Inspection on 10/07/07 for Dury Falls

This inspection was carried out on 10th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Dury Falls 02/08/06

Dury Falls 05/12/05

Dury Falls 15/08/05

Dury Falls 22/03/05

Dury Falls 21/04/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Dury Falls 35 Upminster Road Hornchurch Essex RM11 3XA Lead Inspector Ms Harina Morzeria & Ms Jackie Date Key Unannounced Inspection 10:00 10th July 2007 – 31st July 07 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 DS0000027842.V345389.R02.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. DS0000027842.V345389.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dury Falls Address 35 Upminster Road Hornchurch Essex RM11 3XA 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) 01708 447786 01708 476555 june@duryfalls-carehomes.co.uk Mr Barry Stack Mrs Christine Ann Stack Ms Mary Ellen Leedham Linda Springall Care Home 28 Category(ies) of Dementia - over 65 years of age (28), Old age, registration, with number not falling within any other category (28) of places DS0000027842.V345389.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 2nd August 2006 Brief Description of the Service: Dury Falls is a privately owned care home for 28 older people situated in a residential area of Upminster. The home is currently managed by Maureen Leedham and Linda Springhall who job share this position and are registered as joint managers of the home with the Commission for Social Care Inspection. The property is a 16th Century, grade 2 listed, two storey building, with a garden to the front and side. Internally some of the original features, such as low ceilings, doorways and narrow corridors have had to be retained and this limits disabled access. There are two lounges and a dining room on the ground floor, as well as some bedrooms, toilets and a bathroom. The remaining bedrooms are on the first floor, which is accessed by a lift and stairs. There are 8 single and 10 double rooms, six of which are en - suite. The home is situated on bus routes, and within walking distance of a tube station. Personal care is provided on a 24-hour basis, with health care needs being met by visiting professionals, such as district nurses. There is a wide range of activities provided within the home although outings are limited. A hobby therapist is employed who is highly motivated and provides activities suitable for people with dementia. The current scale of charges range from £466 to £480 per week. Additional costs are for items such as hairdressing, chiropody and newspapers. Prospective service users are informed about the service via the Statement of Purpose and the Service User Guide as well as via a brochure. DS0000027842.V345389.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place over one day. Another inspector Jackie Date joined the lead inspector in carrying out the inspection of Dury Falls Residential Home. The inspectors spoke to a number of residents about their experience of moving into and living at the home and to two relatives who were visiting at the time of the inspection. Feedback questionnaires were distributed to a number of relatives, residents and all members of staff. A very good response was received. The local authority commissioning officer was also consulted. A health professional was contacted for her views and comments. Discussions took place with the manager and care staff. Staff were spoken to about care practices and their employment at the home. They were observed directly and indirectly providing care to residents. A tour of the home was undertaken and a number of resident and staff files as well as other records were examined. Further information was obtained from the Annual Quality Assurance Assessment (AQAA) completed by the service provider and submitted to the Commission prior to the inspection. What the service does well: What has improved since the last inspection? The information pack for service users has been developed in a pictorial format which allows residents with poor eyesight, hearing and dementia to understand what to expect. The AQAA information received states that the ‘End of Life’ tool, the preferred place of care in the event of dying and death, has been implemented for each service user and this document is sent with the service users if they have to be sent to hospital so that they are aware of the resident’s individual choice in relation to end of life care. DS0000027842.V345389.R02.S.doc Version 5.2 Page 6 The home have developed their own web site so that prospective residents and their families can view the home and its facilities. Two bedrooms have been redecorated with furniture/fittings replaced. The dining room has been redecorated and the lighting in the lounges has been replaced. The lift has undergone extensive refurbishment. An ongoing staff training programme has been developed and staff have received training in the protection of vulnerable adults and administering medication. What they could do better: The Statement of Purpose needs to include detail about space restriction in the home which may impact on the home’s ability to care for people to the end of their life as they become frail. As this home is registered to care for people with dementia, the care plans need to reflect clearly the type of dementia a person suffers from and specify how their needs will be met by staff, as each individual presents their symptoms in a different and specific way so that