Inspection on 13/11/07 for The Old Downs Care Home

This inspection was carried out on 13th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Old Downs Care Home 23/11/06

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

CARE HOMES FOR OLDER PEOPLE The Old Downs Care Home Castle Hill Hartley Dartford Kent DA3 7BH Lead Inspector Mrs Sue Gaskell Key Unannounced Inspection 13th November 2007 10:00 X10015.doc Version 1.40 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 Old Downs Care Home DS0000068715.V352338.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 Older People. 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 Old Downs Care Home DS0000068715.V352338.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Downs Care Home Address Castle Hill Hartley Dartford Kent DA3 7BH 01474 702146 01474 709639 the.old.downs@nellsar.com 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) Nellsar Limited Mrs Gillian Anne Dixon Care Home 41 Category(ies) of Dementia (41) registration, with number of places The Old Downs Care Home DS0000068715.V352338.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd November 2006 Brief Description of the Service: The Old Downs residential home is registered to provide specialist support for 41 people with dementia. There are 41 single bedrooms located on three floors and there is a shaft lift and a stair lift. Seven bedrooms have en-suite facilities. There are three lounge areas, a sun lounge and dining room all located on the ground floor, with two more communal areas and a quiet room on the upper floors. The home has a garden surrounding the property with patio areas and a summer-house. The home is in a rural area but there are public transport facilities nearby at Hartley. There is car parking available at the home. The Home has a registered manager, deputy manager, and a team of carers. The Home also employs an activities co-ordinator, kitchen and domestic staff an administrator and a maintenance man. The current fees range from £410.00 to £650.00 per week. The Old Downs Care Home DS0000068715.V352338.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 13th November between 10.00am and 3.00pm. There are currently 40 residents living in the home. Some residents have limited communication and therefore I sat with residents whilst they were having lunch in order to see whether they appeared relaxed and comfortable. I spoke with the registered manager, deputy manager, two carers and chef. I also spoke with a District Nurse and a specialist physiotherapist who were visiting residents and a relative who was visiting his wife. I toured the building and looked at bedrooms and all communal areas. The inspection process also consisted of information collected before and during the visit to the home, and feedback from three resident’s relatives and two care managers. The annual quality assurance assessment required by the CSCI was completed in a satisfactory manner. Other information seen included general assessments, risk assessments and care plans, medication records and the duty rota. There were no outstanding requirements from the previous inspection and no requirements made following this inspection. What the service does well: The home prepares care plans, which assists staff in providing consistent and appropriate care. The food is varied, nutritious and well presented. Staff are caring, friendly and well supported. The home provides a homely, safe, clean environment. The Old Downs Care Home DS0000068715.V352338.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Old Downs Care Home DS0000068715.V352338.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Old Downs Care Home DS0000068715.V352338.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 People who use the service experience excellent outcomes in this area. The statement of purpose and service user guide says what service will be offered. Prospective residents can be confident that their needs can be met This judgement has been made using available evidence including a visit to this service. The Old Downs Care Home DS0000068715.V352338.R01.S.doc Version 5.2 Page 9 EVIDENCE: The home’s Statement of Purpose and Service User Guide are reviewed and amended on a regular basis. They provide residents, prospective residents and their relatives with all necessary information about the home. Copies of these two documents can be made available in large print or Braille if required and are also on a compact disc. New residents (or their representatives) are provided with a Statement of Terms and Conditions/Contract; this sets out in detail what is included in the fee, and what they may be charged extra for. Of the six care plan files I examined, three referred to residents who have been admitted recently. All files inspected include comprehensive preadmission assessments carried out by the home, some with supporting information from health care professionals or care managers. This assessment of prospective resident’s needs is carried out by the registered manager, either in the resident’s home or in hospital. Residents are encouraged to visit the home prior to their admission and/or to stay for a trial period. The Old Downs Care Home DS0000068715.V352338.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use the service experience excellent outcomes in this area. Residents’ care plans are reviewed and their health care needs are met. Residents are protected by the home’s policies and procedures for dealing with their medication. Residents are treated with respect. This judgement has been made using available evidence including a visit to this service. The Old Downs Care Home DS0000068715.V352338.R01.S.doc Version 5.2 Page 11 EVIDENCE: Each resident has a care plan which includes reference to all aspects of daily living including mobility, nutrition, behavioural, emotional and personal needs. The care plans were seen to be reviewed recently and include risk assessments and guidelines on how best to assist residents and details of their condition and any allergies. A key worker system is in place so that the staff who have most contact with residents have an input into the care plans and reviews. The daily records are clear and contain enough detail to monitor residents’ health and well being. There is further evidence in the care plan of monitoring residents’ health care needs and general well being, eg there are records to show where residents receive extra checks during the night or where they require particular attention because of their needs or