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Inspection on 31/03/09 for Dunollie Care Home

Also see our care home review for Dunollie Care Home for more information

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People live in a large home, which has pleasant views across Scarborough. Many people enjoy spending time in the extensive gardens. The meals provided are enjoyed and people have access to some activities.

What has improved since the last inspection?

Dunollie Care HomeDS0000043116.V374743.R01.S.docVersion 5.2Page 7The recruitment files are easily accessible and contain all the relevant checks. A new call bell system is in place, which is more efficient. A new manager has been in place for three months, this helps maintain consistency.

What the care home could do better:

The management of the home could seek views of people using the service more this would help the service develop. The manager also needs to be more effectively supported by the organisation. People are at risk of developing pressure sores. Some people`s health needs are not met because the pressure area care is poor. Care plans need to be more individualised with regular reviews and evaluations. This will help ensure staff are aware of individual needs. People are at risk of been neglected due to staff not recognising and acting upon signs of abuse. The medication system needs to be more robust so people are confident that prescribed medication is administered and recorded correctly. The initial assessment could be more detailed and comprehensive. This will allow staff to understand a person`s needs more effectively. A review of the staffing levels is needed to ensure enough staff are always available to care for people.

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 31st March 2009 9:00 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.V374743.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.V374743.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 Dementia (58), Old age, not falling within any registration, with number other category (58) of places Dunollie Care Home DS0000043116.V374743.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 2. Dementia - Code DE, maximum number of places 58 The maximum number of service users who can be accommodated is: 58 11th November 2008 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.V374743.R01.S.doc Version 5.2 Page 5 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 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.V374743.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 0 star. This means the people who use this service experience poor quality outcomes. 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 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 took place on Tuesday 31st March 2009. This inspection was brought forward 8 months due to concerns raised regarding staffing levels, and care practices, record keeping, communication and issues regarding potential neglect. A random inspection also took place on 11th November 2008 where three requirements were made. Prior to the visit the information from the following sources was obtained and considered: Details of complaints and allegations raised by people connected to the service. Information from the previous inspection report. At the site visit two inspectors spent seven hours at the home. 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 senior management from European Care. What the service does well: What has improved since the last inspection? Dunollie Care Home DS0000043116.V374743.R01.S.doc Version 5.2 Page 7 The recruitment files are easily accessible and contain all the relevant checks. A new call bell system is in place, which is more efficient. A new manager has been in place for three months, this helps maintain consistency. 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.V374743.R01.S.doc Version 5.2 Page 8 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.V374743.R01.S.doc Version 5.2 Page 9 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): People who use this service experience adequate outcomes in this area. People have their needs assessed but this needs to be more detailed to ensure needs are understood and can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People have their needs assessed using a format which asks for personal, social, psychological and medical information relating to an individual. People may be funded either privately or through the local authority. The manager confirmed that she would go out and assess someone either in hospital or in their own home; this is in addition to an assessment from the Care Manager. Assessments for older people and younger adults were inspected, this gave mixed information. The assessments undertaken before the new manager Dunollie Care Home DS0000043116.V374743.R01.S.doc Version 5.2 Page 10 started three months ago were detailed and gave a good picture of the needs of that particular individual, this then helps inform the care plans. However, one older person was admitted over ten days ago and the manager is still waiting for the Care Manager’s assessment. The home’s assessment whilst having some details regarding basic information has not been filled in correctly. There are blank forms regarding the social care assessment, Doctor’s details, which risk assessments are needed, along with religious and psychological needs. There are no care plans in place (see next outcome group-Health and personal