CARE HOME ADULTS 18-65
Dyscarr Grange Care Home Doncaster Road Langold Nottingham S81 9RJ Lead Inspector
Jayne Hilton Key Unannounced Inspection 20th July 2006 03:00 Dyscarr Grange Care Home DS0000008663.V302833.R01.S.doc Version 5.2 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 Dyscarr Grange Care Home DS0000008663.V302833.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. Dyscarr Grange Care Home DS0000008663.V302833.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Dyscarr Grange Care Home Address Doncaster Road Langold Nottingham S81 9RJ 01909 540 607 01909 540 607 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) H4037@mencap.org.uk Royal Mencap Society Debra Morley Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Dyscarr Grange Care Home DS0000008663.V302833.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 26th February 2006 Brief Description of the Service: Dyscarr Grange is a residential home registered for seven places, for people who have a learning disability. It has a village location, being situated on the main road through Langold, and very close to local shops, chemists, and the Doctors surgery. Langold lies approximately five miles north of Worksop town centre, and is situated on a main bus route. The home is managed by Mencap Homes Foundation, and the property is owned by New Era Housing Association. Dyscarr Grange is well equipped to meet the needs of residents who have an additional physical disability, and there is a passenger lift as well as stairs to access the upper floor. Fees range between £335-£343. Residents have to self-fund for hairdressing, holidays, meals out, transport costs etc. Dyscarr Grange Care Home DS0000008663.V302833.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Regulation Inspector Jayne Hilton carried out the unannounced key inspection, at 3pm on 20th July 2006. The homes manager position has become vacant and the deputy was also not present. The inspector wishes to thank the three support workers who were on duty and assisted with the inspection process including through teatime. The residents have limited communication skills and therefore could not participate verbally in the inspection process. That said there were some excellent examples of good practice to promote the rights and choices of residents and which support a quality lifestyle for individuals in the home. All service users were in the home on the day and one of them particularly participated in the inspection process. The evidence obtained, indicates a very active and empowered service user group. Other information was obtained from records and talking to staff. The overall evidence demonstrated that Dyscarr Grange continues to be an extremely well managed home, providing a very high standard of accommodation and support to the service users living there. There is currently a difficult situation regarding the transport facilities as the bus drops off on the opposite side of the road, which mean that the residents have to be helped across a busy road. Communication is in progress to look at arrangements with the day centre and transport company and also in campaigning with the local authority for a zebra crossing for ways to minimise the risk to residents. What the service does well:
Dyscarr Grange operates a lengthy ‘getting to know you’ period, where visits to the home are made, for meals, and over night stays. Each resident was seen to have an Assured tenancy agreement within his or her file. Residents were happy and relaxed during the visit and appeared well suited in relation to compatibility within the peer group. There are no residents currently in the service who have any assessed specific cultural or diversity needs but staff confirmed that promotion of individual choice and rights was a fundamental part of the homes philosophy and that they receive training in diversity. Residents care plans provided evidence for this and staff were observed offering residents choices and facilitating their wishes. Because some of the residents have limited communication, staff offered many options to ensure that they understood what the resident’s wishes were where this was not immediately clear. On the whole staff appeared very knowledgeable of the service users and skilled in communication and interaction with the individuals according to their needs. Care plans also contain a section “all about my communication needs” Residents do know that their assessed and changing needs will be part of their individual plan. Residents are assisted to make Dyscarr Grange Care Home DS0000008663.V302833.R01.S.doc Version 5.2 Page 6 decisions about their lives by the staff. Residents at Dyscarr Grange do take risks as part of their daily lives. Touring the building revealed evidence of a number of different activities available to residents, from relaxation areas to art and craft activities. One resident requested staff support in putting a Compact Disc player on, another said she liked to dance, another two residents were watching television and another preferred quiet time alone. Other residents were involved in the inspection dialogues from time to time. A photographic record for activities was seen which demonstrated the various activities provided, such as Pizza making evening, gardening, throwing a ball for a dog, baking etc. A written record for each