Inspection on 04/07/07 for The Dell Residential Care Home

This inspection was carried out on 4th July 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Dell Residential Care Home 25/07/06

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 John Goodship Unannounced Inspection 4th July 2007 09:00 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.V345177.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 Dell Residential Care Home DS0000066686.V345177.R01.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 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 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places The Dell Residential Care Home DS0000066686.V345177.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th July 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. It now has accommodation for 41 people in single rooms and two shared rooms. Oulton Broad and the Oulton Broad South railway station 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 recent 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 rooms on the first floor, which can be accessed by a stair lift or shaft lift. The home has a large dining room, two lounges and a conservatory. The owner informed the inspector that at the time of the inspection the standard charge for new residents was £500 per week. The Dell Residential Care Home DS0000066686.V345177.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit was unannounced and covered the key standards which are listed under each outcome group overleaf. This report includes evidence gathered during the visit together with information already held by the Commission. The inspection took place on a weekday and lasted seven and a half hours. The manager was present throughout, together with the two proprietors. The inspector toured the home, and spoke to some of the residents, and the staff, both individually and in a group. The inspector also examined care plans, staff records, maintenance records and training records. A questionnaire survey was sent out by the Commission to residents and to relatives. Eleven residents responded and thirteen relatives. Their answers to the questions and any additional comments have been included in the appropriate sections of this report. A staff survey was returned by six staff, and one social worker responded. The manager had completed an Annual Quality Assurance Assessment, a new self-assessment form which the Commission has introduced this year. What the service does well: The home was an attractively furnished, comfortable and well maintained environment. The home was clean and free from offensive odours. There were several communal areas where residents could choose to relax and enjoy, including the new lounge extension and conservatory. The new bedrooms were of a high standard with en-suite facilities and excellent access. Residents spoken with during the inspection said that they were comfortable in the home and were complimentary about the approach of the staff at the home. Comments from residents and relatives in the surveys included the following: “I always receive the care and support I need from the very kind and friendly staff.” “The staff are excellent when we need help to understand.” “During my relative’s recent battle with ill-health, the home was never less than courteous, helpful and willing.” The Dell Residential Care Home DS0000066686.V345177.R01.S.doc Version 5.2 Page 6 When asked what the home did well, relatives praised all aspects of the home, the attitude of the staff, the food, the health care support, the rooms, and the garden. Staff spoken to were knowledgeable about the residents they were providing a service to. Interaction between staff and residents was observed to be positive and respectful. What has improved since the last inspection? What they could do better: The manager is aware that staff levels must be reviewed as the number of residents increases to 41. A review of how the home finds out and meets the wishes of residents about how they would like to spend their day should be undertaken, with responsibility for the development of activities placed with a named member of staff. All records should be up-to-date, complete and dated. Staff must record when medication is administered and if not the reason must be given. Entries should be made in each resident’s daily record as frequently as required by the home’s policy. The room where the medications are stored should have a thermometer to ensure that the medication is store below 25°C. The fridge in that room should also have its temperature monitored. The Dell Residential Care Home DS0000066686.V345177.R01.S.doc Version 5.2 Page 7 The accessibility of call bells in all private and communal rooms should be reviewed to ensure the safety of residents. The schedule of staff supervision sessions should be brought up-to-date and then maintained on a minimum of six sessions a year, to ensure that staff’s competencies are kept up-to-date. The policy for recording accidents and incidents affecting residents should be reviewed, to give a complete picture of each resident. 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 Dell Residential Care Home DS0000066686.V345177.R01.S.doc Version 5.2 Page 8 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.V345177.R01.S.doc Version 5.2 Page 9 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): 1,2,3,5. Standard 6 is not applicable to this home. Quality in this outcome area is good. Prospective residents can be assured that they will have sufficient information to decide if this home is where they wish to live. The home will also collect information about the person to assure them that the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the inspection visit, there were twenty-nine residents, out of a total capacity of forty-one. The manager reported that there had been five referrals that week, and that two people were due to be admitted that day. The Statement of Purpose was examined and it contained all the information required by regulation. The fees charged were clearly stated, and the The Dell Residential Care Home DS0000066686.V345177.R01.S.doc Version 5.2 Page 10 additional charges that would be payable for items such as hairdressing, and