CARE HOMES FOR OLDER PEOPLE
Dyneley House 10 Allerton Hill Leeds West Yorkshire LS7 3QB Lead Inspector
Ann Stoner Unannounced Inspection 21st February 2006 09:30 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 Dyneley House DS0000001445.V283301.R01.S.doc Version 5.1 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. Dyneley House DS0000001445.V283301.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Dyneley House Address 10 Allerton Hill Leeds West Yorkshire LS7 3QB 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) 0113 268 1812 0113 266 7356 Greendown Trust Limited Mrs Pamela McGown Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Dyneley House DS0000001445.V283301.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18th October 2005 Brief Description of the Service: Dyneley House is owned by Greendown Trust and is a registered charity. The home provides care, without nursing, to 21 people of both sexes over the age of 65. It was originally set up to provide care and support specifically to members of the Christian Science Church, but now people of all faiths are welcome. The home is set in mature well-tended gardens, and is situated in a suburb of Leeds, close to local shops, and restaurants. There are 21 single bedrooms, all with an en-suite facility, and spacious communal space includes a lounge, dining room and 2 conservatories. There is a no smoking and no alcohol policy in the home. Dyneley House DS0000001445.V283301.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Over an inspection year from April until March, care homes have a minimum of two inspections a year; these may be announced or unannounced. The last inspection was announced and took place on the 18th October 2005. There have been no further visits until this unannounced inspection. The purpose of this inspection was to monitor progress in meeting the requirements and recommendations made at the last inspection and to look at the standard of care for people living in the home. This inspection was carried out by two inspectors between 9.30am – 5.00pm. The people who live in the home prefer the term resident therefore this will be used throughout this report. During the inspection, we looked at records, we saw staff carrying out their work and spoke with residents and staff. Feedback at the end of the inspection was given to the manager. Comment cards/questionnaires are left for residents, visitors and other professionals at each inspection. These provide an opportunity for people to share their views of the home with the Commission for Social Care Inspection (CSCI). Comments received in this way are shared with the provider and/or the manager, without revealing the identity of those completing them. Since the last inspection none have been returned. What the service does well: What has improved since the last inspection?
Although more work is needed, there has been a great improvement to the care plans. These now give staff detailed information on the care that should be given. All of the recommendations made at the last inspection have been addressed. These include making some changes to the way that medication is
Dyneley House DS0000001445.V283301.R01.S.doc Version 5.1 Page 6 recorded so that the risk of mistakes is reduced and completing nutritional assessments when people are admitted so that any nutritional risks are identified. The adult abuse policy has been amended advising staff to refer to the Multi Agency Adult Protection Procedures. Recruitment records are more detailed. All accidents are recorded and an analysis is kept to identify any patterns or trends. Staff are attending training on Parkinson’s Disease. 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. Dyneley House DS0000001445.V283301.R01.S.doc Version 5.1 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 Dyneley House DS0000001445.V283301.R01.S.doc Version 5.1 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): These standards were not assessed at this visit. EVIDENCE: Dyneley House DS0000001445.V283301.R01.S.doc Version 5.1 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, 9 & 10. There has been a big improvement to the level of detail recorded in care plans, but these must be developed further so that care staff have precise instructions on the way that care should be delivered. The way that medication is recorded has improved. The privacy and dignity of residents is respected. EVIDENCE: The care records of three residents were sampled and a big improvement was seen in the level of detail recorded. These should now be developed further as there was no information for staff on how to reassure a resident who becomes anxious and distressed when trying to find her daughter. Information on one person’s nutritional assessment indicated that she was at risk, and should be given full cream milk and nutritional supplements, but this information was not transferred to her dietary care plan. Assessment information for one person showed that she previously enjoyed baking, but this information was not transferred to her social and leisure care plan and opportunities for joining in or watching baking sessions had not been provided. A requirement has been made to address this.
Dyneley House DS0000001445.V283301.R01.S.doc Version 5.1 Page 10 Care plans were signed by residents and/or their relative and there was an excellent monthly evaluation carried out by keyworkers. Staff said that they no longer need to make handwritten entries on medication administration records (MAR), because they have changed their supplying pharmacy and all medication is pre-printed on the MAR. An audit of a short course of antibiotics for one resident was carried out and found to be in order. Both care and domestic staff were seen knocking on bedroom doors before entering, and care staff reminded residents about personal hygiene needs in a discreet and sensitive way. Dyneley House DS0000001445.V283301.R01.S.doc Version 5.1 Page 11 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): 15 Residents have a well balanced diet. EVIDENCE: Residents were complimentary about the meals. The lunchtime meal, of sausage casserole with potatoes, carrots, cabbage and peas, looked appetising. Although there is no choice at lunchtime an alternative vegetarian option is always available. Residents are given a choice of four options at teatime, which includes a selection of hot and cold dishes. Mid-morning, midafternoon and supper snacks are provided. Residents choose their teatime meal at some point during the morning, but are not always aware of the lunchtime menu until the meal is served. A recommendation about this has been made. One resident had adapted cutlery and crockery, which staff said helped him to retain his independence. When assistance was needed this was given in a sensitive and dignified way. Dyneley House DS0000001445.V283301.R01.S.doc Version 5.1 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): These standards were not assessed at this visit. EVIDENCE: Dyneley House DS0000001445.V283301.R01.S.doc Version 5.1 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, 24 & 26. Residents live in a pleasant, comfortable, safe and well-maintained environment. Some practices increase the risk of the spread of infection. EVIDENCE: The home has recently been decorated and new carpets have been fitted throughout. Bedrooms were very comfortable and individualised with personal possessions creating a homely touch. A handyperson visits weekly to do minor repairs and senior staff explained about the systems for emergency maintenance work. A visit from the West Yorkshire Fire & Rescue Service has recently been carried out. There were no recommendations from this visit. The manager said that there are plans to decorate the kitchen. This must be given priority and she was advised to contact Environmental Health for advice about suitable wall covering. Staff said that they only wear protective aprons and gloves when dealing with heavily soiled materials and cleaning staff do not wear gloves and aprons when
