CARE HOMES FOR OLDER PEOPLE
The Dales Main Street Ellenborough Maryport Cumbria CA15 7DX Lead Inspector
Nancy Saich Unannounced Inspection 21st January 2006 09:45 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 The Dales DS0000022548.V277550.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. The Dales DS0000022548.V277550.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Dales Address Main Street Ellenborough Maryport Cumbria CA15 7DX 01900 817977 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) Dales Care Homes Limited Mrs Joan Margaret Iredale Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability over 65 years of age (1) of places The Dales DS0000022548.V277550.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Registered for 40 older people (OP), 1 of whom may have a physical disability (PD(E)). 7th June 2005 Date of last inspection Brief Description of the Service: The Dales is an older property that has been adapted and extended to provide a home for up to forty older people. It is situated in the centre of Ellenborough, a residential area of Maryport. The home is owned by the Iredale family and they each have a role in the home. Mrs Joan Iredale is the registered manager. Residents’ accommodation is on two floors, and most rooms are accessible by the passenger lift, but a small number of rooms are accessible only by a staircase. There are a number of places where people can spend time together including six lounges, three conservatories and a dining room. There are bathrooms and a shower room equipped to assist people with a disability. All of the bedrooms had en-suite toilet facilities. There is a seating area outside that residents use in fine weather. The Dales DS0000022548.V277550.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that started just before ten o’clock on a Saturday morning. The inspector met with all the directors of the company including the registered manager. She also spoke to the staff on duty both in the morning and afternoon. She spent time with groups of residents and spoke privately with one or two individuals and had lunch with them in the dining room. She also met a number of relatives and friends who were visiting the home and asked their opinions on the care and services. She also toured all areas of the home with the exception of the laundry. She read a number of documents that backed up what was seen or said to her. What the service does well:
This home is good at making sure that they only admit new residents that they are sure they can care for and who will fit into the existing group. The residents were very happy with the way the staff group cared for them. They thought they were “nice lasses” and were friendly and caring. The inspector watched the staff and residents together and she felt that there was a lot of respect and affection on both sides. The staff treated the residents in a sensitive way and were good at dealing with personal things in a private way. The home is good at making sure the residents have good health care and give them plenty of support through times of illness. The residents looked very healthy and one person said it was down to “good food and being well looked after”. Residents were happy with the range of activities on offer. The inspector was very impressed with the work the art group had done. It was nice to meet people in their nineties who had developed new skills. It was also nice to see that people had choice about how they spent their days and that people could opt into formal activities or just follow their own interests. Local groups visit the home and residents friends and relatives are made very welcome. One visitor said “I used to go out a lot for tea with mum and coming here for afternoon tea is a nice way of keeping this up…I am always made welcome here and I feel like part of the family…” The food provided in the home is of a very high standard. The residents said they could have cooked breakfast, choice at lunch and teatime. They also said they enjoyed afternoon tea where they had “lovely cakes” and supper when they had a choice of snacks and hot drinks before bedtime. The kitchen was stocked with a wide range of nutritious foods.
The Dales DS0000022548.V277550.R01.S.doc Version 5.1 Page 6 The home is good at managing complaints. They have a number of residents’ relatives who will help residents out if they have any complaints. There were details around the home of how to make a complaint. A group of residents said they felt that there would “always be little things to niggle about when you live with other people but we can sort things out for ourselves here…and we would speak up on behalf of another resident who couldn’t do it for themselves…” The Iredale family are good at providing a homely environment where residents and their families feel ‘at home’. The home is well decorated and furnished and was clean in all areas. Residents were happy with the way the home was kept clean and said their laundry was done properly. Some parts of the home were a bit untidy and some things in the home were no longer being used and needed to be disposed of. The inspector will look at this again at the next inspection. The home has an established staff team who felt they worked well together. The inspector checked the rosters and found that there were good numbers of staff on duty at all times. She also noted that experienced staff always worked alongside newer members of the team. The residents felt that the staff were properly trained and experienced. The home has a mature and experienced manager who residents, staff and visitors trust and respect. The management systems in the home run fairly smoothly and residents felt that his allowed them to feel confident that the home was being run properly. The inspector checked on the way health and safety was being dealt with and everything was in order. What has improved since the last inspection? What they could do better:
The Dales DS0000022548.V277550.R01.S.doc Version 5.1 Page 7 The individual written plans were of a good standard but one or two newer residents didn’t have plans. The home must make sure that all the residents have written plans as soon as they start to give care to residents. The home has a written policy about what abuse is but this document needs more work so that it describes in full the action staff need to take if they suspected abuse. Staff hadn’t had formal training in handling abuse recently and the inspector thought it would be a good idea to update this. The home does check on how well things are going for residents but the inspector wants them to pull together all the opinions of residents and their families and put this together with other checks they do. This ‘quality audit’ needs to be shared with residents and visitors. 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 Dales DS0000022548.V277550.R01.S.doc Version 5.1 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 The Dales DS0000022548.V277550.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The home is good at making sure that they only take new residents that they know they can care for and who will fit into the rest of the group. EVIDENCE: The inspector spoke to new residents and they said that they had been visited by a senior member of staff who asked about their needs and then they and their families were invited to visit the home. The inspector saw files with information that backed up what the residents said. Staff knew about the needs of residents and were keen to make sure that new people settled into the home. The Dales DS0000022548.V277550.