Inspection on 15/11/05 for The Dovecote

This inspection was carried out on 15th November 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Dovecote 24/04/08

The Dovecote 31/10/07

The Dovecote 16/04/07

The Dovecote 22/04/06

The Dovecote 07/02/06

The Dovecote 20/06/05

The Dovecote 20/01/05

The Dovecote 27/04/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 The Dovecote Care Home The Dovecote Residential Home 69 Bagshaw Street Pleasley Mansfield Nottinghamshire NG19 7SA Lead Inspector Jayne Hilton Unannounced Inspection 15th November 2005 09:00 The Dovecote Care Home DS0000008661.V265915.R01.S.doc Version 5.0 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 Dovecote Care Home DS0000008661.V265915.R01.S.doc Version 5.0 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 Dovecote Care Home DS0000008661.V265915.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Dovecote Care Home Address 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) The Dovecote Residential Home 69 Bagshaw Street Pleasley Mansfield Nottinghamshire NG19 7SA 01623 480 445 01623 480 446 Dovecote@carehomenet.co.uk The Dovecote Trust Limited Mr Bryan Leonard Hogg Care Home 18 Category(ies) of Learning disability (18) registration, with number of places The Dovecote Care Home DS0000008661.V265915.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th June 2005 Brief Description of the Service: The Dovecote is a care home providing personal care and accommodation for 18 younger adults who have a learning disability and has facilities for some who also have a physical disability. The home provides long-term care and will take emergency admissions. The Dovecote Trust runs the home, which is a registered charity. The building is owned by Leicester Housing Association. The home is located in Pleasley and is close to shops, pubs, the post office, a community centre and working man’s club. The home was opened in 1987 and consists of a converted vicarage and purpose built, bungalow which has disabled access. Sixteen of the home’s bedrooms are single, and 2 of the bedrooms have en-suite facilities. Bedrooms are located on the 1st and 2nd floors in the converted vicarage where I stair lift has recently been fitted and ground floor level in the bungalow. Ramps provide access in the two buildings and gardens. The home has an enclosed garden and a nature trail in the grounds and there is car parking available. The home has its own minibus. The Dovecote Care Home DS0000008661.V265915.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on Tuesday 15th November 2005 and lasted 4.5 hours. The inspection focused on key inspection standards not inspected at the previous inspection and the assessment of the requirements and recommendations set at the previous visit. The bungalow accommodation was particularly assessed at this visit. During the course of the inspection a sample section of three care plans were examined. Difficulties were experienced in securing involvement of service users in this inspection due to communication limitations as a result of their disabilities so there are few service user comments in this report. Other methodology used were examination of records, a tour of the building and discussions with three staff and the manager. Not all of the aspects of the requirements and recommendations were inspected at this visit due to time constraints and the inspector needing to focus on other issues arising throughout the inspection. What the service does well: Service users appeared happy and relaxed and were dressed appropriately for the season and in which reflected their own style and age group. There was clear evidence in the care plans examined, which demonstrated, choice about hairstyles, clothes and appearance. A key worker system is in place and staff work 1:1 with named service users. The bungalow provides suitable accommodation, aids and equipment to maximise independence. Care plans provided evidence of specialist input regarding psychiatrists and occupational therapists etc. From observations made during the inspection staff interacted well with service users and appear to be aware of the individual needs. A training programme including an induction supported this. There was information seen regarding service users being involved in an advocacy group. Information regarding how to access an advocacy service should be posted on the notice board for service users and relatives. From the assessment and care plan documentation the overall general needs of service users, appear to be met. Service users needs are assessed and there is ongoing work to include appropriate risk assessments within the care plan documentation. Service users have contracts in place, [however these have not been fully assessed as to Standard 5.] Service users are clearly able to take part in age, peer and culturally appropriate activities at home and in the community. The Dovecote Care Home DS0000008661.V265915.R01.S.doc Version 5.0 Page 6 Service users’ rights are overall respected and they enjoy a varied and balanced diet. Service users attend various daytime activities including Redoaks day services, college, recycling and activities arranged by the home such as pub lunches, crafts, dance nights, swimming, walks functions etc. The bungalow accommodation houses a sensory room and a service user reported that she enjoys horse riding and attends a beauty therapy course at the local college. Some service users participate in daily household tasks such as potato peeling and ironing and receive remuneration for this. Staff reported that they are aware of the Disability Discrimination Act gave examples of how places to visit are assessed for disability access and of a situation where staff challenged a venue about the act. Some service users attend a local church, which staff reported the congregation to be helpful and supportive with the service users. Staff reported that there were no issues with