resident was also included and staff reported that a DVD had also been produced to music so the residents could also enjoy watching their achievements and could be used to engender evaluation and feedback. This project idea was deemed to be excellent by the inspector. Dyscarr Grange is situated right in the middle of the village, residents are actively involved in the village life, and a local pub will even prepare food in a certain way, so that a particular resident is able to eat it. All residents attend day care. Holidays are facilitated and residents and staff confirmed that holidays had taken place or were booked for Butlins at Skegness and Ashgate. Family contact is encouraged, and with most of the families living fairly locally this is not a problem. Inside the front door, there is a ‘visitors statement’, which sets out a range of information for visitors including whom to talk to if there is a problem. The homes routines are transparent and flexible. Service users were observed on the day making decisions. Staff was observed interacting flexibly with the service users. Service users enjoy privacy in their own rooms, being able to lock their own doors where possible and having lockable facilities within. The homes philosophy and induction process promotes service users right to choice dignity and privacy. Service users and staff spoken with confirmed this. Service users open their mail, sometimes with support from staff to assist in explaining the contents. Service users support is tailored to the individual and participation in maintenance of common areas is built into the care plan and varies to suit the individual’s wishes and capabilities. The home is accessible to service users throughout. There are definitive house rules and some routine, which do not impact on individual’s rights, but offers some continuity and stability. Service users choose freely what to eat and meals are recorded retrospectively. Within the limits of their abilities service users take part in the preparation of meals, table laying etc. or they accompany staff carrying tasks out on their behalf. There is detailed and well-documented information relating to the healthcare needs of the residents. This project work was deemed excellent by the inspector as the files are person centred and contain photographs of medication and equipment used for the individual and even includes a photograph of the residents named consultants. Separate sections are included for Chiropody, hearing checks, annual health checks, etc. The healthcare folders contain consent for medication and all records relating to medication were found to be complete and in order. Dyscarr Grange Care Home DS0000008663.V302833.R01.S.doc Version 5.2 Page 7 Service users live in a homely, comfortable, clean and safe environment, with specialist equipment to maximise their independence. Residents can be confident that their views underpin the self-monitoring review and development of Dyscarr Grange. Residents and staff at Dyscarr Grange benefit from sound Health & Safety policies and procedures. Service users are supported by competent; well-trained and supported qualified staff. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Dyscarr Grange Care Home DS0000008663.V302833.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dyscarr Grange Care Home DS0000008663.V302833.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2,3,4, 5 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Prospective residents would have the information they require to make an informed choice about coming to live at Dyscarr Grange. Prospective residents are well assessed prior to admission to Dyscarr Grange. Prospective residents do have an opportunity to test drive the service. Each resident has an assured tenancy agreement. EVIDENCE: The Statement of Purpose and Service User Guide were seen. Both of these documents were well presented and contained all of the information required by Care Homes Regulations. Two resident’s files were seen, including a newly admitted resident and these contained an Extended Community Care Assessment, a Health Assessment, a day Care assessment, together with a range of ‘in-house’ assessment material. Dyscarr Grange operates a lengthy ‘getting to know you’ period, where visits to the home are made, for meals, and over night stays. Each resident was seen to have an Assured tenancy agreement within his or her file. Residents were happy and relaxed during the visit and appeared well suited in relation to compatibility within the peer group. There are no residents currently in the service who have any assessed specific cultural or diversity needs but staff confirmed that promotion of individual choice and rights was a fundamental part of the homes philosophy and that they receive training in diversity. Residents care plans provided evidence for this and staff were observed offering residents choices and facilitating their wishes. Because some of the residents have limited communication, staff
