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Inspection on 05/11/07 for Dunollie Care Home

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

This inspection was carried out on 5th November 2007.

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

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

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

Dunollie Care HomeDS0000043116.V353789.R01.S.docVersion 5.2Page 7The home is located in Scarborough and many of the rooms have beautiful views of the sea and surrounding area. One person said "I love my room and I spend a lot of time in it". The new manager has identified shortfalls in the service and is working hard to implement systems to improve the outcomes for people.

What has improved since the last inspection?

People living at the home are treated in a more respectful manner, staff were observed having a pleasant manner and attitude with people and their visitors. The home have a dedicated and committed manager in place who has the skills and experience needed to make improvements to the service provided. Staff are deployed to different areas of the home more effectively, this has resulted in more continuity of care. One person said "the staff are wonderful, they know what they are doing, and we see the same people". The home has recently employed more administrative staff who are starting to improve the record keeping, this will make the current systems more robust. The home have an experienced deputy in place who is able to support the manager in running the home. More experienced nurses have been employed since the last inspection and this had had a positive effect on the service people receive.

What the care home could do better:

People must have their care needs assessed and recorded effectively and individual plans of care must be drawn up. This ensures that staff are aware of specific needs and how they can be metThe medication system needs to be more robust this includes completing regular stock balances, auditing the medication charts and correctly signing for controlled drugs. This will help to minimise any errors. People should have access to a range of activities which they can choose to participate in. This will provide stimulation for people. People must be given assistance by staff at mealtimes in a dignified manner. People must be able to live in a home which is clean and well maintained. Recruitment files must be complete to evidence that the appropriate checks have been made i.e two references, police check and vulnerable adults check. This ensures that people are cared for by safe and competent staff. People need to be cared for by staff who have received in-depth induction training, this should help improve the standard of care people using the service receive. This must include infection control and food hygiene training. People`s views and opinions need to be sought and acted upon. This is part of the quality assurance system which needs implementing. This was highlighted at the last inspection. Clear audits of care plans and medication charts need to be in place to help minimise errors and identify the action to be taken if issues arise. Room doors must not be propped open by unauthorised means. This compromises people`s well being in the event of a fire.

