Care Home: Dalmuir Home

Similar services:

• The Shelley
• Springfield House
• Sutton Lodge Nursing Home
• St Helier`s Residential Hotel
• St Joseph`s
• Ridgemount
• Wingham Court
• Old Hastings House

What the care home does well Residents live in a well maintained, decorated and homely environment with their private accommodation personalised to their individual preferences. Consistent feedback was received regarding the importance of the homely environment at the home. There is a range of needs being accommodated at the home with the majority of residents reported to have some level of dementia. Residents receive individualised care and support from staff that know them, in a dignified manner. A sample of comments by residents, relatives and health care professionals about their experience of the home includes: “The best thing I have ever done is move here, you do not have to do anything it is really lovely it is good fun” “a very friendly place” and “ “It is my professional Dalmuir Home DS0000013621.V377658.R01.S.doc Version 5.2 judgement that the home provides an excellent service. This is borne out by the fact that the home always has full occupancy with a waiting list. They are always very receptive to any requests made and accommodating at all times with information required. They have a full understanding of their service users and the families”. Links with families and friends are valued and supported by the home. Resident’s lives are enriched by the home providing various opportunities for occupation. A resident said: “they also arrange entertainment and activities to keep us entertained and our minds active they also encourage us to take part when we can”. The meals are good offering both choice and variety, feedback about the food included: “good home cooked food with a good choice to choose from” and “kindness is shown regarding eating and drinking at night and during the day between meals, food and drink is given on request. Good wholesome food with a good choice of meals”. The health needs of residents are well met with evidence of regular input from a range of health care professionals. Staff make a positive contribution in residents lives as they benefit from a stable and trained staff team who are robustly recruited and employed in sufficient numbers as is necessary to meet their needs. A Health care professionals said; “very caring staff. always senior staff on duty to liaise with, I would recommend the home to my patience”. Resident’s benefit from a motivated and experienced manager who promotes good practices and provides a clear sense of leadership and direction enabling staff to provide good quality care. A health care professional fedback: “professional and efficient home manager”. What has improved since the last inspection? In line with the previous requirement the manager confirmed that radiators which did not have covers on them to protect from accidental scalding have been risk assessed to ensure residents safety and guards fitted to any areas at risk. The home continues to undergo a programme of gradual redecoration and upgrade which provides a nice pleasant environment in which to live. What the care home could do better: Residents need to have a range of information about the homes services and facilities including a terms and conditions to ensure that they are aware ofDalmuir HomeDS0000013621.V377658.R01.S.doc Version 5.2 charges and their rights and responsibilities while residing at the home so they can make informed decisions. Although residents clearly receive individual care and support, this is not always supported by an individualised care plan to ensure that support can be provided in a consistent way. Care plans need to fully reflect the range of residents needs and provide the guidance for staff on how to meet these needs to ensure they receive consistent support. Care plans also need to identify residents capacity to make decisions and how various decisions have been made which effect residents lives. Areas in need of improvement which the manager either agreed to promptly address or had identified themselves include: To update the home literature to more accurately reflect practices and services at the home. The need to undertake a risk assessment on the management of commodes to ensure adequate infection control practices. For additional external dementia care training for staff. Key inspection report CARE HOMES FOR OLDER PEOPLE Dalmuir Home 25 Gresham Road Limpsfield Oxted Surrey RH8 0BU Lead Inspector Jane Jewell Key Unannounced Inspection 29th September 2009 10:27 DS0000013621.V377658.R01.S.do c Version 5.3 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 homes for older people 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. Dalmuir Home DS0000013621.V377658.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 Dalmuir Home DS0000013621.V377658.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dalmuir Home Address 25 Gresham Road Limpsfield Oxted Surrey RH8 0BU 01883 715630 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) mikenoorbaccus@btinternet.com Mr Mike Noorbaccus Mrs Myrna Noorbaccus Mrs Diana Marjorie Connolly Care Home 16 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Dalmuir Home DS0000013621.V377658.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP). 