Care Home: 21 Dimmingsdale Bank

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What the care home does well Two of the people living in the home told us that they were happy living there. Some comments from relatives of the people living in the home stated: " The service does a marvellous job in looking after the residents in its care. Whenever I visit I am made welcome and am always impressed by how clean 2 Dimmingsdale Bank DS0000016927.V377191.R01.S.doc Version 5.2 and orderly the premises are. I have always been kept fully informed about X`s progress including her health and welfare." " Good standard of care in respect of clients physical needs, food, cleanliness, clothes washing, health and medication. Generally relaxed and friendly environment. Co-operative with family visits and allowing access t telephone for ME to maintain family contacts. Good co-ordination with other agencies eg day centre." There are good care plans in place that provide staff with the information they need to support the people living in the home to meet their personal and health care needs. The people living in the home are encouraged and supported to do some things for themselves. People living in the home are provided with a safe and comfortable homely environment. Individuals` bedrooms are personalised to reflect the individuals` likes and personalities. The people living in the home are given choices about who will support them and how they want to spend their time so that they can control some aspects of their lives. People are supported to go on holiday and we were told by some of them that they had been to Blackpool and the Safari park and enjoyed this. The staff spoken to during the inspection and observations made confirmed that there were good relationships between the staff and the people living in the home. Staff are recruited and provided with training that ensures that they are suitable individuals to support the people living in the home. The people living in the home receive a varied diet and there are choices available at meal times. What has improved since the last inspection? Improvements have been made to the physical environment by replacing the flooring in the lounge and dining rooms. A new television and chairs have been purchased for the lounge and dining room to improve the facilities for the people living in the home.2 Dimmingsdale BankDS0000016927.V377191.R01.S.docVersion 5.2The people living in the home have decided to have a fish tank and fish to look after in the lounge area. This means they have been able to make choices and take responsibility for looking after them. Some bedrooms have been redecorated making them more personalised. A new boiler has been installed to ensure that there is sufficient hot water in the home at all times to ensure that the needs of the people can be met when and how they want. What the care home could do better: The people living in the home would benefit from having an established, permanent staff team who they know and feel comfortable with and who can provide them with continuity of care. The staff in the home must ensure that records such as the food and fluid intake charts are fully completed ensuring that a judgement can be made about whether individuals are having the correct amount of calorie intake to keep them healthy. The organisation`s procedures must be followed to ensure that the people living in the home are safeguarded for example safeguarding referrals and maintenance of financial records. Staff must ensure that food is dated when it is put into the freezer or used before the use by dates to ensure that the people living in the home are given food that is safe to eat. The plans for the provision of additional private space for people to meet with friends and family should be progressed. Key inspection report CARE HOME ADULTS 18-65 2 Dimmingsdale Bank Woodgate Valley Birmingham West Midlands B32 1ST Lead Inspector Kulwant Ghuman Key Unannounced Inspection 18th August 2009 10:00 2 Dimmingsdale Bank DS0000016927.V377191.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. 2 Dimmingsdale Bank DS0000016927.V377191.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address 2 Dimmingsdale Bank DS0000016927.V377191.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 2 Dimmingsdale Bank Address Woodgate Valley Birmingham West Midlands B32 1ST 0121 422 7500 F/P 0121 422 7500 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) joannesp@trident-ha.org.uk Trident Housing Association Miss Yvette Patricia Purville Care Home 7 Category(ies) of Learning disability (7), Physical disability (7) registration, with number of places 2 Dimmingsdale Bank DS0000016927.V377191.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following caregories: Learning disability (LD) 7 Physical disability (PD) 7 The maximum number of service users who can be accommodated is: 7 21st August 2008 2. Date of last inspection Brief Description of the Service: Dimmingsdale Bank is a purpose built home for seven people who have a learning and additional physical disability. It was first registered in 1995. It is situated in a residential area on the south side of the city known as Woodgate Valley. It is within easy reach of local shops, public transport and local amenities. The property comprises of three linked houses, set out with a pleasing frontage of small areas of shrubs and spacious off road parking. The facilities include a large open plan communal area, which is utilised as a combined lounge and dining room. There is a main kitchen, and five bedrooms, all with en suite facilities, which can be accessed directly from the combined lounge/dining area. The office, sleep-in accommodation, laundry and a further two bedrooms are located on the first floor accessed via a stair lift. To the rear of the property there is a cushioned or astro turf patio with flowerpots, surrounded by a raised