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 Unannounced Inspection 5th November 2007 09:15 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.V353789.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.V353789.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 vacant post Care Home 58 Category(ies) of Old age, not falling within any other category registration, with number (58), Physical disability (58) of places Dunollie Care Home DS0000043116.V353789.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home with nursing - Code N To services users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Physical Disability - Code PD of the following age range : 40 years and over The maximum number of service users who can be accommodated is: 58 Service Users to include 58 OP and 58 PD up to a maximum of 58 service users. Service Users in the category PD to be aged 40 years plus and require nursing care. 21st May 2007 2. 3. 4. Date of last inspection Brief Description of the Service: Dunollie Care Home provides nursing care, social care and accommodation for a maximum of 58 people. Some of these people may be admitted from the age of 40 years old and may have a physical disability requiring nursing care. The service consists of the main house that can accommodate 49 people and The Lodge that can accommodate 9 people. The home is owned by European Care (SW) Limited and is located on Filey Road in Scarborough, a seaside resort. It is within walking distance of the local shopping area and close to the Italian gardens and Spa complex. It is about a mile away from the town centre. Access to the home is via a steep driveway with car parking facilities outside the main entrance or via steps for pedestrian access. The home is accessible on a level approach from the car park. It is set in extensive, well maintained, grounds that have several patio areas for residents and visitors to enjoy. These are reached from several points around the home without the need to negotiate any steps. The accommodation in the main house is divided into the garden wing, which is specifically designed for people with a physical disability, and the main house. There is a passenger lift access to all floors in the main house, the garden wing and The Lodge Dunollie Care Home DS0000043116.V353789.R01.S.doc Version 5.2 Page 5 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 regarding the service is available in the previous inspection report and service users guide. Dunollie Care Home DS0000043116.V353789.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection has used information from different sources to provide evidence for the report. These sources include: • • Reviewing information that has been received about the home since the last inspection. Information provided by the new manager in an annual quality assurance assessment. Due to the information being received one month late not all the survey information could be included in this report. Ten service user surveys were sent out, two were received. Three relative surveys were also sent out. The information regarding healthcare professionals was not received, though this was requested. A revised improvement plan which details how the service plans to progress. This was received in July 2007. A visit to the home carried out by one inspector that lasted for ten hours. Information gathered at a random visit on 3rd July 2007 where previous requirements were discussed. • • • During the visit to the home people using the service, visitors, and staff were spoken with. Records relating to four service users were inspected. Two of these people lived in the main house (nursing), one person in The Lodge (residential) and one person in the Younger Adults unit. Staff members, visitors and the management activities of the home were also discussed. Care practices were observed, the lunchtime meal was observed, and time was spent observing interactions between staff, people using the service and their visitors. The new manager discussed the progress the service has made in relation to health and safety, complaints, medication and the care people receive. Verbal feedback was given at the close of the inspection to the manager. Some of the requirements made relate to the overall service, however specific requirements have also been made which only relate to the care of older people and not younger adults. What the service does well: Dunollie Care Home DS0000043116.V353789.R01.S.doc Version 5.2 Page 7 The home is located in Scarborough and many of the rooms have beautiful views of the sea and surrounding area. One person said “I love my room and I spend a lot of time in it”. The new manager has identified shortfalls in the service and is working hard to implement systems to improve the outcomes for people. What has improved since the last inspection? What they could do better: People must have their care needs assessed and recorded effectively and individual plans of care must be drawn up. This ensures that staff are aware of specific needs and how they can be met. Dunollie Care Home DS0000043116.V353789.R01.S.doc Version 5.2 Page 8 The medication system needs to be more robust this includes completing regular stock balances, auditing the medication charts and correctly signing for controlled drugs. This will help to minimise any errors. People should have access to a range of activities which they can choose to participate in. This will provide stimulation for people. People must be given assistance by staff at mealtimes in a dignified manner. People must be able to live in a home which is clean and well maintained. Recruitment files must be complete to evidence that the appropriate checks have been made i.e two references, police check and vulnerable adults check. This ensures that people are cared for by safe and competent staff. People need to be cared for by staff who have received in-depth induction training, this should help improve the standard of care people using the service receive. This must include infection control and food hygiene training. People’s views and opinions need to be sought and acted upon. This is part of the quality assurance system which needs implementing. This was highlighted at the last inspection. Clear audits of care plans and medication charts need to be in place to help minimise errors and identify the action to be taken if issues arise. Room doors must not be propped open by unauthorised means. This compromises people’s well being in the event of a fire. 