Inspection on 09/02/06 for The Dales

This inspection was carried out on 9th February 2006.

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 26/07/05

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 Inspection 9th February 2006 09:30 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 DS0000029150.V277204.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 DS0000029150.V277204.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Dales Address Woodhall Road Off Gain Lane Bradford BD3 7DY 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) 01274 656110 www.bupa.co.uk BUPA Care Homes (GL) Ltd Mrs Dorothy Walker Care Home 108 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (108), Old age, not falling within any other of places category (108) The Dales DS0000029150.V277204.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the category of DE be used for the service user named on the application signed on 03/03/05 26th July 2005 Date of last inspection 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 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 DS0000029150.V277204.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Over an inspection year from April until March, care homes have a minimum of two inspections a year; these may be announced or unannounced. The last inspection was unannounced and took place on the 26th July 2005. There have been no further visits until this inspection, which is also unannounced. The purpose of this inspection was to monitor progress in meeting the requirements made at the last inspection and to look at the standard of care for people living in the home. This inspection was carried out by two inspectors between 9.30am – 4.30pm. The people who live in the home prefer the term resident therefore this will be used throughout this report. During the inspection, we looked at records, we saw staff carrying out their work and spoke with residents and staff. Comment cards/questionnaires are left for residents, visitors and other professionals at each inspection. These provide an opportunity for people to share their views of the home with the Commission for Social Care Inspection (CSCI). Comments received in this way are shared with the manager, without revealing the identity of those completing them. Since the last inspection 10 have been returned. What the service does well: What has improved since the last inspection? The Dales DS0000029150.V277204.R01.S.doc Version 5.1 Page 6 Although more work is needed, there has been a great improvement to the care plans. The manager now has an assistant who is helping to improve this further. Most of the requirements raised at the last inspection have been addressed. These include doors that were warped and very hard to close, now fixed. Waste bins have been replaced, deep cleaning in residents’ bedrooms had taken place and hairdressing no longer takes place in resident bedrooms. 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 DS0000029150.V277204.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 The Dales DS0000029150.V277204.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): 3 and 4. More information is needed on the pre admission assessment of residents to give assurance that their needs will be met. EVIDENCE: The pre admission assessments were inspected for a service user recently transferred from another home. Several days before admission the home had received a faxed copy of an assessment by an RMN. This gave the home very little information about the personality and strengths of resident and was limited to ‘needs nursing care’. The assessment carried out by the home before admission gave a brief overview of physical care needs and included some poorly photocopied medication sheets. There was nothing to conclude how the home could meet identified needs and help the person in their transition from one home to another. A Basol assessment form (which identifies mental abilities) had been completed using the scoring system but there were no comments to provide the basis for a plan of care. The Dales DS0000029150.V277204.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): 7,8,9 and 10. There has been a big improvement to the level of detail recorded in care plans, but these must be developed further so that care staff have detailed guidance to provide consistency in the way that care is delivered. Medication records are well maintained and the privacy and dignity of residents is respected. EVIDENCE: In the care file of a recently admitted resident there was excellent information from the family who clearly wanted to assist the staff to care for their mother by letting them know what kind of person she had been before her illness. The staff had written a brief but informative social history, which included dietary preferences. Closer examination of the information revealed some confusion in completing two sets of forms and the information was conflicting. The factual information sheets did not identify the cultural or ethnic background of each resident. This may prove important in meeting spiritual and emotional needs. The Dales DS0000029150.V277204.R01.S.doc Version 5.1 Page 10 Care plans identified some needs but the earlier care plans involved too much repetitive written introduction. This could have been briefer and focussed on the outcome to be aimed for. As the guidance on how the needs were to be met was so general it could be open to the interpretation of individual members of staff and lead to inconsistencies of care. There was little reference made to the progress of the care plans in the daily notes