Inspection on 16/04/07 for The Dovecote

This inspection was carried out on 16th April 2007.

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 3 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 22/04/06

The Dovecote 07/02/06

The Dovecote 15/11/05

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 The Dovecote Residential Home 69 Bagshaw Street Pleasley Mansfield Nottinghamshire NG19 7SA Lead Inspector Jayne Hilton Unannounced Inspection 16th April 2007 07:30 The Dovecote DS0000008661.V333977.R01.S.doc Version 5.2 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 DS0000008661.V333977.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 DS0000008661.V333977.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Dovecote 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 DS0000008661.V333977.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st August 2006 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. Leicester Housing Association owns the building. The home is located in Pleasley and is close to shops, pubs, the post office, a community centre and workingman’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 three of the bedrooms have en-suite facilities. Bedrooms are located on the 1st and 2nd floors in the converted vicarage, which can be accessed by a staircase or stair lift. All bedrooms in the bungalow are at ground floor level. 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 Registered Manager provided information about fees on 11/4/07 Current Fees range between £368-£1,183 dependent on needs. Service users are expected to contribute mobility allowances in relation to transport arrangements. The Dovecote DS0000008661.V333977.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was undertaken on 16th April 2007, was unannounced and took any previous information held by Commission for Social Care Inspection about the home into account. The inspection included a site visit, which took place over six hours. The main method of inspection used was called case tracking. This involves selecting a proportion of residents and tracking the care they receive through the checking of records, discussions with staff that care for them and observation of care practices. On the day of the visit most residents were only present periodically, as they attend various activities throughout weekdays. Three residents were spoken with and two staff. A partial tour of both houses was also conducted which included looking at bedrooms, communal areas, kitchens and the laundry facilities. Documentation was sampled and the care records of two residents were examined. The registered person provided information prior to the inspection in the pre inspection questionnaire, three relatives responded and seven residents with their own questionnaires about their view on the quality of service provided. Information from all of the above was used to make an assessment of the service. Three requirements have been made. A random inspection was undertaken on 1st August 2006 at the service a copy of the inspection outcome letter is available on request. What the service does well: There was some evidence of quality monitoring systems in the home, including the responsible individuals monitoring visits. Meetings are currently underway for development of The Quality Tree and residents confirmed attendance at these as did staff. The manager reported that he intends setting up a residents committee and quality surveys once the training has been completed. The Dovecote DS0000008661.V333977.R01.S.doc Version 5.2 Page 6 Residents know how to make a complaint if they are not happy and say their privacy and dignity is respected. Residents said they were happy with the food provided and a good range of activities appears to be experienced by the residents. Residents have their needs assessed and are provided with a written contract. The systems in place for the management of medication are generally safe. Comments from relatives made in the returned questionnaires are as follows: “ I feel that the Dovecote offers a homely experience. The residents individually are given exceptional attention. As a family we have nothing but the highest praise to give to what we feel is a very special environment offering the highest care possible” “ It is very difficult to improve what really is as near to perfect in the social care sector you can get” “We offer out thanks to all the team at the Dovecote for everything that is done for our relative” “The home creates a warm friendly environment for its residents and visiting guests”. What has improved since the last inspection? Noted Improvements have been made in the ethos, leadership and management of the home and the health safety and welfare of residents are promoted and protected. Staff are now provided with a good level of mandatory training. There were no food safety issues identified at this inspection. A stair carpet in the Lodge, which was worn, has now been replaced. Water outlet temperatures were sampled and records of these kept viewed. One double room has recently been converted to a single room with en-suite. The conversion had provided excellent facilities for one resident, which included a shower unit and seating area. The activities room in the bungalow has been converted to a bedroom. The Dovecote DS0000008661.V333977.R01.S.doc Version 5.2 Page 7 Improved systems are now in place to protect service users from harm but staff require further input and guidance to ensure residents are safely supervised at all times. The lounge and dining rooms have recently been redecorated and the manager reported that quotes have been obtained for re-decoration of the identified areas recently. The system in place for monitoring the resident’s healthcare needs has been improved. What they could do better: A