Inspection on 15/09/08 for Dunsfold

This inspection was carried out on 15th September 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 20 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Dunsfold 27/11/07

Dunsfold 31/01/07

Dunsfold 09/06/06

Dunsfold 08/12/05

Dunsfold 07/07/05

Dunsfold 24/01/05

Dunsfold 18/05/04

Dunsfold 20/10/03

Dunsfold 19/05/03

Dunsfold 17/12/02

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Dunsfold West End Road Herstmonceux East Sussex BN27 4NX     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Deborah Calveley     Date: 1 5 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Dunsfold West End Road Herstmonceux East Sussex BN27 4NX 01323832021 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Kim Elizabeth Allcorn Type of registration: Number of places registered: Mr Paul Hughes,Mrs Indra Hughes care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is twenty (20). The registered person may provide the following category of service only: Care home providing personal care (PC) to service users of the following gender: Either M/F Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Date of last inspection Brief description of the care home Dunsfold is registered to provide a home for twenty older people with dementia. The home is a large detached property situated in the small village of Herstmonceux. The home is set within its own grounds and is approximately half a mile from the main road, which includes local amenities such as shops and local transport links. Resident accommodation consists of twelve single rooms and four shared rooms. Some of the room sizes are below the New National Minimum Standard and there is not level access throughout the home although the home is exempt from these regulations as it was Care Homes for Older People Page 4 of 35 Over 65 0 20 Brief description of the care home first registered before April 2002. Communal areas comprise of a lounge, dinning room and library/second dining area. There are three bathrooms and five additional toilets in the home. The home welcomes pets and some residents keep cats in their rooms. The external grounds include a large rural garden, and a large parking area, including courtyard tables/chairs. An alarmed gate separates the garden from the road and allows residents freedom of movement as well as ensuring their security. The home does not provide level access internally or externally and there are some steps out to the garden from some exits. The home is better suited for those without mobility needs particularly as upstairs rooms are only accessible by stairs. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at Dunsfold will be referred to as ‘residents’. This was a key inspection that included an unannounced visit to the home and follow up contact with resident’s representatives and visiting health and social care professionals. This unannounced inspection was carried out by two inspectors over 6.5 hours on the 15 September 2008. There were 11 residents living in the home on the day, of which Care Homes for Older People Page 6 of 35 four were case tracked and spoken with. During the tour of the premises four other residents both male and female were also spoken with. The purpose of the inspection was to check that the requirements of previous inspections had been met and inspect all other key standards. A tour of the premises was undertaken and a range of documentation was viewed including the Service Users Guide, Statement of Purpose, care plans, medication records and recruitment files. Three members of care staff and the cook were spoken with in addition to discussion with the deputy manager and registered provider. Telephone contact was made with visiting professionals following the visit and their views and comments are incorporated into the report. The information received verbally during the site visit has been incorporated into this report. An Annual Quality Assurance Assessment was received from the registered person completed in full following this key inspection. What the care home does well: What has improved since the last inspection? What they could do better: The home needs to confirm in writing to the prospective resident or their representative that with regard to the needs assessment completed the home can meet the needs of the prospective resident. This ensures that decisions around admission to the home are informed. At the last inspection a new care plan had been introduced and therefore it was disappointing to see that the improvements made have not been sustained. The care documentation including individualised care plans and risk assessments need to be improved to ensure residents receive appropriate and person centred care that meets their assessed needs and to minimise any risks. They need to be regularly reviewed to ensure that their health needs are evaluated and expert advice sought as necessary. The care plans need to be assessable to staff and not locked away. Medication practices need to improve to ensure that the residents health needs are promoted and protected. Care Homes for Older People Page 8 of 35 The activities did not evidence the improvements needed as identified at the last key inspection. Therefore it is identified again as an area that requires development to meet all the residents’ social needs. Activities should be an important part of life to the residents of Dunsfold so as to encourage and promote social independence and mental stimulation. The environment of the home needs to be closely