Inspection on 22/04/06 for The Dovecote

This inspection was carried out on 22nd April 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 15 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 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 Care Home The Dovecote Residential Home 69 Bagshaw Street Pleasley Mansfield Nottinghamshire NG19 7SA Lead Inspector Jayne Hilton Unannounced Inspection 22nd April 2006 07:30 The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 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.V290614.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th February 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 2 of the bedrooms have ensuite 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 Responsible Individual provided information about fees on 25/4/06 Current Fees range between £358.50-£953.42 dependent on needs. Service users are expected to contribute mobility allowances in relation to transport arrangements. The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on Saturday 22nd April 2006 and was concluded on Tuesday 25th April 2006. 12 hours in total was spent at the home. The inspection focused on the requirements and recommendations set at the previous visit and the key standards were assessed. Due to a large number of reported incidents of challenging behaviour by service users, many which have resulted in Safeguarding Adults referrals there was also a particular focus on assessing the safety of service users in relation to this. Three service users were case tracked, eight staff were spoken with and nine service users throughout the inspection. Difficulties were experienced in securing full 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 was examination of records, a tour of the buildings, discussion with the manager and responsible individual. The home has a policy for equal opportunities in place. There were no issues highlighted for action in relation to equality and diversity from this inspection. What the service does well: Service users needs are assessed and generally reviewed and the needs of service users are generally laid out within care plans. Medication management is assessed as overall; safe in practice but improvement is required to meet the standard and regulations fully. Service users are generally encouraged to make choices within their daily routines Service users are encouraged to have appropriate personal and family and relationships. Service users are offered a healthy diet and enjoy their meals. The system in place for recording complaints is satisfactory. Complaints from service users were seen in the complaints file. The service users’ bedrooms that 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. Planning permission is being sought The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 6 for an administration block to be built and which then will provide extended accommodation to the Lodge building which will increase the shared space for service users benefit Disposable gloves and practices for infection control were observed in the home. Training for staff in infection control has taken place as part of the health and safety training. Service users live in a homely, comfortable and generally safe environment. Recruitment practices were satisfactory. It was clear from speaking with staff that they generally worked consistently were committed and supportive of service users The manager of the home is qualified and has many years of experience. Quality monitoring is now underway. What has improved since the last inspection? Training provision is in hand in relation to dealing with challenging/violent/aggressive behaviour and to meet the mandatory requirements. Service users now have an individual contract with the home as specified in St 5. Medication management is assessed as overall; safe in practice but improvement is required to meet the standard and regulations fully. Minor repairs and the health and safety issues which are outstanding from the previous two inspections are now met or in hand. Service users or their representative’s views are now being obtained and evaluated within a quality assurance process Radiators covers are on order. The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 7 What they could do better: There was not sufficient evidence to make a professional judgement in relation to the needs of service users with challenging behaviour and those of service users that live with them. Record keeping in the home should be improved and should be audited regularly. Health and safety practices were still not satisfactory as a number of issues were identified. Therefore the service users health, safety and welfare may be compromised because of these issues. Care plans are not being kept fully up to date. Where aggressive incidents occur, service users rights are not upheld. Service users may be being placed at risk by unsafe practices of staff. The activities provision does not always meet service users needs. Service users rights are not always respected. Service users may not receive personal support in the way they prefer and require and their needs not always met. Privacy and dignity is not always maintained and upheld. The systems in place do not fully protect service users from abuse, neglect and self-harm. A staffing review is needed to ensure that staffing levels, skill mix is appropriate to meet the needs of all service users. The inspection raised issues about observed staff practices, skill mix and appropriateness of some training. Recruitment practices were satisfactory. There are identified issues of concern in relation to the overall management of the home in relation to the level of challenging behaviour/safeguarding adults issues and staff practices that need to be addressed. The manager is required to update with knowledge and attend training. Service users Health and Safety may be compromised by practices observed in the