neighbours and that they found most people helpful. Service users reported that they recently attended a bonfire and staff informed the inspector that parties were being planned for Christmas. Rotas are arranged to ensure that service users needs are met regarding meeting their social and leisure needs at evening and weekends. The overall outcomes for service users are assessed as positive. Medication management is assessed as overall, safe in practice. Service users complaints are listened to and acted upon and service users live in a clean homely, comfortable environment. Service users are supported on the whole by a well -supervised staff team and are protected by the homes recruitment practices. What has improved since the last inspection? Staff reported that a service user who required extra support for getting up in a morning and who previously had refused to participate in activities or daily life has an improved quality of lifestyle. The service user is supported by an outside agency and this arrangement is reported to be working extremely well. A new minibus has been provided and staff, are assessed as competent under certain criteria before being allowed to be a driver. Staff, are keeping better records, regarding meals eaten by service users. The Dovecote Care Home DS0000008661.V265915.R01.S.doc Version 5.0 Page 7 Service users have been encouraged to keep their personal toiletries in their bedrooms. The financial systems have been reviewed in light of recent incidents. Some service users rooms have undergone a spring clean and re-furbishment. Recruitment practices are improved. Risk assessments are being carried out in relation to activities and holidays. What they could do better: Service users or their representative’s views are not obtained and evaluated within a quality assurance process and this is not satisfactory. The policies and procedures for the home are not reviewed and require standardising. Record keeping in the home should be improved and should be audited regularly. Health and safety practices were not satisfactory as a number of issues were identified. Therefore the service users health, safety and welfare may be compromised because of these issues. The care plan documentation does not reflect changing needs and personal goals of service users and it is felt that service users should be consulted more, and encouraged to make decisions and participate particularly regarding meal choices and in devising a weekly menu. Risk management processes should be further improved to ensure that all possible risks to service users are identified and that there is clear documentation in place to minimise these and where limitations or restrictions are in place that these are fully authorised. The documentation regarding the healthcare needs of service users and monitoring and evaluation of behaviour can be improved. Medication management requires some improvement is required to meet the standard and regulations fully. Service users complaints are listened to and acted upon. The protocols within the home are not sufficient to protect service users from abuse. Advice was given by the inspector regarding this. There are some areas for improvement in relation to minor repairs and health and safety issues and still some aspects of training provision to achieve to fully meet the standards. The Dovecote Care Home DS0000008661.V265915.R01.S.doc Version 5.0 Page 8 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 Dovecote Care Home DS0000008661.V265915.R01.S.doc Version 5.0 Page 9 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 Dovecote Care Home DS0000008661.V265915.R01.S.doc Version 5.0 Page 10 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): 2,5 Service users needs are assessed and there is ongoing work to include appropriate risk assessments within the care plan documentation. Service users have contracts in place, however these have not been fully assessed as to Standard 5. EVIDENCE: At the previous inspection it was identified that very detailed assessment was seen on the five care plans examined, which identifies areas for specific care plans. The assessments include service user preferences, such as bedtimes, getting up and likes and dislikes. The assessment does not identify risks as required by standard 2.3[iv] and the inspector advised that a further section be included to remedy this. At this inspection the manager provided evidence of some specific risk assessments being undertaken for activities, which had not yet been incorporated into the care plans as these were being finalised with key workers. Copies of risk assessments were seen for tasks around the home which service users may be involved in such as ironing, using the vacuum cleaner etc, however the inspector advised that individual copies of the risk to each individual need to be linked into the care package and kept in the individuals care plan file. Service users appeared happy and relaxed and were dressed appropriately for the season and in which reflected their own style and age group. The Dovecote Care Home DS0000008661.V265915.R01.S.doc Version 5.0 Page 11 From observations made during the inspection staff interacted well with service users and appear to be aware of the individual needs. A training programme including an induction supported this. There was information seen regarding service users being involved in an advocacy group. Information regarding how to access an advocacy service should be posted on the notice board for service users and relatives. From the assessment and care plan documentation the overall general needs of service users, appear to be met. There was one exception, which concerned the inspector regarding the possible inappropriate placement of one service user. The issue was discussed with the registered manager and Responsible Individual for the home and they were advised by the inspector to contact the service users social worker regarding a