person centred approach to care planning is needed with the core care elements of an individual being consolidated into one care plan file which contains an holistic picture of the individuals lifestyle choices, associated risk assessments and which monitors the input by staff to support this and evaluates how or if this is being achieved/or not. Care plans must fully inform staff of service users current needs and risk assessments and be kept under review. In respect of the identified mobility needs of a resident when bathing. In respect of medication details in the care plan and the reviewing of this. In respect of safe supervision of residents. This is required to ensure the needs of residents are fully met. Complaints are not fully documented within the formal complaints records. This is required by regulation and provides information that complaints are being dealt with appropriately. There is much scope to be progressive and innovative and to develop and introduce communication systems for those service users with limited verbal communication and complex needs. Staff need further input to provide them The Dovecote DS0000008661.V333977.R01.S.doc Version 5.2 Page 8 with the necessary skills and knowledge with up to date and current good practice. There is no pre-planning of menus but 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 at all times. Residents would benefit from staff receiving further input to provide them with the necessary skills and knowledge with up to date and current good practice. The Responsible Individual and Social Services are still debating staffing issues, however this must be addressed promptly to ensure that safe staffing levels are maintained at an appropriate level. In the Lodge, observations of the higher areas indicated that these were not included in the cleaning schedules and it is recommended that cleaning staff be employed for this purpose also in The Lodge also. Towels and flannels are in need of replacement as those viewed were worn and frayed and attention is needed to ensure continence pads and toiletries are stored safely. Fourteen good practice recommendations have been made. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Dovecote DS0000008661.V333977.R01.S.doc Version 5.2 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 DS0000008661.V333977.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have their needs assessed and are provided with a written contract. Information is available for any new prospective residents but existing residents have not been issued with their own copy. EVIDENCE: A service user guide with symbols was viewed in the home, but residents did not appear to have their own personal copy, neither did the document inform the reader how to access a copy of the inspection report. Out of the seven questionnaires returned by residents five said they had been given enough information about the home before they moved in, one person didn’t know and one person could not remember. The document should be revised to include information about accessing inspection reports and evidence available that existing residents have been provided with their own copy Contracts were viewed and these were, signed by the individual resident. Resident’s needs are assessed prior to admission and the home undertakes its own social needs profile assessment which acts as a combined care plan and The Dovecote DS0000008661.V333977.R01.S.doc Version 5.2 Page 11 risk assessment. There have been no new admissions to the home since the last inspection. It is recommended that the document be further developed to embrace equality and diversity, to ensure any cultural, religious, sexuality, gender, disability needs are fully addressed. The Dovecote DS0000008661.V333977.R01.S.doc Version 5.2 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. 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. Residents have their basic needs met however, a person centred approach to care planning is needed with the core care elements of an individual being consolidated into one care plan file which contains an holistic picture of the individuals lifestyle choices, associated risk assessments and which monitors the input by staff to support this and evaluates how or if this is being achieved/or not. EVIDENCE: Two residents care files were examined as part of the inspection. Care plans were in place. Diaries are used for each service users daily log. One persons care plan was found not to have a mobility risk assessment completed despite the person having some mobility problems. The care plan did identify the person’s mobility needs and walking aids used however there was no care plan in place in relation to the persons needs in respect of bathing The Dovecote DS0000008661.V333977.R01.S.doc Version 5.2 Page 13 and this must be put into place as a priority. It is also recommended that an appropriate professional assessment be obtained in respect of suitable aids and adaptations for the identified persons personal care needs. Care plans varied as to the information on whether the residents hold keys to their bedrooms and lockable cupboards to what residents said. One person had not got a key to either of his bedroom door or lockable cupboard because he keeps losing them, however this was not documented within the care plan. Care plans cover financial details and a statement that mobility allowances are used as a contribution for transport provision in the home. One person’s care plan differed in information about medication details to what was being prescribed and indicated was last reviewed on 24/05/06. If medication profiles are introduced these would identify where any changes are made by medication reviews or otherwise and contain up to date information. Residents spoken with said they did not know what a care plan