non-NHS professional services. The Service Users’ Guide had been updated to include the names of the owners, details of the complaints procedure, and the fire procedures. It was produced in large print for easier reading. It included a helpful directory of local services. The Contract of Care set out the Conditions of Admission and the terms of business. One resident who spoke to the inspector said that their family had chosen this home after looking at several others. The resident had then come to the home for a day to see if they would like it. “All seemed very friendly and efficient.” In the survey, nine out of eleven responders said that they had received sufficient information about the home before they moved in. The care plan for the person recently admitted for long-term care contained a full pre-admission assessment covering all aspects of personal, social, and physical care needs. This was not dated. There was also an admission checklist to ensure that all information was gathered necessary for the care, and that the appropriate information was given to the resident and their relatives. One of these items covered the wishes of the resident when they died. The Dell Residential Care Home DS0000066686.V345177.R01.S.doc Version 5.2 Page 11 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 good. Residents can expect staff to identify and review their care needs to ensure appropriate care is given. Their safety is protected by the home’s medication procedure. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two care plans were examined, one for a recent admission, and one for a resident who had been living in the home for eighteen months. They were both split into similar sections of care need. One had a care plan which identified needs by listing them under a spreadsheet with the headings “Problem, Aim, Action, By whom”. These included clear guidance for staff on how to support the resident to overcome the ‘problem’. For example, checking the hearing aid regularly, spending time with the resident to reduce their sense of isolation The Dell Residential Care Home DS0000066686.V345177.R01.S.doc Version 5.2 Page 12 due to their communication difficulties, and cutting up their food. The other care plan did not have this format. The support listed as necessary above was not recorded in this resident’s daily record. Some entries merely stated: No problems. There were no entries at all for four days in the previous month and no entry since two days before the inspection for one resident. It was recommended by the inspector that there should be at least one entry every twenty-four hours, and good practice should ensure an entry at the end of each shift. One person had been found on the floor of the corridor having fallen out of bed. Although there was a detailed recording of this in the daily record, there was no evidence of any review of the resident’s risk assessment. This had previously been revised after an earlier medical emergency. The inspector recommended that such incidents should be recorded in the home’s accident file to enable an analysis of incidents to be done and action taken to eliminate or reduce the likelihood of recurrence. Both plans contained weight charts, with weekly monitoring of their weight. However, one resident’s weight had not been recorded for a period of three months earlier in the year and there was no explanation for this gap. One carer had recorded in the daily record that a resident was in pain from their feet and needed to see the chiropodist. There was no further information in this record on any follow up. However the manager showed the inspector the home’s Communications Book, where the resident’s name was listed to be seen by the chiropodist the day after the entry in the daily record. Unfortunately the chiropodist did not have time to fit this resident in, so they would be listed for the chiropodist next visit. The inspector recommended that this information should be in the daily record linked to the resident’s care plan to avoid information being overlooked when checking for follow up, or when reviewing care plans. There were contacts sheets in the care plans recording all contacts with NHS services. Needs assessments included dependency, moving and handling and pressure area care. One file for a person who had been in the home over twelve months contained the notes of a review meeting in February 2007 with the resident, their daughter, the keyworker and the manager. Nine out of eleven residents who replied to the survey said that they always or usually received the medical support they needed. “I find the staff very aware of any medical issues I have and act on them very promptly.” The manager stated that the home was developing a new strategy for care plans to be implemented shortly. The Dell Residential Care Home DS0000066686.V345177.R01.S.doc Version 5.2 Page 13 The lunchtime medication round was observed. It was noted that the correct procedure was followed by signing the Medicine Administration Record (MAR) sheet after the medication had been seen to be taken. The MAR sheets were correctly completed, except for two gaps in signatures for one resident on a PRN medication. It was noted that there was no thermometer in the room where the medication was stored. Most medication is required to be kept below 25°C. Nor was there a thermometer in the drug fridge. A double metal cupboard in the store room containing stock items which could not be held in the drug trolley could not be locked. The maintenance manager inspected it at once and stated that it needed a new hinge. The owner said that this would be fitted the next day. The cupboard was in a room kept locked when staff were not in there. Residents were seen to be treated with respect by the staff. They knocked on residents’ room doors before entering, and they told the inspector that personal care and medical care was given in the privacy of residents’ rooms. All rooms were able to have a telephone fitted. One relative had written to the home: “Thank you…for the caring and kindness you gave to XXXX, the support and kindness to me and my family…and most importantly you helped XXXX maintain their dignity to the end.” The Dell Residential Care Home DS0000066686.V345177.R01.S.doc