Care Home: Dene Court

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What the care home does well Staff are friendly and attentive to people who use the service. Dene Court has a homely and domestic feel. People who have received end of life care at the home were, according to the lead district nurse: "Looked after exceptionally well". What the care home could do better: The laundry door must not be held open and therefore pose a risk should there be a fire. We made an Immediate Requirement that this unsafe practice be stopped. Staff should have liquid soap and hand towels available to them to wash their hands in people`s rooms. People providing personal or nursing care must be able to wash their hands effectively where and when ever that care is delivered.Medicines should only be administered from a container (trolley) with sufficient space for all medicines to be locked away in an emergency during a medicines administration round. We would expect the home to provide such a trolley to comply with regulations relating to the safe handling of medicines. Records required by regulation for the protection of people, such as when staff check to see if they are alright during the night and accident records, must be maintained, up to date and accurate. There should be more effective methods for management and staff to communicate important information, so they can be very confident all that all necessary information is passed on. There will also be an audit trail for them to check what is happening in the home. Random inspection report Care homes for older people Name: Address: Dene Court Butts Road Heavitree Exeter Devon EX2 5HU two star good service The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Anita Sutcliffe Date: 2 1 0 1 2 0 1 0 Information about the care home Name of care home: Address: Dene Court Butts Road Heavitree Exeter Devon EX2 5HU 01392274651 01392274651 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) : Mr John Willis Hall care home 31 Number of places (if applicable): Under 65 Over 65 31 31 31 31 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Conditions of registration: Date of last inspection Brief description of the care home 0 0 0 0 Dene Court is registered to provide personal care for up to 31 older residents. However the home normally has a maximum of 29 residents as only one registered double room is used as such. The home is situated in a residential area of Heavitree, in Exeter. It is close to some local shops and public transport is available into the centre of the city. Care Homes for Older People Page 2 of 10 Brief description of the care home There are a variety of communal areas within the home. The home has areas of garden which residents enjoy sitting in during the fine weather. There is some parking available. Fees at the time of the last key inspection were £372 - £420 each week. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at /www.oft.gov.uk . The reports produced by CQC are available on request from the office. Care Homes for Older People Page 3 of 10 What we found: A safeguarding alert was made following the admission of a resident from Dene Court to Devon and Exeter hospital as they were found to have hypothermia and subsequently died. We decided to visit the home to look at the heating arrangements and whether people had any concerns about the temperature at the home. We made one unannounced visit to the home on Thursday 21st. January spending two and a half hours there. We spoke with five staff, the acting manager, three people who use the service and a person visiting to provide nursing care on behalf of the Primary Health Care Trust. We then rang the lead community nurse, who has good knowledge of the home, and the business organisation which is contracted to service and maintain the homes heating system. We visited all parts of the building. We saw that staff are attentive to people and they appear to be provided in sufficient numbers to meet the needs of the people who use the service. The lead district nurse told us that two people who have recently received end of life care were: Looked after exceptionally well. He also said that the home makes appropriately contact with the district nursing team; neither too infrequently or when it is not necessary. We found the home was warm throughout. Staff, people who use the service and nurses who have recently visited the home every day, told us that the home is never cold, it is, in fact, often very hot. One person told us how she likes her window to be held open because of the heat and when we visited her room it was open as she had said. The acting manager told us that one of the three boilers which supplies the heating system had failed in January, due to customer error but was adamant that the home had not become cold. We confirmed that there is a contract to service and maintain the heating system in a safe and working state. The acting manager told us that she has the authorisation to arrange any servicing or maintenance necessary and staff confirmed that any maintenance problems are dealt with promptly. We did not find any evidence that the home had become cold when the boiler had been faulty. We looked at the records pertaining to the person whose death led to the safeguarding alert. Her plan of care was last updated July 2009 and was not currently up to date, in that it did not include any information about recent changes in her behaviour. However, staff were aware of the changes in her behaviour. We also confirmed that the home has sought health care advice relating to her physical and mental health care needs. We looked at how night staff are informed about peoples needs and how they are