Care Home: Dalling House

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What the care home does well The health needs of residents are well met with evidence of good multi disciplinary working taking place. Staff provide personal support to residents in such a way that promotes and protects resident`s privacy and dignity. Resident`s benefit from a well planned activities calendar that is both stimulating and meaningful and arranged according to their choice. Residents experience mealtimes that are unhurried, whilst all meals are home cooked with an alternative option being available for each mealtime. Resident`s can be assured that there is an efficient complaints procedure in place and that the homes processes and staff training should protect residents in the event of an allegation of abuse. The location and layout of the home are suitable for its stated purpose. Most areas of the home are accessible to residents. Resident`s experience the benefits of a staff team that have the necessary skills and experience to the meet their needs. Staff training is on going and is appropriate to the level of needs of current resident`s. The management and administration of the home is good, with evidence of consideration being given to resident`s and/or relatives opinion at all times. What has improved since the last inspection? The Statement of Purpose and Service User Guide had been amended to reflect the management team following the previous inspection. Improvements have been made the home`s Terms and Conditions of Residence Agreement in order to be in full compliance with all the elements of National Minimum Standard 2. The home has improved the Pre Admission Assessment process in order to ensure that it is able to demonstrate that it has the capacity and authority to meet the assessed needs (including specialist needs) of resident`s. Copies of all funding authorities` multi-disciplinary adult protection protocols have been obtained, in order to ensure that there is a timely and co-ordinated approach, should any instance of abuse ever occur. The suitability of bath seats has been reviewed, ensuring that any risks to resident`s has been reduced/eliminated. All WCs (communal and en-suite) have been deep cleaned and the use of bar soap and fabric towels in communal facilities has been discontinued, in order to reduce/eliminate the risk of spread of infection. In order to protect the health, safety and welfare of resident`s and staff, the practice of wedging open of doors has discontinued and Dorguards have been fitted. Portable cash tins are no longer stored in resident`s bedrooms and are maintained in the homes safe, reducing the risk of resident`s monies being lost or stolen. A copy of the latest Environmental Health Officer (EHO) report has been submitted to the CSCI and it has been confirmed that the home`s washing machine does not have a sluice or disinfecting cycle but that suitable provisions have been made for sluicing/disinfecting soiled items, in accordance with EHO advice and recommendations. The home has installed a shower so that residents have a choice about their bathing preferences. CARE HOMES FOR OLDER PEOPLE Dalling House Croft Road Crowborough East Sussex TN6 1HA Lead Inspector Rebecca Shewan Unannounced Inspection 13th May 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Dalling House DS0000021085.V363565.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. Dalling House DS0000021085.V363565.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dalling House Address Croft Road Crowborough East Sussex TN6 1HA 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) 01892 662917 Aspenglade Limited Vacant Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Dalling House DS0000021085.V363565.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users to be accommodated is twenty one (21). Service users must be older people aged sixty-five (65) years or over on admission. 4th June 2007 Date of last inspection Brief Description of the Service: Dalling House is close to Crowborough town centre, within walking distance of shops, churches and buses. The home is registered for twenty one (21) older people. Seventeen single and two double bedrooms, many with en suite facilities, are situated on three floors and are served by a passenger lift. There is a through dining room and lounge with a sunroom that looks out onto a well- maintained rear garden, with a water feature. There are grab rails placed throughout the home in areas where residents may require some assistance with mobilisation. The range of weekly fees is £450.00 - £525.00. There are additional fees for Hairdressing (£5 basic cut), Chiropody (£16 per session), Transport for external appointments (£25.00), Newspapers/magazines and dry cleaning (prices vary). This information was provided to the CSCI on the 18th May 2008. Potential new service users can obtain information relating to the home by word of mouth, CSCI inspection reports, placing authorities, and Social Workers/Care Managers. Dalling House DS0000021085.V363565.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced inspection took place during the morning of the 13th and 18th May 2008. The Annual Quality assurance assessment (AQAA), incident reports and previous inspection reports, held by the Commission for Social Care Inspection, were read before the inspection. The inspection of the home took six and a quarter hours. Records such as care plans, staff files and medication records were also viewed. Seventeen service users (known as residents) were accommodated at the home at the time of the inspection. A tour of the whole home was undertaken and the Appointed Manager, three staff and two residents were spoken with. The CSCI also conducted Service User and staff surveys. Of which four surveys from service users surveys were returned. The responses from the surveys received were positive in all areas relating to the home and the care provided. Comments received included: ‘‘I feel at home not like I live in a home!’ ‘I would like to go on more outings.’ ‘‘I can honestly say that I will never move from here!’ NB: Elements of this report include the findings of a thematic inspection. A thematic inspection is a short, focused inspection that looks in detail at a specific theme. This inspection looked at the quality of care people with dementia experience when living in care homes, looking at ‘Safeguarding’ as an important part of people’s quality of life. The findings of this thematic inspection will be used as part of a wider investigation that we are doing, about the quality of care that people with dementia experience. This report will be published in 2008. Further information on this, and thematic inspections can be found on our website www.csci.org.uk. Overall, the inspection showed that the homes policies, procedures and staff training in Safeguarding Adults should protect the people who use the service. The home also had good written information to make sure that staff understand how to do their jobs properly in the event of an allegation of abuse being made. Dalling House DS0000021085.V363565.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The Statement of Purpose and Service User Guide had been amended to reflect the management team following the previous inspection. Improvements have been made the home’s Terms and Conditions of Residence Agreement in order to be in full compliance with all the elements of National Minimum Standard 2. The home has improved the Pre Admission Assessment process in order to ensure that it is able to demonstrate that it has the capacity and authority to meet the assessed needs (including specialist needs) of residents. Copies of all funding authorities’ multi-disciplinary adult protection protocols have been obtained, in order to ensure that there is a timely and co-ordinated approach, should any instance of abuse ever occur. The suitability of bath seats has been reviewed, ensuring that any risks to residents has been reduced/eliminated. All WCs (communal and en-suite) have been deep cleaned and the use of bar soap and fabric towels in communal facilities has been discontinued, in order to reduce/eliminate the risk of spread of infection. Dalling House DS0000021085.V363565.R01.S.doc Version 5.2 Page 7 In order to protect the health, safety and welfare of residents and staff, the practice of wedging open of doors has discontinued and Dorguards have been fitted. Portable cash tins are no longer stored in residents bedrooms and are maintained in the homes safe, reducing the risk of residents monies being lost or stolen. A copy of the latest Environmental Health Officer (EHO) report has been submitted to the CSCI and it has been confirmed that the home’s washing machine does not have a sluice or disinfecting cycle but that suitable provisions have been made for sluicing/disinfecting soiled items, in accordance with EHO advice and recommendations. The home has installed a shower so that residents have a choice about their bathing preferences. What they could do better: It is required that the Statement of Purpose and Service User Guide be reviewed and amended to reflect the change of the management team, in the last six months, in order to ensure that new and existing residents are in receipt of the correct information. Care plans require some amendments to ensure that residents are involved in the care planning formulation and review processes. Care plans also need to be reviewed on a consistent monthly basis, to determine that residents changing needs are addressed in an appropriate and timely manner. Risk assessments are also required for residents who have visual impairments and require staff assistance with meeting their needs. Self medicating risk assessments also need to be implemented for residents who administer their own prescribed creams/lotions. Such risk assessments require consistent monthly reviews to determine that any changes are highlighted and addressed, as appropriate. Staff recruitment procedures need to be robust and new staff must not commence employment until all satisfactory recruitment checks have been conducted, to ensure that residents are not put at risk of harm. All Control Of Substances Hazardous to Health (C.O.S.H.H) products are to be stored in accordance with the C.O.S.H.H Regulations, in order to ensure that the health and safety of both staff and residents is protected at all times. Recommendations for good practise have also been made in that daily records should be recorded in a time specific manner, the home should have ready access to the Royal Pharmaceutical Society Guidance on the administration and storage of medication, the access to rear garden should be assessed regarding the restriction incurred by the level change, a Loop system should be considered in TV rooms for use by residents with hearing aids and the safety Dalling House DS0000021085.V363565.R01.S.doc Version 5.2 Page 8 of the gradient up to front entrance from the road should be risk assessed for residents who use wheelchairs or mobility aids. 