CARE HOMES FOR OLDER PEOPLE
St Dunstan`s Greenways Ovingdean Brighton East Sussex BN2 7BS Lead Inspector
Merle Blakeley Announced Inspection 9th February 2006 10:00 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 St Dunstan`s DS0000014041.V282998.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. St Dunstan`s DS0000014041.V282998.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service St Dunstan`s Address Greenways Ovingdean Brighton East Sussex BN2 7BS 01273-307811 01273-302704 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) St Dunstan`s Mrs Jacqueline Sandra Greer Care Home 77 Category(ies) of Physical disability (0), Sensory impairment (77) registration, with number of places St Dunstan`s DS0000014041.V282998.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service users in receipt of personal care does not exceed 37 within the registered numbers That the maximum number of service users to be accommodated is seventy-seven (77) 10th August 2005 Date of last inspection Brief Description of the Service: St Dunstans is a nursing and care home that provides nursing and social care and accommodation for up to seventy-seven residents with visual or physical impairment. St Dunstans is run by a charitable organisation that provides care to ex-servicemen and women who are visually impaired. The home is situated in its own grounds at Ovingdean, near Brighton. St Dunstans provides its own transport services and drivers to enable residents to go shopping in Brighton, or participate in day trips. The home provides many facilities to enable service users to participate in activities, including a gym, sports hall, swimming pool and crafts workshop. Facilities are also provided to enable service users to accommodate guide dogs. Accommodation is provided in single, en-suite rooms, with a number of shared rooms available if required. St Dunstans has five floors, with service users accommodated on the first, second and third floor. Passenger lifts enable residents to access all areas of the home. A variety of communal space is provided in a large lounge/bar area, dining area and two further lounge areas. There is also a small seating area situated on each floor, and a further small dining area on each unit. There is an enclosed garden that provides a pleasant area for residents to sit, and a gardening club enables residents to participate in landscaping this area. St Dunstan`s DS0000014041.V282998.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This Announced Inspection was carried out over a period of seven hours on 9th February 2006. The inspection process included a returned pre-inspection questionnaire, twenty-seven service users comment cards, twenty-one relatives/visitors comment cards, tour of the premises including the nursing floors, residential floors, administrative areas and the kitchen, document reading and informal talks with several residents, staff members in both care and non care areas and the Head of Care Manager. Of the twenty-seven service user comment cards returned all stated that they liked living at St Dunstan’s and overall felt very well cared for. Three commented that they only sometimes like the food. On talking with one resident he felt that a quiet lounge area for the permanent residents would be beneficial, as he found the lounge areas on the ground floor quite noisy. The manager stated that there was a quieter area residents could use if they wish. One resident also said he missed having staff read the daily newspaper to him and this was discussed with the manager. Twenty-one relatives/visitors comment cards were returned and they were all extremely positive about the care their loved ones were receiving at St Dunstan’s. Several commented on the friendly and caring way staff treated residents and how their relatives well being had improved since moving into the home. What the service does well: What has improved since the last inspection?
Since the last inspection the home has provided a second lockable facility for all residents who self medicate. Consents were also sought from residents so that they were aware that duplicate keys were being held by the home for their lockable drawers in their rooms. This was to ensure that if a resident lost
St Dunstan`s DS0000014041.V282998.R01.S.doc Version 5.1 Page 6 their key then a spare would be available. The home has created two additional quiet lounge areas on the nursing floors by converting two offices. The inner courtyard garden area has recently been refurbished. The home is also creating more space by removing large pieces of equipment in the in-house dental surgery, as it is no longer needed. Another subject the home is addressing is the resident’s smoking areas within the building. Staff need to be protected from second hand smoke and the home has decided to install two smoke machines, which will reduce the amount of smoke created in these areas. Major external building works are due to commence in February 2006 and this will involve replacing all the windows and renewing parts of the brickwork. The home has involved the residents and informed them that a certain amount of noise will be involved with this type of work. 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. St Dunstan`s DS0000014041.V282998.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 St Dunstan`s DS0000014041.V282998.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): 1&2 The home has produced a service users guide. All residents receive a contract/statement of terms and conditions. EVIDENCE: The home has produced a service users guide in booklet form, which is available in Braille, large print format or as an audio version. Contracts/terms and conditions are provided to all residents once they have been admitted. The contract includes a four-week trail period. St Dunstan`s DS0000014041.V282998.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): 9 Nursing staff must record all medications that residents bring into the home with them. All residents who self medicate must have a risk assessment carried out. EVIDENCE: Random medication charts were checked on both the nursing and residential floors. There were a number of discrepancies found on the charts for respite residents on the nursing floors. Senior nursing staff are admitting residents without recording the correct amounts of medication they are bringing in with them, consequently it is difficult to ascertain as to the amount of a particular drug each resident should have stored in their personal medication cupboard. All medications brought into the home must be correctly recorded. The manager stated that the home has a comprehensive policy on recording medication and all staff are made fully aware of this during their periods of induction and training. It was also noted that residents who self medicate have not had a risk assessment carried out. If residents choose to self medicate they sign an agreement with the home to state that they wish to control their own medication, however the home must also ensure that the resident is assessed to gauge whether they are able to manage their own medications.
