Care Home: Dauntsey House Care Ltd

What the care home does well There is a clear admission procedure in place. People are encouraged to visit the home before making a decision to move in, enabling successful placements. People have good access to health care provision. Clear systems are in place to manage medication administration, which minimises the risk of error. Regular medication reviews take place. People are able to choose their preferred routines and spend their time as they wish. Important relationships are supported. The meals are good and based on variety, fresh produce and people`s preferences. The home is comfortable, homely and well-maintained. Bedrooms are personalised with people`s own furniture, pictures and ornaments. There is a large, well maintained garden with various seating areas. People are consulted on a regular basis and are clear about raising their concerns. Any concern is addressed immediately with an emphasis on being satisfactorily resolved. Clear focus is given to regular, on going staff training so that staff have the skills to meet people`s needs. An ordered approach is given to health and safety systems to ensure people`s well being. Fire safety is well managed. What has improved since the last inspection? The environment has been enhanced with new carpets and redecoration in the entrance hall, downstairs corridors and the lounge. New furniture and curtains have been purchased for the lounge. A stair lift has been installed and a mechanical device has been fitted to the office door to ensure it can be safely propped open. People now have greater opportunities for social activity provision. A wider range of activity both in house and within the community has been developed. Designated activity hours are now in place throughout the week. A new nutritional assessment tool has been introduced following staff training in nutrition. An additional snack such as a sandwich is now offered at 9pm with a hot drink. Staff have received adult protection training and the local safeguarding procedures have been discussed individually with staff. A domestic has been employed, which takes some of the cleaning responsibilities away from care staff.The standard of `high` cleaning is much improved. What the care home could do better: While care plans show details of people`s basic care needs, greater detail is needed to clarify the support people need. Staff appear aware of people`s needs yet this information should form part of the care plan and not be `unwritten.` All care documentation must be reviewed as a whole to ensure that conflicting information within documents is not apparent. In the event of a Community Nurse providing intervention, the person`s care plan must demonstrate the support being given. Staff should not solely rely on the Community Nursing notes. Documentation should show the size, colour and location of any wound, for monitoring purposes. All care staff should contribute to the written recording of information within people`s daily records. Information should not be transferred by another person onto the daily records. Whoever is involved in a person`s support, should record their interventions themselves. The need for each person to have care charts should be reviewed. If the chart is deemed necessary, it must be fully completed and evaluated. The condition of the commodes must be checked. Any commodes that are old and difficult to keep clean must be replaced. Consideration should be given to a sluicing facility within the home. The existing practice of soaking soiled linen before laundering should be stopped. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Dauntsey House Care Ltd Dauntsey House Care Ltd 9 Church Street West Lavington Devizes Wiltshire SN10 4LB     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: Alison Duffy     Date: 0 7 0 5 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 34 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 34 Information about the care home Name of care home: Address: Dauntsey House Care Ltd 9 Church Street Dauntsey House Care Ltd West Lavington Devizes Wiltshire SN10 4LB 01380812340 01380812340 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Avenue Care (Fareham) Limited care home 20 Number of places (if applicable): Under 65 Over 65 4 16 mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 0 Dauntsey House is a residential care home that is registered to care for twenty older people. The home does not provide intermediate or nursing care. Any nursing task would need to be undertaken by the Community Nursing Service. Dauntsey House is located within the village of West Lavington approximately six miles from Devizes. The building has been a care home for over forty years. There are eighteen single rooms and one twin. The twin room is often used as a single room and has an en-suite toilet and shower. People are able to furnish their room as they wish and therefore all are individual in style. Rooms are on the ground and first floor. There is a passenger lift. The home has a main lounge, conservatory and a separate dining room. Additional seating is also available within the main entrance hall. There are large, well-maintained gardens providing various seating areas. The Registered Provider is Avenue Care Care Homes for Older People Page 4 of 34 Brief description of the care home (Fareham) Limited and the Director is Mr Stephen Press. Mr Press is also responsible for another care home and therefore spends his time between the two services. The Registered