lawn and shrubbery. Due to the gradient of the lawn people living in the home are not able to access it. Wheelchair access into the house and out to the rear garden is evident. The ground floor facilities are fully accessible. However, the first floor 2 Dimmingsdale Bank DS0000016927.V377191.R01.S.doc Version 5.2 Page 5 accommodation can only be utilised by those who are able to use a stair lift. The statement of purpose stated that the fees at the home range from £990 to £1250 per week which includes accommodation, care and support, laundry and all meals within the home. The fees do not include TV licences, activities, specialist equipment required after initial assessment and moving in and personal services including hairdressing, aromatherapy and transport. A copy of the latest inspection report is available in the home for visitors who wish to read it. 2 Dimmingsdale Bank DS0000016927.V377191.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out over two days by one inspector. The home did not know that we were going to visit. The focus of inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law, and an Annual Quality Assurance Assessment (AQAA). This is a document that provides information about the home and how they think that it meets the needs of people living there. Two people living in the home were case tracked. This involves establishing individual’s experiences of living in the care home by meeting them, observing the care they receive, discussing their care with staff, looking at care files and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. We looked around some areas of the home. A sample of care, staff and medication records were looked at. Where people who use the service were able to comment on the care they receive their views have been included in this report. We received 6 surveys completed by people who use the service, 1 person who worked there and 3 representatives of the people living in the home. What the service does well: Two of the people living in the home told us that they were happy living there. Some comments from relatives of the people living in the home stated: The service does a marvellous job in looking after the residents in its care. Whenever I visit I am made welcome and am always impressed by how clean 2 Dimmingsdale Bank DS0000016927.V377191.R01.S.doc Version 5.2 Page 7 and orderly the premises are. I have always been kept fully informed about Xs progress including her health and welfare. Good standard of care in respect of clients physical needs, food, cleanliness, clothes washing, health and medication. Generally relaxed and friendly environment. Co-operative with family visits and allowing access t telephone for ME to maintain family contacts. Good co-ordination with other agencies eg day centre. There are good care plans in place that provide staff with the information they need to support the people living in the home to meet their personal and health care needs. The people living in the home are encouraged and supported to do some things for themselves. People living in the home are provided with a safe and comfortable homely environment. Individuals bedrooms are personalised to reflect the individuals likes and personalities. The people living in the home are given choices about who will support them and how they want to spend their time so that they can control some aspects of their lives. People are supported to go on holiday and we were told by some of them that they had been to Blackpool and the Safari park and enjoyed this. The staff spoken to during the inspection and observations made confirmed that there were good relationships between the staff and the people living in the home. Staff are recruited and provided with training that ensures that they are suitable individuals to support the people living in the home. The people living in the home receive a varied diet and there are choices available at meal times. What has improved since the last inspection? Improvements have been made to the physical environment by replacing the flooring in the lounge and dining rooms. A new television and chairs have been purchased for the lounge and dining room to improve the facilities for the people living in the home. 2 Dimmingsdale Bank DS0000016927.V377191.R01.S.doc Version 5.2 Page 8 The people living in the home have decided to have a fish tank and fish to look after in the lounge area. This means they have been able to make choices and take responsibility for looking after them. Some bedrooms have been redecorated making them more personalised. A new boiler has been installed to ensure that there is sufficient hot water in the home at all times to ensure that the needs of the people can be met when and how they want. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. 2 Dimmingsdale Bank DS0000016927.V377191.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 2 Dimmingsdale Bank DS0000016927.V377191.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission process into the home ensures that people receive written information about what is available in the home. An assessment is carried out to ensure that peoples needs can be met and that they are able to visit the home on several occasions to ensure that the home is suited to them. EVIDENCE: The service user guide includes all the relevant and required information and is available in a format that is easy for the people living in the home to understand. The area manager confirmed that the organisation is still in the process of developing an audio and DVD format of the service user guide to ensure that it is suitable and appropriate and easy to understand for people living in the home. The people living in the home have lived there for several years and there are no vacancies. Therefore, the standard relating to assessment of peoples needs before they move in was not assessed. 