Inspection on 26/07/05 for The Dales

This inspection was carried out on 26th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Dales 11/06/09

The Dales 09/02/09

The Dales 06/03/07

The Dales 09/02/06

The Dales 14/03/05

The Dales 14/01/05

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Dales Woodhall Road Off Gain Lane Bradford BD3 7DY Lead Inspector Hebrew Rawlins Unannounced 26th July 2005 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 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 J52 J03 S29150 The Dales V240895 260705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Dales Address Woodhall Road Off Gain Lane Bradford BD3 7DY Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01274 656110 BUPA Care Homes (GL) Ltd Mrs Dorothy Walker Care Home with Nursing 108 Category(ies) of Dementia Over 65 (108) Old Age (108) registration, with number Dementia (1) of places The Dales J52 J03 S29150 The Dales V240895 260705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: That the category of DE be used for the service user named on the application signed on 3-3-05 Date of last inspection 14/3/05 Brief Description of the Service: The Dales is owned by BUPA and is located in a central position on the Leeds Bradford border. It is designed to care for service users with all levels of confusion, mainly with a diagnosis of dementia related conditions and nursing requirements.The Home is comprised of five separate units providing care for a total of 108 service users. Each unit is self-contained with its own lounge facilities and kitchenette. The bedrooms are fully furnished, most with en-suite facilities. Service users are encouraged to bring personal effects such as ornaments, pictures and small items of furniture.The Home has an activity organiser. The hairdresser visits the home weekly and all areas of the home have assisted bathing facilities. The Dales J52 J03 S29150 The Dales V240895 260705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out on the 26th July 2005 by two inspectors. The purpose of the inspection was to ensure the home continues to provide a good standard of care for its residents. The Registered Manager was on duty and made her self-available throughout the inspection. Service users and staff present at the visit were made aware of the inspection through discussion with the inspector. They were invited to give their views on the care and services provided. Records were inspected and these included resident’s care plans and staff recruitment files. What the service does well: What has improved since the last inspection? Staff training continues to improve, care workers spoken to confirmed they had training in first aid, dementia, palliative care, manual handling. Fire training updates take place every month. The Dales J52 J03 S29150 The Dales V240895 260705 Stage 4.doc Version 1.40 Page 6 The organisation has produced very good information and training pack on nutrition to raise staff awareness about the importance of good nutrition for older people. The manager was checking each book as staff completed the programme. 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 Dales J52 J03 S29150 The Dales V240895 260705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection The Dales J52 J03 S29150 The Dales V240895 260705 Stage 4.doc Version 1.40 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 standard(s) 1,2,3,4,and5. The admission’s process is effective, and residents and their families receive relevant information and support. Assessments information was fairly basic and did not identify the resources the home provide to show they could meet each person’s range of human needs and made no mention of the outcome of any pre admission visit, which was part of the admission process. EVIDENCE: The home has a general BUPA brochure, which includes an insert with more specific information about The Dales. This describes the ‘specialist dementia care’ provided by the home, the ‘well trained staff’, the enclosed garden area, activities and trips out. The Terms and Conditions of occupancy was amended in December 04 in line with the Office of Fair Trading Report. This shows the fees, room number to be occupied and the services each person can expect to receive. It also shows those services not included in the fees so people are aware of their own responsibilities. A signed copy of the agreement by a representative of each resident is held in the administrative office. Assessments carried out by the home, with one exception, had been done a few days before admission. However, the information was fairly basic and did The Dales J52 J03 S29150 The Dales V240895 260705 Stage 4.doc Version 1.40 Page 9 not identify the resources the home provide to show they could meet each persons range of human needs and made no mention of the outcome of any pre admission visit, which was part of the admission process. A family of three people were visiting the home on behalf of a relative at the time of the inspection. A member of staff spent time with them. Their overall impression was favourable and described as ‘unlike the other homes visited’. The pre admission assessments carried out by other professionals were not inspected as they were not in the care files but held in the main office. The Dales J52 J03 S29150 The Dales V240895 260705 Stage 4.doc Version 1.40 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 standard(s) 7,8,10 ,and 11. Further developments are still needed, to ensure consistency and continuity of information in care plans so that resident’s needs are not overlooked. The home provides good healthcare and works effectively with healthcare services. Accidents should be recorded in a way, which allows for ease of monitoring. Staff must be mindful of the rights and privacy of residents. Alternative arrangements must be made to provide a dedicated hairdressing room. EVIDENCE: The layout of the care plans made them easy to read as it separated the need from the action to be taken by staff to meet the need. However, the care plans were variable and did not include the details of the residents’ personal preferences such as appearance, getting up and going to bed times, favourite types of music. One included some specific guidance for staff on how to approach a person exhibiting challenging behaviour. Others were written from the perspective of what the person could not do, rather than what they could still do and how staff might continue to help them to maintain skills. Statements were made