Manager is Mrs Mair Rowles. Staffing levels are maintained at two or three in the morning and two in the evening. There is sometimes an additional 10am-6pm shift. At night there are two waking night staff. Care Homes for Older People Page 5 of 34 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 key inspection took place over a period of two days. The first day was on the 6th May between 2pm and 6pm. The second day was on the 7th May between 11.30am and 5.30pm. Mrs Rowles was available throughout the inspection and received feedback. We met with people who use the service within communal areas and in private, in their bedrooms. We spoke to three staff members. We toured the accommodation and saw people having lunch. We looked at the medication systems and at care-planning information, staff training records and recruitment documentation. We also looked at documentation in relation to health and safety, complaints and quality assurance. Care Homes for Older People Page 6 of 34 We sent the home surveys, for people to complete if they wanted to. We also sent the home surveys to be distributed to staff and health care professionals. Feedback is reported upon within this report. We looked at all the information that we have received about the home since the last inspection. We sent Mrs Rowles an Annual Quality Assurance Assessment (AQAA) to complete. This is a self assessment which identifies how well the service is performing. It also gives information about the services future plans. Information from the AQAA is detailed within this report. All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the experiences of people using the service. The last inspection of this service took place on the 2nd and 9th May 2007. What the care home does well: What has improved since the last inspection? The environment has been enhanced with new carpets and redecoration in the entrance hall, downstairs corridors and the lounge. New furniture and curtains have been purchased for the lounge. A stair lift has been installed and a mechanical device has been fitted to the office door to ensure it can be safely propped open. People now have greater opportunities for social activity provision. A wider range of activity both in house and within the community has been developed. Designated activity hours are now in place throughout the week. A new nutritional assessment tool has been introduced following staff training in nutrition. An additional snack such as a sandwich is now offered at 9pm with a hot drink. Staff have received adult protection training and the local safeguarding procedures have been discussed individually with staff. A domestic has been employed, which takes some of the cleaning responsibilities away from care staff. Care Homes for Older People Page 8 of 34 The standard of high cleaning is much improved. 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 printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 34 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 34 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 are assessed before being offered a service so that they can be assured the home will meet their needs. Evidence: Mrs Rowles told us that there have been no changes to the homes admission processes. People who are planning to use the service are encouraged to visit the home before making their decision to move in. People are able to look around the home and talk to people currently using the service and members of staff. They are able to have a meal if they wish. Some people choose to have a short break at the home to see if they like what is provided. Mrs Rowles said that in her experience, this sometimes makes the decision of choosing the home easier. A number of people have been admitted to the home since our last inspection. Mrs Rowles told us that she continues to assess people in their own homes before a Care Homes for Older People Page 11 of 34 Evidence: placement is agreed. She said she tries to gain as much information as possible about the person. This ensures that the home is suitable to meet the persons needs. One person told us I liked what I saw as soon as I got here. Within the AQAA, a clear admission process was confirmed. In addition to the homes own assessment process, the AQAA states that a copy of any placing authority assessment is also gained before a placement is offered. Each person is able to have a trial period in order to give them time to make their decision of becoming a permanent resident. Within surveys, people told us that they received sufficient information about the home before they moved in. One person said I spent two weeks at Dauntsey House, before I came in for good. We looked at the written assessments of two people who had recently moved in. The information contained basic information about peoples care needs. Mrs Rowles told us that sometimes it is difficult to gain detailed information, especially when people are nervous. She said further information is always gained when the person begins living at the home. Staff told us that they are informed about the persons needs following Mrs Rowles initial assessment visit. They said they are kept up to date with information within handovers. They are also able to read the persons documented assessment and their care plan. Care Homes for Older People Page 12 of 34 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. Peoples basic care needs are reflected in their care plan yet greater clarity would ensure staff have more accurate information