2 Dimmingsdale Bank DS0000016927.V377191.R01.S.doc Version 5.2 Page 11 The AQAA stated and the area manager told us that the organisation had developed a new assessment process that would be used if anyone was to move into the home in the future. 2 Dimmingsdale Bank DS0000016927.V377191.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans provide the staff with the information they need to support the people living in the home. The people living in the home are involved in making decisions about their lives. EVIDENCE: During the inspection we case tracked two people living in the home. This means that we made observations about their care, looked at their care files, spoke to the staff, individuals and relatives where possible about their care. This helps us to decide if their needs are being met. The records of the two of the people living in the home we case tracked showed us that the care plans provided good details about their needs and how 2 Dimmingsdale Bank DS0000016927.V377191.R01.S.doc Version 5.2 Page 13 the staff were to assist the individuals to have these needs met. They included information about how much they could do for themselves and what staff needed to do to support this. The care plans included information about the individuals communication needs, personal care, mobility, oral and nutritional needs. The care plans were person centred and written from the point of view of the individual. There was evidence to show that individuals had been involved in the care plans indicating that people were able to direct their care. Alongside the care plans were risk assessments and most of these were in place. For one individual it was evident that a tissue viability assessment had been undertaken that identified the individual at risk of developing pressure ulcers. No management plan was found to be in place correlating to this assessment and staff stated that they had not seen one. The individuals needs had recently changed and it was important that the risk assessment was updated and a management plan put in place to ensure that any actions to prevent a pressure ulcer developing were put in place. Observations made during the inspection confirmed individuals involvement in their care as they were seen to be asked about who from the staff team on duty they wanted to support them and what they wanted to do during the day. We observed that one person sitting in a wheelchair needed their feet to be strapped to the footplates however, one of the straps were missing. This issue was raised with staff and we were told that it was broken however, later in the day the strap had been fitted to the footplate. Staff needed to be mindful of ensuring that equipment was used properly to ensure that unnecessary injuries did not occur. The AQAA stated that each person had monthly meetings with their key worker. Records sampled showed that these were generally taking place however, the forms were not always fully completed so it could not be determined whether the meeting had actually taken place or whether no activities had taken place during the month and whether they had been successful. Monthly meetings were being held with the people living in the home to discuss issues such as food, activities, holidays and fire safety. This showed that the people living in the home were involved in making decisions about the running of the home. We received 6 completed surveys from the people living in the home and they all said that they were happy with everything in the home. One of the completed relative surveys said: 2 Dimmingsdale Bank DS0000016927.V377191.R01.S.doc Version 5.2 Page 14 Good standard of care in respect of clients physical needs, food, cleanliness, clothes washing health and medication. Generally relaxed and friendly environment. Another relative said: What I have seen when I have visited X I have been very happy. He seems very contented there. 2 Dimmingsdale Bank DS0000016927.V377191.R01.S.doc Version 5.2 Page 15 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): This is what people staying in this care home experience: 12, 13, 15, 16 and 17 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home decide on and take part in activities that mean that they have meaningful lives. They are provided with a varied diet that enables them to choose what they eat. The records kept in the home do not always support that their needs have been fully met. EVIDENCE: The AQAA told us that 5 of the people living in the home attended day centres throughout the week where they developed their social skills, friendships and relationships with others. It also told us that people had gone on trips to safari parks, shopping malls, eating places, football grounds, swimming and to the cinema. Several of the people living in the home also attend the Kennedy 2 Dimmingsdale Bank DS0000016927.V377191.R01.S.doc Version 5.2 Page 16 House Club which enabled them to attend when they wanted rather than having rigid routines. The AQAA told us that within the home individuals were supported to attend theatres and access community facilities and to take part in activities such as exercise. Staff support individuals to go on holiday, day trips and visit families. There are activity plans in place for individuals living in the home and activity logs that should be completed to determine how successful the activity had been and whether it could be improved in any way. The activity logs were not always being completed so that a full picture could not be seen of what had been tried and whether it had been successful or not. Some of the comments we received in completed questionnaires were: Could have more social activities outside the home More opportunities for residents to participate in domestic activities, food and drink preparation, shopping Encourage more visitors/volunteers bringing activities into the home. We did observe one individual being involved by a member of staff