home. The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 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.V290614.R01.S.doc Version 5.1 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.V290614.R01.S.doc Version 5.1 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): 2,3,5 Service users needs are assessed and generally reviewed, however there was not sufficient evidence to make the same professional judgement in relation to the needs of service users being met. Service users have an individual contract with the home as specified in St 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was evidence within the three care plans examined that the manager had undertaken further review of the service users assessed needs and had identified any risk assessments from this, including where service users may present challenging behaviour, however there was not sufficient evidence in order to make a professional judgement that the needs of service users in general are fully met and in particularly in relation to the service users who present challenging behaviour and those service users who live with them are being met. [See standards 19 and 23]. The information in the care plans did not clearly demonstrate the reason why care plans were changed, neither were they fully up to date with current information about service users needs. The manager reported that one service users care plan was in the process of being updated from a care review, which took place two weeks ago. It was agreed that there was therefore a gap in staff therefore being given information about the changing needs of service users and what action was to be implemented to meet those changed needs. The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 11 Staff commented that the format of the care plans were not easy to follow and on speaking with staff they were not fully aware of information pertaining to one service users needs that had been agreed in a review earlier in the month. Key workers are allocated and staff reported that key workers would possibly know more information about the person. Unfortunately the key workers for those case tracked were not on duty on the day of the inspection. The care plans should however inform all staff in sufficient detail of service users current assessed needs. Staff spoken with felt that a separate section within the care plans for dealing with aggressive and challenging behaviours would be extremely useful. The inspector recommends that this be set up as part of the ongoing action to reduce aggressive incidents within the home. There was still some paperwork within the care plans that should be archived [bowel chart and a data sheet for reviews which, appeared to be not used [as out of date] as the care plan documentation itself demonstrated some reviews had taken place. The landlord provides a tenancy agreement, which includes a section for which there is a statement that the Dovecote covers the care element of the agreement. The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 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): 6.7.9 The needs of service users are generally laid out within care plans, however these are not being kept fully up to date. Service users are generally encouraged to make choices within their daily routines however where aggressive incidents occur, service users rights are not upheld. Service users may be placed at risk by unsafe practices of staff. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” (*Delete as necessary). EVIDENCE: Care plans were in place. Diaries are used for each service users daily log. [The daily logs were found not to be recorded in sufficient detail, for example times and details of incidents/events were not fully documented and one incident although recorded on an incident record was not documented in the The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 13 daily diary. Details of a service users seizure had not been documented within the accident records, neither was there any indication of the time of the seizure which had resulted in a fall and injury to the service user] 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 no documentation was initially found in relation to the requirement of service users and relatives/representatives signing in agreement to the care plan or any limitations or restrictions that may be 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. Evidence has been provided to CSCI of authorisation of bedrails for one service user. At the last inspection the manager opposed the need to include the signed authority within the care plan, however the manager was advised it should be cross -referenced within the plan of care as to its whereabouts and existence and staff need to have an awareness of the limitation and its justification. Although information was seen in relation to bedrails, there were other areas that imposed on individual’s rights that were not clearly written in the day-to-day working care plan. For example monitor alarms were in place for three service users, staff reported that two only were used at night. Bedroom doors were propped open either with wedges or with chairs; one door was wedged open with a holdall belonging to another service user. Staff made varying comments about service users wishes and their practice that was not detailed within the care plan. Care plans should contain all of the relevant details about individuals care needs to ensure that their needs are fully met. At the previous inspection it was found that not all of the individual’s current care information/risk assessment/or agreements for imposed restraint and limitations is kept in the working care plan as the system at Dovecote is for three files to be kept. Two of the files are kept locked away with only authorised personnel having access to these. Some information held in the Dovecote other files, needs to be available for inspection and may be missed if the manager is not available during an