2. Dementia (DE). The maximum number of service users to be accommodated is 16. Date of last inspection 11th October 2007 Brief Description of the Service: Dalmuir Home is registered to provide residential care for up to sixteen older people some of whom will have dementia. The home is located on the outskirts of Oxted town centre in a residential area. Access to local amenities such as Dr surgeries, shops cafes, pubs and train links are within approx half a mile walk away. The premises is a converted domestic property, which is presented across three floors with access to above the ground floor being via chair lifts or stairs. Communal space consists of a dinning room and separate large lounge areas that leads out onto a veranda. This over looks a rear secure garden which has ramps to provide level access. Residents accommodations consists of seven single and two double bedrooms with five bedrooms providing en-suite facilities. The provider confirmed that the fees for residential care are currently £372 to £650 per week, depending on the services and facilities provided. Extra such as: newspapers, hairdressing, chiropody, toiletries are additional costs. Refer to the homes literature for the actual amounts charged for any additional costs. Dalmuir Home DS0000013621.V377658.R01.S.doc Version 5.2 Page 5 Dalmuir Home DS0000013621.V377658.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 Two Star. This means the people who use the service experience Good quality outcomes. The information contained in this report has been comprised from an unannounced inspection undertaken over seven hours and information gathered about the home before and after the inspection. The manager and an external consultant had completed an Annual Quality Assurance Assessment (AQAA) form within the date requested and the information contained in this document has been used to inform the inspection process. Although this contained information about the service it did not always reflect the actual practices at the home or provide clear evidence to confirm what was being reported. This was fedback to the provider and manager. The inspection was facilitated by the Diana Connolly (registered manager) and in part by the registered provider Mike Noorbaccus. The focus of the inspection was to look at the experiences of life at the home for people living there. The inspection consisted of being shown the communal areas, and being invited to view some residents bedrooms, examination of the homes documentation and observations of resident’s daily routines and in their interactions with staff during lunch time and over the afternoon period. Nine residents, five staff and were interviewed as part of the inspection process. Feedback surveys were sent to the home for distribution, in order to obtain the views on the quality of the services and facilities being provided. Seventeen were returned in total, nine from residents five from staff and five from health care professionals. Their feedback is included in this report. There were sixteen residents living at the home at the time of the inspection. What the service does well: Residents live in a well maintained, decorated and homely environment with their private accommodation personalised to their individual preferences. Consistent feedback was received regarding the importance of the homely environment at the home. There is a range of needs being accommodated at the home with the majority of residents reported to have some level of dementia. Residents receive individualised care and support from staff that know them, in a dignified manner. A sample of comments by residents, relatives and health care professionals about their experience of the home includes: “The best thing I have ever done is move here, you do not have to do anything it is really lovely it is good fun” “a very friendly place” and “ “It is my professional Dalmuir Home DS0000013621.V377658.R01.S.doc Version 5.2 Page 7 judgement that the home provides an excellent service. This is borne out by the fact that the home always has full occupancy with a waiting list. They are always very receptive to any requests made and accommodating at all times with information required. They have a full understanding of their service users and the families”. Links with families and friends are valued and supported by the home. Resident’s lives are enriched by the home providing various opportunities for occupation. A resident said: “they also arrange entertainment and activities to keep us entertained and our minds active they also encourage us to take part when we can”. The meals are good offering both choice and variety, feedback about the food included: “good home cooked food with a good choice to choose from” and “kindness is shown regarding eating and drinking at night and during the day between meals, food and drink is given on request. Good wholesome food with a good choice of meals”. The health needs of residents are well met with evidence of regular input from a range of health care professionals. Staff make a positive contribution in residents lives as they benefit from a stable and trained staff team who are robustly recruited and employed in sufficient numbers as is necessary to meet their needs. A Health care professionals said; “very caring staff. always senior staff on duty to liaise with, I would recommend the home to my patience”. Resident’s benefit from a motivated and experienced manager who promotes good practices and provides a clear sense of leadership and direction enabling