Inspection on 23/11/06 for The Old Downs Care Home

This inspection was carried out on 23rd November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 13/11/07

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 Eamonn Kelly Key Unannounced Inspection 23rd November 2006 10:30 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.V322568.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.V322568.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 01992 636 464 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.V322568.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: The Old Downs residential home offers 41 single bedrooms located on three floors. Seven bedrooms have en-suite facilities. Residents have the benefit of a passenger lift between the 3 floors (and a stair lift). The home is registered to provide specialist support for people with dementia. Public transport facilities are nearby at Hartley. There is car parking available at the home. Weekly fees are: 1. Kent County Council funded residents: £410 per week. 2. Privately funded residents: £472-£688 (the higher end of the range is for occupation of a larger bedroom with an en-suite facility). Additional charges are made for hairdressing (prices displayed in hairdressing salon) and chiropody (£9 per session). The home has advised the commission that no further additional charges are made. The Old Downs Care Home DS0000068715.V322568.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection on 23rd and 28th November and 4th December 2006 consisted of meeting with management staff, residents, visitors and members of staff on duty. Most bedrooms and communal areas were visited and a number of records associated with resident care were assessed. Residents, relatives and care managers returned 14 completed survey questionnaires. Comments made were generally positive but some concerns were raised about pressures on staff that have a negative affect on residents. The inspection visit concentrated on the care and support in place for residents. Meetings with members of staff and residents served to give a broad understanding of how resident’s current and changing needs are addressed. The results indicated that residents are well cared for at the home by a hardworking group of staff. Visitors met were satisfied with the support their relatives at the home received. What the service does well: What has improved since the last inspection? The premises have been refurbished since the new owner bought the business. Members of staff receive induction training, mandatory training and support with achieving NVQ qualifications. A programme of training in dementia care The Old Downs Care Home DS0000068715.V322568.R01.S.doc Version 5.2 Page 6 has begun for an initial group of staff and all support workers will receive this training during 2007. During 2006, staff had the benefit of a two-day course facilitated by specialists in the field of dementia care. 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.V322568.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.V322568.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, 4, 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives do not receive the level of support they need before they enter residential accommodation because the written information is not sufficiently accurate. EVIDENCE: Prospective service users and their representatives receive, as part of admission procedures, a copy of the home’s “Nelsar Welcome Pack: Resident’s Guide”. This document is potentially a useful document but its limitations were discussed during the inspection visit and the manager undertook to prepare a revised document. The revised resident’s guide would be given to all new The Old Downs Care Home DS0000068715.V322568.R01.S.doc Version 5.2 Page 9 residents and their supporters. This would be a single document based on current regulations and national minimum standards. Shortfalls in the current document tend to give a distorted picture of life at the home. For example, it states that dinner is at 5pm; during the inspection on one occasion this comprised a drink and a round of sandwiches. Much space is allocated to a charter of rights and other generalisations, all of which should be regarded as basic tenets of support for residents. The staffing section is misleading (some staff met did not have the training claimed in the document although they were hardworking and enthusiastic). The organisation structure is further misleading in that it portrays owners and other members of the wider company (which currently operates some 10 residential homes) as staff of the home. The actual organisation chart does not show the names and numbers of senior care staff and other workers at the home. The section on admission to the home does not adequately explain the admission procedure necessary for admission of people with dementia. There is also a statement in the document that “our fees reflect the cost of our services and in particular the large number of staff we require to meet our statutory obligations…”. During the inspection it was found that there were significant staffing shortfalls. It cannot be readily assumed therefore that standard 4 is adequately met (ie. that service users and their representatives will know that the home…will meet their needs. The current guide has not been prepared specifically for this home and the nature of its services. All new residents (but more generally his/her representative) receive a personal contract. Prospective residents receive an assessment prior to admission to the home. They receive an assurance from the manager that their support needs will be properly addressed. During the inspection, a case tracking exercise revealed that, in the inspector’s opinion, some residents were unlikely to be receiving the type of specialist support they need for their present (and deteriorating) conditions. Residents are not admitted for the purpose of receiving care after hospital stays to enable them to return home as facilities are not available for this type of support. The Old Downs Care Home DS0000068715.V322568.