about the support people need. Peoples health care needs are met through good access to health care professionals. Systems to manage peoples medication are clear and therefore minimise the risk of potential error. Evidence: People told us that they were very happy with the care they received. One person said they will do anything for you. The girls are lovely, very friendly, always smiling. Another person said they always come very quickly if you need them. They never make you feel you are a nuisance. I get on very well with all of them. Within surveys, people also told us that they were happy with the care they received. One person however, commented that they would like a little more support to go to sleep at night. Another person said I am very well cared for and my needs satisfied. Care Homes for Older People Page 13 of 34 Evidence: Staff told us that each person has a care plan in place. They said these are updated on a monthly basis or as changes occur. They said that people are encouraged to be involved in the development of their plan. Within the AQAA, we saw that care planning was identified as an area to be developed over the next 12 months. We looked at three care plans in detail. We saw that a long term needs assessment had been completed. This showed details of the persons overall care needs. Short term care plans were also in place. These showed specific short term needs such as the administration of antibiotics, the application of a topical cream or the management of a sore area of skin. Whilst peoples basic care needs were identified within their plan, we advised greater detail in some areas. For example, full dentures but doesnt wear them was stated. We suggested that the impact of this, including the foods the person could and could not eat be stated. Another plan stated, in relation to skin integrity, s/he can become sore on sacrum area, one carer to assist and observe daily. We said this instruction needed to be clearer so that staff knew exactly, what support the person needed. We saw that terms such as turn regularly and assist with were used within documentation. We talked to staff about the assistance some people required. They were clear about the persons needs. We said that specific factual information should be used within documentation rather than subjective terminology. We saw within one persons care plan that they had been put on an hourly food/fluid chart. We said the reasons for this should be clearly stated. While the charts had been completed, they had not been evaluated within the care plan. Further in the plan, documentation stated the person was at risk of a urinary tract infection. The plan said staff to encourage fluids daily. There was no reference to the fluid chart, the frequency of drinks or a satisfactory amount the person should receive. We advised that further detail be identified. The persons preferred drinks should also be included. There was good detail about the management of antibiotics and how the person needed to finish the course. Other aspects such as the removal of facial hair and the management of a head wound were well recorded. We saw that each care plan had a section about key worker input. This had not been regularly completed. There was a section about peoples social interests. We saw that people were encouraged to continue with past hobbies if they wished to do so. Peoples preferred daily routines were stated within their care plan yet these generally identified spending time in the lounge. We said that this information could be expanded upon to include aspects such as preferred times of getting up, reading the newspaper or watching the news, for example. Care Homes for Older People Page 14 of 34 Evidence: While the care plans were being reviewed on a monthly basis, we said that each document must be evaluated against the care plan. For example, within one plan, there was conflicting information although each area had recently been reviewed. There were personal care charts in place. These enabled staff to record when a person had a bath or a strip wash. Another chart recorded the frequency of peoples bowel movements. We asked if this chart was needed as in one instance, it had not been fully completed and was therefore not fulfilling its purpose. Mrs Rowles told us that she would remind senior staff of the importance of accurate documentation. We saw that people have good access to health care professionals, when needed. Within daily records, we saw that if a person was found to be unwell, a GP would be called. Mrs Rowles told us that if a person had more than two falls in quick succession, medical advice would always be sought. A GP would also be called if a person had a fall, which was not witnessed. People told us that they could see their GP when they needed to. One person said I just ask if I feel I need to see someone. They are very good at calling the doctor. They come up to my room in private, which is nice. Mrs Rowles told us that one GP practice in particular was very good at reviewing peoples medication. We saw that people had manual handling, tissue viability, nutritional and fall risk assessments in place. Mrs Rowles told us that work regarding peoples nutritional needs had been improved upon, in response to recent staff training in nutrition. People had special pressure relieving cushions and mattresses, as required, to minimise the risk of developing a pressure sore. In the event of a sore area of skin, documentation showed what topical creams were to be applied. We advised that