE
Dunollie Nursing Home 31 Filey Road Scarborough North Yorkshire YO11 2TP Lead Inspector
Mary Slattery Unannounced 19 May 2005 10:00am 24 May 2005 2pm.
th th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dunollie Nursing Home J53_J04_S43116_Dunollie Nursing Home_V221687_270405_Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Dunollie Nursing Home Address 31 Filey Road, Scarborough YO11 2TP Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01723 372836 European Care (SW) Ltd Post Vacant. Care Home 49 Category(ies) of Old age, not falling within any other category registration, with number (49), physical disability (49), terminally ill (5) of places Dunollie Nursing Home J53_J04_S43116_Dunollie Nursing Home_V221687_270405_Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: Yes Service users to include 49 OP, 49 PD and 5 TI up to a maximum of 49 service users. Service users in the category PD to be aged 40 years plus. Date of last inspection 2nd November 2004. Brief Description of the Service: Dunollie Care Home provides nursing care and accommodation for up to 49 service users. Service users over the age of 65 years who need general nursing care, service users who are terminally ill and service users over the age of 40 years of age who have physical disabilities and need nursing care. The home is owned by European Care (SW) Limited and was registered with the Commission in August 2003. Dunollie is located close to the centre of Scarborough its amenities and facilities. The home is a large detached building and shares its extensive private grounds with Dunollie Lodge. The accommodation provided is both single and double bedrooms, a variety of communal space and a passenger lift to all floors. There are well tended gardens around the home accessible to service users and parking space for visitors and staff. Dunollie Nursing Home J53_J04_S43116_Dunollie Nursing Home_V221687_270405_Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report relates to the unannounced inspection carried out on the 19th and 24th May 2005. The inspection took 12 hours plus 4 hours preparation time. A tour of the home was carried out which included service users private accommodation, the laundry, kitchen and the communal areas. A number of the homes records were looked at and time was spent observing the activity in the home, gathering the views of service users, visitors and staff. Discussions were held with representatives of the provider. What the service does well: What has improved since the last inspection?
There have been no improvements made to the overall service provided since the last inspection. Dunollie Nursing Home J53_J04_S43116_Dunollie Nursing Home_V221687_270405_Stage 4.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Dunollie Nursing Home J53_J04_S43116_Dunollie Nursing Home_V221687_270405_Stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Dunollie Nursing Home J53_J04_S43116_Dunollie Nursing Home_V221687_270405_Stage 4.doc Version 1.20 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 4. People are invited to the home to discuss what is offered. The information gathered about people moving into the home is insufficient to ensure that their needs will be met in a safe manner. EVIDENCE: The policy of Dunollie is that a member of the qualified nursing staff will visit prospective service users to assess their care needs before they move into the home. The assessment records looked at gave limited information about service users nursing care needs and in some instances no information about why they needed nursing care. Little progress has been made in improving the quality of the assessment records since the last inspection. There was no evidence in the care plans to show that service users and/or their representative had agreed the findings of the assessments that have been carried out.