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,10 Residents were being given good levels of care but staff need to confirm this by writing down everyone’s needs. EVIDENCE: The inspector read all of the written plans that tell staff what residents need and want. These ‘care plans’ were detailed and centred on all the things people told the inspector were important to them. A number of the plans had been changed to reflect changes in residents’ lives. The senior carers checked on them on a regular basis. Unfortunately there were at least two plans that needed some updating and two residents who had been in the home for a few months who didn’t have a care plan. Residents said that they got good support in keeping themselves as healthy as possible. A number of people put this down to “good food and being well looked after”. Residents said that they saw the doctor or the nurse when they needed. Nurses were in the home during the morning of the visit. Residents’ files showed that any problems were dealt with quickly and a number of residents said they were taken to hospital appointments and given
The Dales DS0000022548.V277550.R01.S.doc Version 5.1 Page 11 lots of support. Residents said the staff were good at looking after them when they were ill. Residents said that staff were kind and caring. The inspector watched staff as they worked with residents. Residents responded well to all of the staff on duty and the staff treated each resident properly but with different approaches depending on their individual personalities. There was a lot of humour and a lot of genuine affection seen in these interactions. The Dales DS0000022548.V277550.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 This home provides the kind of lifestyle that residents expect and everyone felt happy with the choices on offer. EVIDENCE: The inspector met a resident who was in her nineties who told her about having a certificate presented to her by the Bishop of Carlisle during the Christmas carol concert to show she had participated in an adult learning class. She also told the inspector she had received communion using a chalice she had made herself in this art class. The inspector saw some of this artwork and was very impressed by the outcomes of these classes. Residents were very enthusiastic about this. They also spoke about doing reminiscence in another class. Residents also said they had the opportunity to go out and one person said he was a ‘regular’ at the pub next door. Another person said he preferred reading and watching TV. Another resident said how nice it was to have a TV/video in her room so she could watch music videos. A number of bedrooms had these and the home had bought them so that residents could watch videos in their rooms. The visitors’ book showed that lots of people came to see their friends and family. It was nice to see visitors sitting with residents having afternoon tea. One visitor said “I used to go out a lot for tea with mum and this is a nice way
The Dales DS0000022548.V277550.R01.S.doc Version 5.1 Page 13 of keeping this up…I am always made welcome here and I feel like part of the family…” Residents were fully aware of what was happening in the home, in Maryport and out in the wider world. They were all very happy to talk to the inspector as they felt that their opinions were valued and were used to telling the management and staff what they thought – in some cases this was done in a very forceful way. Everyone in the home and all of the visitors spoken to were of the same opinion about one thing. They all said the food in the home was excellent. They said it was nice to be able to choose once they sat down at the table. Everyone ate the well-presented meal at lunchtime and were keen to come back to the table shortly afterwards for afternoon tea. The kitchen had a good range of nutritious foods and the cook understood how to make sure that residents were fed properly. The Dales DS0000022548.V277550.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The home is good at allowing residents views to be heard but needs to improve on some of the ways they protect residents from harm. EVIDENCE: There were copies of the complaints procedure around the home. Residents could tell the inspector about the three people act as volunteers to help support them if they needed to complain. The home has had this arrangement for some time where three independent people who come to the home regularly make sure that residents have no complaints or concerns. The procedure tells residents how to contact them. A number of people said that they would talk to the manager or another member of the family or the senior carers first. They said they would all do their best to solve the problem. No one had any complaints on the day. Daily notes showed that one person had been a little troubled by something said to her but that the senior carers and the manager had dealt with this. The resident didn’t feel there was any need to talk to the inspector about this. A group of residents said they felt that there would “always be little things to niggle about when you live with other people. We can sort things out for ourselves here…and I would speak up on behalf of another resident who couldn’t do it for themselves…” They said there was nothing happening in the home that worried them. They felt that there was nothing ‘untoward’ happening in the home. They though that the senior carers or the manager would “soon sort anything like that”. Staff were very clear about what was abusive and knew how how to deal with this. The senior carers knew that they would have to contact Social Services if
The Dales DS0000022548.V277550.R01.S.doc Version 5.1 Page 15 something was a problem and everyone said they would contact the inspector if things were not being deal with. They had some training on this as part of their NVQ but nothing more specific. The inspector felt that the home needed to remind staff of their responsibilities on a regular basis. The manager asked if they could do this by means of a training video and this was agreed. The inspector looked at the policy and procedures and these didn’t really help staff to recognise or deal with abuse. The home needs to makes sure these are written up so that staff can use them to deal with any potential abuse situation in the best way possible. The Dales DS0000022548.V277550.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 This Dales provides residents with a warm, clean and comfortable home where they feel safe and relaxed. EVIDENCE: The Dales is a comfortable home and the residents were all very happy with their rooms and all the different shared spaces they can use around the home. The communal areas of the home – the dining room and the various lounges – were well furnished and decorated and residents were very relaxed in all of these areas. The inspector spent some time with one group of ladies who were sitting together watching TV. This area had a fireplace, sofas and chairs and was a comfortable place to be on a cold afternoon. The home was clean in all areas if a little untidy in some places. Residents said they hadn’t noticed this and only cared that the home was clean- and they thought it was. The family agreed that after being open for nearly twenty years they did have some furniture and equipment that they really ought to get rid of. The inspector will look at how they progress with this ‘spring clean’ at the next visit.