care). The lack of information means it is difficult to have a clear picture as to what this person’s needs are and whether they can be met. And staff have nothing to refer to, to make sure they are providing the right care. The assessment shows the person is high risk for developing pressure sores, however no pressure-relieving mattress has been obtained. In discussion with the manager she said this is not the case and a mattress is not needed. But this is not documented anywhere as part of the assessment. The manager is aware that the home can admit older people and younger adults with personal and nursing care needs. The registration certificate is to be amended to reflect this. Dunollie Care Home DS0000043116.V374743.R01.S.doc Version 5.2 Page 11 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): People who use this service experience poor quality outcomes in this area. People do not have their health and personal care needs consistently met; this is detrimental to their well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care practices in the home were observed in the younger adults area and in the main house where people receive health and personal care. Four care plans were also inspected. The format of the care plans includes all aspects of health Dunollie Care Home DS0000043116.V374743.R01.S.doc Version 5.2 Page 12 and personal care, There are areas for health care professionals to record information and reviews and evaluations can take place. There is a risk assessment system in place where moving and handling, prevention of pressure sores, risk of falls and dependency levels can be recorded. However, those plans inspected had many shortfalls. One person had no care plans at all. A nutritional assessment had been completed eight days after admission. Although a full body check identified the person had bruising and various rashes to feet and ankles, no action had been taken to look into this. One person had daily statements of well being which over almost two weeks included comments as “not feeling well, feeling hot, still not well” but there was no evidence that the Doctor had recently been called more than once. One person did not have their pressure-relieving cushion checked by staff for almost two weeks. The person developed a severe pressure sore because the equipment had become deflated without staff noticing. The tissue viability nurse was then asked to visit. However, subsequent to this, one nurse at a meeting said they would start to check the cushion “on a weekly basis”. This is not good enough. At least daily checks should be in place. The record keeping regarding this is poor and staff are not alert to potential risks. Some reviews and evaluations of care plans have taken place and plans are audited as part of the quality assurance system. The pressure area care of people using the service was discussed with the manager. The home has thirty-one pressure relieving mattresses (as confirmed by senior management). Staff need to be clear about what type of mattress is needed and how this can be obtained. One wound assessment looked at reported “bruising and broken skin from bed pan”. This is due to poor care practice by staff; whilst this was recorded no action had been taken to improve this situation. One person who was having problems eating and drinking had an “input and output chart” in place to record every time drinks were taken and food was eaten. However, this was not consistently documented and blanks were a regular occurrence on the form. Another person who was mostly self-caring had specific personal care needs, which they looked after themselves. This was not documented in the care plan, which meant if the person couldn’t manage this themselves then staff would not know and this would affect the well being of the individual. Different health care professionals had seen another person and evidence of investigations were in place. However there was no record of action taken or outcome. For example blood tests and urine samples had been obtained on six occasions and no results were recorded. Bed rails are in use and some risk assessments are in place. One comment was “its like been in prison” referring to having bed rails. Staff should have Dunollie Care Home DS0000043116.V374743.R01.S.doc Version 5.2 Page 13 discussed this with the individual to see if they were happy with the bed rails or if an alternative could have been found. People can access Doctors, chiropodist and specialist healthcare professionals as needed. Though advice is often sought when the issue is serious rather than at the preventative stage. The home does complete a form which is sent to The Commission. This shows any incidents or injuries that have occurred. Though this is not done in a timely manner. Privacy and dignity in the home is not maintained. Call bells sometimes go unanswered for long periods of time (see also environment outcome). One person said “I just poo in my knickers”. This is the result of having to wait a long time for the call bell to be answered. Staff do not always communicate effectively with people. Staff were observed using the hoist to move a person and they did not explain or talk to the person, whilst they were carrying out the manoeuvre. One person was having a bath independently and there were no screens in the bathroom or an “in use” sign on the door. This meant anyone could go into the bathroom without realising it was been used. The medication system was inspected. A monitored