Inspection on 03/10/08 for The Dales Nursing Home

This inspection was carried out on 3rd October 2008.

CSCI found this care home to be providing an Adequate service.

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

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOMES FOR OLDER PEOPLE The Dales Nursing Home 19-20 Howell Road Exeter Devon EX4 4LG Lead Inspector Dee McEvoy Unannounced Inspection 3rd October 2008 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 Nursing Home DS0000072320.V373647.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Dales Nursing Home DS0000072320.V373647.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Dales Nursing Home Address 19-20 Howell Road Exeter Devon EX4 4LG 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) 01392 221266 Chartbeach Limited Mrs Marie Young Brown Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places The Dales Nursing Home DS0000072320.V373647.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who may be accommodated is 31. 31st October 2007 Date of last inspection Brief Description of the Service: The Dales Nursing Home is situated in central Exeter just north of the city centre. Since the last inspection the home has been sold and a new provider Chartbeach Limited has been registered with the Commission. The Home is located in a residential area away from the main thoroughfare of traffic. The centre of Exeter is less than a mile away; the bus stop and shops are within easy walking distance. There is a public park opposite the Home. The Home is registered to care for 31 older people with general nursing needs. The building itself is of an older character and comprises two former dwellings converted into one. Accommodation is on three floors, there are 25 single rooms and 3 shared rooms. There is lift access to all floors, which have level access throughout. There are two communal sitting rooms and two separate dining rooms. There are well-maintained gardens to the front and rear of the property. The Home has minimal car parking space however time-limited parking is available in the surrounding roads. The cost of care is ranges from £517-700 per week at the time of inspection. Additional costs, not covered in the fees, include chiropody, hairdressing and personal items such as toiletries and newspapers. Previous inspection reports are available on request. The Dales Nursing Home DS0000072320.V373647.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. Several weeks before this key inspection took place the home submitted a completed Annual Quality Assurance Assessment (AQAA) to the Commission, which contained general information about the home, and an assessment of what they do well and what they plan to improve upon. Before our visit to The Dales we sent a number of confidential surveys to people living there, to staff and outside professionals to hear their views. Relatives had helped 7 people living at the home to complete surveys. We also received completed surveys from 6 staff. The comments and responses we received have helped us to form the judgements we have reached in this report. We (the Commission) spent 11 hours at the home. To help us understand the experiences of the 31 people living at the home, we used the services of an ‘expert by experience’. These people have experience of using services, and they join some inspectors to help us get a good picture of the service from the viewpoint of the people who use it. Experts by experience can provide a unique contribution to the assessment of quality. On this occasion the expert by experience spoke with 9 people living The Dales about the social activities and food at the home. He met and spoke with 4 visitors in order to get their views and comments about the service. He also had lunch in the dining room with several people, and looked around the home. His observations and findings are contained within this report. We looked at the way the home admits new people and the way they assess their care needs and plan and delivered care. Where possible we spoke with these people in depth. We also spoke with staff about their knowledge and understanding of people’s needs. Most people living at the home were seen or spoken with during the course of our visit and 13 people were spoken with in more depth to hear about their experience of living at the home. Time was spent observing the care and attention given to people by staff. We also spoke with 10 relatives/visitors, and seven staff members including the manager and the provider. A tour of the building was made and a sample of records was looked at, including medication records, care plans and assessments, and staff files. The Dales Nursing Home DS0000072320.V373647.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The home has acted on the requirements and most of the recommendations made at the last inspection. People’s personal care was well attended to. The expert by experience noted, “All residents were seen to be clean, well groomed and dressed in freshly laundered clothing”. Some aspects of the management of medication have The Dales Nursing Home DS0000072320.V373647.R01.S.doc Version 5.2 Page 7 improved and medicines were seen to be disposed of safely (see ‘what they could do better). The home is developing more activities for people and will be consulting about the type of activities and outings they may like (see ‘what they could do better). The way the home addresses and records complaints suggests that people can be confident that their complaint or concern will be listened to and acted upon. All staff, including the manager have received ‘safeguarding adults’ training