staff to provide good quality care. A health care professional fedback: “professional and efficient home manager”. What has improved since the last inspection? What they could do better: Residents need to have a range of information about the homes services and facilities including a terms and conditions to ensure that they are aware of Dalmuir Home DS0000013621.V377658.R01.S.doc Version 5.2 Page 8 charges and their rights and responsibilities while residing at the home so they can make informed decisions. Although residents clearly receive individual care and support, this is not always supported by an individualised care plan to ensure that support can be provided in a consistent way. Care plans need to fully reflect the range of residents needs and provide the guidance for staff on how to meet these needs to ensure they receive consistent support. Care plans also need to identify residents capacity to make decisions and how various decisions have been made which effect residents lives. Areas in need of improvement which the manager either agreed to promptly address or had identified themselves include: To update the home literature to more accurately reflect practices and services at the home. The need to undertake a risk assessment on the management of commodes to ensure adequate infection control practices. For additional external dementia care training for staff. 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. Dalmuir Home DS0000013621.V377658.R01.S.doc Version 5.3 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 Dalmuir Home DS0000013621.V377658.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 4 and 5 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 both prospective and existing residents, with a range of information about the home and what to expect when living there, this does need minor additions to help ensure residents have all the information they need to make informed choices, including terms and conditions of residency. The way in which prospective residents are assessed ensures that the home admits only those residents who’s needs it can meet. The home is able to demonstrate that it can meet the range of residents needs. EVIDENCE: Dalmuir Home DS0000013621.V377658.R01.S.doc Version 5.3 Page 11 The home’s statement of purpose, which is a book that tells people who the home is for and the service users guide, which is the book that tells people how the home works, provides a range of information about the home. These are made available at the home and given to prospective residents, representatives and other interested parties. It was discussed that the statement of purpose should fully reflect the range of placements, services and facilities offered by the home. This is necessary in order to ensure prospective residents are enabled to make informed choices. The manager agreed to ensure that the information was updated promptly and therefore no requirement is made on this occasion. It was not clear whether all residents had been provided with a terms and conditions of residency, as these were not maintained at the home. It is required that residents are provided with terms and conditions, in order that they are aware of the charges and their rights and responsibilities whilst residing at the home. The home ensures that prospective residents are accommodated only following an assessment of their needs by the manager or placement authority. Advice is sought during the assessment process from health care professionals and others who know and understand the needs of the prospective resident. The needs assessment now also includes a mental capacity section to help identify a resident’s level of decision making, which has recently been introduced. The manager spoke of the assessment documentation being recently introduced and was aware of the need for some slight modification to ensure that more detail were able to be recorded on it. The needs assessment then forms the basis of a care plan. This helps staff to be aware of the recorded needs of new residents prior to them moving into the home. The majority of residents are assessed as having a low to medium level of needs with the majority of residents reported to have some level of dementia. The home provided individual support and demonstrated that it could meet the needs of the residents currently residing at the home. However, as discussed under standard seven of this report staffs knowledge of resident’s individual needs must be supported by a thorough care planning system. Without exception all person consulted spoke positively about their experiences at the home. A sample of residents comments included: “The best thing I have ever done is move here, you do not have to do anything it is really lovely it is good fun” “Looks after us well with our everyday needs of personal care” “keeps me safe” and “a very friendly place”. A health care professional stated: “It is my professional judgement that the home provides an excellent service. This is borne out by the fact that the home always has full occupancy with a waiting list. They are always very receptive to any requests made and accommodating at all times with information required. They have a full understanding of their service users and the families”. Staff consistently stated that what the home does best is to provide a caring family environment. Dalmuir Home DS0000013621.V377658.R01.S.doc Version 5.3 Page 12 Residents