Inspection on 18/04/06 for The Dolphins

This inspection was carried out on 18th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Dolphins 13/09/07

The Dolphins 03/01/06

The Dolphins 06/09/05

The Dolphins 15/03/05

The Dolphins 23/07/04

The Dolphins 27/01/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 The Dolphins 32 Aylesbury Road Thame Oxfordshire OX9 3AW Lead Inspector Catherine Kane Unannounced Inspection 18th April 2006 12:30 The Dolphins DS0000013077.V290160.R01.S.doc Version 5.1 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 Dolphins DS0000013077.V290160.R01.S.doc Version 5.1 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 Adults 18-65. 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 Dolphins DS0000013077.V290160.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Dolphins Address 32 Aylesbury Road Thame Oxfordshire OX9 3AW 01844 212463 01844 212463 haroon@caretech-uk.com 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) Caretech Community Services Limited Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (1) of places The Dolphins DS0000013077.V290160.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The total number of persons that may be accommodated at any one time must not exceed 6. 3rd January 2006 Date of last inspection Brief Description of the Service: The Dolphins is a large detached house with gardens situated in Thame, Oxfordshire. It is registered to provide 24 hr care and support for up to six people with a learning disability. It is run and managed by CareTech Community Services, an organisation with experience in supporting people with learning disabilities. The fee for this service is currently £1056.70 per week. The Dolphins DS0000013077.V290160.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’. The inspector arrived at the service at 12.30 and was in the service for almost 4 hours. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s owner or manager, and any information that CSCI has received about the service since the last inspection. The inspector asked the views of the people who use the services and other people seen during the inspection or who responded to questionnaires that the Commission had sent out. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. What the service does well: What has improved since the last inspection? A new carpet has been fitted in the lounge. An experienced deputy manager has joined the staff team. CareTech have completed a health and safety audit for this home. The manager states that recommendations made from this have been followed. The Dolphins DS0000013077.V290160.R01.S.doc Version 5.1 Page 6 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 Dolphins DS0000013077.V290160.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Dolphins DS0000013077.V290160.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s pre-admission assessment records were poor and did not state how the home would meet the needs of a new resident. EVIDENCE: During the inspection a new resident, who has recently moved into the home, spent some time with the inspector. From discussions with staff and notes kept, a planned introduction with visits and some overnight stays took place prior to the resident moving in. A review following a trial period of six weeks is planned. Information and assessments from the funding authority and previous placements were available. However, the home’s assessment that would clearly set out how the home plans to meet the needs of this new resident and provide staff with clear guidelines on how to support this person was not available. It is important to make sure that the home is the right place, the needs and wishes of all the people who already live in the home are carefully considered and the staff team have the right skills before offering a place to any new resident. The Dolphins DS0000013077.V290160.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care planning system in place to provide staff with the information they need to satisfactorily meet service users’ care needs is poor and is not person centred. EVIDENCE: Two residents’ care records were randomly selected for inspection and in each case the files had all the relevant information but the records continued to be confusing and disorganised. It appears that the home has decided to revert to the old care planning system that promotes the use of charts and task checklists for staff. Some work had already been started on the introduction of a new person centred planning system at the time of the inspection held on 6 September 2005. The inspector made a recommendation at that time that this new system be given priority. Risk assessments had been reviewed and updated. The Dolphins DS0000013077.V290160.R01.S.doc Version 5.1 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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, 15, 16 and 17 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Opportunities for residents to take part in interesting activities are poor. EVIDENCE: During the inspection the inspector observed that one resident preferred to stay in their room for most of the day. One other resident also went to their room to rest after lunch. Three other residents watched TV in the lounge. One resident went with staff to the supermarket. From reading notes kept in residents’ Social Diaries that indicated when and what activities took place, it was clear that the choice and opportunity for residents to take part in interesting activities is very limited. Some activities listed for one resident over the last four months were going out for a walk, going shopping, going out for a coffee and a peace dance session. Notes kept in the home indicated that some staff time was allocated to taking residents out. This does not happen for each resident every day. The manager must consult with each resident about their personal interests and he must make arrangements that each resident is provided with opportunities to take part in interesting and fulfilling The Dolphins DS0000013077.V290160.R01.S.doc Version 5.1 Page 11 social and leisure activities, in the home and in their local community, taking into account their needs and wishes. A comment card from a resident’s relative indicated that they were satisfied with the care their relative receives. The home continues to provide a varied menu and residents’ special dietary needs are catered for. The Dolphins DS0000013077.V290160.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ personal care and healthcare support needs are adequate. Systems for the storage of residents’ medication are poor. EVIDENCE: Information needed by staff to be able to provide personal and health care support was included in residents’ files. As stated before, residents’ care plan files were confusing and disorganised and would benefit from the introduction of the person centred approach. Staff help residents to get to see their local GP and other community healthcare services when needed. A comment card received from a resident’s GP indicated that the care provided in this home is satisfactory. This home uses a monitored dose system from a local pharmacy service. Residents’ medicines are delivered to the home from the pharmacy. This is then stored in a locked boiler room until it is transferred to the appropriate locked medicines cabinet. The temperature recorded in this boiler room on the day of the inspection was 30.5°c. Medicines must be stored safely following The Dolphins DS0000013077.V290160.R01.S.doc Version 5.1 Page 13 the guidance issued on patient information leaflets available from the pharmacist. The Dolphins DS0000013077.V290160.