Dyscarr Grange Care Home DS0000008663.V302833.R01.S.doc Version 5.2 Page 10 offered many options to ensure that they understood what the resident’s wishes were where this was not immediately clear. On the whole staff appeared very knowledgeable of the service users and skilled in communication and interaction with the individuals according to their needs. Care plans also contain a section “all about my communication needs” Residents do know that their assessed and changing needs will be part of their individual plan. Residents are assisted to make decisions about their lives by the staff. Residents at Dyscarr Grange do take risks as part of their daily lives. Dyscarr Grange Care Home DS0000008663.V302833.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents do know that their assessed and changing needs will be part of their individual plan. Residents are assisted to make decisions about their lives by the staff at Dyscarr Grange. Residents at Dyscarr Grange do take risks as part of their daily lives. EVIDENCE: Dyscarr Grange are incorporates a Person Centred Plan approach to their ‘plans’ Health care records are kept in this format. This is a comprehensive planning system, which uses pictures and symbols to make it more accessible to individual resident. There was a great deal of evidence of the use of pictures within the building to assist residents in decision making. There is also a suggestion book where residents can make comments on a whole range of matters, affecting their lives. Teatime is a free choice meal, with residents making the decision about what to eat when they return home from the Day Centre. These choices are then recorded, and the meal is prepared. Each of the three files contained detailed risk assessments covering a wide range of the activities of daily living. In Addition there was a file containing a number
Dyscarr Grange Care Home DS0000008663.V302833.R01.S.doc Version 5.2 Page 12 of environmental risk assessments, which covered other areas of living within the house. Two residents care and support needs records were examined and these were well documented and detailed, including evidence of good observations made by staff in the records. The residents who live at Dyscarr Grange have complex needs and excellent work was evidenced in enabling the resident’s empowerment. The plans were reviewed regularly. The annual care reviews were date as 2004 and 2005 in the two plans examined and staff said the residents would have had more recent annual reviews, staff were asked to check this and ensure annual review documentation is brought up to date. Dyscarr Grange Care Home DS0000008663.V302833.R01.S.doc Version 5.2 Page 13 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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, 16, 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents at Dyscarr Grange do take part in age, peer and culturally appropriate activities. Residents are part of the local community. Residents at Dyscarr Grange do have appropriate relationships with their family and friends. Service users rights are respected and responsibilities recognised in their daily lives. They are offered a healthy diet and enjoy their meals and mealtimes. EVIDENCE: Touring the building revealed evidence of a number of different activities available to residents, from relaxation areas to art and craft activities. One resident requested staff support in putting a Compact Disc player on, another said she liked to dance, another two residents were watching television and another preferred quiet time alone. Other residents were involved in the inspection dialogues from time to time. A photographic record for activities was seen which demonstrated the various activities provided, such as Pizza making evening, gardening, throwing a ball for a dog, baking etc. A written record for each resident was also included and staff reported that a DVD had also been produced to music so the residents could also enjoy watching their
Dyscarr Grange Care Home DS0000008663.V302833.R01.S.doc Version 5.2 Page 14 achievements and could be used to engender evaluation and feedback. This project idea was deemed to be excellent by the inspector. Dyscarr Grange is situated right in the middle of the village, residents are actively involved in the village life, and a local pub will even prepare food in a certain way, so that a particular resident is able to eat it. All residents attend day care. Holidays are facilitated and residents and staff confirmed that holidays had taken place or were booked for Butlins at Skegness and Ashgate. Residents are charged for transport and the home has provision of a mobility vehicle. There is currently a difficult situation regarding the transport facilities as the bus drops off on the opposite side of the road, which mean that the residents have to be helped across a busy road. Communication is in progress to look at arrangements with the day centre and transport company and also in campaigning with the local authority for a zebra crossing for ways to minimise the risk to residents. Staff informed the inspector that interim arrangements had been made for a four week period for one resident who was deemed to be more at risk because of the situation. Family contact is encouraged, and with most of the families living fairly locally this is not a problem. Inside the front door, there is a ‘visitors statement’, which sets out a range of information for visitors including whom to talk to if there is a problem. The homes routines are transparent and flexible. Service users were observed on the day making decisions. Staff was observed interacting flexibly with the service users. Service users enjoy