monitored and systems devised to ensure that it is clean, safe and hygienic for those living there and visiting. The policies and procedures of the home need to be assessable for staff at all times. Recruitment practices need to be improved so as to ensure that residents are protected from harm. The staffing levels in the home need to be reviewed regularly and the staffing roster needs to be up to date and an accurate reflection of the staff working. The management team of the home needs to ensure that the home is run efficiently and competently to meet its stated purpose, aims and objectives and ensure that residents health, welfare and safety is promoted and protected at all times. The home management team need to ensure that a suitable quality monitoring system is maintained to ensure residents and their representatives views are taken into account and demonstrates ongoing review and improvement to the quality of care and services in the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides prospective residents and relatives with a good level of information about the home, its facilities, services and the costs involved. The admission procedures allow for the needs of prospective residents to be assessed by a competent person before admission, however little information is documented thus not ensuring their needs can be met and people are not assured in writing that their needs will be met. Evidence: The Statement of Purpose and Service Users Guide are in a brochure format and contain information about the home and the services it provides. It also contains information and photographs regarding the nearby sister home located in Hastings. Copies of these are available from staff on request. The brochure needs to be updated in respect of the registering body. It would also be beneficial for the people reading it if the format used was enlarged and more user friendly. Contracts were seen and were Care Homes for Older People Page 11 of 35 Evidence: written in plain English. There is a copy of the terms and conditions of residency included in the Information pack. A review of the care documentation confirmed that pre-admission assessments are completed by the manager or the provider. Four residents were identified for case tracking which included the latest admission to the home. The information recorded was brief and did not include much pertinent information regarding the person to be admitted to the home. One resident was admitted to home with health needs, spiritual needs and behavioural needs, which were not included in the care plan and of which staff spoken with had no knowledge. Therefore the assessment did not inform the admission process and did not form the basis of the plan of care. Prospective residents are seen either in their home or hospital before admission and the input from relatives and other professionals is used whenever possible. This approach should be more clearly recorded on the assessment documentation to demonstrate the procedure followed. There was no evidence in the documentation that the home confirm having regard to the assessment that the home can meet the assessed needs of the prospective resident. This was discussed with the deputy manager who was advised that this should be completed in writing in accordance with the required documentation. Trial visits to the home can be arranged. The manager confirmed that self-funding residents are invited to a trial period to ensure suitability of the home; this is clearly stated in the Statement of Purpose and in the statement of terms and conditions Care Homes for Older People Page 12 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst care documentation provides a good framework for the assessment of residents needs, the lack of information recorded, regular review and evaluation place residents at risk from uninformed staff. Procedures and practices in the home do not allow for the safe administration of medicines and therefore do not protect and promote the residents health. Evidence: Four care plans were reviewed in depth as part of the inspection process, the care plan format in use now has been introduced since the last key inspection in November 2007. The care plan format is a good assessment tool, but does not develop in to a plan of care for individual residents needs and contains no guidance for staff to follow in meeting those needs. The documentation viewed was not person centred and was seen to be task orientated. If this format was developed and maintained it would be useful informative tool. Some residents medical history and diagnosis is not included in the information of the residents care plan, and when discussed with staff they were not aware of a resident having a pacemaker or that he was an atheist. These Care Homes for Older People Page 13 of 35 Evidence: incomplete records place the residents at risk. It was also noted that resident’s social emotional and psychological needs were not assessed or addressed within the care records. There was little evidence of regular review, some have not been reviewed since the last key inspection in November 2007 and there was no evidence that residents or their families have been involved in the formation of a care plan. Risk assessments for some health needs such as nutrition and moving and handling were in place but these need to be followed up thoroughly within the care documentation. Residents’ weights are being recorded but despite weight loss being documented, no action is being instigated. One resident has lost 24 lbs