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a clear protection from abuse policy and the complaints procedure is good. EVIDENCE: The manager related that he has received no complaints. Staff have attended specific training on protecting vulnerable people from abuse and information about local adult protection procedures in line with the Oxfordshire Multi-agency Codes of Practice was seen on the staff notice board The Commission has received no information relating to complaints in the last year. The Dolphins DS0000013077.V290160.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The overall standard of décor and furnishings throughout the home is adequate but shabby and does not create a particularly pleasing or pleasant environment to live in. The standard of cleanliness is poor. EVIDENCE: The damaged lounge carpet has been replaced since the last inspection. Other requirements set at the last inspection have not been fully met. The manager informed the inspector that the new landlord has made a commitment to address issues relating to the general upkeep of the building and deal with the thick moss that grows on the roof and guttering that has been falling onto the patio area and potentially puts residents and staff at risk. The manager must provide details of the programme of maintenance and renewal for the home to keep both the external and internal areas in a good state of repair. The bathroom used by residents on the 1st floor had mildew and areas of ground in grime on the floor. Other areas of the home looked grimy and The Dolphins DS0000013077.V290160.R01.S.doc Version 5.1 Page 16 uncared for. Curtains had come off their rails in the conservatory/dining area. The home would benefit from a thorough clean. The Dolphins DS0000013077.V290160.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff morale has improved since the new deputy manager has started. The training programme undertaken by staff is poor. EVIDENCE: When the inspection started at 12.30 three members of staff and a regular agency member of staff were on duty. Two staff left at shift change time and the deputy manager and one other member of staff arrived. Staff were seen to be busy throughout the time of the inspector’s visit. Two members of staff have left since the last inspection, two new staff have been recruited and one staff member has transferred from another CareTech home. This is a relatively new staff team. The inspector interviewed two members of staff. A member of staff commented that staff morale has improved with the arrival of the experienced deputy manager. The inspector viewed staff files for two recently recruited staff. One file was incomplete; the manager related that essential documentation was still to be sent from CareTech HR section at their head office. The Dolphins DS0000013077.V290160.R01.S.doc Version 5.1 Page 18 A senior CSCI manager has undertaken an audit of Criminal Records Bureau (CRB) disclosures made on staff and stored at the CareTech head office. The following recommendations were made. All CRBs with a criminal record should be reviewed by one person who is a senior manager within CareTech. All staff with a CRB showing a criminal record must have a query sheet. The query sheet or other form should provide greater detail as to the evidence, risk assessment and reasons for the decision to appoint or not. As is the case, the Protection of Vulnerable Adults (POVA) First should only be used when the risk not to do so is serious for the service users. However any person appointed under POVA First should be asked to sign that they do not have a criminal record over and above their answers within their application forms. The home has not achieved the expected target of 50 NVQ qualified staff by the end of 2005. The manager must provide details of how the home plans to ensure that staff receive training appropriate to their work to ensure a suitably qualified and skilled staff team. The Dolphins DS0000013077.V290160.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. After a period of instability in the management structure there is now a permanent manager and experienced deputy manager to provide structure and organisation to this home. The standard of management is adequate. EVIDENCE: An application to register the manager with CSCI is currently being processed. The inspector receives copies of the proprietors’ representative’s monthly visit reports. CareTech has undertaken a health and safety audit of this home. The manager informed the inspector that issues raised from this audit have been addressed. The home must complete accident and incident reports in accordance with Data Protection legislation and a copy must be kept in the home and available for inspection. The Dolphins DS0000013077.V290160.R01.S.doc Version 5.1 Page 20 CareTech, who run this service, has financial and accounting systems subject to internal and external audits. The Dolphins DS0000013077.V290160.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 2 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X X 2 X The Dolphins DS0000013077.V290160.R01.S.doc Version 5.1 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA24 Regulation 23(2)(b) Requirement Timescale for action 15/06/06 2. YA24 3. YA2 4 YA12 The manager must provide details of the programme of maintenance and renewal for the home to keep both the external and internal areas in a good state of repair. Revised timescale from the requirement made at the previous inspection. 13(4)(a) The manager must provide 15/06/06 details of how the problem of falling moss from the roof will be kept under control. Revised timescale from the requirement made at the previous inspection. 14(1)(a) The home’s assessment must 15/05/06 provide sufficient detail that the home is suitable and can meet a new resident’s needs. 16(2)(m),(n) The manager must consult 15/06/06 with each resident about their personal interests and he must make arrangements that each resident is provided with opportunities to take part in interesting and fulfilling social and leisure activities, in the home and in their local community, taking into DS0000013077.V290160.R01.S.doc Version 5.1 The Dolphins Page 23 5 YA20 113(2) 6 7 YA30 YA35 23(2)(d) 18(1)(c) 8 YA42 17(1), (2) account their needs and wishes. The manager must ensure that residents’ medicines must be stored safely following the guidance issued on patient information leaflets available from the pharmacist. This was made an immediate requirement at the time of the inspection. The manager must ensure that the home is kept clean and hygienic. The manager must provide details of how the home plans to ensure that staff receive training appropriate to their work to ensure a suitably qualified and skilled staff team. The home must complete accident and incident reports in accordance with Data Protection legislation and a copy must be kept in the home and available for inspection. 18/04/06 15/05/06 15/05/06 15/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations The inspector strongly recommends that the new person centred care planning system should be fully introduced and time to organise residents’ care plan records a priority. This was recommended at the inspection held on 6 September 2005. All CRBs with a criminal record should be reviewed by one person who is a senior manager within CareTech. All staff with a CRB showing a criminal record must have a query sheet. The query sheet or other form should provide greater detail as to the evidence, risk assessment and DS0000013077.V290160.R01.S.doc Version 5.1 Page 24 2 YA34 The Dolphins reasons for the decision to appoint or not. As is the case POVA first should only be used when the risk not to do so is serious for the service users. However any person appointed under POVA first should be asked to sign that they do not have a criminal record over and above their answers within their application forms. The Dolphins DS0000013077.V290160.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South, Cowley Oxford OX4 2SU 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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