about behaviour but with one exception this was not followed by a strategy for care. The Dales J52 J03 S29150 The Dales V240895 260705 Stage 4.doc Version 1.40 Page 11 It was pleasing to note that care staff write in the daily logs but in order to improve the quality and relevance of the information recorded this should be monitored as part of the process of staff supervision. Daily records made generalised repetitive comments which did not make reference to the care plan therefore it was not clear how key-workers gathered the information to write a progress diary. One for example described a person becoming more unsettled with more incidents but this was not followed by an action plan. A bowel chart in another file showed a change in pattern but there was no evidence to show if this had been followed up. The records showed one person who had been admitted to the home had not had a care plan for several days. By the end of the inspection staff reified this. The home had a monitoring system for the care of a pressure sore and had involved the tissue viability specialist. Written records allowed the progress of care to be tracked back. Fluid input and output charts and turning charts were being kept up to date. The home has a duplicate accident record book for each unit. A copy of any accident goes to the manager and one is held on file with the date and number of the form written on the stubs in the book. It is recommended that the name of the person the form relates to also be recorded on the stub to allow any patterns of accidents to be recognised at an early stage and action taken. The hairdresser (one of two) was visiting but, due to the lack of hairdressing space, was using a resident’s bedroom as a hairdressing room for everyone on the unit. This was an infringement of privacy and rights of the lady concerned. Alternative arrangements must be made to provide a dedicated hairdressing room for the home. The standard of cutting and hair care was good. A group of residents and five visitors said the manager and staff are kind and caring. The Dales J52 J03 S29150 The Dales V240895 260705 Stage 4.doc Version 1.40 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 standard(s) 12,13,15 Residents are encouraged to participate in social and leisure activities, to maintain links with their friends and family. However it was not clear from the case files how activities were related to personal interests. Staff were pleasant and interacted well with residents to create a relaxed and friendly atmosphere More visual aids should be used to help residents to make choices. Residents should not be expected to make decisions too far ahead. The quality of the bread used for sandwiches on the day of the inspection was unsatisfactory. EVIDENCE: The home has a team of activities coordinators and a system for recording what activities each person has participated in each day. The activities file included a very useful activities prompt sheet, which could be used by care staff to provide stimulation. It was felt by staff that there is more input of activities in some units than others. It was good to note that all staff on the unit responded to the residents and were seen to offer reassurances and assistance. One of the units holds a weekly coffee morning, which anyone can attend. The list of activities featured special events such as watching Ascot and tennis on TV and simply spending time chatting to people. The limited background The Dales J52 J03 S29150 The Dales V240895 260705 Stage 4.doc Version 1.40 Page 13 history in some files must make it difficult for staff to initiate conversation. It was not clear from the care files how activities were related to personal interests. The menu board was up to date and showed the choice of meals for the day. The light lunch (tinned ravioli, assorted sandwiches and chicken soup followed by fresh fruit or lemon meringue pie) had been chosen the previous day, a difficult task for anyone and more so for people with dementia who have difficulty conceptualising. Staff were reminding people what they had chosen but were doing this verbally rather than showing and fully explaining what was in the sandwiches and the type of soup. The sandwich bread was dry and tasted stale though it was said it had been delivered that morning. It is understood the bread supplier is to be changed. The staff were pleasant and encouraging and assisted those people who needed feeding in an appropriate manner. The organisation has produced a very informative Nutritional learning book, which all staff were going through the process of completing and returning to the manager. Staff and most residents participated in verbal banter and the social atmosphere was good throughout the day. A staff member said she enjoyed talking to the residents because ‘ they had good stories to tell’. Visitors to the home said they were made welcome and were kept up to date with any changes in their relative’s wellbeing. The Dales J52 J03 S29150 The Dales V240895 260705 Stage 4.doc Version 1.40 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 standard(s) 16,18 The home provides clear information on how to make a complaint about the service. It includes reference to the Commission for Social Care Inspection if people want to take a complaint outside the home. Visitors were confident that any concerns would be dealt with fairly. Staff had an understanding of adult protection but all staff must have adult protection training if they and residents are not to be at risk. EVIDENCE: A relative had raised concerns about the lack of activities and a visiting professional had expressed some concerns about care plans. Both had been attended to. The home had exchanged the rooms of two people in order to provide ground floor accommodation for a person who was being cared for in bed. This had been done in consultation with the families of both residents. The inspector was assured that the contracts had been amended to reflect the change of room number though this was not checked. Talking to staff, they are all clear on their responsibility about reporting any allegations of abuse. However there are some staff that have not yet had adult protection training. The manager was in the process of investigating an alleged adult protection incident. The Dales J52 J03 S29150 The Dales V240895 260705 Stage 4.doc Version 1.40 Page 15 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 standard(s) 19,20,21,23,24,26 Some work on the environment has taken place, but further