Inspection on 24/04/08 for The Dovecote

This inspection was carried out on 24th April 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Dovecote 31/10/07

The Dovecote 16/04/07

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 69 Bagshaw Street Pleasley Mansfield Nottinghamshire NG19 7SA Lead Inspector Jayne Hilton Unannounced Inspection 24th April 2008 9:30 The Dovecote DS0000008661.V362988.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.V362988.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.V362988.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Dovecote Address 69 Bagshaw Street Pleasley Mansfield Nottinghamshire NG19 7SA 01623 480 445 01623 480 446 dovecotetrust@yahoo.co.uk 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 Trust Limited Mr Bryan Leonard Hogg Care Home 18 Category(ies) of Learning disability (18) registration, with number of places The Dovecote DS0000008661.V362988.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st October 2007 Brief Description of the Service: The Dovecote is a care home providing personal care and accommodation for 18 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 Limited 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. All of the home’s bedrooms are single, and three of the bedrooms have ensuite 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 29/04/08 Current Fees range between £483.19- £1281.58 dependent on needs. This covers everything – people living in the home only spend their own money on their own leisure activities and clothes. The previous inspection report and Service User Guide is available. The Dovecote DS0000008661.V362988.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for service users and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. This key inspection was undertaken on 24th April 2008, 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, of five hours. The main method of inspection used was called ‘case tracking.’ This involves selecting three service users and looking at the quality of the care they receive by talking to them, examining their care files and discussing how support is offered to them by staff members. Six members of staff and the manager were spoken with as part of this inspection, documents were read and medication inspected to form an opinion about the quality of the care provided to residents. Prior to completing this visit the inspector assessed the homes previous inspection reports, the service history including complaints and safeguarding referrals and the Annual Quality Assurance Assessment sent to us by the Provider. Surveys were returned by, fourteen service users, three relatives and three staff. Two visiting professionals also returned a survey. Their comments are included within the report. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. What the service does well: People are confident that the care home can support them. This is because there is a detailed a assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. Information is available for any new prospective residents. The Dovecote DS0000008661.V362988.R01.S.doc Version 5.2 Page 6 Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. People have nutritious and attractive meals and snacks, at a time and place to suit them. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. People live in a comfortable environment and the garden area has various activity areas, including equipment such as an enclosed trampoline for service users activities. There is an excellent sensory room in the bungalow. People living in the home 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. Lost people know how to make a complaint if they are not happy and say their privacy and dignity is respected. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People who live in the home said they were happy with the food provided. Relatives told us they thought there is a good range of activities to be experienced. People who live in the home have various contact with relatives and where possible relatives are involved in care reviews. Friendships between people living in the home are promoted. Staff are friendly and seemed to support the people well. The health safety and welfare of individuals living in the home are mostly promoted and protected and the home now has Quality Assurance systems in place to monitor the service to improve outcomes for people. What has improved since the last inspection? The range of activities has been increased by using community based transport facilities. The use of communication aids and use of pictures and symbols in the home. The Dovecote DS0000008661.V362988.R01.S.doc Version 5.2 Page 7 Choice options in meal planning and the documentation of this and weekly residents meetings have been introduced. Records are kept of any limitations agreed with the service user as to the service users freedom of choice, liberty of movement and power to make decisions. Action has been taken to eliminate offensive smells and a new carpet has been laid in the lounge and dining room of the bungalow. Recruitment processes have been improved and use of the Common Induction Standards Workbook for staff. Quality-monitoring systems are now in place and staff are undertaking Quality Tree Training. Food safety practices have been improved. A new fire Safety Assessment has been completed and water checking has been put into place to guard against legionella. What they could do better: Three requirements have been set, two are in respect of medication issues, one of which is outstanding from the previous inspection. Ensure the medication systems are safe in respect of handwritten prescriptions discussed at the inspection. This will ensure service users are