Inspection on 14/10/05 for Dunsland House

This inspection was carried out on 14th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Dunsland House 23/04/07

Dunsland House 30/04/05

Dunsland House 17/11/04

Dunsland House 24/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Dunsland House 5 Shrublands Road Berkhamsted Hertfordshire HP4 3HY Lead Inspector Hazel Wynn Unannounced Inspection 14th October 2005 10:00 X10015.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 Dunsland House DS0000019330.V259120.R01.S.doc Version 5.0 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. 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. Dunsland House DS0000019330.V259120.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Dunsland House Address 5 Shrublands Road Berkhamsted Hertfordshire HP4 3HY 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) 01442 866703 dunslandhouse@aol.com Mrs Sheila Smyth Mr R.J. Smyth Mrs Sheila Smyth Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Dunsland House DS0000019330.V259120.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th April 2005 Brief Description of the Service: Dunsland House is a home for older people who need support with their health care, personal care and social care. The home is registered for fifteen older people. Service Users who have dementia or physical disabilities are not admitted to the home; however, the home will continue to provide a service to service users who during their time at the home, become more dependent, for as long as the home can fully meet their needs. Input from relevant professionals is accessed for individuals via the G.P. referral process. Dunsland House is situated in the village of Berkhamsted. It is a large double fronted semi-detached family-style house built in 1898. The home has a lift and assisted bathrooms, a domestic style kitchen, lounge, dining room, en-suite bedrooms and attractive gardens. The house is situated close to the village shops and amenities. Dunsland House DS0000019330.V259120.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place during the daytime of 14th October 2005. Two inspectors were present in the home for this inspection. Not all of the standards were looked at on this occasion and the content of this report is a snapshot of the inspection hours. Samplings of records, including staff files, care plans, client invoicing, communication book, accident and incident records, complaints record, fire records and risk assessments were carried out. One requirement was made to take out of use a day and night reporting system in order to ensure that all information about service users is kept individual in the interests of data protection; this information is transferred to their individual files but in its duplication creates a breach in data protection. A new manager has joined the company and is working alongside the registered manager with an aim to apply for the registered manager post when Mrs Smyth decides to retire. Records were well maintained and the six service users spoken to reported being happy with their care. The new manager was reviewing the service and plans to increase the level and range of activities. What the service does well: The home is small and is able to seek users views on a day to day basis, which was confirmed by Service Users; changes in line with clients’ views are made where possible; if this would create a conflict of opinion with another client then negotiation takes place to arrive at a collective satisfactory outcome. Most of the clients know the home well, having lived fairly close by and having previously had a friend or relative accommodated in the home. All prospective clients are provided with an up to date service users guide, are invited to visit and try out the home prior to accepting a trial period. There is a waiting list; currently there are two client vacancies and four prospective clients have applied for placement. The home has provided a variety of appropriate activities to date but needs are changing and the new manager is currently reviewing these along with other services in place. Clients are encouraged and supported to maintain links with the community. Links with family and friends are well supported. A good variety of home cooked nutritious food is served in a comfortable setting and service users are consulted and give input to menu planning. The home prides itself on serving seasonal menus from fresh produce and catering Dunsland House DS0000019330.V259120.R01.S.doc Version 5.0 Page 6 for individual tastes. There is a good choice of menu and alternatives. Snacks and beverages are readily available. The home is clean and comfortable and service users are encouraged to make it their home, through inclusion in decision-making and encouragement to personalise individual rooms. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Dunsland House DS0000019330.V259120.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dunsland House DS0000019330.V259120.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 – 5 Standard 6 is not applicable. Prospective clients are provided with information about the home; visits are encouraged prior to a choice of home being made and a full assessment of need is carried out to ensure the service has the capacity to meet need. Each Service User is given a copy of the terms and conditions, signed by both parties. EVIDENCE: The Service User Guide sets out what the home can and cannot offer, its terms and conditions and complaints procedure; it gives a profile of the home and local facilities. Service Users are given a copy of their signed agreement and a copy is kept on the files seen in the home. All prospective Service Users or their representatives are encouraged to visit the home prior to making a decision to accept admission on a trial basis. Many of the current Service Users knew the home well prior to looking for a placement themselves, having a relative or friend who had been previously Dunsland House DS0000019330.V259120.R01.S.doc Version 5.0 Page 9 accommodated there. There is a long waiting list for prospective Service Users. Full and comprehensive assessment of needs were seen in individual files, it is evident that these are carried out in conjunction with the Service User and all significant others by the manager who is qualified to carry out such assessment. The new manager will continue with this work for the future and provided an example of a comprehensive system she has ready for this purpose. The home does not provide intermediate care. Dunsland House DS0000019330.V259120.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Std 7, 8, 10 and 11 The health, personal and social needs of clients are set out in individual plans of care and health care needs are fully met. The home’s care team provide the utmost in sensitivity and respect to the client and their family at the time of their death . EVIDENCE: The initial assessment of need forms the basis of the individual care plan, and those seen had been regularly reviewed; progress notes revealed that the home was able to meet those needs; the recording of the progress notes provided good examples of how the care plan is kept tracked. All identified health care needs were being met and observations are maintained in order to respond quickly to any changes; as noted from the records seen. Members of the care team attended the funeral of a recently deceased client during this inspection. A thank you letter was seen from a relative following the death of her grandmother; this noted the tremendous support given to the client during her lifetime and to the family both during her lifetime and post her sudden death. Dunsland House DS0000019330.V259120.