and staff spoken with were aware of their responsibility to raise any concerns about people’s wellbeing at the home, which helps to protect people. General cleanliness within the home has improved since our last visit. The expert by experience noted, “…the home was clean and free from unpleasant odours”. The home has increased the number of staff holding a nationally recognised qualification in care (NVQ), which helps to promote good general standards of care. The home has taken adequate precautions against the risk of fire, by ensuring that an up to date risk assessment is completed. A fire safety inspection earlier this year found satisfactory standards. Accidents are being properly recorded to allow the manager to follow up any accident with an investigation and review the measures in place to reduce the risks to people. What they could do better: Two requirements and eight recommendations for good practice have been made as a result of this inspection. The home must improve records relating to medication to ensure that a safe auditable system is in place. In order to protect people from unnecessary risks the home must improve infection control practices. Care plans do not have enough detail to guide staff about individual needs, including social needs, and how to meet them. People are not consistently involved or consulted when their individual care plans are compiled. As a result some people’s preferences are not being met. Following the inspection the provider contacted us to say that people are now fully involved in the planning of their care. The home has been asked to be mindful about people’s preferences so that people’s privacy and dignity is promoted at all times. Some people living at the home, relatives and staff felt that activities and occupation at the home could be improved. Activities need to be personfocussed and better planned. The home should help people get involved in more activities and outings and provide stimulation appropriate to their The Dales Nursing Home DS0000072320.V373647.R01.S.doc Version 5.2 Page 8 individual preferences and capabilities. Since this key inspection an activities co-ordinator has been employed to improve activities. In order to protect people, any restraint measures, such as the use of bed rails, must be undertaken with full consent and discussion with the multidisciplinary team and/or family. This is carried over from previous inspections. Areas of the home need refurbishment and there are outstanding works/repairs to be addressed in order to ensure that people live in pleasant and homely surroundings. The new providers are keen to improve the overall environment and have produced an audit of the work to be undertaken, for example replacing carpets and soft furnishings, and decorating. They also plan to refurbish the bathrooms and install a shower/wet room. Following the inspection the provider contacted us to say that the communal lounge and hallway had been redecorated and re-carpeted. Many other improvements are underway. The manager should continue to develop the quality assurance systems in order to identify where change or improvements are needed. This will ensure people are happy with the care they receive. The manager should continue with the management course in order to ensure the future good management of the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Dales Nursing Home DS0000072320.V373647.R01.S.doc Version 5.2 Page 9 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 Nursing Home DS0000072320.V373647.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good admission procedures are followed before people decide to move in, including a thorough assessment of their needs, good information and opportunities to visit and get to know the home. EVIDENCE: The home has a Statement of Purpose, which tells people about the home and what they can expect. There is also a website that includes photographs of the home and some of the staff team. This will be up-dated by the new providers. Six people returning CSCI surveys told us they had received enough information about the home so that they could decide if it was the right place for them. Some people told us that family members had visited the home on their behalf prior to moving in. One relative wrote, “Very helpful advice from the matron and owner who showed us around the whole home with no pressure”. Another family told us, “We looked at three homes before deciding The Dales Nursing Home DS0000072320.V373647.R01.S.doc Version 5.2 Page 11 that The Dales would suit Mum’s needs. Overall we have been happy with the care she is receiving”. We looked at the assessments of two people recently admitted to the home to see how the home manages new admissions. The manager will visit people, if possible, before admission to provide information about the home, to answer any questions, and to carry out an assessment. One person told us, “The matron visited me in hospital. She was so kind and nice”. Information about people’s abilities and care needs is also gathered from other professionals such as social workers and nurses, for example, we saw detailed and important information supplied by one palliative care nurse. This combined information gives the home a good idea about peoples’ abilities, usual routines, and needs, so that they can decide if the home can care for them and meet their needs. One visiting health professional told us the home was very careful when assessing people’s needs and that the home had established a “good working relationship” with the local hospice. Six of the seven people responding to our survey said they had a contract, which ensures that they are aware of their rights and responsibilities. However, contracts will need to be re-issued to everyone by the new provider. Following the inspection the provider contacted us to say everyone at the home had been issued with new contracts. This home does not provide intermediate care. The Dales Nursing Home DS0000072320.V373647.