not placed at risk. Ensure medication records are always completed after administration and are accurate at all times. This will ensure service users receive the medication they need in respect of their health and well -being. The registered manager needs to undertake the appropriate registered managers award. This will ensure he has the most appropriate qualifications for managing the care home. In addition fourteen ‘Good Practice’ recommendations have been made which include: The Dovecote DS0000008661.V362988.R01.S.doc Version 5.2 Page 8 Provide individual copies of ‘The Service User Guide’ to each service user, so they have the information they need about the home. Expand the assessment documentation to embrace equality and diversity, to ensure any cultural, religious, sexuality, gender, disability needs are fully addressed. Review the current assessment and support/care plan system to provide a person centred approach to care planning and which includes their goals and aspirations and how they are being supported to achieve these. Consolidate and streamline the many systems used to document the support provided to people living in the home. Further improve the use of communication aids and use of pictures and symbols in the home, which will enable people with communication difficulties to express their choices and preferences. Improve the systems in place for the management of medication to minimise the risk of harm to people living in the home. Provide training for all staff in diabetes, food and nutrition, communication skills, key working, care planning, safeguarding adults, equality and diversity and epilepsy. Further develop the Quality Monitoring systems to include the views of visiting professionals and staff. Provide lockers for staff to store their personal belongings. Take action to address the circumstances of the high turnover of staff and staff views in respect of their low morale. Ensure supervision sessions for staff occur at least six times year with at least one session of observation of practice. 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.V362988.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.V362988.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, and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are confident that the care home can support them. This is because there is a detailed assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. Information is available for any new prospective residents but existing residents have not yet been issued with their own copy of The Service User Guide. EVIDENCE: A service user guide with symbols was viewed in the home, but there was still no evidence that residents or their representatives have their own personal copy as required by regulation. 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 risk assessment. 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.V362988.R01.S.doc Version 5.2 Page 11 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. Service Users have their needs met however, a person centred approach to care planning is needed. EVIDENCE: Three service users care files were examined as part of the inspection. Diaries are used for each service users daily log. Additional record books and sheets have been added over time and staff said they create additional workload which takes extra time to complete and inevitably one record can be missed/overlooked if time pressured. Although there is reference within the care review minutes of service users attendance, there was still no evidence that service users or relatives are involved in the compilation of their care plans or that they have agreed to what they contain. The Dovecote DS0000008661.V362988.R01.S.doc Version 5.2 Page 12 Where restrictions of movement of freedom have been implemented, for example the use of door alarms, there was now documentation of agreement to their use. Risk assessments are integral within most of the care plans, some have been devised on a different system in respect of behaviour. The manager with a date stamp currently updates care plans regularly, but there is no evidence of a process in place of why the care plan has been changed. One persons care needs had changed in respect of their medication two days prior to the inspection, but the care plan had not yet been updated, however staff on duty were aware of the persons changed circumstances and information was posted on an alert board for all staff to be aware. 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. Key staff only has access to this information. Relative’s responses in surveys returned to the Commission were positive, one said there were sometimes minor issues around state of dress for their relative, but that when they have raised this issues have been rectified. One relative was particularly pleased that people living in the home can be involved in domestic chores and felt this was important to their relative residing there. A resident spoken with confirmed that he chose their daily lifestyle and that he was very happy and settled in the home and praised the staff for their support and said that his needs were fully met. The staff are currently undertaking Quality Tree Training and some have received training in ‘Person Centred Planning’ to improve the participation of people living in the home. It is recommended that all of the care assessment and support plan documentation be reviewed, so that all of the documentation can be consolidated, streamlined, brought up to date, and which is resident and staff user friendly. The service understands the right of individuals to take control of their lives and to make their own decisions and choices but evidence is limited. Staff are able to communicate with