since his admission and this was not identified as a concern and no action was taken by the home. Another resident collapsed in the home and was admitted to hospital, the resident was found to be anaemic and following a blood transfusion went home, however there was a lack of follow up by the staff at the home, and her care plan did not reflect this change to her health needs. Residents identified with continence problems did not have an assessment in place or a plan of care for staff to follow in meeting this need. Overall the care plans lack vital information, regular review and evaluation and also lack the guidance needed regarding the action the staff need to follow in caring for their residents in in a consistent manner in key areas. E.g. nutrition and feeding, dementia, personal hygiene, communication and continence. It was not evident from the documentation available whether all the health and welfare needs of the residents were being met. There was evidence to confirm that carers are recording the care provided, however it was found that staff cannot access the care plans easily as they are locked away in the office. This has changed since the last inspection and the staff could not explain why this had occurred. If an incident/accident happened before 0900 hrs and after 1700 hrs staff would not be able to inform the family or get important information for transfer to hospital until the person on call could get to the home. The plans of care need to be available to staff at all times. Discussion with staff identified that staff do not receive a handover at shift change, and so could be unaware of any changes in care and this would benefit and improve communication. It was noted that staff are using a blackboard in the dining room to inform staff of changes in needs and use of pads and this needs to be reviewed as it impinges on residents dignity. Residents prescribed medication is delivered in the Nomad system and stored in a cupboard in the dining room and is used on a weekly basis, other medicines are kept for longer periods such as lactulose. The cupboard area did not have any ventilation and was not having its temperature monitored. This needs to be introduced to ensure Care Homes for Older People Page 14 of 35 Evidence: that the medications are kept at the correct temperature. At the last key inspection the manager had said were going to use a medicine trolley, which would have been more suitable, this has not happened. The medication administration records (MAR) were reviewed and it was noted that 0 is used when medicines are not given but this is then not clarified and followed up with the G.P. Gaps were identified and this needs to be monitored regularly by senior staff and action taken as necessary. The directions on one residents chart, which had been hand written by staff was incorrect and could have been a serious drug error. This was identified to the provider immediately. Medication for one resident was stopped by the G.P on the 09/09/08 but was still given by staff on the 10/09/08 and 11/09/08. These are serious shortfalls and the competency of staff must be monitored closely. There is no clinical fridge and they use the normal fridge for eye drops and other medicine that require refridgeration. The eye drops had not been dated when they are opened so staff had no way of knowing when they have expired and were stored in the fridge in the kitchen but not in a separate container as required. The home does not have any Controlled Drugs(CD) and when they do, the storage facilities at present do not meet the new legislation. The registered manager and the owner were advised of the new legislation and the need to ensure appropriate storage for any CD that is brought into the home. The MAR charts were not being used to check that the correct medicines were being received in to the home, however the deputy manager was using a stock audit and was following what the previous manager had put in place. The interaction between residents and staff was in the main suitable, but some interaction by staff was seen to be inappropriate for people with dementia. This needs to be addressed at individual supervision with staff. Residents were seen to be addressed by their names and were wearing their own clothing. However the directions from the district nurse concerning one residents leg coverings were not being followed. Care Homes for Older People Page 15 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lifestyle experienced by residents does not always match their expectations, choice or preferences. Residents would benefit from the introduction of a robust and stimulating activity programme. The meals remain good in respect of choice and quality. Evidence: Dunsfold still do not have a daily activity programme in place it, staff said that outside entertainers visit the home, but they are not a regular occurrence and that they continue to celebrate residents birthdays and other special occasions. There were no separate care plans in place for activities and from discussion it was said that staff write the one to one interaction in the daily notes, however as previously found there were no entries found of any social or physical activity. The pen profiles on residents care files were not all completed and there was little insight shown in to finding out the interests of the residents. Activities should be an important part of life to the residents of Dunsfold so as to encourage and promote social independence and mental stimulation; therefore it is