to take some part in preparing a drink but this should be a regular occurrence as part of their daily routine, especially where individuals are in the house for all or most of the day. The home has a minibus that can be used for taking people out of the home but this is dependent on whether there are people with the ability to drive it being on duty. However, staff do support individuals to use public transport or taxis where necessary. In response to what the home could do better one of the completed surveys said: To have all staff available to drive the mini bus. Most times we have wanted him out for the day we arrange our transport. This was discussed with the area manager and it is a difficulty that the organisations grapples with as the ability to drive is not an essential requirement of being a support worker. The organisation may want to look into a shared driver for homes in the locality. There were regular meetings with the people living in the home for them to make decisions about activities and holidays and any other issues to be discussed such as fire safety. Minutes of these meetings indicated that although some matters had been acted on there were several that were carried forward for several months without any reason as to why they had not been 2 Dimmingsdale Bank DS0000016927.V377191.R01.S.doc Version 5.2 Page 17 achieved. This could mean that the people living in the home feel that they are not being listened to. Observations during the inspection indicated that the staff were very busy all the time and some staff commented on how tired they got. Some of the people living in the home have high and complex needs and would benefit from more one to one time however, the organisation had found it difficult to access this funding. This can mean that individuals do not have the one to one time that they would benefit from. The AQAA told us that all staff have received Eden Principles training. This is about involving people who live in long-term care homes to have more involvement with animals, plants and children. Studies have shown that this helps to reduce and eliminate the loneliness, helplessness and boredom that people can often experience. A pat the dog volunteer has been visiting the home as part of this programme. The people living in the home have since decided to have a fish tank and fish in the lounge which they will look after and take responsibility for. The area manager told us that although the Eden ethos is being developed within the organisation this needed to be further developed to ensure an holistic approach. Family and friends are able to visit the home when they want. The people living in the home are supported to keep in touch with family and friends via the telephone and by sending cards at special occasions. One relative told us that it was difficult to have private time with the personal living in the home as there was no facility on the ground floor where they could sit in private. The organisation has been looking at providing a facility such as a summer house or conservatory but the relative was concerned at the length of time this is taking. The menus in the home provide a variety of choices and ensure that dietary needs are met in respect of culture and medical needs. One of the individuals whose care we looked at needed to be supported quite closely with their nutritional intake. We saw that the individual was provided with thickened drinks, whole milk, dried milk and food supplements were available to increase calorie intake and foods were liquidised. The home did keep records of food and fluid intake and it is acknowledged that the individual has a number of medical problems. However, the food records were not always completed consistently and in sufficient detail to ensure that anyone assessing the individual could see how the food had been fortified and 2 Dimmingsdale Bank DS0000016927.V377191.R01.S.doc Version 5.2 Page 18 to determine that any loss or lack of gain in weight was down to an organic reason as opposed to not receiving a sufficiently high intake of calories. The records did not record snacks in between meals so that it appeared that snacks were not available in the home although the AQAA stated that they were. 2 Dimmingsdale Bank DS0000016927.V377191.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home are supported to have their personal care and health care needs met in a personalised way. The management of medicines could be improved to ensure that they were administered to the people living in the home in the way prescribed. EVIDENCE: Throughout the inspection good interactions were observed between the staff and the people living in the home. The people living in the home were addressed by their preferred names and were dressed appropriately to their age, weather and personal preferences. The privacy and dignity of the people living in the home was maintained during personal care as each person had an en suite facility in their bedroom. 2 Dimmingsdale Bank DS0000016927.V377191.R01.S.doc Version 5.2 Page 20 There are two bedrooms on the first floor and the two people living up stairs use a stair lift to access their bedrooms. The individuals need support from the staff to use the stair lift and they use the call system when they need assistance. There were assisted bathing facilities available where needed and the care plans identified the support that the individuals needed. The AQAA stated and the records we looked at showed that each person has a health action plan in place. This is a plan about what support the individual needs to stay healthy and identifies who is involved in their care. The records showed that the people living in the home were supported to have their health care needs met. There was evidence of the involvement of a variety of professionals being involved in meeting the health needs of the people living in the home. The home was