Care Home: Dapplemere

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What the care home does well The people who live in the home seemed well cared for and only complimentary remarks were received about the care and service provided. One-to-one care and attention were given to individuals as required. The service has a team of dedicated nurses and care workers who have knowledge of the people who live in the home and assist them according to their care needs and preferences. Staff have appropriate training and they are well supported by management to enable them to meet people`s care needs appropriately. The care workers are involved in the activity programme as part of the caring process. The residents spoken to gave positive feedback about the care and service provided. Similar complimentary remarks were received from residents, relatives and other respondents in a recent survey carried out by us. Comments received included: "We have been very pleased with the service provided." "Treats everybody as an individual. They understand my needs completely." "Dapplemere is a nice friendly and homely place to live in. I have no complaints." "I can`t praise the home enough. All the staff are caring and helpful." What has improved since the last inspection? Since the last inspection some refurbishment and redecoration work have been completed in the home. The kitchen has been fully refurbished and it was awarded three stars by the environmental health officer. The reception area, corridors, some bedrooms and the dining room have been redecorated. New dining room furniture has been purchased. There is now a toilet facility designated for staff only. The service is recruiting a laundry worker so that care staff can spend more time with the people who live in the home rather than doing the laundry. What the care home could do better: Further improvements to the environment are planned for the coming months to benefit the people living in the home. The management confirmed that the refurbishment work to improve the shower room will be undertaken over the next few weeks. Improved facilities will include a permanent assisted shower seat, a wash basin and toilet facilities. An extractor fan is to be installed in the sluice to remove any malodour. The management has agreed to install a ramp in corridors where there are steps to ensure safety and comfort for both residents and staff assisting residents using wheelchairs and hoists. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Dapplemere Shepherd`s Lane Chorleywood Hertfordshire WD3 5HA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Yoke-Lan Jackson     Date: 1 8 0 8 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Dapplemere Shepherd`s Lane Chorleywood Hertfordshire WD3 5HA 01923282119 F/P01923282119 matron@dapplemere.co.uk www.pressbeau.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Pressbeau Ltd care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category terminally ill Additional conditions: One named service user can be accommodated in the dementia category. This condition will be removed if the named person leaves the home permanently for any reason. Date of last inspection Brief description of the care home Dapplemere is a registered nursing home for 22 people in the older age category. The home is located in a rural setting a short drive away from the Chorleywood railway station and the M25 motorway. The building is a two storey period house to which a modern single storey extension 1 0 0 Over 65 0 15 7 Care Homes for Older People Page 4 of 25 Brief description of the care home has been added. The extension provides seven en suite bedrooms and the two storey extension provides six en suite bedrooms. The remaining rooms are not en suite. There is an assisted bathroom and a shower room available nearby. The home has a passenger lift to all the floors. The original building is constructed on several levels and in some areas there are steps and slopes so residents accommodated in some of the bedrooms need to have a degree of mobility and there is limited space for the use of hoist and wheelchair. The communal rooms, the kitchen and a laundry room are all on the ground floor. The home has a spacious and attractive garden with patio and there are garden furniture and seating for people to use. The garden is wheelchair accessible. The home charges £650 to £700 per week. Information about the home and the service it offers is contained in the Statement of Purpose and the Service Users Guide. A copy of these and the most recent CQC inspection report are available in the home. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This service had a key inspection in August 2007 and an annual service review in August 2008. An annual service review is a review of information received about the service without a site visit since the last key inspection. This unannounced key inspection was carried out on 18/09/2009. The home manager was present. There are 19 people in residence. The inspection visit included a tour of the premises, lunchtime observation and observation of how the staff interacted with the residents in the communal areas. Staff and residents were spoken to and key documents were examined. The inspection ended with a thorough discussion with the home manager. Survey questionnaires were sent to the residents and relatives and their responses and other information received by us were reviewed. This included the Annual Quality and Care Homes for Older People Page 6 of 25 Assurance Assessment (AQAA) which providers of registered services are required to complete annually. The AQAA focuses on how the outcomes are being met for the people using the service and also provides us with statistical data. