Inspection on 25/07/06 for The Dell Residential Care Home

This inspection was carried out on 25th July 2006.

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

The inspector 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 Residential Care Home 04/07/07

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE The Dell Residential Care Home The Dell Residential Care Home 45 Cotmer Road Oulton Broad Lowestoft Suffolk NR33 9PL Lead Inspector Julie Small Unannounced Inspection 25th July 2006 11:15 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 Dell Residential Care Home DS0000066686.V302879.R02.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 Dell Residential Care Home DS0000066686.V302879.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Dell Residential Care Home Address The Dell Residential Care Home 45 Cotmer Road Oulton Broad Lowestoft Suffolk NR33 9PL 01502 572591 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) Maria Assumpta Egan Peter John Egan Mrs Jean Spoor Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places The Dell Residential Care Home DS0000066686.V302879.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th January 2006 Brief Description of the Service: The Dell Residential Care Home is situated in Oulton Broad, Lowestoft. The home was first registered in 1985 to provide care for up to 27 older people, and was taken over by new proprietors Mr and Mrs Egan in March 2006. Oulton Broad and the south Oulton Broad railway is within walking distance and a bus service is available to Lowestoft. A variety of local shops and facilities are situated close by. The home is a large two storey Victorian House with a ground floor extension set in pleasant well maintained gardens, which provides seating areas for service users to enjoy if they choose. The majority of bedrooms are situated on the ground floor, with the remaining eight rooms on the first floor, which can be accessed by a stair lift should mobility be a problem. The home has a large dining room, two lounges and a conservatory. The manager informed the inspector that at the time of the inspection fees for the home were £331 to £349 per week. The Dell Residential Care Home DS0000066686.V302879.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on Tuesday 25th July 2006 over a period of eight hours. The inspection was a key inspection which focused on the core standards relating to older people and was undertaken by regulatory inspector Julie Small. The report has been written using accumulated evidence gained prior to and during the inspection. The homes manager, Mrs Jean Spoor was present during the inspection and assisted the inspector in the process; the homes proprietors were present for a portion of the inspection. Residents, staff and visitors and relative’s questionnaires regarding the service and a pre inspection questionnaire were sent to the home prior to the inspection and a number were returned to the inspector, a summary of responses can be found in the main body of the report. Methodology used during this key inspection included a tour of the building, viewing of records including service users care plans, menus and staff rotas, observation of usual work practice and a number of staff and residents were spoken with. There had been some concerns raised including an increase in charges at the home, residents being charged for the fitting of a door guard and deterioration in the quality of care and food since the change of proprietors; standards including these issues were inspected. The home refers to service users as residents at the home; this term is used throughout the report. What the service does well: What has improved since the last inspection? The storage and administration of medication had improved, with the provision of a dedicated treatment room situated next to the dining room. It was reported that the temperatures to food had improved, the proprietors said that they had improved the homes menus offering a varied diet and that the home had recently recruited a trained cook. The Dell Residential Care Home DS0000066686.V302879.R02.S.doc Version 5.2 Page 6 The home had completed a quality assurance exercise which included requesting residents and their representative’s views about the care they provide. Notifications of notifiable incidents are routinely forwarded to CSCI. It was noted that there were no fire doors wedged open during the inspection. Staff recruitment records were viewed and there were two written references present for recruited staff. The staff team had received vulnerable adults training since the last inspection. The homes complaints procedure has been amended to include contact details of CSCI, the procedure had previously provided details of the previous inspection body. Comments, complaints and suggestions guidance for staff, service users and representatives provides information about contacts they may wish to make to Suffolk County Council Customer 1st. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Dell Residential Care Home DS0000066686.V302879.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Dell Residential Care Home DS0000066686.V302879.R02.S.doc Version 5.2 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): 2, 3, 6 The quality in this outcome area is adequate. Prospective residents can expect that prior to them moving into the home they have their needs assessed. Each residents has a written contract and statement of terms and conditions with the home, however they cannot be assured that they will be formally notified of additional charges or changes to their charges. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home did not provide intermediate care. Six residents records were viewed, there was evidence that residents had received assessments of need prior to moving into the home. One assessment viewed did not have the date of the assessment or an indication of who completed the assessment. The proprietors stated that this was completed prior to them taking over the home. All records should be signed by the individual completing it and dated to indicate when the record was completed. There were care plans present which included how the home meets the resident’s day to day living needs. The Dell Residential Care Home DS0000066686.V302879.R02.S.doc Version 5.2 Page 9 Concerns had been raised regarding increased fees for service users and an additional payment request for a door guard. During the inspection the proprietors were asked for further information regarding the door guard, one proprietor said that the fire service do not endorse door guards for bedroom doors and so were not provided by the home and residents who had requested them were informed of an additional charge. A request for information was received by CSCI (Commission for Social Care Inspection) from a resident’s family member regarding increased fees and the request for additional payment for the charging of the resident’s scooter. A letter was written to the home by a family member asking for further information regarding the fees. During the inspection the homes proprietor provided a copy of the response which identified that increased fees were required because the resident had paid ‘far too little’ for their care in the past, that it was unreasonable to expect the home to subsidise the charging of the scooter. A new contract would be issued in due course and that the home would be happy to provide an invoice, however, the proprietor added that an additional charge may be made for administration costs. Two residents spoken with during the inspection raised concerns about the affordability of increased rates. Residents spoken with confirmed that they had received a letter the month before, informing them of the increases. Five residents records viewed included contracts and conditions of admission and of terms of business, which stated that fees might be increased provided four weeks notice was provided. There was also reference to extras that residents may be required to make which included services such as physiotherapy, chiropody, opticians and hairdressing and stated that there would be additional charges made for services such as storage and charging of mobility carriages and other services. There was information in resident’s records from the local authority regarding their contributions, where applicable, to paid fees. The pre inspection questionnaire stated that additional charges included hairdressing, chiropodist, toiletries, newspapers and magazines, holidays, collection for church and hospital visits. Seven ‘have your say about…’ resident’s questionnaires were returned to CSCI. Three said that they had contracts; two said that they did not and two did not respond to the question. The Dell Residential Care Home DS0000066686.V302879.R02.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 The quality in this outcome area is good. The health and personal care, which a resident receives is based on their individual needs. The principles of respect, dignity and privacy are put into practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Five residents records were viewed, each had care plans identifying how the resident’s day to day living needs were met. Residents records also included a ‘spider chart’, providing a pen picture of the residents care plan such as how the resident bathes, allergies, their oral hygiene needs and specific dietary needs. There was evidence that care plans were updated regularly by staff which reflected residents changing needs. There were some risk assessments in place, such as risks of falls. There were daily records, which identified resident’s actions and well being throughout each day. Resident’s records viewed included health care records including their doctor, dentist and optician contact details and details of appointments and treatment received. During the inspection there was a chiropodist providing a service to residents at the home. The manager said that they were private chiropodist The Dell Residential Care Home DS0000066686.V302879.R02.S.doc Version 5.2 Page 11 and it was the resident’s choice to use them, they said that there is also a state chiropodist who provides a service. There were dependency assessments, which included risks of pressure areas, safety, habits, hygiene, sleep, socialisation, weight and continence. There was evidence that staff had received training regarding the use and maintenance of hearing aids and eye care and eye disease. During a tour of the building it was noted that there was a notice posted on the notice board advertising a music, dance and movement activity which residents could participate in if they wished to. Since the last inspection there was improvements made with regards to the procedure for administering medication. There was a ‘treatment room’, which had previously been an office, where the drugs trolley was stored. One proprietor showed the inspector a device which they had bought to fasten the trolley to the wall. The drugs trolley and treatment room was locked when not in use. The lunchtime medication was observed and the staff member administering medications