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s health needs are met and the home provides a good standard of care for people approaching the end of life. However, personalised care will be improved with the development of person centred care planning. The management of medication is adequate with the exception of records. EVIDENCE: Most people returning CSCI surveys told us they “always” or “usually” receive the care they need. One person told us they “sometimes” receive the support they would like. Comments from surveys included, “Quite pleased with the home”, “All staff very helpful” and “Mostly good. Quality generally excellent or very good. Staff mostly kind and caring”. We spoke with a number of people during our visit and they were generally happy with the care provided; their comments included, “I like all the staff, they are very conscientious, very gentle and concerned that they do not hurt The Dales Nursing Home DS0000072320.V373647.R01.S.doc Version 5.2 Page 13 you, I admire their patience”. One person said “I love it here, everything is so nice. The girls never say ‘no’ and they are very gentle”. Another person on learning of the inspection told our expert by experience, “You won’t find anything wrong here”. In all we met with 10 relatives during our visit, overall their views were positive about the care delivered to their relatives. Their comments included, “I am very satisfied with the staff who give good medical and nursing care under the direction of the matron who is very capable”. Another told us, “ This is a really good home and I have more peace of mind since my mother moved here. The staff are brilliant, very friendly, competent and approachable”. Others told us, “Mum seems very happy here. They are good as gold here”, “We are happy with the care. Everyone seems very pleasant and they are doing their best for Mum”. We looked at three care plans, and spoke with people receiving care, relatives and staff (where possible), about the way care is planned and delivered. The AQAA tells us the home’s care plans and risk assessments focus on “person centred care”. The quality of the information in care plans varied, however, two care plans contained useful information that would help staff to understand people’s current health and personal care needs. One also contained a personal history, which described past interests and life experience to help staff understand this person better. A relative told us, “They can chat about her past life as they collect information”. In two care plans some areas of psychological support and social activities had been considered but not consistently. A third care plan for a person admitted 2 weeks before the inspection was basic and not all areas of the care plan had been completed. This person told us they were generally satisfied with the care provided but said that they would prefer to receive personal care from a female member of staff. This preference was not recorded and we were told by this person that they get “anxious and embarrassed” when male carers are delivering personal care. Care plans had not always been reviewed as people’s needs changed. For example one person had a catheter removed but this had not been reviewed with instructions about how staff were to assist with continence needs. The skin risk assessment showed this person was at high risk of developing sore skin and daily notes showed that their “bottom was sore”. Two staff spoken with gave different accounts of the care to be provided. This potentially puts people at risk; clear instructions will ensure that consistent care is delivered. The care plans we looked at contained little or no information about people’s interests or hobbies; this information could help the home develop meaningful activities (refer to standard 12). The Dales Nursing Home DS0000072320.V373647.R01.S.doc Version 5.2 Page 14 There was no indication that people had been consulted when their care was being planned; none of the people we spoke with, or their relatives were aware of the care plans. Staff felt care planning could be improved to ensure they had up to information about people’s needs. Three told us, mainly via surveys, “sometimes” have up to date information about people, one said this “usually” the case, and two felt they “always” had the information needed. date they was they Risk assessments for skin care, risk of falls, swallowing and choking risks were seen in two care plans, and we saw that staff followed the instructions carefully when assisting one person with their meals. We saw that appropriate moving and handling assessments and plans had been completed and we saw staff using appropriate moving and handling techniques when needed. One person who requires assistance with mobility told us, “Staff are gentle with me, and no one pulls me around”. They added, “I feel confident they know what they are doing”. People’s personal care appeared to be well attended to. Our expert by experience noted, “All residents were seen to be clean, well groomed and dressed in freshly laundered clothing. A passing carer noticed one resident’s hair had become ruffled since being brushed an hour or so earlier and returned to brush it again making a friendly comment”. One relative told us, “Mum looks clean and is nicely dressed”, another relative