privacy in their own rooms, being able to lock their own doors where possible and having lockable facilities within. The homes philosophy and induction process promotes service users right to choice dignity and privacy. Service users and staff spoken with confirmed this. Service users open their mail, sometimes with support from staff to assist in explaining the contents. Service users support is tailored to the individual and participation in maintenance of common areas is built into the care plan and varies to suit the individual’s wishes and capabilities. The home is accessible to service users throughout. There are definitive house rules and some routine, which do not impact on individual’s rights, but offers some continuity and stability. Service users choose freely what to eat and meals are recorded retrospectively. All indicated preferences are recorded in the care plans. On weekdays, as most service users are away from the home, they tend to eat a main meal out. Within the limits of their abilities service users take part in the preparation of meals, table laying etc. or they accompany staff carrying tasks out on their behalf. One service user has been diagnosed as having dysphagia and therefore has to have thickened fluids. Dyscarr Grange Care Home DS0000008663.V302833.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users receive personal support in the way they prefer and require. Resident’s physical and emotional needs are well met. Residents do not selfmedicate, but are protected by the Dyscarr Grange policies and procedures related to medication. EVIDENCE: Privacy is well promoted in the home and supported in the policies and procedures, which inform care practice. Where people need mobility support, within safety limits staff, always takes their lead from the service user and their preferred style of handling. Risk assessments were observed to be well balanced in promoting individuals choice with minimising risks. The home is well equipped to respond to a range of mobility needs and will be able to support people, as they get older. Tissue viability needs are supported by the district nurse and pressure relieving equipment was in place where needed. People are enabled to choose what they wear each day, and are have their hygiene needs supported. There is a key worker system established, this is reviewed twice yearly to ensure relationships are working well, and changes can be made at any time in response to requests or adverse reactions.
Dyscarr Grange Care Home DS0000008663.V302833.R01.S.doc Version 5.2 Page 16 The two resident’s files examined contained detailed and well-documented information relating to the healthcare needs of the residents. This project work was deemed excellent by the inspector as the files are person centred and contain photographs of medication and equipment used for the individual and even includes a photograph of the residents named consultants. Separate sections are included for Chiropody, hearing checks, annual health checks, etc. It is recommended that the annual healthcare check include well women and well man issues such as breast screening and testicular examinations etc. The healthcare folders contain consent for medication. Dyscarr Grange uses a Monitored Dosage System (MDS), which is operated and maintained by the local chemist. Storage of medication was seen during the Inspection, and all records relating to medication were found to be complete and in order. It is recommended that the policies for the safe handling of medicines is reviewed and updated in line with the Royal Pharmaceutical Societies guidance, particularly in relation to Homely Remedies and should also include information about Covert use of medication, crushing of medication etc. It is recommended that the use of Homely remedies section within the individual healthcare folder or include this to be reviewed at the annual healthcare check. Dyscarr Grange Care Home DS0000008663.V302833.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their families will be able to feel that their views are listened to and acted upon. Residents are protected from abuse, neglect and self-harm. EVIDENCE: The complaints procedure is prominently displayed within Dyscarr Grange, picture and symbol formats are also displayed and records within the complaints book showed that the last complaint was received in September 2004. Staff training records showed that every member of staff had received abuse training (Mencap’s own ‘Protect and Respect’ training) during the period November 2002 to June 2006. The organisation has tried to access other training in Safeguarding Adults, but has found that this is oversubscribed and waiting time s unfortunate. There have been no incidents referred under Safeguarding Adults criteria. Staff were spoken with about the Nottinghamshire Committee For Protection of Vulnerable Adults protocols and advised to speak with the Safeguarding Adults Unit to ensure the home had up to date guidance in line with what to report under No Secrets. This should be in accordance with the following category descriptions from ‘No Secrets’: • physical abuse, including hitting, slapping, pushing, kicking, misuse of medication, restraint, or inappropriate sanctions; Dyscarr Grange Care Home DS0000008663.V302833.R01.S.doc Version 5.2 Page 18 • sexual abuse, including rape and