identified again as an area that requires development to meet all the residents’ social needs. It was discussed in full with the deputy manager and provider during the inspection. Care Homes for Older People Page 16 of 35 Evidence: Residents are facilitated to maintain their independence for as long as they are able within the home and encouraged to mobilise independently. It was observed during the inspection that the routines at the home are flexible to a certain degree, but this is sometimes impacted on by the staffing levels. During the site visit residents were restricted to the lounge and dining area and nobody was out enjoying the garden. Residents are able to re enter their bedroom and walk around the lower floor corridors. The home has an advocacy policy in place and the information regarding this is available to all residents. There are no restrictions on visiting times as long as consideration is shown to all the residents. Trips out are arranged occasionally, and information received from staff and from their care plans, their religious and cultural needs are discussed with the resident if possible and their representatives. However as previously identified in this report, the staff did not realise that one of the residents was an athesist. Four residents have their pets with them, two dogs and two cats and the staff said they support the residents in caring for them. This is a positive aspect of life in Dunsfold however some guidelines need to be drawn up to ensure that they are housetrained and staff all take responsibility for ensuring the rooms they live in are kept clean and hygienic. The Statement of Purpose states that staff will support residents in ensuring that their lifestyle choices will be met. This needs to be reflected in their individual care plans. It was observed during the inspection that there are no time constraints to meal times. Breakfast service was said to be staggered and flexible and residents are not hurried and allowed to finish their meal in their own time. This was confirmed by direct observation as some were still eating their breakfast at 0900 hrs when the site visit started. However again from direct observation during the inspection, it was not evident that residents are offered choices of beverages, or if they would like music or the television on and no one to one interaction was observed. There are two dining areas that are used for meal times and residents were seen sitting where they choose, residents can also eat from small tables in the lounge. From direct observation staff were seen supporting and assisting residents with their meals. The menus are worked out on a weekly basis and demonstrated a varied and nutritious range based on the residents known preferences. One main meal is prepared, but alternatives are offered at every meal. It was confirmed that a blended version of the meal is prepared for those that require it. The cook completes the recommended ‘safer food better business’ diary. The kitchen was clean and well organised and cleaning Care Homes for Older People Page 17 of 35 Evidence: rotas were seen to be in place. Also employed are a weekend cook and supper cook, both of whom have a relevant qualification and up to date food and hygiene certificate. The cook has worked in the home for nine years and is knowledgeable regarding the residents dietary needs and was able to discus their likes and dislikes. The cook is also a carer and was seen to have a positive relationship with the residents. Care Homes for Older People Page 18 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Practice in the home ensures that complaints are responded to, with residents and representatives being confident that they are listened to. However the policies and procedures need to be readily available for staff to use. Practice in the home ensures that adult protection issues are responded to when identified. Evidence: The complaint policy and procedure was not immediately available and from discussion it was at the home of the manager who is currently off sick. They have not been in the home for some weeks and therefore not available for the new staff or existing staff to refer to. There is a copy however in the Service Users Guide. A system of recording complaints was demonstrated during the site visit, the home has received one complaint since the last inspection. The management team have a clear understanding of adult protection guidelines and are aware of how to initiate an investigation if required. Staff have now all received POVA training. The AQAA received shortly following the site visit States ‘The home have a clear policy on complaints/ concerns and will deal with them within the time scales. Staff are given training on POVA and are aware of what action to take. Staff are aware that the residents capacity to make decisions may change daily and access these. Procedures are in place to respond to evidence or suspicion of neglect. An IMCA can be contacted should the need arise’. However on the site visit the home did not have the homes policies and procedures in the home in respect of the relevant guidelines on safeguarding Care Homes for Older People Page 19 of 35 Evidence: vulnerable adults. There are currently five safeguarding referrals under investigation, which is the reason for this key unannounced inspection. Care Homes for Older People Page 20 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Dunsfold provides residents with a homely and comfortable environment with communal rooms, however the residents