was and there was still no evidence that they are involved in their compilation or that they have agreed to what they contain. Care plans are currently updated regularly by the manager with a date stamp, but there is no evidence of a process in place of why the care plan has been changed. Regular review meetings take place, outcomes of these meetings are documented but contain a brief summary of action points but not an overview of the persons lifestyle/events/achievements or difficulties experienced leading up to the review. Not all staff has access to this information. Residents spoken with and those that returned questionnaires confirmed that they were able to make choices and decisions about their lifestyles and care plans do address likes/dislikes, and preferences. They were also able to confirm that they were involved in Advocacy groups. Risk assessments are integral within most of the care plans, some have been devised on a different system in respect of behaviour in the community. Therefore the inspector continues to recommend that the system in place be reviewed and updated and that person centred planning is introduced and that the manager and staff receive training on appropriate care planning and record keeping. The Dovecote DS0000008661.V333977.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A good range of activities appears to be experienced by most residents and staff and residents confirmed this however the current staffing resources may compromise the lifestyle of those service users who users wheelchairs. Service users enjoy their meals. EVIDENCE: Residents attend swimming, dances and bingo, which are specially organised for people with learning disabilities and usually go out to the pub at weekends. Some residents attend day centres. One resident informed the inspector that he worked part time at a local burger bar and enjoyed a Nature group at weekends. Another person said they had recently been to watch an ABBA tribute band, which was brilliant! The Dovecote DS0000008661.V333977.R01.S.doc Version 5.2 Page 15 One person was going bowling on the day of the inspection and reported that he can knock all of the skittles down in one go. He and the staff member supporting him said they had planned to go for lunch out afterwards. Residents and staff spoken with informed the inspector that holidays had been planned in Mablethorpe, Blackpool and one to be taken in Wales. Residents confirmed that staff treated them with respect and that they enjoy the food. They said this was the best thing about Dovecote. They also stated that they could get up and go to bed when they want to and get involved in some jobs around the home such as laundry and cooking and some can make a drink when they want one. Although a good range of activities appears to be experienced by the residents and staff and residents confirmed this, comments were made about staffing levels which in the main are two staff to seven residents currently, however four service users in the bungalow require wheelchair provision for outings and some residents have one to one support provided, so the provision of two staff therefore limit the residents in relation to socialisation and activities. There are a number of service users at The Dovecote who have limited communication skills. The inspector has been recommending that the home be innovative and progressive in relation to exploring other methods of communication to benefit service users for some while now. There was no progress made in relation to this at this inspection. Person Centred Plans would address individual’s needs and preferences for social, recreation and leisure. Additional specific knowledge; skills and facilities for more effective methods of communication are required in order for the care home to deliver an individually tailored service for the unique and complex needs of individuals living in the home. The inspector’s professional judgement is that staff was receptive to the ideas presented to them for developing alternative communication methods for service users and that training in this area would be extremely advantageous for both service users and staff and in bringing the home up to date with current good practice. Residents have various contact with relatives and where possible relatives are involved in care reviews. Friendships between service users are promoted. The variety of food recorded appeared balanced and nutritional but there is much scope for improved practice in this area. The Dovecote DS0000008661.V333977.R01.S.doc Version 5.2 Page 16 There is no pre-planning of menus but 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 at all times. It is recommended that at least two meal options are provided on each daily menu and the choices documented. The Dovecote DS0000008661.V333977.R01.S.doc Version 5.2 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. 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. The system in place for monitoring the resident’s healthcare needs has been improved. The systems in place for the management of medication are generally safe. The privacy and dignity of service users are respected. EVIDENCE: The system in place for monitoring the resident’s healthcare needs has been greatly improved and now includes follow up records of blood tests etc. The system could still be further improved and should be integral to the individuals person centred plan. The area of food and nutrition needs to be more focused upon and included within a healthcare profile for each individual and in particular where specialist dietary needs are highlighted. It is therefore recommended that advice and training is sought from the dietician or district nurse services about introducing nutritional screening tools for service users to identify where there are any specific