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get Care Homes for Older People Page 8 of 25 printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can be confident that they will be supported since the home will only admit a prospective client whose care needs can be met. They can be assured that a thorough pre-admission assessment will be carried out to ensure that the home can meet all their care needs. Evidence: The pre-admission documents for two new admissions were examined and they were found to be detailed and informative. The manager had carried out a thorough assessment of each prospective clients personal, healthcare and social care needs. The home manager confirmed that the two recent admissions have also been diagnosed with dementia but their nursing care needs outweighed their dementia conditions. The service is not registered for dementia. However, the two residents seemed settled in their new home and they appeared well cared for. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can expect to be treated with respect and they will receive personal and healthcare support in the way they prefer and require and they will be protected by the homes medication policy and procedures. Evidence: Each resident has a written care plan which is detailed and informative. The home manager said that work is in progress to improve all written care plans to reflect the person-centred care provided. This applies equally to those admitted with dementia as a secondary condition. This ensures that those who are looking after the residents have the required information to deliver the personal, social and healthcare needs of the people living in the home. During the admission process, a named nurse is assigned to the new resident. Both the resident and their family are given the opportunity to make decisions during the care planning process. Risk assessments are also being carried out. Choices and preferences, particularly on mobility issues and nutrition are discussed with the resident and their family. Following admission there is a six week review of care needs Care Homes for Older People Page 12 of 25 Evidence: that involves the resident, their next of kin and the relevant healthcare professionals. Subsequent reviews are made annually with them. The named nurse carries out a monthly review of care needs and makes appropriate adjustment to the care plan. Residents have access to their own doctor and to specialist medical and other therapeutic services including the occupational therapist, the speech and language therapist and the physiotherapist when required. Currently the home has two residents who have superficial pressure sores which are improving. There is a wound progress chart in place for each person. Many of the current residents have restricted mobility and require hoisting. Many were in the communal areas on the day of the site visit. They appeared content and well cared for. A trained nurse administered the medication. All medicines are stored in the medication storage room and there is a controlled drug cupboard. The room temperature is monitored daily. The home uses the monitored dosage system (MDS) for the residents medicines and these are supplied by a local pharmacy. All records for the ordering and receipt and administration of medication are appropriately kept. The medication administration recording records (MAR) were accurately kept. The management carries out regular audits and the home manager confirmed that there have been no medication errors since the last inspection. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that they will be given the opportunity to make everyday choices and their wishes and preferences will be respected. They will be encouraged to maintain links with their friends and families and they will be encouraged to have a healthy diet. Evidence: The home manager continues to ensure that the activities are based on residents choices and preferences. There is a range of activities both recreational and therapeutic. The care workers are involved in planning and organising the activities which include games of skittles, quizzes, reminiscence and armchair exercises. Periodically there are outside entertainers and every Wednesday residents listen to a live piano recital by a relative who volunteered to entertain the residents before lunchtime. The service has no activity co-ordinator at the present time. It was noted during the inspection that the home has a stream of visitors throughout the day. Many of the residents are often taken out by their relatives. The visitors spoken to gave very positive feedback about the service and the care provided. During lunchtime, members of staff were readily present to assist the individual to the Care Homes for Older People Page 14 of 25 Evidence: dining room for lunch. It was noted that lunchtime was unhurried. A number of residents preferred to have their meals in the communal areas and some needed assistance, and members of staff were readily available to help them. It was noted that the hot lunch of poached salmon, potatoes and vegetables was beautifully presented and was served with a glass of wine. All the residents spoken to were complimentary of the food served. The menu is reviewed regularly and the daily menu is displayed on the noticeboard. The chef discusses the menu with the residents and takes into account those residents with dietary needs. Some residents have been referred to a dietician who assists residents to ensure that their nutritional needs are balanced. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that the service has a robust Complaints Policy and Procedure and they can be assured that they will be listened to and any concerns raised will be investigated and appropriate action taken. Evidence: The home has a comprehensive Complaints Policy and Procedure which is included in the Service User Guide and it is well publicised in the home and to the visitors and residents. There have been no complaints since the last inspection. There are regular Residents and Relatives Meetings and minutes are taken. The home manager will take immediate action to resolve any issues raised before they escalate into a written complaint. These are well documented. All members of staff have received training on the Protection of Vulnerable Adults and the Hertfordshire Joint Safeguarding Procedure. They are aware of the WhistleBlowing Policy. There have been no safeguarding referrals since the last inspection. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that the management will continue to improve the environment and that appropriate facilities are provided to make the place homely, safe and comfortable for them. Evidence: The home has a rolling maintenance programme. Since the last inspection, the reception area, corridors, some bedrooms and the dining room have been redecorated. New dining room furniture has been purchased. The kitchen has been refurbished with new kitchen equipment installed. It was awarded three stars by the environment health officer in their recent visit. There is however more refurbishment work to be done to improve the facilities. The home manager confirmed that the existing shower room will be refurbished and it will include a shower seat, a wash basin and toilet facilities. The adjacent toilet has been designated as a staff toilet and the home manager is hoping to clear the spare room so as to use it temporarily as a staff room until a more permanent staff facility is provided. Generally the premises appeared clean and tidy. However, in the main building, there was an unpleasant odour in the corridor next to the sluice because of inadequate ventilation. The home manager has made arrangements for an extractor fan to be Care Homes for Older People Page 17 of 25 Evidence: fitted as soon as possible. The service has employed a part-time maintenance person who ensures that the surrounding grounds and the garden are well-maintained. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that the home has an effective staff team who will support them and can be confident that they are safeguarded by the homes robust Recruitment Policy and Procedures. Evidence: The home has an effective team of nurses and care workers who are supportive and caring towards the residents. The home manager is in the process of employing a laundry worker to assist with the laundry so that care staff can spend more time with the residents. The service has recently employed a deputy manager whose role includes medication auditing. The home manager said that at the present time one nurse is allocated per shift but reassured us that additional nurses will be deployed if the need should arise. The home manager herself prefers to be hands-on to get to know her staff and residents well. The training for nurses and their practice skills have been well maintained in line with the requirements of the registration body, the Nursing and Midwifery Council. Nurses recently undertook refresher courses on wound management and medication administration. All staff have had refresher courses recently on Safeguarding and Health and Safety. The home manager is arranging for all staff to have training on Dementia. The Healthcare Protection Agency provides training on Infection Control. All new staff have mandatory training in accordance with the Skills for Care Guidelines. Care Homes for Older People Page 19 of 25 Evidence: The home manager herself is an instructor on Moving and Handling and she provides this training for all the staff. The service has a robust recruitment and selection process and all new staff are vetted and they only commence working after clearance following the Criminal Record Bureau (CRB) and the Protection of Vulnerable Adults (POVA) checks. Two new staff records were examined and they were well maintained. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that the home is run in their best interest and that their health and safety are promoted and protected. Evidence: The standards of administration and management of the service are well maintained. The home manager is an experienced and qualified nurse who has worked in nursing and residential services including services specialising in dementia care. She has attained NVQ4 Registered managers Award since the last inspection and is also an instructor for Moving and Handling. The management ensures the health, safety and welfare of the residents. All records for the protection of residents and all servicing records have been kept updated. The staff records showed that the staff are appropriately supervised and that there is an annual appraisal. The service is not involved in the residents personal finances. The provider carries out an annual quality assurance and monitoring survey. This Care Homes for Older People Page 21 of 25 Evidence: includes written questionnaire feedback from residents, relatives and others. In addition, senior management conducts a monthly visit and produce a monthly report as required by legislation. The Annual Quality Assurance and Assessment (AQAA) forms issued by us were received on time for this inspection. The information provided was detailed and informative and it was included in this report. The home manager confirmed that in their recent surveys feedback received included: Great appreciation for the friendly and considerate manner shown. The staff are all very helpful and respectful. My (relative) is always very well cared for. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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