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health, personal and social care needs are generally met. Residents would be further helped if each received the level of personal support expected from a home registered to provide specialist support and care. EVIDENCE: Care plan records contain a great deal of information about each resident and how he/she is being supported. Members of staff said that they find the personal profiles of residents useful as these explain some facts about the resident’s past and may help to explain why the resident is acting in a particular way. Some profiles seen were good; others were sketchy. It would help if each profile was typed and more easily read. Some staff said that they are unaware of the specific disabilities of resident’s as it is their job to provide physical care and domestic support. The Old Downs Care Home DS0000068715.V322568.R01.S.doc Version 5.2 Page 11 A case tracking exercise revealed that the care plan record might have little material effect on the levels of professional support for residents with high dependency needs and whose health is deteriorating. These examples were discussed with the manager and various alternative means of support were included in this review. In the inspector’s opinion, some residents were not receiving adequate professional support. The very low staffing levels have an impact on the position because care staff have responsibility for a wide range of domestic tasks and their training is, as yet, insufficient for the specialist care of 41 older people with different forms of dementia and physical disabilities. This pressure is increased because accommodation is located over a very dispersed area and there are so many physical impediments to free movement throughout the premises. Staff were, during the inspection visits, unable to cope on many occasions with the wide variety of resident dependency although they are hardworking and committed. Part of a medication round was seen on two occasions. Medication administration is restricted to nominated members of staff who, in the opinion of the manager, are sufficiently trained and experienced in this task. The medication rounds observed showed that the administrator took reasonable care to record the administration and to help residents take their medication. Residents have reliable access (according to care plan records) to GP’s, district nurses, a dentist and optician. Whilst the resident’s guide claims that residents have access to physiotherapy services, the case tracking exercise revealed that where this service would have been expected it was not provided or considered. A significant number of instances of contact between residents and staff were observed. In all cases, members of staff were kind, courteous, considerate and supportive to residents. Residents were treated with respect and visitors were helped at all times. The Old Downs Care Home DS0000068715.V322568.R01.S.doc Version 5.2 Page 12 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Visitors are welcome and residents have the benefit of a reasonable range of support for activities. They are likely to benefit more if activity organiser hours were significantly increased, adequate staffing numbers were in place in proportion to their support needs and residents had freedom of movement throughout the premises. EVIDENCE: Many visitors called whilst the inspection visits were taking place. Those met said they were satisfied with the way their relative was being supported. Some relatives’ responses (in the CSCI survey) reflected concern about pressures on staff during the week and at weekends. Meeting with staff indicated that, where necessary, fortified drinks are provided for residents. Their weights are recorded at least monthly. Reasons for concern are assessed and interventions agreed. The mid-day meal observed indicated that there were alternative meals provided for a few residents. Residents The Old Downs Care Home DS0000068715.V322568.R01.S.doc Version 5.2 Page 13 received help with feeding in some cases. The evening meal observed (described as “dinner” in the resident’s guide) comprised a drink and round of sandwiches. There were no tablecloths or condiments. Some residents left their sandwiches and some had no drinks. Residents receiving their “dinner” in their bedroom additionally did not receive sufficient staff support. A senior member of staff said that this situation was exceptional and does not normally happen. Twenty-five hours per week for specific activities is provided (the resident’s guide states that these are given on 3 days a week). The manager is increasing this number of hours to 30 which is a helpful progression. A more reasonable figure for professional activities support for residents in a specialist service would be at least one hour per week per resident; the current and proposed figure falls short of this. Care staff are expected to fill the gap. They were seen to be making a good effort to do this but they have too heavy a workload already to be properly effective. Membership of a professional organisation (eg. National Association for