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. Dalling House DS0000021085.V363565.R01.S.doc Version 5.2 Page 9 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 Dalling House DS0000021085.V363565.R01.S.doc Version 5.2 Page 10 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 in this area. This judgement has been made using available evidence including a visit to this service. Potential new residents partially benefit from receiving relevant information, which is made available to them prior to admission, though this is in need of updating to reflect the current management team. The processes in place for ensuring that suitable Pre Admission Assessments are conducted is good, with services being offered to only those service users whose needs can be met. EVIDENCE: Following the key unannounced inspection of June 2007, the Registered Providers have made improvements to ensure that the statement of purpose be reviewed and amended, in accordance with Schedule 1. The Statement of Purpose and Service User Guide were viewed and these were noted to reflect the management team following the previous inspection. In the past six months there has been further changes to the management and this has not Dalling House DS0000021085.V363565.R01.S.doc Version 5.2 Page 11 been reflected by amending and updating both these documents. Therefore a Statutory Requirement has been made. Since the key unannounced inspection of June 2007, the Registered Providers have made improvements to ensure that the home’s Terms and Conditions of Residence Agreement should be amended to obtain full compliance with all the elements of standard 2. A newly admitted residents contract was viewed and this was found to be comprehensive and covered all aspects of this National Minimum Standard. Following the key unannounced inspection of June 2007, the Appointed Manager has made improvements to ensure that the home is able to demonstrate that it has the capacity and authority to meet the assessed needs (including specialist needs) of service users. The Appointed Manager conducts pre- admission assessments. Copies of care management assessments from the placing authority are also obtained, where these exist. The Appointed Manager addresses any issues, which are highlighted within this assessment. Documented records are maintained of all correspondence with the placing authority. Records inspected showed that pre- admission assessments are carried out on all new and potential service users. Intermediate care is not offered by this home. Dalling House DS0000021085.V363565.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are offered a good provision of health care and personal support by the home. Care plans require some improvement to ensure that residents needs and limitations are recorded appropriately and should also be reviewed consistently. Residents should be involved in the care planning processes. All care is administered in way that protects residents privacy and dignity. Medication procedures ensure that all necessary precautions are taken to ensure errors do not occur and that medications are stored and administered safely. EVIDENCE: Care plans were sampled and it was evidenced that they were comprehensive and detailed in content. It was observed that there was no evidence to support that residents are involved in the care planning formation and review processes. 75 of care plans sampled showed that monthly reviews are undertaken, therefore a shortfall in consistent care plan reviewing processes Dalling House DS0000021085.V363565.R01.S.doc Version 5.2 Page 13 was highlighted. Care plans include risk assessments that are comprehensive for most residents. It was observed that there were no risk assessments in place that detail the limitations of residents who are Registered Blind. Risk assessments also do not have a monthly review, which occurs in accordance with the general care plan review. Therefore Requirements have been made. Daily care records were also viewed and these were found to be written in accordance with residents care needs. There is a need however, for entries to be made in a time specific manner, as opposed to ‘am’, ‘pm’ and ‘night’. Therefore a Recommendation has been made. From the records sampled and surveys received, it was evidenced that the health needs of residents are well met with evidence of good multi disciplinary working taking place, on a required basis. Residents are registered with a GP from one of three local surgeries. Local residents are encouraged to maintain their own GP. GP visits to the home are arranged in order to review residents. Residents are also encouraged to attend appointments where able. Chiropodist visits the home 6 weekly and on an as required basis, whilst two residents attend the specialist foot clinic at the local hospital. Speech and Language Therapist, Physiotherapy and Occupational Therapy are arranged via the District Nurse team. District Nurses attend the home twice daily at present though this can be increased or decreased according to residents needs. The District Nurse team also provide training in pressure area care, diabetes, epilepsy and other health related issues. Residents access the NHS dentist via Tunbridge Wells Hospital. Private dentists are also sourced locally. Audiology and optician referrals are made via the GP and access to the private hearing clinic is also available. The Stoma Nurse attends the home to review those residents that require Stoma Care and also provides training to staff. The home has good procedures in place for the monitoring and recording of all drugs administered, disposed of and those entering and leaving the home. The stores for medication were viewed and these were found to be maintained in a clean and orderly manner. Medication administration records were viewed and these were found to be maintained appropriately. Staff training in medication is conducted as part of the Induction process, refresher training is also provided. Staff records viewed confirmed this. Some residents currently self administer prescribed creams/lotions. There were no self medicating risk assessments in place for these residents. A copy of the Royal Pharmaceutical Society Guidance on the administration and storage of medication, should be readily available to staff who administer medication. Therefore recommendations for good practice have been made. Staff were observed providing personal support to service users in such a way that promoted and protected residents privacy and dignity. Dalling House DS0000021085.V363565.