and their relatives spoke of being provided with the opportunity to visit the home in advance to assess the quality, facilities and suitability of the home as many times as they liked. The manager confirmed that the first six weeks of occupancy is looked upon as a trial period. Following this, placements that are funded by social services are reviewed, to establish whether the home is meeting a residents needs. A formal process is also in place for privately funded residents to have a say whether they wish to remain at the home and become a permanent resident. Intermediate care is not offered at the home therefore this standard is not assessed. Dalmuir Home DS0000013621.V377658.R01.S.doc Version 5.3 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 and 11 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. Although residents clearly receive individual care and support, this is not always supported by an individualised care plan to ensure that support can be provided in a consistent way. Residents receive a good standard of health care support. Medication practices are well managed promoting good health. Personal support is offered in ways, which promotes and protect resident’s privacy and dignity. EVIDENCE: Individual plans of care are available for each resident and five were looked at. These contained some information about the needs of residents, however were standardised in some cases and did not reflect the support being undertaken by staff or include the range of residents needs and how decisions and choices Dalmuir Home DS0000013621.V377658.R01.S.doc Version 5.3 Page 14 have been made by resident’s or on their behalf. For example in relation to managing residents challenging behaviour, mobility needs and everyday routines and preferences were not identified in care plans. Although staff showed a good understanding of residents needs guidance must be provided in the care plan to ensure a consistent approach to meeting residents individual needs. There was no evidence of how residents have made a choice to share a bedroom or why several residents eat meals on their own. This is necessary to help ensure that resident’s rights are being protected. The regular review of care plans helped to ensure that changes in resident’s needs and preferences can be promptly identified. Annual placement reviews are also held with the placement authorities and residents families. This helps to identify whether the home can continue to meet a resident’s needs. A health care professional said “excellent in recording reviews and includes family members fully and constructively”. The home maintains a daily record for each resident on events and occurrences. The standard of daily recording was noted to be good with an account of actions and events that had occurred which was written in a respectful tone. Individual risk assessments were in place, which covered core and specialist areas of risks, and recorded the actions to manage any identified risks, minor additions are needed to the documentation to ensure that the guidance is clear for staff as to what hazard is being assessed. Any risks faced by a resident that the inspector noted during the course of inspection had been assessed. Records show that prompt action is taken to address any medical concerns, including the involving of any additional specialist services including dieticians, speech therapist and specialist nurses. Residents confirmed that when they have asked to see a GP staff have sought this promptly on their behalf. A local district nurse fedback that they have a good relationship with the home and that staff always followed any medical instructions. None of the residents accommodated are assessed as safe to administer their own medication. Medication profiles are in place which provides information on how much medication is provided, how medication should be administered and when it is administered. Only staff who have received training administer medication. Medicines were well organised and stored. Good practices were noted on the individual instructions provided for staff on the administration of “As Required” medication. These made clear the individual requirements for when these medicines should be administered. During the inspection staff were seen to be respectful and considerate to all residents and visitors. Staff consulted with showed a good understanding of good practices in preserving resident’s rights to privacy and dignity. Staff were able to give examples of how they promote these rights in their every day care Dalmuir Home DS0000013621.V377658.R01.S.doc Version 5.3 Page 15 practices. Residents were observed to be dressed in well laundered clothing and residents enjoyed the regular input from the visiting hairdresser. Staff spoke of the support they had received in the past from Health Care professionals during the care of residents who are receiving end of life care. Staff also spoke sensitively about the care and support provided to residents and their families when residents have become terminally ill. Dalmuir Home DS0000013621.V377658.R01.S.doc Version 5.3 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 and 15 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 practices of the home ensure that residents are treated as individuals and generally enable residents to exercise some choices and control over their lives, however some further work is needed to provide