inspection. It was recommended that where this is the case a cross reference system is used and that a sheet is placed at the front of the main working care plan file, informing inspectors and other authorised personnel that other information may be contained in the other files and how these can be accessed. There was no evidence that this had been put into place. Evidence that the bedrails in use have been assessed as appropriate to meet the needs of service user has now been provided to CSCI. The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 14 Some staff members spoken with did not have any knowledge of how advocacy was promoted within the home; one staff member recalled that one staff member had been involved with some service users in an advocacy group. There is a policy in place should service users go missing. Staff reported that they had not had any incidents in this respect, apart from on occasions one service user does ‘run off’. There was evidence of a care plan in place for this area of need for the service user. On speaking with staff about the apparent increasing amount of aggressive incidents by service users, they reported that there had always been aggression/challenging behaviour. The comments from staff included long serving members of staff and this statement, was endorsed by the manager and the Responsible individual. Staff also commented that staffing levels were not always appropriate, often they worked with short numbers of staff and sometimes with inexperienced staff. They reported that aggressive behaviour had been tolerated for many years and there was no real management of this. Some service users hit out at others on a regular basis. The inspector asked staff, if those service users who had been assaulted by other service users had been informed of their rights to report the assault to the police. Staff commented that service users have expressed a wish to report aggressive incidents in the distant past but not in recent months/years. Staff felt that the management would disapprove this. The responsible individual commented that although she accepted the individual’s rights to report such incidents, she would expect police involvement to be a last resort. There was concern raised that aggressive incidents were sometimes now occurring on the minibus and this raised safety issues for service users and staff and for the wider public should this result in affecting the safety of the driver. There was no risk assessments available for these events and therefore must be implemented promptly. There was some evidence that triggers for behaviour were being monitored, however the information recorded by staff did not demonstrate sufficient skills and knowledge about what they should be evaluating. There was evidence that input from the psychologist and consultant psychiatric was already in place or being sought in relation to individuals challenging behaviour. Some staff had attended training the day before the inspection, which they reported positively about and stated that they felt more confident and equipped to deal with the behaviours presented by service users and that they would be able to de-escalate behaviour early on. The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 15 Service users likes and dislikes are recorded in care plans but some information could be more detailed. The rights of service users are not fully respected in relation to challenging behaviour and privacy and dignity issues. The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 16 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 15,16,17 The activities provision does not always meet service users needs. Service users are encouraged to have appropriate personal and family and relationships. Service users rights are not always respected. Service users are offered a healthy diet and enjoy their meals. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The activities provision was reported to have been affected by staff shortages and because drivers for the minibus were limited. On the day of the inspection the morning walk had to be cancelled due to a service user needing to be escorted to hospital. Seven service users attend day centres. Service users attend swimming, dances and bingo, which are specially organised for people with learning disabilities and usually go out to the pub at weekends. The manager reported that activities for service users are never limited due to driver availability as staff are directed to use a minibus taxi service. Evidence on the day of the inspection however demonstrated that service users needs were not always being met due to staffing issues. [See standard 32] The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 17 A volunteer provides a craft session every two to three weeks. Recruitment checks on the volunteer were in place. Service users likes and dislikes are recorded in care plans but some information could be more detailed. The rights of service users are not fully respected in relation to challenging behaviour and privacy and dignity issues. Service users were observed being offered choices for breakfast and observation provided evidence that service users were allowed to eat at their own pace without being rushed. The variety of food recorded appeared balanced and nutritional. Food stocks were ample and fresh fruit was seen in the kitchen. A delivery of food was made on the day of the inspection. The menu in the Bungalow varied from the meat item that was defrosting. There was no indication why the menu item had been changed; the reason had not been handed over to staff either. 