positive oucomes are impacted on negatively by an inadequate cleaning and maintenance programme. Evidence: The provider confirmed that they are continuing to follow an improvement programme that will benefit the residents and visitors to the home and will when completed, provide a welcoming and comfortable environment. The tour of the home evidenced that work is on-going. The entrance area and library area were clean and bright. The lounge décor remains unchanged, but the quality of furniture has improved with new chairs, it was noted however that all the chairs were of the same height with no variables. There is still a need to improve the quality of furniture throughout the home, bedroom and dining room furniture and it was discussed that this needs to be included in a written refurbishment plan with achievable timescales set. There are sufficient communal bathrooms and shower rooms in the home, but only one with specialist equipment, which enables frail residents and those with a physical disability to enjoy the facilities available. However the bathrooms are not attractive and inviting and are in need of redecorating. This was discussed at the last inspection and has not been addressed by the refurbishment programme. Specialised equipment Care Homes for Older People Page 21 of 35 Evidence: to encourage independence is provided e.g. handrails in bathrooms, hoists, ramps to provide levelling of steps and wheelchairs. Call bells are provided in all areas. There are different call systems for the front door gate with various differing ring tones which as visitors were found intruding and unpleasant. The lighting in the home is of domestic quality and the temperature in the home was comfortable. All radiators were found appropriately covered and the open fire is not in use at present and has the appropriate fireguards in place to ensure the residents safety. Water temperatures are controlled, monitored monthly and a record kept. There are systems in place for monitoring safety issues such as fire checks, fire drills, PAT testing, electrical tests and gas and boiler checks and all the rooms are routinely checked for safety and maintenance issues. Certificates asked for were provided. The records in the home confirmed they were up to date. The tour of the home confirmed that staff are aware of the fire safety policies, no doors were found inappropriately wedged open. On entering the home there was an unpleasant odour, which was also found in many of the bedrooms, even the empty rooms. The general standard of cleaning in the home needs to be improved and should include regular shampooing of carpets. The carpets were dirty and some has food debris on the floors. Rooms were dusty and grimy. One room that was identified to the provider with a lino was dirty under the mat. The home does allow pets and this is beneficial for the residents, however staff need to ensure that infection control measures and schedules are devised in this area. The residents bedrooms did not provide liquid soap and paper towels for staff to use. The home was tidy and incontinence pads disposed of hygienically. The divan mattresses did not all have an appropriate cover when needed and some protectors were seen to be torn. Care Homes for Older People Page 22 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A review of staffing levels based on residents’ dependency levels needs to be implemented to ensure there are sufficient skilled staff to meet residents needs. The recruitment practice at present does not protect and support residents living in the home. Evidence: The staffing levels on the day of the site visit were slightly confusing as it was said by the deputy manager that there were two staff on at the beginning of the shift, herself and another carer and then during the tour of the building another member of staff was seen with the residents. On querying the staffing levels, the deputy said due to sickness a member of staff had been brought over from the sister home. The staffing rota was asked for and viewed, it was inaccurate and the deputy manager changed it during the site visit. It also demonstrated that a new member of staff who was awaiting a Criminal Record Check is working nights without appropriate supervision. It was discussed the importance of maintaining an up to date and accurate staffing rota. The rota evidenced that with 11 residents living in the home, the staffing levels were 2 carers on at 08 00 hrs, with the deputy manager in at 0900 hrs, 2 carers on during the afternoon and the deputy manager on until 1700 hrs, there are two waking carers on at night. Care Homes for Older People Page 23 of 35 Evidence: The staffing levels need to be reviewed to ensure that there are enough staff on duty to meet the residents health, social and welfare needs. A selection of staff recruitment files were viewed and evidenced that the recruitment process has not been maintained to the previous good standard. This was discussed in full. The provider confirmed that the induction programme is now in place and has been introduced for all new staff. Files seen though did not confirm this. Discussion with the management team confirmed that all staff are supported and encouraged to complete a National Vocational Qualification (NVQ), the AQAA stated 50 of staff have an NVQ with a further 35 currently working towards an NVQ. This however was Februarys figures taken from the AQAA. Staff spoken with said that training opportunities at the home are good and they are well supported by the