Inspection on 11/03/09 for The Dell

This inspection was carried out on 11th March 2009.

CSCI found this care home to be providing an Good 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

The Dell 29/09/07

The Dell 17/01/07

The Dell 16/02/06

The Dell 03/12/05

The Dell 03/02/05

The Dell 28/07/04

The Dell 09/03/04

Similar services:

Claremont House

Chesham House

Oak Ridge

Argyll House

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Extracts from inspection reports are licensed from CQC, this page was updated on 07/08/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Dell The Dell Nelson Way Beccles Suffolk NR34 9PH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: John Goodship     Date: 1 1 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: The Dell Nelson Way The Dell Beccles Suffolk NR34 9PH 01502712683 01502712683 nicki.fountain@socserv.suffolkcc.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Suffolk County Council Name of registered manager (if applicable) Mrs Nicki Fountain Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 1 The home may accommodate one named service user with Mental Disorder as detailed in the variation application dated 26/2/06. Date of last inspection Brief description of the care home The Dell is a purpose built home owned and managed by Suffolk County Council. Situated on the outskirts of the market town of Beccles in a residential area with shops and other facilities nearby. The home has access to a tail lift mini bus. The home has a landscaped garden with car parking and an attached day centre, which is run separately but available to residents of the home. Care Homes for Older People Page 4 of 27 care home 38 Over 65 12 1 27 0 0 0 Brief description of the care home The home is set out on two floors and divided in to four houses, Balmoral, Windsor, Homelea and Gloucester house. Each house other than Balmoral, which also has it?s own laundry, has bedroom, sitting and dinning rooms, a kitchen, bathroom and toilet facilities. There is a central main kitchen and laundry servicing the home and day centre. The Dell is registered to provide care to 38 older people, the places in Balmoral House being offered to people with a diagnosis of dementia. The fees at the time of this inspection started at £380.00 per week. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We visited the home for a key unannounced inspection, which focussed on the outcomes for the residents assessed against the national minimum standards for older people. Our visit lasted six hours. The manager was present throughout the visit, and showed us around the home. We spoke to two residents alone, and three residents sitting in the communal areas. One of these had two visitors who talked to us about the home. The manager had completed an Annual Quality Assurance Assessment (AQAA) some time before our visit, so we took the opportunity to update some of the information. Surveys had been sent out for residents and staff, but none had been returned by the Care Homes for Older People Page 6 of 27 date of this report. There were twenty six people living in the home on the day of our visit. We tracked two of them through examining their care plans, talking to staff about them, and in one case talking directly to them about their life in the home. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to have their needs assessed before being offered a place, and they will be able to assess whether they wish to live in the home. Evidence: We looked at the information available to people who were planning to move into the home. The statement of purpose and the service user guide gave information about the criteria for admission, how the home was run, what facilities residents had in their room and in the communal areas, and where the homes most recent inspection report could be seen. Both documents had been updated to include the name of the manager who had started in May 2008, and the fees charged. At the date of our visit, the fees started at £380.00 per week. This latter item explained that fees actually paid would be dependent on residents income and capital. All referrals came through the local authority who assessed residents financially. The home did not accept private payers. Care Homes for Older People Page 11 of 27 Evidence: We examined the records for two recent admissions. Both had had assessments done by a social worker as well as one by The Dell. These assessments showed that the home had considered whether the persons needs could be met by the home. Both files held copies of the contracts signed by the residents. The manager told us that three new admissions were expected during the next week. The AQAA stated that visits were arranged to the home prior to admission to enable residents and their families to see where they would be living and meet other residents and staff. It also stated that there had been no placement breakdowns in the last twelve months. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to have a care plan they have helped to write that is reviewed regularly to ensure that it continues to meet their needs. Evidence: The AQAA told us that all residents had a care plan which was reviewed and updated regularly. We examined two care plans. Both held information on the persons needs and translated these needs into a care plan under headings relevant to each person. Both recorded that the plans had been reviewed on a monthly basis, and one showed that changes had been made to the care plan following one of these reviews. Particular attention was paid to moving and handling assessments including wheelchair risk assessments. One persons weight was being monitored and their level of nutrition screened. We were able to talk to one of these residents who confirmed that they had agreed and signed the care plan and were aware of the changes. One resident had no hearing or speech. We saw staff communicating with them by a combination of the person signing and writing things down. A staff member told us Care Homes for Older People Page 13 of 27 Evidence: that they could communicate with this