St Dunstan`s DS0000014041.V282998.R01.S.doc Version 5.1 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): 15 Residents receive a well balanced diet. EVIDENCE: An in-house catering company provides the meals at St Dunstan’s. As this is such a large home employing over seventy staff there is also a staff canteen situated on the top floor of the building. There is a large dining room on the ground floor where all residents and visitors can take their meals. It is a pleasant and convivial area but also quite large and some residents have stated that it can become quite noisy at times. The home has taken steps to reduce a certain percentage of ‘catering noises’ etc but it is difficult to reduce the sound of peoples voices when they are talking to each other. Catering staff are on hand to serve residents their meals and discreetly assist them if it is required. There are also smaller dining areas with newly refurbished serveries on the nursing floors and nursing residents are able to take their meals in here usually assisted by staff. Weekly menus provide a varied range of meals and also include various other diet options such as low fat, vegetarian etc. The large commercial kitchen is run by a professional team of chefs and kitchen assistants. The kitchen was found to be very clean and tidy and efficiently run. St Dunstan`s DS0000014041.V282998.R01.S.doc Version 5.1 Page 11 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 The home has a comprehensive complaints policy and procedure. EVIDENCE: The complaints record showed that seven complaints had been recorded with two of these pertaining to residential care. The residential complaints were about excessive noise from some resident’s radios and TV’s in their rooms and about a night staff member’s attitude. Both complaints had been dealt with immediately with positive outcomes for all parties concerned. St Dunstan`s DS0000014041.V282998.R01.S.doc Version 5.1 Page 12 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): 21, 22 & 26 The home has sufficient bathing & toilet facilities. The home provides an excellent level of specialist equipment. The home is very clean and maintained to a high standard. EVIDENCE: All residents rooms have en suite facilities and in addition there are a number of assisted baths on both the nursing and residential floors. Toilets are located throughout the building. St Dunstan’s has been purpose built and designed for people who have visual impairments and therefore has a large variety of specialised equipment and aids within the home. Qualified physiotherapists and rehabilitation officers for the visually impaired have assessed the home. The home is very clean and tidy and maintained to a high standard. The home employs a team of maintenance staff.
St Dunstan`s DS0000014041.V282998.R01.S.doc Version 5.1 Page 13 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 has a dedicated HR Department. Staffing files need to contain photos of each staff member. EVIDENCE: St Dunstan’s has its own dedicated HR section, which deals with staff recruitment. A number of staffing files were viewed and they contained all the relevant documents as set out in Schedule 2 of the National Minimum Standards, however the files need to contain recent photographs of each staff member. St Dunstan`s DS0000014041.V282998.R01.S.doc Version 5.1 Page 14 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): 32, 34, 35, 37 & 38 The home is managed in a professional and caring manner. The home carries out suitable accounting procedures. Resident’s personal finances are safeguarded. All relevant records are maintained. Residents and staff are protected by the homes health & safety procedures. EVIDENCE: On talking with residents it appeared that they felt comfortable in approaching the Head of Care Manager if they have any issues or concerns. Residents meetings are held regularly and this is an opportunity for the residents to discuss their suggestions or concerns with the manager. The home is managed in a friendly, caring and professional manner. The home carries out all the required financial procedures and has a current public liability insurance policy. A business plan has been produced. St Dunstan’s is a registered charity.
St Dunstan`s DS0000014041.V282998.R01.S.doc Version 5.1 Page 15 Residents are able to manage their own finances if they wish, however there is also a Finance Officer available who can assist residents with their money. Each resident has their own spreadsheet, which clearly indicates resident’s cash and cheque transactions. Several residents finances were checked and were all found to be in order. All resident’s finances are securely maintained within the home. St Dunstan’s is operating a very effective system for handling resident’s finances. As well as a Finances Officer the home also employs a Wills and Trusts Coordinator who can assist residents with these matters. The Co-ordinator can also organise probate, power of attorney, solicitors, grants and advocates for residents. The home correctly maintains all the required records. As St Dunstan’s is such a large property a Health & Safety Manager is employed 35 hours a week. The home also employs a dedicated maintenance team who ensure that the environment is maintained to a high standard and is safe for residents, staff and visitors. Regular checks are made on all systems throughout the home and records are maintained. The home is very proactive in its approach to health & safety. St Dunstan`s DS0000014041.V282998.R01.S.doc Version 5.1 Page 16 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 3 3 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 X 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 3 17 X 18 X X X 3 4 X X X 3 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 3 X 3 4 X 3 4 St Dunstan`s DS0000014041.V282998.R01.S.doc Version 5.1 Page 17 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 OP9 Regulation 13(2) Requirement To ensure that nursing staff clearly record all medications that are brought into the home by residents. That risk assessments are carried out and regularly reviewed on all residents who self medicate. To ensure that all staff have recent photos attached to their recruitment files. Timescale for action 10/02/06 2 OP9 13(2) 10/02/06 3 OP29 Schedule 2 NMS 10/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Dunstan`s DS0000014041.V282998.R01.S.doc Version 5.1 Page 18 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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