Dunollie Nursing Home J53_J04_S43116_Dunollie Nursing Home_V221687_270405_Stage 4.doc Version 1.20 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9. There are no clear systems in place to ensure that service users needs are met in a safe manner. EVIDENCE: The staff spoken to at the inspection were well informed about the needs of the service users but they have failed to produce comprehensive care plans for all of the service users and evidence that care had been provided. The information available was insufficient in detail to evidence that the service users health, personal and social care needs had been assessed and there was an absence of care plans to assist staff in meeting their needs in a consistent way. Where service users had suffered loss and were grieving there was no evidence to show that they had been supported professionally. Risk assessments had been carried out for some service users and equipment for the relief of pressure ulcers was provided. Dunollie Nursing Home J53_J04_S43116_Dunollie Nursing Home_V221687_270405_Stage 4.doc Version 1.20 Page 10 There was a lack of attention to the risk to service users who needed bed safety rails. The safety rails were unsafe and protective bumpers were not in place to protect the service user from injury. There is monitored dosage medication system in operation and all medication was safely stored and the records were in good order. Dunollie Nursing Home J53_J04_S43116_Dunollie Nursing Home_V221687_270405_Stage 4.doc Version 1.20 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14 and 15. The daily routines in the home restrict service users from making choices and taking control of their daily lives. EVIDENCE: The staff told us about the daily routines in the home, they are rigid and revolve around the staff’s work routine and not the service users daily lives. Service users choice about the time they wish to rise from and retire to bed is restricted by the routines in the home. A number of the service users who need the temporary use of a wheelchair are not transferred into comfortable seating when they are in the communal lounges. The service users have little or no choice about the number of baths they can have. Meal times are not flexible and the time between meals does not allow for proper digestion and for building up an appetite for the next meal. Lunch is the only meal taken in the dining rooms. A number of the service users were observed taking their evening meal at 4:30pm in the entrance hall.
Dunollie Nursing Home J53_J04_S43116_Dunollie Nursing Home_V221687_270405_Stage 4.doc Version 1.20 Page 12 A number of service users and visitors said that the quality and quantity of the food provided in the evening had deteriorated and served in smaller portions. Staff reported that service users are not offered any food at suppertime and that service users can have biscuits if they request one but that none are offered. Within the homes assessment and care planning documents there is capacity for nutritional assessments to be done and a number of the service users are at risk if they do not receive a good nutritious diet. There was no evidence to show that the food budget had been reduced. Dunollie Nursing Home J53_J04_S43116_Dunollie Nursing Home_V221687_270405_Stage 4.doc Version 1.20 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18. Poor response to complaints, poor recruitment practices and lack of abuse awareness training does not ensure the protection of service users. EVIDENCE: A number of complaints have been made against the service, which have included concerns about food and drink, staff shortages and poor standard of cleanliness. Service users and their relatives reported that they feel their complaints are not really acknowledged and that they are not truly resolved. A number of the staff records were looked at and staff have been employed prior to the required number of references being taken up, CRB and POVA checks being completed. There have been no arrangements made for staff to attend abuse awareness training and opportunities to become familiar with the policy and procedure for reporting incidents of abuse. Dunollie Nursing Home J53_J04_S43116_Dunollie Nursing Home_V221687_270405_Stage 4.doc Version 1.20 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,25 and 26. The standard of the environment needs to improve to provide service users with a safe place in which to live. EVIDENCE: Service users rooms are personalised with items that reflect their lives and interests. There is a variety of spacious communal rooms and an attractive entrance hall. The gardens are well tended and there is a selection of seating areas for the service users. There were areas around the home including some bedrooms that were not clean and unpleasant odours were detected. Unwashed clothes were left on a bedroom floor. There were a number of serious issues identified regarding the safety of the premises. There was no fire risk assessment in place and a number of fire door closures were not operating properly. Some fire doors are not closed at night.