and keyworker diaries seen in one unit, therefore it was difficult to see where the evidence to back up reviews came from. This would be helped by simpler and more focussed aims in the care plans The residents who were being cared for in their rooms looked clean, comfortable and well cared for. Staff were aware of personal tastes in music and appropriate background music created a tranquil atmosphere for people who were in their bedrooms. Some people in the lounge were communicating well whilst others were sleeping. The staff felt the team was working well but one person felt the communication between staff and staff and residents could be improved. Staff were observed to be supportive and attentive and mindful of privacy and dignity. Care files included a section on health care which showed when and which GP had visited. Body charts and photographs were used to monitor skin integrity, with fluid intake and output charts and turning charts correctly maintained for people with higher dependency needs. Risk assessments were seen in the files but the action plan to manage risk was not easy to see and was general in content. It is recommended that this be given a higher profile. The checking, storage and administration of medication is the responsibility of the trained nurses. Medication is delivered to the home pre dispensed from the pharmacist on Fridays and checked by the night staff. A medication sheet and the controlled drug records were checked against the medication held and were found to be in order. The medication records include a photograph of each resident alongside their medication sheet and guidance on ‘homely’ remedies. Additional food supplement drinks are provided on prescription and were readily available in the rooms of the people who were being nursed in bed. A care worker said that staff are kept informed of any changes in medication, the reason the medication is being given and any possible side effects. Staff were observed to speak to residents kindly and with respect. Both care and domestic staff were seen knocking on bedroom doors before entering, and care staff gave assistance with personal care discretely. The layout of some of the shared rooms, though fitted with curtain screens, could compromise the privacy of the person nearest the en suite bathroom if their room mate needs the wc during the night. The Dales DS0000029150.V277204.R01.S.doc Version 5.1 Page 11 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 and 15. Residents have a well balance diet, however, the quality of the cooking on the day was poor. The vacant activity organiser post needs to be filled so that activities for resident could be improved. EVIDENCE: The home employs people to organise activities but had one vacancy at the time of the inspection. A care worker said staff try to introduce activities, usually in the afternoons. Social assessment sheets are not always completed. There was some information in some care files to show peoples’ interests but no activity seen in the units inspected other than the TV and CD player. In one semi open plan unit one resident was actively watching a film on the TV but there was a conflict of noise between the TV and different music playing in each of the other two areas. Magazines, books and a daily newspaper were seen on one unit. A member of staff felt that the staff struggled to maintain topics of conversation with residents and felt this area could be developed further. One resident said she enjoyed the Videos and books of the royal family. Spiritual needs were catered for but this was not evidenced in the care files. The Dales DS0000029150.V277204.R01.S.doc Version 5.1 Page 12 The menu for the day was clearly shown. This offered choice and was sufficient to allow for second helpings. The regular chef was on his day off and the assistant cook had prepared the meal. The manager said the quality of the meals had improved under the new chef. The midday meal, home made soup, assorted sandwiches and a savoury potato dish followed by jam doughnuts sounded tempting. However, the quality of the cooking was poor with thick floury tasting soup and a bland almost colourless potato dish in watery gravy. A resident described it as ‘weak’ and said she was only eating it so that she wouldn’t be hungry. The texture of the food required a spoon to be able to eat it. The manager has changed bread supplier since the last inspection and the sandwiches were fresh and wholesome. Some salads were available as an additional alternative. Staff were attentive during the meal assisting and encouraging residents to eat in an appropriate manner. It was not clear why staff were wearing blue plastic gloves to assist residents with their food. The Dales DS0000029150.V277204.R01.S.doc Version 5.1 Page 13 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): 18. All staff must have training on adult protection and the multi agency approach to the protection of vulnerable adults. EVIDENCE: Staff have not had formal training on adult protection. They were aware of the ‘whistle blowing ‘ policy but indicated they still felt a little uncomfortable about using it. Adult protection is on this year’s training programme. The Dales DS0000029150.V277204.R01.S.doc Version 5.1 Page 14 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, 20, 22 and 24. In parts residents live in a pleasant, comfortable well-maintained environment. However the organisation must look at ways of improving the control of unpleasant odours by improving the natural ventilation in some parts of the home. Natural ventilation to a resident’s bedroom is required