reassessment of need. There was no evidence in the service users care plan that their assessed needs had been reviewed by the home or any risk management strategies implemented. The registered manager needs to continually assess service users to ensure the home can continue to meet their needs. The contract now informs the service user of the arrangements regarding contributions of mobility payments. The document was not fully assessed due to time constraints and will be fully re-assessed at the next inspection. The Dovecote Care Home DS0000008661.V265915.R01.S.doc Version 5.0 Page 12 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): 6,7,8,9 The care plan documentation does not reflect changing needs and personal goals of service users and it is felt that service users should be consulted more, and encouraged to make decisions and participate particularly regarding meal choices and in devising a weekly menu. Risk management processes should be further improved to ensure that all possible risks to service users are identified and that there is clear documentation in place to minimise these and where limitations or restrictions are in place that these are fully authorised. EVIDENCE: Care plans were in place, but these should be expanded to include goal plans for service users, as the ones seen were really brief statements. Care plans are reviewed regularly and updated as necessary. Diaries are used for each service users daily log. Care plans cover financial details and a statement that mobility allowances are used as a contribution for transport provision in the home. In the sample of care plans examined and in related documentation it was clear that service users and relatives/representatives were not signing in agreement to the care plan or any limitations or restrictions that may be The Dovecote Care Home DS0000008661.V265915.R01.S.doc Version 5.0 Page 13 imposed. Whilst it was the inspectors professional judgement that the limitations imposed were in the best interests of those service users, service users, relatives and staff need to be aware of the reasons/risks involved and agree in writing as required by regulation. In particular the use of bedrails, monitor alarms and access to the kitchen. The homes policy on restraint clearly guides the management and staff in this area. It is recommended that the management and staff team re-visit the policy on restraint and ensure they follow their own policy. Where service users or their relatives cannot have input, professionals involved with the individual service users care should be used such as social workers or Community Psychiatric nurses etc. In discussion with a staff member about decisions for food choice and access to the kitchen it was evident that staff make some decisions on behalf of service users. There were some justified safety reasons and there was some evidence of this in the care plans examined. The inspector found some evidence that service users had chosen alternatives to the main meal served, but again this needs to be developed further to ensure that service users have an informed choice. A good example would be to provide menus in picture or symbol formats. The service users could be involved in meal planning by offering a suggestion for the menu for the following week. It would be good practice to have a house/service user meeting on a weekly basis to facilitate this. Several service users are members of an advocacy group and the inspector was informed that this had been in place prior to the last inspection. As stated in Standard 2 There was evidence of service users being able to take responsible risks and risk strategies implemented, one example seen was for a service user who had a job doing the ironing. There was now some evidence that risk assessments carried out however for activities and holidays and household tasks in general. The Dovecote Care Home DS0000008661.V265915.R01.S.doc Version 5.0 Page 14 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, 14, 17 Service users are clearly able to take part in age, peer and culturally appropriate activities at home and in the community. Service users’ rights are overall respected and they enjoy a varied and balanced diet. Further work on menu options is recommended. EVIDENCE: Observation on then day evidenced that service users have a key to their bedroom and the assessment documentation provides information regarding ability to open mail. Staff was observed interacting with service users, not exclusively with each other, Service users were observed having unrestricted access to the home and grounds [where applicable upon risk assessments]. The statement of purpose states that pets may be allowed at personal discretion. Service users attend various daytime activities including Redoaks day services, college, recycling and activities arranged by the home such as pub lunches, crafts, dance nights, swimming, walks functions etc. The bungalow accommodation houses a sensory room and a service user reported that she enjoys horse riding and attends a beauty therapy course at the local college. Staff reported that a service user who required extra support for getting up in a morning and who previously had refused to participate in activities or daily The Dovecote Care Home DS0000008661.V265915.R01.S.doc Version 5.0 Page 15 life has an improved quality of lifestyle. The service user is supported by an outside agency and this arrangement is reported to be working extremely well. Some service users participate in daily household tasks such as potato peeling and ironing and receive remuneration for this. A new minibus has been provided and staff, are assessed as competent under certain criteria before being allowed to be a driver. Staff reported that they are aware of the Disability Discrimination Act gave examples of how places to visit are assessed for disability access and of a situation where staff challenged a venue about the act. Some service