CARE HOMES FOR OLDER PEOPLE
Durham House Residential Home Mains Park Road Chester Le Street Durham DH3 3PU Lead Inspector
John Trainor Unannounced Inspection 10:00 20th April 2007 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 Durham House Residential Home DS0000007465.V335689.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. Durham House Residential Home DS0000007465.V335689.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Durham House Residential Home Address Mains Park Road Chester Le Street Durham DH3 3PU 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) 0191 3871265 0191 3875916 Sortuseful Limited Mrs Eileen Oates Care Home 31 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (31) of places Durham House Residential Home DS0000007465.V335689.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 31 Dementia - over 65 years of age - Code DE(E) , maximum number of places: 20 The maximum number of service users who may be accommodated is 31. 15th February 2006 2. Date of last inspection Brief Description of the Service: Durham House is a family owned and run establishment that aims to provide care in a friendly and homely atmosphere. The home is registered to provide residential personal care for up to 31 older people. Up to 20 of these people may have dementia care needs. The home consists of a large period house that has been extended and improved to provide spacious and comfortable accommodation. The home is located in Chester-le-Street, close to the local high street with shops and amenities. The accommodation is arranged over two floors, with stair and lift access available to both. It consists of 14 single with en suite toilet and washing facilities, and 17 single rooms without en suite facilities. Communal space is located throughout the home, with a selection of lounge areas, a conservatory, a quiet room, a smoking room and dining room. Residents also have access to an enclosed courtyard garden. Communal toilet and bathroom facilities, including specialist bathing equipment, are located conveniently through out the home. Fees at the time of inspection ranged from £399.50 to £504.00. There are additional charges for hairdressing, chiropody, toiletries, personal newspapers and magazines and escorting outside of the premises. Durham House Residential Home DS0000007465.V335689.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Information was provided to the Commission for Social Care Inspection before a site visit which was unannounced and lasted 11.5 hours over 3 days. This information was used to identify issues to look at when we visited. During this visit we inspected records including health and safety records, care plans and recording. We watched how people were looked after to see what life was like for people and spoke to staff, management and people living in the home. What the service does well: What has improved since the last inspection?
Management arrangements have been reorganised in the home to ensure the manager has the recommended qualification to run a care home. Some development of care plans has taken place to account for psychological and behavioural needs. Durham House Residential Home DS0000007465.V335689.R01.S.doc Version 5.2 Page 6 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. Durham House Residential Home DS0000007465.V335689.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 Durham House Residential Home DS0000007465.V335689.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): 2, 3 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People could generally make an informed choice to move into the home but lapses in recording meant they could not always be assured their needs could be met. EVIDENCE: People were given information on the home and could visit before they chose to move in. One person said her daughter brought her to the home she had a look round and then decided to move in, “it was a nice room.” Most care files inspected included pre admission assessments. One file for a person recently admitted did not contain this information and it was not clear whether the home was sure they could meet the persons needs before they moved in because they were not recorded.
Durham House Residential Home DS0000007465.V335689.R01.S.doc Version 5.2 Page 9 Some people did not have contracts/terms and conditions of residence and the existing documents needed revision. This was completed over the course of the inspection and all people were to be given a copy of the terms and conditions of residence in future. Durham House Residential Home DS0000007465.V335689.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People had their health and personal care needs met though the behaviour of some staff meant that people were not always treated well. EVIDENCE: People said their health and personal care needs were met by a kind and considerate staff team, who were quickly accessible when needed, most of the time. Care records showed appropriate access to the doctor and district nurse. Medication was stored, administered and recorded safely and staff were trained in medication issues. Feedback from a social worker was positive, “I praise Durham House highly. It’s always spotlessly clean, residents are well looked after. I’ve never had any complaints.” Care files were structured in such a way that there was not one individual access point for each individual’s care records. Records were grouped into themed files rather than individualised care files. Some records were kept
Durham House Residential Home DS0000007465.V335689.R01.S.doc Version 5.2 Page 11 communally and this did not meet date protection standards. The relevant detail in care plans was variable in quality for example some risk management plans were better than others. Risk management was not always recorded clearly so mistakes could, and were seen to be made. Risk plans had space to record level of risk and this was not always filled in. Instruction on management of challenging behaviour was sometimes unclear. Plans would benefit from task specific detail which clearly tell the story of how people should be looked after. A staff member was seen to treat people in a thoughtless and dismissive manner which, though not malicious, did not respect their dignity as people. Also when assisting someone moving the risks to the person were not well managed. During discussion with another staff member the risks were known but this was not written in a risk management, moving and handling plan. Durham House Residential Home DS0000007465.V335689.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s lifestyle was good but could be improved by more attention to individual preference when offering activities. EVIDENCE: The majority of people said the food was good. There was a choice of menu though the choice had to be made the day before. One person liked crosswords and had a crossword book. Another person was reading a book loaned from a fellow resident. There was television and radio. People could have their own facilities in their rooms if they wished. There were games available in the home and people reported playing dominoes. Religious services were organised in the home for people who wished to attend. Feedback from people and their carers said the home would benefit from more for people to do. The home organised events for people but was less good at organising activities on a day to day basis so peoples occupational needs could be met. People were seen to interact with one another and staff and so had