management of the home.Staff confirmed that compulsory training such as manual handling, adult protection, first aid and fire safety have been undertaken, however the training matrix and staff files did not evidence regular training and updates. This needs to be updated to ensure the staff have received the necessary training to care for the residents living in Dunsfold. The training matrix did evidence that 5 of the 17 staff employed have received dementia training and this needs to be extended to all the staff. Care Homes for Older People Page 24 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager has the relevant skills and experience, however the current management structure does not provide clear leadership to the staff and therefore impacts on the positive outcomes for residents. Quality assurance processes need further development to ensure that the Home is run in the best interests of residents. The health, safety and welfare of residents and staff are not robustly promoted and staff training and regular safety checks in the home need to be introduced and maintained. Evidence: Since the last inspection the manager has been registered by the CSCI. Unfortunately she was not present at the key inspection due to ill health. There is a deputy manager in post that has stepped into the day to day running of the home. The registered manager has the necessary qualifications and experience to run the home efficiently. At present there is no clear management structure in the home and from the Care Homes for Older People Page 25 of 35 Evidence: documentation seen, it has not been present for some time and this is not just due to the absence of the manager. The documentation has not been reviewed and evaluated which places residents at risk from uninformed staff. The management team are sending out quality assurance surveys to residents, families, representatives and stakeholders. The surveys results are then audited, however from reviewing the questionnaires, the results have not been acted on and therefore the systems are not used being used effectively. Resident meetings are not beneficial in this particular home, but it was confirmed that one to one interaction takes place. Relative meetings are poorly attended and this will be reviewed as to ways of encouraging participation. Residents’ financial interests are safe guarded by robust policies and procedures. The staff have no involvement with the residents personal allowances. Staff supervision was discussed and staff supervision has been commenced and is documented. Staff spoken with confirmed that they receive supervision and a plan of the year’s supervision sessions seen. It is stated that the homes policies and procedures are reviewed regularly and for the purpose of this inspection, the policies were requested and were not available. They were recovered and are comprehensive in the information they contain. It is however a concern that they have not been in the home for some weeks and therefore not assessable to staff and this impacts on the safe outcomes for residents. The accident book was reviewed and there is evidence of a trips and falls audit, which highlights repetitive falls/injuries of specific residents, however this is not reflected in the individual\care records. Some poor practice was observed during the inspection in respect of the safe moving and handling of residents, and this needs to be monotored, supervised and training put in place to protect residents. The staff were aware of fire precautions, and due to recent incidents the security of the home has been reviewed and all exits and gates are alarmed. Several residents have challenging behaviour and this sometimes put other residents at risk, these are being managed effectively by staff at this time, however the care plans do not reflect actions to be taken. This was fully discussed with the management team. Care Homes for Older People Page 26 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 12 16(m) & (n) That the Registered Person ensures that activities must be individually tailored to meet the needs of each resident to provide a stimulating and interesting environment. (Timescale 0f 01/04/07 not met.) 01/02/2008 2 19 13(4)(a) That the Registered Person 01/02/2008 ensures that a written programme of refurbishment and redecoration is in place with realistic time scales. That the bathrooms are redecorated to provide a comfortable environment for bathing. Care Homes for Older People Page 27 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 That the registered person 02/12/2008 ensures that all prospective service users have a full needs assessment performed before admission to ensure that the home can meet their identified needs. To ensure that all admissions to the home are suitable. 2 4 14 That the registered person confirms in writing to the service user that having regard to the assessment the care home can meeet the needs in respect of their health and welfare. To ensure that the home can meet the needs of the service user and it is agreed. 02/12/2008 3 7 15 That the registered person 02/12/2008 ensures that a comprehensive plan of care is in place to meet the heath, welfare and social needs of the service users in Care Homes for Older People Page 28 of 35 a consistent manner. That service users and/or their representatives are consulted regarding the formation of the care plans To ensure that the service users needs are met in a consistent and discussed with the service user and family. 