Care Home: Dale Mount Residential Home

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What the care home does well Residents receive support in moving about the premises either independently or with help. There are several areas where residents can meet visitors in private. Resident`s relatives and friends are welcome to visit. According to residents and staff, good food and meals are provided. Residents have a considerable area to walk around which is particularly helpful for people with dementia. What has improved since the last inspection? Progress was made in improving the way care staff recorded their observations about the health and disposition of residents. The manager has increased the number of recorded one-to-one staff development meetings as one way of helping staff to reflect on their practice. Emphasis is continuing to be placed of substantive staff training to meet the high support needs of residents. The manager has improved the induction procedure by bringing it into line with the requirements of the relevant care sector organisation, Skills for Care. What the care home could do better: As stated in the AQAA (annual quality assurance assessment), the quality of written pre-admission information is being improved. An application has been made to achieve registration of a manager with the commission. Individual care plans are being improved. Residents should receive the levels of mental and physical stimulation they need. The environment, including the elimination of unacceptable odours, must be maintained at all times. CARE HOMES FOR OLDER PEOPLE Dale Mount Residential Home Dale Road Southfleet Gravesend Kent DA13 9NX Lead Inspector Eamonn Kelly Unannounced Inspection 11:30 19 February 2008 th 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 Dale Mount Residential Home DS0000023934.V359285.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. Dale Mount Residential Home DS0000023934.V359285.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dale Mount Residential Home Address Dale Road Southfleet Gravesend Kent DA13 9NX 01474 834877 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) roz.kelly@njch.co.uk Nicholas James Care Homes Ltd Vacant Care Home 13 Category(ies) of Dementia - over 65 years of age (13) registration, with number of places Dale Mount Residential Home DS0000023934.V359285.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st January 2007 Brief Description of the Service: This residential home provides support and accommodation for up to 13 older people who have dementia. Miss Rosalyn Kelly also manages Dale Lodge residential premises that are on the same grounds. These premises support up to 20 older people with dementia. Many facilities and procedures are shared between both premises. Bedrooms (9 single, 2 shared) are on the ground and first floors. There is no stair or passenger lift. Staffing arrangements, cooking of main meals and most administration matters are conducted from Dale Lodge. The 2nd floor of Dale Mount is currently used by about 5 staff from the provider organisation for administration and income collection for the owner’s homes (about 14). Weekly fees are as follows: 1. Local Authority funded clients: £427 (plus “top-ups” payable by individual residents or their supporters) and 2. Privately funded clients: £500. Residents are additionally charged for hairdressing, newspapers, personal requisites, phone costs, clothing, optician costs where applicable, and medications other than those obtained by prescription. Residents must pay for journeys including hospital visits where a member of staff accompanies them (the personal contract says this fee is agreed before the visit takes place). Dale Mount Residential Home DS0000023934.V359285.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection on 19th and 21st February 2008 consisted of meeting with the manager (Rosalyn Kelly), members of staff, residents and visitors. The report concentrates on the care and support in place for residents. Meetings with members of staff, residents and visitors served to give a broad understanding of how resident’s current and changing needs are addressed. The previous inspection report asked for a number of issues to be addressed within timescales shown in the report. Progress has been made in addressing the requirements contained in that report. We received a completed AQAA (annual quality assurance self-assessment) from the service. This was helpful in completing this report. This report contains no requirements. The manager is implementing an improved care planning procedure. There has been improvement in the quality of recording of staff observations of resident’s health and well being during the day and night. The quality rating for this service is 2 Star. This means that people who use the service experience good quality outcomes. What the service does well: What has improved since the last inspection? Progress was made in improving the way care staff recorded their observations about the health and disposition of residents. The manager has increased the number of recorded one-to-one staff development meetings as one way of helping staff to reflect on their practice. Emphasis is continuing to be placed of substantive staff training to meet the high support needs of residents. The manager has improved the induction procedure by bringing it into line with the requirements of the relevant care sector organisation, Skills for Care. Dale Mount Residential Home DS0000023934.V359285.R01.S.doc Version 5.2 Page 6 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. Dale Mount Residential Home DS0000023934.V359285.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 Dale Mount Residential Home DS0000023934.V359285.