Care Home: Derham House

What has improved since the last inspection? With the employment of the new registered manager the home now shows leadership and a much more stable workforce. This has resulted in improved quality of care to residents, and a reduced use of agency staff. Care is provided in a more person centred way and there is much more good interaction between staff and residents. Staff were much less task focused and more aware of the individual needs of the residents. Improvements to the environment on Foxhall unit has greatly benefited the residents living on this unit as it has given them much more space in which to relax, walk and participate in social activities. Daily activities continue to improve on both units but this was much more noticeable on Foxhall unit where people are living with dementia. Mealtimes have improved since staff are now more aware of the need to deliver person centred care, and residents were observed being given the necessary assistance in a sensitive and unhurried way. Drinks and snacks are freely available throughout the day, and night. What the care home could do better: Protocols need to be in place for the administration of PRN (as required) medication as this will be to the benefit of residents and staff. This is a requirement in this report. End of life/preferred place of care documentation still requires attention in the care plans of most of the residents and therefore this requirement, made at the last key inspection will remain. Some elements of this previous requirement have been complied with. Training for all care staff in the Mental Capacity Act must be undertaken in the very near future, as this is a very important piece of new legislation, and again this is a requirement in this report. It is acknowledged that the manager and senior staff have undertaken this training. It is not acceptable that residents are left sitting in wheelchairs for long periods, and staff on Bridge unit must address this, especially first thing in the mornings. Arrangements need to be made for the ongoing maintenance of the fish pond, as this is a focus of enjoyment for some of the residents, and also can be a source of offensive odours in the event of hot weather.Derham HouseDS0000069403.V375471.R01.S.docVersion 5.2Page 7 Key inspection report CARE HOMES FOR OLDER PEOPLE Derham House Harwood Hall Lane Upminster Essex RM14 2YP Lead Inspector Mrs Sandra Parnell-Hopkinson Unannounced Inspection 26th May 2009 07:30 DS0000069403.V375471.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Derham House DS0000069403.V375471.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Derham House DS0000069403.V375471.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Derham House Address Harwood Hall Lane Upminster Essex RM14 2YP 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) 01708 641 441 01808 641 743 Emma.bryer@barchester.com www.barchester.com Barchester Healthcare Homes Ltd Emma Bryer Care Home 64 Category(ies) of Dementia (64), Old age, not falling within any registration, with number other category (64) of places Derham House DS0000069403.V375471.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP 2. Dementia - Code DE The maximum number of service users who can be accommodated is: 64 2nd June 2008 Date of last inspection Brief Description of the Service: Derham House is a single storey purpose built home providing care with nursing for sixty-four older people, some of whom have dementia. Opened in 1996, there are two separate 32 place units, Foxhall for those service users with dementia, and Bridge for those service users with a nursing need. Both units have a lounge and a dining room. All bedrooms are single and have ensuite toilet and washbasin. The building is fully accessible to wheelchair users. It is situated in a quiet rural area of Upminster within the London Borough of Havering, behind Harwood Hall Equestrian Stables, with a long drive leading to the main entrance of the home. The grounds are well maintained with two enclosed courtyard gardens. Upminster Station (District Line) is approximately two miles away, and other public transport is limited. A copy of the statement of purpose and last inspection report was available in the reception area of the home, and a copy of the statement of purpose can be obtained on request to the manager of the home. At the time of this inspection fee levels ranged from £750 per week, with negotiated fees being agreed with local authorities and primary care trusts. Derham House DS0000069403.V375471.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 stars. This means the people who use the service experience good quality outcomes. This was an unannounced key inspection undertaken by the lead inspector Mrs. Sandra Parnell-Hopkinson together with a colleague Mrs. Julie Legg. It took place on the 26th May 2009 between the hours of 07:30 hours and 17:00 hours. The registered manager was available throughout the inspection and was available for feedback at the conclusion of the visit. The inspection process included information contained in the annual quality assurance assessment (AQAA), regulation 37 notifications, a tour of the home and documentation viewed at the home during the visit. We were also able to take with many of the residents, some visiting relatives and staff (both night and day staff). We case tracked 14 people who use the service (7 on each unit). What the service does well: The service continues to provide nutritional and well balanced meals in dining areas where tables are laid to make them look welcoming. Menus are varied and offer choice to residents. The cook has a very good knowledge of the likes and dislikes of residents. Comprehensive pre-admission assessments are undertaken by qualified staff and prospective residents and/or their family can visit the home without making a prior appointment to do so. Administrative functions within the home remain good, as does the administration of medication on both units. Recruitment procedures remain robust with all of the necessary references and checks being undertaken prior to the commencement of employment. All areas of the home are maintained to a good standard with a high standard of cleanliness and odour control throughout the home. Complaints and safeguarding issues are given a high priority and outcomes are used to improve service delivery. Derham House DS0000069403.V375471.