dosage system is in use. Some medication charts are handwritten. These were not completed correctly as they did not have the signature of the person who wrote the chart and dates were missing. One person was prescribed morphine sulphate tablets, however the total amount did not tally with the amount recorded in the controlled drug register and a different number was written on the medication chart. There were some blanks on the chart and staff were not writing the reasons why a person had not had their medication. Currently those people on warfarin have their blood results recorded in the care plan and acted on accordingly. This helps prevent errors occurring. Staff are not always making a record of when certain medication is opened, this includes eye drops, and antibiotics. This may mean they are not as effective once out of date. The medication stored in the fridge is not kept secure. It is in an open office and is not locked. Staff need to do a full audit of the medication system. Dunollie Care Home DS0000043116.V374743.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): People who use the service experience adequate quality outcomes in this area. People have access to some activities and mealtimes are generally enjoyed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home have an activities organiser who plans arts and crafts, trips out, entertainers and one to one sessions throughout the home. Easter bonnets were been made and walks to local gardens, the beach or coffee shops often Dunollie Care Home DS0000043116.V374743.R01.S.doc Version 5.2 Page 15 take place. Recently six people have been out for Sunday lunch. Social activities are recorded in individual care plans though this needs to be more consistent. The home is fundraising for a mini bus and visitors to the home are encouraged to be involved. A church service takes place on a six weekly basis and staff have previously taken people into Scarborough to visit their place of worship. The activities person is aware that some activities suit older people whilst others are suitable for younger adults. Equality and diversity is considered and staff confirmed they would cater for different cultural and religious needs as required. People visit the home at different times and sign in the visitor’s book. Links with family and friends are encouraged. Autonomy and choice was discussed. Staff need to review how daily routines are organised. This should depend on the service user’s needs and not the routine of the staff. Care plans did not demonstrate that this was the case. The lunchtime meal was discussed and partly observed. The manager is aware that the dining furniture could be in better condition. Though this area was pleasant and people were seen enjoying the food and drink provided. It was evident that when people are given morning drinks these are often left without staff checking if a person has had sufficient to drink. One person had cold tea left on their table, and evidence of half full cups of drink were observed in the corridor areas on trays. Dunollie Care Home DS0000043116.V374743.R01.S.doc Version 5.2 Page 16 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): People who use the service experience poor quality outcomes in this area. People are not confident that any concerns will be dealt with effectively, and staff need to be more alert to signs of abuse as currently people are at risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure, which is displayed in the home. Some people knew how to complain “I would go to the nurse if I had any problems” was one comment. As there is a new manager people are not as familiar with this person. There is an advocacy service available if needed. People use this service if they need a person to represent them. Recently a complaint was made to social services regarding pressure area care at the home, the call bell system and one member of staff’s attitude and manner. Information was given to the manager and matron, as an investigation was needed to confirm if the concerns were substantiated or not. This has not been concluded yet. At the inspection regarding pressure area care the alleged issues were substantiated, and evidence of staff not answering call bells was obtained. For example waiting ten minutes without any staff coming to assist. Complaints Dunollie Care Home DS0000043116.V374743.R01.S.doc Version 5.2 Page 17 need to be dealt with more robustly by senior management, with discussions taking place with the Nursing and Midwifery Council where issues involving registered nurses and care practices have been substantiated. The home needs to encourage people to speak about concerns so that the manager has the opportunity to put things right and they do not become formal complaints. The culture of the home needs improving with staff been open and approachable so people using the service and their relatives feel confident that their concerns will be listened to, but also acted upon in a prompt manner. Safeguarding in the home was discussed. Staff have received training in different types of abuse and how to report this. One person knew what action to take and was familiar with ‘Whistle blowing’ (after some prompting). The manager needs to be more familiar with the local safeguarding procedures. Social services are the lead agency and previous meetings have taken place with the home regarding complaints and safeguarding. Staff need to fully understand what the term ‘neglect’ means. Issues discussed regarding pressure area care, staff not answering call bells and poor care practices could constitute neglect and action needs to be taken to prevent this happening as currently people are been put at risk of harm. Dunollie Care Home DS0000043116.V374743.R01.S.doc Version 5.2 Page 18 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): People who use the service experience good quality outcomes in this area. People have a pleasant environment to live in, though some areas of the home could smell better. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: The home is divided in The Lodge area for people with personal care needs only, the garden wing for younger adults and the main house for people with Dunollie Care Home DS0000043116.V374743.R01.S.doc Version 5.2 Page 19 nursing needs. The communal areas are spacious, and some people have wonderful views across Scarborough (this was evident at the last inspection People were observed enjoying sitting in the garden which is well maintained. The room sizes are good and there are enough toilet and bathing facilities. A new call bell system has been introduced, though staff need to respond to this more quickly. Moving and handling equipment is in use and there are enough chairs and tables for people to use for dining or socialising. Staff were observed wearing aprons and gloves and hand washing techniques were in use. People were observed wearing clean and well-ironed clothes and the laundry area was suitable for its purpose. The sluice rooms should be kept locked and in one area of the home there was a strong smell of wounds that had not healed (pressure sores). The person relating to this was very aware of the smell but staff had not taken any action to reduce this. However, other parts of the home smelled pleasant and were odour free. Some staff have completed infection control training, though this could not be confirmed, as the records were unavailable. Dunollie Care Home DS0000043116.V374743.R01.S.doc Version 5.2 Page 20 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): People who use this service experience poor quality outcomes in this area. People do not receive the care they need or deserve, because staff do not have the right skills and knowledge to meet individual needs, though they are safely recruited. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: People in the home do not have their needs met. This is very evident regarding pressure area care. The home has a new manager who is supported by a matron and other registered nurses. There are generally two nurses on duty during the day with eight or nine care staff. This is for a maximum of fiftyeight people (though there are currently forty seven people). Overnight there is one registered nurse with four carers. This is a large adapted home with a Dunollie Care Home DS0000043116.V374743.R01.S.doc Version 5.2 Page 21 separate building for people with personal care needs only. People have nursing needs and this includes younger people with physical disabilities and older people. The staffing levels should be reviewed. Many of the issues regarding poor care practices, staff felt were due to insufficient staff. The call bell was pressed at the site visit and after ten minutes this still was not answered. A concern was raised recently where relatives stated that they waited for one hour for staff to attend to the person and eventually they had to leave because no one answered the call bell. This is been investigated. As different staff work in all areas they need to have a wide range of skills and knowledge to meet people’s needs. Some staff have completed an NVQ Level 2 or 3 in Care and this is encouraged, though this training is not followed up. Induction training is equivalent to ‘Skills for Care’ and covers orientation to the home, health and safety and care practices. One new member of staff had been recruited safely with two written references and a police and vulnerable adults check. However, they had some brief orientation to the home but have not completed any mandatory training relating to moving and handling, fire safety, infection control, or abuse awareness. This person does not have a mentor and works in different areas of the home. There was no evidence that the induction process had been commenced. Two other recruitment files were examined; these had the relevant checks, though training certificates were not fully in place. One registered nurse confirmed they receive some training but nothing specific to the client group. Dunollie Care Home DS0000043116.V374743.R01.S.doc Version 5.2 Page 22 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): People who use this service experience adequate quality outcomes in this area. The home is not consistently run in the best interests of the people using the service. The service needs to be more pro-active to improve and progress. We have made this judgement using available evidence including a visit to this service. Dunollie Care Home DS0000043116.V374743.R01.S.doc Version 5.2 Page 23 EVIDENCE: The home have employed a new manager (3 months ago), she is hoping to complete an NVQ Level 4 in Management and become registered with The Care Quality Commission. She has previously been a deputy at another Care Home. The manager is currently getting to know the organisation and the different systems in the home. There have been limited improvements in the home since the last inspection, though the atmosphere is calm and more relaxed and staff felt