Dunollie Nursing Home J53_J04_S43116_Dunollie Nursing Home_V221687_270405_Stage 4.doc Version 1.20 Page 15 A review of the fire detection system is outstanding and not everyone is able hear the fire alarm bells. The fire detection equipment was not being tested as required. Combustible material was not stored correctly this posed a fire risk. Cleaning solutions and denture cleaning tablets were not stored safely. A number of bed safety rails were deemed unsafe and were not fitted with protective bumpers. A letter detailing the issues with regard to the safety of the premises has been sent to the acting manager of the home to ensure these issues are dealt with as a matter of priority. Concerns were raised about the safety of items of kitchen equipment. There are no facilities for keeping food hot when meals are being served to service users in their own rooms. There is insufficient storage space and some equipment is placed near a fire exit door. There is also a concern about security in this area. Dunollie Nursing Home J53_J04_S43116_Dunollie Nursing Home_V221687_270405_Stage 4.doc Version 1.20 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29. The numbers of staff on duty are sufficient to meet the needs of the service users. Failure to carryout the required checks on staff poses a risk to the service users. EVIDENCE: Action has been taken to increase the staffing levels in the home. Initially with agency staff until permanent staff are recruited. The home employs qualified nurses with the relevant general nursing qualification but there are no staff employed who specialise in care of people with physical disabilities. NVQ training is in place for care staff. There are staff employed to undertake catering, domestic and laundry duties, general maintenance and administration. The service users are not protected by the current recruitment and selection practices. Staff have been employed prior to the required check being carried out and references taken up. A number of staff had not been issued with a contract of employment and their conditions of employment were contrary to company policy. There was evidence that staff required training on care planning, assessment of risk, equal opportunities and race equality. Dunollie Nursing Home J53_J04_S43116_Dunollie Nursing Home_V221687_270405_Stage 4.doc Version 1.20 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33 and 38. The home is not run in the best interests of the service users. EVIDENCE: There is no registered manager in post and the home had not been effectively managed and or monitored for some time. Arrangements have been made for the temporary management of the home. There was evidence to show that the activities of daily living are decided upon by the staff and not the service users. The policies and procedures are designed to promote the welfare of the service users but a number of health and safety issues were identified that compromised their health and welfare.
Dunollie Nursing Home J53_J04_S43116_Dunollie Nursing Home_V221687_270405_Stage 4.doc Version 1.20 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 1 1 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 x 14 1 15 1
COMPLAINTS AND PROTECTION 1 1 x x x x 1 1 STAFFING Standard No Score 27 3 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 x 1 1 x 1 x x x x 1 Dunollie Nursing Home J53_J04_S43116_Dunollie Nursing Home_V221687_270405_Stage 4.doc Version 1.20 Page 19 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 3and4 Regulation 14(1) Requirement The registered person is required to keep accurate records of the outcomes of assessments and to ensure that service users know that their needs will be met. The registered person is required to have in place a care plan for each service user with details of how their needs are to be met. The registered person is required to make proper provision for the health and welfare of the service users. The registered person is required to acertain and take into account the service users wishes and feelings about how they wish to live life in the home. The registered person is required to ensure that service users are provided with al nutritious diet including food at suppertime. And that the intervals between meals are evenly spread throughout the day. The registered person is required to ensure that any complaint made is fully investigated and theat people are informed of the findings. Timescale for action 30th June 2005. 2. 7 15 30th July 2005. 30th July 2004. 30th June 2005. 3. 8 12(1) 4. 12 and 14 12(1)(3) 5. 15 16 (i) 30th June 2005. 6. 16 22(3) 30th June 2005. Dunollie Nursing Home J53_J04_S43116_Dunollie Nursing Home_V221687_270405_Stage 4.doc Version 1.20 Page 20 7. 8. 18 19 and 20 and 38. 13(6) 13(4)(a) 9. 10. 25 29 16(k) 19 and17(2). Schedule 4 12(b) The registered person is required by training staff to prevent service users being harmend The registered person is required to ensure that all parts of the home are free from hazards to the safety of service users and staff. The registered person is required to keep the home free from offensive odours. The registered person is required to have robust recruitment and selection procedures in place. The registered person is required to assist staff to enable service users to decide their own activities of daily living. The registered person is required to provide suitable equipment for the safe storage and transport of food. The registered person is required to consult with the fire safety officer regarding fire safety in all areas in the home. 30th July 2005. 30th June 2005. 30th June 2005. 30th July 2005. 30th July 2002. 30th August 2005. 30th June 2005. 11. 31 and 33 12. 19 16(g) 13. 19 and 38 23(4) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Dunollie Nursing Home J53_J04_S43116_Dunollie Nursing Home_V221687_270405_Stage 4.doc Version 1.20 Page 21 Commission for Social Care Inspection Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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