4 8 12 That the registered person ensures that suitable risk assessments are completed in all areas of risk and cover the use of bedrails, risk of choking and risk of falls to promote resident safety. THat risk assessments in respect of continence, nutrition, dementia and moving and handling are in place. That appropriate risk assessments are in place with an action plan for those residents that do not have the capacity to ring the call bell. To ensure the safety of all service users in respect of risks. 5 9 13 That the registered person ensures that there are suitable arrangements in place for accurate recording of medicine administration and supply of medicines. 02/12/2008 02/12/2008 Care Homes for Older People Page 29 of 35 To ensure the service users health needs are met in a safe manner. 6 10 17 That the registered person ensures that all staff recieving appropriate training in interacting with people who suffer from dementia: comunicating with respect. To ensure service users are treated with dignity and respect. 7 12 16 That the Registered Person ensures that activities must be individually tailored to meet the needs of each resident to provide a stimulating and interesting environment. To ensure that the service users social and recreational needs are met. 8 14 12 That the registered person ensures that the service users are are involved in making decisions with respect to the care they are to recieve and their health and welfare. To ensure that service users are helped to exercise choice and control over their lives. 9 16 22 That the registered person ensures that there is a clear and accessible complaints policy and procedure in place for staff to follow. 02/12/2008 02/12/2008 02/12/2008 02/12/2008 Care Homes for Older People Page 30 of 35 To ensure service users and their families are confident that their complaint is listened to and acted upon. 10 18 12 That the registered person ensures that there are clear policies and procedures in place for staff to refer to in respect of safeguarding adults. To ensure service users legal rights are protected. 11 19 23 That the registertred manager ensures that the home is suitable for its stated purpose in that it is well maintained. That the home is well maintained. 12 22 16 That the Registered Provider 02/12/2008 ensures that the specialist equipment in the home is maintained and in good working order. This pertains to:· Call bell facility to be in reach of service users, staff and visitors. To ensure the service users safety at all times. 13 26 13 That the Registered Provider 02/12/2008 ensures that the necessary repairs are made to the laundry floor to prevent cross infection.That all staff follow the homes policies and procedures in the standard of cleanliness and infection control measures.That the soap 02/12/2008 02/12/2008 Care Homes for Older People Page 31 of 35 dispensers and paper towels are full and ready for use. That the home is kept clean and hygenic. 14 27 17 The registered person must 02/12/2008 ensure that at all times suitably qualified, competent and experienced staff are deployed in the home in such numbers to meet the health and welfare needs of residents. That a copy of the duty roster of persons working in the care home and a copy of whether the roster was actually worked. To ensure that the service users needs are met by a appropriate number of staff. 15 29 19 That the registered person operates a thorough recruitment procedure and ensuring the protection of service users. To ensure that service users are supported and protected by the homes recruitment policy and practices. 16 30 18 That staff receive regular 02/12/2008 training to ensure that they are appropriately qualified and competent and have the skills to meet all the needs of residents in the home. To ensure that staff are trained and competent to do their jobs. 02/12/2008 Care Homes for Older People Page 32 of 35 17 31 10 That the registered person ensures that the home is well managed and run efficiently to meet its stated purpose, aims and objectives. To ensure that the residents are protected by the management structure. 02/12/2008 18 33 24 That the registered person 02/12/2008 ensures that a suitable quality monitoring system is maintained to ensure residents and their representatives views are taken into account and demonstrates ongoing review and improvement to the quality of care and services in the home.This should take into account any complaints and concerns raised with the home. To ensure that the home is run in the best intrests of the service users. 19 37 17 That the registered person 02/12/2008 ensures that records required for the protection of service users and for the the effective and efficient running of the home are maintained, up to date and accurate. This pertains to care records of individual service users and the homes policies and procedures. To ensure the health, safety and welfare of service users. Care Homes for Older People Page 33 of 35 20 38 12 That the registered person ensures that there are suitable arrangements are put in place to promote residents and staff health and safety. This will include appropriate staff training and monitoring of staff practices. To ensure that the health, safety and welfare needs of service users are promoted. 02/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 That the brochure is updated to include correcet address of the registering body. Care Homes for Older People Page 34 of 35 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 35 of 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!