risks to individuals The Dovecote DS0000008661.V333977.R01.S.doc Version 5.2 Page 18 and then to set up appropriate monitoring and recording systems. The provision of food and nutrition training for staff would benefit service users living in the home. There was no specific step-by-step instruction for staff to follow in monitoring the service users healthcare needs. There was still no record of annual health checks being carried out [NMS 19.4] but staff reported that all residents had changed their GP practice and were undergoing medical checks through that process. Service users spoken with confirmed they their felt that privacy and dignity was respected. There were no issues highlighted at this visit in relation to privacy and dignity. Policies and procedures were in place. A procedure for dealing with drug errors was seen as accessible for staff, but it is recommended that a reminder note be added that all drug errors are to be notified to CSCI [Commission for Social Care] under Regulation 37. The management of medication was overall satisfactory. There are no service users reported to be self-medicating currently. Staff spoken with and training records confirmed training in medicines management. It is once again recommended that Medication Profiles should be developed for service users medication and which encompass medication reviews and changes and the reasons for this as part of healthcare monitoring. Consent for medication is also a necessary component and the manager is advised to prepare for the implementation of The Mental Capacity Act, in April 2007. It is recommended that two signatures witness any “as required” medication. The community pharmacist visited the home on 5th February 2007 and made the following recommendations: Handwritten entries in the lodge need two signatures. Homely remedies policy to be reviewed with new GP Consider changing Omeperizole capsules to tablets so they can be blistered. Dispose of old tablets more than twelve months from dispensing. There were no issues identified in relation to the recommendations at this visit. The Dovecote DS0000008661.V333977.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improved systems are now in place to protect service users from harm but staff require further input and guidance to ensure residents are safely supervised at all times. Residents are not fully protected from harm. Residents know how to make a complaint if they are not happy. EVIDENCE: Records were examined for complaints received by the home, since the last inspection there have been two complaints made to the home. Evidence of another complaint was viewed within a residents care notes, which had not been transferred to the formal complaint record. Residents confirmed that they knew how to make a complaint and one person said that when he had he felt that he had been listened to and the problem acted upon by the manager. A relative commented “never had to make any complaint any concerns have been dealt with directly with staff and have been kept informed at all stages” The manager has submitted regulation 37 notifications where appropriate to the Commission. Residents spoken with said they felt safe. The Dovecote DS0000008661.V333977.R01.S.doc Version 5.2 Page 20 There have been three Protection of Vulnerable Adults investigations during the past twelve months. Improved practice recommendations have been made to the home as an outcome of these. During the inspection a vulnerable resident who should be supervised at all times by staff was left alone with other residents, whilst the staff member undertook some cleaning tasks in the home. The issue was discussed with the registered manager and responsible individual and they confirmed that they would address the situation and provide further guidance for staff in prioritising safeguarding above work tasks. Staff have undertaken training in Protection Of vulnerable Adults and for dealing with challenging behaviour. Staff spoken with were aware of the whistle blowing policy and demonstrated knowledge of reporting any poor practice. The restraint policy was in place and examined; it stated that where restraint may be necessary, individual care plans will inform staff of what strategies may be used. Staff reported that there is no service user now at the home that with this kind of need. There were two recorded incidents of use of restraint during the previous twelve months. A sample of resident’s financial records were examined and were satisfactory. The Dovecote DS0000008661.V333977.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a comfortable and hygienic environment. Ongoing consultation with the Environmental Health Officer will ensure this continues to be so. Further re-furbishment of the home will improve the quality of the environment for the residents. EVIDENCE: Several residents’ bedrooms were viewed; all were personalised. Residents can provide furniture of their choosing and evidence was seen of this. One double room has recently been converted to a single room with en-suite. The conversion had provided excellent facilities for one resident, which included a shower unit and seating area. One resident had moved his television, which had created trailing cables. The registered manager confirmed that a risk assessment would be devised and support provided to assist the individual to consider safer options. The Dovecote DS0000008661.V333977.R01.S.doc Version 5.2 Page 22 A range of comfortable safe and fully accessible shared space is provided both for shared activities and for private use. Some areas are looking tired, particularly the hallways, staircases and bathrooms. The lounge and dining rooms have recently been redecorated and the manager reported that quotes have been obtained for re-decoration of the identified areas recently. Attention