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. It was reported that service users are now involved in meal planning by offering a suggestion for the menu for the following week. Evidence of the service users name on each week was seen. One service user had a food chart in place to monitor dietary intake, there appeared to be a delay in setting this up from the recommendation being set at a care review. It is recommended that at least two meal options are provided on each daily menu and the choices documented. Service users have various contact with relatives and where possible relatives are involved in care reviews. There were no issues raised in relation to sexual relationships between service users or their friends. Friendships between service users are promoted. The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 18 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 may not receive personal support in the way they prefer and require and their needs not always met. Privacy and dignity is not always maintained and upheld. Medication management is generally safe. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 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. Healthcare checks should include an annual well person checks. There was evidence that breast screening had been documented. 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 Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 19 the home can continue to meet the individual needs. Weight records are in place, but this is recorded on the calendar section of the daily diary and therefore does not allow space for comments by staff regarding any significant weight loss or gain and effect on well being/mental health status. The inspector explained to staff once again that weight records were a fundamental component of a service users care plan/well being and the system in place should be reviewed to reflect this. At the previous inspection the manager stated that the local GP has refused to undertake well person screening for the service users. The inspector recommended that this decision is obtained in writing from the GP and the issue be taken up with the Primary Care Trust. The issue was discussed once again with the Manager and the Responsible Individual and the inspector is awaiting the outcome of any discussions with the GP/PCT. Staff spoken with was not aware of any well person checks being undertaken and there was no record of these in the three care plans examined. At the previous inspection it was found that staff undertake, blood sugar monitoring for a service user with diabetes, records were satisfactory, Staff reported that they had been trained for this procedure 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. Some changes have been made within the home to address compatibility issues/vulnerability of service users and is currently being evaluated. Some staff have been provided with training regarding strategies for crisis intervention and prevention the rest of the staff team are to undertake the training in the following week. The training was reported by staff to very welcome and positively spoken about. Staff said that the training had provided them with more confidence; skills and knowledge in dealing with aggression presented by service users and stated they felt that situations would now be de-escalated early. Observation of staff practice on the day of the inspection demonstrated that staff interacted with service users appropriately and engaged with them within the daily routines and whilst undertaking personal care, however staff practices The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 20 demonstrated that privacy and dignity was not always maintained and respected. In the bungalow all of the bedroom doors were wedged open, which staff offered differing reasons for this, which could not be backed up by care plans or risk assessments. There was also conflicting information about the use of monitoring alarms for epilepsy. The manager has been asked to address these issues and ensure that appropriate documentation and practice is put into place. Medicines management was assessed briefly. Overall the system was satisfactory. 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. Medicines policies were in place 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 the policy for drug errors is accessible for staff if such an incident occurs. Medication details for service users was seen in care plans 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. There was no BNF seen in either building. A medicine round was observed in the bungalow, the staff member was observed to sign the medication record chart before the service user had actually taken the medication The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 21 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 The system in place for recording complaints is satisfactory. Complaints from service users were seen in the complaints file. The systems in place do not fully protect service users from abuse, neglect and self-harm. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Records were examined for complaints received by the home, since the last inspection there have been two complaints made to the home. One complaint was made to CSCI, which was forwarded to the responsible individual to investigate and which was found to be not upheld. The issues raised were in relation to employment topics and staffing issues. The other was a complaints made on behalf of a service user which has been resolved where possible. The registered manager is appointee for several service users, which is not appropriate. [Reference Regulation 20 – Restrictions on acting for a service user] The responsible individual informed the inspector that this is now being progressed The manager and the administrator informed the inspector that the process of assessment for mobility monies/costs/charges issue identified earlier in the The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 22 year is still ongoing and that he will inform the inspector of the outcome and action decided. 