Inspection on 06/09/05 for The Dolphins

This inspection was carried out on 6th September 2005.

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 but made no statutory requirements on the home.

Other inspections for this house

The Dolphins 13/09/07

The Dolphins 18/04/06

The Dolphins 03/01/06

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 Oxon OX9 3AW Lead Inspector Catherine Kane Unannounced 06 September 2005 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 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 Stationary 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 H57-H08 S13077 The Dolphins V222601 060905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Dolphins Address 32 Aylesbury Road, Thame, Oxon, OX9 3AW Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01844 212463 01844 212463 haroon@caretech-uk.com Caretech Community Services Limited Stephen Norman (Acting) Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (1) of places The Dolphins H57-H08 S13077 The Dolphins V222601 060905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 15 March 2005 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 Dolphins H57-H08 S13077 The Dolphins V222601 060905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit took place on the morning of Tuesday 6 September 2005. The purpose of the visit was to see how the home is meeting National Minimum Standards. The visit took just over four hours and the inspector spent this time with the five residents and the three staff on duty. The inspector also spoke with the recently recruited home manager. The inspector listened to their views and discussed their experiences. The inspector also read notes kept in the home, watched how staff help residents to look after their medication and was present while residents were having their breakfast. The home is coming to terms with the recent sad death of a resident. The inspector would like to thank each resident for taking the time to speak with her and thank the staff for their assistance during the inspection. What the service does well: What has improved since the last inspection? 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 H57-H08 S13077 The Dolphins V222601 060905 Stage 4.doc Version 1.40 Page 6 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 Standards Statutory Requirements Identified During the Inspection The Dolphins H57-H08 S13077 The Dolphins V222601 060905 Stage 4.doc Version 1.40 Page 7 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 standard(s) None The inspector has not made a judgement on these standards on this visit. The outcomes of these standards will be looked at during the next inspection. EVIDENCE: The Dolphins H57-H08 S13077 The Dolphins V222601 060905 Stage 4.doc Version 1.40 Page 8 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 standard(s) 6, 7 and 9 The care planning system in place to provide staff with the information they need to satisfactorily meet service users’ care needs is disorganised. A suitable arrangement is needed for residents to be able to access their personal money whenever they want to. EVIDENCE: Two residents’ care records were randomly selected for inspection and in each case the files had all the relevant information but the records were confusing and disorganised. Risk assessments had been reviewed and updated. The new person centred system to be used within the home explained to the inspector at a previous inspection has not been fully implemented, although it looked like some work had been started. Time should be made to implement this piece of work as a priority. At the time of the inspection a resident could not get access to their personal money so that they could go out. The inspector was informed that all monies, including the home’s housekeeping and petty cash, were kept locked and only the manager had access to this. Staff stated that often they used their own The Dolphins H57-H08 S13077 The Dolphins V222601 060905 Stage 4.doc Version 1.40 Page 9 money and this was reimbursed but this was not always possible and relied upon staff goodwill. The home should have a suitable arrangement for residents to be able to access their money whenever they wish to. The Dolphins H57-H08 S13077 The Dolphins V222601 060905 Stage 4.doc Version 1.40 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 standard(s) 12, 13, 14 and 16 Residents have limited opportunities to take part in activities of their choice and within their local community. Some progress to replace unsuitable locks on residents’ bedroom doors has been made. EVIDENCE: During the inspection the inspector spent some time with one resident who let her know that they like to get out and about every day. Notes kept in the home indicated that some staff time was allocated to taking residents out but this was not always as much as some residents would like and does not happen every day. During the inspection one resident went out for a walk with a member of staff, two residents spent time with another staff member doing some art work and other residents watched TV or listened to music. Three residents had been on holiday this year. At the time of this inspection decisions about the holiday plans of the two other residents had not yet been made. The Dolphins H57-H08 S13077 The Dolphins V222601 060905 Stage 4.doc Version 1.40 Page 11 Work to replace unsuitable lock devices on some residents’ bedroom doors had begun. This work should be completed without delay, as some residents are experiencing difficulties opening their bedroom doors. The Dolphins H57-H08 S13077 The Dolphins V222601 060905 Stage 4.doc Version 1.40 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 standard(s) 18, 19, 20 and 21 Guidance on how staff provide personal and healthcare support is satisfactory. Recording systems for the administration of residents’ medication could be improved. Bereavement counselling could have been provided to support residents and the staff team through a sad time. 