wrote, “…she likes having colour co-ordinated clothes and beads. Mrs X is always dressed well and thoughtfully by staff”. Most people told us they “always” receive the medical care they need; one person told us this was “sometimes” the case. One relative told us, Matron really knows what she is doing and even phoned and visited my mother in hospital ensuring that she continued to receive the correct drugs”. Records showed that outside professionals visit people regularly, for example the GP, specialist nurses, chiropodist, and other specialists. People are also supported to attend out patient clinics. Conditions such as diabetes are well monitored. During our visit we spoke with a visiting health professional. They told us that the home had an “excellent working relationship” with them and the local hospice to ensure people received the care they needed. The nurse told us the home follows any suggestions or instructions given and added, “they seem keen to learn”. The matron and staff work closely with the local hospice to offer end of life care at the home with support from specialist nurses. The nurse specialist told us, “There is excellent communication…matron and staff always seem to know what’s going on”. One relative told us, “I am full of admiration for the Matron and staff for the way they have treated my terminally ill father, I could not ask The Dales Nursing Home DS0000072320.V373647.R01.S.doc Version 5.2 Page 15 for more”. Another relative told us, “Mum appears to be comfortable. We have no concerns about her care”. The matron and some nursing staff have attended courses in palliative care at the local hospice to ensure their practice is up to date. A visiting hospice care nurse told us, “Staff are very receptive to our input”. She felt that staff had the “skills and competencies” to deliver palliative care. She confirmed that the home uses recognised care pathways for people approaching the end of life, which helps to ensure people receive the care and attention they need at this time. We looked at the way the home stores, administers and records medicines. Only trained nurses administer medication and no one living at the home currently manages their own medication. The records of medicines received into the home, and the disposal of unwanted medicines provide a clear method of auditing. Medicines that are classified as a controlled drug are stored securely. We found that records relating to the medication within a syringe driver were not entirely accurate, as the home had omitted to record the amount of water used. This was discussed with the nurse in charge to ensure accurate records were kept. We found where a variable dose of medication is prescribed records did not indicate the actual dose given, which is considered good practice. One person’s care plan indicates that cream is used on vulnerable pressure areas; we could find no record to indicate that this cream had been prescribed by the GP. We looked at several Medicine Administration Records (MAR). We saw that records for the use of other prescribed creams had not been completed. Some people are prescribed creams to be applied daily. In some cases records were poorly complete indicating that this may not be happening. We looked at how the home promotes and maintains people’s privacy and dignity. People spoken with told us that staff were respectful, one person said, “Staff are patient and ask me how I would like things done”. Another person told us, “They (staff) are gentle and respectful”. In surveys people told us staff “always” listen and act on what they say, meaning that staff respect people’s wishes and preferences. During our visit, staff were polite and friendly when delivering care. We saw staff knocking on people’s bedroom doors and addressing people in a respectful way. The expert by experience noted, “The staff appeared to be very busy but were kindly attentive to their charges”. One visitor did say that “once or twice” they found their relative in other people’s clothes. This does not promote people’s dignity and should be avoided. The expert by experience noted, “In three top floor bedrooms only a curtain screened the toilet, which offers little in the way of privacy or containment of The Dales Nursing Home DS0000072320.V373647.R01.S.doc Version 5.2 Page 16 odours”. The new provider is aware that these arrangements are less than ideal. The Dales Nursing Home DS0000072320.V373647.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are some activities, and contact with family and friends is good, however more specific recreational opportunities suited to peoples’ individual needs and abilities would support a better quality of life. People usually enjoy the food, which takes their dietary needs into account. EVIDENCE: Support is generally offered in a way that promotes choice and flexibility for most people. People spoken with told us routines within the home generally suited their preferences. The expert by experience noted, “On rising and retiring times, people were content that these were of their choosing. One adding “Partly my choice and partly not, as I do all I can to be less demanding so it is by mutual arrangement. I am usually in bed by 10pm to listen to a favourite radio programme and like to get up at 6am”. Another person told us they were “entirely satisfied” with the daily routine and added, “I can say when I want to go to bed.” The Dales Nursing Home DS0000072320.V373647.R01.S.doc Version 5.2 Page 18 The expert by experience found that people he spoke with seemed content with their lifestyle, “enjoying the views from their rooms, reading or watching television”. However, we