users attend a local church, which staff reported the congregation to be helpful and supportive with the service users. Staff reported that there were no issues with neighbours and that they found most people helpful. Service users reported that they recently attended a bonfire and staff informed the inspector that parties were being planned for Christmas. Rotas are arranged to ensure that service users needs are met regarding meeting their social and leisure needs at evening and weekends. There was no documentary evidence seen that service users are encouraged to vote, however staff confirmed that service users are assisted with reading voting cards and asked if they wish to vote and think it is probably written in the daily notes. The inspector advised that this could be an area to include as part of the individuals care plan and evidence that the service user has participated recorded in the review and evaluation process. Policies were seen for equal opportunities, which staff were clear were in place. Most service users were supported with an annual holiday in the last twelve months. Two service users preferred to stay at home but have day trips arranged. One service user was still eating breakfast when the inspector arrived and this provided evidence that service users were allowed to eat at their own pace without being rushed. The menu is recorded in a diary with food probe temperatures [some had been missed]. The variety of food recorded appeared balanced and nutritional. Food stocks were ample and fresh fruit was seen in the pantry. A service user reported that she likes to make cups of tea for herself, other service users and staff. Another service user was observed to have access to the kitchen freely to make himself a cup of tea. The inspector recommends that a pre devised menu be formatted with picture/symbol or photographic formats, which can be used to assist service users in making an informed choice about their meal options and which should offer at least two options and service users preferred option be documented. A local supermarket and a farm shop deliver the food supply. The lunchtime meal on the day of the inspection was Sausage casserole, potatoes and a selection of vegetable although this was changed to peas due to the impact of the inspection. Records indicated that supper was provided and is usually sandwiches, crumpets, cakes or angel delight. The Dovecote Care Home DS0000008661.V265915.R01.S.doc Version 5.0 Page 16 The Dovecote Care Home DS0000008661.V265915.R01.S.doc Version 5.0 Page 17 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, 20 Service users appear to receive personal support, which meets their needs, however the documentation regarding the healthcare needs of service users and monitoring and evaluation of behaviour can be improved. Medication management is assessed as overall; safe in practice but improvement is required to meet the standard and regulations fully. EVIDENCE: There was clear evidence in the care plans examined, which demonstrated, choice about hairstyles, clothes and appearance. A key worker system is in place and staff work 1:1 with named service users. The bungalow provides suitable accommodation, aids and equipment to maximise independence. Care plans provided evidence of specialist input regarding psychiatrists and occupational therapists etc. The assessment identifies the healthcare needs of service users and there was improved record keeping of health checks, however there was still evidence that not all blood tests etc had been followed up. Healthcare checks should include an annual well person check, hearing checks and smear and breast screening as applicable. Where service users reach 60 years plus their care plans need to address ageing processes and ensure that regular reviews are held to ensure the home can continue to meet the individual needs. Weight records are in place, a section should be added for comments by staff The Dovecote Care Home DS0000008661.V265915.R01.S.doc Version 5.0 Page 18 regarding any significant weight loss or gain and effect on well being/mental health status. The manager stated that the local GP has refused to undertake well person screening for the service users. The inspector recommends that this decision is obtained in writing from the GP and the issue be taken up with the Primary Care Trust. Staff undertake, blood sugar monitoring for a service user with diabetes, records were satisfactory, however it became apparent that the district nurse draws up\insulin and staff inject the service user. Staff reported that they had been trained for this procedure by the deputy manager, however this is not satisfactory as any staff undertaking this procedure must firstly consent, be trained and competency assessed by the district nurse who must sign that the staff member has undertaken this training and is competent to carry out the task under the responsibility of the district nurse. Incidents of aggression are recorded on incident sheets and in care plans and the incident sheets assess the antecedent, behaviour and consequences. Care plans do inform staff of the likely situations that the service user may present challenges to the service, but overall the guidance for staff in dealing with challenging behaviour and strategies for minimising risks to other service users appeared insufficient. The manager reported that there was some evaluation ongoing currently regarding one service users behaviour and the inspector wishes to have a copy of the outcome when this is finalised. A recent meeting had been held regarding the same service user and the inspector was shown the minutes of these. The inspectors professional judgement is that improved strategies are needed to ensure that the staff can continue to meet the needs of the service user, to protect other service users and that the bungalow accommodation may not be the appropriate environment for this service user, particularly as