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Social, cultural, religious and recreational interests are catered for wherever possible. Clients are supported to have control over their lives and to make choice. Contact with family and friends is supported; visitors are made very welcome. More is needed in the area of activities to keep up with changing needs. Wholesome and balanced diets are served in congenial settings and Service Users have a choice of menu. EVIDENCE: Clients stated that they are encouraged to maintain their social, cultural, religious and recreational interests. One service user spoken to stated that there are less people who want to join in with the activities she used to enjoy but this had been discussed and she believed management where looking at improving this area again. The new manager pointed out that needs are changing and she is reviewing the activities to ensure provision continues to satisfy the wishes and abilities/enablement of clients. Relatives are encouraged to visit the home at any time and are always made welcome; as verified by service users spoken to. The wife of a service user praised the service and stated her husband is so well cared for and content. Dunsland House DS0000019330.V259120.R01.S.doc Version 5.0 Page 12 Representatives from the local church visit the home and provide for spiritual expression and friendship. In fair weather some of the Service Users stated that they go out to the local church. Residents meetings are held informally (this being a smaller home where it is easier to obtain views and discuss issues and the way forward). Clients stated that they are encouraged to voice their opinions regarding how their expectations and preferences are being met and action will be taken to remedy any dissatisfaction. The menu seen provided for a nutritious and varied diet. Large windows pleasantly enhance the congenial setting of the dining room. Provision is made for clients to take their meal in their own room if this is preferred. Most clients prefer to dine with a group of with whom they have made friends or identify with. The chef meets with service users to discuss the menu periodically and also on request individually. There is flexibility to meet clients needs to dine outside of arranged meal times. Two clients said that alternative meals are provided if they don’t want the meals on the menu and also stated that the food is very good. Snacks and beverages were readily available. Dunsland House DS0000019330.V259120.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Clients and their relatives/friends/representatives can be confident that their complaints will be listened to and responded to appropriately. Clients are protected from all forms of abuse. EVIDENCE: Two clients confirmed that they have “only just to mention something and it is done”. The service user guide contains a clear guide to the complaints procedure and there is a complaints policy and procedure in place. The complaints file was seen and no complaints had been recorded since the last inspection. A whistle blowing policy is in place and staff were able to clearly quote from this; systems and staff training ensure all reasonable measures are taken to provide protection to clients from all forms of abuse. Dunsland House DS0000019330.V259120.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25, 26 The environment is safe and well maintained and the clients live in safe and comfortable surroundings. The home is maintained in a clean, pleasant and hygienic condition. EVIDENCE: The fire safety records and certificates were seen and showed robust auditing and servicing. Building work was in progress as part of the maintenance programme and this was being carried out with the least of disruption to the clients. The manager stated that when the work is completed new carpets are to be laid in the hallway, stairs and landing. Despite the building work the home remained comfortable, clean and hygienic. The proprietor (Mr Smyth) carries out a regular maintenance audit and keeps the property very well maintained. Dunsland House DS0000019330.V259120.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The home is adequately staffed. Both mandatory and needs led training is provided to staff; there is a mix of skills within the team to meet the needs of the Service Users. The homes recruitment procedures are robust. EVIDENCE: On the day of the inspection the home was adequately staffed and the staff rota, which was seen, reflected a pattern of good staff cover. Staff files seen were well maintained and training was recorded. Staff training records show a variety of courses have been attended, including: First Aid, Moving and Handling, Medication, Continence Training, Fire Safety, Diabetes. Robust recruitment practices are observed to offer protection to Service Users and in line with legislation; all documentation including CRB and POVA checks was maintained on the staff files; a sample of which were seen at this inspection. Dunsland House DS0000019330.V259120.R01.S.doc Version 5.0 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 - 38 Dunsland House is well run, in the best interest of the clients, by a competent proprietor/manager. Clients financial interests are safeguarded and formal supervision is in place. The health, safety and welfare of Service Users and Staff are promoted and protected. EVIDENCE: The proprietor/manager has managed this home for several years to the satisfaction of clients and resulting in positive reports being submitted. In considering retirement the proprietor has taken on a manager to take over from her and will announce her retirement when the new manager decides to make application for registration. The new manager has many years experience in care and recently resigned from a registered manager post to take up the post at Dunsland House. Dunsland House DS0000019330.V259120.R01.S.doc Version 5.0 Page 17 Clients spoken to stated that the home more than meets their expectations and that they are very happy, feel valued and respected in the home. The wife of a client stated that she couldn’t wish for better. Clients stated that they only have to mention something and they always get a positive response. Clear financial accounts are maintained by the home and show how the clients are invoiced for expenses. Receipts are given to service user when an invoice is paid and copies of these are maintained by the home. All financial records are maintained electronically and a selection of these were seen at this inspection; they were clear to follow showed accuracy and were up to date. Health and Safety Training is provided on a rolling training programme and records showed that health and safety checks had been carried out and these included fire safety equipment testing and servicing and fire safety checks. Corgi registered personnel carry out gas safety checks and certificates were up to date. Records pertaining to care provision for individual clients were well maintained and samples of these were seen. A day and night record was being utilised as a shift record; the inspector required this to be discontinued (see earlier in this report) the information is transferred to the clients individual notes prior to the end of each shift. The use of a daily report covering all clients is obsolete in accordance with data protection. Policies and procedures were in place to provide for the protection of clients and staff and these had been reviewed. Regular self auditing is in place in this home. Dunsland House DS0000019330.V259120.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 1 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 Dunsland House DS0000019330.V259120.R01.S.doc Version 5.0 Page 19 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 OP10 Regulation 17 (1) Requirement Take out of use the day and night record book so that information about clients is not collectively stored. Timescale for action 14/10/05 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 OP12 Good Practice Recommendations Continue to consult clients to provide activities according to preferences. Dunsland House DS0000019330.V259120.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 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 Dunsland House DS0000019330.V259120.R01.S.doc Version 5.0 Page 21 - 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. 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