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Protocols need to be in place for the administration of PRN (as required) medication as this will be to the benefit of residents and staff. This is a requirement in this report. End of life/preferred place of care documentation still requires attention in the care plans of most of the residents and therefore this requirement, made at the last key inspection will remain. Some elements of this previous requirement have been complied with. Training for all care staff in the Mental Capacity Act must be undertaken in the very near future, as this is a very important piece of new legislation, and again this is a requirement in this report. It is acknowledged that the manager and senior staff have undertaken this training. It is not acceptable that residents are left sitting in wheelchairs for long periods, and staff on Bridge unit must address this, especially first thing in the mornings. Arrangements need to be made for the ongoing maintenance of the fish pond, as this is a focus of enjoyment for some of the residents, and also can be a source of offensive odours in the event of hot weather. Derham House DS0000069403.V375471.R01.S.doc Version 5.2 Page 7 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Derham House DS0000069403.V375471.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Derham House DS0000069403.V375471.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 1, 2, 3 and 5. (standard 6 is not applicable) People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service and their representatives have the information needed to choose a home that will meet their needs. EVIDENCE: A copy of the statement of purpose, service user guide and the last key inspection report are available in the reception area of the home. The home understands the importance of providing sufficient information to prospective residents and their families, and every assistance is given to enable people to make a positive choice. The home has a booklet, published in conjunction with the Alzheimers Society, for those people with dementia to Derham House DS0000069403.V375471.R01.S.doc Version 5.2 Page 10 help them find a suitable care home. On the day of the inspection relatives of a prospective resident were being shown around the home. Admissions are not made to the home until a full needs assessment has been undertaken by qualified staff. There may be some exceptions to this in the event of an emergency situation. The assessment is conducted professionally and sensitively and involves the individual and his/her family or representative where appropriate. Where an assessment has been undertaken through a local authority or a primary care trust the service insists on receiving at least a summary of the assessment and a copy of the care plan. Admissions to the home take place if the service is confident that staff have the skills, ability and qualifications to meet the assessed needs of the prospective resident. Any specialist training to meet the assessed needs will be given to the staff prior to admission. New residents are given a contract or provided with a statement of terms and conditions. These set out in detail what is included in the fee, the role and responsibility of the provider and the rights and obligations of the individual. The manager actively promotes opportunities for discussions and clarification. Derham House DS0000069403.V375471.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: We looked at a total of 14 residents’ files (7 on each unit) and all had a comprehensive care plan. Some of these residents were recent admissions to the home. Where risks had been identified, assessments were in place for such things as falls, use of bed rails, moving and handling, tissue viability and nutrition. Fluid monitoring charts and turning charts were being completed at the time of the giving of fluids or the action of turning. However, daily recordings still require improvement so that they are more reflective of the identified outcomes in the care plans. Good daily recorded information will contribute to a more positive monthly review for each resident, and also as to the successful achievement of the desired outcomes. Derham House DS0000069403.V375471.R01.S.doc Version 5.2 Page 12 Residents are now receiving more effective personal and healthcare support using a person centred approach. Staff were very aware that the way in which support is given is a key issue for people. Residents told us that “staff are very kind and considerate and most of them always seem to be happy, and that makes us feel better.” Personal support is flexible, and due to a more stable work force, is more consistent and able to meet the changing needs of the residents. In discussions with some of the staff they demonstrated a good