behaviours. These records include risk assessments and guidelines for staff. Residents’ eating preferences are recorded and they are weighed regularly. Residents have access to local health care services and are referred for specialist care when necessary. . All residents have access to G.P.’s, District Nurses, Physiotherapists, dentists, opticians and other community services. Two care managers who visit their clients regularly said that they are very pleased with the service and one commented that the home goes “the extra mile” to meet the residents’ needs. A Physiotherapist and a District Nurse who both call regularly also expressed satisfaction with the way the home carries out their requests. The home has a comprehensive medication policy which has been reviewed recently. Staff confirmed that they do not administer medication unless they have received training, been judged as being competent, and feel confident. There are appropriate records for the receipt, administration and disposal of medication. Separate records are kept for particular types of medication which require special attention. Medication is safely and securely stored in a lockable medication trolley in the clinical room which is kept locked when not in use. The room also contains a lockable fridge and a special cabinet for specific medication. There is reference in the procedures to residents storing and administering their own medication but there are currently no residents where this would be appropriate. Two residents and four residents’ relatives said that the residents are well care for and that the staff are always very kind and helpful. The relatives said that they feel that the manager and staff provide care in manner that respects The Old Downs Care Home DS0000068715.V352338.R01.S.doc Version 5.2 Page 12 residents’ choice and dignity. They also said that they are always kept fully informed of any changes in the care of their relatives living in the home. The Old Downs Care Home DS0000068715.V352338.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, & 15 People who use the service experience excellent outcomes in this area. Residents’ lifestyle preferences and expectations are generally met. Residents have regular contact with their families and friends. Residents receive a nourishing and balanced diet. This judgement has been made using available evidence including a visit to this service. The Old Downs Care Home DS0000068715.V352338.R01.S.doc Version 5.2 Page 14 EVIDENCE: The care plans contain a list of residents’ needs, likes and dislikes and preferences, and what activities they enjoy. There was evidence in the residents’ daily records to show that families, and other visitors are encouraged and welcomed. I spoke with one resident’s relative during the inspection and three more relatives by phone after the inspection. All of the relatives I spoke to visit regularly and said that they are always made to feel welcome and offered refreshments and meals. Residents may take meals in the dining room, in their own rooms, or wherever suits them. The food served on the day of the inspection appeared appetising and wholesome and two of the residents said that it tasted good. Staff said that there is always an alternative to the main midday meal and a wider choice for breakfast and the evening meal. Staff complete a record of whether residents have eaten and enjoyed their meals. The store cupboard contained a wide range of food including fresh fruit and vegetables. The home employs an activities co-ordinator who keeps a record of the activities offered, including cooking, arts and crafts, games and exercise. Several residents’ relatives praised the activities co-ordinator and said how much trouble she takes to involve and stimulate residents. The home has a range of sensory equipment and is waiting for it to be installed in one of the upstairs communal areas. There are regular visiting entertainers and an area set aside for watching films. One resident’s relative also commented how the manager and staff have ensured that there is a place for residents who prefer to sit quietly. The residents have the use of a secure garden and there are regular events and outings to which residents’ relatives are also invited. The home has very little involvement in residents’ finances, but on the odd occasions where it is necessary, it is fully recorded alongside the relevant receipts. There are no residents at present with different ethnic or cultural needs but the manager showed great sensitivity to diversity issues and residents are supported with personal relationships whatever their gender or choice of lifestyle. The Old Downs Care Home DS0000068715.V352338.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience excellent outcomes in this area. Residents and/or their representatives can be confident complaints will be listened to and dealt with appropriately and that they will be protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service user guide includes the home’s complaints procedure. Although it was not possible to confirm this with the residents, several residents’ relatives confirmed that they would feel comfortable in mentioning any complaints to the manager or staff and confident that any concerns would be resolved. The Old Downs Care Home DS0000068715.V352338.R01.S.doc Version 5.2 Page 16 Staff confirmed that they are provided with initial training on safe guarding adults and are issued with a copy of the company’s “whistle blowing” procedures during their induction period. The staff interviewed all showed an awareness of the complaints procedure and of all of the issues concerning safe guarding adults. The home has a copy of the Kent and Medway Safeguarding Adults Procedures. The Old Downs Care Home DS0000068715.V352338.