Inspection on 30/04/05 for Dunsland House

This inspection was carried out on 30th April 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 14/10/05

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 30.04.05 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 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 I52 s19330 Dunsland v223968 270405 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Dunsland House Address 5 Shrublands Road Berkhamsted Hertfordshire HP4 3HY Telephone number Fax number Email 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 Mrs Sheila Smyth Mrs Sheila Smyth Care Home 15 Category(ies) of OP OP Old age - 15 registration, with number of places Dunsland House I52 s19330 Dunsland v223968 270405 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: The home may cater for up to 15 people who are over the age of 65 years Date of last inspection 17.11.2004 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 fiffteen 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 I52 s19330 Dunsland v223968 270405 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 30th April 2005 and was conducted by one inspection officer. All of the standards assessed were met and staff and service users gave positive feedback regarding employment conditions, management of service, user care and the way in which the home is run generally. What the service does well: The service supports service users in choice of home; it provides a service user guide and encourages prospective service users or their representatives to visit the home prior to accepting a trial stay. The home is small and is able to seek users views on a day to day basis, (which was confirmed by Service Users), and will make changes where possible to incorporate their views; making changes both on an individual basis and collectively. The home carries out thorough assessments of needs and does all that is reasonable to ensure service user and staff safety and protection. The home provides a variety of appropriate activity and service users are encouraged and supported to maintain links with the community. Links with family and friends are well supported. 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. 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 for individual tastes. There is a good choice of menu and alternatives. Snacks and beverages are readily available. Dunsland House I52 s19330 Dunsland v223968 270405 stage 4.doc Version 1.30 Page 6 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 I52 s19330 Dunsland v223968 270405 stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Dunsland House I52 s19330 Dunsland v223968 270405 stage 4.doc Version 1.30 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 standard(s) 1,2,3,4 and 5. Standard 6 is not applicable. Prospective service users are provided with information about the home and encouraged to visit prior to making a choice. The proprietors ensure they have the capacity to meet assessed needs. Each service user is given a copy of the terms and conditions. EVIDENCE: The home has a Service User Guide, which 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 file 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 accommodated there. There is a long waiting list for prospective Service Users. Dunsland House I52 s19330 Dunsland v223968 270405 stage 4.doc Version 1.30 Page 9 There was a full and comprehensive assessment of needs in individual files, which was carried out in conjunction with the Service User and all significant others by the registered manager who is qualified to carry out such assessment. The initial assessment of need forms the basis of the individual care plan, and those seen had been regularly reviewed and progress notes revealed that the home was able to meet those needs. The home does not provide intermediate care. Dunsland House I52 s19330 Dunsland v223968 270405 stage 4.doc Version 1.30 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 standard(s) 7,8,9 and10. Service users health, personal and social care needs are fully met. Medication is well managed and policies and procedures are in place. Service users’ privacy is maintained and rights are protected. EVIDENCE: The care plans for named individuals health, personal and social care needs contained clear information and guidance for staff to meet the needs. Health care and personal needs are set out in a quick view profile of all of these needs and there is a separate file for recreational and Social needs; we recommended that a reference link to other files be added to the quick view care plan to direct the reader to other plans in use Progress notes and review notes provided information that needs were being met. Service users spoken with also verified that they felt their needs were well met. Policies and procedures are in place to protect Service Users who are able to manage their own medication; this is kept reviewed and risk assessments are in place. A lockable space is provided. One Service User was managing part of Dunsland House I52 s19330 Dunsland v223968 270405 stage 4.doc Version 1.30 Page 11 her own medication (a home remedy for pain, and this is risk assessed and kept reviewed). We spoke to the majority of the Service Users accommodated (this being a smaller home) and the Service Users stated that they felt respected and valued and that their rights were observed in a very professional yet friendly manner. Policies and procedures are in place to support the provision of services with dignity, respect and the preservation of rights. Dunsland House I52 s19330 Dunsland v223968 270405 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13,14 and 15. Social, cultural, religious and recreational interests are catered for wherever possible. Service users are supported to have control over their lives and to make choices. Contact with family and a friend is supported; visitors are made very welcome. Wholesome and balanced diets are served in congenial settings and Service Users have a choice of menu. EVIDENCE: Service users stated that they are encouraged to maintain their social, cultural, religious and recreational interests and they further stated that the home met their expectations and preferences very well indeed. Relatives are encouraged to visit the home at any time and are always made welcome; as verified by service users spoken to. 