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, 2, 3, 6. People who use the service experience good quality outcomes. This judgement was made using a range of evidence including a visit to the service. Prospective residents and their representatives are encouraged to visit the premises to see if their support needs are likely to be met. The manager and staff give them the information they need to make a decision about entering residential care. EVIDENCE: The manager carries out all pre-admission assessments. This involves visiting prospective residents in hospital or other locations, meeting with relatives and discussions with health service and care staff. Prospective residents receive information written information to help them make a decision about taking up residential accommodation. The current written pre-admission information is not clear and accurate enough so as to be of optimum assistance to prospective residents and their supporters. The AQAA (annual quality assurance assessment) refers to improvements being made to Dale Mount Residential Home DS0000023934.V359285.R01.S.doc Version 5.2 Page 9 written pre-admission information available to prospective residents and their supporters. Residents receive a personal contract to help them understand the rights and responsibilities of both parties. Fees and charges for residents are as shown earlier in this report. Where residents are local authority funded, care managers provide an outline of the client’s current circumstances and local authority expectations. These and, and in the case of privately funded residents, initial assessments by the manager are used in preparing individual care plans. The service does not provide recuperative support for former hospital patients. Dale Mount Residential Home DS0000023934.V359285.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): 7-11. People who use the service experience good quality outcomes. This judgement was made using a range of evidence including a visit to the service. Resident’s health, personal and social care needs are being met. EVIDENCE: The manager carries out pre-admission assessments for all potential residents. This involves preparation of an individual care plan at this stage including where people are admitted for short periods of respite care. In examples discussed, the specific needs of new residents are identified and recorded and, as the needs of residents change or become better known, individual goals of care are allocated. There has been improvement in the quality of recording of staff observations of resident’s health and well being during the day and night. The manager is working on a new care planning and recording procedure based on an Alzheimer Society model. This is likely to provide a suitable vehicle for members of staff and will complement their experience and qualification in dementia care and support. Dale Mount Residential Home DS0000023934.V359285.R01.S.doc Version 5.2 Page 11 Members of staff maintain a weight chart for each resident. The chair scales are kept at Dale Lodge; these scales are checked and left to stabilise overnight after transfer between premises to give confidence that recorded weights are accurate. Nutritional charts are raised automatically for residents with diabetes and following review for those with significant weight loss or gain. Residents have routine access to healthcare and social care provision. In addition to GP and district nurse involvement (by a number of practices), a dentist and optician regularly visit both premises. There is also contact in individual cases with community psycho-geriatrician services. The system for administering and storing medication has been recently reviewed and some changes were made to help avoid administration errors. Medicines are securely stored and all administrations are recorded in MAR sheets. Residents are treated with understanding and respect by staff. Members of staff have experience in helping people who are seriously ill and those who are receiving terminal care. The AQAA (annual quality assurance assessment) refers to consideration being given to the need for a passenger lift. We noted an example of good practice where a resident moved to a ground floor bedroom when severe mobility problems occurred and a new personal contract was due to be issued. Dale Mount Residential Home DS0000023934.V359285.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): 12-15. People who use the service experience good quality outcomes. This judgement was made using a range of evidence including a visit to the service. Residents receive support to keep physically and mentally active and they would benefit from additional support. EVIDENCE: An activities co-ordinator visits Dale Mount and Dale Lodge respectively on 2 afternoons a week. The previous inspection report requested improvement in this important area of resident support. The commission has been advised that the activities co-ordinator has other commitments and cannot provide the additional time needed. The service advises the commission that “staff encourage activities of everyday living so that people maintain their everyday skills for as long as possible. You will often see people at Dale Mount involved in activities of daily living. Some help with folding napkins, washing dishes etc”….”Most of our residents also go out with their own families”. A carer works as a private hairdresser at both premises when not on the staffing rota as a carer. Dale Mount Residential Home DS0000023934.V359285.R01.S.doc Version 5.2 Page 13 Food is transported in two boxes from Dale Lodge. It is plated up in the kitchenette at Dale Mount. The AQAA contains good reflection of the difficulties in helping residents with dementia to eat. The manager has obtained advice from the Alzheimer’s Society and other sources. She outlines how carers try to encourage clients to eat well. In the afternoons, carers take a fruit platter to residents with different fruits cut into manageable portions for them to choose and eat independently. Carers have observed how residents react to this and they believe residents find the exercise enjoyable. We know that the cook is aware of the need for residents to receive good food and makes every effort to meet the manager’s directions in this regard. Weight charts and nutritional assessments are maintained. Dale Mount Residential Home DS0000023934.V359285.