work (some minor) is required if odour is to be kept under control, the risk of cross infection reduced and satisfactory standards maintained. As the home provides a specialist service for people with dementia more work should be done around the building to assist people to orientate themselves towards their rooms and toilet areas. Bedrooms should be personalised in a way, which reflects the personalities of the occupants and makes each room distinct and recognisable. EVIDENCE: Maintenance records were up to date and work was being carried out on one of the units to complete the final phase of the fire safety officer’s recommendations and to redecorate. The grounds were neat and tidy and the secure garden areas contained items to stimulate interest. More work could be done inside the lounges and other parts of the building to assist people to orientate themselves towards their rooms and toilet areas. It was disappointing to see how few of the rooms were personalised in a way which reflected the personalities of the occupants. The Dales J52 J03 S29150 The Dales V240895 260705 Stage 4.doc Version 1.40 Page 16 Notice boards were up to date and clear and large faced clocks were correct. Locks have been delivered which, when fitted and doors adjusted will bring the bedroom doors up to standard. Overall the home was clean on the surface though some bedrooms had a slight odour and deep cleaning is required in parts. Staff in discussion did state the home is better cleaned during the week than at weekends. The home appears to have problem in one of its unit the walls are damp, condensation and ventilation appears to be poor on that unit. Bathrooms were cluttered and used as storerooms due, it was said, to lack of storage space. There is a badly cracked mirror and several warped doors. Some of the waste bins throughout the home had either broken or missing lids. Clean net pants attached to a linen trolley were dangling over the toilet seat The Dales J52 J03 S29150 The Dales V240895 260705 Stage 4.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29.30 The home has a robust interview process when recruiting staff and training is now high on the home list. However some staff needs to be reminded of the training they have received in manual handling and ‘good care practice’. EVIDENCE: Several staff recruitments files were looked at. References were in files and Criminal Records Bureau checks were completed. There was a nurse and three care staff on each unit. All were very pleasant and appeared to be communicating well. The nurses were working alongside care staff as active team members. A care worker confirmed she had done training in first aid, dementia, palliative care and that manual handling and fire-training updates took place on the first Tues of every month. Staff were observed transporting a resident across the full length of a lounge on a standing hoist. This was brought to the attention of the manager at the feedback of the inspection. The manager said she would look into this matter The Dales J52 J03 S29150 The Dales V240895 260705 Stage 4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,35,38 The manager is highly respected, hardworking and committed to providing a quality service. Some service users money could be used to enhance their quality of life. EVIDENCE: The manager is well on the way towards completing the NVQ level 4 Management course. She had systems in place to monitor the care on each of the units and displayed a good knowledge of the individual residents in the home. The minutes of meetings held with the staff on each of the units showed that she was dealing with situations where staff were forgetting to put the needs of residents first. People described her as approachable and were confident that they could bring any concerns to her. The administrator was able to provide a print out of the balance of each resident’s personal allowance, which showed added interest. The Dales J52 J03 S29150 The Dales V240895 260705 Stage 4.doc Version 1.40 Page 19 Some resident’s balances indicated more could be done to use the money to enhance the quality of life for those people. The Dales J52 J03 S29150 The Dales V240895 260705 Stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 2 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 3 2 x 3 3 x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 3 x x 3 x x 3 The Dales J52 J03 S29150 The Dales V240895 260705 Stage 4.doc Version 1.40 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 3 Regulation 14 Requirement Assessments information was fairly basic and did not identify the resources the home provide to show they could meet each person’s range of human needs and made no mention of the outcome of any pre admission visit, which was part of the admission process. Further developments are still needed, to ensure consistency is applied to the care plans. The use of resident’s bedroom as a hairdressing room is an infringement of privacy and rights; alternative arrangements must be made to provide a dedicated hairdressing room. The lack of adult protection training for all staff may put resident or staff at risk. Damp, ventilation problems and condensation in the unit identified at the inspection should be addressed. The waste bins, throughout the home were either broken or missing and doors were warped and very hard to close. Bathrooms should not be used as storage space. J52 J03 S29150 The Dales V240895 260705 Stage 4.doc Timescale for action 30/9/05 2. 3. 7 10 15 23 30/9/05 30/9/05 4. 5. 18 19 18 23 16/10/05 30/10/05 6. 19 23 30/9/05 7. 21 23 30/9/05 Page 22 The Dales Version 1.40 8. 9. 26 30 23 18 Some bedrooms had a slight 30/9/05 odour and deep cleaning is required. Staff must put training they have At oncei received in care into practice. 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 8 Good Practice Recommendations The name of the person who has had an accident should be recorded on the stub of accidents reports to allow any patterns of accidents to be recognised at an early stage and action taken. It was not clear from the case files how activities were related to personal interests. Food should be fully explained to residents if need be pictures should be showed and fresh bread should be used to make sandwiches. Some residents money could be used to enhance their quality of life. 2. 3. 4. 14 15 38 The Dales J52 J03 S29150 The Dales V240895 260705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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