staff can provide appropriate care to the residents at all times. For accountability any handwritten amendments or additions to Medication Administration Records (MAR) sheets must be signed and dated by the person making the entry. The entry must also include the source of the information. e.g. GP, registered nurse. Guidelines are needed on the action to be taken in the event of a medication error occurring. This will ensure that medication is administered as safely as possible and any problems that might arise are appropriately dealt with. Guidelines/ protocols must be in place to indicate when and why any “as required “ medication should be given to any individual. This will ensure that staff are clear about when and why to give “as required” medication and that residents receive their prescribed medication appropriately when needed. The arrangements for health and personal care must ensure that residents’ right to privacy is upheld. The registered person must ensure that all areas of the home are safe and fit for purpose particularly in relation to the kitchen. Appropriate assessments must be carried out to ascertain what specialist equipment is required in the home to meet residents’ needs. This equipment must then be made available. Residents’ bedrooms must suit their needs and room dimensions and layout options ensure that there is room on either side of the bed, to enable access for carers and any equipment needed. The manager must review the staffing arrangements for all shifts to ensure that at all times care staff are engaged in care work and do not undertake other tasks to the detriment of residents. The registered persons must ensure that care staff receive training in caring for people with dementia and a mental disorder. Also that all staff receive training in equality and diversity issues so that the needs of people living at the home can be met according to their wishes and choices. DS0000027842.V345389.R02.S.doc Version 5.2 Page 7 All of the necessary health and safety checks must be carried out regularly to ensure that a safe environment is maintained for residents. 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. DS0000027842.V345389.R02.S.doc Version 5.2 Page 8 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 DS0000027842.V345389.R02.S.doc Version 5.2 Page 9 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): 1,2,3,4 and 5 (standard 6 is not applicable to this home) People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Prospective residents and their relatives have information on the home to enable them to make an informed choice about moving into the home, however some amendments are required in the information provided to fully reflect the constraints in service provision due to the lack of space available. A pre-admission assessment is undertaken of all prospective residents, this ensures that their identified needs can be appropriately met by the home. Prospective residents and their relatives are invited to visit home prior to their admission so that they know the home they enter will be able to meet their needs. Residents have a written contract with the home. Intermediate care is not a service provided by Dury Falls, therefore standard six is not applicable. EVIDENCE: DS0000027842.V345389.R02.S.doc Version 5.2 Page 10 The Statement of Purpose sets out the objectives and philosophy of the service. However, this needs to include details about space restriction in the home due to most rooms being shared rooms. This can mean the home may not be able to provide long term care to a person whose mobility may deteriorate and they may require the use of aids and specialist equipment such as a hoist which the home can not safely use due to space restriction. At the time of inspection one resident was being re-assessed for nursing care as the person’s mobility had deteriorated requiring assistance from two staff as well as specialist aids which could not be used for reasons stated above. This needs to be stated in the home’s Statement of Purpose and Service User Guide to enable anyone considering moving in to Dury Falls to be fully aware of the space limitations. These documents also need to clarify the home’s policy on smoking as some staff and residents do smoke and others do not. It should also specifically refer to areas that demonstrate good dementia care, good care for those with a mental disorder as well as good care for those older people through old age who are living at the home. This document should also include details of specialist treatments the home can deliver with a commitment to person centred planning, and refer to the skills and ability of the staff group. There are copies of both these documents available in the residents’ dining room. It was evident from case tracking that people have a pre-admission assessment undertaken before moving into Dury Falls which covers areas such as health, religion, personal care and other background information which is used to aid the admission process. Files of four residents were examined. The manager had undertaken an assessment and had also gathered information from the family and health professionals, as well as the local authority. Residents and relatives are offered the opportunity to visit the home prior to a resident moving in. DS0000027842.V345389.R02.S.doc Version 5.2 Page 11 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): 7,8,9,10,11 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Care