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. The home provides a wide range of social, cultural and recreational facilities, with resident’s choice and wishes being respected. EVIDENCE: There is a published list of activities, which details that activities are arranged Monday to Saturday (morning and afternoon). The Appointed Manager stated that Sunday is kept free to allow residents to have a rest day. Activities include: Bingo, Skittles, Knitting club, movement to music, visiting pantomimes, reminiscence, sing a longs, motivation and pat dogs. There are some residents who users attend the local ‘Darby and Jones’ Club. ‘Care at Home’ services attend the home to conduct 1:1 activities for residents with dementia. Residents spoken with said that they attend activities at a level of their choosing. A ‘Residents Fund’ has recently been implemented to encourage funding for external activities, which currently do not take place on a regular basis. Though there are some planned outings for the future. Dalling House DS0000021085.V363565.R01.S.doc Version 5.2 Page 15 Holy Communion is held bi monthly. Religious festivals are celebrated. Roman Catholic mass and confessional are also provided. Discussions with the Assistant Manager highlighted that although the current residents had similar religious beliefs, the home would welcome any potential new resident who has special cultural/religious/spiritual beliefs and would make provision to accommodate their needs. The management of the home believes in promoting an equal and diverse culture among staff and residents. Residents are encouraged to attend local community events. Contact with family and friends is positively encouraged with visitors being able to attend the home at any time and in accordance with the resident’s wishes. Residents are treated with respect and there is a good rapport between staff of the home and residents. Residents reported that the home assists them to maintain their independence with their daily living and daily routines. The home’s menus are devised on a four week rolling programme. All meals are home cooked with an alternative option available for each mealtime. Mealtimes can be varied upon request and residents guests are also welcome to have meals at the home. Meals can be taken in the residents bedroom or in the communal dining room. Medical, therapeutic or religious diets are provided as needed. Drinks and snacks are available at all times. The meal served during the inspection was ample in quantity and attractively presented. The lunchtime meal was observed to be unhurried. Residents commented in their surveys that they would like ‘less ice cream and more light desserts such as semolina or rice pudding’. Dalling House DS0000021085.V363565.R01.S.doc Version 5.2 Page 16 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 in this area. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a robust and efficient complaints procedure, whilst the homes procedures, processes and staff training should protect resident’s in the event of an allegation of abuse. EVIDENCE: The home has an established complaints procedure in place. There was a need for the complaints policy to be amended, to indicate that the CSCI and the Parliamentary Ombudsman could be contacted at any stage of a complaint. The complaints procedure had been updated and placed in all required documentation between the inspection dates of 13th and 18th May 2008. The home has received four complaints within the past twelve months, three of which have been recorded as addressed, whilst the remaining unresolved complaint occurred the day prior to the second inspection date. Each of the resolved complaints have had appropriate action taken by the Appointed Manager in order to ensure that actions were taken to address the concerns raised. Following the key unannounced inspection of June 2007, the Appointed Manager has made improvements to ensure that copies of all funding authorities’ multi-disciplinary adult protection protocols have been obtained in order to ensure that there is a timely and co-ordinated approach, should any Dalling House DS0000021085.V363565.R01.S.doc Version 5.2 Page 17 instance of abuse ever occur. Criminal Record Bureau (CRB) checks have been carried out on all existing staff. Both CRB and Protection of Vulnerable Adult (POVA) checks are carried out on all new staff. Staff have attended training in the Protection of Vulnerable adults within the last twelve months and training in this subject is continual throughout the year. This was evident from the staff files and training matrix viewed. There have been no Safeguarding Alerts raised by the home in last twelve months. Residents reported that they would know who to approach should they need to raise an allegation and that they would feel safeguarded. Dalling House DS0000021085.V363565.R01.S.doc Version 5.2 Page 18 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides accommodation for residents that is safe, hygienic and odour free, whilst infection control procedures are adhered to at all times. EVIDENCE: The location and layout of the home are suitable for its stated purpose. The home is well maintained and all areas of the home are accessible to residents. The home has an ongoing plan of refurbishment in place. Following the key unannounced inspection of June 2007, the Appointed Manager has made improvements to ensure that the suitability of bath seats have been reviewed, that