person as they could interpret their wishes very quickly. The manager told us that staff were not yet trained in sign language. The communication sensory team were meant to come to the home for two hours each week but no-one was available to do that at the moment. This resident would be moving to very sheltered housing shortly. Care plans included records of all contacts with health professionals such as the GP, optician, chiropodist and Hearing Support Services. We were told about a previous external review of the care given on the Balmoral unit, and how it met the needs of those with dementia. We saw evidence that staff were very skilled at connecting with the residents, establishing eye contact when speaking to them, getting down to their level if they were seated. Staff offered residents choices whenever possible through picture menus, where they wished to sit, and offering them drinks. The manager told us that twelve beds were currently unoccupied as admissions had been restricted because of the need earlier in the year for several residents to have two members of staff with them when they needed personal care, such as moving and hoisting. Staffing recruitment restrictions had meant that no additional staffing posts were agreed by the local authority. However the situation had eased and three new admissions were due the following week. Staff told us that, for the residents needs, the home had sufficient hoisting equipment. We observed part of the lunchtime medication round undertaken by a team leader. Each administration was checked on the record sheet, given and seen to be taken by the resident and then signed for. There were no gaps in the records seen by us. The records for the administration of creams were not complete in all cases. Creams were stored in each persons room in a lockable wall cupboard originally intended to hold all their medication. Staff responsible for administering medication had been trained by a local college course The safe administration of medicines. We saw the schedule for two acting team leaders to undertake the course. The manager told us that the pharmacy supplier visited to undertake a medication audit every six months. We observed staff interacting with residents in a friendly and sensitive way. One person told us that staff like to chat with me. Another person told us that it was their choice to spend all day in their room. The staff are very nice. They come when I ring the bell. A relative told us that the staff always keep me informed of any changes. Care Homes for Older People Page 14 of 27 Care Homes for Older People Page 15 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to enjoy a good quality of life, and be given a nutritious and varied diet. Evidence: There was a day centre attached to the home run by the local authority where many residents could join in the entertainment which was put on there. Staff told us about sessions of gentle exercising, bingo, and visiting entertainers.The AQAA told us that the home liaised with the day centre to use their minibus for outings. One resident told us about a trip to Southwold. The manager told us that the home no longer had an dedicated activity carer three days a week. This person used to involve residents in arts and crafts, making items to be sold at fundraising events. Now staff carried on these activities as time allowed during their shift. We saw items which residents had made on display in the lobby. We saw a computer in the lobby which the manager told us was being used by some residents to keep in touch with distant family. One resident on the special needs unit was helping a carer to fold towels. A previous study by the home had found that more involvement in domestic chores would be a benefit to residents. Staff told us that Care Homes for Older People Page 16 of 27 Evidence: some residents helped to lay the tables. A residents told us that its very nice here. Its better than living on your own. I have my own ornaments in my room. Another said We have very good food here. The menu that day, which was on each table, consisted of sausage meat pie, potatoes and vegetables, or macaroni cheese. followed by ginger sponge and custard. The tea choice was cheese and potato pie, toasted crumpets, sandwiches and cakes. Tables in each unit were set with napkins. The kitchen had been inspected by the local authority in December 2008. Their report noted that the kitchen was clean and very well organised. Well done. Care Homes for Older People Page 17 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect the home to respond to any concerns they have, and to ensure that they are protected from abuse. Evidence: Information on the complaints system was available in the foyer of the home. Relatives had told us at previous inspections that they were aware of the formal system, although some said that they would see the manager if they were not happy. There had been no formal complaints in the twelve months preceding our visit. The AQAA told us that information on any complaints received, including the issues raised and the outcomes, was passed to the providers Customer Rights Team. The home had advised the Commission that they had referred two cases to the safeguarding system. We discussed the outcomes of these with the manager. The manager had taken the proper steps in both cases. New risk assessments around aspects of care had been made and were filed in the care plan. We saw the records of staff training sessions on the protection of vulnerable adults, and staff told us about their training and showed that they understood their responsibilities. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to enjoy a homely, clean and well-maintained environment. Evidence: The home was divided into four units which were designed for small group living. There were dining and lounge areas on all units, and there were communal areas and quiet rooms for residents to socialise or meet their visitors in private. Two regular visitors were in the lounge of one unit, and there was a lively and friendly atmosphere. The manager reported that two weeks prior to our visit, the home had been affected by an unpleasant smell. This had initially been thought to be a gas leak and the appropiate service had been called. Nothing was found. An air quality check was undertaken and found that there was no danger to residents and staff. The provider had also conducted a health and safety audit to confirm that systems were in place and procedures were followed. At the time of our visit, the home was clean and free of any unpleasant odours. Individual rooms had some of the residents own belongings, ornaments and pictures. In the special needs unit they had the occupants name in large letters on the door. The photographs of the staff on duty were displayed as well. Care Homes for Older People Page 19 of 27 Evidence: The manager told us that two new fire doors were on order and a new bath for one of the units. The home had an improvement plan for the coming year which included these items as well as some redecoration. It was not yet clear how much was able to be funded by the provider. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to be cared for by properly recruited and trained staff. Evidence: On duty during our inspection were one duty team leader, two carers on Balmoral the special needs unit, and one carer on each of the other three units. In addition, two carers were used as floats in the mornings, and one as a float in the evening. The rota showed that at night there were two carers on and a team leader. Admissions had been stopped for a time because there were seven residents needing two carers to provide personal care including moving and handling. This number had now reduced so that admissions were able to be accepted. The manager was well aware of the need to maintain a careful balance of staffing to residents care needs. In the absence of being able to take on more staff, the control would normally be to restrict admissions. At the time of our visit, the home was advertising one carer vacancy. The filling of other vacancies in the past year had meant a reduction in the agency staff used, and more reliance on the homes own relief staff, This gave more continuity to the care and residents were more likely to know the carers. There were twenty six residents in the home on the day of our visit, with three more expected within a week. Care Homes for Older People Page 21 of 27 Evidence: We examined the personal files of two staff who had been recruited in the last six months. All the recruitment, identification and protection documents were in place following the providers policy and procedure. Training records were also in the files, showing that new staff attended the Common Induction Standards course run by the provider, as well as other training such as fire procedures,people moving, and the prevention of abuse. General training records listed the full range of training undertaken and planned. Some training took place at the providers training centre at Kerrison, while other sessions were conducted through DVDs. Following a requirement made at the last inspection, the cook confirmed that she had completed Food Safety training for all staff in 2008. Certificates were on file. We interviewed two carers, one of them a team leader. The team leader confirmed their training programme, and were able to describe thier particular responsibilities, especially in regard to infection control and their supervision of staff. They told us that they were responsible for the supervision of the domestic staff. The other carer was newly appointed. They described their in-house induction, prior to the off-site induction programme. They demonstrated their ability to communicate with residents even those who had difficulty hearing or speaking. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to live in a safe environment and for their views to be sought on the running of the home. Evidence: The Certificate of Registration was displayed in the hall. It showed that the registered manager post was vacant, as the current manager, who had been in place since May 2008 and had transferred from a registered manager position in another home run by the provider, was required to be registered with the Commission in respect of The Dell. She had now completed her fit person interview for this post and was awaiting the outcome. The home was subject to the providers in-house monthly inspection process, which met the requirements of the Care Home Regulations. We saw the December 2008 report but the home had not yet received the written report for the next month. Care Homes for Older People Page 23 of 27 Evidence: The AQAA told us that staff meetings were held and the senior team met regularly. We were told that residents meetings were held, by unit, usually once a year. We saw the notes of the last meeting held on one unit. There were comments about the choice of food on the menu. The team leaders also completed a monthly report for the manager. Annual questionnaires were sent to residents and relatives. We saw the returned forms for 2008. All the comments made said the care was good. The AQAA told us that residents had lockable drawers for safekeeping their valuables or personal papers in their rooms. Their personal allowances could be paid into a personal account and withdrawn on their behalf at any time. This was controlled through the treasury office of the provider. The home did not keep residents monies. Staff were subject to two monthly supervisions, and an annual appraisal. Staff confirmed that team leaders did their supervisions, and the records of these were held in staff files. We saw records of health and safety checks, such as hot water temperatures, checks on fire equipment, updating the fire risk assessment and completing incident reports. The latter were sent to the providers health and safety adviser. The home sent reports of serious incidents to the Commission as required in a timely way. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 Staff should be reminded of the need to record on each occasion when medicinal creams are administered to residents. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!