Activities Organisers) for activities organisers is likely to be of benefit to the activities organiser. The home provides some outings for residents (a minibus is shared with other homes owned by the company) and visiting entertainers are employed. In order to “contain” residents within the premises there is an unusually high number of locks and physical bars to free movement. There are 4 stairs gates, 6 key pad locks and 4 baffle locks; staff routinely lock 9 bedroom doors when the resident is not in the room. Reasons were put forward as to why these impediments to free movement were in the interests of resident comfort and safety. The cumulative effect is that many residents are somewhat corralled into the communal areas on the ground floor whilst others are room-bound and relatively isolated. The door to the conservatory has no door furniture so most residents are unable to travel through easily; several were seen fumbling and then giving up. Such high levels of restraint do not suggest an effective framework for residents retaining adequate control over their lives and daily routines and has overtones of a secure facility. The Old Downs Care Home DS0000068715.V322568.R01.S.doc Version 5.2 Page 14 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected from abuse at the home. EVIDENCE: The home’s complaints policy is displayed in several locations. This will be included in all new service user guides. Social services and the commission’s telephone numbers are not shown. The displayed policy is in small print and placed rather high on the wall for easy reading. These shortfalls will, according to the manager, be addressed when a copy is included in the revised resident’s guide. The home’s induction procedure is inadequate in that new staff receive their induction in one day at the beginning of their employment (this situation is assessed elsewhere in this report). Accordingly, there is no proper training at this stage for how staff should deal with suspicion of abuse to residents within the home (this shortfall is addressed later in this report). Nevertheless, some staff were aware that they have a duty to report their suspicions and of how this should be done. The Old Downs Care Home DS0000068715.V322568.R01.S.doc Version 5.2 Page 15 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, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have the benefit of living in a comfortable and safe home. The premises are suitable for the care of frail older people. EVIDENCE: The premises provide 41 single bedrooms located over 3 floors served by a passenger lift. Seven bedrooms have an en-suite facility. There are communal rooms on the ground floor. A new conservatory to be located off the dining room is planned. There are sufficient communal WC and bathroom facilities. Some bedroom doors have computer-generated pictures placed on them. The intention is that residents will recognise the information. The unusually high number of locks and bars to free movement throughout the premises has been The Old Downs Care Home DS0000068715.V322568.R01.S.doc Version 5.2 Page 16 referred to earlier. Consultant psychologists with specialist knowledge of best practices for working with people with dementia would provide the home, if commissioned, with information about how best to employ means other than locks and physical restraint to help residents with dementia avoid certain areas. The layout of the home is potentially suitable for such measures and current measures are relatively crude. Baths, showers and hot water outlets in bedrooms have been fitted with temperature control valves to reduce the danger of residents being scalded. It was stated that weekly manual checks are made (and outcomes recorded) to further prevent mishap if valves fail. There is easy access to the garden area from the dining room and conservatory. The home has a hairdressing salon. There were a number of obvious defects identified during the inspection visit: 1. The housing mechanism for the electric door in the serving hatch was dangerous for residents and staff. 2. Many clocks throughout the premises showed the wrong time. 3. TV reception in most bedrooms was poor and no external aerial system was available. 4. Some bedrooms were equipped with oil-filed heaters because the central heating system in those areas was inadequate. When used, the heaters were too hot and liable to cause burns. 5. Some bedrooms were far too hot for comfort. 6. At least one of the stair “child gates” had a specific potential defect that was reported to the manager during the inspection visit. 7. Some beds did not have a headboard. 8. Some door furniture was inadequate. The manager stated that all these defects would be immediately addressed. These premises defects were, as stated, fairly obvious and this report should not be read as a full property safety inspection. The manager indicated that a new fire safety report and risk assessment had been prepared by a person qualified to do so under the new fire regulations. There is a call bell system to the home from the nearby 8 private homes. As these premises are not part of the registered premises, the bells should be removed and staff should not be responsible in any way for the residents in these premises. There are suitable laundry facilities in the basement with a service lift to the ground floor. The Old Downs Care Home DS0000068715.V322568.R01.S.doc Version 5.2 Page 17 The premises were reasonably but not exceptionally clean during the inspection visits. In one case, a member of staff said that an area had not been cleaned for 2 days. The Old Downs Care Home