the other service users in this accommodation are more vulnerable at could be at risk from the service user. Staff are not provided with adequate training regarding strategies for crisis intervention and prevention. Medicines management in the bungalow was assessed. Overall the system was satisfactory but the storage temperatures of the medication are not being taken. Insulin and other medication stored in the fridge were found to be satisfactory and date labelled as opened. Medication Administration records were satisfactory. There are no service users reported to be self-medicating currently, however a risk assessment document was seen for this purpose should this be needed. There were no sample staff signatures for those authorised to give medication on the front sheet of the medication records and this is recommended. Photographs were seen, but it would be good practice to actually have individual photographs on the dividers between each individual record sheet. There is a list of homely remedies, but staff reported that advice is sought from the manager and GP and usually a prescription arranged. The manager is advised to obtain a copy of The Royal Pharmaceutical Societies Guidance booklet for care homes to ensure that medicines procedures are followed. Homely remedies lists must be obtained from the GP with the GP The Dovecote Care Home DS0000008661.V265915.R01.S.doc Version 5.0 Page 19 signature of consent for staff to give service users from the list. PRN [prescribed as required] medication is only given to service users under procedures for authorisation from the staff supervisor or deputy manager and recorded on the back of the MAR and in the care plan. Ordering and returns appeared satisfactory. There was very brief information on the medication policies about informing CSCI of any drug errors. A policy for drug errors is needed with clear instruction for staff of procedures to follow should an error be made in drug administration, e.g. how to seek medical advice/attention for a service user, who may have been given the wrong medication or wrong dose etc. It is recommended that a medication profile be included in the service users care plan, which details information on the service users prescribed medication, any changes and why and documents medication reviews. This would provide also a useful history record which staff may find beneficial when overseeing health care needs of service users. Staff spoken with and training records confirmed training in medicines management. The medication record folder was untidy and contained information that could be kept in another file. It would be good practice to ensure that a copy of the drug error policy with clear direction for staff is kept accessible, at the front of the Mar sheets. The Dovecote Care Home DS0000008661.V265915.R01.S.doc Version 5.0 Page 20 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, 23 Service users complaints are listened to and acted upon. The protocols within the home are not sufficient to protect service users from abuse. EVIDENCE: The complaints procedure is displayed and meets requirements. Records of complaints were examined four complaints had been made on behalf of service users by staff and were upheld. This provided evidence that service users views are listened to. Another complaint had been made by an outside professional regarding staff conduct and another complaint was made regarding staffing issues. All were found to be upheld. A complaint had been submitted to the Commission in relation to mobility allowances and was investigated at the last visit. The complaint was, found to be partly upheld. The registered manager is appointee for several service users, which is not appropriate. [Reference Regulation 20 – Restrictions on acting for a service user] The manager reported that this has been looked into, but there has been difficulty finding alternative appointees to act on service users’ behalf. It is recommended that the registered manager seek advice from adult payment services regarding the issue. The inspector has not been informed that this issue is resolved. Mobility allowances are pooled to cover the costs of the provision of the minibus, taxis and public transport. There was evidence that this was documented within individual care plans and in a statement in the service user guide. The manager reported that audits had shown that transport costs for the home were well in excess of the contributions by service users. The Dovecote Care Home DS0000008661.V265915.R01.S.doc Version 5.0 Page 21 The last inspection found that the system in place was not a fair and appropriate one as service users were awarded differing rates of allowance and there was no evidence regarding whether or when the service user had actually used the transport. An appropriate record of service users financial outgoings must be kept, which identifies; • • When service user’s expenditure on transport occurs. [Activities participated in] What contributions are based on, and reflect the appropriate level of allowance. and: • Where service users are found to be contributing and not using the facility, appropriate reimbursement should be made to the service users and/ or a system be devised where contributions are calculated at a rate per mile used only. The manager informed the inspector that the process of assessment for this is still ongoing and that he will inform the inspector of the outcome and action decided. It became evident that two of the complaints made were about service users being at risk from another service user and there was evidence that the service user had physically assaulted some particularly vulnerable service users. Adult protection procedures had not been instigated by the home and this is an area of concern. The manager was advised to contact the adult protection unit for advice in the matter and for future reference to update knowledge on the reporting procedures. It is