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.V353789.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Dunollie Care Home DS0000043116.V353789.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): All the key standards were assessed People who use the service experience adequate quality outcomes in this area. Whilst people have their needs assessed this is not always recorded effectively. This may mean that staff are not aware of a person’s specific needs. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: Four pre-admission assessments were inspected. The manager or one of the registered nurses visits people either in their own home, in hospital or wherever they are residing. An assessment format has been developed and three out of four of these were completed in detail. This covered health, social Dunollie Care Home DS0000043116.V353789.R01.S.doc Version 5.2 Page 11 and personal care. One person in the younger adults area confirmed that an assessment had taken place along with one person in the residential area. Another person who was admitted three weeks ago had very little information in the pre-admission assessment. This was not sufficient to identify what the persons needs were and whether they could be met. This was discussed with the nurse who carried out the assessment who said she did not have time to complete this. Whilst information had been received from the care manager again this had not been used to formulate the assessment or care plan. This information must be completed in detail and clearly recorded Dunollie Care Home DS0000043116.V353789.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service Users, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): All the key standards were assessed People who use the service experience adequate quality outcomes in this area. Health and personal care needs are starting to be consistently met. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: Dunollie Care Home DS0000043116.V353789.R01.S.doc Version 5.2 Page 13 The care that people receive in the home is variable. People spoken to in the residential area felt their needs were met and they were happy with the care they received. Two people in the younger adults area discussed the care and how their needs are met. However in the main house not everyone was clean and well cared for. One person said he had been waiting from 8am to get washed and dressed. Staff came to him at 11.10am. Whilst there have been many new staff employed which is positive some people felt they did not know who was going to look after them on a morning. Four care plans were checked, some information was detailed with risk assessments for moving and handling, the prevention of pressure sores and the risk of falls being in place. On one occasion (the person without a detailed pre-admission assessment) no specific care plans were in place, whilst the member of staff was aware of this person’s needs this had not been documented to inform other staff, and the documentation was not user friendly. For example the risk assessments were also plans though there was insufficient room to complete a plan in the same place. Staff were unsure how to fill this in. One risk assessment identified a problem but not what the risk was. The detail did not confirm that the person using the service had any input into how the risk would be managed and if they agreed to this. The care plans contained daily progress sheets, care staff are starting to complete these. However, in one case a person in the main house had been involved in an accident which resulted in a fractured hip. The care plan records were incomplete. An entry on 1st November (was written as 1st October) at 19.30hrs which was then proceeded by an entry on 2nd November at 7.50am when staff had found the person on the floor. No other entries were made by the night staff and therefore it was impossible to confirm whether this person had been checked overnight or when the accident had taken place. This was discussed with the manager. Notifications are sent to the CSCI under Regulation 37 to inform us of any incidents or accidents affecting the wellbeing of people using the service. The manager is aware of how to access healthcare professionals. Evidence in the care plans showed input from the GP, continence advisor and community dietician. People spoken with confirmed the chiropodist and hairdresser visits. The home are now completing nutritional risk assessments, three out of four were completed correctly. Staff must be aware that these need completing to identify any risk, rather than identifying a risk and then completing them. The medication system was inspected and discussed. Staff have medication training and are aware of the guidance from the Royal Pharmaceutical Society regarding administration of medicines in care homes. Medication charts were checked and whilst these were completed correctly it was evident that routine stock balances of medication do not take place. The blister pack system is in use, though one person who had been in the home for three weeks did not have his medication dispensed in this way. At the visit a new month of Dunollie Care Home DS0000043116.V353789.R01.S.doc Version 5.2 Page 14 medication had been started. This would mean that the blister pack for this person could not be ordered for another month. Staff should have picked up on this as this system is more robust than having tablets