Care Home: Dent House Nursing Home

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What the care home does well Appropriate information about the Home is available to people who might come to live at the home, and the people helping them which allows them to decide whether the service is right for them. They all have a carefully worked out plan of care and these indicate that they are treated as individuals and their personal goals are being considered. The staff provide activities and services that are age-appropriate and valued, and these are worked out so that independence and the development of a broad range of skills are promoted. Good procedures for handling complaints and abuse are in place and these ensure that the people living at the home are fully protected. They live in a safe and well-maintained environment, which is furnished and decorated to a good standard. The staff team is a stable one with few changes since the home started operating. They are selected using well-established procedures and provided with a training programme that helps them work safely and professionally. The home is well managed and operated using good systems of administration and record keeping, and modern principles and thinking ensure that the best interests of the people living there are maintained. What has improved since the last inspection? All of the requirements and recommendations made at the last inspection have been dealt with and this has resulted in improved systems for managing medicines and a safer working and living environment. What the care home could do better: No statutory requirements have been made as a result of this inspection and there are four good practice recommendations that relate to indirect aspects of care activities. CARE HOME ADULTS 18-65 Dent House Nursing Home 30 Chesterfield Road Matlock Derbyshire DE4 3DQ Lead Inspector Brian Marks Unannounced Inspection 17th April 2008 09:00 Dent House Nursing Home DS0000068662.V362537.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Dent House Nursing Home DS0000068662.V362537.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dent House Nursing Home DS0000068662.V362537.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dent House Nursing Home Address 30 Chesterfield Road Matlock Derbyshire DE4 3DQ 01629 584172 01629 584172 denthouse@caritasservices.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Caritas Services Limited Vacant Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Dent House Nursing Home DS0000068662.V362537.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Caritas Services Limited is registered to provide nursing, personal care and accommodation for service users whose primary care needs fall within the following categories: Learning disabilities (LD) The maximum number of persons to be accommodated at Dent House is 10. 22nd June 2007 2. Date of last inspection Brief Description of the Service: Dent House is a large detached property close to the town centre of Matlock with easy access to local facilities and on a main bus route. It provides personal and nursing care for up to ten people with learning disabilities and has single en-suite bedrooms on the ground, first and second floors. The first and second floor bedrooms are not accessible to wheelchair users or people with limited mobility, but the ground floor provides for easy access with a number of communal rooms for people to be sociable or private. The fees for the Home are from £806 to £2425 per week. The Statement of Purpose provides prospective service users with appropriate information about the Home. Dent House Nursing Home DS0000068662.V362537.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was a Key unannounced inspection that took place at the home over the mornings of two days. Additionally, time was spent in preparation for the visit, looking at key documents such as the last inspection report and the written annual quality assurance assessment document (AQAA) that was returned before the inspection. This allowed for the preparation of a structured plan for the inspection. Because of the small size of the home no written questionnaires were sent out to residents before the inspection, as it was part of the inspection plan to interview or observe all the residents personally. At the home, apart from examining documents, care files and records, time was spent with the members of staff on duty and the manager, who was present on the second day of the inspection. A brief tour of the building was also undertaken. The care records of the four people who currently live at the home were examined in detail and, although they were unable to involve themselves directly with the process of the inspection, because of the nature of their disabilities, they were observed within the environment of the home being cared for and interacting with staff. No other visits have been made to the home since the last key inspection in June 2007 and the assessment was made against the key National Minimum Standards (NMS) as well as other Standards that were felt to be most relevant. What the service does well: Appropriate information about the Home is available to people who might come to live at the home, and the people helping them which allows them to decide whether the service is right for them. They all have a carefully worked out plan of care and these indicate that they are treated as individuals and their personal goals are being considered. The staff provide activities and services that are age-appropriate and valued, and these are worked out so that independence and the development of a broad range of skills are promoted. Good procedures for handling complaints and abuse are in place and these ensure that the people living at the home are fully protected. They live in a safe and well-maintained environment, which is furnished and decorated to a good standard. The staff team is a stable one with few changes since the home started operating. They are selected using well-established procedures and provided with a training programme that helps them work safely and professionally. Dent House Nursing Home DS0000068662.V362537.R01.S.doc Version 5.2 Page 6 The home is well managed and operated using good systems of administration and record keeping, and modern principles and thinking ensure that the best interests of the people living there are maintained. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Dent House Nursing Home DS0000068662.V362537.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dent House Nursing Home DS0000068662.V362537.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Detailed information about the people living at the home is obtained before they move in, so that staff are able to support and care for them in safe and consistent ways. EVIDENCE: All of the care records looked at contained comprehensive information about the people living at the home, obtained before and at the time of them coming to live there. This includes a ‘Screening Assessment’ and ‘Strengths and Interventions (Activities of Daily Living)’ documents, which give information about both the needs and capabilities of the person, their likes and dislikes and important things in their lives. A number of these documents had not been signed or dated. Additional assessments of problem areas are carried out when the people come to live at the home, and these include more details about healthcare needs and about areas that present particular hazards and risks in their lives All of care records looked at contained a contract of residence for each person and these outline rights and responsibilities of everybody concerned and have been signed on their behalf. Dent House Nursing Home DS0000068662.V362537.