people using the service, and understand what their needs are. However, communication methods are basic, with little understanding of innovative or individual communication styles. The Dovecote DS0000008661.V362988.R01.S.doc Version 5.2 Page 13 That said there was some excellent examples of staff developing their ideas for new systems such as a new pictorial menu book and new menu board and the staff member is commended for this progress made. There is some evidence that individuals are involved in some decision making about the home, such as day to day living and social activities, but this tends to be the people using the service whose communication styles are more easily understood by staff. Individuals with more diverse needs find it harder to have their opinions listened to. Areas where individuals can affect change are limited. Both in interviews on the day of the inspection and in returned surveys staff expressed that not all people living in the home had a choice of social activities and that these were chosen by the manager and were the same every week, for example one person goes to a farm park every week and staff told us that it was their opinion that the venue was not totally suitable to meet the persons needs. [See lifestyle] The manager reported in the AQAA [Annual Quality Assurance Assessment] submitted to CSCI [Commission for Social Care Inspection] that they are hoping to form a residents committee in the next twelve months. A weekly residents meeting has been recently commenced The Dovecote DS0000008661.V362988.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 good. This judgement has been made using available evidence including a visit to this service. Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. People have nutritious and attractive meals and snacks, at a time and place to suit them. The activities provision has been improved, however further work is needed to ensure they meet individual needs and preferences. EVIDENCE: Service Users are provided with a varied programme of activities including swimming, dances and bingo, which are specially organised for people with learning disabilities and usually go out to the pub at weekends. Some service users attend day centres and work experience also. People who live in the home and staff spoken with informed me that holidays had been planned in Skegness and Wales. The Dovecote DS0000008661.V362988.R01.S.doc Version 5.2 Page 15 Although a good range of activities appears to be experienced by most people, comments were once again made about staffing levels which in the main are two staff to seven residents in each building with one floating staff member between both buildings currently, however four service users in the bungalow require wheelchair provision for outings and some service users have one to one support provided, so the provision of two staff therefore sometimes limit the residents in relation to socialisation and activities. On reviewing the rotas there was evidence that extra staff are now rotered to enable people to go out more and examination of three of the people who use wheelchairs, care plans in detail, showed an acceptable level of activities have been provided, however outing destinations appeared to be repetitive, such as going to watch swimming or visits to the spa or same pub for lunch every week. There was no evidence of any consultation with the individuals as to whether this meets their requirements. Several people are included on the journeys to day centres as part of their activities programmes. Staff comments on the day and in surveys were on the whole positive but comments were made that people living in the home are not always provided with activities that are suitable to their needs. One person told us “ residents are made to do activities they dislike, its annoying and frustrating”. Relatives said in surveys that they consider that the diversity needs of individuals are always met and that their relative attends church regularly and made the following comments “ They are very good at dealing with residents social needs holidays outings etc” On the day of the inspection however staff said that one persons activities had to be cancelled because of a training course held at the home for staff and another persons hospital appointment. Records are now being kept of each individual’s participation in activities but there is no evaluation in respect of comments above or if the person refuses what is on offer. A service user spoken with said he has a choice what to do. He said, “I go to the day centre I also do cleaning work here which I am paid for. On Sunday I walk to church” The manager stated in the Annual Quality Assurance Document that the home has limited staff resources and uses these to the best of their ability to enable people to participate in a number of activities during the week, but that it is not possible to fully do all the things they would wish to. The Dovecote DS0000008661.V362988.R01.S.doc Version 5.2 Page 16 Excellent work has been achieved by one member of staff who has developed a pictorial menu book for people who live in the Lodge, to enable people living in the home to choose their meals. This work should be replicated for the people who live in the bungalow and expanded to menu boards and a similar tool could be developed for enabling choice of activities. Service users have various contact with relatives and where possible relatives are involved in care reviews. Friendships between service users are promoted. Menu choices have been greatly improved. People living in the home confirmed they are involved in choosing what they want on the menus and said they liked being in the home and that the food was marvellous. The Dovecote DS0000008661.V362988.