CARE HOMES FOR OLDER PEOPLE
Dussindale Park Nursing & Residential Home Mary Chapman Close Dussindale Norwich Norfolk NR7 0UD Lead Inspector
Mrs Ginette Amis Unannounced Inspection 7th November 2005 11:35 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 Dussindale Park Nursing & Residential Home DS0000044398.V262434.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dussindale Park Nursing & Residential Home DS0000044398.V262434.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Dussindale Park Nursing & Residential Home Address Mary Chapman Close Dussindale Norwich Norfolk NR7 0UD 01603 701900 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) Alphacare Services (UK) Ltd Care Home 58 Category(ies) of Old age, not falling within any other category registration, with number (58) of places Dussindale Park Nursing & Residential Home DS0000044398.V262434.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Fifty-eight (58) Service Users may be accommodated of either sex who are aged over 65 years. From time-to-time a service user between the age of 50 and 65 years may be accommodated. The total number not to exceed fifty-eight (58). Date of last inspection 5th May 2005 Brief Description of the Service: Purpose built in 1994, Dussindale Park is situated in a modern residential suburb of Thorpe St Andrew on the outskirts of Norwich. The home can accommodate 58 older people with residential or nursing needs, in 38 single and 10 double rooms; 38 of the rooms have en-suite facilities and some of the ground floor rooms open up to patio areas. The accommodation is on the ground and first floor levels, and can be accessed by passenger lift. The second floor is used for offices and storage. The surrounding lawns and garden areas are well maintained and can be accessed by service users. There is ample parking space at the front and to the rear of the premises. The home is supported by the local GP practices and other health professionals. Dussindale Park Nursing & Residential Home DS0000044398.V262434.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place from 11.35am to 3.50 pm on Monday 7th November 2005. The manager of the care home was available to assist with the inspection throughout the day. She and other members of staff were courteous and helpful. A number of residents contributed their views of the care home, 3 being interviewed formerly in private and 4 spoken with in the lounges. In addition, it was possible to join with 10 residents who were taking part in an afternoon activity organised by staff. Four relatives of residents who happened to be visiting that day also offered their views of the care home. Since the last inspection an application to register the manager appointed earlier this year has been made and is currently being processed by CSCI. What the service does well: What has improved since the last inspection?
A refresher course on the protection of vulnerable adults from abuse has been arranged and a new improved induction programme introduced. Staff are receiving formal supervision and annual appraisals. Staff turnover has become more stable. Care staff are learning to contribute to residents care plan files. Effort has been made to keep residents more aware of daily events, the
Dussindale Park Nursing & Residential Home DS0000044398.V262434.R01.S.doc Version 5.0 Page 6 regular activities that have been organised for them and the available menu through introduction of a weekly flyer and bi monthly news-letter. 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. Dussindale Park Nursing & Residential Home DS0000044398.V262434.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dussindale Park Nursing & Residential Home DS0000044398.V262434.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1236 Information about the care home is available but residents must be given their own copy of the service user guide, including the complaints procedure. Assessments of need are conducted prior to admission for all potentially permanent or short stay residents. EVIDENCE: A service user guide is available in the main foyer but residents have not been given a copy to keep for their own use. All residents receive a contract/terms and conditions of residency. The 4 residents’ files examined contained details of needs assessment. The manager related that the care home only occasionally offers short term accommodation and this is subject to the same assessment of needs as for people seeking permanent residency. Dussindale Park Nursing & Residential Home DS0000044398.V262434.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Residents and their relatives were at ease with staff and confident of health and personal care needs being met in a sensitive and appropriate manner. Improvements to the documentation of residents’ needs were in view but planned changes should be implemented as soon as practicable. EVIDENCE: Residents’ files were found to contain relevant information as to health, personal care and some social needs. Confidential medical information remained stored at the nurses’ work-stations while other information was retained in a second file kept by the resident in their own room. These files were somewhat confusing in layout and failed to be user friendly. The manager was planning to introduce a new system, currently in preparation, and was working with care staff to improve their confidence in contributing to the care planning process and record keeping system. A recommendation was made for this new improved system to be implemented as soon as possible. Medication was appropriately stored and records kept in a designated medical room. Residents and their relatives spoke highly of the respectful, caring attitudes of staff and expressed confidence that their health and personal care needs would always be met in an appropriate and timely manner.