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care arrangements at the home promote safety and consistency, and staff take care to treat them as individuals with their own personal goals. EVIDENCE: All the care records looked at have detailed individual plans that indicate how staff support the person, and these are based on the information brought together through the assessment process described above. The written plans include documents written in the first person such as ‘What a good day is like’ and ‘Hopes and dreams for the future’, and a ‘Networking Chart’ that indicates the important people in that person’s life. As described above, the assessments were broadly based, covering social, emotional and physical needs, and these are mirrored by the care guidelines and long-term goals. The former describe more general areas such as diet, communication, oral health and activities, whilst the latter described the detailed actions for staff to follow in, for example, managing behaviours that challenge and managing epilepsy. Taken with the detailed descriptions of areas of hazard and risk in people’s lives and their management, the daily logs made by both nurses and carers, and the maintenance of specific records such as weight charts, a very Dent House Nursing Home DS0000068662.V362537.R01.S.doc Version 5.2 Page 10 substantial file is created. Additionally there are documents that indicate the process of regular reviewing and updating of all these. From the contents of these care records and from discussion with and observation of staff, the people living at the home are encouraged to express their preferences about day to day activities and staff described how they have learned to identify these. Although the levels of disability are substantial in the current group and they require high levels of support and supervision, staff showed how they are committed to respecting them as individuals and helping them to become as independent as possible. Success has been demonstrated by a steadily decreasing pattern of disturbed behaviour and incidents. This has become extended to helping people take reasonable risks in the lives that they are able to lead, and to extend the boundaries of their experience. Dent House Nursing Home DS0000068662.V362537.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoy a wide range of leisure and social opportunities that promote wellbeing, both inside and outside the home, and enjoy their meals and mealtimes. EVIDENCE: All residents have an activity plan for the week, but this is not fixed and is changed routinely to suit the mood and needs of the individuals concerned. There was evidence of service users being enabled to take part in activities that were valued by them and fulfilling. One service user has identified horse riding as one item in a list of personal ‘Hopes and dreams’ and he has continued this for some months; another goes swimming with staff support, and outings in the home’s transport occur almost daily and include shopping, visits to local attractions and countryside and to a weekly social club. Otherwise individuals spend time around the home or in their rooms, occupying themselves and interacting with staff. The care support workers described other examples of service users being involved in age-appropriate and personally valued activities. Funding difficulties and appropriateness have Dent House Nursing Home DS0000068662.V362537.R01.S.doc Version 5.2 Page 12 prevented referral to local specialised disability services, such as day centres and further education, but the wellbeing of all residents has been enhanced by their life at the home so far. Contact with families has been encouraged and this occurs by visits and telephone calls. Plans for a sensory environment were discussed with the manager during the inspection, which would also promote wellbeing, relaxation and contact for individuals with their tactile environment. Arrangements in the kitchen are domestic in style and although staff do the cooking, they described sessions of fun cooking with the residents’ involvement. A regular menu has been set, which staff said was more or less adhered to, depending on individual resident wishes, and this is cosmopolitan in style to suit the likes and dislikes of the residents. One resident has had eating problems in the past and has been encouraged to put on weight since he has been living at the home. The manager described variations from the menus that involve eat outing, takeaway meals from local outlets or themed evenings such as Italian or Indian night. Residents are involved in the weekly shop at local supermarkets. Dent House Nursing Home DS0000068662.V362537.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The personal and health needs of residents are dealt with in a satisfactory way, as is the administration of medicines; safety and wellbeing is maintained in this area of people’s lives. EVIDENCE: All personal needs of the people living at the home are identified in their care records, and information about these matters is extensive with staff providing prompting, supervision or direct ‘hands on’ support as required. General interactions between residents and staff were observed to be warm, friendly and appropriate, and the staff were unhurried and relaxed in the way that they communicated. The morning routines of the two days of the inspection were very different with people appearing at different times as the mood takes them. Staff said that every day is different and routines are flexible or rigid depending on the individual. One of the people living at the home has suffered from increasing mobility problems and is assisted by staff using a mobile hoist and bed rails for safety. Residents’ care records contain detailed and comprehensive assessments of healthcare, emotional and psychological needs and indicate regular access to specialist and general health services and facilities, with staff support. The Dent House Nursing Home DS0000068662.V362537.R01.S.doc Version 5.2 Page 14 manager described a particularly good relationship with the local doctors, who have been involved with the complexities of arriving at a balanced medicines regime for the people who suffer from epilepsy. Medicines are managed by staff and examination of written records, storage and stock levels indicated satisfactory arrangements. This includes the arrangements for occasional use medicines (prn) and controlled drugs, for which appropriate storage and recording systems have been introduced since the last inspection. Nursing staffs are responsible for the day-to-day management of medicines but care staff confirmed that they had received appropriate training for the times when they are away from the home, particularly in the emergency use of anti-convulsants. The home’s pharmacist had recently carried out an inspection and the report of that was positive about arrangements. Dent House Nursing Home DS0000068662.V362537.