explained the process clearly to the inspector. Medication was appropriately dispensed and the staff member ensured that the residents had taken the medication before signing for it. The home uses a monitored dosage system. Records of controlled medications were appropriately kept and the inspector checked the amount of controlled drugs with the record and it was found to cross-reference. Controlled medicines were stored in the trolley, the proprietors said that it had previously been stored in a lockable metal cabinet attached to the wall, and controlled medicines were returned to this location. One staff member was spoken with and explained the methods for disposing of medicines, recording when residents were at hospital and when residents refused to take their medication. Medication records were viewed which evidenced that appropriate actions were taken. It was noted that there were some gaps in signatures to show that medication had been administered. The manager was spoken with who explained that one gap was when a review of a resident’s medication had been requested by the manager, they provided records that coincided with the identified date. The staff member undertaking the administration of medication produced a training certificate which evidenced that they had received training in the safe handling of medicines. There was two bottles of cough medicine which, a staff member who was spoken with said were the only unprescribed drugs kept in the home, these were clearly labelled and securely stored. There was a metal cabinet in the treatment room where stocks of medicines were kept, such as medicines which had recently been delivered to the home; this cabinet did not have a secure locking device which worked, however, the cabinet was located in a room which was lockable when staff members were not present. The Dell Residential Care Home DS0000066686.V302879.R02.S.doc Version 5.2 Page 12 Eight residents spoken with said that their privacy was respected at the home and staff treated them with respect. Interaction between staff and residents was observed to be positive and respectful. Residents confirmed that staff members knocked their bedroom door before entering and this was observed to be the case during the inspection. Three residents were asked if they were addressed by a term they preferred, which they confirmed to be the case. Seven residents questionnaires returned to CSCI, included the question ‘do you receive the medical support you need?’, six answered always and one answered usually. The Dell Residential Care Home DS0000066686.V302879.R02.S.doc Version 5.2 Page 13 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, 13, 14, 15 The quality in this outcome area is good. Residents are able to choose their lifestyle, social activity and keep in contact with family and friends. Social cultural and recreational activities meet resident’s expectations. Residents receive a healthy, varied diet according to their assessed requirement and choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residents questionnaires ask the question ‘are there activities arranged by the home that you can take part in?’, one responded always, five responded usually and one responded sometimes. During a tour of the building, there was a notice board which showed forthcoming activities which residents could participate in if they chose to, activities included day trips out such as to Southwold and Beccles, shopping trip to a supermarket, music and movement and board games. The manager was spoken with and said that Salvation Army, singers and coffee mornings were also activities provided in the home. The manager had purchased some large print and giant print books for residents to read if they wished, there was a library service regularly provided to the home. There was previously a chapel in the home, which was being removed in the homes extension. The manager The Dell Residential Care Home DS0000066686.V302879.R02.S.doc Version 5.2 Page 14 informed the inspector that there were ministers of various denominations that visited residents at the home. There were religious services held in the home bi-weekly, for all denominations of Christians. During the inspection there was a visit to the home by a Seventh Day Adventist minister. There were also several places of worship in the area, which residents could attend if they wished to. Some residents were observed sitting in a lounge and chatting, a group of three residents was observed sitting in the second lounge which had the television on, one resident was reading the newspaper, which they said they get every day. Some residents were spending time in their bedroom and one resident was observed sitting in the garden with a visitor. Residents spoken with said that they had enough to do at the home, they said that sometimes the manager and a resident play the piano in the lounge and they could sing. Residents said that they receive visitors at the home and they were made welcome. Six visitors/relative comment cards were returned to CSCI, six responded that they were made welcome when visiting the home and six responded that they could visit their friend or relative in private. Staff members spoken with said that they had previously spent time with residents doing things such as painting their nails, doing their hair, or talking, which they no longer had time to do. Three residents were spoken with and said that they had bought personal belongings and some items of furniture to the home when they moved in, which was in their bedroom. One resident said that they could bring