keeping records of any bruises or injuries that were occurring so that any patterns could be identified and appropriate actions taken. The records showed that people who were responsible for administering medicines had had the appropriate training. The home uses a monitored dosage system for the management of medicines. The medication is stored in a locked cabinet on the first floor. The home does not have a medication trolley and this was discussed with the area manager. Two staff were seen to dispense and record that the medicines have been given and taken as required. Some people had liquid medicines only due to their needs. Protocols were in place for as and when required medicines to ensure that they were dispensed consistently by the staff. These protocols had been agreed with doctors. A photograph of the person for whom the medicines were intended was in place with the medication administration record (MAR). One of the MAR charts we looked at indicated that one of the medicines was to be given PRN, we were told that the individual would not have the capacity to say if it was needed or not, The instruction had been crossed out on MAR chart but it was not signed or dated, and the MAR stated that none had been supplied in that cycle. The medicine in the cupboard did not tally with the amounts carried forward and the tablets administered so it was not possible to determine that the individual was having their medicine as prescribed. For another individual who had been prescribed a food supplement the MAR chart did not evidence that they were being given as prescribed. We were told that there were no controlled medicines in the home and no antibiotics that needed to be stored in a fridge. Between the last and current inspection we have been informed of one instant when an individual did not get their prescribed medicine. The organisation 2 Dimmingsdale Bank DS0000016927.V377191.R01.S.doc Version 5.2 Page 21 investigated this matter and systems have been put in place to check the tablets given. 2 Dimmingsdale Bank DS0000016927.V377191.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home feel listened to and happy and are generally protected from harm. EVIDENCE: There is a complaints procedure in the home that is easy for the people living there to understand Following the last inspection some concerns were raised that one person living in the home was not receiving sufficient support to ensure that sufficient calories were being taken in. The issue was looked into by the organisation and the person raising the concerns was satisfied that there were other issues affecting the weight of this individual. However, at this inspection it was again noted that the daily food and fluid records for this individual were not being fully completed. This means that anyone looking at the records cannot make an informed decision as to whether any weight loss is due to an organic problem with the individuals health or because they are not receiving the required amount of calories. There has been a safeguarding alert raised by the home following the practice of an agency staff member and there were some concerns about one person falling in the home. These matters were appropriately raised by the 2 Dimmingsdale Bank DS0000016927.V377191.R01.S.doc Version 5.2 Page 23 organisation although in one case the manager did not pass on the information as soon as possible to the appropriate person. In this instant the individual was not put at any further risk however, the procedures in place should be followed by the manager who is in a position of setting a lead to the other staff in the home. The recruitment procedures ensure that only suitable people are employed to work in the home and that all the required recruitment checks are in place before they start their employment. There were some people who were being supported with the management of their monies. The management systems in place did not fully safeguard the individuals as in one case the records indicated that the cash card had not been booked back into the safe for a protracted period of time. However, the card was in the safe. Expired cash cards needed to be destroyed and a list of all items in safe keeping for individuals should be listed and kept safe. Receipts of the amounts of monies being withdrawn from the bank were not available at the time of the inspection so that it could not be determined that the manager was checking the amounts of monies being taking out with the amounts being brought into the home. Also the payments made by individuals for using the minibus from their mobility allowances were not able to be located during the inspection. Surveys completed by people living in the home suggested that they felt listened to and were happy in the home. 2 Dimmingsdale Bank DS0000016927.V377191.R01.S.doc Version 5.2 Page 24 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides the people living there with a homely, comfortable, clean and safe environment that meets their individual needs. EVIDENCE: The ground floor of the premises is open plan giving a clear space for people using wheelchairs to have sufficient room for moving around. The lounge and dining areas have had their flooring replaced since the last inspection. The television and dining room chairs have also been replaced. Furniture is of good quality and provides a homely environment. There is a fish tank in the lounge area that the people living in the home take part in maintaining. 