is needed to ensure continence pads and toiletries are stored safely. The manager reported that new schedules have been introduced for cleaning and hygiene management and cleaning staff contracted for the bungalow for deep cleaning. Support staff, however, undertakes most of the cleaning responsibilities. In the Lodge, observations of the higher areas indicated that these were not included in the cleaning schedules and it is recommended that cleaning staff be employed for this purpose also in The Lodge also. Towels and flannels are in need of replacement as those viewed were worn and frayed. The Environmental Health Officer and the Landlord [Leicester Housing Association] are currently in discussion about accessing water storage temperatures as there is an identified problem with valves/gauges on the water tank. Evidence of Chlorination of the system and cleaning of showerheads to prevent Chlorination was viewed. The Environmental Health Officer visited the home in August 2006 to inspect the management of food safety. Issues identified included the need for fly screens, cooked meats were being stored below salad products and antibacterial spray was not being used however there were no food safety issues identified at this visit. The Dovecote DS0000008661.V333977.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are provided with a good level of mandatory training. Residents would benefit from staff receiving further input to provide them with the necessary skills and knowledge with up to date and current good practice. The Responsible Individual and Social Services are still debating staffing issues, however this must be addressed promptly to ensure that safe staffing levels are maintained at an appropriate level. EVIDENCE: Records viewed and staff confirmed that a good level of training is provided. The resident’s lifestyle would be improved by staff having further input/ training in key working care planning, food and nutrition and communication skills The registered manager provided information in the pre –Inspection record that 67 of staff hold NVQ level 2 or above. The recruitment files for four staff were examined and found to be satisfactory. The Dovecote DS0000008661.V333977.R01.S.doc Version 5.2 Page 24 Supervision is in place; staff, paperwork, senior staff and the manager evidenced this. However even with the annual appraisals held, the sessions fall short of six a year and one session, which should be observation of practice. The issue of staffing levels are still causing confusion. The Registered Person had carried an assessment about staffing resource issues, but evolving circumstances has altered this course. Discussions are underway with Social Worker and Commissioning Teams currently. Rotas viewed showed that without one to one hours [Total of 100 one to one hours in the Lodge and 117 one to one hours in the bungalow] a total of 137 hours a week are provided for daytime hours in the Lodge and 144 hours in the bungalow. 8 hrs a week cleaning is also being provided. There are currently six residents living in the bungalow and seven residing in the Lodge It is therefore recommended that the minimum basic staffing hours be separated out for each establishment as previously stated and that as based on current guidance equate to 210 hours care from 7am until 10pm. Additional hours for domestic/laundry at two hours per resident and catering hours at two hours per resident need to be allowed. One to one hours funded by social services should be in addition to the above and not included as part of the calculation. There is a varying level of dependency needs for each resident, some of which require two staff for transfer and mobility assistance. Although the incidents of challenging behaviour have greatly reduced to almost non-existent currently, there is still an issue of debate around safe staffing levels. The Dovecote DS0000008661.V333977.R01.S.doc Version 5.2 Page 25 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. 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. Residents can be confident their views underpin all self-monitoring reviews in the home. Noted Improvements have been made in the ethos, leadership and management of the home and the health safety and welfare of residents are promoted and protected. EVIDENCE: The manager has been in post for several years, he holds a social work qualification. It appeared that the manager had tried to put systems into place for exchange of information and communication, such as the supervision and appraisals, through the staff structure, requests in writing, and a staff bulletin. The Dovecote DS0000008661.V333977.R01.S.doc Version 5.2 Page 26 The meeting structure was set up to address priority issues. Clearly some staff still do not feel included in meetings and that they are not fully consulted with or informed as they should be. Currently only senior staff are involved in operational meetings and key staff in care reviews. It is the opinion of the inspector that staff at all levels may have innovative ideas and could make valuable contributions to the development and modernisation of the service. It is recommended that the manager consider setting up development groups to enable the service to move forward in the weaker areas of practice identified through many inspections. There was some evidence of quality monitoring systems in the home, including the responsible individuals regulation 26 visits [these should be sent to the Commission for Social Care Inspection on a monthly basis however and a copy kept in the home]. Meetings are currently underway for development of The Quality Tree and residents confirmed attendance at these as did staff. The manager reported that he intends setting up a residents committee and quality surveys once the training has been completed. 