loose in a box. Information regarding how many tablets the person had brought in was unavailable. Staff do record the fridge temperatures on a daily basis and they are aware of how to store insulin and eye drops correctly. A regular audit of the medication system needs to take place, any concerns can then be highlighted. The controlled drugs register confirmed that two people sign when a drug is administered. However, one person’s signature was an initial rather than the full signature and it was difficult to know which person this related to. This needs to be in place to ensure there is a detailed system for recording medication. Privacy and dignity in the home was maintained, staff had a good rapport with people using the service and their visitors. Staff were observed knocking on room doors prior to entering, and people were addressed using names which they had chosen. Dunollie Care Home DS0000043116.V353789.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service Users have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All the key standards were assessed People who use the service experience adequate quality outcomes in this area. Some activities are available and autonomy and choice is generally encouraged. Though aspects of the dining experience need to be improved. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: Dunollie Care Home DS0000043116.V353789.R01.S.doc Version 5.2 Page 16 The home offers a range of activities and family members and friends are encouraged to get involved with people using the service, for example escorting to hospital appointments (not just recreational activities). This was detailed in the annual quality assurance assessment. Regular entertainers visit and staff are aware of how to meet religious needs. This is documented in individual care plans. The home encourage family and friends to dine with their family, and there is a volunteer fundraiser who is able to plan entertainment and holidays for people. The manager is aware that more individualised activities are needed. Visitors were observed coming and going throughout the day, the visitors book also confirmed this. It would be beneficial having a clear visitors policy which details the expectations of visitors regarding their behaviour whilst in the home. For example, when people are offered food and drink is there an expectation that this is complimentary. Do visitors know how to raise concerns they have and how is this dealt with, when healthcare professionals visit or other relatives who should welcome them and is it appropriate for visitors and not the staff to do this? These issues were discussed with the manager and clearly need to be addressed to ensure people using the service do not have their well-being affected. The culture of the home and the attitude and manner of staff is starting to promote autonomy and choice for people. This incldues when people get up and go to bed and where they can have their meals. The lunchtime meal was observed and the food was sampled. People can dine in a range of areas, some ladies sat in one room and the gentleman sat in another (this was their choice). In the future the home is going to ask people if they would prefer breakfast in their own rooms rather than coming down to the dining area. The food served was appetising, people have a choice of main course and alternatives are offered. The dining room observed was pleasant and two ladies said how much they look forward to mealtimes. Suitable crockery and cutlery is offered, and whilst some people were sat at the table in wheelchairs this was their choice. The dining experience was calm and relaxing. Fish and vegetables were offered, a mix of fresh and frozen vegetables, and a homemade dessert and custard was provided. One person asked for ice cream instead and this was readily available. Whilst staff had a good rapport with people, some staff (both registered nurses and carers) stood over people whilst assiting them with their meal. Though one carer was observed sitting down and chatting to the person whilst assistance was given, this was carried out in a dignified manner. The cook was spoken to and clearly had a good understanding of the needs of the people living in the home, the menus are in the process of being reviewed. The kitchen was clean and the cook was aware of how to puree food and cater for people who were udnerwieght or overweight and those needing a diabetic or soft diet. Dunollie Care Home DS0000043116.V353789.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service Users feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All the key standards were assessed People who use the service experience good quality outcomes in this area. People are aware of how to complain and feel their concerns will be acted upon. Staff are aware of how to protect people from harm. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: The home have a complaints procedure in place and this is disucssed at the point of admission to the home. The annual quality assurance assessment states “we offer an open door policy for all in order to raise concerns and complaints”. This was evident during the day with people speaking to the manager and staff. Three visitors spoken to all confirmed they are aware of how to complain. One person in the younger adults unit and another in the residential area said “I would go to the manager if I had any concerns”. The home have dealt with four complaints and the new manager is very aware of how to respond to complaints in a timely fashion, issues regarding care practices have been dealt with. The home have a vulnerable adults procedure in place, the new manager has dealt with allegation of abuse and has acted approrpaitely to protect people Dunollie Care Home DS0000043116.V353789.R01.S.doc Version 5.2 Page 18 living in the home. Whilst the manager is aware of how to refer people onto the protection of vulnerable list this decision is taken in collaboration with European Care. Staff spoken to were aware of the different types of abuse, though not all staff have completed training in this area. People in the home looked safe and comfortable in the environment. Staff have police checks and protection of vulnerable adults checks priore to starting work in the home. Dunollie Care Home DS0000043116.V353789.