items of furniture with them, but there was a limit to what they could get into their bedroom. There was a concern raised prior to the inspection that a resident had preferred brown bread, which the home did not provide and they had to purchase it if they wanted to eat it. One proprietor was spoken with and said that there was a resident who preferred a particular type of bread, they had been provided with the money by the home and were supported to go to the shops to purchase the bread. They said that it was a positive action which had provided the resident with some independence and encouraged them to go out into the community. All residents were spoken with said that they were provided with a choice of brown or white bread. The homes menu was viewed and was found to be varied and each meal included a vegetarian option. Lunchtime was observed, residents had chicken potatoes and vegetables and they had scrambled eggs on toast and sandwiches for their evening meal. The dining room was large and provided sufficient seating for residents. The Dell Residential Care Home DS0000066686.V302879.R02.S.doc Version 5.2 Page 15 The kitchen was seen and food was found to be appropriately stored, the kitchen was clean. There was a separate freezer for vegetarian food. There were lots of fresh vegetables stored in the fridge. The majority of food stored was shops own brand food; with the exception of vegetarian food which was brand named. It was noted that there were no bowls of fresh fruit in the home for residents to help themselves. The manager said that there was a fruit bowl which residents can choose a piece from each morning. Fresh fruit was stored in the pantry in the kitchen and consisted of bananas. There were tins of grapefruit and orange segments, and prunes available; the manager said that they also provide apples. Residents were observed to have drinks provided throughout the day. Prior to entering the kitchen the manager provided the inspector with an apron and ensured they washed their hands in a newly installed sink near to the entrance of the kitchen. The resident’s questionnaires asked the question ‘do you like the meals at the home?’, three responded always, three responded usually and one responded sometimes. One relative/visitors comment card had a comment that food was warm, and hot drinks were not hot enough and cold drinks were not cold. The manager was spoken with and said that they had rotated the order that residents were served their meals. One proprietor said that they were planning to put the hot plate in an alternative place and that they but ice cubes for drinks. Residents spoken with said that the temperature of food and drinks was acceptable. One resident spoken with said that the food at the home was adequate, they said that they did not choose what they could eat, they ate what was served. One resident spoken with said that the meat was of good quality and the home used a butchers to purchase their meat rather than a supermarket. One resident spoken with said that the cornflakes were a shop’s own brand, which they said were not as good as the named variety. Four residents spoken with said that the staff ask them each morning what they want to eat from the menu for that day and can choose an alternative if they do not like what is on the menu. A copy of a letter sent to the home regarding a concern about the inferior quality of cereals at the home and that a resident subsidises their meals with snacks they purchase from the shops. A response from the proprietor was provided to the inspector which responded that the fees paid do not allow the home to purchase branded cereals and that the food had improved since they had purchased the home and that residents were provided with sufficient food. A staff member was observed assisting a resident to eat their meal; they remained with the resident until they had finished their meal. There was a concern in one staff comment card regarding care staff assisting in the kitchen and the risk of cross infection. Care staff were observed to assist The Dell Residential Care Home DS0000066686.V302879.R02.S.doc Version 5.2 Page 16 in serving the lunchtime and preparing and serving evening meal, all were observed to be wearing protective white aprons while undertaking the task. The Dell Residential Care Home DS0000066686.V302879.R02.S.doc Version 5.2 Page 17 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, 18 The quality in this outcome area is good. Residents can expect that they have access to a complaints procedure and that their complaints will be acted upon and that they will be protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During a tour of the building it was noted that the homes complaints procedure was displayed on a notice board, which was accessible to residents and visitors to the home. Residents spoken with said that they would speak to the manager or the proprietors if they wanted to make a complaint. The Dell had produced comments, complaints and suggestions information for the attention of staff, service users and representatives which provided guidance for raising issues. The guidance included reference to CSCI and Suffolk County Council Customer 1st. The homes complaints procedure was viewed and includes contact details of CSCI, details of how to make a complaint, who to contact in the home, what actions would be taken and how the individuals making the complaint would be kept informed. Eleven staff comment cards were received, all stated that they were aware of the homes complaints procedure. Six relatives/visitors comment cards were received, three stated that they were aware of the homes complaints procedure and three said that they were not. Seven residents ‘have your say about...’ comment documents were received, one question was ‘do you know how to make a complaint?’, three said always, two said usually and two did not answer the question. The Dell Residential Care Home DS0000066686.V302879.R02.S.doc Version 5.2 Page 18 Previous concerns and complaints records were viewed and were appropriately acted upon. One recent concern regarding the quality of food and the payment of fees, was raised by a residents family member, the response letter from the home, which had been sent within appropriate timescales, stated that it may have been more appropriate to approach the homes proprietors or manager before speaking to CSCI. The home has a whistle blowing procedure, which was viewed, the procedure clearly explains what actions staff could take if they were concerned about any aspects of the care provided in the home. Staff spoken to were aware of methods of reporting concerns, although recent concerns raised regarding the service which is provided by the home were made to sources outside of the home. Staff expressed some concerns about outcomes if they raised a concern or made a complaint. The home had recently updated their policies and procedures in line with the change in proprietors. The home provided policy and procedures regarding acceptance of gifts, aggression towards staff, missing persons, racial harassment and vulnerable service users. Training records were viewed which evidenced that staff had attended the TOPSS (now Skills for Care) induction and foundation training at the local authority and included the protection of vulnerable adults sessions. The homes manager was spoken with and showed the inspector a training pack on ‘no secrets’, which was used to train staff in the home. Staff members spoken with were aware of how to raise concerns about the safety of residents living at the home. Seven staff comment cards were received and all stated that they had received training in the homes abuse policy. The homes protection of service users policy was viewed and was found to be informative and clear. The policy included defining abuse, identifying abusers, the role and accountability of staff in relation to abuse, managers responsibility, preventing abuse from occurring, identifying actual or possible abuse, action when abuse has or is alleged to have occurred and planning further action, the policy refers to other policies and procedures which related to the protection of residents. The Dell Residential Care Home DS0000066686.V302879.R02.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25, 26 The quality in this outcome area is adequate. Residents can expect to live in a safe, comfortable and well maintained environment which is clean and pleasant, they cannot be assured that there are adequate hygiene standards. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the building was undertaken and it was found to be attractively furnished, well maintained and clean, there were no unpleasant odours identified in the home. There was domestic staff on duty in the morning and early evening during the inspection. The homes buildings manager was spoken with and confirmed that they did minor repairs required in the home and undertook regular water temperature checks. One of the proprietors told the inspector that they had an inspection from the fire service during the morning of the inspection and they had ‘passed with flying colours’, there had been no feedback received from the fire service at the time of writing this report. The Dell Residential Care Home DS0000066686.V302879.R02.S.doc Version 5.2 Page 20 There were areas in the home where residents could relax, a group of residents were observed sitting in a large airy lounge, which had the doors to the garden open, the room was comfortable and the residents said that they were comfortable. There were two lounges and a conservatory where residents could choose to relax and there was a large well maintained garden with seating which residents could enjoy if they chose to. The weather was hot and sunny during the inspection and residents spoken with said that they could sit outdoors if they chose to, but preferred to stay indoors on that day because it was too hot. One resident was observed enjoying the grounds with a visitor during the inspection. All rooms were airy and well ventilated during the inspection. The laundry was viewed and found to provide suitable equipment to meet the needs of the residents. There was hand wash in dispensers in all toilets and bathrooms and next to the entrance of the kitchen, not all toilets and bathrooms were provided with disposable paper towels, there was a towel hanging up for individuals to dry their hands. One of the proprietors said that there were paper towels on order, however, there must be suitable hand drying materials provided to ensure that the risk of cross infection is prevented. Prior to entering the kitchen during the inspection the inspector was provided with a white apron and requested to wash their hands prior to entering the kitchen, the inspector was provided with a towel to dry their hands on. The manager was spoken with regarding the disposal of soiled pads, they stated that they were sealed in ‘nappy sacks’ and were disposed of by the council. Staff spoken with said that bags to dispose of soiled pads were not always available. Staff were observed in serving meals and in assisting in the preparation of the evening meal, they all wore white aprons over their clothing. One staff comment card received stated that they felt there was a risk of cross infection when staff were required to work in the kitchen following any personal care duties. During a tour of the building it was noted that there was no shower in the shower room, following investigation by the registered manager it was found that the shower was in the process of being repaired. Seven residents ‘have your say about…’ questionnaires were received, one question asked ‘is the home fresh and clean?’ five stated always and two stated usually. The Dell Residential Care Home DS0000066686.V302879.R02.S.doc Version 5.2 Page 21 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, 30 The quality in this outcome area is good. Staff in the home are trained, skilled and sufficient in numbers to fill the aims of the home and meet the changing needs of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The homes rota was viewed and showed that there were three care staff on duty for the early shift, three staff on the late shift and two staff during the night, the rotas included the managers hours of working and where staff were sick, on holiday or training. One proprietor was spoken with and explained how they complete the rota and that they ensure that the rota is completed in sufficient time to make any required changes to meet staff requests and needs. Six relatives/visitors comment cards were received three said that they felt there were always sufficient staff on duty and three answered no. one comment was ‘sometimes there are only two staff on duty which I don’t think is enough as they have to prepare meals as well’. Seven residents ‘have your say about…’ questionnaires were received, one question was ‘are the staff available when you need them?’, three stated always, three stated usually and one stated sometimes. The pre inspection questionnaire stated that there were 20 care staff at the home, six staff had achieved NVQ (National Vocational Qualification) in care at The Dell Residential Care Home DS0000066686.V302879.R02.S.doc Version 5.2 Page 22 level 2 or above and that eight staff had almost completed their NVQ level 2. Three staff members were spoken with and confirmed that they were working on their NVQ award and had almost completed their award. Two staff members said that they felt that their award would be completed in approximately two months time. The home have not yet met the target of at least 50 of staff to have achieved the minimum of NVQ level 2, however, this would be met when staff who were working on their NVQ award have completed. Staff recruitment records were viewed and the home were found to have made appropriate checks, including two written references and CRB (criminal records bureau) checks. Staff training records were viewed and evidenced that staff were provided with the necessary induction training, which the manager explained was provided by the local authority. There were various training courses which had been provided to staff which included health and safety, eye care, hearing aid care, death and dying, manual handling, first aid, medication, incontinence and dementia. The home were providing in house fire and no secrets training. Eleven staff comment cards were received, one question was ‘do you feel the home has a good training and development programme, to support staff?’, ten stated yes, one was not answered and to the question ‘do you feel that you have received sufficient training to undertake your role?’ eleven said yes. The Dell Residential Care Home DS0000066686.V302879.R02.S.doc Version 5.2 Page 23 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): 31, 33, 35, 37, 38 The quality in this outcome area is adequate. Residents can expect that they live in a home which is run and managed by a person who is fit to be in charge and that their financial interests are safeguarded. However they cannot be assured that they will be consistently informed of changes in costs. Service users health, safety and welfare is promoted, however, safety items such as paper towels and disposable bags must always be readily available. This judgement has been made using available evidence including a visit to the home. EVIDENCE: The homes registered manager was found to be competent through the registration process, their qualifications and training certificates were displayed in the home. The manager was spoken with and clearly understood their role and lines of accountability. They were knowledgeable about the needs of the service users they provide a service to. The pre inspection questionnaire stated The Dell Residential Care Home DS0000066686.V302879.R02.S.doc Version 5.2 Page 24 that the manager had undertook training courses and attended local conferences, including care home seminar, regional conference, quality assurance and care planning management, provider forum Suffolk County Council and East Anglian ambulance service regarding falls. The homes proprietors confirmed that they had recently undertaken a quality assurance exercise, including seeking the views through questionnaires of service users and their representatives. No evidence was seen to confirm this. They were planning to undertake the exercise on a regular basis and would be used to continue to monitor and improve their service. There were also opportunities used to gain the views of residents through a meeting and informal day to day discussions. There was minutes of the residents meeting displayed on a notice board, which introduced the homes proprietors to them. Seven ‘have your say about…’ resident’s questionnaires answered yes to the question ‘do the staff listen and act on what you say?’ One resident spoken with said that the proprietors and manager were approachable and kind. The homes previous inspection report was displayed in the entrance hall and was available to visitors and residents. Actions required which were identified in the previous inspection report had been undertaken in the agreed timescales. The homes proprietors were spoken with and said that they had recently updated all the home policies and procedures in line with their taking over of the home. The home was undergoing and extension at the time of the inspection, with the aim to increase the number of residents living at the home, the application had been submitted to CSCI. Three residents were spoken with and said that family members ensure that their finances were monitored and they said that they were happy with the arrangements. The pre inspection questionnaire stated that one resident handles their own financial affairs and there were records kept of the management of personal allowances for two residents. The manager and proprietors do not act as appointee for any resident. The home has a procedure regarding service users money and financial affairs management. There had recently been increased fees to the home and some concerns were raised regarding extra payments that were sought for items such as charging of a scooter and a door guard. One resident’s family member had sought clarification of costs and were informed that they may be required to make a further payment for itemised information. The homes records viewed were secure, up to date and in good order and met requirements. The home provided routine notifications of any events that affected the well being or safety of the residents to CSCI. The Dell Residential Care Home DS0000066686.V302879.R02.S.doc Version 5.2 Page 25 The pre inspection questionnaire stated that the home had nine staff that held first aid certificates, regular health and safety checks were undertaken including fire, water, electrical and gas appliances. COSHH (control of substances hazardous to health) assessments had been completed and electrical wiring certificate had been issued. The fire safety records were viewed and evidenced that regular checks were undertaken. The homes buildings manager was spoken with and explained their responsibilities for ensuring hot water checks and fire checks were made and ensuring that the homes maintenance and safety was regularly monitored. There was a robust fire safety procedure which was viewed, staff were provided training sessions on the homes fire safety procedure. Food storage in the kitchen was found to be appropriate. Three staff spoken with had a good knowledge of infection control. There were health and safety procedures available in the home. Accident records were viewed and found to be appropriately kept; the majority of accidents in the home were falls. There were no identified patterns or identification of particular residents, they were different residents in varying circumstances, and actions had been taken to alleviate risks. During a tour of the building it was noted that there were some toilets and bathrooms which did not have disposable hand drying towels. There were towels hanging in the bathrooms, which could pose a cross infection risk. Staff raised concerns that there were not always sufficient disposal bags for soiled pads. Staff members commented that they were not comfortable in approaching the homes proprietors regarding concerns they had about service users welfare and safe working practices. The Dell Residential Care Home DS0000066686.V302879.R02.S.doc Version 5.2 Page 26 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 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 3 2 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 3 X 3 X 2 2 The Dell Residential Care Home DS0000066686.V302879.R02.S.doc Version 5.2 Page 27 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 OP38 Regulation 12(5)(a) Requirement The registered provider and registered manager should maintain good personal and professional relationships with staff and service users to ensure that any concerns may be raised and solved Staff must record when medication is administered and if not the reason must be given The registered person must ensure towels are not used for hand washing in toilets and bathrooms and that there is disposable hand wash towels available to prevent the spread of infection The registered person must ensure that there are appropriate methods of disposing of soiled pads There must be information available to individual service users regarding what is included in fees and what extra payments service users will be required to pay The shower must be repaired and available for service users DS0000066686.V302879.R02.S.doc Timescale for action 31/08/06 2. 3. OP9 OP26 OP38 13(2) 13(3) 31/08/06 31/08/06 4. OP26 OP38 13(3) 31/08/06 5. OP2 OP35 5(b) 31/08/06 6. OP19 23(2)(j) 31/08/06 The Dell Residential Care Home Version 5.2 Page 28 use 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. 2. Refer to Standard OP15 OP3 Good Practice Recommendations It is recommended that a greater choice of fresh fruit is provided to residents throughout the day. All records should be signed by the individual competing them and dated when completed The Dell Residential Care Home DS0000066686.V302879.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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