also necessary for the relevant service users social workers to be informed of the incidents and the manager must inform the inspector of the outcome of this contact. Staff spoken with were aware of the whistle blowing policy. There is a policy for abuse awareness which informs staff to report any concerns of abusive practice and contains a flow chart regarding alerting. The information does not make the reporting procedures clear and does not reflect the guidance of the Nottinghamshire Committee for the Protection of Vulnerable Adults and CSCI regulation 37 notifications. The above incidents had not been notified to CSCI as required by Regulation 37. Where it is reported that a service user has made allegations about staff or other service users the Adult Protection procedures must be followed. In addition to this where unexplained bruising is observed the manager, appropriate action must be demonstrated that this has been investigated and action taken to minimise this occurring again. Where the bruising may, be The Dovecote Care Home DS0000008661.V265915.R01.S.doc Version 5.0 Page 22 noted to be caused, by poor manual handling practice, appropriate action should be taken and appropriate risk management strategies incorporated. There is a policy in place for staff, regarding the use of service users monies and includes making purchases on service users behalf and states that staff must not benefit from service users. It is recommended that the policy be further developed which clearly identifies that staff must not use their bonus point schemes, credit cards etc. The Dovecote Care Home DS0000008661.V265915.R01.S.doc Version 5.0 Page 23 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, 30 Service users live in a clean homely, comfortable environment. There are some areas for improvement in relation to minor repairs and regarding health and safety issues. EVIDENCE: Most of the service users’ bedrooms were inspected; all were personalised, clean and free from mal odour. Service users can provide furniture of their choosing and evidence was seen of this. A range of comfortable safe and fully accessible shared space is provided both for shared activities and for private use. Disposable gloves and practices for infection control were observed in the home. Training is planned for staff in infection control over the next twelvemonth period. The activities room in the bungalow is also used to store broken chairs, the hoist and other items. A service user accesses the computer, which is in the activity room. The Dovecote Care Home DS0000008661.V265915.R01.S.doc Version 5.0 Page 24 The carpet is damaged which presents a trip hazard and needs repair/replacement. The stored items in the activity area, also pose a health and safety hazard, particularly as the items may block a fire exit route. The registered manager reported that this was on the agenda and agreed to organise action promptly to ensure it was cleared See Requirements for St 42. The home was found to be clean and free from mal odour. Standard 42 highlights some areas not assessed at this inspection that are carried forward until the next visit. The bathroom cupboards have been removed and therefore the bathroom and toilets in the bungalow require re-decoration. There is some plaster damage in the entrance area to the bungalow, which requires attention. The electric fuse room is not kept lock and the inspector requires the registered manager to provide evidence from the fire officer that this is acceptable practice. The Dovecote Care Home DS0000008661.V265915.R01.S.doc Version 5.0 Page 25 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): 33, 34,35, 36 Service users are supported on the whole by a well -supervised staff team and are protected by the homes recruitment practices. There are still some aspects of training provision to achieve to fully meet the standards. EVIDENCE: An in house induction has been devised by the manager, which is reported to meet skills for work standards. The induction booklet covers the values and principals of care work but there was no evidence that all new staff have covered the mandatory training topics within 6 months of employment. Training in NVQ 2 and 3 was evident but there was nothing on LDAF [Learning Disability Accreditation Framework]. The registered provider wishes the report to state that staff are always advised to choose the NVQ units, which relate directly to LDAF. There was no evidence of staff /team meetings, staff members reported that the manager had endeavoured to provide these but which had been poorly supported by staff. Any concerns that staff have are encouraged to be put forward and meetings arranged. There was no evaluation of how this was working at this time, but staff felt that action had been taken where concerns had been raised and resolved satisfactorily. A staff bulletin is provided on a regular basis to promote communication. Due to a lack of time, the inspector did not assess the recruitment practices at this visit, but through discussion with the manager he confirmed that he was fully aware of the current the current legislation in relation to POVA checks and The Dovecote Care Home DS0000008661.V265915.R01.S.doc Version 5.0 Page 26 had telephoned the Nottingham CSCI office to confirm the correct arrangements. Training records indicated that training has been provided in manual handling, food hygiene, fire safety, medicines management, adult protection first aid, aggression management, infection control and the managers own training on working with strengths and needs of people with learning disabilities. The manager explained that free training had been obtained for the next twelve months, which includes training in health and safety and infection control. From discussion with staff and the manager at the inspection, it is recommended that the manager carry out periodic competency assessments on staff to ensure that they are practicing in a