Dyneley House DS0000001445.V283301.R01.S.doc Version 5.1 Page 14 cleaning toilets. Although the home has a supply of water-soluble bags for handling and laundering of soiled linen, these are not used correctly. Staff carry soiled linen through the home to the laundry room, where it is then hand sluiced before going into the washer. This increases the risk of infection. Toilet brushes and holders were soaking in a sink in the laundry room, which again creates the risk of cross infection. There were no gloves and aprons in the laundry room, and there was no clinical waste bin. Requirements have been made to address these issues. Dyneley House DS0000001445.V283301.R01.S.doc Version 5.1 Page 15 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): 29 The home’s recruitment practices are robust and protect residents. EVIDENCE: The recruitment records of a recently appointed member of staff were seen. The records contained completed application form, 2 written references, interview records and a successful CRB/POVA (Criminal Record Bureau/Protection of Vulnerable Adults) disclosure. Two people carried out the recruitment interview, which is good practice. Dyneley House DS0000001445.V283301.R01.S.doc Version 5.1 Page 16 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): 35 & 38. Residents do not have access at all times to any money held on their behalf. The health and safety of residents is monitored but some practices in the kitchen must be reviewed. EVIDENCE: Where the home keeps money for safekeeping on behalf of residents a record of all transactions is kept, but only one signature is recorded. Where money is handed over, a signature is not obtained from the person handing over the money and the person receiving the money. The administrator, who has responsibility for dealing with all financial transactions, works Monday to Friday, which means that residents do not have access to any money held on their behalf over the weekend period. The home does not have an official receipt book. A receipt for any item handed over for safekeeping is given in the form of a petty cash voucher. This system makes it difficult to carry out an audit.
Dyneley House DS0000001445.V283301.R01.S.doc Version 5.1 Page 17 Records showed that residents contribute towards a birthday gift for staff. The manager said that this was only for ‘special’ birthdays, such as a 50th and was always done with the resident’s permission and agreement. The home has a policy, about staff receiving gifts. This practice not only contravenes this policy, but could also be considered abusive. The home now completes an accident form for all accidents and the manager carries out a monthly analysis so that any patterns or trends can be identified. This has had a positive effect for one resident, as the analysis identified a high proportion of falls, resulting in the home requesting that her medication be reviewed. As a result of this she has had no further falls. This is good practice. Care staff were seen using good moving and handling techniques, but moving and handling training is not offered to cleaning and administration staff. Some care staff were seen in the kitchen without protective tabards, and used the kitchen as a short cut to other areas of the home. There is no dedicated area for staff to store their own food, so it is stored in a disused sink. Some cleaning materials are stored in the same cupboard as pots and pans, and vegetables were stored under the sink area coming into contact with the ‘U’ bend. Requirements and recommendations have been made to address these issues. Dyneley House DS0000001445.V283301.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X X X X 3 X 2 STAFFING Standard No Score 27 X 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 2 X X 2 Dyneley House DS0000001445.V283301.R01.S.doc Version 5.1 Page 19 NO 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 OP7 Regulation 15 Requirement Care plans must set out in detail the action which needs to be taken by staff to make sure that all aspects of the resident’s health, personal and social care needs are met. A programme of decoration must take place in the kitchen. All staff must wear protective aprons and gloves when dealing with any bodily fluids. Timescale for action 30/04/06 2 3 OP19 OP26 23 (2) 13 (3) 31/08/06 22/02/06 4 OP26 13 (3) Cleaning staff must wear protective aprons and gloves when cleaning toilets. Infection control measures must 27/02/06 be reviewed to make sure that the risk of the spread of infection in the home is minimised. The home must use water soluble bags when transferring and laundering soiled linen. A supply of disposable aprons and gloves must be provided in the laundry room. Dyneley House DS0000001445.V283301.R01.S.doc Version 5.1 Page 20 A clinical waste bin must be provided in the laundry room. Toilet brushes and holders must not be cleaned in the laundry room. Residents must not be encouraged to contribute towards gifts for staff. Residents must have access at all times to any money that is held for safekeeping on their behalf. They must also have immediate access to their current balance and any transactions carried out. All staff in the home must complete moving and handling training. Care staff must wear protective clothing when entering the kitchen. The kitchen must not be used as a shortcut to other areas of the home. Storage facilities in the kitchen must be reviewed. 5 6 OP35 OP35 13 (6) 17 Sch 4 22/02/06 31/03/06 7 8 OP38 OP38 18 13 30/04/06 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 OP15 OP35 Good Practice Recommendations A daily menu should be made available to residents before meals are served. Where money is held by the home on behalf of the residents, there must be two signatures against all records of transactions. Dyneley House DS0000001445.V283301.R01.S.doc Version 5.1 Page 21 3 OP35 Where money is handed over on behalf of the resident a signature should be obtained from the person handing over the money and the person receiving the money. The home should obtain an official receipt book. A receipt should be given when any item is handed over for safekeeping and a copy should be held on the person’s care records. A signature should be obtained from the person handing over the item and the person receiving the item. If the property is returned to the owner, a signature should be obtained from the person handing over the item and the person receiving the item. Dyneley House DS0000001445.V283301.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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