received mixed survey responses from people living at the home when asked about the activities provided. Three people said there was “usually” some social activity to take part in, three said this was “sometimes” the case; and one person felt there were “never” appropriate activities for them to enjoy. One person felt their deafness excluded them from “most things”. We spent time in the two sitting rooms observing how staff interacted with people. During the morning activities or stimulation for people was limited and eight people were unoccupied and sleeping in their chairs for most of the morning. Staff were busy and had little time to spend with people in communal areas. In the afternoon five people attended an exercise and movement session with music. We saw that three people joined in but two others did not participate and appeared to be uncomfortable with the loud music. Several people spend the majority of time in their own room and we were unclear about the social stimulation or meaningful activity they receive. One person who spent most of their time in their room told us, “I haven’t been out yet but would like to go out one day”. No one mentioned the possibility of visits out as detailed on the home’s website. Two relatives felt an area for improvement was activities. One told us, “Although Mum is not that bothered it would be nice if she had something to occupy her time”. Another said, “Activities are minimal so could be improved”. The home currently has a limited activities programme with activities such as occasional outside entertainers/singing; exercise, hairdresser visits and nail care being undertaken. We looked at some activities records to establish what sort of activities people had been involved in. We could see that records mostly recorded brief chats with family, staff or matron. Care plans did not contain detailed information about people’s interests or hobbies, which would help to ensure that activities are person centred and appropriate for individuals. The new providers are keen to develop more opportunities for activities. The AQAA indicates that the home wants to “Strengthen the activities program further”. The home has also told us they plan to, “Enhance the social activities programme and involve more residents in popular events both inside and outside the boundaries of the Home”. Information in the AQAA indicated that the vast majority of people living at the home were of the Christian faith; survey responses confirm this. The expert by experience noted, “Spiritual needs are covered by a weekly visit from the local Curate who conducts a communion service attended by 4 to 6 people. He will also take the sacraments to people in their rooms”. The Dales Nursing Home DS0000072320.V373647.R01.S.doc Version 5.2 Page 19 The home has ‘open’ visiting arrangments and several people had visits from family and friends during the day. We met with 10 relatives/visitors during our time at the home. All said they felt welcome at the home and could visit at any time. We saw that relatives were given a warm welcome by staff and offered a tray of refreshments. Relatives told us the home communicates well with them and they are informed of any chnages or other important information. People told us (via surveys) that staff “always” listen and act on what they say, this helps to promote choice and enables people to make decisions about their daily life. During our time at the home we saw that staff responded to people’s requests in a friendly and courteous way. Some people lack capacity and have difficulty expressing their wishes clearly. Agreed routines and preferences would be useful to guide staff and ensure that all people are helped to exercise choice and control over their lives. In surveys three people told us that they “always” like the food, two said they “usually” like the food and one person said this was “sometimes” the case. On the question of food, the expert by experience found, “All spoke highly of the cook but no one could recall being asked for a choice of main meal although they all said they were given a wide choice at teatime. The staff advised that every morning the choice of lunch menu is given to each resident. Breakfast was seen to be a very movable feast with one late riser having this meal at 10.30am. Evening snacks are available on request and one person usually has soup at 9pm prior to retiring. Bowls of fresh fruit are placed in each bedroom. People exercise the choice of eating in their bedrooms, the lounges or the dining rooms. Assistance was given where needed mostly with the carer sitting alongside the diner. People said the food was “Very nice”, “On the whole pretty good, my likes and dislikes are known by the cook who is open to suggestions. Ample choice and variety at teatime”, “I am fed very well” and “Alright”. A visitor said, “The liquidised food for my Mother is served in the separate identifiable portions unlike the combined way it is done in hospital and at her previous home”. On the day of the visit lunch consisted of a plated meal of fish and chips with peas or omelette with mashed potatoes and cauliflower, followed by sponge pudding and custard. The meal was suitably hot and well presented”. Two people, including a relative described the teatime meal as “repetitive”. One relative felt the nutritional value at suppertime was “not great”. The new owners are aware that the teatime/suppertime menu needs to be reviewed to ensure that people get a good nutritious meal, which suits their needs and preferences. The Dales Nursing Home DS0000072320.V373647.