CARE HOMES FOR OLDER PEOPLE
Domain Care Limited Staley House Huddersfield Road Stalybridge Tameside SK15 2PT Lead Inspector
Sylvia Brown Unannounced Inspection 27th February 2007 10:15a 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 Domain Care Limited DS0000063408.V331042.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 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. Domain Care Limited DS0000063408.V331042.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Domain Care Limited Address Staley House Huddersfield Road Stalybridge Tameside SK15 2PT 0161 304 8939 0161 338 6713 gilmours@runbox.com 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) Domain Care Limited Care Home 27 Category(ies) of Dementia - over 65 years of age (27), Mental registration, with number disorder, excluding learning disability or of places dementia (1), Old age, not falling within any other category (27), Physical disability over 65 years of age (27) Domain Care Limited DS0000063408.V331042.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 27 service users to include: *up to 27 service users in the category of DE(E) (Dementia over 65 years of age); *up to 27 service users in the category of PD(E) (Physical disability over 65 years of age); *up to 27 service users in the category of OP (Old age not falling within any other category); * up to 1 named service user in the category of MD (Mental disorder excluding learning disability under 65 years of age). 22nd November 2005 Date of last inspection Brief Description of the Service: Staley House is a large detached building, converted and extended to provide residential care for up to 27 older people, some of whom may have dementia or a physical disability. The property was previously a vicarage. The accommodation is provided on two floors. There are a total of 25 single rooms, 12 of which benefit from ensuite facilities, and one shared room. Located on the ground floor are two lounges and the dining room. In addition to aids and adaptations, there is a full passenger lift. Car parking is provided to the front and side of the building. To the rear is a secure patio area accessed from a lounge that overlooks pleasant lawns and woodland. Garden benches are also provided at the front of the house. The home is located in a conservation area close to the centre of Stalybridge. Domain Care Limited DS0000063408.V331042.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection of Staley House was an unannounced key inspection and commenced at 10:15am and lasted approximately seven hours. Key inspections specifically look at all the key National Minimum Standards (NMS) which have to be inspected each year by The Commission for Social Care (CSCI). These standards are clearly identified within the report. Other standards may also have been looked at and will be detailed in the report. During the inspection time was spent sitting with service users and observing their day-to-day routines. Two service users were case-tracked, which means they were observed and their full care records looked at to ensure that they receiving the care and support they required. One mealtime was shared with service users and kitchen routines and records were looked at. Staffing records were examined and a number of records relating to health and safety and management of the home were also evaluated, as were parts of the building. Throughout the inspection the registered owners made themselves available as did the new manager. Discussions were held with them about developments at the home since the last inspection. Future plans were also discussed and action they had identified for the continual improvement of the home. Comment cards were provided to service users, staff and visitors. Unfortunately, none were returned prior to the completion of the draft report, therefore all comments received prior to the next inspection will be included within the next inspection report. What the service does well:
Staley House continues to develop both in its environment and care practice. Service users appeared to be well looked after and contented with their living arrangements. From comments received from service users and relatives it appears that the home provides a happy and caring environment. All comments identified that the home was kept clean and that staff were usually available to support them and talk with them. Relatives generally stated that they were kept informed and that their respective relatives were happy with the services at the home. Domain Care Limited DS0000063408.V331042.R01.S.doc Version 5.2 Page 6 Service users have nice living accommodation which continues to improve. They have their health care needs looked after and their general well being is routinely monitored to ensure, where possible, good health. Service users receive personal care support appropriately which ensures their personal hygiene and they have clean well laundered and maintained clothes. The registered owners monitor all aspects of the home and maintain good records of their findings and the action to be taken where it is identified that parts of the service are not as they should be. What has improved since the last inspection?