sexual assault or sexual acts to which the vulnerable adult has not consented, or could not consent or was pressured into consenting; psychological abuse, including emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, isolation or withdrawal from services or supportive networks; financial or material abuse, including theft, fraud, exploitation, pressure in connection with wills, property or inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits; neglect and acts of omission, including ignoring medical or physical care needs, failure to provide access to appropriate health, social care or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating; and discriminatory abuse, including racist, sexist, that based on a person’s disability, and other forms of harassment, slurs or similar treatment. • • • • (No Secrets, para 2.7). Staff spoken with reported that there had been no incidents where restraint had been used in relation to behaviour and care plans clearly document strategies where intervention is necessary. Where bedrails are in use, risk assessments and authorisation signatures are obtained. Where residents cannot advocate agreement to the restraint and do not have relatives, an appropriate representative or advocate should be found to support the staff member’s judgement of its use. Monitor alarms are in place for epilepsy and these are also fully documented within car plans. A sample of resident’s finances was examined and appeared to be satisfactory. Dyscarr Grange Care Home DS0000008663.V302833.R01.S.doc Version 5.2 Page 19 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26,27,29,30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users live in a homely, comfortable, clean and safe environment, with specialist equipment to maximise their independence. EVIDENCE: On entering the home, a distinctly domestic and appealing atmosphere is noticeable. The home is very well decorated and service users choices are reflected in choices of colour and furniture, in private and communal areas. All aspects of accommodation exceed minimum standards. A high standard of maintenance and cleanliness is maintained throughout. The home also provides appropriate equipment and facilities. A vertical lift, parker bath, a bath with a chair hoist, walk in shower, hoists and stand aids are all available and all radiators are of the low surface temperature type. A second communal area is designated as a relaxation area, with sight and sound stimulants. Various squares of differing coloured paint was noted in this room and a staff member explained that these were possible colours for use in re-decoration of the room and that the squares of paint were used to work with the residents to obtain their views and preference of which colour the room should be painted.
Dyscarr Grange Care Home DS0000008663.V302833.R01.S.doc Version 5.2 Page 20 The large gardens and patios are being landscaped in consultation with service users and families and with help from the local community service teams. These provide large areas of lawn and raised beds to work with and barbecue and relaxation areas for service users and their guests. There are plans for the fencing to be repainted and the car park to be extended. There is a range of specialist equipment provided including a passenger lift, mobile hoist over bath, and a parker bath a walk in shower and ramps to access the garden. Handrails are sited throughout. There is a low fitted sink in the kitchen and doorways are wide enough to accommodate wheelchairs. Sensory lighting was seen and an epilepsy monitor. Occupational Therapy assessments are obtained as necessary. Bedrooms are personalised and were well decorated and furnished. Coordinated accessories enhanced the rooms and which residents are able to choose with guidance from staff. The hallways had several mirrors affixed. The inspector recommended that a tactile board or differing tactile touch boards could be introduced to the home. Residents are not able to hold keys to their rooms but can lock the room for privacy when required from the inside. The care plan documentation should include risk assessments as evidence that the resident is unable to manage a bedroom door key. Lockable facilities are provided in each room and these should also be included in the risk assessment. The home was clean and fresh throughout. The staff with stated they receive training in hygiene measures and the control of infection, and this is supported by written policies and procedures and from staff training records observed. There is a joint approach to cleaning and service users are encouraged where appropriate to participate and create ownership and control within the home. Hand washing facilities are readily available and adequate laundry facilities are present with sluicing facilities, should they be required. Staff were observed wearing aprons for food preparation and washing their hands routinely. The inspection was carried out during the heat wave period, although the inspector did not specifically examine any documented heat wave plan, observed practice evidenced that staff were aware and actioning of ventilating the rooms, placing of fans and drink supplies were plentiful. Dyscarr Grange Care Home DS0000008663.V302833.R01.S.doc Version 5.2 Page 21 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are supported