plans do not provide staff with sufficient information to ensure that care needs are being appropriately met on a daily basis. Not all of the residents have detailed risk assessments, which could impact on the safety of the residents and staff. More attention needs to be paid to the changing needs of people who use the service. Residents are supported to get the healthcare that they require. Residents are treated with respect and arrangements for their personal care ensure that their right to privacy is upheld however this may not always be achieved when personal care needs to be provided in shared bedrooms. The administration and recording of medication is not robust and needs to be improved to ensure that the residents are given prescribed medication as safely as possible and to minimise the risk of error. EVIDENCE: DS0000027842.V345389.R02.S.doc Version 5.2 Page 12 The files of four residents were examined and all had a care plan, which covered various aspects such as personal care needs, health care needs, communication, activities, nutrition and mobility. However, there was not always a care plan or risk assessment about all of the person’s needs. As this home is registered to care for people with dementia, the care plans need to reflect clearly the type of dementia a person suffers from and specify how their needs will be met by staff, as each individual presents their symptoms in a different and specific way. Also, one resident is physically very dependent. There was no moving and handling risk assessment, no hoist or details of how to assist her. Hence, there is not a clear or consistent method of supporting this person resulting in the person falling and having a number of accidents. This was also noted for a number of other residents which is verified by a large number of Regulation 37 notifications relating to falls and injury notifications received by the inspector. There was evidence that the care plans are reviewed monthly but there was not always evidence that the individual person had been involved in the reviewing of his/her care plan. It is essential that the individual person is always included in any reviews of his/her care since all care delivery should be person centred to ensure that the correct type and level of care is being given at any one time. Another resident has, over the time that she has lived at the home, become very confused but there isn’t a detailed plan about how she will be supported by staff when she becomes confused and aggressive or starts wandering or accurate guidance for staff about ways of supporting her to settle down when she is in this agitated state. The AQAA completed by the operations manager for the home states that due to a shortage of Local Authority care managers that some service users are not having their placement reviewed annually. This matter needs to be addressed by the provider with the placing authorities urgently. All people are being weighed on a monthly basis, and more frequently if the need is indicated. Input from dieticians and nutritionists was indicated on the care plans where necessary. People receive regular visits from the GP, chiropodist, dental services and the optician. There was also clear evidence on the files that where a person needed to attend a local hospital or clinic they were able to do so with the necessary support from either staff or relatives. Where there were concerns around continence input from the continence service was always sought and the recommendations followed. However, as people share bedrooms their privacy and dignity is not always maintained with regard to, for example, consultation with and examination by health and social care professionals or using the commode in a shared room. DS0000027842.V345389.R02.S.doc Version 5.2 Page 13 It was clear from discussions with the manager, and from observations and discussions with people living at the home, that the need to maintain good health is of prime importance. Medication is stored in an appropriate metal cabinet that is attached to the wall in the dining area. The senior carers administer medication. All of the senior staff have had medication training. The list of staff names authorised to give medicines, which includes a record of their signed initials and signatures, is available for reference with the MAR (Medication Administration Record) charts. This is good practice. The medication file contained appropriate information and this included photographs of residents and details of any allergies. This is also good practice. Examination of the MAR (Medication Administration Record) found that there were handwritten entries. For accountability any handwritten amendments or additions to Medication Administration Records (MAR) sheets must be signed and dated by the person making the entry. The entry must also include the source of the information. e.g. GP, registered nurse. A relative of a resident said “her medical needs are taken care of and we are pleased with the overall care.” Guidelines are needed on the action to be taken in the event of a medication error occurring. Specific advice on this was given to the manager at the time of the visit. This will ensure that medication is administered as safely as possible and any problems that might arise are appropriately dealt with. Some residents are prescribed “as required medication” but there are not any guidelines or protocols to indicate when and why this medication should be given and these need