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Medication systems do not always follow good practice or safe practice guidelines and has needed action. EVIDENCE: The manager stated in the Annual Quality Assurance Assessment that the staff team recognise they could put an intense effort in to enable some people to administer their own medication and that over the next twelve months they will identify and assess whether any people living in the home could self administer their own medication. Medication records are not up to date; there were several gaps in recording and information. Several handwritten prescriptions and alterations by staff were not always signed by the person making the entry or by a witness. The current practice and lack of adequate recording puts people who use the service at risk. The The Dovecote DS0000008661.V362988.R01.S.doc Version 5.2 Page 18 manager does not assess the competency of staff in the practice of medication management. The manager told us an audit system had been implemented and responsibility for this had been delegated to a member of staff. This system was clearly inadequate and ineffective. People have access to health care services both within the home and in the local community. The majority are able to choose their own GP and attend local dentists, opticians and other community services. People unable to access local services are supported by visits to the home by health care professionals. Health needs are monitored and appropriate action and intervention taken. Health Action Plans should however be integral to the support plan and include medication profile sections. Risk assessment tools for pressure areas and nutritional screening tools should be introduced into the care planning systems. Staff encourage individuals to be independent and to take responsibility for their own personal hygiene. Visiting healthcare professionals said that appropriate referrals are made but recommendations made had not always been acted upon, although there had been improvements recently. They also told us that consideration had been demonstrated towards planning for a person’s deterioration in mobility e.g. in the provision of equipment. There was also comments made that individual privacy and dignity was not always supported for example, one person has been observed running around the house, not fully dressed, only wearing continence aids and standing to eat in the kitchen. The Manager needs to address this. People receiving services are happy with the way that staff deliver their care and respect their dignity and rights. There were no issues in respect of privacy and dignity noted at the inspection. The Dovecote DS0000008661.V362988.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): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. If people have concerns with their care, they or people close to them mostly know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. EVIDENCE: The home has an open culture that allows residents to express their views and concerns in a safe and understanding environment. Residents and others involved with the service say that they are happy with the service provided, feel safe and well supported. User-friendly complaints procedures are on display. Since the last inspection there have been no complaints or safeguarding referrals made in respect of the home the home. The service has a complaints procedure that is clearly written and easy to understand. One relative said they were not aware how to make a complaint should they need to however. The Dovecote DS0000008661.V362988.R01.S.doc Version 5.2 Page 20 The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. The home understands the procedures for safeguarding adults and will always attend meetings or provide information to external agencies when requested. Training of staff in safeguarding is regularly arranged by the home. Other training around dealing with physical and verbal aggression is also made available to staff as needed. Staff spoken with was aware of the whistle blowing policy and demonstrated knowledge of reporting any poor practice. There were no recorded incidents of use of restraint during the previous twelve months. A sample of resident’s financial records was examined and were satisfactory. All staff, understand, what restraint is and alternatives to its use in any form are always looked for. Equipment that may be used to restrain individuals such as bed rails, keypads, recliner chairs and wheelchair belts are only used when necessary. People are involved in the decision making process about any limitations to their choice in this area. Individual assessments are completed which involve the individual where possible, their representatives and any other professionals such as the care manager or GP. The Dovecote DS0000008661.V362988.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): 24 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People live in a safe and well-maintained home that is homely, mostly clean, pleasant and hygienic. EVIDENCE: The home provides a physical environment that meets the specific needs of the people who live there. The home is comfortable but some areas in the Lodge look shabby and in need of re-decoration, particularly the hallways, staircase, bathrooms and staff toilet. Cleaning of high areas in both first floor bathrooms in the Lodge was observed to be neglected. In one bathroom the pipe work and boxing in is stained and requires attention. People who live in the home can personalise their rooms. They also say they the home is clean, warm, well lit and there is usually sufficient hot water. The Dovecote DS0000008661.V362988.R01.S.doc Version 5.2 Page 22 There