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. People who use the service experience good quality outcomes. This judgement was made using a range of evidence including a visit to the service. Residents are protected from abusive practices. Good recruitment and training procedures are in place for the protection of residents. EVIDENCE: We are not aware of any significant complaints about the service in the past year. People connected to the service are encouraged to make their views known to the manager and members of staff and note is taken of these comments or views. Written surveys are also used for this purpose. The service has a complaints procedure. The manager is updating policies and procedures for safeguarding people and these are readily available for staff. Members of staff receive Safeguarding Adults training. The manager advises social services and the commission of issues affecting resident’s health and well being. Staff files indicate that references are taken up and members of staff now receive induction that meets the requirements of the relevant care-sector organisation (Skills for Care). Some improvement is needed in the way references are obtained (see section on staffing). The AQAA (annual quality assurance self-assessment) indicates that the manager plans to provide staff with training on working with residents with Dale Mount Residential Home DS0000023934.V359285.R01.S.doc Version 5.2 Page 15 challenging behaviours to enable staff to work confidently and effectively when problems and new situations arise. Dale Mount Residential Home DS0000023934.V359285.R01.S.doc Version 5.2 Page 16 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, 24, 26. People who use the service experience good quality outcomes. This judgement was made using a range of evidence including a visit to the service. Residents have the benefit of premises that meet their accommodation and support needs. EVIDENCE: The premises have 9 single and 2 shared bedrooms on ground and first floors. There is no stair or shaft lift. Five bedrooms (one of which is shared) are on the ground floor. Handrails have been fitted throughout the premises for residents’ safety. The ground floor bathroom has recently been refurbished. There is new lounge furniture and some parts of the premises have been re-painted. The AQAA suggests further redecoration is imminent. Dale Mount Residential Home DS0000023934.V359285.R01.S.doc Version 5.2 Page 17 The home is mainly administered from Dale Lodge. This includes the cooking of meals at Dale Lodge and transportation around the central green to Dale Mount. The chair scales are used at both premises but procedures are followed to make sure that it remains properly calibrated following temporary transfers. Some five external administrators employed by the owner have the use of the second floor. Where a problem was identified during the inspection in one particular area of the premises, the manager undertook to ensure that the persistent odours are immediately controlled. Soluble red bags are used for soiled clothes to prevent the spread of infection. Both premises have contracts for removal of clinical waste and for pest control. In at least one area of the premises TV reception was poor. Members of staff recognise that it is important for residents to have access to perfect TV reception in their bedrooms. Steps are being taken to ensure that all TV’s receive good reception. Lounge areas are comfortable as is the dining room. An advantage of the premises is that residents are able to walk around a large area, useful particularly for residents with dementia. The surrounding gardens are suitable for use by frail older people under supervision. The AQAA indicates an imminent intention to obtain new garden furniture. Dale Mount Residential Home DS0000023934.V359285.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): 27-30. People who use the service experience good quality outcomes. This judgement was made using a range of evidence including a visit to the service. Recruitment, selection and training procedures contribute to the support and protection of residents. Members of staff are well trained and are encouraged to achieve qualifications pertinent to the support needs of residents with dementia and other significant health challenges. EVIDENCE: Two members of staff (one awake and one asleep) are on duty at night. Two members of staff (awake) are on duty at night at Dale Lodge. During the inspection visit, 3 carers were on duty at Dale Lodge in the afternoon. Two were on duty at Dale Mount. The manager advised the commission that current staff numbers are deemed sufficient for the support of residents. The manager has a deputy manager in place at both residential premises on the site. Recruitment procedures include the requirement for detailed application forms and checking of these, taking up of references, probationary periods, and enhanced CRB checks. The AQAA refers to the improvements being made to bring the induction procedure into line with “Skills for