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. The policy has been further developed which clearly identifies that staff must not use their bonus point schemes, credit cards etc. There is a policy in place for dealing with violence and aggression and for the use of restraint, but not all staff was aware of these or if they were, could not relate what the homes policy was. It was reported that some forms of restraint has been witnessed, but staff were unclear if the technique used was actually allowed or appropriate. Most staff said they would report any concerns about abuse, however the restraint issues do not appear to have been raised or discussed. There were conflicting reports from staff in relation to consistency of approach within the team and reports that staff had developed their own way of dealing with service user behaviour. The training now in place should address some of these issues but the manager has been requested to review the behaviour management issues within the home and implement improved strategies for its prevention and intervention. Some staff expressed that the philosophy of the home did not reflect the dependency needs of service users. This has been discussed with the manager to address. Policies were in place for Abuse awareness and whistle blowing. As already covered in several other sections of the report, numerous incidents of challenging behaviour between service users have resulted in referrals being made under Safeguarding Adults protocols and which are currently being looked into by Social Services Teams and which CSCI is contributing to. The Inspector has been working with the manager to ensure that all incidents which place service users at risk to harm are appropriately notified under the Safeguarding Adults Protocols are duly reported and addressed. The inspector has needed to prompt the manager on several occasions to necessitate the protocol and a recent incident/disclosure was not actioned despite the inspector requesting this to be referred. As the manager failed to take appropriate action to ensure service users safety is promoted at all times and Immediate Requirement was made as follows: The Registered Person must ensure that measures are taken to prevent service users being harmed, suffering abuse or being placed at risk of harm or abuse. The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 23 Other requirements are made for the manager to undertake training in safeguarding adults reporting and referring protocols, and for all staff to undertake training in abuse awareness. The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 24 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): 24,25, 30 Service users live in a homely, comfortable and generally safe environment. Action is required to ensure that service users are safe at all times. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service users’ bedrooms that 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. Planning permission is being sought for an administration block to be built and which then will provide extended accommodation to the Lodge building which will increase the shared space for service users benefit Disposable gloves and practices for infection control were observed in the home. Training for staff in infection control has taken place as part of the health and safety training. The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 25 The activities room in the bungalow is currently being refurbished and has been made safe. The notices informing that the room was currently out of use were not adequate and could easily be removed or be lost. [The flooring in the activities room is damaged which presents a trip hazard and needs repair/replacement.] The home was found to be clean and free from mal odour. The minor repairs and redecoration of bathrooms and toilets has now been completed. A stair carpet in the Lodge was observed to be worn and requires replacement. See Standard 42. The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 26 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34,35,36 A staffing review is needed to ensure that staffing levels, skill mix is appropriate to meet the needs of all service users. Although there is a satisfactory level of supervision and training now in place, the inspection raised issues about observed staff practices, skill mix and appropriateness of some training. Recruitment practices were satisfactory. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector made an attempt to assess the staffing levels. The rota is difficult to calculate as the manager allocates one to one time for some service users dependent on their funding. The manager stated that there are no service users funded for actual one to one care/time when informed that some staff expressed some concern that service users were not getting allocated one to one time. Clearly the current staffing levels appear not to be adequate to meet the service users individual needs and for ensuring service users safety with the level of challenging behaviours presented. Staff are also expected to undertake catering, cleaning and laundry duties within their roles and as found on the day of the inspection, an incident occurred in The Lodge whilst one staff member was preparing food in the kitchen. As one staff member has been re-located temporarily to the bungalow, in order to provide cover to escort a service user The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 27 to hospital, this left one other staff member [although experienced] with nine service users, six of which are challenging. A member of staff had telephoned in sick that day, however this member of staff would have been allocated to activities. The activities were cancelled because of this and because of the service user needing to attend hospital. There was evidence that on occasions shifts were being covered by a trainee [under 18years of age and an experienced staff member] Staff under 18years cannot provide personal care and therefore should not be counted in the staffing numbers. Otherwise two staff are rotered on duty in a morning during the week and three on evenings and