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home responds to complaints made by residents and their representatives according to a written procedure, and aims to protect residents from harm. EVIDENCE: The ways in which people can make a complaint about the service of the home is described in the Service User Guide and displayed in the communal area; the procedure includes details of the Commission for Social Care Inspection (CSCI). The manager has also made a suggestions box available for anybody to use but there have been no formal complaints made since the home opened. A representative from the local advocacy service is regularly at the home and meets with the residents. Appropriate procedures are in place to safeguard and protect residents from harm, and these have been supported through a staff training programme, with the result that all staff have knowledge of their responsibilities in this area. There have been no incidents at the home that have required the use of any statutory procedures since it was registered. Dent House Nursing Home DS0000068662.V362537.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is equipped, furnished and maintained to a modern standard and offers homely and spacious facilities for residents to enjoy; it is a valued environment in which to live and work. EVIDENCE: The home is a large detached family house that has been extended to provide additional bedrooms on the ground floor, and refurbished and redecorated to meet the requirements of the current registration. People with mobility problems are accommodated on the ground floor only and the first and second floors are planned for occupation by more independent people. All the work required at the time of registration had been completed and the reports from the last visits by the Fire and Environmental Health Officers are both positive. The Home was clean and pleasant on the day of the inspection and the laundry has recently been upgraded with new machinery that meets the standards fully. Dent House Nursing Home DS0000068662.V362537.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The interests and overall welfare of people living at the home are protected by a staff team who are recruited properly, deployed in good numbers and well trained. EVIDENCE: The residents are well supported by the numbers of staff on duty with a nurse and two support workers for the long day shift, and a nurse and a support worker at night. The staff are responsible for all of the duties around the home including cooking and cleaning. The manager is included in the staffing roster and of necessity has a direct ‘hands on’ role with residents, although he stated that as resident numbers increase his time will be additional. The company has a well-established procedure for recruiting staff to its homes and most of the current staff group started employment at the time the home opened in 2007. It is company policy that people do not start working until two written references and a positive check from the Criminal Records Bureau (CRB) have been received and the two staff files looked at contained all the required documents. Dent House Nursing Home DS0000068662.V362537.R01.S.doc Version 5.2 Page 18 At the beginning of their employment staff go through a programme of basic training that prepares them to work safely and professionally. However this is not accredited by the Learning Disability Award Framework, the nationally recommended organisation. The company has given a high level of commitment to the programme of staff training and development and, apart from all the required health and safety topics, individual staff confirmed that they had instruction in more specific subjects such as restraint and challenging behaviour, medicines administration and topics related to specific conditions of people living at the home, such as dementia care. All of the current staff group have achieved level 2 in the National Vocational Qualification (NVQ) and one has achieved level 3, which five others have recently started. This is a high level of achievement and is to be commended. A system of formal 1-to-1 staff supervision has been put into place but meetings have not been held at the required regularity; staff said there is always somebody available to contact and good levels of support are available. Dent House Nursing Home DS0000068662.V362537.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and run in the best interests of the people living there. EVIDENCE: The home’s manager has applied to register with the CSCI and his application is in the final stages. He is also in the process of completing the Registered Manager’s Award and is a qualified nurse with some years experience of working in homes for people with a learning disability. The manager is well supported by regular visits from the parent company’s directors, and the required monthly visit undertaken on behalf of the Registered Provider has been taking place on a monthly basis. The manager has completed an annual development plan for the home and has obtained a copy of an NHS self assessment for completion as part of a Quality Assurance system, along with surveys for family members and other people involved with Dent House Nursing Home DS0000068662.V362537.R01.S.doc Version 5.2 Page 20 the home. As mentioned above a worker from the local advocacy service regularly visits the home to support the people living there in order to help them express their views of the service. Because of the newness of the home all of the checks required for safe operation were carried out within the registration process. Documentation looked at during the inspection indicated that safety standards at the home have continued in a satisfactory way, including a weekly fire alarm test which forms part of a full fire safety weekly check. As noted above staff training remains an activity that has been given an ongoing priority to make sure that residents are living in a fully safe environment. Dent House Nursing Home DS0000068662.V362537.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Dent House Nursing Home DS0000068662.V362537.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations The extent and contents of the care records of people living at the home should be reviewed to make sure that they remain efficient and effective tools to help staff care for and support them. All hand-written entries on medicine records should be signed, countersigned and dated, in order to maintain a clear audit trail. Training and development activity carried out by staff must be accredited by the Learning Disability Award Framework, as part of a nationally recommended standard. The system of formal pre-planned 1-to-1 meetings with the home’s management should occur 6 times per year so that staff are given opportunities to be consulted and their work can be properly monitored. 2. 3. 4. YA20 YA35 YA36 Dent House Nursing Home DS0000068662.V362537.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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