has been some consultation with residents about the décor, especially for their own rooms. Some en-suite facilities are available. There is currently work in the bungalow to convert unused rooms into an en suite bedroom and sitting room. The carpet in the bungalow lounge and dining room has been replaced. A workstation/desk has been provided for staff to undertake their administrative work in the Lodge. There is a small office in the Bungalow and a spacious main administration office also. Staff coats and handbags were observed left in offices. No lockers are provided for staff personal belongings. The laundry area was inspected at this visit. Hygiene equipment is available and staff, were observed to wear protective clothing during their work as appropriate. Food safety practices were observed to be satisfactory. Staff spoken with and their training records confirmed that they receive training in infection control. The Dovecote DS0000008661.V362988.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): 32,33, 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. People have safe and appropriate support as there are mostly enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get mostly the relevant training and from their manager. EVIDENCE: Staffing rotas mostly take into account the needs and routines of the people using the service. The manager reported in the AQAA[Annual Quality Assurance Assessment] that rotas are devised in manner to ensure adequate numbers and is balanced in team according to skills and experience. The service recognises the importance of training, and tries to delivers a programme that meets any statutory requirements and the NMS [National Minimum Standards]. The manager is aware that there are some gaps in the training programme and plans to deal with this. The service is also able to recognise when additional training is needed, but is not always in a position to provide this training. The Dovecote DS0000008661.V362988.R01.S.doc Version 5.2 Page 24 All staff are clear regarding their role and what is expected of them. People using the service report that staff working with them know what they are meant to do, and that they meet their individual needs in a way that they are satisfied with. The service has a recruitment procedure that meets statutory requirements and the NMS. The procedure is followed in practice and there is accurate recording at all stages of the process. The manager has delegated the task of recruitment to senior staff and an improved requirement checklist has been devised. Commencement of a Common Induction Standards workbook is improving understanding of role and expectations of new staff. The home has a high level of staff turnover with 50 of staff leaving in the previous 12 months. There was an expression of low staff morale made at the inspection by six staff and that they still do not feel listened to. They expressed that they have continually worked with lack of a full staff compliment which means they have to cover extra shifts/work long hours. Although it was acknowledged that some staff have requested extra hours of working, this may affect their capacity to provide the service they would like for people living in the home and that paperwork may be overlooked because of this. Staff reported that they had their first full staff meeting recently. Staff also expressed that they felt new staff should have a longer induction period before being expected to work on the rota. The manager has delegated staff supervision to senior staff, records are kept, but one person reported that they have had only two appraisals in three years of employment and no supervision. Records confirmed this to be the case. The manager reported in the ‘AQAA’ that it is hard to maintain the frequency required of supervision sessions because of the tightness of staff resources. Visiting professionals made the following comments ‘The home has staffing issues in that some residents require 2:1 or 1:1 support and this has not always been possible e.g. in the bungalow there are only 2 staff on duty, when one resident needs both to support another member of staff has to be sent for from the main house and this may mean staff shortage at the main house’ The Dovecote DS0000008661.V362988.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, 38,39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health safety and welfare of individuals living in the home are mostly promoted and protected and the home now has Quality Assurance systems in place to monitor the service to improve outcomes for people. Management systems should be included within the quality monitoring reviews to assess their effectiveness and ensure the views of staff are listened to and acted upon. EVIDENCE: The manager has been in post for several years, he holds a social work qualification. The manager also has achieved a Master of Philosophy [in Social Work Practice] and DipYW. The manager told us he is not now retiring from his position as manager for the home. However, he does not hold the The Dovecote DS0000008661.V362988.R01.S.doc Version 5.2 Page 26 registered managers award so this now needs to be undertaken to ensure he meets with the requirements of Regulation 9. There was no evidence in the training records that manager keeps up to date with practice and continuously develops his management skills. The manager was not present for the full inspection, he told us that he had to attend a pre booked meeting. Staff reported that they did not feel that they saw enough of the manager and that in their opinion he tended to be reactive to issues and that there was a blame culture when things went wrong and that the home would benefit from a more pro-active management