details of the wound including its size and location be stated for monitoring purposes. Within one plan, we saw that a Community Nurse was regularly visiting to dress a persons wound. There were records of the visits yet no details of the actual wound and its management within the homes records. We said that staff should not rely on the Community Nursing notes. Any wound and its management should be clearly stated within the persons care plan. We saw that people had access to a visiting chiropodist, dentist and optician. Mrs Rowles told us that referrals to specialised services such as physiotherapy, occupational therapy and the falls clinic, were made as required. Within the AQAA, we saw that a dental hygienist was being sought. A dietetic advisor was also planning to visit. We saw a poster advertising Hearing Screening. Mrs Rowles told us that this was a new service. She said people received very good support to meet their health care needs. Within surveys, people confirmed this. They told us they were happy with the medical care they received. One person said the doctor is always available when I Care Homes for Older People Page 15 of 34 Evidence: need him. Within their survey, a GP told us good homely personal care delivered with emphasis on maintaining patient independence/mobility. Within the office, there were certificates showing the recent medication training staff had completed. Mrs Rowles told us that all staff administering medication to people have had up to date medication training. We saw that a monitored dosage system continues to be used to administer medication to people. Medication policies and procedures were readily available for staff reference. The medication records were satisfactorily signed to show the administration of each medication. Records were maintained in relation to the receipt and disposal of medicines. We saw that any hand written medication administration instruction had been signed, dated and countersigned by another member of staff. In the event of an as required medication such as pain relief, staff had recorded this separately on the back of the record. We suggested that the reason for the administration be identified for monitoring purposes. All medication was satisfactorily stored. People told us that staff respected their privacy and dignity. We heard staff knock on doors and wait to be asked in before entering peoples rooms. All interactions were respectful. We saw that staff used some peoples first names while others were addressed with their title. One member of staff told us I fully respect the people living here. They have so much experience and knowledge that I am privileged to work with them. We saw one member of staff interact well with a person who was visually impaired. They clearly explained the persons meal and where each item was on the persons plate. With a survey, a GP stated that the service always respects individuals privacy and dignity. In order to promote peoples dignity, we saw that items such as incontinence pads and disposable protective clothing were generally discreetly stored. There was one box of disposable gloves in the corridor yet these were later removed. In one room however, there was a small handwritten notice on a wardrobe door instructing staff to ensure discreet storage. We advised this notice be removed as it drew attention to something which was aiming to be discreet. Within surveys, one staff member told us Service users are treated as an individual and their views, beliefs are respected. Communication between staff is very good and the service users are discussed during handover with care and respect. Another staff member said I have the right support, experience and knowledge to respect the diversity and different cultures and values and to promote equal opportunities for service users. Care Homes for Older People Page 16 of 34 Care Homes for Older People Page 17 of 34 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 are benefiting from increased social activity both in house and within the local community. People are able to have visitors when they wish. People are provided with a range of meals that they enjoy. Evidence: During our visit we saw that people listened to music and later played quoits. One person worked on a jigsaw puzzle. Another person went out with their relatives. One person spent time in their room. They told us they liked doing this. They said they liked their own company and enjoyed the peace and quiet. They said staff respected their wishes. Another person told us they liked to sit in the entrance hall, as they could see people coming and going. Staff told us that social activity provision had recently improved. A designated staff member is allocated the role of doing an activity with people on each shift. We saw a record of the activities people were involved with at a weekend. Staff told us that people continue to enjoy the cinema evening when an old film is watched. A physiotherapist visits the home on a weekly basis to do an exercise class. We saw that a form of outside entertainment is arranged on a monthly basis. A group of school Care Homes for Older People Page 18 of 34 Evidence: children also regularly visit to sing and spend time with people. Within the AQAA it states entertainment is held in the home. Singing, quizzes, parties, arts and crafts, bingo, card games, knitting, flower arranging and music and movement sessions. Residents are encouraged to help with housekeeping tasks such as laying the tables and baking. We saw that