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. It is recommended that this be addressed and includes issues of staffing levels to improve the quality of life for service users living in the home. Records were kept secure. Record keeping overall was noted to be improved at this inspection. Health and safety records were viewed of the following: Portable appliance testing. The annual gas safety check The manager has completed a fire risk assessment in conjunction with the fire authority and regular checks were viewed. There was still no evidence however in the fire safety records of which, staff and residents had participated in fire drills. The five yearly electrical safety check has been undertaken and the certificate to be issued once any remedial work is completed. The Dovecote DS0000008661.V333977.R01.S.doc Version 5.2 Page 27 The Dovecote DS0000008661.V333977.R01.S.doc Version 5.2 Page 28 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 2 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000008661.V333977.R01.S.doc 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 2 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Dovecote Score 3 2 2 X 3 X 2 X X 3 X Version 5.2 Page 29 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 YA3 Regulation 12,14,15 Requirement Care plans must fully inform staff of service users current needs and risk assessments and be kept under review. Ensure all of the service users healthcare needs are appropriately documented, monitored and evaluated and that there is a system in place for follow up action to blood tests, weight loss etc. Partly met Previous timescale 01/10/06 not fully met. In respect of the identified mobility needs of a resident when bathing. In respect of medication details in the care plan and the reviewing of this. In respect of safe supervision of residents. This is required to ensure the needs of residents are fully met. Timescale for action 16/06/07 The Dovecote DS0000008661.V333977.R01.S.doc Version 5.2 Page 30 2 YA22 22 Ensure all complaints are fully documented within the formal complaints records. This is required by regulation and provides information that complaints are being dealt with appropriately. The staffing review must be completed to ensure all resident’s needs are fully met. 16/06/07 3 YA33 18 16/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations Ensure all residents are given a copy of the Service user Guide, which informs the reader how to access a copy of inspection reports. Expand the assessment documentation to include Equality and Diversity needs of residents. A person centred approach to care planning is needed with the core care elements of an individual being consolidated into one care plan file which contains an holistic picture of the individuals lifestyle choices and monitors the input by staff to support this and evaluates how or if this is being achieved/or not. Ensure the holding of keys to bedroom doors and lockable cupboards is fully documented and agreed within the care plan. Provide an overview of the persons life /events/achievements within the care review minutes, which will demonstrate the support offered in achieving goals and for meeting the persons needs and aspirations. Ensure the resident who likes to move his Television has DS0000008661.V333977.R01.S.doc Version 5.2 Page 31 2 3 YA2 YA6 4 YA7 5 YA9 The Dovecote 6 7 YA12 YA16 an appropriate risk assessment in place and receives appropriate guidance on electricity safety Ensure residents who use wheelchairs are provided with support to use the local community facilities and enjoy meaningful activities. The use of communication aids, such as menus in symbol or photographic formats should be explored and implemented to promote informed choice. Provide at least two options of menu items. It is recommended that advice and training is sought from the dietician or district nurse services about introducing nutritional screening tools for service users to identify where there are any specific risks to individuals and then to set up appropriate monitoring and recording systems. The provision of food and nutrition training for staff would benefit service users living in the home. Step-by-step instruction for staff should be provided to follow in monitoring the service users healthcare needs and a record of annual health checks being carried out. It is once again recommended that Medication Profiles should be developed for service users medication and which encompass medication reviews and changes and the reasons for this as part of healthcare monitoring. Consent for medication is also a necessary component and the manager is advised to prepare for the implementation of The Mental Capacity Act, in April 2007. Ensure continued compliance with the issues identified by the community pharmacist. Ensure two staff witnesses the medication administration record for the decision to give “as required” medication. Replace all towels and flannels Attention is needed to ensure continence pads and toiletries are stored safely. In the Lodge, observations of the higher areas indicated that these were not included in the cleaning schedules and it is recommended that cleaning staff be employed for this purpose also in The Lodge also. Keep CSCI informed of any further issues with the Environmental Health Officer. The residents lifestyle would be improved by staff having further input/ training in key working, care planning, food DS0000008661.V333977.R01.S.doc Version 5.2 Page 32 8 9 YA17 YA19 10 YA20 11 12 YA24 YA30 13 YA32 The Dovecote 14 YA39 and nutrition and communication skills Further develop the quality monitoring and development plan for the home The Dovecote DS0000008661.V333977.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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