to be developed. This will ensure that staff are clear about when and why to give “as required medication” and that residents receive there prescribed medication appropriately when needed. Although overall medication is safely stored, the medication systems do not always follow good practice and the implementation of the above requirements will make medication administration more robust. There was evidence that end of life care had been discussed with either the residents or their relatives, and the AQAA states that this plan is sent with a resident who is sent to hospital so that health care professionals are aware of a person’s wishes leading up to the process of dying and death. Staff have received some training in this area. In discussions with the registered manager it was evident that any person wishing to remain at Dury Falls rather than being transferred to hospital would be enabled to do so with the appropriate care being given and support for family, friends and staff. The accident records were also inspected and these were well documented with details of the action taken recorded. DS0000027842.V345389.R02.S.doc Version 5.2 Page 14 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, 15 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to the service. A hobby therapist has responsibility to ensure that the residents have a varied programme of activities which suits individual needs, preferences and capacities specially suited to people with dementia. Visiting times are flexible and people are made to feel welcome when visiting the home enabling the residents to maintain contact with their family and friends. Residents are assisted to exercise choice and control over their lives. Residents receive meals that meet their preferences and needs. EVIDENCE: The inspector spoke to a number of residents to seek their views about living in the home. All the residents spoken to stated that they receive good care from the staff and all their needs are being met in a caring and professional manner. DS0000027842.V345389.R02.S.doc Version 5.2 Page 15 A resident’s feedback was received as follows: “ Everybody has been very kind to me since I arrived here at Dury Falls, I am not lonely anymore and I enjoy the company of all the residents.” The following comment was received from a relative: “ They are very flexible, residents can go to bed when they like and get up in the morning when they choose.” The visitors’ book showed that there is a steady stream of visitors to the home on most days. As well as friends and family, other visitors included the hobby therapist, hairdresser, an entertainer, as well as church visitors. There are a wide range of activities provided within the home although outings are limited. The inspector saw the activities and outings leaflet which reflected a varied programme of activities. Activities include quizzes, bingo sessions, reminiscence and watching videos. Residents confirmed that they are free to choose if they wish to participate in the activities or not. Several residents said they appreciated and enjoyed the activities offered by the hobby therapist who is highly motivated and provides activities suitable for people with dementia. On the day of the visit residents did some flower arranging and also had a quiz. The residents involved in this said that they enjoyed the activity and the arrangements were then put on the dining tables. The hobby therapist said that she encourages those with dementia to participate in activities but also said that for some people their hearing problems made things very difficult. It is recommended that the home purchase a portable hearing loop system to assist residents with hearing problems to participate in activities and meetings. Outside entertainers visit the home monthly and barbecues and other social events are arranged. Evidence was seen that residents are consulted via residents’ meetings which are held on a regular basis. Family and friends feel welcome and know they can visit the home at any time. Staff make time to talk to visitors and share information with the agreement of the resident. It is clear that the home encourages individuals and groups from the community to visit the home. Residents have a choice of where to see their relatives, including one of the lounges or in their own bedroom, however this choice is limited due to people sharing bedrooms. Residents’ finances are mostly handled by their family members or representatives. There is a clear financial policy and procedure in place to protect the residents. However, at the time of writing this report a concern was raised around a financial issue, which is dealt with in another section of this report. DS0000027842.V345389.R02.S.doc Version 5.2 Page 16 Residents are encouraged to bring their own personal possessions with them when coming to live at the home and this was evident when the inspector visited some of the residents’ bedrooms. The inspector spent time in the dining room when residents were having their lunch. About 20 of the residents ate in the dining room, others prefer to eat in their room or in the lounge. Residents were asked what they wanted for lunch and one resident was shown two meals and encouraged to point to the one that she wanted. Residents were offered a variety of cold drinks with their meal and staff refilled these as and when required. From viewing the menus, discussions with the stand - in cook, the residents, the manager and observations, it