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints process with evidence that complaints are listened to and acted upon. Staff are aware of the procedure to follow to protect people from abuse or harm. EVIDENCE: The AQAA tells us the home has a “very open approach to complaints. A complaint is constructive criticism”. The home has received three complaints since the last inspection, one of which was referred to the home by the Commission. All complaints were addressed within the agreed period of time and two were upheld by the home. A fourth complaint was being dealt with at the time of the inspection. Surveys showed that the majority of people know who to speak with if they are unhappy or if they have a complaint. One person told us, “I would always speak with the Matron. She would listen to me”. A relative told us, “If we have any worries we tell them and they correct things immediately”. Another relative wrote, “Can talk to staff & they will sit and chat. Especially good when she first arrived and was confused. Always someone near”. The Dales Nursing Home DS0000072320.V373647.R01.S.doc Version 5.2 Page 21 Since the last inspection, the manager keeps a clear record of all complaints, including the nature of the complaint, the action taken to address the complaint and the outcome. All people spoken with told us they felt “safe” or “very safe” at The Dales. People described staff as “caring, patient and kind”. During our visit we observed interactions between staff and people living in the home. Staff demonstrated genuine warmth when engaging with people. One relative told us, “They (staff) all love our Mum. We are happy with her care”. The AQAA tells us the home “Implemented frequent and regular training of all employees with regard to protection of vulnerable adults”. Records show and staff spoken with confirmed, that staff attend ‘Safeguarding Adults’ training to ensure people are protected from abuse or harm. Since the last inspection the manager has undertaken the Devon County Council Manager’s safeguarding training. The manager is aware of her duty and the agreed protocols for dealing with alerts of possible abuse. Staff spoken with recognised what may be poor practice or evidence of abuse and all were aware of their responsibility to report any concerns. Staff were aware of who to contact outside of the home should they have concerns about people’s wellbeing, which helps to protect people. At previous inspections we noted that a large number of bed rails were being used which could potentially put people at risk and restrict their freedom, as bed rails are not always suitable and need regular monitoring. During this visit we found there were basic risk assessments relating to the use of bed rails but there was no evidence that a multidisciplinary approach had been taken to decide when to use bed rails and consent had not been agreed. The Dales Nursing Home DS0000072320.V373647.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The planned improvements to the home will ensure that people live in homely and comfortable surroundings. Poor practice relating to infection control could put people at risk. EVIDENCE: Several areas of the home need attention, carpets are stained and worn, and some of the furniture is old. Communal areas and some bedrooms would benefit from re-decoration. The expert by experience noted, “Many of the carpets throughout, although sound, were heavily stained and/or worn and overdue for replacement”. He added, “The dining rooms are dark, uninviting and unattractive”. Some relatives also felt the environment could be improved, one told us, “The only negative thing is the environment. It gives a poor first impression and could put people off”. The Dales Nursing Home DS0000072320.V373647.R01.S.doc Version 5.2 Page 23 The new owners of the home acknowledge that there is work to be done to ensure that people live in homely and comfortable surroundings. They have already completed an audit of the work to be undertaken, for example replacing carpets and soft furnishings, and decorating. They also plan to refurbish the bathrooms and install a shower/wet room. A prioritised (but not timetabled) list of intended replacement, renovations and repair work was seen. Surveys from people living at the home indicated that the home was “usually” clean and fresh. During our visit cleaners were on duty and the home was generally clean and free from odour. The expert by experience also noted, “the home was clean and free from unpleasant odours”. Since the last inspection regular deep cleaning of carpets and furniture is undertaken, although records had not been completed since June to say this had actually happened. The AQAA indicates that all staff have received infection control training, which aims to reduce the spread of infection within the home. However we saw two incidents of poor infection control practice. Two members of staff were seen to move between tasks and rooms without taking their gloves off. We saw one domestic leaving a cleaning job in the ground floor toilet to answer the front door and then enter a bedroom with gloves still on. Another member of staff came out of a bedroom, where they had been delivering personal care, wearing gloves. They went into two other bedrooms looking for “pads” but wearing the gloves. This was discussed with one member of staff, who told us they had received training about infection control and said that they realised their practice was not acceptable. We also discussed this with the manager and provider. Staff need more supervision and monitoring to ensure they understand training and maintain good practice at all times. The Dales Nursing Home DS0000072320.V373647.