Inspection on 23/04/07 for Dunsland House

This inspection was carried out on 23rd April 2007.

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 14/10/05

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 Mrs Jan Sheppard Unannounced Inspection 23rd April 2007 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.V336198.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. 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.V336198.R01.S.doc Version 5.2 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.V336198.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th October 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 Berkhamstead. 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. The current fees range from £460 to £580 per week. Copies of recent CSCI inspection reports are available in the homes entrance hallway to be read by those interested. Information regarding the service is available in the Statement of Purpose and Service User Guide. Dunsland House DS0000019330.V336198.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day during which all the residents who wished to do so were spoken with individually and discussions were also had with the homes manager, the owner and all the staff on duty. A visiting nurse a chiropodist and a visiting relative were also consulted. The comments in this report reflect the findings made by the inspector during that visit and also take account of information gathered over the past months from the homes management and by way of the pre inspection questionnaires completed by the residents and by the homes manager. This was a positive inspection with the key standards examined being found, with the exception of two, to be met. There were no outstanding requirements from the last inspection. Two requirements and two recommendations are made following this inspection. Since the last inspection a new manager has commenced her duties. Her application for registration by the Commission is currently in process. At the time of this inspection the home had a calm peaceful and homely atmosphere where residents and staff were seen to be interacting very positively. Without exception the residents all spoke very positively about the care that they received in the home confirming that their wishes were always taken into account and that the staff paid good attention to meeting their individual needs. What the service does well: What has improved since the last inspection? Since the last inspection and the appointment of the new manager a number of improvement changes have been introduced and the manager’s programme for this is ongoing. A much bigger range of activities is now offered with each resident having an individual activity programme planned to meet their needs and interests. Dunsland House DS0000019330.V336198.R01.S.doc Version 5.2 Page 6 The format of the residents care plans has been revised and improved with identified key workers and a person centred care plan format being introduced. Improvements have been made to the staff-training programme to include access to some external courses. The number of holders of NVQ qualifications has increased 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. The summary of this inspection report can be made available in other formats on request. Dunsland House DS0000019330.V336198.R01.S.doc Version 5.2 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.V336198.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable to this home as it does not provide intermediate care. People who use this service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to the service. Admissions to the home are not agreed until a full needs assessment has been carried out and the home is satisfied that it can meet these needs. Sufficient information is provided for prospective residents and their families to enable them to make an informed choice about admission into Dunsland House. EVIDENCE: One new resident recently admitted to the home told the inspector that she was very happy with the manner in which her admission had been arranged. She said that the manager had made a number of visits to talk with her prior to her being invited to visit the home to share a meal and spend time with other residents. She confirmed that she had quickly felt settled and comfortable in the home and that she liked her room. She said “ All the staff Dunsland House DS0000019330.V336198.R01.S.doc Version 5.2 Page 9 are very kind helpful and patient and this made the whole process of leaving ones own home and entering a residential setting much easier”. The paper work pertaining to this admission evidenced that the home had followed its policies and procedures and had taken time in assessing the compatibility of the new person with the existing residents. The records also evidenced that all the residents have the required information about the home including the Statement of Terms and Conditions and the Service Users Guide. The manager told the inspector that she and the proprietor are currently reviewing these documents. Dunsland House DS0000019330.V336198.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. People who use this service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. The home maintains good quality care plans for each resident. They have prompt access to medical services whenever these are needed. Residents are given every opportunity and encouragement to make as many decisions about their own lives, as it is safely possible for them to do. The homes medication storage and administration system is robust and gives good protection to the residents. EVIDENCE: The health and personal care needs of the residents are met following an assessment of their individual needs and with due reference to retaining their respect dignity and privacy. Aids and equipment are provided usually following an OT assessment so to encourage maximum independence for the residents and their need for this equipment is regularly reviewed to accommodate any changing needs. The care records reviewed showed that residents have Dunsland House DS0000019330.V336198.R01.S.doc Version 5.2 Page 11 regular access to doctors the community nursing services, chiropodists, opticians, dentists and to a hairdressing service. All the residents were observed to be wearing smartly laundered clothing. Overall the personal hygiene of the residents was very good and supported their dignity. Personal care was seen during this inspection to be being delivered to the residents in a kind and understanding manner by staff that clearly knew and understood their care needs, both physical and emotional. A member of