style. It is the opinion of visiting professionals, that the home could improve ‘handovers’ to ensure continuity of care and that staff should be fully informed of any concerns/changes in care/plans. They said ‘ Staff should not be on duty if they have not received a comprehensive handover or are not fully conversant with residents needs’ The manager stated in the AQAA that the ‘Board of Trustees’ have now established monitoring systems, evidence was seen at the inspection. Staff confirmed they are currently undertaking training with The Quality Tree, but are unsure how they will implement this yet. Residents meetings are now in place. The Chair of the Trustee’s completes monthly visits and reports as required by Regulation 26. The manager acknowledged in the AQAA that the home needs to improve feedback systems. Eleven returned relative surveys were viewed at the home, all were positive. Surveys for staff and visiting professionals should be developed now. All sections of the AQAA were completed and the information gives a reasonable picture of the current situation within the service. The AQAA lets us know about changes they have made and where they still need to make improvements. It shows clearly how they are going to do this. The data section of the AQAA is accurately and fully completed. There were no health and safety issues identified at the inspection other than with medication management. The manager is aware of the need to promote safeguarding and has developed a health and safety policy that generally meets health and safety requirements and legislation. The manager reported in the AQAA that a more detailed Fire Safety Assessment has been completed and a risk assessment of the water system The Dovecote DS0000008661.V362988.R01.S.doc Version 5.2 Page 27 has been completed and the appropriate checks are being done to protect against legionella. The Dovecote DS0000008661.V362988.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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 2 36 2 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 3 13 3 14 3 15 3 16 2 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 2 3 X X X 2 The Dovecote DS0000008661.V362988.R01.S.doc Version 5.2 Page 29 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 YA20 Regulation 13 [2] Requirement Ensure the medication systems are safe in respect of handwritten prescriptions discussed at the inspection. This will ensure service users are not placed at risk. Previous timescale 31/12/07 Not Met. 2 YA20 13 [2] Ensure medication records are always completed after administration and are accurate at all times. 24/06/08 Timescale for action 24/06/08 3 YA37 9 [2][b] This will ensure service users receive the medication they need in respect of their health and well -being. The registered manager needs to 24/10/08 undertake the appropriate registered managers award. This will ensure he has the most appropriate qualifications for managing the care home. The Dovecote DS0000008661.V362988.R01.S.doc Version 5.2 Page 30 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. Ensure information about the fees charged is included in the Service User Guide. 2 YA3 YA6 Review the current assessment and support/care plan system to provide a person centred approach to care planning and which includes their goals and aspirations and how they are being supported to achieve these. 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. It is recommended that the assessment document be further developed to embrace equality and diversity, to ensure any cultural, religious, sexuality, gender, disability needs are fully addressed. Ensure the non-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. 3. YA7 4. YA14 The use of communication aids, such as menus in symbol or photographic formats should be explored and implemented to promote informed choice in respect of DS0000008661.V362988.R01.S.doc Version 5.2 Page 31 The Dovecote activities. 5. YA17 Involve people who live in the home with shopping to promote a wider experience of what is available and to make choices from. 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. 6. YA19 7 8. YA19 YA20 Develop Health Action plans within the care plan format. 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. A reminder note should be added to the policy for medication error that all medication errors are to be notified to CSCI [Commission for Social Care] under Regulation 37. 9. YA32 Service users, lifestyle would be improved by all staff having further input/ training in key working, care planning, food and nutrition and communication skills, diabetes, safe guarding adults and equality and diversity and epilepsy. Provide lockers for staff to store their personal belongings. DS0000008661.V362988.R01.S.doc Version 5.2 Page 32 10. YA24 The Dovecote 11 12 13 14. YA33 YA36 YA37 YA39 [Please refer to Regulation 23[3][a] Take action to address the circumstances of the high turnover of staff and staff views in respect of their low morale. Ensure supervision sessions for staff occur at least six times year with at least one session of observation of practice. Provide evidence of the manager’s personal training and development plan for the next inspection. Further develop the Quality monitoring systems to include the views of staff and visiting professionals and provide evidence of feedback of any action taken as a result of listening to peoples views The Dovecote DS0000008661.V362988.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. Extracts may not be used or reproduced without the express permission of CSCI The Dovecote DS0000008661.V362988.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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