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Recruitment practices are good and therefore protect people living at the home. The staff training and development arrangements ensure that competent staff are in place to care for people. EVIDENCE: The majority of people responding with surveys told us staff were “usually” available when needed. Two people felt staff were “always” available when needed. The expert by experience spoke with several people about staff availability. He told us, “Call bell response time was said to be “Very quick”, “Usually within 5 minutes or less”, “Two minutes or perhaps a bit longer (but never more than 10 minutes) if the girls are very busy elsewhere“. Relatives also told us there were usually enough staff on duty to “see to people’s needs”. One told us, “There are usually three or four staff floating around”. We looked at staff rotas, which showed that there were 6 staff (nursing and care staff) on duty in the morning and between 4 and 5 staff in the afternoon. Nursing and care staff are supported Monday to Friday by the Matron, a cook, kitchen assistants and housekeeping staff. Staff told us (via surveys) there were “always” or “usually” enough staff to meet people’s needs. One told us, “If we are short staffed people cover shifts or agency come in”. Although staff were busy during our visit and did not appear to have a great deal of time to spend one to one with people or engage people socially in the The Dales Nursing Home DS0000072320.V373647.R01.S.doc Version 5.2 Page 25 morning, people’s care needs appeared to be met. The provider told us they were planning to employ an activities co-ordinator, which should improve social care at the home. The home has a diverse staff team and the gender mix matches that of the people living there. One staff member told us, “We have female & male staff for people who want a certain gender looking after them”. The expert by experience noted, “Although for many staff English was not their first language there did not appear to be any great communication problems. One comment was “Speech variable depending on accent and lack of vocabulary”. One relative told us, “It was difficult to communicate with overseas staff at first but it’s OK now”. We looked at the recruitment files for three people appointed since the last inspection. Relevant pre-employment checks, including references and Criminal Records Bureau checks (CRB & POVA) had been taken up prior to employment. This helps to ensure that individuals’ are suitable to work with vulnerable adults. Information in the AQAA tells us that 52 of staff have a nationally recognised qualification in care - NVQ2 or above, which helps to ensure general care needs are met. A further 35 of staff are working towards this qualification. Surveys from staff indicate that they receive training relevant to their role and which keeps them up to date with new ways of working. Training records show that staff have training in key areas, such as health and safety, as well as some specialist areas such as working with people with dementia or palliative care needs. Staff responding with surveys said they had received an induction training when they first starting working at the home to help them understand how the home works and how to care for people safely. One member of staff told us, “We constantly have different people coming into the home to give us training in manual handling, infection control etc”. The Dales Nursing Home DS0000072320.V373647.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from the manager’s approach, which is open and efficient. People will benefit from being involved in the running of the home and the planned improvements to monitor the quality of the service. Health and safety is generally well managed with the except of infection control. EVIDENCE: The manager is a qualified nurse and has several years of experience. She has been the registered manager of the home since 2006. Due to difficulties with the training company she has not completed the Registered manager’s Award The Dales Nursing Home DS0000072320.V373647.R01.S.doc Version 5.2 Page 27 as planned. However she reports that she has now resumed the course and is hoping to complete it early in 2009. The manager keeps her practice up to date by attending various training courses, for example palliative care and mental capacity courses. She has a “hands on” approach and appears to be well known and liked by the people living at the home. Staff told us that the manager meets with them regularly to provide support and that there was “usually” good communication between the manager and staff. Since the last inspection the home has been sold and the new providers were registered with the Commission two weeks before this inspection. The providers are experienced providers of social care. They intend to be involved daily at the home and have several plans for improvements. The AQAA tells us that the home wants to “encourage more involvement from the residents to provide ideas themselves about their desires for daily stimulation”. The AQAA also indicated that the home wanted to “Improve the feedback process and method for staff, residents and relatives…” The manager told us that she had tried to organise ‘resident’s meetings’ but people “were not interested”. The manager told us that an “open door policy” operates at the home and that she welcomed feedback from people living there, their relatives/representatives and staff. Several relatives confirmed this and told us that the manager was approachable and receptive to their suggestions or concerns. The home is developing formal quality assuarnce