way they have been trained, particularly in relation to unexplained bruising and manual handling techniques. There was evidence of staff formal supervision in place and the manager reported that every effort is made to hold sessions with individuals up to six times a year. Evidence was confirmed of annual appraisals also. The Dovecote Care Home DS0000008661.V265915.R01.S.doc Version 5.0 Page 27 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): 39,40, 41, 42, 43 Service users or their representative’s views are not obtained and evaluated within a quality assurance process and this is not satisfactory. The policies and procedures for the home are not reviewed and require standardising. Record keeping in the home should be improved and should be audited regularly. Health and safety practices were not satisfactory as a number of issues were identified. Therefore the service users health, safety and welfare may be compromised because of these issues. EVIDENCE: There was still no evidence of quality monitoring systems in the home, apart from the regulation 26 visits. The registered person now needs to address this issue as four years on from the Care Home Regulations 2001 and the National Minimum Standards. An annual development plan is needed for the home, based on a systematic cycle of planning-action –review, reflecting aims and outcomes for service users. The Dovecote Care Home DS0000008661.V265915.R01.S.doc Version 5.0 Page 28 There should be continuous self-monitoring as specified in standard 39.2 and a service user survey a standard 39.4-39.10. The manager reported that the chairperson of the trust visits weekly and there was now evidence of Regulation 26 reports in the home. The chairperson of the trust visited the home on the day of the inspection. There have been no regulation 37 notifications submitted for the incidents identified by the inspector. This is an outstanding requirement. Failure to comply with this may result in enforcement action being taken. Staff reported that they have signed that they have read and understood the policy manual. The policy manual was not assessed regarding compliance with appendix 3 due to time constraints. Food safety issues were once again identified regarding out of date foods in the fridges in the bungalow. Opened food items, such as pork pies, scotch eggs and packet hams and meat had not been air sealed or date when opened. The manager reported that regulating valves are fitted to all taps there were records of checks for these but temperatures recorded above 43 degrees did not indicate any action taken to remedy temperatures exceeding 43 degrees and a retest. The following items were not checked at this inspection due to time constraints and will be listed in the requirement for health and safety to be assessed at the next visit. Where service users have fridges in their rooms, temperature checks should be recorded. The health and safety posters were not completed or up to date. The fire safety tests were examined, several gaps were found. There was some missing window restrictors noted throughout the Lodge, these must be repaired. Not all radiators were off the low surface type and did not have safety covers. It was reported that covers are on order. There was no evidence of risk assessments regarding surface temperatures of radiators and these should be carried out and where high risk areas are identified such as bathrooms, behind chairs/beds, where service users have epilepsy, these should be made priority. There was no evidence regarding what is in place to control risk of legionella, this must be provided. It is advisable that guidance is sought from a registered plumber. The Dovecote Care Home DS0000008661.V265915.R01.S.doc Version 5.0 Page 29 Risk assessments were in place for fire safety and generic work topics. There was liquid soap and paper towels were seen in bathrooms. Pull cords for light fittings, should be changed when they become grubby. Service users’ personal toiletries are not now stored openly in bathrooms. The Insurance certificate was up to date. The income and expenditure account was made available upon request. Travel expenses, outings and holidays are noted to be included in one heading. In light of the recent complaint is advised, that separate accounting headings be used for service users contributions and transport costs. The Dovecote Care Home DS0000008661.V265915.R01.S.doc Version 5.0 Page 30 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 2 X X 2 Standard No 22 23 Score 3 1 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 2 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X 3 3 2 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Dovecote Care Home Score 3 2 2 X Standard No 37 38 39 40 41 42 43 Score X X 2 2 1 2 3 DS0000008661.V265915.R01.S.doc Version 5.0 Page 31 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 YA2YA23 Regulation Requirement Timescale for action 14/02/06 2 YA2 3 YA6 4 YA19 14, 15, 17 Ensure risk assessments are completed for all identified risks. The Registered Person must review the risk management strategies overall in reference to individual needs, challenging behaviour, use of restraint or limitations and in relation to suspected abuse or poor practice. 14, 15, 25 Ensure that the home can 14/01/06 continue to meet the needs of all service users and that an assessment of need is reviewed accordingly. 14, 15, Ensure there is written evidence 14/02/06 17, 25 that the service user or representative is agreement to the individuals care plan and any limitations imposed, use of bedrails etc are consented to,and the service user or their representative have been informed fully of any risks or necessary details. 18 Staff must only be permitted to 14/01/06 administer insulin with a] their consent, b] with training and a competency assessement carried out and documented by the DS0000008661.V265915.R01.S.doc Version 5.0 The Dovecote Care Home Page 32 district nurse. 