Dussindale Park Nursing & Residential Home DS0000044398.V262434.R01.S.doc Version 5.0 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Residents at Dussindale Park were content with their lifestyle, appreciated their meals and felt that events and activities were enjoyable. Relatives of residents were equally satisfied with the care home in these respects. EVIDENCE: Residents expressed satisfaction with their lifestyle at Dussindale Park. This was a view endorsed by residents’ relatives. One said they were “always made particularly welcome there, irrespective of the time of day”. Weekly flyers had been introduced explaining the choices available on the menu and programme of activities on offer. These were distributed in key locations around the home. Activities had been re-organised to try to meet residents’ needs and preferences. One resident gave a full account of an outing he had been taken on saying how greatly he, and he believed others, had enjoyed the experience. Residents observed participating in a group activity were clearly enthusiastic and having a good time. The manager has introduced an attractive and informative bi monthly newsletter about events and activities at the care home. Dussindale Park Nursing & Residential Home DS0000044398.V262434.R01.S.doc Version 5.0 Page 11 Residents and relatives offered praise for the quality of the meals offered saying standards were consistently high. Dussindale Park Nursing & Residential Home DS0000044398.V262434.R01.S.doc Version 5.0 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Residents and their relatives were confident that any issues of concern or complaints they raised would be dealt with in a timely and appropriate manner. Appropriate training and guidance regarding the protection of vulnerable adults from abuse was being made available to all staff. EVIDENCE: A small number of complaints had been logged since the last inspection, all of which had been fully investigated and resolved. While residents were confident any issue they might raise would be sympathetically addressed, the lack of a service user guide meant the exact terms of the complaints procedure were unfamiliar to some. (See Requirement 1) The need for vigilance and procedures to follow to protect vulnerable adults from abuse was routinely addressed during staff induction and a further refresher course scheduled to be held in late November 05. Dussindale Park Nursing & Residential Home DS0000044398.V262434.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 21 26 Dussindale Park was clean and well maintained. It offered comfortable accommodation. Bathrooms would benefit from some improvements. EVIDENCE: The location of Dussindale Park was pleasantly quiet while close to a supermarket shopping centre and bus route. The premises were purpose built and suitable. They appeared safe and well maintained. Some redecoration work remained outstanding but plans for completion were in hand. New mobile side tables had been provided throughout and those rooms entered were clean, well furnished and had been personalised by their occupants. While bathing facilities were adequate it was noted how bathrooms were austere and being used for inappropriate storage. A recommendation was made for these areas to be made more comfortable and welcoming. Dussindale Park Nursing & Residential Home DS0000044398.V262434.R01.S.doc Version 5.0 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Adequate numbers of staff, who were trained and supervised to do their work were employed at the care home. The requirement from the previous inspection for all staff involved in food handling to undertake food hygiene training had not been met and was brought forward. In addition staff must be encouraged to seek NVQ accreditation. EVIDENCE: On the day of this inspection there were appropriate levels of nursing, care and auxiliary staff on duty. Appropriate recruitment policies and procedures were in place and all staff CRB checked. Staff had been recruited from abroad with evidence of police checks in their native country, prior to subsequent police checking in the UK. Records of the useful training staff had undertaken were available but as yet, the requirement for all staff involved with food handling to receive food hygiene training had not been met so was repeated. Due to high staff turnover in the past, less than 50 of care staff had NVQ accreditation and those yet to enrol should continue to be encouraged to do so. The manager had introduced regular staff supervision. Annual appraisals were in process on the day of this inspection. Dussindale Park Nursing & Residential Home DS0000044398.V262434.R01.S.doc Version 5.0 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 38 The care home had benefited from the appointment of a manager with a clear sense of direction. It was acknowledged that further improvements to practice were planned. Residents’ health safety and welfare along with their finances were being safeguarded. EVIDENCE: The current manager had been in post for the past 6 months and registration with CSCI was in process. It was evident that improvements to daily practice had come about since her appointment and that staff turnover had stabilized. The manager freely acknowledged that there remained further changes and improvements to practice she wished to bring about, particularly in relation to care planning. Some residents had cash in the safe keeping of the care home, with records of this maintained.
Dussindale Park Nursing & Residential Home DS0000044398.V262434.R01.S.doc Version 5.0 Page 16 Both staff and residents meetings were being held. The provider conducted regular monthly inspections. Questionnaires for residents and relatives to offer feedback on their view of the service had been prepared and it was intended the manager would circulate these before the end of the year. Good records were maintained with regard to health and safety, fire prevention and staff training along with servicing of equipment in use. Dussindale Park Nursing & Residential Home DS0000044398.V262434.R01.S.doc Version 5.0 Page 17 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 X X X 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 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 2 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 3 X 3 X 3 Dussindale Park Nursing & Residential Home DS0000044398.V262434.R01.S.doc Version 5.0 Page 18 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 OP1 Regulation 5 (2) Requirement A copy of the service user guide that includes details of the complaints procedure must be supplied to each resident All members of staff who handle food must be trained in food hygiene (Repeat Requirement) The providers and the management must continue to promote and provide training opportunities for staff to undertake NVQ accreditation (Repeat Requirement) Timescale for action 31/12/05 2. OP15 18 (1)c 31/01/06 3. OP30 18 (1) a b c 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP21 Good Practice Recommendations The planned changes to the care planning process should be implemented as soon as practicable Bathrooms should be more comfortable and not used for
DS0000044398.V262434.R01.S.doc Version 5.0 Page 19 Dussindale Park Nursing & Residential Home inappropriate storage of excess items. Dussindale Park Nursing & Residential Home DS0000044398.V262434.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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