evidence of how decisions are made on behalf of residents. Links with families and friends are highly valued and supported by the home. Resident’s lives are enriched by the home providing various opportunities for occupation. The meals are good offering both choice and variety. EVIDENCE: Resident’s views regarding activities varied between those who enjoy socialising and others who were not so interested, however all residents confirmed that their preference was respected by staff. Staff are responsible for providing suitable occupation and stimulus for residents as part of their duties. Residents spoke of undertaking sing-along’s, walks, reading magazines Dalmuir Home DS0000013621.V377658.R01.S.doc Version 5.3 Page 17 and games. A resident said “they also arrange entertainment and activities to keep us entertained and our minds active they also encourages us to take part when we can”. Pictures of various activities are used to help resident’s choose what they would like to do with staff saying that the activities programme is very flexible depending upon the preferences of residents at the time. A relative fedback that there was a good range of activities provided. The home has access to a mini bus in order to access the wider community. Relatives fedback upon how welcomed they are made to feel when they visit, this included being offered beverages or meals and staff being friendly and approachable. A health care professional fedback that the home was “Compassionate to families” During the inspection residents were observed to move around the home freely choosing which room to be in and what level of company they wanted to enjoy. It was clear that residents are able to choose when they rise and have breakfast as there are various breakfast arrangements in place to suite individual needs. Good practices were observed in staff offering choices of beverages and not assuming residents have the same preferences each day. Practices were in place to promote the cultural and spiritual needs of residents. Practices observed clearly ensured that residents were treated as individuals, however as previously noted further consideration must be given to when decisions are made on a resident’s behalf to ensure that this process is recorded in their care plan and in accordance with legislations (Mental Capacity Act). For example with regard to sharing a bedroom or daily routine where rights are restricted. The inspector observed part of the lunch time meal which was presented well with individual preferences respected, specialist diets due to health needs or cultural preferences were also provided for. The menu provided variety with the cook confirming that menus have been developed based on residents likes and dislikes, with food pictures used to help aid residents choice. Residents who required support received discrete sensitive assistance from staff. The majority of residents eat their meals in a pleasantly decorated environment conduce to providing a relaxed environment. Staff were observed eating their meal with residents which promoted a social atmosphere. Three residents were supported to eat their meals in the lounge whilst remaining in lounge chairs, prior to the main meal sitting. Although good practices were observed in the use of a screen to help preserve their privacy it was not clear that this was their choice or in their best interest to remain seated in lounge chairs, which was not recorded as part of an assessed need. This practice did not aid good digestion due to sitting posture in a lounge chair, socialisation or orientation for people who have dementia. The manager agreed to ensure that this was reviewed. Dalmuir Home DS0000013621.V377658.R01.S.doc Version 5.3 Page 18 Without exception all persons consulted spoke positively about the food and meals provided. A sample of comments made included: “good home cooked food with a good choice to choose from” “kindness is shown regarding eating and drinking at night and during the day between meals, food and drink is given on request. Good wholesome food with a good choice of meals” and “ good food and served on time”. Dalmuir Home DS0000013621.V377658.R01.S.doc Version 5.3 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 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. There is an effective complaints system with evidence that residents and relatives feel that their views would be listened to. Staff have the guidance and training necessary to show them what to do if abuse is suspected. EVIDENCE: There is an accessible complaints procedure for residents, their representatives, and staff to follow should they be unhappy with any aspect of the service. All residents and relatives consulted with said that they felt able to share any concerns they had with the manager and where they have raised minor issues with them, this has been addressed promptly. The manager reported that there has been no complaints received. The home has written policies covering safeguarding adults and whistle blowing. These make clear the vulnerability of people in residential care, and the duty of staff to report any concerns they may have to a responsible authority for investigation. The majority of staff has received formal training in safeguarding adults and prevention of abuse and the staff consulted with showed a good understanding of their roles and responsibilities under Dalmuir Home DS0000013621.V377658.R01.S.doc