Care” standards. The manager also says that better formal supervision is leading to improved levels of support and guidance for staff in addition to day-to-day contact in addressing operational issues that arise. The manager is also improving the way references are obtained. Dale Mount Residential Home DS0000023934.V359285.R01.S.doc Version 5.2 Page 19 A list of all staff including administrative staff working for NMCH Ltd on the 2nd floor showing details of dates/reference numbers of CRB checks was not available. The manager is not aware if external NMCH staff have CRB checks and has undertaken to confirm that they have. Most carers have achieved NVQ Level 2 and/or 3 in Care. The manager has developed and is maintaining contacts within, in particular, Orpington and Bexley colleges to avail of qualification courses they offer at different times. Members of staff say that they have benefited from participation on the Certificate in Dementia Care. Also they referred to the in-depth knowledge they are receiving through work on NCFE and RVQ certificated courses. The manager is maintaining a balance between enabling staff to benefit from achieving qualifications via RVQ and NCFE programmes and attendance on short training sessions in mandatory topics. There is evidence that this good staff development procedure benefits staff and enables them to gain in-depth knowledge in specific areas of expertise. Dale Mount Residential Home DS0000023934.V359285.R01.S.doc Version 5.2 Page 20 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. People who use the service experience good quality outcomes. This judgement was made using a range of evidence including a visit to the service. Residents have the benefit of living in an environment that is well managed. EVIDENCE: The commission temporarily accepted a request some 18 months ago from NJCH Ltd. to allow one person to manage both Dale Lodge and Dale Mount subject to conditions. The current position is that both homes operate as one entity and we might formally recognise this reality subject to confirmation that the conditions are being met. Meals are prepared at Dale Lodge and transported by staff to Dale Mount. Both premises are registered to admit people with dementia. Recruitment and staffing procedures are common to both premises. Some operational files for both premises are retained at Dale Lodge. The chair weighing scales is transported between the premises when necessary. Dale Mount Residential Home DS0000023934.V359285.R01.S.doc Version 5.2 Page 21 Progress has not been made by NJCH Ltd. following the informal agreement referred to above. Options regarding registration are either a single registration for both premises or for each home to be separately registered and managed. If the intention is to seek a variation to the home’s registration for the premises to be managed by the manager of Dale Lodge, we need confirmation that the necessary building blocks are in place to achieve the necessary outcomes for residents and staff. These include job descriptions and contracts for the deputy managers including, for example, agreement on the supernumerary hours available to them for management and supervisory work. The current levels of supernumerary hours are unlikely to be sufficient. The deputy manager for one of the premises has not been available for several months. The individual deputy managers are experienced in supporting people who have dementia and have achieved relevant NCFE and RVQ qualifications. The manager has experience in the provision of residential support for older people since the early 90’s and, in that time, has been the manager of one and then both residential homes on the site. She has completed the Registered Manager’s Award, Certificate in Dementia care and other relevant NCFE and RVF training awards. The AQAA contains a declaration that the necessary safety checks and associated certificates are in place and are updated at the required times. This includes a fire safety assessment, fire safety checks and portable appliance tests. The manager is making good progress in maintaining procedures that are suitable for the support of people with dementia. This report refers to examples of this progress. There are systems to monitor staff adherence to policies and procedures during their practice. These procedures are complemented by support in obtaining relevant qualifications as well as knowledge/skills obtained from short training sessions delivered from internal and external sources. There is evidence of operational monitoring by representatives of the owner. Records are of a good standard and are routinely completed and updated. This part of NJCH Ltd. has access to professional business and financial advice and has the necessary insurance cover to enable it to fulfil any loss or legal liabilities. Information, for example, about insurance for resident’s possessions is contained in personal contracts. Residents who cannot manage their own financial or legal affairs are helped to obtain independent advice. Dale Mount Residential Home DS0000023934.V359285.R01.S.doc Version 5.2 Page 22 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 2 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x 3 x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x x 3 Dale Mount Residential Home DS0000023934.V359285.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Dale Mount Residential Home DS0000023934.V359285.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone 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 Dale Mount Residential Home DS0000023934.V359285.R01.S.doc Version 5.2 Page 25 - 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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