Version 5.2 Page 14 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 good. Residents can expect to be offered a choice of activities, to be supported to maintain family and other contacts and to be offered a choice of nutritional meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Of the residents who completed the survey, eight out of eleven said they always or usually liked the meals. The manager said that the menu was changed regularly in response to comments from residents’ meetings. On the day of inspection, the lunch was gammon or vegetarian chicken, followed by jam sponge or peach crumble. Residents in the dining room told the inspector that they liked the food and most cleared their plates. It was seen that special diets, either for medical or religious reasons were catered for. There were sufficient staff on duty to support residents during lunch. A social care The Dell Residential Care Home DS0000066686.V345177.R01.S.doc Version 5.2 Page 15 professional said that the food had improved. The people they placed in the home were happy with their meals. One resident had commented that they would like hot desserts. The cook on duty confirmed that they liked to prepare hot desserts, and there were two hot choices on that day. However the cook said that she always had to be ready with a choice of cold desserts as well to meet some people’s preferences, and changes of mind. The catering staff were following the “Safer Food, Better Business” system of catering documentation recommended by Environmental Health officers. The manager explained the needs of those residents who had lived in the home since it was run by a religious organisation. Regular services were held for them in a flat in the grounds that had been turned into a chapel. Representatives of other denominations visited on request. An enlarged communal lounge had been built at the rear of the home at the same time as the extension. This was a light and well furnished area, with the chairs placed in groups to encourage a more homely look. Four residents were sitting there during the morning. One of them said they liked to sit there. A new conservatory had been built off this lounge overlooking the garden. There was an entertainment schedule on the notice board. Ten of the eleven residents who responded to the survey said that there were always, usually or sometimes activities that they could take part in. One person said that they looked after the putting out of serviettes for lunch. No activities were observed taking place during the inspection. Several residents who were visited by the inspector in their room said that they preferred to stay there most of the day except for their meals. However with the increased number of places, residents would benefit from a more pro-active approach to activities, by finding out what each person would like to do, either by themselves or in a group, and encouraging participation, for improved mobility, and mental stimulation. There was a notice in the hall advertising the first meeting of “The Friends of the Dell” to be held on July 10. The formation of this group had been mentioned by a relative as a way for them to become more involved in helping residents. “Feel we could help more if asked”. The home had used a minibus to take some residents on outings. This was being replaced by a new one with twelve seats and a rear wheelchair lift. It would be driven by the buildings manager, and possibly in the future by The Friends. One resident was able and was encouraged to take a walk most days around the area without staff support. This had been agreed with their family. This resident, and others, had a mini fridge in their room. There was also a The Dell Residential Care Home DS0000066686.V345177.R01.S.doc Version 5.2 Page 16 reminder board for the resident, and a pin board where their jewellery was displayed to allow them to choose what they wished to wear. The Dell Residential Care Home DS0000066686.V345177.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17. Quality in this outcome area is good. Residents can be assured that their views will be listened to, taken seriously and acted upon. There is a proper policy, procedure and training programme in place to give residents confidence that they are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All the residents who responded to the survey said they knew how to make a complaint. All but one of the thirteen relatives who responded said they did. One relative suggested that relatives could be given information on this area on admission. In fact, this was already done by the home as part of the client handbook. The home’s complaints policy was displayed in the home and was accessible to residents and visitors. One relative wrote that their relative had raised a few concerns at the residents’ meeting and these had usually been responded to positively. Eight out of thirteen relatives who replied to the survey said the home always or usually responded appropriately if concerns were raised. The Dell Residential Care Home DS0000066686.V345177.R01.S.doc Version 5.2 Page 18 The home had a complaints log but it was empty as the manager said no complaints had been received. The Commission had received an anonymous complaint in April 2007 about the numbers of staff on duty. The home was able to evidence that the level of staffing was appropriate for the residents’ needs. It would have been proper for this to be recorded in the complaint log. Many letters of appreciation had been received and shown to the inspector, particularly from families of residents who had been able to stay in the home during their last days. Staff had received training in the protection of vulnerable adults either through their NVQ courses or by watching the ‘No Secrets’ video and workbook. These sessions were recorded. The cash held by the home on behalf of one resident was checked. A regular amount was received from the resident’s solicitor each month. The resident then took an amount weekly for their personal purchases, which they signed for. Entries were seen in the receipt book and the balance reconciled with withdrawals. The Dell Residential Care Home DS0000066686.V345177.