staff was seen to reassuringly intervene with one resident who became somewhat anxious this being done in a manner, which promoted their independence and feeling of well being. The home benefits from having well established professional working relationships with their local GPs, the community nursing team and with various specialist Consultants this ensuring that any changing health needs can be quickly met. There have been no changes to the medication administration system since the last inspection. Staff who administer medication have been trained to do so. Records of the medication entering and leaving the home are checked in and out with appropriate records kept. The mediation administration record sheet (MAR) was found to be accurately kept with no omissions and to be regularly checked for accuracy by the homes manager although no written record of this check could be evidenced. Appropriate storage, discrete surveillance procedures and risk assessments were found to be in place for the residents who self-administer all or part of their medication. Appropriate facilities and arrangements are in place for the administration of controlled drugs. Dunsland House DS0000019330.V336198.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. People who use this service experience an adequate quality of outcome in this area. This judgement has been made using a range of evidence including a visit to the service. The diverse social and activity needs of the residents are now better supported but further improvements could be made in this area. The residents receive a healthy diet of freshly prepared good quality food but this is somewhat limited in variety. EVIDENCE: Since the appointment of the new manager work has been undertaken in reviewing the provision of daily life and social activities to better meet the particular individual needs of the current residents. Several residents told the inspector that they did not wish to be part of group games or activities such as bingo but that they were very happy with the manner in which staff were now consulting them as to their particular interests and making appropriate suggestions for new activities. One resident is now regularly taken to the library whilst another enjoys a wheelchair journey down the high street and being able to stop at a particular shop and restaurant. Several others are supported to attend church services at the local church. Dunsland House DS0000019330.V336198.R01.S.doc Version 5.2 Page 13 Other residents told the inspector of the plans being discussed for small group outings during the summer months into the local countryside to visit a garden centre or to have a pub lunch. Many of the residents, most of them originally lived in the locality, are well supported by local family and friends and several are able to make regular visits out to see them. Good quality freshly cooked food is provided according to a pre set menu. On the whole the residents said that they enjoyed their meals and that there was always sufficient food that it was attractively presented and served at the right temperature. One resident commented that they know the cook well and that she often comes to talk with them. However several residents said that whilst they appreciated that communal cooking could never be as personal as their own individual home cooking how much they missed not being able to cook anything for themselves. Another resident said that whilst they would not wish to complain they did find the meals generally disappointing “ very ordinary” and mentioned several dishes that they would like to be included in the menus. The inspector noted that the written menus did not demonstrate that a daily choice of meal was available and although staff said that alternatives were available at every meal this could not be evidenced from the written records. At the lunch meal observed only one dish was served. Dunsland House DS0000019330.V336198.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use this service experience good quality outcomes in this area. This judgement has been made using a range of evidence, including a visit to this service. There is an open culture that allows the residents to express their views and concerns in a safe and understanding environment. The complaints policy is clear and freely available. Staff have a good understanding of the policies and procedures concerning Adult Protection and Whistle Blowing and how these give protection to the residents. EVIDENCE: There have been no complaints since the last inspection. Information concerning the complaints policy and procedure was seen to be available in the entrance hallway along with the latest inspection report. Residents consulted had good awareness of the complaints procedure, but several said that if they had any complaint they would first bring this to the managers attention because they had every confidence that this would be sorted out simply without need to resort to formal procedures. A record of the compliments that are received is also maintained. There have been no incidents concerning Safeguarding Adults (Adult Protection) since the last inspection and as far as the manager was aware there never had been any such incidents since the home opened. Staff spoken with had a good awareness of this subject which several said that they had Dunsland House DS0000019330.V336198.R01.S.doc Version 5.2 Page 15 studied as part of their NVQ course. All staff had recently attended an in house refresher-training course on this subject and several commented to the inspector that this had reminded them of the local safeguarding procedures and of what their individual responsibilities were if they should ever have concerns or suspicions. Copies of the Hertfordshire County Council Joint Agency Adult Protection procedures were seen to be freely available for all staff. Dunsland House DS0000019330.V336198.