DS0000068715.V322568.R01.S.doc Version 5.2 Page 18 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have the benefit of being in the care of hardworking, caring and enthusiastic support workers. Their care would benefit from better staff support procedures. EVIDENCE: Elsewhere in this report, reference has been made to the poor staffing arrangements at the home and the probable impact on service users. The manager stated that she is planning to increase the numbers of care assistants available in the mornings and afternoon by one. This is a reasonable starting point. Care assistants are responsible for a wide range of duties. An experienced member of staff outlined how a minimum requirement should be 2 carers (possibly 3 because of the current corralling of many residents in this area) at all times in the communal areas and sufficient other staff available for resident toileting, room checks (kylie sheet replacement, wipe commodes, replace soiled bedding, tidy bedroom), tea trolley service and bathing. In addition care assistants are responsible for a range of further domestic tasks (delivering meals to bedrooms, helping at meals, assistance with feeding in the dining The Old Downs Care Home DS0000068715.V322568.R01.S.doc Version 5.2 Page 19 room and at other locations). Care assistants were also making reasonable attempts at keeping residents mentally and physically alert as activity organiser hours are severely limited. There were many instances where service users were wishing to leave to, as they explained, collect their children from school, meet their wives/husbands, go to their cars etc. These residents must receive reassurance on a regular basis; care assistants need a high level of knowledge about each resident, why they are acting as they are and how best to intervene. Some residents had taken to their bedrooms and were adamant about not coming out. Clearly there was not enough time available to staff to work properly with service users who have varying degrees of physical disabilities and types of dementia. Care assistants were seen to intervene with good consistency of practice but there are underlying defects in the ways some residents are supported. For example, in some cases members of staff said “X insists on staying in bed all day…X refuses to have personal care…”. During the series of inspection visits there were experienced staff on duty but there was a significant number of new and relatively inexperienced staff and several agency staff were present to augment numbers. A case tracking exercise indicated that some residents were not receiving appropriate support. There were some signs that the cleaning of the home, whilst generally reasonable, was not outstanding. The commission expects homes to have sufficient numbers of trained staff in place to meet resident’s support needs. In this case, the home claims (via it’s registration as a specialist home for older people with dementia and related assertions in it’s resident’s guide) to have sufficient numbers of trained staff on duty at all times. The proposed increase in staffing levels must be further augmented to meet the support needs of residents. Twenty-five hours of activity organiser time per week should also be increased to at least one hour per week per resident. These improvements are expected to be shown in the revised resident’s guide by 31/01/07. Induction procedures do not meet standards set by the current recognised body (“Skills for Care”). In the examples seen, induction comprised most elements expected in such a 3-month programme but completed on one day with a senior member of staff signing off each element as “competency assessed”. The manager stated that most members of staff have now completed NVQ Level 2 or 3 in Care. The Old Downs Care Home DS0000068715.V322568.R01.S.doc Version 5.2 Page 20 A number of care assistants have started an RVQ (Level 2) in Dementia Care. This is a positive step as the home is registered to provide specialist support for people with dementia. It is expected that all care staff will complete this course in 2007. The home’s deputy manager is undertaking this qualification and the commission would also expect the manager to complete it during 2007. Some members of staff, including those without NVQ qualifications, have not completed full mandatory training. The manager has recognised this and is reviewing the support needs of all staff through formal supervision. A member of staff is a trained trainer in moving and handling and provides initial training and updates. The home has good fire training procedures. Staff files checked indicated that a number of members of staff had either not received or returned a signed copy of their contract. All new members of staff complete an application form, 2 references are taken up (plus telephone references) and CRB (and POVA) checks are taken up. The Old Downs Care Home DS0000068715.V322568.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, 38. Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. Residents live in a well managed home where efforts are being made through quality assurance measures to improve their quality of life. EVIDENCE: At the previous inspection visit in February 2006, the manager gave an assurance that a formal staff supervision programme would be put in place. The purpose was to assess the skills of staff and meet their personal development needs. It is assumed that this programme is successfully underway. The Old Downs Care Home DS0000068715.V322568.R01.S.doc Version 5.2 Page 22 The manager, Mrs Gillian Dixon, has achieved the Registered Manager’s Award and amongst other relevant training achievements holds a full first aid certificate. The manager made a written declaration in the pre-inspection questionnaire that all relevant safety checks have been carried out with associated safety certificates in place. Resident’s families (or independent solicitors and/or financial advisors) look after resident’s financial and legal affairs. Social services financial affairs officer may also be involved in some circumstances. The home is not completely conducted solely in the best interests of residents. The evidence for this has been referred to elsewhere in this report. However, the owners and manager are progressing towards better systems and facilities and their good intentions are not in doubt. There is no doubt that the manager and members of staff are kind, considerate and thoughtful towards residents who are at a highly vulnerable stage of their lives. The manager was pro-active in giving an assurance that the issues raised in this report would be appropriately addressed for the benefit of residents and staff. The Old Downs Care Home DS0000068715.V322568.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 1 x 3 2 x 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 1 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 x x 3 The Old Downs Care Home DS0000068715.V322568.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. 1 Standard OP1OP1 OP4OP4 Regulation 4, 5, 6 and Schedule 1. Timescale for action The home must have a resident’s 31/01/07 guide that is accurate and up-todate. This must include information about services and facilities that are provided in the ways claimed in this preadmission document. Copies must be given to all residents or their representative. This information should play an important part in enabling an assurance to be given to prospective service users (ie. resident and representative) that their current support needs will be met and that any deteriorating health or social care needs are likely to be properly met. The revised document should include the revisions as discussed during the inspection visit including information about staffing and staff development (which is also part of requirements 3 & 4 below). “ The registered person shall The Old Downs Care Home DS0000068715.V322568.R01.S.doc Version 5.2 Page 25 Requirement compile…a written statement…and…written guide to the care home…” 2 OP7OP7 OP8OP8 12 & 15 Whilst the home maintains a 31/01/07 care plan record for each resident, all members of staff must be more fully conversant with the care plans in operation for each resident. Where, for example, a resident needs physiotherapy (and the home’s resident’s guide claims to be able to provide or arrange this) this service must be provided and any absence of such support must be included in the care plan record. The care plan record must include more accurate descriptions of why resident s are “refusing to get up” or “refusing personal care” etc and how better specialist support is to be provided. Care assistants should be fully aware of the types of dementia each resident has as well as other disabilities and illnesses and how these are being treated. The personal profile of each resident should be up-to-date and preferably typed so that it is more easily read and accessible to all staff. The present position where residents could effectively be regarded as nursing patients should be reviewed so that some residents are not increasingly isolated because of the severity of their condition and the possible failure of the home to provide adequate and appropriate support. “The registered person shall…make the..plan available to the service user (and representative)…keep the plan under review…”. “The registered person shall ensure…proper provision for the health and welfare of service users…”. 3 OP27OP27 18 Staffing numbers and skill mix DS0000068715.V322568.R01.S.doc 31/01/07 Page 26 The Old Downs Care Home Version 5.2 must be appropriate to the assessed need of service users, the size, layout and purpose of the home. The proposed increase in staffing (one additional care assistant during both day shifts) is a good starting point. The minimum improvement expected is that the afternoon and evening shifts must be further increased. This is because of the evidence collected over 3 days of the inspection visit that showed the pressures on staff and the effects on residents. In addition, it would be expected that formal activities organiser hours should be at least one hour per week for each resident. “The registered person shall…ensure that…persons…in such numbers as are appropriate for the health and welfare of service users”. 4 OP30OP30 18 All members of staff must have completed the home’s programme of mandatory training. Likewise all new members of staff must complete over a period of at least 3 months the programme of induction training recommended by the recognised body in this field (Skills for Care) and be able to prove this by use of a suitable induction record. “The registered person shall ensure that persons employed…receive training appropriate to the work they perform…and suitable assistance…”. 31/01/07 The Old Downs Care Home DS0000068715.V322568.R01.S.doc Version 5.2 Page 27 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.V322568.R01.S.doc Version 5.2 Page 28 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. Extracts may not be used or reproduced without the express permission of CSCI The Old Downs Care Home DS0000068715.V322568.R01.S.doc Version 5.2 Page 29 - 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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