The owners of Staley House have continued to invest heavily in the refurbishment of the home and upgrading major ‘unseen’ parts of the home. One relative commented that there have been problems with the heating and ‘sometimes it has been cold in parts of the home’. Two new boilers have been installed within the last year and though occasional difficulties arise with the heating, it is much improved. Plans are underway to install new radiators within the rear lounge in an attempt to improve the heating in that area. A complete new lighting system has been installed and electrical wiring checked and replaced where required. There have been a few teething problems with the new energy saving system, however there was evidence that the owners were attempting to resolve matters. Re-carpeting and redecoration continues with all parts of the home receiving attention. Fixtures and fittings have been replaced and during the inspection the owners were in the process of purchasing fireplaces which, once installed, will provide focal points for rooms and add to the homeliness of Staley House. The owner and manager stated that they have been working with staff to develop and improve the care practices of staff. This has not been without difficulties and has culminated in some staffing changes. The management and administration of medication have been improved and consideration is currently being given to a new administration system. The provision of activities and opportunities for service users to have social contact and stimulation have also improved. Lots of events have taken place since the last inspection and the home continues to develop its activities programme to ensure the needs of those with failing mental health and/or dementia related illnesses have their social needs met. Domain Care Limited DS0000063408.V331042.R01.S.doc Version 5.2 Page 7 A new manager has been appointed, who has successfully completed the registration process with the CSCI and was approved as the registered manager in February 2007. 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. The summary of this inspection report can be made available in other formats on request. Domain Care Limited DS0000063408.V331042.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Domain Care Limited DS0000063408.V331042.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 5. Standard 6 is not applicable to this service. The quality in this outcome area is good. Service users have their needs assessed prior to moving into the home and are able to visit prior to making any decisions about their future. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The inspection of service users records identified that they have their needs assed by both the placing authority for those who receive funding support and by the home prior to being accommodated. The registered owners and manager stated they visit service users in their own home or placement prior to them making any decisions about moving into the home. At such visits, service users have their care needs assessed and are provided with information about the home. Domain Care Limited DS0000063408.V331042.R01.S.doc Version 5.2 Page 10 They are invited to visit the home and ‘test’ the service and observe the day to day routines, after which they can make an informed choice about their future. At the time of the inspection, those service users spoken with could not remember their admission to the home or were confused as to where they were. Therefore, the pre-assessment process could not be confirmed by service users. However, from the returned comments cards it would appear that service users and relatives received sufficient information about the home to make an informed choice. Advice has been given to the registered owner regarding the recording of the pre-admission procedures, including confirmation to service users that, after assessment, the home can or cannot meet their needs. Records should also be made regarding the observations and assessments of the service users when they visit and the action taken by staff to welcome them into the home, etc. Domain Care Limited DS0000063408.V331042.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 9 Quality in this outcome area is good. Service users have their health care needs assessed, recorded and met. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Each service user has their needs recorded. Records identified that health care checks, such as doctors’ visits and medical support services, were in place, as were optical checks, chiropody treatments and dental appointments. One service user spoken with stated she ‘felt alright’ and was ‘looked after fine.’ Comment cards confirmed that service users felt they had their health care needs met appropriately. Domain Care Limited DS0000063408.V331042.R01.S.doc Version 5.2 Page 12 Care support requirements were recorded, as were some of the service users’ personal preferences for how they wanted those needs met. The registered manager stated she was aware that further details were required and that the care planning system was under review. General reviews were in place and monitoring of service users’ wellbeing was evident. One service user who has behavioural difficulties had specific records maintained regarding outbursts and difficult management situations. Advice was given regarding clearer recording systems, such documenting time and place and any contributing factors which may have led to the behaviour. Records of service users’ weights were recorded and though some service users had low weights, it was evident that slight gains were being obtained where required. Advice was given to increase the frequency of recording of weights for those at risk of sudden weight loss or at a low weight. An action plan should also be in place for such service users which directs all staff on what is required of them to support the service users and/or report any weight loss. In general, daily records for all service users were very brief, information such as ‘No problems today’ would lead the reader to think that only problems are recorded. Other comments made such as ‘Ate well’ and ‘Quite unsteady’ do not inform anyone of anything relevant and need to be expanded upon. Medication administration records were fairly well maintained. The home’s medication policy appears to require more information and a record of staff signatures for those with responsibility for medication administration needs to be in place for reference purposes. The home should ensure that it has a copy of the Royal Pharmaceutical Society’s guidance for the safe management and administration of medicines on the premises and easily available for staff. Domain Care Limited DS0000063408.V331042.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. Service users have their social care needs met and are able to make decisions and choices for themselves. They receive a well balanced diet from a menu which offers variety and therefore promotes good health. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The home provides service users with plenty of opportunity to join in social events and activities. General activities include dominoes, bingo and music. Special occasions and events are organised, such as Halloween, Christmas and Valentine parties. Numerous events took place over Christmas and new year. During the inspection service users were invited to join in a specific activities session which was led by a specialist group of people who understand the needs of those with mental and dementia type illnesses. Domain Care Limited DS0000063408.V331042.R01.S.doc Version 5.2 Page 14 After the activity it was clearly evident that service users benefited from the activity and staff themselves enjoyed learning how to provide such activities. The registered owners stated it is their intention to develop and obtain specialised training for staff in order to provide stimulating and meaningful activities for the service users at Staley House. Church services are held at the home for service users who want to continue with their religious beliefs and practices. A record of service users’ individual participation in activities is recorded within their own care files. All the returned comment cards stated service users’ satisfaction with the amount of activities provided by the home. Service users are able to receive visitors in private when they desire. The record of visitors was maintained at the entrance to the home and indicated that relatives and friends frequently visit at the home. At the commencement of the inspection some service users had received breakfast whilst others were still rising and receiving breakfast. Some service users remain in their room, preferring solitude rather than community living. Breakfasts and lunches were served to some in their rooms, whilst some went to the dining room at meal times. Staff were aware of who was in their room and of their health conditions and need for privacy. One mealtime was observed. Service users have the choice of two sittings, with the first being mainly for those who require assistance and prefer quieter surroundings when eating. Portion sizes were plentiful and one service user stated the soup was “lovely”. Domain Care Limited DS0000063408.V331042.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. Service users have access to and use the home’s complaints procedure and are protected from abuse. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Staley House has a written complaints procedure which is known to service users. The home maintains a full record of all complaints made including those from service users. Records recorded the nature of the complaint and the action taken to resolve all matters raised. The registered owners check all records of complaints and, at times, deal directly with the complainant to reach an agreeable resolution. Staff training records indicated that all staff have received adult protection training. There have been no allegations of abuse made. Domain Care Limited DS0000063408.V331042.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. Staley House offers service users comfortable and well maintained surroundings which are clean and free from odours. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Throughout the inspection parts of the home observed were clean and well maintained. The home continues to be upgraded and significant investment has been made by the owners. One of the owners currently undertakes most general repairs and ensures that work is completed to the appropriate standard. During the inspection work continued at the home and redecoration was being completed within one service user’s room.