weekends. Management cover is not counted in the rota and is not calculated within the care hours, however as on the day of the first day of the inspection, senior staff moved roles to provide care due to staff sickness. On the second day of inspection the deputy manager was struggling to cover several shifts due to staff sickness. Staff informed the inspector of conflicting views, some said that generally shifts are covered and others were concerned about shifts that were not and about inexperienced staff being on shifts and having to manage behaviour that they are not fully skilled to do and where this puts extra pressure on the more experienced staff when incidents escalate. One staff member is on duty in each building and they, are supported by a floating staff member. Staff expressed dissatisfaction about the risk of this arrangement to themselves. A requirement has been made that the Registered Person undertakes a staffing review to ensure the needs of service users are fully met and that proper provision for the care education and supervision of service users and that the home is conducted as to promote and make proper provision for then health and welfare of service users. The manager explained that free training had been obtained for the next twelve months, which includes training in health and safety including infection control, risk assessment, fire safety, stress awareness and crisis intervention. Staff and records confirmed they had undertaken health and safety/infection control, first aid, and fire safety, crisis intervention. There were concerns in relation to the observed practice of staff in relation to moving and handling of service users. Staff reported that they had undertaken distance-learning training for this topic, but no practical training or skills assessment had been made of their actual practice. The manager was advised to seek advice from the Health and Safety Executive in relation to meeting the Manual handling operations Regulations, in relation to staff training and manual handling risk assessments. The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 28 Because of observations of unsafe manual handling practices by staff on the day of the inspection a requirement is made that all staff must undertake updated training in moving and handling which provides practical instruction as specified by the Manual Handling Operations Regulations. Some staff had received training recently in manual handling for objects only, no people handling training was covered 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. It is recommended that the manager attend training in manual handling in respect of this. In order to ensure service users needs being fully met. Training for staff should also be provided in epilepsy management, diabetes care and Dementia Care. NVQ’s are ongoing. This standard was not fully assessed at this inspection due to other priorities. The recruitment files for two new staff and a volunteer were examined and found to be satisfactory. Supervision is in place; staff, paperwork, senior staff and the manager evidenced this. The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 29 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,42 The manager of the home is qualified and has many years of experience. There are identified issues of concern in relation to the overall management of the home in relation to the level of challenging behaviour/safeguarding adults issues and staff practices that need to be addressed. The manager is required to update with knowledge and attend training. Quality monitoring is now underway. Service users Health and Safety may be compromised by practices observed in the home. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in post for several years, he holds a social work qualification and has enrolled on the Registered Managers Award and has completed one unit. The manager has not undertaken other periodic training to keep himself up to date and this is a requirement of Registration. A Requirement has been set in relation to the manager undertaking training in Safeguarding Adults reporting protocols. It was clear from speaking with staff The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 30 that they generally worked consistently were committed and supportive of service users, but that moral was low and that they felt the manager should be more involved in the day to day activities of the home. Staff reported that the staffing structure meant that the manager had little contact with care staff and that information was not always passed up or down. The manager reported that staff, were invited to put any concerns or specific requests/individual issues in writing and that these are always addressed. It was suggested that a culture of hearsay had developed within the staff team and this measure was taken because of this. There was evidence from the inspection that hearsay was a base for some staff concerns and that staff had not fully understood the circumstances of events or the reasons for some directives. 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 meeting structure was set up to address priority issues. Clearly some staff did not feel included in meetings and that the communication systems were not working. An evaluation of this perhaps would identify where shortfalls are evident and where improvements could be made. There was some evidence of quality monitoring systems in the home, apart from the regulation 26 visits. Anonymous questionnaires have been sent out to various supporters/relatives of service users. The manager reported that when returned these would be evaluated and the results feedback to everyone involved with the home. 