Inspection on 14/11/05 for The Dales Care Home

This inspection was carried out on 14th November 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Dales Care Home 22/08/07

The Dales Care Home 13/06/06

The Dales Care Home 19/04/05

The Dales Care Home 19/10/04

The Dales Care Home 27/04/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Dales, The Care Home Fisher Close Repton Derbyshire DE65 6GS Lead Inspector Jo Wright Unannounced Inspection 14th November 2005 08:40 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 Dales, The Care Home DS0000036259.V264301.R01.S.doc Version 5.0 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. Dales, The Care Home DS0000036259.V264301.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Dales, The Care Home Address Fisher Close Repton Derbyshire DE65 6GS 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) 01283 238200 01283 238203 Derbyshire County Council Yvonne Cara McComish Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Dales, The Care Home DS0000036259.V264301.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th April 2005 Brief Description of the Service: The Dales cares for 22 older people, in a purpose built, single storey building. The home is set in its own grounds, and service users have access to a number of garden areas. It is located in a residential area in the village of Repton, close to local amenities. All 22 bedrooms are single occupancy. The building is laid out in wings, each with its own lounge and dining space. Toilet and bathroom facilities are on each wing. Service users are able to move around the whole building. A resource centre is attached to the home. Service users living in the home are able to make use of the facilities provided at the resource centre. Dales, The Care Home DS0000036259.V264301.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection and the duration of the visit was approximately 5 hours. A number of residents were spoken with during the inspection. Records such as care plans (as part of the case tracking process, which is used to help determine how the home meets the needs of individual service users) were not examined in depth during this inspection. Other records such as staff files, servicing of equipment records and medication records were examined. An assessment was made with respect to the requirements made at the last inspection of this service. The manager has been away from the Dales since July 2005, working at the local area office. Although the manager was present at the inspection, this was her first day back at the Dales. The findings of the inspection were discussed with the manager at the end of the visit. What the service does well: What has improved since the last inspection? What they could do better: Staff need to make sure that they use the footrests on wheelchairs when transferring residents. Please contact the provider for advice of actions taken in response to this Dales, The Care Home DS0000036259.V264301.R01.S.doc Version 5.0 Page 6 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Dales, The Care Home DS0000036259.V264301.R01.S.doc Version 5.0 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 Dales, The Care Home DS0000036259.V264301.R01.S.doc Version 5.0 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): These standards were not assessed during this inspection. EVIDENCE: Dales, The Care Home DS0000036259.V264301.R01.S.doc Version 5.0 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 The care planning system was clear and consistent, and provided staff with the information they need to satisfactorily meet residents needs. Inconsistent staff practice for administration of medication potentially placed residents at risk. EVIDENCE: Residents spoken with said that they were happy living at the Dales. Residents commented that the staff team were good, and would ‘do anything for you’. One resident said that they had chosen to move into the home for good, after receiving regular short term care. Staff were attentive to residents needs, and responded to requests for assistance quickly. Residents’ files were not looked at in depth during this inspection. A previous requirement had been made about reviewing individual care plans regularly. The three files looked at showed that staff had reviewed the care plans each month, and that whenever able, the resident and/or family had been involved in this process. Staff were recording incidents in the daily logs, but were not always describing the incidents fully, or following through observations. This was discussed with the manager, who was advised to look into these incidents in more depth. Dales, The Care Home DS0000036259.V264301.R01.S.doc Version 5.0 Page 10 A previous requirement had been made to review general and individual risk assessment in residents files on a regular basis. The files looked at showed that staff were reviewing the risk assessments regularly, and taking appropriate action as required. Residents were referred to the community nursing services as required, and this information recorded appropriately. The medication records and storage of medication were checked. Storage of medication was satisfactory. A dedicated refrigerator was available for medication requiring cold storage. The temperature of this refrigerator was checked daily. The refrigerator was ready to be defrosted. Medication for one resident was stored in a container with a hand written label, stating the resident’s first name and name of medication. This was used to store the tablets that were not required, as the dose had changed from two tablets to one tablet mid month and the monitored dosage packs contained two tablets. Storage of medication that was awaiting disposal was discussed with the manager during the inspection. The dispensing label had been removed from a box of ‘movacol’. The person completing hand written medication records had not signed them, and the records not been checked for accuracy and countered signed by another person. The dispensing label for one person receiving short term care had been altered from two tablets to one tablet. Staff had not recorded in the logs whether they had checked the correct dosage with the resident’s GP. Dales, The Care Home DS0000036259.V264301.R01.S.doc Version 5.0 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, 14 and 15 Residents were provided with meals that were varied and which they enjoyed. Activities within the home and resource centre supported residents to meet their social and recreational needs. EVIDENCE: The atmosphere at the Dales was relaxed throughout this inspection. It was observed that the home was run along flexible lines, with an emphasis on personal choice. Residents were able to exercise as much control over their lives as possible (dependency permitting). The dedicated social activities worker in post at the time of the last inspection has changed her role and now works in the daycentre. Staff reported that people living at the home were encouraged to socialise with the people at the day centre and to join in with the activities. The manager reported that she hopes to recruit to the activities post in the near future. Written evidence supported that people living at the home were on the electoral register, and provided with postal votes. The manager reported that although advocacy services were not currently being used, she was aware of how to access external advocacy services if required. Dales, The Care Home DS0000036259.V264301.R01.S.doc Version 5.0 Page 12 Those residents spoken with commented that they enjoyed