knowledge and understanding of the individual needs of the residents. The staff group is balanced to enable resident’s choice of male or female related preferences when receiving personal care. Bedroom or bathroom doors were closed while staff were delivering personal care to a resident. Aids and equipment are provided to encourage maximum independence, and all aids and equipment are maintained in good working order. All residents are weighed on admission and thereafter on a monthly basis or more frequently if the need is identified. On both units staff were observed to be interacting well with residents, and this was a marked improvement since the last key inspection. Assistance was given in a kind and respectfully way with staff ensuring that the needs of the residents were being met. All of the files viewed showed evidence of the involvement of a GP, chiropodist, dentist and optician where relevant. Also referrals are made to tissue viability nurses, dieticians and other health professionals when necessary. Staff members were observed to be very alert to changes in mood, behaviour and general wellbeing and this was particularly evident on Foxhall unit where people with dementia are living. The home has developed efficient medication policy, procedure and practice guidances, and medication records were viewed and found to be in good order. An exception is protocols around the use of PRN (as required) medications for residents. This was discussed with both of the senior nurses and the manager who will arrange for these protocols to be put into place. End of life and or preferred place of care plans still require improvement and again this was discussed with the manager. However, we are satisfied that the service is efficient when caring for residents who are terminally ill or dying, and are sensitive to religious and cultural needs of the individual or their family. The home has developed a good working relationship with the local hospice who will provide training on such things as syringe drivers and other palliative care needs. Recently there was an issue around information being sent with a Derham House DS0000069403.V375471.R01.S.doc Version 5.2 Page 13 resident going to hospital as an emergency admission. The home has reviewed its procedures in this area, and will ensure, as far as is possible, that the resident being transferred is suitably clothed. However, people do need to be aware that when an ambulance is called and a resident is being transferred to hospital, then the responsibility for that resident transfers to the ambulance service, and then to the National Health Service on admission to the accident and emergency department. It may have been necessary for either the ambulance crew or the staff in the accident and emergency department to undertake procedures which may result in items of clothing having to be removed. The manager is also developing a good working relationship with the local hospital trust and other providers around the effective discharge of residents from hospital in emergency situations such a winter pressures. Derham House DS0000069403.V375471.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use services are able to make choices about their life style, and are supported to retain life skills. Social, cultural and recreational activities are now more able to meet expectations. EVIDENCE: The home continues to improve around the provision of activities, and the two activity co-ordinators remain in post with their responsibilities now more clearly defined in that one is responsible for Bridge unit and 1 for Foxhall unit. We did observe that other staff are now taking more responsibilities for the provision of daily activities which can include talking to residents, sitting with them to read a newspaper or magazine or doing a jigsaw puzzle. It was noticeable that staff were less task orientated and now more aware of the need for person centred care. Derham House DS0000069403.V375471.R01.S.doc Version 5.2 Page 15 Improvements to the daily life and social activities for people living on Foxhall unit were very noticeable. This has been in part due to the refurbishment of the environment with the demolition of some partition walls. This has meant that the lounge area is now much bigger and more open which enables people living with dementia more freedom and space to walk around. The dining area has been opened up and a small kitchen area has been installed. Residents were seen to be participating in small group activities with the activity coordinator, others were seen interacting on a 1:1 basis with care staff in either looking at a magazine or newspaper or just talking. One lady was seen sitting at a typewriter and having great fun pressing the keys. Residents were observed to be using the lounge and dining areas with much more freedom now that the partition walls have gone. We also observed that on this unit residents were no longer sat for long periods in wheelchairs, but that they were more comfortably seated in lounge chairs. There is also a Wii on this unit for the use of residents with the assistance of staff and/or relatives. We are hopeful that the improvements made on Foxhall unit will be transferred to Bridge unit. However, we did observe that staff were more fully interacting with residents on Bridge unit, but at times residents were left sitting in wheelchairs for fairly long periods. This is not good practice and was discussed with the manager during the inspection. One of the activity co-ordinators has changed her working pattern so that she now sometimes works on a Saturday, and again this