they could go to the new manager with their concerns. The home have a quality assurance system in place. This includes sending out surveys to people using the service and their relatives. Audits are in place regarding care plans and medication, though these need to be fully investigated when issues have been identified. Resident and staff meetings are planned and health and safety audits help keep the environment safe. The organisation needs to seek the views and opinions of people more regularly. People spoken with commented that it was nice to have people talking to them and asking their thoughts about the home. One person discussed their room and and said they did not like one aspect. This was discussed with the management team who could have responded in a more pro-active way. Monthly visits by a senior manager take place, the results of these need to be actioned in a more timely manner. People’s personal money was discussed and inspected. The administrator is responsible for ensuring this is safely stored and recorded. Three files were examined and these were all well maintained with accurate records. The home has a range of policies and procedures in place. A fire risk assessment and regular fire alarm testing is clearly recorded, though due to lack of a training matrix and certificates not up to date in staffs individual files, it was difficult to confirm if fire safety refresher training is provided in a timely way. One person said, “I would keep calm” but was unclear what action to take next. Moving and handling was observed and staff were familiar with using this equipment. Previously staff have completed infection control and food hygiene training. European Care have a training plan in place, which all their care homes follow. The manager is aware that this training needs to be implemented as soon as possible. Dunollie Care Home DS0000043116.V374743.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 x 3 2 4 x 5 x 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 1 ENVIRONMENT Standard No Score 19 3 20 x 21 x 22 x 23 x 24 x 25 x 26 2 STAFFING Standard No Score 27 1 28 1 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No Score 31 1 32 x 33 2 34 x 35 3 36 x 37 2 38 1 Dunollie Care Home DS0000043116.V374743.R01.S.doc Version 5.2 Page 25 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 OP7 Regulation 15 Requirement Care plans must accurately reflect the person’s individual needs. These must be regularly reviewed and evaluated. This will help to ensure needs are been met. People must have an effective pressure care risk assessment in place which then informs the care plan. This needs to be clearly documented with staff been pro-active in the prevention of sores. Medication must be correctly written on the administration charts. The stock balance of medication must tally with the amount recorded. This will ensure people are getting the medication prescribed. Privacy and dignity must be maintained at all times to ensure people are respected and treated well. The manager must foster an open culture so people feel confident in raising their concerns, and any allegations of abuse are dealt with DS0000043116.V374743.R01.S.doc Timescale for action 29/05/09 2. OP8 12 29/05/09 3. OP9 13 29/05/09 4. OP10 12 29/05/09 5. OP16 13 29/05/09 Dunollie Care Home Version 5.2 Page 26 appropriately and in a timely fashion. This will help protect people from harm (Previous timescale 01/12/08) This is being dealt with under our enforcement procedures. 6. OP18 13 Staff must recognise that any poor care practices are signs of neglect. Action then needs to be taken by the manager. This is being dealt with under our enforcement procedures. A review of staff competencies must take place, this relates to all care practices to ensure people have the right skills to deal with this client group. Staff must have the skills and knowledge to care for people who are at risk of developing pressure sores. So that people receive the right care and systems are introduced promptly to manage and reduce that risk. This is being dealt with under our enforcement procedures. Staff need effective induction, which covers mandatory training. This will ensure they are prepared and able to meet people’s needs. Records relating to people using the service must be thoroughly completed in a timely manner. This is being dealt with under our enforcement procedures. 29/05/09 7. OP27 OP30 18 29/05/09 8. OP28 OP30 18 29/05/09 9. OP30 18 29/05/09 10. OP37 17 29/05/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000043116.V374743.R01.S.doc Version 5.2 Page 27 Dunollie Care Home 1 2. 3. Standard OP3 OP14 OP15 4. 5. 6. OP27 OP27 OP37 Assessments need to be more detailed to ensure staff understand what a person’s needs are. Staff need to understand that the routines in the home are in line with the needs of people living there and not the needs of the staff. Staff need to check how many drinks are given and whether people actually drink them. This especially relates to people who need assistance or are at risk of been under nourished. Staff should ensure the call bells system is answered quickly. A review of the staffing levels needs to take place to ensure needs are been met. Record keeping regarding care plans and training of staff should be improved. Dunollie Care Home DS0000043116.V374743.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.V374743.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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