there are plans to develop outside activities such as container gardening. A further development was stated as looking to liaise with local groups and historical societies and include in the care plan peoples goals and aspirations that they may wish to achieve whilst in the home. Within surveys, people told us that they were happy with the social activity provision offered. One person said the Home provides excellent support for all my pleasure activities. Another person said I enjoy sitting in the conservatory listening to the music. The garden is excellent and I enjoy going out there for a walk. A staff member told us within their survey, we provide a homely environment for both residents and staff. We have good entertainment and activities. Another staff member said regular entertainment is provided by staff as well as professionals i.e. singer, physio. Staff told us that people are now supported to go out more. With the better weather approaching, further trips are being organised. Photographs of events have been displayed in the entrance area of the home. We saw that strawberry picking was planned. A trip to Longleat for a picnic was also advertised. People told us that they could follow their preferred daily routines. They could get up when they wanted to and go to bed at a time of their choice. People said they could spend time in their rooms and have visitors when they wanted. Within surveys, people told us that they were happy with the food they received. One person said I look forward to meal times, they are excellent. Staff also commented about food within their surveys. They said all meals are home cooked and of a very high quality. There are never any complaints and food is always well presented and options are available for those who wish to have something else. We saw that the menus were displayed on the notice board in the entrance hall. The menus showed a variety of traditional meals. We saw people having lunch. The meal looked appetizing and nicely presented. The dining room was quiet and people were not rushed with their meal. People told us that the food was very good. Specific comments included the food is excellent, its always very good. I look forward to my meals and its like being in a hotel. The food is the best thing about the place. The catering manager told us that all food is fresh and cooked from scratch. She spoke of the importance of food in terms of health and well being and also in terms of a social Care Homes for Older People Page 19 of 34 Evidence: event. She said vegetarian food is worked into the menu. This is to give people choice but also to enable a person who is vegetarian to have what is on the menu rather than feel different due to their dietary needs. The catering manager told us that she had recently completed refresher food hygiene and nutrition training. Staff told us that it had been identified that there was a long time between the evening meal and breakfast time. As a result, people now have the choice of a sandwich as well as their usual biscuit, with their evening drink. Ms Rowles told us that fresh water is available when required in the lounge. However, hot drinks are now served in the dining room. Mrs Rowles told us that people are now spending more time socialising with each other, when having a coffee. She said some peoples mobility has also improved since using the dining room more. Care Homes for Older People Page 20 of 34 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 are aware of how to make a complaint and benefit from any issues raised being dealt with quickly and efficiently. Greater focus upon adult protection has provided better safeguards for people. Evidence: We saw that a copy of the homes complaint procedure was displayed on the notice board in the main entrance hall by the visitors signing in book. Surveys requesting views about service provision were also readily available. Within discussion, it was evident that Mrs Rowles aims to immediately resolve any areas of concern. Within the AQAA, it stated the manager gives residents individual time to enable them to discuss any concerns they may have about the home/staff/environment. A record of issues addressed on a day to day basis is maintained. Shortly before the inspection, we received a concern about staff not answering the telephone. The concern was sent to Mrs Rowles to deal with. We saw that the concern had been addressed. People told us that they would tell a member of staff or Mair [Mrs Rowles] if they had a concern. One person said it wouldnt come to that. You could easily just discuss things Care Homes for Older People Page 21 of 34 Evidence: and it would be resolved. You wouldnt need to make a complaint. Another person said a complaint, no, if anyone complained here, they would just be miserable. Staff told us they would inform Mair [Mrs Rowles] if a person made a complaint to them. They said she would discuss the concern and investigate it accordingly. Within surveys, people told us that they knew how to make a complaint. One person said I go to Mrs Rowles or whoever is deputising for her. Another person said I would go to the manager to make a complaint. Staff told us that they had received training in adult protection. One staff member spoke of the vulnerability of people. They were aware of what to do if an allegation of abuse was made to them. They also were aware of the local safeguarding adults team. Mrs Rowles told us that staff had undertaken abuse training. They had also completed questionnaires and had