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 now commenced imminently and address the ongoing issues of behaviour management strategies and staffing levels to improve the quality of life for service users living in the home. The manager reported that the chairperson of the trust visits weekly and there is evidence of Regulation 26 reports in the home. The chairperson of the trust visited the home on both days of the inspection. Regulation 37 notifications are now being submitted for incidents. These have been numerous since the last inspection and have raised concern as to the level of challenging behaviour incidents on an almost daily basis. Backdated notifications have been submitted for both The Lodge and The Bungalow for the last six months and incident reporting is ongoing. At the previous inspection it was noted that a visitor’s book is used in the Lodge, however visitors to the bungalow were not always recorded in this. This was not in place on the first day of the inspection, although staff did request that the inspector did attend the lodge to sign the visitor’s book. There was evidence that visitors to the bungalow were still not being recorded in the The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 31 main log. A visitor’s record sheet was provided in the bungalow on the second inspection day. On questioning staff, not all were aware of policies and procedures that should inform their practice. Observations on the day provided evidence that staff did not have clear written guidance about decision making and risk assessments for health emergencies and crisis management and that decision making processes were not always satisfactory. There was also staff practice that needs to be addressed in relation to injuries/ poor mobility of service users, amount of transfers between wheelchair and chair/use of hoist etc that has been fully discussed and presented to the manager for action. Food safety issues were noted to be overall improved at this visit, however there was a bottle of fizzy drink placed in the meat tray. The fire safety tests were examined, weekly fire alarm testing was evident but the records for monthly emergency lighting tests was confusing and not satisfactory. There was no evidence in the fire safety records of staff fire drills. The inspector recommends that the fire risk assessment process is reviewed and that the recommended format provided by the fire authority is used and a copy kept in the fires safety log. Not all radiators were off the low surface type and did not have safety covers. It was reported that covers are on order. The manager reported that these were to be fitted in the near future. There was liquid soap and paper towels were seen in bathrooms. There was no issues observed in relation to security of exterior doors on this visit, however a number of service users doors were wedged open by varying means. This is a breach of regulation and poses a risk to the health and safety of service users. The issue of bedroom doors being wedged open presents many other issues, in relation to security, privacy and dignity and the manager has been requested to address these. The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 32 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 2 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 2 2 2 X 2 X The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 33 No 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 be kept up to date to fully inform staff of service users current needs and risk assessments. In relation to reviews and • Changing needs. • Include a separate section for behaviour management with clear guidance for staff in strategies to be implemented and evaluated. Monitor alarms. Dietary needs Moving and handling Daily entries Incident recording Timescale for action 25/05/06 • • • • • The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 34 • Use of transport and risk assessments in relation to transport. Activities/leisure 25/05/06 • 2 YA6 12,14,15 • Staffing levels Care plans must be kept up to date to fully inform staff of service users current needs and risk assessments. In relation to reviews and • Changing needs. • Include a separate section for behaviour management with clear guidance for staff in strategies to be implemented and evaluated. Monitor alarms. Dietary needs Moving and handling Daily entries Incident recording Use of transport and risk assessments in relation to transport. Activities/leisure Staffing levels Version 5.1 • • • • • • • • The Dovecote Care Home DS0000008661.V290614.R01.S.doc Page 35 3 YA7 12,14,15 Care plans must be kept up to date to fully inform staff of service users current needs and risk assessments. In relation to reviews and • Changing needs. • Include a separate section for behaviour management with clear guidance for staff in strategies to be implemented and evaluated. Monitor alarms. Dietary needs Moving and handling Daily entries Incident recording Use of transport and risk assessments in relation to transport. Activities/leisure 25/05/06 • • • • • • • 4 YA9 12,14,15 • Staffing levels Care plans must be kept up to date to fully inform staff of service users current needs and risk assessments. In relation to reviews and • Changing needs. 25/05/06 The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 36 • Include a separate section for behaviour management with clear guidance for staff in strategies to be implemented and evaluated. Monitor alarms. Dietary needs Moving and handling Daily entries Incident recording Use of transport and risk assessments in relation to transport. Activities/leisure 25/05/06 • • • • • • • 5 YA7 12[4] • Staffing levels The Registered Person shall make suitable arrangements to ensure the care home is conducted in a manner, which respects the rights, privacy and dignity of service users. In relation to • Challenging behaviour/assaults by other service users Personal care • The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 37 • • 6 YA9 12[4] Bedroom doors/security Monitor alarms 25/05/06 The Registered Person shall make suitable arrangements to ensure the care home is conducted in a manner, which respects the rights, privacy and dignity of service users. In relation