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 and during harsh weather, this is less of a problem as the clergy also visit the home and offer services. Residents meetings are held informally (this being a smaller home where it is easier to obtain views and discuss issues and the way forward). Service Users stated that they are encouraged to voice their opinions regarding how their Dunsland House I52 s19330 Dunsland v223968 270405 stage 4.doc Version 1.30 Page 13 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 light the dining room. Provision is made for service users to take their meal in their own room if this is preferred. Most service users prefer to dine with a group of service users 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. Staff stated that although there are set times for meals individual arrangements are made when the need arises, i.e. if a service user is going and returning late or for some other reason. A group of service users said that alternative meals are provided if they don’t want the meals on the menu and they further stated that the food is very good. Snacks and beverages were readily available. A member of staff was observed supporting a Service User with her meal in a gentle, supportive manner in the privacy of the lounge. Dunsland House I52 s19330 Dunsland v223968 270405 stage 4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17 and 18 The home deal with any complaint in a satisfactory manner in accordance with its policies and procedures. Service users legal rights are protected and they are protected from all forms of abuse by the homes policies procedures (which includes a whistle blowing policy) and through robust recruitment and staff training. EVIDENCE: There is a clear complaints policy and procedure and a record of all complaints is kept; records show that a timely response is made and wherever possible the complaint is resolved satisfactorily. Records pertaining to Service Use care and Health and Safety are maintained. Policies and Procedures are in place, together with staff training in abuse awareness, to afford Service User the right to protection from abuse. Service Users stated that they have the support of advocates but that the home also supports them to exercise their legal rights. Dunsland House I52 s19330 Dunsland v223968 270405 stage 4.doc Version 1.30 Page 15 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 standard(s) 19,20,21,22, 23,24,25 and 26. The home is well maintained and safety checks are carried out. There are adequate communal and personal facilities for toileting and bathing/washing. Personal rooms are personalised and any specialist equipment is in place for those who require it. The home is clean and pleasant/comfortable and the gardens are well maintained. Good hygiene practices are adhered to. EVIDENCE: Health and Safety Policies and procedures are in place and records seen provided evidence that service users and staff are offered the protection of reasonable safety measures. We observed that the home and gardens were well maintained; there is a rolling programme for maintenance in addition to quick response to any problem arising. Specialist equipment is in place for those who require this, bath hoists and other aids are kept serviced. One Service User has some very specialist equipment to aid quality of life and her dignity and to also support her to Dunsland House I52 s19330 Dunsland v223968 270405 stage 4.doc Version 1.30 Page 16 maintain as much independence as is possible; this equipment includes a specialist chair and a possum which she can use to control electrical appliances and the lighting in her room. The home and gardens are accessible and provide for safe and sufficient access to suitable washing/bathing and toilet facilities. The home was seen to be clean and fresh with appropriate hygiene policies and procedures being put into practice. Service Users personal rooms were comfortable, clean and pleasant with many of their personal possessions and photographs adding to ownership of their space. Dunsland House I52 s19330 Dunsland v223968 270405 stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 and 30. Dunsland House is adequately staffed by trained 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 had attended the following courses: First Aid, Moving and Handling, Medication, Continence Training, Fire Safety, Diabetes and staff had been offered bereavement counselling following the death of a Service User who had been accommodated at the home for a long period. 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. Dunsland House I52 s19330 Dunsland v223968 270405 stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,35,36 and 38. Dunsland House is well run, in the best interest of the Service Users, by a competent registered manager. Service Users 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 registered manager has managed this home for several years and previous inspections have consistently resulted in positive reports being submitted. Service Users stated that the home provides them with even more than they expected and many stated that it goes further that the Statement in the Service User Guide. This is a smaller home and we were able to meet with most of the Service Users who stated that if they want something different or want something done differently, they always get a positive response. Review Dunsland House I52 s19330 Dunsland v223968 270405 stage 4.doc Version 1.30 Page 19 notes show new instructions, where there has been a change that has been agreed in their best interest. Clear financial accounts are maintained by the home and show how the Service Users 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 available readily for inspection. Health and Safety Training had been 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 Service Users were well maintained. Policies and procedures were in place to provi9de for the protection of Service Users and staff and these had been reviewed. Dunsland House I52 s19330 Dunsland v223968 270405 stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 x 3 3 x 3 Dunsland House I52 s19330 Dunsland v223968 270405 stage 4.doc Version 1.30 Page 21 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 Regulation Requirement Timescale for action 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 OP7 Good Practice Recommendations Add a reference to the quick view Health and Personal care needs plan to direct the reader to the additional care plans in use which state the individual Service Users recreational and Social Needs. (N.B. it is noted that recreational and Social needs were recorded and being met). 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