Domain Care Limited DS0000063408.V331042.R01.S.doc Version 5.2 Page 17 Service users’ comment cards again stated their satisfaction with the standard of accommodation provided. Domain Care Limited DS0000063408.V331042.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. Service users are protected through robust recruitment procedures. Care staff are trained and are competent to do their job. Sufficient numbers of staff are on duty ensuring service users’ needs were met. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: One month’s rota was looked at. Overall, sufficient staff are on duty for the current dependency levels of service users. None of the service users spoken with, nor any observations, suggested that service users’ needs were not being met. Two staff files were looked at. Both files demonstrated that the staff had been recruited and selected appropriately with application forms being in place. References and statutory checks were received prior to employment commencing. Staff training and development records were in place. At the time of the inspection, the owners and manager had begun to evaluate staff training needs and plan for the next year’s training. Domain Care Limited DS0000063408.V331042.R01.S.doc Version 5.2 Page 19 Induction programmes are in place, however they do not currently comply with the level stated by Skills for Care. The manager stated that such induction training programmes were being considered for future use. Throughout the inspection all staff were observed to be courteous and polite with service users. Moving and handling techniques were completed correctly and, when spoken with, staff were knowledgeable about service users’ needs and individual requirements. All comment cards returned by service users stated either staff always or usually were available when required. Furthermore, service users stated they felt listened to. Domain Care Limited DS0000063408.V331042.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 & 38 Quality in this outcome area is good. Staley House is a well managed home which is run for the benefit of service users. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The new manager has experience in the caring profession and is appropriately skilled and trained to manage a care home. She was able to explain the areas of improvement since she became manager at the home and her vision to improve service in the future. Domain Care Limited DS0000063408.V331042.R01.S.doc Version 5.2 Page 21 The owners have a strong management style and have clear aims and objectives for the home and how they expect it to run for the benefit of service users. They explained that there have been difficulties regarding securing an appropriate manager and are pleased with the appointment of the current manager. It is their intention to work alongside and support the registered manager until the home meets their required standard and that systems are in place to ensure the consistency of good practice is maintained. Service users’ meetings have commenced and it is the intention of the home to increase the frequency of such meetings. The home intends to encourage family meetings and promote their involvement in influencing how the home is run and develops. Satisfactory systems are in place to protect the residents’ rights, finances and other interests. Health and safety records identified that Staley House takes its responsibility to safeguard service users seriously. All certificates for the servicing of equipment and safety systems were in place and up to date. Staff files identified that one to one supervision has commenced. The registered manager is aware that staff should have formal supervision no less than six times a year and that staff appraisals should be undertaken annually. The registered person completes detailed Regulation 26 visits each month and follows through all outstanding issues. Fire safety records failed to confirm that all staff had received appropriate practical fire drill training. A number of issues regarding the management of the kitchen and related staff were discussed with the owner and manager. Both were aware of difficulties in this area and were resolving them through their own internal procedures within the home. Domain Care Limited DS0000063408.V331042.R01.S.doc Version 5.2 Page 22 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 3 x 3 Domain Care Limited DS0000063408.V331042.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action Domain Care Limited DS0000063408.V331042.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations The registered person should ensure that daily records detail the daily routines and achievements of service users and reflect their life within the home, including care support given. The registered person should ensure that where service users are at risk of weight loss, specific care plans are in place which detail the action to be taken to encourage weight gain, monitoring systems and action to be taken if weight decreases. The registered person should have records of signatures for those with responsibility for administering medication. The registered person should ensure that a copy of the Royal Pharmaceutical Society’s guidance for the safe management and administration of medicines is obtained and made available to all staff who manage and administer medication within the home. The registered person should ensure that those with responsibility for producing meals for service users are appropriately trained and have knowledge in nutrition and specialist diets. The registered person should ensure that kitchen management routines comply with environmental health standards, including cleaning schedules and required records. The registered person should ensure that induction programmes meet the standards set by Skills for Life. The registered person should ensure that all staff receive up to date practical fire drill training 2 OP7 3 4 OP9 OP9 5 OP15 6 OP38 7 8 OP30 OP38 Domain Care Limited DS0000063408.V331042.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection North West Regional Office 11th Floor West Point 501 Chester Road Old Trafford M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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