was evident that the quality of the food is good. Fresh vegetables and fruit are available and there were ample supplies of food in fridges, freezers and the store cupboards. Meals were well presented and the dining tables nicely laid. One resident is diabetic and she is supported to have an appropriate diet. One resident has a liquidised diet and each item is separately liquidised so that this person can still experience the different tastes. Staff said that some of the residents need to have their meat liquidised but not the rest of the meal. During the course of the afternoon residents are asked what they want to eat for supper and then staff prepare this. There is a choice of hot and cold food and a variety of sandwiches. Residents spoken to said that the food was good and that they could choose what they wanted to eat. Therefore residents receive meals that meet their preferences and needs. Currently several of the residents and staff smoke and they use the rear of the building. Obviously this is acceptable in good weather but not when it is cold and raining. Under the new Smoke-free (Exemptions and Vehicles) Regulations 2007 introduced on the 1st July 2007, residential care homes have to provide a room for residents, which is designated as a ‘smoking area’ and be well ventilated. Further information on this can be obtained from the relevant H.M. Government website, and the Commission understands that an information pack has been sent to all residential care homes. It will also be essential for the management to ensure that consideration is given to protecting the health of care staff who are looking after residents who smoke. The Royal College of Nursing (RCN) has produced a helpful booklet “Protecting community staff from exposure to second-hand smoke” and is available on their website www.rcn.org.uk. DS0000027842.V345389.R02.S.doc Version 5.2 Page 17 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): 16,18 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to the service. Residents and their relatives can be confident that their complaints will be listened to and taken seriously and acted upon in their best interests. Residents are protected from abuse through the training of staff and robust safeguarding adults policies and procedures are implemented. EVIDENCE: There is a complaints procedure that is clearly written, and available to residents. However, this does now need to be put into a format which can be more easily understood by those residents who have a degree of memory loss, confusion or who may be living with dementia. However, some residents spoken to said “we know who to complain to if we needed to, and that would be the manager.” Complaints are viewed by the management as positive and are used as a means of service development. This was evidenced in discussions with the manager and in viewing the complaints log. Two complaints have been addressed by the management as evidenced during the inspection. DS0000027842.V345389.R02.S.doc Version 5.2 Page 18 All staff have undertaken training in safeguarding adults and this forms part of the induction training for new staff. Three adult protection concerns were reported to the CSCI in the last twelve months, all of which have been dealt with under the London Borough of Havering Safeguarding Adults procedures. None of the allegations were substantiated. At the time of writing this report an issue relating to financial concerns has been reported and is being investigated under the local authority’s safeguarding adults procedures. However, the home was not responsible for managing this persons finances and were in no way implicated. The manager has reported the matter to the police, the placing authority and the commission but did not report it to the host authority who have responsibility for coordinating the safeguarding adults procedure. After discussions with the inspector, this matter was later resolved. The manager is now clear about the procedure to be followed. The inspector has received anonymous letters raising concerns about the quality of care received by the residents in the home. An unannounced inspection has been carried out with feedback received from staff and other stakeholders and the matter referred to the safeguarding adults team in the London Borough of Havering to investigate further. The General Manager has carried out an investigation, and the local authority has accepted the findings of her thorough investigation. DS0000027842.V345389.R02.S.doc Version 5.2 Page 19 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, 20, 21,22, 23, 24, 25, 26 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to the service. The home has a welcoming atmosphere and residents live in a generally clean environment. However, more needs to be done to meet the National Minimum Standards on the environment, to provide a safe and suitable environment which fully meets the needs of the service users. There are sufficient numbers of suitable toilets and bathrooms for the number of residents accommodated. The use of double rooms, and a lack of en - suite toilets means that not all bedrooms suit individual needs and preferences and do not promote peoples privacy and dignity, or provide sufficient positive choice when entering the home. DS0000027842.V345389.R02.S.doc Version 5.2 Page 20 EVIDENCE: The building was toured by the inspectors, accompanied by the manager during the visit and all areas were inspected. The living