2 Dimmingsdale Bank DS0000016927.V377191.R01.S.doc Version 5.2 Page 25 There are five bedrooms on the ground floor and two on the first floor. They all have en suite facilities and one has a bath that is suited to the individuals needs. There is a stair lift to help individuals with restricted mobility and a call system is in place to enable people to call for assistance when needed. One of the en suite facilities that we looked at was in need of upgrading. The area manager was aware of this and it was being planned. The bedrooms seen during the inspection were found to be pleasant, comfortable and a reflection of the occupants personal preferences. The AQAA stated that the people living in the home are consulted on changes of décor and furniture. The AQAA states that there is a shortage of private space for visitors and that they are waiting for a conservatory to be built. This has been discussed elsewhere in this report. The main office and laundry are located on the first floor of the home which means that they are not accessible to the majority of people living in the home. This issue has been raised in previous reports however, the structure of the home means that there is little scope for any changes. The home was clean and free from offensive odours. During the inspection it was noted that one person had not been able to have a bath due to a shortage of hot water. The area manager stated that there had been some problems with the boiler but the boiler had been replaced. On testing the hot water temperatures in two of the bedrooms it was noted that one was slightly hotter than the other but not excessively so that it was not a risk of scalding but the home needed to be mindful of ensuring that it did not increase. The hot water temperatures were checked on a regular basis. The kitchen was found to be clean and well stocked. There were some meats in the fridge and freezer that had been bought fresh but not dated on freezing and the use by dates on the packets had passed. These foods should be dated on freezing to ensure that the people living in the home are not affected by food that is unsafe for eating. 2 Dimmingsdale Bank DS0000016927.V377191.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home can be assured that they are supported by people who have the right skills and knowledge needed to assist them safely but would benefit from a more stable staff group who know them well. EVIDENCE: We were told and the staffing rotas showed that there were three members of staff on duty throughout the day and one waking night staff with one person on sleeping in duty. The home has some staff vacancies that means that 4 or 5 regular agency staff and a pool of bank staff are used to cover the rotas.. This means that the people living in the home do not have new people to get used to all the time. Staff undertake a multi tasking role involving supporting with care needs, cooking, undertaking activities and cleaning. This does mean that the time available to be spent with the people living in the home is limited. 2 Dimmingsdale Bank DS0000016927.V377191.R01.S.doc Version 5.2 Page 27 A comment made by one of the relatives was: We believe that Dimmingsdale Bank has a relatively high staff turnover which can be unsettling for the residents. Staff shortages have curtailed outside activities. Seldom are staff available to escort residents out. Shift times limit later evening outings. Staff are reluctant to take residents on holidays. We still await the long promised conservatory. No review meeting for X for some time 2 years. The AQAA confirmed that of the ten staff at the home only four have been at the home for more than 12 months. This high turnover of staff can be upsetting for the people living in the home. Around 50 of the staff team had achieved National Vocational Qualification (NVQ) to level 2 or above and there was a cross section of cultures reflected within the staff group ensuring that there were staff in the home with the knowledge, skills and backgrounds to care for the people living in the home. The area manager told us that shift times are flexible to be able to take people out in the evenings if individuals want to go out. As stated earlier there were good relationships observed between the staff and the people living in the home. From discussions with the staff it was noted that the staff were well aware of the needs of the people they cared for. A recent recruitment drive had resulted in the appointment of two staff and more staff were waiting to take up their posts. This would mean that the home was fully staffed and this should lead to some stability in the staff team so that the people living their can be assured that they know the people who will be helping them and with whom they can develop relationships. Staff told us that there was plenty of training available for them and that the manager was supportive. The training matrix showed that there were regular updates on training needed to ensure that the people living in the home were safe. The organisation was in the process of organising training for staff about the specific needs of the people living in the home. We looked at the files of three staff and this showed us that the recruitment process ensured that only suitable people were employed to work at the home. The AQAA told us that people using the service were involved in the recruitment process when staff were being employed. This shows that the people living in the home can have a say in who is employed to assist them. 2 Dimmingsdale Bank DS0000016927.V377191.R01.S.doc Version 5.2 Page 28 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements ensure that the home is run to benefit the people living there. Policies and procedures are not always followed completely and as such do not fully promote the protection of the people living in the home. EVIDENCE: The registered manager was not present during this inspection. The area manager, deputy manager and staff in the home assisted us during the inspection. 