all WCs (communal and en-suite) have been deep cleaned, the use of bar soap and fabric towels in communal facilities has been discontinued, the practice of wedging open of doors has discontinued and Dalling House DS0000021085.V363565.R01.S.doc Version 5.2 Page 19 Dorguards have been fitted, portable cash tins are no longer stored in residents bedrooms and are maintained in the homes safe, has submitted a copy of the latest Environmental Health Officer (EHO) report and confirmed that the home’s washing machine does not have a sluice or disinfecting cycle but that suitable provisions have been made for sluicing/disinfecting soiled items, in accordance with EHO advice and recommendations. It was a previous inspection recommendation that the home should consider installing a shower so that residents have a choice. This was observed to have been actioned. A recent water authority inspection has however deemed them to be unsafe, as the showerhead could be taken from the wall and put into the toilet. The service is currently awaiting the Water Inspectors report to determine the requirements and recommendations made. General building and Health & Safety risk assessments were evidenced. Recommendations for good practice however, have been made in relation to the access to rear garden being risk assessed regarding the restriction incurred by residents as a result of the level change. The safety of the gradient up to front entrance from the road should also be risk assessed for residents who use wheelchairs or mobility aids. It is also recommended that a Loop system is installed in the homes TV rooms for use of residents with hearing aids. The home has an infection control policy in place and staff are trained in infection control procedures, staff training records viewed confirmed this. Staff were observed adhering to infection control procedures. The home was clean and odour free throughout. There is a daily cleaning schedule in place. Dalling House DS0000021085.V363565.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a staff team that have the necessary skills and experience to the meet the needs of current residents. Improvements are required with recruitments processes in order to ensure that robust and effective recruitment procedures are followed, prior to new staff commencing employment. Staff training is appropriate and enables staff to conduct their roles in an efficient and safe manner. EVIDENCE: A competent staff team, sufficient in number, meets the resident’s needs. There is a staff rota in place, which details staff designations and hours of working. Staff are deployed in such a manner that there are four Care staff in the morning, three care staff in the afternoon and two waking night care staff. The Appointed Manager reported that staffing levels would be increased should residents current level of needs change. The home has a permanent staff team of the Appointed Manager, Deputy Manager, one Senior Carer, sixteen Care Assistants, Two Cooks, one Domestic, one Kitchen Assistant and a handyman. Four Care Assistants and the Deputy Manager are National Vocational Qualification (NVQ) level 2, in care, trained Dalling House DS0000021085.V363565.R01.S.doc Version 5.2 Page 21 and are currently undertaking the NVQ level 3 course. Whilst a further six Care Assistants are currently near completion of the NVQ level 2 course. The home has an Equal Opportunities policy in place and is an equal opportunities employer. Staff recruitment files were viewed and it was evidenced that these files did not contain all items required under the Care Homes Regulations 2001. All new staff are employed with a CRB check and POVA 1st check in place. One newly recruited staff member was observed to be working despite not having two references in place. The Appointed Manager stated that all staff are employed on the basis that a satisfactory CRB POVA 1st check and references are sourced, however this does not meet the regulations and therefore a Requirement has been made. Following the key unannounced inspection of June 2007, the Appointed Manager has made improvements to ensure that there is a staff training and development programme in place, which meets the National Training organisation (NTO) workforce training targets, and ensures staff fulfil the aims of the home and can meet the changing needs of residents. This was evidenced from records viewed and staff spoken with. Mandatory training consists of Moving and Handling, Infection Control, Fire Safety, Basic Food Hygiene, Induction, Medication, Health & Safety and Protection of Vulnerable Adults. Staff induction training is conducted in line with Care Skills Sector guidance. Additional training is also provided and consists of Stoma Care, pressure area care, risk assessments, Team Leading, supervision and appraisals, diabetes, reminiscence and life review, the Mental Capacity Act and other subject matters that arise from the residents changing needs. Staff spoken with confirmed both training and supervision has ‘improved immensely in the last six months’ and that t ‘now feels that training is now provided for the benefit of service users and staff development rather then meeting CSCI requirements.’ Dalling House DS0000021085.V363565.R01.S.doc Version 5.2 Page 22 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, 34, 35, 36 & 38 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents experience the benefits of a home that is well managed and administrated. Consideration is given to resident’s choice and opinion in all aspects of provisions provided. With some improvements required to ensure that the health, safety and welfare of residents and staff are protected at all times. EVIDENCE: The Appointed Manager has been in post for six months and is currently awaiting a CSCI CRB before making application to register as Manager. The Appointed Manager has previous experience of being employed as a Regional Manager for large Domiciliary Care Agency and has many years experience of Dalling House DS0000021085.V363565.R01.S.doc Version 5.2 Page 23 working with the elderly. The Appointed Manager also has been a qualified nurse, though the registration to practice as a nurse has lapsed. Residents and staff spoken with said that the Appointed Manager was friendly, approachable and always takes residents concerns or comments about the home seriously. Quality Assurance questionnaires recently conducted the results of which are being correlated for publishing and presentation at the planned service user meeting on 23/05/08. The Appointed Manager reported that the Annual Quality Assurance process is scheduled for every April. The first ever residents meeting is planned 23/05/08. The Appointed Manager stated that this has received a good response from both residents and their family members. The Appointed Manager reported that one of the aims of the meeting is to plan and formulate future meetings, which are held in keeping with residents preferences being taken into consideration. Regulation 26 visits are conducted and reports are produced, these were viewed at the time of the inspection. Staff meetings are held bi monthly, the minutes and agenda’s of which were viewed. Issues raised during these meetings were evidenced as having been or in the process of being addressed. Regulation 37 reports are received by CSCI. Since the key unannounced inspection of June 2007, the Appointed Manager has made improvements to ensure that Aspenglade Ltd should produce a business development plan for this home. This was viewed and found to be comprehensive in detail. The home does not take any responsibility for many of the resident’s finances and most residents have family, friends or representatives who protect their financial affairs. Personal allowance accounts are maintained for some residents. The accounts maintained for these allowances are maintained in such a manner that there is a clear audit trial of all monies entered and debited from the account. Each resident has an individual pot where their money is stored. All monies are kept in a locked safe to which only the Appointed Manager and Deputy Manager have access. Following the key unannounced inspection of June 2007, the Appointed Manager has made improvements to ensure that all care staff have the requisite level and frequency of formal documented supervision sessions. Records viewed and care staff spoken with confirmed this. It was a previous inspection requirement that all parts of the home, to which service users have access, are risk assessed to ensure they are free from hazards to their safety, including door wedges. Records viewed confirmed that this had been actioned. The homes AQAA provided evidence that fire drills, fire alarm testing and fire equipment checks, health & safety checks and water checks had been carried out. On the tour of the premises it was noted that products deemed to be C.O.S.H.H products (alcoholic hand wash, bubble bath and shampoo, which were unnamed and for communal use) were located in the homes WC’s and bathroom areas. Therefore an Immediate Requirement Dalling House DS0000021085.V363565.R01.S.doc Version 5.2 Page 24 was made. This had been actioned and nil products were noted on the second inspection date of 18/05/08. Dalling House DS0000021085.V363565.R01.S.doc Version 5.2 Page 25 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 2 8 3 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 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Dalling House DS0000021085.V363565.R01.S.doc Version 5.2 Page 26 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 OP1 Regulation 4 (1) & Schedule 1 15 (1) & (2) (c) 15 (2) (b) Requirement That the statement of purpose be reviewed and amended, in accordance with Schedule 1. That care plans are formulated and reviewed with the involvement of residents and/or their representative. That all elements of care plans, including risk assessments are reviewed consistently on a monthly basis. That suitable risk assessments are in place for all residents who are Registered Blind. That all new staff are employed once the home are in receipt of all satisfactory recruitment checks, as listed in this Regulation and associated Schedule. That all C.O.S.H.H products are stored in the appropriate manner. This is an immediate requirement. Timescale for action 30/06/08 2. OP7 30/06/08 3. OP7 30/06/08 4. OP7 5. OP29 17 (1) (a) & Schedule 3 (l) & (q) 2 (1) (6) & Schedule 2 13 (4) (a) (b) (c) 30/06/08 30/06/08 6. OP38 13/05/08 Dalling House DS0000021085.V363565.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. 1. 2. 3. Refer to Standard OP7 OP9 OP9 Good Practice Recommendations That daily records are recorded in a time specific manner. That self medicating risk assessments include the self administration of prescribed creams/lotions. That the home should have ready access to the Royal Pharmaceutical Society Guidance on the administration and storage of medication. That the access to rear garden should be assessed regarding the restriction incurred by the level change. That a Loop system is recommended in TV rooms for use with hearing aids. That the safety of the gradient up to front entrance from the road should be risk assessed for residents who use wheelchairs or mobility aids. 4. 5. 6. OP19 OP19 OP19 Dalling House DS0000021085.V363565.R01.S.doc Version 5.2 Page 28 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 Dalling House DS0000021085.V363565.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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