has made an improvement to the lives of those residents living on Foxhall unit, since often the weekends are very quiet. Currently the home is busy organising a summer fete. Festivals such as birthdays, Christmas, Valentines, St. George’s day and Halloween are also celebrated at the home. People living at the home have the opportunity to develop and maintain important personal and family relationships. Residents are encouraged to take part in community activities wherever possible, and one resident is going to visit family abroad. One visitor told us “staff are very good and patient. I don’t have any concerns. The staff are very kind and look after me as well.” We observed breakfast being served on Bridge unit and lunch being served on Foxhall unit. On both units tables were nicely laid and staff were observed giving assistance in an appropriate manner, and at the speed dictated by the individual resident. It was apparent that mealtimes, on both units, are now more enjoyable than was observed at the previous key inspection in 2008. Meals are balanced and nutritious and choices are given. Fresh fruit is available daily and during the morning and afternoon snacks are available for all residents. We were able to speak with the chef who is very aware of the needs of the residents, and menus are reviewed on a regular basis. There is very little Derham House DS0000069403.V375471.R01.S.doc Version 5.2 Page 16 reliance of frozen or pre-packed ingredients and wherever possible fresh produce is always used. Many of the residents told us that “mostly the meals are really nice, although occasionally there is something we don’t like, but then there is always something else to choose.” The garden areas were well kept, and the home is participating in the organisation’s Barchester in bloom competition, and this will be with the involvement of residents and staff. There is a fish pond in the sensory garden which is located off Foxhall unit, and some of the residents and staff enjoy feeding the fish. However, it was evident that the pond needed some attention and the manager will be ensuring that responsibility for the ongoing maintenance of the pond will be allocated to an appropriate staff member. Derham House DS0000069403.V375471.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure, and are protected from abuse and have their rights protected. EVIDENCE: During the inspection process we looked at the complaints log and this, and the AQAA (annual quality assurance assessment) submitted by the organisation prior to the inspection, confirmed that the service had received 18 complaints in the last 12 months, and that these 18 had been resolved within the 28 days. 8 of the complaints were found to have been upheld. A letter of concern was also received by the Commission prior to the inspection, and the issues contained within that letter were addressed during the inspection. These issues had also been addressed with the complainant by the organisation in separate correspondence. All complaints made and the actions taken in response to them are fully recorded. A review of the number and nature of complaints made is used as part of the quality assurance procedures. The home learns from complaints in order to improve its service. Particular attention is paid to any themes within complaints that refer to dignity, respect, fairness, autonomy and equality. Derham House DS0000069403.V375471.R01.S.doc Version 5.2 Page 18 There had been issues around the Christmas/New Year period with the boilers which resulted in parts of the home being without heating for a short period. Although appropriate arrangements were put in hand to ensure the wellbeing of the residents, the home also realised that it did not have an adequate emergency procedure in place. This has now resulted in the home having a contract with a company for the provision of an emergency generator if and when the need arises. The service has a whistle blowing policy which is contained within the staff handbook. The new manager has developed an open culture where individuals feel safe and supported to share any concerns in relation to their protection and safety. Policies and procedures regarding safeguarding adults are available to staff and they are given clear guidance about what action should be taken. In discussions with some of the staff they told us that they had undertaken training in adult abuse awareness and other safeguarding issues. The manager is clear when an incident needs to be referred to the local authority as part of the local safeguarding procedures. Since the last inspection 6 safeguarding referrals have been made and this resulted in 2 investigations being undertaken but no referrals were made to the Protection of Vulnerable Adults list. We spoke to staff who understood what restraint is and were aware of alternatives to its use. Equipment such as bed rails, keypads, recliner chairs and wheelchair belts are only used when absolutely necessary, and within a risk assessment framework. The home promotes independence and choice as much as possible, and individuals are involved, as far as is possible, in decisions about any limitations to their choice. The home fully respects the human rights of people using the service. Individual assessments are always completed which involve the individual where possible, their representatives and any health/social care professionals. Derham House DS0000069403.V375471.