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All the key standards were assessed People who use the service experience adequate quality outcomes in this area. People enjoy living in the home though the standard of cleanliness and décor could be improved. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: The home is in a pleasant location with some wonderful views across Dunollie Care Home DS0000043116.V353789.R01.S.doc Version 5.2 Page 20 Scarborough. The home is safe for people though the main house could be cleaner. The younger adults area is fresh and well maintained, and The Lodge area for residential people is homely and meets the needs of people living there. The annual quality assurance assessment states “Our groundsman single handedly manages the gardens and has for several years won the local Council Scarborough In Bloom Competition” People are encouraged to bring into the home any personal pieces of furniture. This was evident when inspecting three people’s rooms.. Pets are also encouraged, there is a budgie in the lounge and shortly a parakeet will be welcomed into the home. The laundry staff feel that there are sufficient washing machines and tumble driers and a new machine for ironing sheets has been obtained. There are enough sluice machines and some staff confirmed they have completed infection control training. Staff were observed wearing protective clothing, and staff hand-washing facilities are in place. From 12th November domestic staff will be part of the overall team and work alongside carers and registered nurses in designated areas. This will help improve the overall cleanliness of the home. Dunollie Care Home DS0000043116.V353789.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All the key standards were assessed People who use the service experience poor quality outcomes in this area. The care delivered is variable, not all staff have the skills to care for older people and younger adults and improvements in the recruitment practices are needed to ensure people are not put at risk. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: People living in the home have mixed experiences regarding the care that is delivered. The new manager is very aware of the standard she expects to drive the service foreward. Some staff have left the home and many new registered nurses and carers have joined the developing team. The approach to care has changed there are now dedicated teams working on each floor in the main house and in The Lodge (residential) and Younger Adults area. This is Dunollie Care Home DS0000043116.V353789.R01.S.doc Version 5.2 Page 22 beneficial as there is more consistency and staff are able to develop their skills more effectively. Visitors to the home are more able to determine which staff member they need to speak to. This format has recently been introduced and whilst this is extremely promising more time is needed to assess the effectiveness of this way of working. Staff spoken to included registered nurses and carers. One carer who had experience in palliative care had an extremely pleasant and caring manner, she was aware of her responsibilities and knew how to meet people’s needs. Another carer spoken to had not received adequate induction training and was working alongside a bank nurse and another carer. One registered nurse spoken with felt that she did not have enough time to meet people’s needs. Some agency staff are used and the manager is aware that this is a new team and skill mix needs to be continually reviewed. The home have an induction process though currently staff receive orientation training rather than a full induction equivalent to skills for care. The manager is in the process of implementing this. Staff are encouraged to undertake NVQ training and this was evident when speaking with staff. This will help ensure that people are all working to the same standard which will improve outcomes for people. Recruitment practices were discussed with the manager and administrator. Two written references are obtained along with a police check and a protection of vulnerable adults check. The home have recently employed administrative staff and they are in the process of reviewing all the staff files to ensure all the information is accessible. Three staff files checked did not have all the relevant details, it was therefore difficult to confirm what checks had taken place. Registered nurses do have their identification numbers checked with the nurses and midwifery council and evidence was available to confirm this. One staff member did confirm that references and a police check had been completed prior to starting employment. This area needs to improve which the manager is aware of. Dunollie Care Home DS0000043116.V353789.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Dunollie Care Home DS0000043116.V353789.R01.S.doc Version 5.2 Page 24 All the key standards were assessed People who use the service experience adequate quality outcomes in this area. The manager runs the home in the best interests of people using the service, though the quality assurance system needs developing and peoples finances need to be recorded in a more robust manner to protect people from harm. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: The new manager of the home is clear about how to run the home in the best interests of people living there. The manager is a registered nurse who is extremely experienced in caring for this client group. She has the knowledge and skills needed to improve the outcomes for people in the home. Whilst the manager has only been in post for seventeen weeks (at the time of the site visit) it is very evident that a range of improvements have taken place in this short amount of time. The manager is aware that the culture of the home needs to improve in order to enhance the quality of life for people. Staff are starting to be effectively performance managed which sends out a clear message to staff regarding their standard of care and the expectations of the manager. The manager is aware that she needs to be registered with the CSCI and completion of an NVQ Level 4 in management would be beneficial. The home have a quality assurance system in place, this needs to be implemented which has been highlighted previously. Residents and staff meetings are in place and the views and opinions of people will be sought though customer surveys. Currently there is no formal auditing of the care plans, the medication system or the overall care provided. This needs addressing so the home can identify where improvements need to be made. Finances were discussed with the manager and administrator. People are able to have ‘pocket money’ up to a certain amount in the home. Whilst there are individual plastic wallets for this currently there is no weekly record of the amount of money coming in or going out. This can be worked out when looking at the receipts but a more robust system needs to be in place. This will identify any errors and hopefully prevent any future errors occurring. Three records were checked and these did tally. The manager again was aware that this system needs improving. Health and safety in the home was discussed with the manager and maintenance person. Clear records regarding fire safety and water temperatures are in place. The annual quality assurance assessment confirmed Dunollie Care Home DS0000043116.V353789.R01.S.doc Version 5.2 Page 25 how equipment is checked including the lift, emergency lighting, and electrical equipment. The call bell system is checked as this was highlighted in the previous inspection. Staff receive fire training and weekly alarm tests take place and unannounced fire drills are in operation. The home have a fire risk assessment and escape routes are routinely checked. There was evidence that three rooms were propped open by unauthorised means. Dorguards were in place which would then be ineffective in the event of a fire. Staff must be vigilant in maintaining fire safety. Mandatory training takes place though staff do need to attend food hygiene, infection control, first aid and moving and handling. The home is in the process of updating to files. People living in the home said they felt safe, no serious health and safety issues were identified and regular checks by the maintenance person helps keep people safe. Dunollie Care Home DS0000043116.V353789.R01.S.doc Version 5.2 Page 26 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 1 4 x 5 x 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 ENVIRONMENT Standard No Score 19 2 20 x 21 x 22 x 23 x 24 x 25 x 26 2 STAFFING Standard No Score 27 1 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 x 33 1 34 x 35 2 36 x 37 x 38 2 Dunollie Care Home DS0000043116.V353789.R01.S.doc Version 5.2 Page 27 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 OP3 Regulation 14 Requirement The pre-admission assessment must be completed and clearly documented, this will be used to create individual care plans. People must have care plans in place to address all their identified needs and assess any identified risks. These must clearly direct staff as to how these needs are to be met within a risk assessment framework. They must be kept under review. Timescale for action 05/12/07 2. OP7 12 05/12/07 3. OP9 13 4. OP15 12 A clear audit trail of each person’s medication must be evident. This includes completing regular stock balances, and auditing the medication charts. Staff must complete the controlled drugs book correctly i.e signature People must be given assistance at mealtimes in a DS0000043116.V353789.R01.S.doc 05/12/07 05/12/07 Page 28 Dunollie Care Home Version 5.2 manner which maintains their dignity. 5. OP26 16 The main house needs a thorough clean. This will help to reduce cross contamination. The skill mix of staff must be reviewed to ensure people receive care from suitably trained and competent staff. Records relating to recruitment must be complete and well maintained, this is to clearly demonstrate that all checks have been made prior to a person being employed. A formalised induction programme must be introduced to ensure staff have the knowledge and skills to care for this client group. Care staff must receive training in the following areas: First aid Infection control Food hygiene The manager needs to be registered with the CSCI. The quality assurance system that is available must be implemented. The views of people that are involved with the service must be sought and their views acted upon. Regulation 26 visits must be carried out in line with the regulations. A copy of the Dunollie Care Home DS0000043116.V353789.R01.S.doc Version 5.2 Page 29 05/12/07 6. OP27 18 05/12/07 7. OP29 19 05/12/07 8. OP30 18 05/12/07 9. OP30 18 05/01/08 10. 11. OP31 OP33 18 24 05/03/08 05/12/07 record of these visits must be forwarded to the Commission for Social Care Inspection monthly. (previous timescale 04/07/07 not met) 12. OP38 23 Doors must not be propped 05/11/07 open by unauthorised means 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 OP9 Good Practice Recommendations Up to date photographs of residents should be attached to the Medication Administration charts. Clear records relating to people’s money kept in the home must be made, this will help reduce the likelihood of an error occurring. 2. OP35 Dunollie Care Home DS0000043116.V353789.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Dunollie Care Home DS0000043116.V353789.R01.S.doc Version 5.2 Page 31 - 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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