the meals provided, and there was always enough to eat. The planned menu was on display, and supported that residents were offered a varied diet. Dales, The Care Home DS0000036259.V264301.R01.S.doc Version 5.0 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): 16 and 18 Records supported that residents felt able to raise issues with the management and staff. However, the system for recognising and recording informal complaints needs to be strengthened. Ongoing staff training was required to ensure that residents were protected from potential abuse. EVIDENCE: Neither the manager nor the Commission has received any complaints about the care and services provided at the Dales. Staff reported that residents will often raise any concerns that they may with their link worker, who would take appropriate action. Discussion took place with the manager about staff recognising that any day to day issues that residents may raise are also complaints/concerns and need to be recorded, investigated and appropriate action taken. Procedures were in place for the Protection of Vulnerable Adults. New staff receive training on the protection of vulnerable adults and abuse as part of their induction. Existing staff also attend the training provided by the local authority. The training records available (not fully up to date) indicated that some members of staff had not attended this training. Dales, The Care Home DS0000036259.V264301.R01.S.doc Version 5.0 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): 26 The Dales provides a comfortable and homely environment for residents. EVIDENCE: The Dales was well maintained and decorated. All areas of the home were clean, tidy and free from odours. The laundry area was well organised, with systems in place for laundering personal clothing. Laundry equipment was in good working order. Care staff were responsible for laundering personal clothing for residents. Dales, The Care Home DS0000036259.V264301.R01.S.doc Version 5.0 Page 15 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, 28, 29 and 30 Suitably skilled staff, in sufficient numbers supported residents. The information available in staff files did not support that residents were fully protected by the recruitment policy and procedures. EVIDENCE: Information in the pre-inspection questionnaire indicated that three members of staff have left their employment, which has resulted in care staff vacancies. Staff reported that cover was provided either internally by staff working extra hours or by relief staff. Additional staff had been recruited but were not in post until all of the required checks were in place. A previous requirement to review the deployment of staff so that sufficient numbers of staff were on duty at all times had been addressed. The manager reported that staff working in the day centre provide support in the period after lunch. The home has achieved the requirement for at least 50 of care staff to be training to NVQ Level 2 or equivalent. NVQ training was provided on an ongoing basis. The manager reported that although recruitment of staff was organised through the personal department, she was responsible for checking the information supplied on application forms for any discrepancies or gaps. New systems were being introduced to update files and ensure that all required information was in place. Not all of the files looked at contained all of the Dales, The Care Home DS0000036259.V264301.R01.S.doc Version 5.0 Page 16 required information. Discussion took place with the manager about ensuring that full employment histories were obtained for all newly recruited staff. All new staff complete the required induction and foundation training, and evidence to support this was contained in the staff files. New systems were being introduced for recording staff training. The training records available at the time of this inspection were not fully up to date, so it was not clear if all staff were up to date with their mandatory training. Dales, The Care Home DS0000036259.V264301.R01.S.doc Version 5.0 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): 35 and 38 Robust systems were in place to protect residents monies. Staff practice did not always protect residents from potential harm EVIDENCE: The manager has been away from the home since July 2005, whilst carrying out other duties at the local area office. One of the deputy managers managed the home in her absence. Whilst the home has continued to run satisfactorily during this period of time, there has not been the overview that the manager provided. This has resulted in several of the issues noted, for example, not following through incidents recorded in the residents logs, training records not being fully up to date. Robust systems were in place for the safe keeping of residents monies. The records and the money held on behalf of a random sample of residents were cross-referenced and found to be accurate. Dales, The Care Home DS0000036259.V264301.R01.S.doc Version 5.0 Page 18 The local authority provides mandatory training for all staff. As previously stated, it was not possible to accurately assess whether all staff were up to date with this training. The manager reported that the community infection control nurse had provided informal infection control training. This information had not been recorded. Staff were observed transferring residents without using the footrests on the wheelchairs. A sample of service/maintenance records was examined. It was over 12 months since the portable appliances had been tested. The manager reported that this would be addressed as a priority. Action had been taken to address the previous requirements relating to health and safety. Locks had been fitted to the linen cupboard doors, and cleaning products were being stored appropriately. Dales, The Care Home DS0000036259.V264301.R01.S.doc Version 5.0 Page 19 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 X X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 2 Dales, The Care Home DS0000036259.V264301.R01.S.doc Version 5.0 Page 20 No 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. 2. Standard OP9 OP9 Regulation 13(2) 13(2) Requirement Medication dispensing labels must not be removed from the original container. The person completing hand written medication records must sign these, and the records must checked for accuracy and countered signed by another person. All staff must receive training on the protection of vulnerable adults and abuse. The systems in place for recording staff training must be accurate and up to date. Staff must use safe working practices when transferring residents in wheelchairs. Timescale for action 30/11/05 30/11/05 3. 4. 5 OP18 OP38 OP38 18(1)(a) & (c) 18(1)(a) & (c) 12(1)(a) 31/03/06 31/03/06 31/12/05 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 Dales, The Care Home DS0000036259.V264301.R01.S.doc Version 5.0 Page 21 1 2 3 4 OP7 OP9 OP9 OP16 Any incidents should be recorded in sufficient detail to clearly describe what has occurred, and investigated appropriately. The medication refrigerator should be defrosted. The systems for storage of loose tablets awaiting disposal should be reviewed. Day to day issues raised by residents should be recognised as informal complaints and managed through the complaints procedure. Dales, The Care Home DS0000036259.V264301.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Dales, The Care Home DS0000036259.V264301.R01.S.doc Version 5.0 Page 23 - 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. 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