watched adult protection training DVDs. Some staff had completed adult protection training as part of their National Vocational Qualification (NVQ.) We told Mrs Rowles that members of the safeguarding team were happy to provide staff training in adult protection. Mrs Rowles said she would look into arranging this. Mrs Rowles told us that all staff have a copy of the Wiltshire and Swindon local adult protection policies, No Secrets. She said she goes through the document with staff to ensure their understanding. We saw within the AQAA that more staff training in adult protection was planned. Care Homes for Older People Page 22 of 34 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 live in an environment that is clean, comfortable and well maintained. On going developments are further enhancing the environment for people. Evidence: Peoples bedrooms are located on the ground and first floor. A passenger lift is available to give easier access. A stair lift has also been purchased for the back stairs. We saw that peoples bedrooms contained personal items such as furniture, ornaments and pictures. One person told us I just love my room. Ive got everything I want. I spend a lot of time in here. Another person told us they let you bring what you like into your room when you move in, as long as its in a reasonable condition and you can fit it in. Communal areas consist of a spacious lounge, a conservatory and a dining room. There is additional seating in the entrance hall. We saw that the lounge, entrance area and main downstairs corridor had been redecorated. New carpets had been fitted and the curtains had been replaced. All furnishings were of a good quality. Mrs Rowles told us that there is an ongoing refurbishment programme of the home. The garden is also being further landscaped. The catering manager told us that there are plans to change the position of the laundry and the food store. Mrs Rowles confirmed this and said that the improvements would be much improved. We saw staff take soiled laundry to the Care Homes for Older People Page 23 of 34 Evidence: laundry room via the front door and the garden. Staff confirmed this route was always taken to avoid going through the kitchen. Due to the planned changes to the position of the laundry room, the facilities were not assessed on this visit. We asked people about the laundry service they received. People told us that their laundry was returned quickly. One person said they do a wonderful job. I put it out for them to take and before you can turn around, its back again. At the last inspection, we recommended that a mechanical device to safely hold the office door open, be installed. The device would enable the door to be automatically closed in the event of a fire. We saw that this had been addressed. Within the AQAA, a number of improvements to the home were identified. These included new patio areas and garden furniture, a new washing machine and light fittings in the corridor and lounge and sit on weighing scales. The AQAA confirmed that the kitchen had been redecorated, the cellar stairs replaced and carpets had been fitted to some peoples bedrooms. A quality environment checklist had also been developed. Mrs Rowles said this was to ensure the home is always kept clean and safe, with areas free from clutter and hazards. At the last inspection, we said that the home was generally clean yet greater attention should be given to high cleaning. We saw that this had been addressed. Mrs Rowles told us that a cleaner had also been employed, which assisted maintaining a good standard of cleanliness. Within some rooms, we saw that the commodes were showing their age and were difficult to keep clean. We advised that these be replaced. We saw that the underneath of a bath seat was becoming rusted. Mrs Rowles told us that this had been identified and a new seat was on order. We saw that new anti-bacterial sprays to minimise the risk of infection were in place. All communal bathrooms and toilets had hand pump soap dispensers yet ordinary hand towels. We advised the use of paper towels. Mrs Rowles told us that this had been suggested yet people using the service did not want them. In response, Mrs Rowles said that staff ensure the towels are washed daily. Within two bathrooms we saw containers, which were used for soaking soiled linen as there are no sluicing facilities. We said that soaking soiled linen, conflicts with infection control guidance and should be avoided. We advised that the installation of a sluicing facility be considered. Within surveys, people told us that they were happy with the standard of the cleanliness within the home. Care Homes for Older People Page 24 of 34 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 benefit from a staff team who are kept up to date through access to regular training. A robust recruitment procedure is in place to protect people from staff who are unsuitable to work with vulnerable people. Evidence: Mrs Rowles told us that there have been a number of staff changes since the last inspection. Recruitment has however been successful and the home is now fully staffed. Staffing levels are maintained at generally three staff on duty until 6pm. At 6pm, staffing levels are reduced to two. At night there are two waking night staff. Staff told us that staffing levels were generally satisfactory to meet peoples needs. We saw that care staff remain responsible for preparing and serving the evening meal. One member of staff said getting tea is not a problem. Its fine by