2 Dimmingsdale Bank DS0000016927.V377191.R01.S.doc Version 5.2 Page 29 We were told that the registered manager was in the process of completing the Registered Managers Award. This will ensure she has the skills and knowledge to run the home for the benefit of the people living there. At the time of the last inspection a deputy manager was being appointed however, that individual was no longer in post. Another deputy manager had been recruited during the few weeks before this inspection. This will mean that the manager will have someone to support her and the staff in providing good care to the people living in the home. The AQAA stated there were regular monthly team meetings during which there is information sharing, discussions about the people living in the home and some training undertaken. The available minutes of these meetings showed that they were happening on a regular basis but not always on a monthly basis. Issues such as key working and recordings were discussed. The area manager told us that there was a Quality Assurance system in place but the organisation was in the process of developing this further. The AQAA told us that the organisation was developing the QA system and were going to involve and consult the people living in the home, families, friends and advocates and develop an action plan which included an improvement plan to develop and direct the service in line with customer and stakeholder view. Monthly visits by a representative of the organisation are carried out however the records did not show that these were happening on a monthly basis. The equipment used in the home is maintained on a regular basis to ensure that it is safe for use. Fire records showed that staff test the fire equipment regularly to make sure is it is in good working order. Fridge and freezer temperatures were checked on a regular to ensure that food is stored at the correct temperatures so that it is not spoilt and becomes dangerous to eat. We found some chops and fish in the freezer that had been bought in fresh and frozen however the date on which the food was frozen was not recorded on them. The use by date on these foods had passed and it could not be guaranteed that this food was safe to eat. In addition, in the fridge there was some bacon that did not have a use by date on it as it was probably part of a multi pack and the date had been removed with the other pack. The issue was also highlighted at the time of the last inspection. There are numerous policies and procedures in place to ensure that the needs of the people living in the home are met and they are kept safe from harm. During this inspection we found that these were not always complied with fully that could mean that the people living in the home were not fully safeguarded. Examples of this are the systems in place for supporting the people living in the home with their finances, the recording of the food and drinks taken by the people living in the home, completion of activity and learning logs and the passing on of information about safeguarding issues as soon as possible. 2 Dimmingsdale Bank DS0000016927.V377191.R01.S.doc Version 5.2 Page 30 2 Dimmingsdale Bank DS0000016927.V377191.R01.S.doc Version 5.2 Page 31 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 X 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 2 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 2 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 X 3 X X 2 X Version 5.2 Page 32 2 Dimmingsdale Bank DS0000016927.V377191.R01.S.doc 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. 1. Refer to Standard YA6 Good Practice Recommendations Staff should ensure that where the needs of the people living in the home have changed the individual plans and risk assessments are updated as soon as possible to prevent the individual being exposed to unnecessary harm. Staff should ensure that all steps are taken to ensure that the people living in the home are not exposed to unnecessary risks. There should be more emphasis on encouraging the people living in the home to be as independent as possible. This will ensure that the people living in the home develop to their full potential. The manager should ensure that where activities requested by the people living in the home have not been arranged as agreed feedback is given as to the reasons why. This will ensure that the people living in the home can be assured that they are listened to. The manager should ensure that the food records are fully completed so that the nutritional intake of the people living DS0000016927.V377191.R01.S.doc Version 5.2 Page 33 2. YA9 3. YA11 4. YA12 5. YA17 2 Dimmingsdale Bank 6. YA20 in the home can be assessed accurately. The manager should ensure that any changes to prescribing instructions on MAR charts should be dated and have a double signature to ensure the changed instructions are correct. Food supplements should be recorded on the MAR charts when given. This will ensure that the people living in the home get their medicines as prescribed. 7. YA22 The manager should ensure that any safeguarding referrals are passed on as soon as practical. The manager should ensure that the financial procedures are followed ensuring all documentation is easily accessed. This will ensure that the people living in the home are safeguarded. The en suite facility in the bedroom sampled should be refurbished as soon as possible. This will ensure that the environment is comfortable and welcoming for the people living in the home. The organisation should review the communal space for the people living there and the lack of a private area for people to meet relatives/ friends other than their bedrooms. Foods should be dated on freezing or used by the use by date. This will ensure that food eaten by the people living in the home is safe for consumption. Where water temperatures exceed 43 degrees centigrade staff should report these to the maintenance team to ensure that the people living there are not at risk of being scalded. 8. YA24 9. YA28 10. 11. YA30 YA42 2 Dimmingsdale Bank DS0000016927.V377191.R01.S.doc Version 5.2 Page 34 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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