by competent; well-trained and supported qualified staff. EVIDENCE: The staffing rota was examined and was deemed appropriate to meet the needs of residents. Three staff are on duty at peak times and two staff cover waking nights. The personal files of staff could not be examined on this visit, however recruitment standards were assessed at an inspection in March 06 and found to fully meet the standard. Staff were able to confirm induction and training provision including manual handling, customer care, confidentiality, pharmacy, epilepsy including the use of rectal diazepam, No bullying, fire training, first aid, health ad safety, food hygiene, Protection of Vulnerable adults. LDAF components such as Protect Me, Communicate with Me, Value Me and Respect Me. 4 staff have achieved NVQ 2 and 3. 10 staff are working towards NVQs. Staff spoken with reported that all staff receives the associations six-week LDAF induction program. This is followed by a six-month foundation course. The staff also have a wide range of basic training courses available to them from MENCAP on a regular basis and can request training for any aspect of care that will assist them in supporting service users. Funding can be
Dyscarr Grange Care Home DS0000008663.V302833.R01.S.doc Version 5.2 Page 22 requested for service-specific courses from external organisations. All training incorporates equal opportunities aspects. Staff said they receive regular supervision sessions and annual appraisal, and the team as a whole are also assessed for service-specific training Staff meetings are held regularly and minutes were seen. All staff have copies of the grievance and disciplinary procedures. Staff confirmed they held copies of The General social care Councils Code of conduct. Dyscarr Grange Care Home DS0000008663.V302833.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be confident that their views underpin the self-monitoring review and development of Dyscarr Grange. Residents and staff at Dyscarr Grange benefit from sound Health & Safety policies and procedures. The manager post is currently vacant. EVIDENCE: The manager’s post is currently vacant, unfortunately CSCI had not received anything in writing before the template of the report was produced and prepopulated with the manager details. Therefore the information held at the beginning of the report is not correct. It is reported that recruitment is currently underway to fill the post. Dyscarr Grange uses the ‘Quality Tree’ model of Quality Assurance, and this is held in a quality assurance file, containing a range of self-assessment tools and information. Regulation 26 visits take place and house audits by staff and residents from other homes. A variety of Health & Safety documentation,
Dyscarr Grange Care Home DS0000008663.V302833.R01.S.doc Version 5.2 Page 24 including Control of Substances Hazardous to Health (COSHH), fire records, Portable Appliance Testing (PAT tests) and Health & Safety checks were seen, and all found to be complete, up to date and correct. Confirmation is required that there are fully safe systems in place in relation to the prevention of legionella. The staff in the home take water temperatures and de-scale showerheads, but more evidence is needed that the storage temperatures in the tank are maintained at a safe level. The accident records were examined, it is advisable that the Environmental Health officer is contacted in relation to the system currently used for recording resident accidents, as there is s different system in place for staff accident recording, which meets Data Protection protocols. Dyscarr Grange Care Home DS0000008663.V302833.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 3 4 4 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 4 27 3 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 X 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 4 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 4 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X X X 4 X X 3 X Dyscarr Grange Care Home DS0000008663.V302833.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? N/A 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA19 YA20 Good Practice Recommendations It is recommended that the annual healthcare check include well women and well man issues. It is recommended that the policies for the safe handling of medicines is reviewed and updated in line with the Royal Pharmaceutical Societies guidance, particularly in relation to Homely Remedies and should also include information about Covert use of medication, crushing of medication etc. It is recommended that the use of Homely remedies section within the individual healthcare folder or include this to be reviewed at the annual healthcare check. Obtain authorisation for bedrails by representatives where relatives are not available. Check that the home is fully up to date in relation to Safeguarding Adults protocols. The care plan documentation should include risk assessments as evidence that the resident is unable to manage a bedroom door key and key for a lockable facility More evidence is needed that the storage temperatures in the tank are maintained at a safe level. 3 4 5 6 YA23 YA23 YA26 YA42 Dyscarr Grange Care Home DS0000008663.V302833.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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