area of the home consists of two large lounges with furniture and fittings which are suited to the age of the property. There is a rolling programme of redecoration, and some bedrooms have been redecorated. The home is a listed building and some of the original features of the building, such as narrow corridors and low doors restrict the use of wheelchairs. There are 10 double and 8 single rooms at the home. Six rooms have en-suite facilities. As at the time of the previous inspection residents have not always made a positive choice to share with each other and are not always given the opportunity to choose not to share when a shared place becomes vacant. In addition the sharing of rooms still includes the use of empty beds for respite care and a permanent resident therefore shares with a stranger for a couple of weeks whilst they are staying for respite. Some of the shared bedrooms are not very big and are cramped especially when at least one resident is a wheelchair user. This was the case in one of the shared rooms and there was very limited room for manoeuvrability and to allow for best practice in terms of moving and handling. The shared rooms do not have en suite toilets and commodes are provided. Shared rooms do have screens, which afford some privacy but can not fully maintain or promote residents dignity especially when using the commode. The residents’ privacy and dignity may also be compromised when health professionals need to carry out examinations in shared rooms. In some parts of the home there are low ceilings and steps in corridors and into toilets, bathrooms and bedrooms. This presents additional risks to residents with mobility problems and could possibly be a factor in the number of accidents/falls that occur at the home. One relative commented, “the decor could be a bit more modern/brighter, but I understand it is a listed building.” There are a sufficient numbers of toilets and bathrooms, however, not all of these are suitable to the needs and preferences of people living in the home. There is a shower room on the ground floor. One of the upstairs toilets does not have a hand basin. The registered providers must ensure that all areas of the home are fit for the purpose and that residents and staff are not put at undue risk. The home is cleaned on a daily basis and throughout the inspection all areas of the home, the standard of cleanliness was good. There are adequate control systems in place to ensure that the home is free from any offensive odour, DS0000027842.V345389.R02.S.doc Version 5.2 Page 21 although one of the comments received from a relative suggests that the home “smells sometimes”. All domestic staff have attended infection control training. DS0000027842.V345389.R02.S.doc Version 5.2 Page 22 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, 30 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to the service. Staffing levels need to be reviewed to ensure that there are sufficient staff on duty to meet the individual assessed needs of the residents. Residents benefit from a committed and experienced team of staff at the home, however staff must receive specific training to meet residents’ needs. The procedures for staff recruitment are satisfactory and are followed robustly thereby ensuring protection to residents. EVIDENCE: A good deal of positive feedback about the staff at the home was received from the residents and their relatives. A typical comment being “the staff are very kind and caring.” “I believe the care home has a good mix of skills and given the very demanding level of attention required by the majority of patients I am particularly impressed by the care shown by the staff. Not an easy role to undertake.” DS0000027842.V345389.R02.S.doc Version 5.2 Page 23 “All staff are extremely kind to my mother and I am very satisfied. I found it very hard to decide to put mum in care but now I know I made the right decision.” “ I feel Dury Falls really is an excellent care home in every way. Like most of the people there my mother has dementia and it was a sad day for me when she had to go into a home but I am so glad she is in Dury Falls. I am in and out of the home several times a week and the staff are all very friendly and go out of their way to be helpful, they put on all sorts of activities, regular entertainment, parties, good choice of food, the place is always clean and has a nice family atmosphere.” The home has had a relatively stable workforce and in discussion with staff it was evident that they fully support the main aims and values of the home. Many of the staff have worked there for a number of years and have built up a good knowledge and understanding of the needs of the residents. The normal staffing levels are 4 staff, (including a senior) on each of the daytime shifts and two waking night staff. In addition there is support from a cook, a domestic, a laundry assistant and a handyman. The cook does not work in the afternoon and staff prepare, serve and clear the tea. They also in a prepare and put drinks in residents’ rooms and do some laundry. Staff said that this takes one person from approximately 3.30 – 6pm. Staff spoken to said that staffing levels can be tight especially in the afternoons and that they are not quite sufficient to meet residents’ needs. Residents do have quite high support needs as many of them have dementia. In addition to this three of the residents require two staff to support them for personal care and moving and