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 & 26 People who use the service experience excellent outcomes in this area. Residents live in a comfortable, safe, clean environment. This judgement has been made using available evidence including a visit to this service. The Old Downs Care Home DS0000068715.V352338.R01.S.doc Version 5.2 Page 18 EVIDENCE: The building is on three levels and there is a lift and an alarm call system. The home is suitable for people with impaired mobility. All of the residents are in single room accommodation, some of which have en-suite facilities. There has been on-going refurbishment of the home since the last inspection, which has included re-decoration, the painting of bathroom and WC doors to make them more identifiable, and the provision of new furniture. All of the issues identified at the last inspection have been dealt with, including improvement to the TV reception in residents’ bedrooms and the central heating. All of the completed bedrooms and living areas are furnished and decorated to a good standard, and contained the type of furniture and equipment necessary to provide a homely environment. Current residents have had some choice in the colour scheme of their rooms. There is a range of individual aids and adaptations to assist resident’s mobility and independence, including bath hoists, raised toilet seats, walking aids, hoists, ramps and grab rails. All windows have been fitted with restrictors or other means of reducing risk and all radiators are either of a low surface temperature type or covered for safety. There is a large all weather conservatory for residents’ use and a secure wellmaintained garden and patio with garden furniture which is used by the residents. All areas of the home are clean and there are no noticeable odours. There are disposable hand drying towels and pump soap dispensers in communal WC’s and in residents’ bedrooms to reduce the risks of cross infection. There is separate laundry room with a commercial washer and a drier. Staff showed a good awareness of health and safety issues. Disposable wipes are used for personal care. There are appropriate foot operated bins for particular waste products and staff confirmed that personal items are disposed of appropriately. The Old Downs Care Home DS0000068715.V352338.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience good outcomes in this area. Staffing numbers are adequate to meet the daily needs of the residents. Residents are protected and supported by the home’s recruitment and induction training procedures. Residents benefit from a well trained and supported staff team. This judgement has been made using available evidence including a visit to this service. The Old Downs Care Home DS0000068715.V352338.R01.S.doc Version 5.2 Page 20 EVIDENCE: Staffing levels and staff training have improved since the last inspection. The staff rota showed that there are generally one deputy manager and/or senior carer and five care staff on duty, in addition to the registered manager and activities co-ordinator. There are adequate kitchen and domestic staff, an administrator, and full time gardening and maintenance staff. Night staffing comprises 3 awake staff and there is an emergency on call system covered by the manager and deputy manager. Five staff files were examined and all contained evidence of sound employment, recruitment and supervision practices. The staff interviewed confirmed that they had to complete application forms, and that the home applied for their references, CRB checks and evidence of identity. The majority of the staff have now completed or are shortly to complete NVQ2 or NVQ3 training. All new staff have a comprehensive induction training and further ongoing training is also provided for issues such as dementia awareness, infection control, COSHH, moving and handling, first aid, fire safety, safeguarding adults and health and safety. Staff said that there is regular supervision and they also commented on the good working atmosphere and high level of support provided by the manager. The Old Downs Care Home DS0000068715.V352338.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 People who use the service experience excellent outcomes in this area. The current management arrangements ensure that the home is being run in a way which benefits residents and staff. The record keeping, and health and safety systems are sufficient to safeguard residents’ welfare, rights and best interests. This judgement has been made using available evidence including a visit to this service. The Old Downs Care Home DS0000068715.V352338.R01.S.doc Version 5.2 Page 22 EVIDENCE: The manager has extensive experience and care and training qualifications. The management of the home and completion of records are generally of a good standard with daily records regularly checked by the registered manager. Several residents’ relatives commented on the approachability of the manager and also on her professionalism. Staff said that the residents are regularly asked for their views and feelings about activities, meals and how things are done. This is either through talking to individual clients or through questionnaires for residents, and/or their families. The questionnaires include questions on satisfaction with personal support, the quality and quantity of the meals, staff attitudes, complaints and the comfort and cleanliness of the environment. The questionnaires state that the people completing them are welcome to remain anonymous. The manager said that policies and procedures are reviewed continuously as issues arise, and several new systems have been put in place since the last inspection to ensure good practice. This includes care checklists for staff to use when caring for residents at night. There are further quality checks by the operations manager as part of the monthly regulation 26 visits, together with weekly senior management staff meetings and an annual business plan. Staff said that the manager and managing team are supportive and that staff morale is good. The manager was also full of praise for all of the staff team. There were no obvious hazards around the home and there was evidence to show that health and safety issues are taken seriously eg staff ensuring that personal items were appropriately disposed of and warning signs in place for wet floors. The fire alarm and emergency lighting are tested regularly. The maintenance file contains current certificates to show that regular checks eg gas, electricity, are carried out. Whilst there are adequate risk assessments on the environment, and for activities involving residents, these would benefit from more detail. The Old Downs Care Home DS0000068715.V352338.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 4 X X 4 HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 4 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 4 X X X X X 4 4 STAFFING Standard No Score 27 3 28 4 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 4 X X 4 The Old Downs Care Home DS0000068715.V352338.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? no 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Old Downs Care Home DS0000068715.V352338.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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