systems to provide ways of consulting and checking people’s views about the home. A small number of questionnaires had been returned to the manager earlier this year and the responses are to be collated and made available to people. The new providers have several ideas of how to implement quality assurance systems to ensure people are receiving a good service, which meets their needs. We will be able to assess the success of the new systems at the next inspection. The home does not manage people’s finances. Where necessary relatives or advocates assist people to manage their finances. The home will invoice people retrospectively for services such as hairdressing, chiropody and other personal items, which may be needed. We looked at the way that the home ensures people are safeguarded from possible injury. We found that staff receive training on health and safety topics, such as fire safety and moving and handling. The AQAA confirms that all catering staff and over 50 of care staff have received training in safe food handling, to help ensure standards in this area are satisfactory. The Dales Nursing Home DS0000072320.V373647.R01.S.doc Version 5.2 Page 28 Windows on the upper floors are restricted to prevent accidents from falls. The use of radiator covers and controlled water temperatures helps to ensure that a safe environment is maintained for people. We received a letter from the fire service in August 2008 informing us that fire safety at the home was satisfactory. Accidents are being properly recorded to allow the manager to follow up any accident with an investigation and review the measures in place to reduce the risks to people. The AQAA showed that maintenance of equipment and systems, such as water, gas and electrical systems, and equipment such as the passenger lift and hoists were up-to-date. The Dales Nursing Home DS0000072320.V373647.R01.S.doc Version 5.2 Page 29 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 3 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 1 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 The Dales Nursing Home DS0000072320.V373647.R01.S.doc Version 5.2 Page 30 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 OP9 Regulation 13(2) Requirement You must ensure that accurate medication records are kept; this includes records relating to the use of Controlled Drugs and other medicines used in syringe drivers. You must ensure any medicines prescribed to people, including creams are given and recorded correctly. You must ensure that the actual dose of medication given is recorded where medicines are prescribed with variable doses. You must ensure that staff are provided with clear guidance within care plans on medication related matters. You must ensure that staff implement good infection control practices in order to reduce unnecessary risks to the health and safety of the people living at the home. Timescale for action 27/02/09 2. OP26 13 (4) (c) 27/02/09 The Dales Nursing Home DS0000072320.V373647.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations In order to deliver care in a person centred way, care plans should include details of all aspects of an individual’s health and social care needs and details of how these will be met. People living at the home should be involved or consulted when their individual care plans are compiled, consulted when plans are reviewed or kept informed of any changes to their care to ensure that they consent to changes. People should be aware that their care plans are available to them if they wish and plans should be written in a format that is accessible to individual needs. You should ensure that people’s privacy and dignity are promoted. People’s wishes regarding the gender of staff delivering their personal care should be considered, recorded and met where possible. To ensure that all people living at the home are enabled to make decisions about daily life, it is recommended that more attention be given to facilitating choice for those people with limited communication skills. Person centred planning with help to achieve this. It is recommended that the home continue to develop stimulating and meaningful activities, which take into account the diverse needs of all people living at the home so that everyone has an opportunity to lead a full and stimulating life. It is recommended that the home does not use bed rails unless there has been a clear multidisciplinary discussion, full risk assessment and consent involving the resident/representative as necessary to ensure the safety of people. In order to provide a pleasant and homely environment for people, you should implement a planned programme for the replacement, renovation and repair work needed at the home. In order to ensure the future good management of the home, it is recommended that the manager complete a leadership and management qualification (in this case the RMA) as soon as possible. DS0000072320.V373647.R01.S.doc Version 5.2 Page 32 2. OP10 3. OP14 4. OP12 5. OP18 6. OP19 7. OP31 The Dales Nursing Home 8. OP33 You should ensure that good arrangements are in place for reviewing the quality of the care provided. You should supply a report in respect of any review conducted for the purpose of reviewing and improving the quality of care provided at the home and make a copy available to people using the service, their relatives, other professionals and CSCI. The Dales Nursing Home DS0000072320.V373647.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Nursing Home DS0000072320.V373647.R01.S.doc Version 5.2 Page 34 - 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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