to meet those need. This would include whether or not to visit them during the night hours. There is a verbal hand over of information between staff and any other information may be written; a note was retrieved from the bin to show us. The home is unable to provide any evidence that the person who died was visited throughout the night, as was expected, or how long she may have lain on the floor before being found there. Care Homes for Older People Page 4 of 10 We looked at records of accidents/incidents at the home. The accident/incident occurred on 18th January but, by 21st January no report had been made. We were told that this is because the staff on duty at the home have since been off duty. We saw that the last entry in the accident records was incomplete. There was a name, date and time but no event recorded. The acting manager was unsure why this would be. One accident recorded a cut to a persons head following a fall. The Commission expect that they should have been notification of the accident, but could not judge how serious it had been. When we toured the home we saw that it was homely and people appeared to be comfortable. However, we found that somebody had positioned a broom stick to prevent closure of the laundry door. This meant that any fire occurring would not be held back, but would spread into the corridor and living spaces. We made an Immediate Requirement that this unsafe practice be stopped. The acting manger did not condone what had been done but said it was because the battery in the Door Guard device had run out; she replaced it immediately. We saw that staff do not have liquid soap and hand towels available to them to wash their hands whilst still in peoples rooms. District nurses and staff confirmed that this is the case. People providing personal or nursing care must be able to wash their hands effectively where and when ever that care is delivered. We saw that many of the beds in the home are divan and the district nurses confirmed that all care, including some end of life care, is provided on these beds. This is unlikely to be acceptable for the reasons of hygiene and safe moving and handling of people. They also expressed concerns about trip hazards and occasional odour in the building. We saw staff administering medicines from an open trolley. The Royal Pharmaceutical Society guidelines state that a trolley used when administering medicines must have sufficient capacity for all medicines to be locked away in an emergency during the medicines administration round. It is required that the home provide such a trolley so as to comply with regulations relating to the safe handling of medicines. What the care home does well: What they could do better: The laundry door must not be held open and therefore pose a risk should there be a fire. We made an Immediate Requirement that this unsafe practice be stopped. Staff should have liquid soap and hand towels available to them to wash their hands in peoples rooms. People providing personal or nursing care must be able to wash their hands effectively where and when ever that care is delivered. Care Homes for Older People Page 5 of 10 Medicines should only be administered from a container (trolley) with sufficient space for all medicines to be locked away in an emergency during a medicines administration round. We would expect the home to provide such a trolley to comply with regulations relating to the safe handling of medicines. Records required by regulation for the protection of people, such as when staff check to see if they are alright during the night and accident records, must be maintained, up to date and accurate. There should be more effective methods for management and staff to communicate important information, so they can be very confident all that all necessary information is passed on. There will also be an audit trail for them to check what is happening in the home. 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 2. Care Homes for Older People Page 6 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 18 37 The home must notify the Commission of all events that are listed in this regulation 31/03/2008 Care Homes for Older People Page 7 of 10 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 1 38 13 There must not be any obstruction to the laundry door being closed. So that, should a fire occur in the laundry, it will be contained, not spread to other parts of the home. 23/01/2010 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 9 13 Lockable storage must be 30/04/2010 available for medicines whilst they are being administered. So they are secure should an emergency occur. 2 26 13 Staff, and visiting nurses, must be able to wash their hands hygienically, where ever personal or health care is provided, including peoples bedrooms. To this end there must be liquid soap and paper towels available. This will reduce the spread of microbs and therefore infection. 31/03/2010 3 37 17 Records must be up to date, including those of care delivered during the night 23/01/2010 Care Homes for Older People Page 8 of 10 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 hours and any accident/incident. For the protection of people who use the service and the efficient running of the home. 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 7 33 The home should ensure that peoples plan of care is kept current and a true record of their needs at all times. There should be a complete review of the way information is communicated within the home, leading to a system which is efficient and provides an audit trail of events. Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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