handling. Hence the management team are required to review the staffing levels and the deployment of staff in order to ensure that there are sufficient numbers of staff to meet the assessed needs of the residents at all times. Staff spoken to said that they receive regular supervision from the job share managers and that staff meetings are held monthly. The manager is aware that formal supervision is important as it allows the staff time and space to reflect on their practice with their manager/senior. Recording the supervision is important, as it provides a retrospective picture of development and change and the manager now does this. DS0000027842.V345389.R02.S.doc Version 5.2 Page 24 The following feedback was received from the residents, relatives and staff “This is a good home, residents have freedom of choice and the staff team are committed”. “Residents are well cared for”. “The carers are good and make time for the residents.” “I have no reason for concern about the way residents are cared for and have not seen any situations where residents were not treated well”. A newer member of staff confirmed that she had an appropriate induction and had worked through an induction pack. She also said that she had been supernumerary for a few shifts. More than 50 of the staff have achieved NVQ level 2 and some have achieved NVQ level 3. Staff told the inspector that they had previously received training in moving/handling, safeguarding adults, fire safety, administration of medication, food hygiene and infection control, and this was confirmed when viewing the training schedule. There is a programme already arranged for future training for some of the staff. However staff have only received basic dementia awareness training which is not a sufficient training for staff in a home registered to look after people with dementia. Staff must receive comprehensive training in caring for people with dementia. Upon examination of staff files, the inspector noted that a robust recruitment procedure is in place, the home had undertaken all the necessary recruitment checks to ensure the protection of residents. CRB checks and references had been taken up and an application form completed, together with a criminal declaration signed by the employee. Certificates of qualification had also been seen and photocopies were on file, which included training in the safeguarding of adults. The introduction of the Mental Capacity Act 2005, with effect from the 1st April, 2007 for those residents who do not have family or friends to act for them, and from the 1st October, 2007 for all other adults was discussed with the manager who is aware of this important legislation, and stated that all staff working at the home have begun receiving training in the implications of the implementation of this Act. DS0000027842.V345389.R02.S.doc Version 5.2 Page 25 DS0000027842.V345389.R02.S.doc Version 5.2 Page 26 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): 31,32,33,34,35,36,37,38 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a view to the service. Residents live in a home that is run in their best interests by registered managers who job share the post. Residents’ financial interests are safeguarded by the policy and procedures of the home. The staff team work well together to make sure that residents are safe and secure whilst living at Dury Falls, however there have been a large number of falls/accidents recorded. Staff receive regular supervision. The residents’ rights and best interests are safeguarded by the home’s recordkeeping policies and procedures. Residents’ and staff health, safety and welfare are generally promoted and adequately protected. DS0000027842.V345389.R02.S.doc Version 5.2 Page 27 EVIDENCE: The manager’s post is a job share position and both the managers are registered with the Commission for Social Care Inspection. One of the managers is in the process of completing the Registered Manager’s Award. The management team generally work together to improve services and provide increased quality of life for residents. Feedback from both the residents and staff was positive about the way in which the home is run. Regulation 26 visits are undertaken by the operations manager on a monthly basis and the reports are forwarded to the inspector. The registered person is aware that the purpose of these visits is for regular internal monitoring and self audit of the service. The inspector is notified of significant events and developments in the home. A quality assurance survey to seek satisfaction levels amongst the residents, staff and relatives has been sent out by the home. The results and outcome of this survey are available in a report published by the providers in order to assess whether the home is meeting its aims and objectives according to the Statement of Purpose. The home has policies and procedures, which are continually being reviewed and updated in line with current thinking and practice. The home works to a clear health and safety policy, which all staff have been made aware of and must be working to. All health and safety certificates and documentation required by Legislations were in order. The inspector was informed that health and safety checks are carried out by the managers on a weekly basis and any matters raised are recorded and passed to the caretaker. However, the inspector is concerned about the number of falls/accidents residents have and the lack of moving and handling equipment at