Version 5.3 Page 20 safeguarding adults guidelines. No safeguarding alerts have been made about the home which have resulted in the need to improve practices. Dalmuir Home DS0000013621.V377658.R01.S.doc Version 5.3 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 22 24 25 and 26 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. Residents live in a well maintained, decorated and homely environment with their private accommodation personalised to their individual preferences. Residents have a range of specialist equipment and adaptations to aid mobility and independence around the home. EVIDENCE: The premises are ideally located in a residential area on the outskirts of a small town with easy access to local amenities. Standard of décor and maintenance are good with evidence of a regular programme of redecoration and repair. Much positive feedback was received regarding the homely environment and atmosphere at the home. Several residents and relatives sighted the importance of the homely atmosphere as the reason for choosing the home. Dalmuir Home DS0000013621.V377658.R01.S.doc Version 5.3 Page 22 Communal space consists of a large lounge, hairdressing area, and dinning room, which are furnished to a good standard. The lounge leads out onto a raised veranda which overlooks a secure well maintained garden. Level access is provided to the garden via a ramp leading from the veranda. The garden also has a vegetable plot with many residents saying how much they enjoy walking in the garden or looking out onto it. All residents consulted with said that their bedrooms provided everything they needed. Resident’s bedrooms had been individualised with residents confirming that they are able to personalise their bedrooms. There is sufficient number of toilets and assisted bathrooms located around the home, including five bedrooms providing en-suite facilities. Fitted throughout the home are call points, which enable assistance to be summoned when pressed. A resident said “if I press the call bell then staff will come quickly to help me”. There is a range of individual aids and adaptations to assist resident’s mobility and independence including: walking aids, height adjustable beds, raised toilet seats, grab rails and manual hoists. Feedback was received from two staff regarding the need for an electric hoist, which was fedback to the manager. All areas inspected were observed to be cleaned to a good standard with any odours confined to a few bedrooms. Some bedrooms have been fitted with lino flooring to aid in the management of odours and help preserve the dignity of residents. The majority of bedrooms are provided with commodes. The manager confirmed the practices for managing this volume of commodes without the use of a sluice machine. There have not been any recorded incidents of cross infections. The manager confirmed that they would undertake a risk assessment to establish that safe infection control practices are being followed at all times, in the cleaning of commodes and the disposal of human waste. Staff confirmed that they have undertaken training in infection control and were observed to be working in ways that minimised the risk of infection through the use of protective clothing. Dalmuir Home DS0000013621.V377658.R01.S.doc Version 5.3 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 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. Staff make a positive contribution in residents lives as they benefit from a stable and trained staff team that know them and who are robustly recruited and employed in sufficient numbers as is necessary to meet their needs. EVIDENCE: Staff, relatives and residents felt that there was always sufficient numbers of staff on duty for staff to undertake their roles in a timely manner and for residents to receive the support they needed. There is a core group of staff who have worked at the home for a number of years and showed an in-depth knowledge of individual residents needs. All staff were observed to have a good rapport with residents and visitor, which promoted a relaxed atmosphere. A sample of comments about staff included: “very caring staff. always senior staff on duty to liaise with, I would recommend the home to my patience” and “staff every so good they really are”. The home has been proactive in ensuring that the majority of staff have completed a National Vocational Qualification in care. Dalmuir Home DS0000013621.V377658.R01.S.doc Version 5.3 Page 24 The manager said that they have a limited staff turnover and therefore do not recruit very often. The personal files of three staff were inspected and these showed that a robust recruitment process is followed which includes the use of an application form, interviews, Criminal Records Bureau (CRB) checks and written references prior to employment commencing. This helps to ensure that only staff who are suitable to work with vulnerable people are employed. There is a commitment to improving staff skills through an ongoing training programme both in practical matters and the broader aspects of working with older people. Staff consulted with confirmed that they have undertaken all of the areas of mandatory training needed for them to work safely with residents. Staff said that part of one day each week is set aside for in house training, and has included such training as using a hoist, pressure care and dementia. The manager recognised that to