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 get to see their local GP and other community healthcare services when needed. A comment card received from a resident’s GP indicated that staff difficulties had been sorted out and they are impressed by the quality of care given to residents. Two confident staff members showed the inspector how residents were supported to look after and take their medication. The system was generally good. The inspector strongly recommends that the home follows guidance The Dolphins H57-H08 S13077 The Dolphins V222601 060905 Stage 4.doc Version 1.40 Page 13 issued by the Royal Pharmaceutical Society of Great Britain. The inspector recommends that any handwritten entries to the medication administration record (MAR) sheets are signed by another member of staff assessed as competent in accordance with good practice. The inspector also recommends that written records of staff assessments of competence and sample of those staff’s initials be kept in the home and available for inspection. Staff told the inspector about the recent death of a resident and how residents and staff supported each other. No formal bereavement counselling took place at the time but support from healthcare professionals involved with the home was available. The Dolphins H57-H08 S13077 The Dolphins V222601 060905 Stage 4.doc Version 1.40 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 standard(s) None The inspector has not made a judgement on these standards on this visit. The outcomes of these standards will be looked at during the next inspection. EVIDENCE: The Dolphins H57-H08 S13077 The Dolphins V222601 060905 Stage 4.doc Version 1.40 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 standard(s) None The inspector has not made a judgement on these standards on this visit. The outcomes of these standards will be looked at during the next inspection. EVIDENCE: The Dolphins H57-H08 S13077 The Dolphins V222601 060905 Stage 4.doc Version 1.40 Page 16 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33 and 35 Staff had a good understanding of residents’ support needs and residents were at ease in their company. The on-call system information was unclear and out of date. The training programme undertaken by staff is limited. EVIDENCE: When the inspection started at 07.45 one member of staff and a regular agency member of staff were on duty. A third staff member came on duty during the inspection. Staff spoken with at the time of the inspection were clear about their role and responsibilities. On the morning of the inspection staff on duty were unable to access the oncall manager for advice and guidance. The information and contact details for on-call manager available in the home was out of date. The on-call system must be responsive and reliable. From information provided by staff about the limited training opportunities the inspector doubts this home will achieve the expected target of 50 NVQ qualified staff by the end of 2005. The Dolphins H57-H08 S13077 The Dolphins V222601 060905 Stage 4.doc Version 1.40 Page 17 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 A period of instability in management structure has affected staff morale within the home. EVIDENCE: From discussions with the staff team and feedback from residents’ relatives met at an earlier meeting organised by CareTech, the inspector was given the impression that morale in this home was low. The inspector has been provided with regular updates on progress from the CareTech area manager. The area manager states he remains optimistic and improvements have been noted since the recruitment of an experienced manager to the home. The manager has informed the inspector that an application to register as manager with the Commission will be forwarded. At the time of writing this report this application had not yet been received. The Dolphins H57-H08 S13077 The Dolphins V222601 060905 Stage 4.doc Version 1.40 Page 18 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 x 2 2 3 x 2 x Standard No 31 32 33 34 35 36 Score 2 2 x x 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Dolphins Score 3 3 2 3 Standard No 37 38 39 40 41 42 43 Score 2 x x x x x x H57-H08 S13077 The Dolphins V222601 060905 Stage 4.doc Version 1.40 Page 19 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 37 Regulation 8 Requirement The manager must forward an application to register as manager with the Commission, and this must be received by 31/10/05. Outstanding requirement - previous tmescale 31/07/05 The manager must ensure that the on-call system for staff guidance and support out-of hours is responsive and reliable. Timescale for action By 31/10/05 2. 31 18.2 Immediate and ongoing 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 6 Good Practice Recommendations The inspector strongly recommends that the new person centred care planning system should be fully introduced and time made to organise residents care plan records a priority. The inspector strongly recommends that the home should have a suitable arrangement for residents to be able to access their personal money when they wish to do so. The inspector strongly recommnds that work to replace unsuitable locks on residents bedroom doors is completed without delay. H57-H08 S13077 The Dolphins V222601 060905 Stage 4.doc Version 1.40 Page 20 2. 3. 7.5 16.3 The Dolphins 4. 20 The inspector strongly recommends that the home follows guidance issued by the Royal Pharmaceutical Society of Great Britain. The inspector recommends that any handwritten entries to the MAR sheets are signed by another member of staff assessed as competent in accordance with good practice. The inspector also recommends that written records of staff assessments of competence and sample of those staff’s initials be kept in the home and available for inspection. The Dolphins H57-H08 S13077 The Dolphins V222601 060905 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection 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. Extracts may not be used or reproduced without the express permission of CSCI The Dolphins H57-H08 S13077 The Dolphins V222601 060905 Stage 4.doc Version 1.40 Page 22 - 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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