me. Since the last inspection, additional hours have been allocated to activity provision. A domestic has also been employed. The staffing roster confirmed the staffing levels Mrs Rowles told us about. We saw that peoples responsibilities within the each shift were highlighted on the staffing roster. This included tasks such as shift leading, administering medication and undertaking a social activity. Mrs Rowles told us that nominating staff to do certain tasks ensured greater organisation and accountability. Care Homes for Older People Page 25 of 34 Evidence: People using the service were very complimentary about the staff. Specific comments included they are all so nice. They would do anything for you, they are all lovely. You wont get better anywhere and they respect you for who you are. Mrs Rowles told us that she felt the staff team were fantastic. She said they are all very loyal, hard working and conscientious. They really care about people and are concerned for them. Within surveys, people told us that staff were available when they needed them. They said that staff listened and acted upon what they said. Specific comments included I often feel that the staff at all levels go out of their way to help me and be nice, I am contented and people are helpful and the staff are kind and helpful. Within part of the homes quality assurance system, a GP had recorded I have always had the impression that the staff are a concerned and caring team attempting to obtain the optimum outcome for their residents. Staff told us that training opportunities within the home were very good. One staff said we have recently done manual handling, fire training and abuse. There is always something going on. Mair [Mrs Rowles] is very good at keeping us up to date. Mrs Rowles told us that she felt staff training was essential for a good staff team. She said you cant get too much training. In order to ensure variety, Mrs Rowles said she uses a range of external trainers and does in house training. She said she also does one-toone training with staff to ensure full understanding. Within the training matrix, we saw that a monthly training session is generally undertaken. We saw that sensory impairment training was booked for the following month. A dietetic advisor was also planned. Within the AQAA, we saw that Mrs Rowles is aiming for each member of staff to have a National Vocational Qualification (NVQ.) At present, there are 15 care staff. 12 have NVQ level 2. Within surveys, staff told us that they have training relevant to their role. One staff member said Yes, I receive training that helps me to understand and meet individual needs of service users. Another staff member said I feel that all the staff work well as a team. This creates a happy atmosphere and working environment. We are constantly training and therefore I think we are all providing a good service to the very best of our abilities. Within discussion, Mrs Rowles told us that staff record any observation or interventions with people within a small pocket notebook. They then give these in at the end of their shift. Senior staff transfer the information onto the care plans. We said this system Care Homes for Older People Page 26 of 34 Evidence: should be reviewed as staff were writing information second hand and could not be assured it was accurate. Mrs Rowles told us that the system was used so that mistakes in recording were not made. We advised that staff be given the responsibility of recording information although also received training to do so competently. Mrs Rowles agreed this would be undertaken. Mrs Rowles told us that each prospective staff member is expected to complete a fully supervised working shift before they continue with their employment application. Mrs Rowles said this enables the person to decide if they like the home. The persons attitude and communication skills are also assessed to ensure they will fit in with the team and work well with people using the service. If this period is successful, they have a formal interview. Checks such as three references and a POVAFirst and Criminal Records Bureau (CRB) check are undertaken. This ensures their suitability to work with vulnerable people. We said that care must be taken to ensure the person is fully supervised at all times during their initial visit. The tasks the person undertakes should also be given careful consideration. We looked at the recruitment documentation of the two most recently appointed staff. We saw that all checks were in place. However, one reference was different than that stated on the persons application form. Another stated Dear Sirs rather than Mrs Rowles. While these aspects were noted, each person had two other satisfactory references on file. Mrs Rowles had recorded the date the reference request letter had been sent, on the application form. We advised that a copy of the reference letter be kept on file to ensure a clear audit trail. Care Homes for Older People Page 27 of 34 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 benefit from a manager who is committed to providing a good standard of care. People are readily encouraged to give their views. Peoples well being is promoted through organized health and safety systems. Evidence: Mrs Rowles has been the registered manager of Dauntsey House for approximately seven years. She has worked at the home since 1992. Mrs Rowles has NVQ levels 2, 3 and 4 and also has the Registered Managers Award. Mrs Rowles told us that she has recently completed training in employment