The Dales DS0000022548.V277550.R01.S.doc Version 5.1 Page 17 There was evidence that showed that all the cleaning tasks of the home were being covered. There was a domestic working on the day of the visit and there is someone on shift every day who makes sure the bedrooms and bathrooms are cleaned properly. The night staff book showed that they cleaned the shared areas on a regular basis. The inspector didn’t check the laundry on the day but spoke to residents about how they thought this was done. They felt that sometimes washing took a while to get back to them but when it did it was done properly. Everyone in the home was nicely dressed and bed linens were fresh and clean. The Dales DS0000022548.V277550.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 30 This home is well enough staffed to allow residents to get good levels of care and services. EVIDENCE: Staff said there was always five people working in the morning and four in the afternoon. The home also employs people to set the tables and serve the residents in the dining room. The care staff are also supported by cooks and domestic staff. The staff said they were “kept going” but that they had time for the residents. They said that they felt that residents were attended to as quickly as possible. Residents felt that there were enough staff to give them suitable care and attention. They were aware that everyone had different needs and thought that staff often had to spend a bit of time with individuals. They thought that there was a good mix of experienced and newer staff. A number of people singled out different members of staff to say how good they thought they were. Residents said that staff did go to training sessions. They thought they were well trained and had enough experience to do their jobs well. The staff talked about the training they had done and what they hoped to complete. Their training covered all the skills and knowledge they needed to do their jobs but they did need to update their training on protecting people from abuse. The Dales DS0000022548.V277550.R01.S.doc Version 5.1 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,38 The home is properly managed and this allows residents to be confident that they are being looked after properly. EVIDENCE: Mrs Joan Iredale has been the registered manager of the home for a number of years. No matter who the inspector spoke to during the visit- residents, staff, visitors and other members of the family – people referred to her and spoke about her with respect and trust. She has undertaken key training over the years and has a lot of experience of caring for older people and managing staff. As a number of people said about all sort of things, “Well I would tell Joan and she would sort it out…”. She is helped in this task by other members of the family. Each of them have specific jobs to do in the home. Residents knew that they formed the management team. They also spoke about the two senior carers. A number of
The Dales DS0000022548.V277550.R01.S.doc Version 5.1 Page 20 people felt that these were the people who helped the manager to make sure the home was running smoothly. Residents said that these people asked them about their needs and preferences and one or two people said they had been formally consulted about how things were in the home. The inspector saw evidence that showed that residents, their families and other interested parties were asked both formally and informally about their opinions of the care and services. The inspector saw evidence around the home that showed that things like health and safety, routine maintenance and checks were kept up to date and that the company had plans for how to improve the care and services. These things all lead to good quality monitoring. The home now needs to make these arrangements a little more formal and write an audit of how well these things are working to give residents the best care. The inspector saw the documents relating to health and safety and also asked residents their opinion. Residents thought that things were checked out properly and the staff were good at making things safe. The staff were aware of their responsibilities. There were no obvious hazards seen on the day. The Dales DS0000022548.V277550.R01.S.doc Version 5.1 Page 21 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 2 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X X X 3 The Dales DS0000022548.V277550.R01.S.doc Version 5.1 Page 22 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 OP7 Regulation 15 Requirement All residents must have an up to date and detailed care plan that has been written after consultation with them or their representative. The policies and procedures relating to adult protection must be updated and staff made aware of the changes An audit of the quality assurance systems must be completed and sent to the inspector and made available to residents and relatives. Timescale for action 14/03/06 2. op18 13 14/03/06 3. op33 24 14/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP30 Good Practice Recommendations It is recommended that all staff receive regular updates to their training on understanding and dealing with abuse. The Dales DS0000022548.V277550.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© 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 The Dales DS0000022548.V277550.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