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,25,26, Quality in this outcome area is good. Residents live in a safe and comfortable environment that is well-maintained, with rooms which they can make their own by their own possessions, and space to receive visitors. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since buying the home in March 2006, the proprietors had built an extension with sixteen new bedrooms, which increased the net number of places by fourteen, as well as extending the lounge and adding a new conservatory. These had been registered by the Commission in January 2007. The Dell Residential Care Home DS0000066686.V345177.R01.S.doc Version 5.2 Page 20 The new bedrooms all had their own en-suite WC, and there were three communal toilet and bath facilities and one toilet and shower throughout the extension, all wheel chair accessible. Two bathrooms were fitted with specialist bath chairs. The other one had a domestic style bath. All bathing areas were provided with a flashing light fire alarm and call bell systems.The lift in the extension was provided with an automatically opening door, wheelchair height controls, and a spoken commentary. A new disabled access had been introduced suitable for wheelchairs. There was also a storage and battery charging facility for mobility scooters. The hall, corridor, staircase and landings were about to be re-carpeted to match that in the new extension. The proprietor confirmed by phone during the inspection that the work was due to start the next day. 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. One resident wrote in their survey: “It always smells lovely and fresh.” Additional domestic staff had been employed since the last inspection to cover the extension. The home’s full time buildings manager confirmed that they did minor repairs required in the home and undertook regular water temperature checks. Residents’ rooms contained items of their own which made them more homely. New hand drying facilities had been installed with a new sink outside the kitchen for easier access by care staff on the floor. A roll of plastic aprons was also positioned close by. The inspector was asked to wear one when entering the kitchen. There were now 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. Only the main lounge was being used while the inspector was there. One resident was taking their daily walk around the garden during the morning. Paper towels and soap dispensers were provided in all communal washing facilities. The temperature of two hot water outlets was taken. Both were within acceptable levels. During the tour of the home, one resident who was in their own room expressed concern that they were unable to use their call bell as the lead did not reach them when they were seated in their wheelchair. The owner was able to offer an immediate solution. The wire was unwound to reach the chair. However it is recommended that there should be a review of all rooms, both private and communal, to check the accessibility of call bells. The Dell Residential Care Home DS0000066686.V345177.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is good. Residents are cared for by trained staff, whose care and concern is appreciated by residents and relatives. Residents can expect that they will be protected by the home’s policy on recruitment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The number of care staff on duty during the daytime had increased in anticipation of the increased number of residents. There were now five carers and a senior carer on in the mornings, and three carers and a senior on in the afternoon/evening. There were two waking carers on at night as before. Three staff in their surveys mentioned that they were concerned that only two staff were on duty at night. The manager said this would be kept under review. One resident said that the staff were far too busy and that there were not enough of them, but 75 of residents who replied to the survey said that staff listened and acted upon what they said, and all but one said that the staff were always or usually available when they needed them. One staff member said that the increased number on duty meant that they could give more time to residents. One relative said that their relative in the home would like to spend more time over a bath, to relax and have a soak. They felt that staff had to rush them out The Dell Residential Care Home DS0000066686.V345177.R01.S.doc Version 5.2 Page 22 as they were in a hurry. However twelve of the thirteen relatives who replied to the survey said that the home always or usually gave the support and care expected. Twelve new staff had been recruited in the past year. The manager explained how this had created a significant induction and training workload which was now settling down. There were no vacancies at the time of the inspection. No agency staff had been used in the past three months. The personal files for three recently appointed staff were examined. They contained all the identification and criminal record checks required. Two did not yet have a photo of the person on the file. The home used an induction checklist with new starters and copies of these were in the files. Staff undertook their common induction standards training at the local authority training centre. This was recorded on their file. In addition, training records showed that some staff had received training in medication in January 2007, and refresher training in moving and handling in March 2007. The manager explained that she was still catching up with the identification of training needs and the development of a planned training programme for the year following the changes of staff over the previous twelve months. Five out the six staff who replied to the survey said that they had been given training which was relevant, met residents’ needs and kept them up-to-date with new ways of working. Eleven staff had completed an NVQ at Level 2 or above, and four staff were working towards an NVQ. The Dell Residential Care Home DS0000066686.V345177.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38. Quality in this outcome area is good. Residents can be assured that there is a system for obtaining their views on the running of the home to ensure it is run in their best interests. Their safety and welfare cannot be fully assured until the staff supervision schedule has been met and records about care and medication are complete and up-to-date. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager was experienced in the care of older people. She was registered with the Commission and held the Higher Diploma in the Management of Care Services. She had also had experience working in palliative care, which helped the staff to offer continuing care to residents at the end of life. She had The Dell Residential Care Home DS0000066686.V345177.R01.S.doc Version 5.2 Page 24 recently had training in stroke care. She was aware of the publications of the Commission called ‘In Focus’ covering recruitment, catering and financial matters. Copies were in the office. One relative wrote: “I like the regular presence of the owners at the home. They are welcoming and have a genuine interest in the welfare of residents and staff.” The home had started holding residents’ meetings on a monthly basis with the notes of each meeting displayed on the notice board. The manager said that she made special arrangements for those residents with communication difficulties. For example one resident was linked to a local group called the ‘Hand in Hand Group’, which was a support group for the visually impaired. It has already been noted that the home ensured that the spiritual and catering needs of all could be met. A visiting social care professional said that the home had an open door management style. The accident book had no recorded accident since November 2006. In discussion with the manager, it was clear that the absence of records was caused by a narrow interpretation of the Regulation and the standard about what should be entered in an ‘Accident Book’. The home had complied with the requirement to report incidents to the Commission, but amongst those reported under regulation 37 were incidents involving falls on 06/03/07, 18/04/07 and 23/06/07, in one case causing a suspected broken hip. Good practice would recommend that all similar incidents, whether reportable to the Commission or not, should be recorded in an accident/incident book, providing a ready source of information when reviewing care practice or care plans, and enabling a regular analysis of incidents to detect trends concerning particular residents, time of day or type of incident. Records were available showing that annual staff appraisals were almost up-todate. The two-monthly supervision sessions were not yet up-to-date, with some staff not having recorded sessions since October 2006. The manager explained that she was trying to catch up with these as quickly as possible. This gap was confirmed by two carers who said they had only had one meeting with the manager in the last twelve months. However half of the responders to the staff survey said they did receive enough support from the manager. As described under previous Outcome Groups, the home had generally good records, but there were some shortcomings in medication records, entries in the Daily Record, care plan omissions and no dates on some records. Maintenance and fire log records were up-to-date. The buildings manager had been upgraded to full time with the opening of the extension. This person was undertaking the Higher Diploma in Management of Care Services at the local college. An additional boiler had been installed to ensure that hot water was available all day independent of the space heating system. The Dell Residential Care Home DS0000066686.V345177.R01.S.doc Version 5.2 Page 25 The inspector was shown a residents’ questionnaire which was issued in May 2007. All the responses returned rated the various aspects itemised as good or excellent. The home had a procedure regarding service users’ money and financial affairs management. The manager and proprietors did not act as appointee for any resident. A random check on cash held on behalf of residents was described under ‘Complaints and Protection’. The Dell Residential Care Home DS0000066686.V345177.R01.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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 2 X X 3 3 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 3 3 X 3 2 2 2 The Dell Residential Care Home DS0000066686.V345177.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) and 17(1)(a) Schedule 3 (3)(i) Requirement Staff must record when medication is administered and if not the reason must be given. This was a requirement at the inspection on 25/07/06. Timescale for action 04/07/07 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. 3. Refer to Standard OP7 OP7 OP9 Good Practice Recommendations Entries should be made in each resident’s daily record as frequently as deemed necessary by the home’s policy. The new strategy for care plans should be introduced as soon as practicable, to include a system of auditing them to ensure that they are complete and up-to-date. The room where the medications are stored should have a thermometer to ensure that the medication is stored below 25°C. The fridge in that room should also have its temperature monitored. The home should consider how best to ascertain the wishes of residents for activities, and how to plan for these, as numbers of residents increase. The accessibility of call bells in all private and communal DS0000066686.V345177.R01.S.doc Version 5.2 Page 28 4. 6. OP12 OP22 The Dell Residential Care Home 7. 8. 9. 10. OP27 OP36 OP37 OP38 rooms should be reviewed to ensure the safety of residents. The number of staff on each shift should be kept under review as the number of residents increases. The schedule of staff supervision sessions should be brought up-to-date and then maintained on a minimum of six sessions a year. All records should be up-to-date, complete and dated. The policy for recording accidents and incidents affecting residents should be reviewed. The Dell Residential Care Home DS0000066686.V345177.R01.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: 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 Dell Residential Care Home DS0000066686.V345177.R01.S.doc Version 5.2 Page 30 - 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. 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