further enhance staffs understanding of good practices in dementia care and care planning that additional external dementia care training would be beneficial. Dalmuir Home DS0000013621.V377658.R01.S.doc Version 5.3 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 36 and 38 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. Resident’s benefit from a motivated and experienced manager who promotes good practices and provides a clear sense of leadership and direction enabling staff to provide good quality care. The home regularly reviews aspects of its performance through a program of self-review and feedback. A range of regular health and safety checks helps to promote the health and safety of residents and staff. EVIDENCE: Dalmuir Home DS0000013621.V377658.R01.S.doc Version 5.3 Page 26 Since the previous inspection the provider has appointed the deputy manager to manage the service, who worked at the home for many years. The manager became registered with the Commission in the summer of 2009. They have undertaken the recommended management qualification and additional training which enables them to train and assess care staff in various aspects of care. They have also undertaken various training to keep up to date with good practices and changes in legislation. They had identified the need to undergo training in the mental capacity act and the deprivation of liberty in order to promote further residents rights. Without exception all persons spoke positively about the manager with particular reference to their approachability. A sample of comments made about the manager included: “can call the manager anytime for advice and support” “manager great very hands on” and “I like it here the manager is very good. A health care professional fedback: “professional and efficient home manager”. There are several mechanisms in place for the home to obtain feedback on the quality of the services provided and whether it is achieving its aims and objectives. This includes annual fedback surveys, yearly placement reviews and direct discussion with residents, staff and stakeholders involved in residents care. It was evident that there is a good standard of communication between the manager, staff and stakeholders with residents consistently saying that they could tell the manager of anything they wanted to improve. An external consultant undertakes the provider’s required monthly audit of the services and facilities and completes a comprehensive written report on their visit. This helps the provider to monitor practices at the home. The provider also visits the home regularly to support the manager and staff. Residents are encouraged to retain control of their own finances for as long as they are able to do so and if unable then this responsibility is taken on by a relative or another responsible person external to the home. Care staff spoke of receiving appraisals and direct supervision through working alongside the manager and felt well supported by them to undertake their role. Written guidance is available on issues related to health and safety. Records submitted by the home prior to the inspection stated that all of the necessary servicing and testing of health and safety equipment has been undertaken. The cook reported that no recommendations were made from the last visit by Environmental Health. Systems are in place to support fire safety, which include regular fire alarms and emergency lighting checks, staff training and maintenance of fire equipment and fire drills were reported to have been undertaken. The manager reported that a fire risk assessment had been completed which records significant findings and the actions taken to ensure adequate fire Dalmuir Home DS0000013621.V377658.R01.S.doc Version 5.3 Page 27 safety precautions in the home. They were aware that this needed to be reviewed regularly and agreed to undertake this as a matter of priority. In line with the previous requirement the manager confirmed that radiators that do not have covers to protect from accidental scalding have been risk assessed to ensure residents safety and guards fitted to areas at risk. Dalmuir Home DS0000013621.V377658.R01.S.doc Version 5.3 Page 28 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 2 2 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 x 3 3 3 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 3 x 3 x 3 3 x 3 Dalmuir Home DS0000013621.V377658.R01.S.doc Version 5.3 Page 29 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 OP2 Regulation 5(1)(b) Requirement Timescale for action 30/11/09 2 OP7 15(1) That service users or their representatives are provided with a copy of the terms and conditions of residency, in order that they are aware of charges and their rights and responsibilities whilst residing at the home That care plans provide clear 30/11/09 guidance for staff on all aspects of the health, personal and social care needs of service users and which make explicit the actions needed to meet these needs. 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 Dalmuir Home DS0000013621.V377658.R01.S.doc Version 5.3 Page 30 Care Quality Commission South East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.southeast@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. 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. Dalmuir Home DS0000013621.V377658.R01.S.doc Version 5.3 Page 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!