Durham House Residential Home DS0000007465.V335689.R01.S.doc Version 5.2 Page 13 company. Care planning failed to plan for people’s social and occupational needs with detail of personal preference and how to motivate people. When a member of staff introduced a quiz to a small group it quickly escalated into involving most of the room. This showed there were things that could be done to improve things for people and make life better on a day to day basis. Durham House Residential Home DS0000007465.V335689.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were protected by the homes policies and procedures on complaints and abuse. EVIDENCE: The home had a policy on abuse and a complaints policy and procedure with records kept. People said they would be able to complain though no one reported having to do so. The overall picture was of an approachable management team. Staff could identify who to go to in case of abuse. No people had been referred to adult protection. One person who lived at the home said, “you can always have a private talk if you want one. Mr and Mrs Oates would listen to us if we had a complaint.” Durham House Residential Home DS0000007465.V335689.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People lived in a safe, clean and hygienic home which was nice for people. EVIDENCE: One relative said of the home, “very, very impressed with this one the cleanliness really appeals to me and the staff are very pleasant.” The home was clean throughout in communal and individual areas. Bathrooms and toilets were stocked with paper towels and liquid soap to promote good infection control. There were two assisted bathrooms. Both shower rooms were out of commission and this would limit peoples choice. The home was maintained to a high standard. The kitchen appeared clean and hygienic. Staff had been trained in food hygiene. The laundry facilities were good and no problems were reported by laundry staff. People said, “no problems with
Durham House Residential Home DS0000007465.V335689.R01.S.doc Version 5.2 Page 16 laundry, always brought back well cleaned.” There were no bad smells in the home. Durham House Residential Home DS0000007465.V335689.R01.S.doc Version 5.2 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 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were looked after by a well trained staff team deployed in sufficient number to meet their needs. EVIDENCE: People said there were enough staff. People appeared clean well presented and comfortable. The majority of people who could express an opinion said the staff treated them well. Medication training included the distance learning recommended course. Staff reported having regular fire training and were receiving relevant health and safety training at appropriate intervals. Staff recruitment processes ensured safety checks were in place. All staff had a 20 hour supernumerary induction. Induction was recorded and signed off. The home had achieved investors in people status. One member of staff was observed engaging in poor practice in terms of not respecting people. Durham House Residential Home DS0000007465.V335689.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefited from a well managed home. EVIDENCE: The deputy manager was taking over as manager in the home. Qualified to NVQ 4 in care and management he was in the process of applying to register with the Commission for Social Care Inspection and was awaiting CRB disclosure. The registered manager was still in the home supporting this transition. Durham House Residential Home DS0000007465.V335689.R01.S.doc Version 5.2 Page 19 Health and safety certificates were in place and regular checks were taking place on the lift, hoists, gas and electrical systems. There were no water storage tanks in the home with direct fired boilers. Water temperature was maintained above 60°C and regulated at the point of delivery to manage risk from legionella. In one Parker bath the shower head was hanging down and this could cause a legionella risk with water accumulating in the pipe. The proprietor was to have the company responsible for maintenance advise on this matter and rectify any problems identified. Service user monies were recorded well and accurate. Insurance was in place with the certificate displayed. Infection control procedures and training were good. The home had a quality assurance process which gathered feedback from relatives service users, staff and visiting professionals but did not co-ordinate this into an annual report on how they were doing to inform interested people. The home was using a home made accident book which amounted to a communal record and did not meet data protection standards. Communal records were kept on bathing and these along with weight files were kept in the bathroom where anyone could have access to them. Durham House Residential Home DS0000007465.V335689.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 4 STAFFING Standard No Score 27 4 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 3 Durham House Residential Home DS0000007465.V335689.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No Durham House Residential Home DS0000007465.V335689.R01.S.doc Version 5.2 Page 22 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 OP2 Regulation 5 Requirement People must be given a contract or statement of terms and conditions when they move into the home. People must not be admitted to the home without having been assessed, by a person qualified to do so and the home confirming in writing the ability to meet the person’s assessed needs. All risks must be identified and risk management strategies in place and understood by all staff to minimise risk and maximise people’s safety. People living in the home must be consulted about activities and having regard to their needs activities must be provided. Records of people living at the home must be stored securely. Communal records must not be kept as it is not possible to allow necessary access without compromising other people’s information. The shower fittings on the assisted baths must be risk assessed and action taken to minimise the risk from legionella. Timescale for action 24/04/07 2 OP3 14 31/05/07 3 OP7 13 (4) 31/05/07 4 OP12 16 (n) 30/06/07 5 OP37 17 (b) 31/05/07 6 OP38 13 (4) 31/05/07 Durham House Residential Home DS0000007465.V335689.R01.S.doc Version 5.2 Page 23 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 It is recommended risk management plans are clear detailed and tell the story of how people are to be looked after to minimise risk. Where risk management involves any restraint this should be recorded. Care plans should include task specific detail to ensure people are looked after with regard for their preference and choice. Care plans should include plans for occupational and social activity which record individual preference and choice. It is recommended that staff be trained in techniques to maximise the opportunity for activities on offer to people in the home and that uptake of activities is supervised and recorded to inform future development. It is recommended the use of the shower rooms be reviewed and action taken to provide accessible shower facilities for those who would prefer this. It is recommended the provider use a recognised accident book which complies with the requirement to record accidents and maintain records in line with data protection legislation. It is recommended consideration be given to having individual care files where all records for a person are kept. This reinforces the information as belonging to the individual. Gives a single point of access for all staff with regard to care information including care planning and delivery. Removes the use of communal records and encourages the use of care plans as a working document for all staff to reference and access. It is recommended staff are reminded in supervision and where necessary through training to treat people with dignity and respect and the value of the person is reinforced. 2 OP12 3 4 OP19 OP37 5 OP38 Durham House Residential Home DS0000007465.V335689.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS 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 Durham House Residential Home DS0000007465.V335689.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. 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!