law, food hygiene and deprivation of liberty and has attended a health and safety seminar. She said she aims to keep up to date with professional guidance and legislation through reading publications. Within surveys, staff were positive about the management of the home. One staff member said we have a good leader manager who tirelessly keeps the home in good repair, staff happy, residents feel safe and happy in a warm, safe, clean environment. Care Homes for Older People Page 28 of 34 Evidence: Another staff member said I know that if there was anything that could be done to improve anything at all, then our manager would do it immediately. Further comments included I meet with my manager, Mrs Rowles daily and she gives a lot of support and advice and discusses with me how I am working and supports the staff well and provides help and training when needed. Mrs Rowles meets with Mr Press on a weekly basis to discuss service provision. Records of the meetings are maintained. Mrs Rowles told us that the following meeting was due to include the development of an action plan. The plan was due to be coordinated from feedback received from surveys, which had been sent to people, to gain their views about the service. Mrs Rowles showed us the surveys. All gave positive feedback. Mrs Rowles told us that as part of the quality assurance system, a range of audits are undertaken. These cover for example, the standard of the environment, the medication systems and food. Mrs Rowles told us that completing various audits had enabled a good standard to be maintained. One person wanted to see the brass within the home cleaned more often. Mrs Rowles told us that this had been addressed. We saw that regular residents meetings are held. A record of each meeting is maintained and available on the notice board. One person told us they really do listen and encourage you to have your say. There is no need for anyone to grumble, as things can easily be sorted out, if need be. Another person said they ask you if you want this or you want that, then its what about this, would you like that? The person laughed and said they involve you alright. Mrs Rowles told us that the home does not hold any personal monies for people on their behalf. People are encouraged to be responsible for their own financial affairs. Alternatively, family members or chosen representatives are encouraged to give support, as required. Mrs Rowles showed us a file containing weekly health and safety environmental checks. We saw that hot water temperature regulators, room temperatures and fire safety systems were checked on a Monday of each week. All water supplies in unoccupied rooms were run to minimize the risk of legionella. An external contractor had also checked for legionella. We saw that all equipment such as portable electrical appliances and the passenger lift had been checked as required. Mrs Rowles said that regular checks of the environment identify any potential health and safety risks at an early stage. This enables the hazard to be rectified at the earliest opportunity. Documentation shows that a record of all accidents is maintained. Any trends in Care Homes for Older People Page 29 of 34 Evidence: aspects such as falls are identified. Measures are applied to minimise further occurrences. A number of risk assessments are in place. These include an assessment for each persons room. We saw that the fire risk assessment and the fire evacuation procedures had recently been reviewed. The catering manager told us that the home had recently had a kitchen inspection by the District Council. They were awarded four stars with no requirements made. Care Homes for Older People Page 30 of 34 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 31 of 34 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 1 7 12 You must ensure that staff do not rely on the Community Nursing notes but have full, documented evidence within the persons care plan of the intervention being given. So that staff are clear about the support needed to meet the persons needs. 30/06/2009 2 7 12 You must ensure that when reviewing documentation, each aspect of the care plan corresponds and shows accurate information. So that staff have accurate information when supporting people. 30/06/2009 3 7 12 You must ensure that if care 30/06/2009 charts are assessed as being required, they must be fully completed and evaluated. So that accurate information can be used when monitoring a care need. Care Homes for Older People Page 32 of 34 4 26 13 You must undertake a review of all commodes and replace those which are old and difficult to keep clean. So that the risk of infection is minimised. 30/07/2009 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 1 2 3 7 7 7 You should ensure the key worker section of the care plan is used to its full potential. You should ensure that care plans are of sufficient detail so that staff are clear about the support the person requires. You should ensure that staff avoid using subjective terminology such as regularly and assist with so that all written accounts are clear and factual. You should ensure that any wound is fully documented and its size, colour and location are clearly identified for monitoring purposes. You should give consideration to a sluicing facility within the home and avoid leaving soiled laundry to soak, before laundering. 4 8 5 26 Care Homes for Older People Page 33 of 34 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. 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