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to the service. The service offers a good environment that is well appointed and subject to regular maintenance. However, residents are not protected from accidental scalding as radiators are now low surface or covered. EVIDENCE: Dunsland House is a large semi detached property in a quiet road with good access to the facilities of the nearby village of Berkhampstead. The building has been renovated for use as a residential home and provides a homely environment with a domestic feel and appearance. Good efforts have been made to adapt the physical design and layout of the home, which is on a sloping site, to enable the residents to have full access and to live in a safe, well maintained and comfortable environment, which encourages independence. The manager discussed with the inspector the planned Dunsland House DS0000019330.V336198.R01.S.doc Version 5.2 Page 17 maintenance programme for the home, which in the near future includes the renewal of carpeting in the hall and passages, which is old and stained. A programme of redecoration of all the bedrooms is also underway. Some of the bathrooms appear bleak and uninviting and would also benefit from redecoration. The home is centrally heated via radiators none of which were protected by guaranteed low surfaces or radiator covers. This deficiency could put residents at risk. On the day of this unannounced inspection the home was found to be very clean and tidy. All the residents have single bedrooms with several having full or partial ensuite facilities. The manager has ensured that the physical environment of the resident’s bed/sitting rooms meets their individual requirements being appropriate for their particular life style and reflects their tastes and interests. One resident has a very large worktable and extra storage facility for their collection of books and craft and stamp collecting activities. Another has an exercise bike, which they told the inspector they use every day. Targeted spot lighting has been arranged to meet the needs of another resident who likes to do close work and a lot of reading. Dunsland House DS0000019330.V336198.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to the service. Experienced and trained staff are employed in sufficient numbers to support the people who use the service and thereby ensure the smooth running of the home. EVIDENCE: The service is fortunate in being able to retain a very stable group of staff, many of have worked at the home for many years. The home has sufficient numbers of permanent and bank staff so that it never has to use agency staff. The staff was observed to be working very well together as a team in a proactive rather than a reactive manner. They were enthusiastic about their work and clearly had very good relationships with the residents, several of who had also been resident in the home for many years. The staff demonstrated a through understanding of the particular needs of the residents and thereby could deliver effective personal centred care. Staff spoken with were keen to undertake further training and personal development. One told the inspector “ even after working here for all these years (11) there are so many changes and so much to still learn”. Dunsland House DS0000019330.V336198.R01.S.doc Version 5.2 Page 19 Since the last inspection the number of staff holding NVQ at level 2 has increased to over 85 with other workers still completing this course and others about to commence studies for NVQ at level 3. The recruitment records for a recently appointed member of staff evidenced that the correct procedures and checks had been carried out and that the new staff member had not commenced duties until a clear CRB check had been received. She had then worked alongside an experienced staff member whilst undertaking her induction-training programme. She told the inspector that she had settled very well into the home and that she felt well supported by the other staff and the manager and was enjoying getting to know the residents. Dunsland House DS0000019330.V336198.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38. People who use this service experience an good quality outcome in this area. This judgement has been made using available evidence including a visit to the service. A competent, experienced and qualified manager leads the home. The management and administration of the home is based on openness and respect. The homes quality assurance systems need to be further developed. EVIDENCE: The manager has the required qualifications and experience and is competent to run the home. She has a clear understanding of the key principles and focus of the service and her aim is to continually improve an increased quality of life for the residents with a good awareness of the need for equality and an understanding of the diversity needs of the residents. Since her recent appointment she has, following consultation with the residents and staff, Dunsland House DS0000019330.V336198.R01.S.doc Version 5.2 Page 21 compiled an action plan of the quality improvements which she judges are needed to ensure that the high standard of care and good reputation of Dunsland House is maintained and that the home is run in the best interests of the residents. She has shared this information and plan with the Commission and has already begun implementing some aspects. Clear health and safety policies are in place which staff had a good awareness of. Random checks are made by the manager to ensure that standards are maintained. Checks made of these records including fire, water temperature, risk assessments, made during this inspection evidenced that records are well maintained and that routine checking is carried out. Records are kept securely and staff are aware of the requirements of the Data Protection Act. Residents are able to gain access to their records and to contribute to them if they wish. The home does not keep any of the resident’s monies. The records evidenced that staff are appropriately supervised and that a programme for annual staff appraisal is in place. The manager was aware that home does not currently carry out a sufficiently well developed quality assurance system. Dunsland House DS0000019330.V336198.R01.S.doc Version 5.2 Page 22 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 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 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 x 2 x 3 x x 3 Dunsland House DS0000019330.V336198.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? no 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 OP19 Regulation 13(4)(a) Requirement To ensure the safety of the resident radiators should have low surface temperature covers. The home must introduce an effective quality assurance system. Timescale for action 31/07/07 2 OP33 24(1) 30/06/07 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. 2 Refer to Standard OP12 OP15 Good Practice Recommendations Continue to consult clients to provide activities according to preferences. Continue to improve the variety and choices of the menus in line with residents expressed wishes. Dunsland House DS0000019330.V336198.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 Dunsland House DS0000019330.V336198.R01.S.doc Version 5.2 Page 25 - 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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