5 YA19 12, 13, Ensure staff are fully equipped to 14/02/06 14, 15, 18 meet all service users need regarding dealing with challenging behaviour and strategies for crisis intervention and prevention. Medicines Ensure that medication 14/02/06 Act procedures are safe and meet with the Royal Pharmeucitical guidance for medicine adminsitration in care homes. A] Ensure there is an appropriate policy for drug errors, which informs staff of appropriate action to take and that it is placed in an accessible place for staff to use should an emergency arise. B] The homely remedies policy must be devised with the input of the GP and contain the GP’s signature of what homely remedies medication is permitted. The Registered Person must ensure that all service users are protected by implementing appropriate adult protection procedures and by following the Nottinghamshire Committee for Vulnerable Adults guidance for notification, alerting and reporting and that the homes procedures refelect this. The registered person must ensure that the recent incidents are reported under POVA and that the relevent service users social workers are informed to allow approriate action to be taken. Training must be provided for all staff for health and safety and infection control DS0000008661.V265915.R01.S.doc 6 YA20 7 YA23 13,19 No Secrets 14/11/05 8 YA35 18 14/02/06 The Dovecote Care Home Version 5.0 Page 33 9 YA39 25 10 YA41 37 11 YA42 16, 23 A quality monitoring system must be implemented and which includes provider visits and reports as specified under regulation 26. Ensure appropriate notifications are made to CSCI under Regulation 37 requirements. Outstanding. Further noncompliance may result in enforcement action. Ensure appropriate systems, staff training and records, are in place to safeguard the health safety and welfare of service users as identified within the report. • Ensure staff comply with food safety practicesoutstanding Ensure staff comply with safe manual handling practices.[All staff must be trained in manual handling] Ensure water temeperatures are regulated to 43 degrees. outstanding Ensure window restrictors are fitted to all windows[not assessed this time] Ensure covers are fitted to radiators where assessed as a risk. Outstanding. Provide evidence that systems are in place for the prevention of legionella to CSCI Seek advice from the fire 14/02/06 14/11/05 14/12/05 • • • • • • The Dovecote Care Home DS0000008661.V265915.R01.S.doc Version 5.0 Page 34 officer regarding the unlocked fuse cupboard and report outcome to CSCI • Ensure fire safety checks are carried and documented as required by regulation. Ensure the carpet in the activities room is made safe Ensure the stored items in the activities room are cleared and the room made safe for 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 3 4 5 6 Refer to Standard YA5 YA6 YA8 YA8 YA14 YA19 Good Practice Recommendations Supply a copy of the contract document as evidence that it meets standard 5 Care plans should also reflect service users goals, aspirations and achievements and contain dialogue within the monitoring and review process to evidence this The use of communication aids, such as menus in symbol or photographic formats should be explored and implemented to promote informed choice A pre-agreed menu should be devised and offer at least two options to service users to choose from. Evidence of the choice should be documented. Service users participation in the civic process should be written into the care plan structure. Obtain in writing the decision by the GP not to offer well person checks to service users and seek advice from the Primary Care Team regarding this. [Inform the inspector of the outcome] Ensure care plans, which address the ageing process, are implemented for service users over 60 years and are DS0000008661.V265915.R01.S.doc Version 5.0 Page 35 7 YA19 The Dovecote Care Home 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 YA19 YA20 YA20 YA20 YA23 YA23 YA23 YA24 YA35 YA39 YA39 YA40 YA43 YA42 YA42 reflected in the policy for ageing and increasing frailty. Add a comments section to the weight record sheet. Ensure staff who are authorised to administer medication have a sample signature documented at the front of the MAR [Medication administration records] file Re-site the photographs of service users to the divider relevant to the person and tidy the file in general. Include medication profiles in care plans which document medication reviews etc. Seek advice from adult payment services regarding appointee ship for service users as discussed at the last inspection Continue and finalise the assessment in relation to service users use of transport and how mobility payments will be costed and send the outcome to the inspector. Ensure the policy for staff use of service users monies clearly details what is not appropriate use under the Finance Acts. Re-decorate the bathroom and toilets in the bungalow. Repair and re-decorate the plaster damage to the entrance hall in the bungalow. The registered person should undertake periodic competency assessments on staff to ensure good practice is maintained. Develop ways to obtain service users views, such as by using outside professional support or advocacy services in service user surveys etc. Consider use of an outside consultancy to audit the care services under standard 39. Review policies and procedures and provide evidence that staff have been issued with a copy or read and understood them. The budget heading for transport , outings and holidays should be seperated out. Where service users have fridges in their rooms, temperature checks should be recorded. The health and safety posters were not completed or up to date. The Dovecote Care Home DS0000008661.V265915.R01.S.doc Version 5.0 Page 36 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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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