to • Challenging behaviour/assaults by other service users Personal care Bedroom doors/security Monitor alarms • • • 7 YA16 12[4] The Registered Person shall make suitable arrangements to ensure the care home is conducted in a manner, which respects the rights, privacy and dignity of service users. In relation to • Challenging behaviour/assaults by other service users Personal care Bedroom doors/security Version 5.1 25/05/06 • • The Dovecote Care Home DS0000008661.V290614.R01.S.doc Page 38 • 8 YA19 12[4] Monitor alarms 25/05/06 The Registered Person shall make suitable arrangements to ensure the care home is conducted in a manner, which respects the rights, privacy and dignity of service users. In relation to • Challenging behaviour/assaults by other service users Personal care Bedroom doors/security Monitor alarms • • • 9 YA23 12[4] The Registered Person shall make suitable arrangements to ensure the care home is conducted in a manner, which respects the rights, privacy and dignity of service users. In relation to • Challenging behaviour/assaults by other service users Personal care Bedroom doors/security Monitor alarms Version 5.1 25/05/06 • • • The Dovecote Care Home DS0000008661.V290614.R01.S.doc Page 39 10 YA23 12, 11 YA23 18 12 YA23 18 13 YA33 12 The Registered Person must ensure that measures are taken to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. Regulation 13[6] The Registered Manager must undertake training in Safeguarding Adults referral protocols All Staff must undertake training in Safeguarding Adults/abuse awareness. A staffing review must be undertaken to ensure the needs of service users are fully met, that proper provision is made for their care, education and supervision and that the home is conducted so as to promote and make proper provision for the health and welfare of service users. In relation to • • Dependency levels of service users Behaviour management strategies Activities provision Trainees [staff under the age of 18years must not be counted within the staffing numbers]. Version 5.1 22/04/06 25/07/06 25/07/06 25/07/06 • • The Dovecote Care Home DS0000008661.V290614.R01.S.doc Page 40 • 14 YA35 Skills mix 25/06/06 15 YA42 12, 13, 18 All staff must undertake manual handling training, which provides practical instruction. 12, 16, 23 Ensure service users health welfare and safety is promoted at all times. In relation to • Food hygiene training and staff practices. Strategies for behaviour management. Fire safety-staff practices. Manual handling operation regulations [risk assessments] 25/06/06 • • • RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA9 YA8 Good Practice Recommendations Ensure ‘advocacy’ information is provided to all staff to enable them to promote this with service users The use of communication aids, such as menus in symbol or photographic formats should be explored and implemented to promote informed choice The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 41 3. YA8 A pre-agreed menu offer at least two options to service users to choose from. Evidence of the choice should be documented. Service users would benefit from the employment of specific staff for day care/activities. Service users would benefit from the employment of specific staff for day care/activities. Service users participation in the civic process should be written into the care plan structure. Where menu options are changed, the reason for this should be documented. 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 reflected in the policy for ageing and increasing frailty. Weight records are a fundamental component of a service users care plan/well being and the system in place should be reviewed to reflect this. Add a comments section to the weight record sheet. 4 5 6 YA12 YA13 YA14 7 8 YA17 YA19 9 YA19 10 YA20 Ensure staff who are authorised to administer medication have a sample signature documented at the front of the MAR [Medication administration records] file Ensure copies of the British National Formulary are available in each building. The manager should undertake competency assessments for staff administering medication. Ensure the procedure for obtaining medical advice for drug errors is place in an accessible position for use in an emergency 11 YA20 Include medication profiles in care plans, which document medication reviews etc. DS0000008661.V290614.R01.S.doc Version 5.1 Page 42 The Dovecote Care Home 12 YA23 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. Replace the stair carpet identified at the inspection The registered person should undertake periodic competency assessments on staff to ensure good practice is maintained. The manager should update knowledge and training The manager should address the issues of concern raised throughout the report in relation to the overall management of the home. It is recommended that a sheet be placed at the front of the main working care plan file, informing inspectors and other authorised personnel that other information may be contained in the other files and how these can be accessed. Develop ways to obtain service users views, such as by using outside professional support or advocacy services in service user surveys etc. Provide an annual development plan for the home, which addresses the issue raised. 13 14 YA24 YA35 15 YA38 16 YA39 17 YA39 Consider use of an outside consultancy to audit the care services under standard 39. Ensure staff are aware of all policies and procedures. Ensure the fire safety records include clear information about emergency lighting tests, fire drills and fire risk assessments. 18 19 YA40 YA42 The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 43 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. Extracts may not be used or reproduced without the express permission of CSCI The Dovecote Care Home DS0000008661.V290614.R01.S.doc Version 5.1 Page 44 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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