without jeopardising the security of the resident. There is a lack of storage space throughout the home, which could raise the risk of cross infection. EVIDENCE: The home employs a maintenance person. Each unit has a repair and maintenance book which staff complete as work comes to their attention. The manager has a good budget for repairs, refurbishment and redecoration. There is a rolling programme of refurbishment, which takes account of those areas which are showing signs of wear and tear. A selection of communal spaces in both units gave scope for residents to move around freely with a minimum of restriction. The Dales DS0000029150.V277204.R01.S.doc Version 5.1 Page 15 Lack of storage space in the units leads to cleaning and soiled linen trolleys being stored in the bathrooms for safety. This is not an ideal situation. A walk in shower was being fitted in a bathroom on one of the units. Specialist beds, hoists and pressure relieving cushions were in use as required. Files contained records of safety checks on bed rails and risk assessments to justify the use of bed rails. The bedrooms seen were pleasantly furnished with a good array of personal items. Efforts have been made to make minor adaptations to the environment to provide visual prompts for people with dementia and help them maintain some independence. Memory boxes have been fitted outside each bedroom which contain items of significance for the rooms owner, this and the pictures on bedroom and bathroom doors, with clear directional signs to the toilets, are intended to help residents to find their way about the home. There are further innovative ideas planned for the improvement of the environment to make it more appropriate for the needs of the client group. One bedroom had French windows opening onto the garden. This provided a very pleasant outlook but did not allow natural ventilation into the room without jeopardising the security of the resident. The corridors in one unit have no natural light or ventilation, which traps unpleasant odours in this area, not noted in other parts of the home. The odour gives visitors a poor and unwarranted impression of the unit. One resident’s bedroom window had been opened and the door propped open to allow some ventilation into the corridor. This should not have to be necessary as it compromises the privacy and security of and individual. The organisation must look at alternative ways of ventilating this area. The Dales DS0000029150.V277204.R01.S.doc Version 5.1 Page 16 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 and 30. Care staff are making good progress towards National Vocational Qualifications (NVQ). All staff must have training in Protection of Vulnerable Adults. Staff were confident, courteous and respectful towards residents. EVIDENCE: The staff spoken with and observed appeared relaxed and confident and had an understanding of their keyworking role. There is a good programme of training, which includes NVQ. 19 care staff have gained the award and 12 are working towards it. There are no financial incentives for staff who gain the award other than developing skills from increased responsibility and some staff leave to work for the NHS. The manager plans to rota time for NVQ work into the shifts to support staff who are doing the course. Staff spoken with stated they have not had training in the Protection of Vulnerable Adults. The organisation expects all staff to complete their course ‘Personal Best’ which encourages people to view the way they work from the point of view of the residents. The Dales DS0000029150.V277204.R01.S.doc Version 5.1 Page 17 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): 36. Formal supervision for all staff is still fully in place. EVIDENCE: A staff member said that there is an appraisal system which takes place approximately two monthly. Staff are able to discuss the care needs of residents and any problems they may be having within the staff team or in meeting care needs. The appraisal generates an action plan. The Dales DS0000029150.V277204.R01.S.doc Version 5.1 Page 18 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 2 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 3 X 3 X 3 X x 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 X X X x X 3 X x The Dales DS0000029150.V277204.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? YES 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 OP3 Regulation 14 Requirement Pre-admission information must identify the resources the home provide to show they could meet each persons needs (raised at last inspection and has improved) The home must ensure consistency is applied to recording information in care plans (raised at last inspection). The home must provide suitable activities for residents. The quality of the cooking must improve when the cook is not on duty. The lack of adult protection training for staff must be addressed as not to put residents or staff at risk (raised at last inspection). The ventilation in the corridors and resident bedrooms must be improved. Lack of storage space in the units leads to cleaning and soiled linen trolleys being stored in the bathrooms for safety must be addressed. Timescale for action 01/05/06 2. OP7 15 01/05/06 3. 4. 5. OP12 OP15 OP18OP30 16 16 18 01/05/06 01/05/06 05/06/06 6. OP19 23 05/06/06 The Dales DS0000029150.V277204.R01.S.doc Version 5.1 Page 20 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 The Dales DS0000029150.V277204.R01.S.doc Version 5.1 Page 21 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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