the time of the inspection, and whether there is a correlation between the lack of space and the layout of the premises and bedrooms which may expose them to suffer from these. This issue has been addressed in the section on Health and Personal Care. In a meeting following distribution of the draft report, the management team stated that they audit and review past falls for common factors and take corrective action where required. DS0000027842.V345389.R02.S.doc Version 5.2 Page 28 Records are generally of a good standard and are routinely completed however some of the records need detail. Residents are aware of safety arrangements however sufficient systems must be in place to ensure safe working practices are in place, for example, the use of moving and handling equipment as well as ensuring that sufficient staffing levels are maintained in the home at all times in order to ensure staff and residents’ health and safety. The home has an appropriate policy and procedures regarding safeguarding residents’ finances. If they wish and are able to, the residents are helped to take responsibility for managing their own money. They are provided with facilities to keep their valuables and money safe. Where the home is responsible for residents’ money the home maintains clear records that are routinely kept up-to-date and can be used to track individual residents’ finances. The inspector was informed that most of the residents’ finances are handled by their family members. A supervision policy and procedure is in place. Staff confirmed that they receive supervision on a regular basis from the manager and senior officers and this is recorded. The manager is committed to keeping records up to date and a requirement has been made elsewhere in this report regarding keeping care plans, risk assessments and other essential information regarding care given to residents up-to date. Fire drills and alarm testing is undertaken regularly. DS0000027842.V345389.R02.S.doc Version 5.2 Page 29 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 2 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 2 2 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 DS0000027842.V345389.R02.S.doc Version 5.2 Page 30 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 OP1 Regulation 5 Requirement The Statement of Purpose needs to include detail about space restriction in the home which may impact on the home’s ability to care for people to the end of their life as they become frail. As this home is registered to care for people with dementia, the care plans need to reflect clearly the type of dementia a person suffers from and specify how their needs will be met by staff, as each individual presents their symptoms in a different and specific way, so that staff can provide appropriate care to the residents at all times. For accountability any handwritten amendments or additions to Medication Administration Records (MAR) sheets must be signed and dated by the person making the entry. The entry must also include the source of the information. e.g. GP, registered nurse. DS0000027842.V345389.R02.S.doc Timescale for action 30/11/07 2 OP7 15 30/11/07 3 OP9 13(2) 30/11/07 Version 5.2 Page 31 Guidelines are needed on the action to be taken in the event of a medication error occurring. This will ensure that medication is administered as safely as possible and any problems that might arise are appropriately dealt with. Guidelines/ protocols must be in place to indicate when and why any “as required “ medication should be given to any individual. 4 OP10 12(4) The arrangements for health and personal care must ensure that residents’ right to privacy is upheld. The registered person must ensure that all areas of the home are safe and fit for purpose particularly in relation to the kitchen. Appropriate assessments must be carried out to ascertain what specialist equipment is required in the home to meet residents’ needs. This equipment must then be made available. Residents bedrooms must suit their needs and room dimensions and layout options ensure that there is room on either side of the bed to enable access for carers and any equipment needed. The manager must review the staffing arrangements for all shifts to ensure that at all times care staff are engaged in care work and do not undertake other tasks to the detriment of residents. The registered persons must ensure that care staff receive DS0000027842.V345389.R02.S.doc 30/11/07 5 OP19 23(2) 30/11/07 6 OP22 13, 14 30/11/07 7 OP23 23 30/11/07 8 OP27 18(1) 30/11/07 9 OP30 18(1) 30/11/07 Page 32 Version 5.2 10 OP38 13(4) training in caring for people with dementia and a mental disorder. Also that all staff receive training in equality and diversity issues so that the needs of people living at the home can be met according to their wishes and choices. All of the necessary health and 30/11/07 safety checks must be carried out regularly to ensure that a safe environment is maintained for residents. 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 It is recommended that the home purchase a portable hearing loop system to assist residents with hearing problems to participate in activities and meetings. The use of double rooms should be reviewed, taking into account the preferences of each service user. 2. OP23 DS0000027842.V345389.R02.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 DS0000027842.V345389.R02.S.doc Version 5.2 Page 34 - 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!