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment. EVIDENCE: We arrived at the home at 07:30 hours and undertook a tour of the whole building. We were pleased to note that although it was early morning there were no offensive odours in any part of the home, and the home was clean and well maintained. This high standard was maintained throughout the day, and the housekeeping staff are to be commended. Some residents and visitors also told us that the home is always kept clean and generally free from Derham House DS0000069403.V375471.R01.S.doc Version 5.2 Page 20 offensive odours. Staff were seen to be practising appropriate infection control methods. All bedrooms are single with en suite facilities, and are personalised by the resident. Furnishings are of a good standard and the home has a programme of refurbishment and redecoration. Many of the overbed tables have been replaced, and the fixing of door closures continues within a risk assessment framework. Major works have now been completed on Foxhall unit with the removal of a large nurses’ station, lounge walls and the doors to the dining area. This has resulted in a much improved environment for those residents living with dementia. Call alarms are in place in all bedrooms and these were seen to be in reach of those residents wishing to remain in their bedrooms. The service also uses assistive technology such as mattress/cushion alarms where an individual may not be able to use the call alarm system. There had been some problems with the boilers over the Christmas/New Year period and this also coincided with a power cut. This has caused the home to review its emergency procedures. The garden areas were well maintained as were other external areas. The manager is making arrangements to ensure that the fish pond located in the sensory garden is kept in good order. We did visit the kitchen which was clean and tidy. However, on this visit we did not visit the laundry, but some residents told us that “our laundry is always returned nice and clean and ironed. “ One resident told us “I always get my own clothes back and have never been given somebody else’s.” Derham House DS0000069403.V375471.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are generally trained, skilled and in sufficient numbers to support the people who use the service, and to support the smooth running of the service. EVIDENCE: Since the last key inspection the new manager has changed the staffing structure on each of the units. There is now 1 nurse and 6 care workers on each unit in the mornings, and 1 nurse and 5 care workers on each unit in the afternoons. At night there is 1 nurse and 2 care workers on each unit. However, there is an expectation that staff on both units will be flexible to give assistance to the other unit when the need arises. Obviously there may be some exceptions due to unexpected absences such as sickness or family problems. The service has a highly developed recruitment procedure and all staff undergo an interview, reference checks, POVA and criminal records bureau checks. Induction and other ongoing training is provided and staff confirmed that this was the case as did the AQAA (annual quality assurance assessment). More Derham House DS0000069403.V375471.R01.S.doc Version 5.2 Page 22 than 50 of the staff have achieved NVQ level 2 or above. All staff are given a copy of the staff handbook and have access to all of the policies and procedures of the service. However, many staff still need to undertake training in the Mental Capacity Act 2005, and the manager has given assurances that this training will be provided. A robust recruitment drive was undertaken and this has resulted in a much more stable workforce, and the reduced use of agency staff. This has resulted in an improved and more consistent service to the residents at Derham House. We also observed that staff are working more closely as teams and that communication between staff and staff, and staff and residents has improved. This was confirmed in discussions with staff and some of the residents. Staff meetings take place regularly, and all staff receive supervision on a regular basis. In discussions with some of the staff they told us that they find the staff meetings and the supervision sessions really useful, and helped them to focus on improving outcomes for the people using the service. Minutes of these sessions are kept on file. Derham House DS0000069403.V375471.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a competent organisation and implemented by a qualified and competent manager. EVIDENCE: There is now a registered manager in post and this has given stability and leadership to Derham House. There have been many problems to overcome, but these are gradually being addressed and resolved. Derham House is benefiting from a qualified, experienced and competent manager and a much Derham House DS0000069403.V375471.R01.S.doc Version 5.2 Page 24 more stable workforce. The manager is also very aware of areas still needing improvement and is actively working to make these improvements. The manager is aware of the organisation’s strategic and financial planning systems and the business plan for the home links into these. Supported by these systems the manager is competent in delivering effective financial planning and budgetary control. In discussions with us, and from observations of the service during the inspection, we are confident that the manager has a clear understanding of the key principles and focus of the service and is working to continuously improve this for people living at the home. There has been an increased and improved quality of life for all residents with a strong focus on equality and diversity issues and the promotion of human rights. There is now a focus on person centred thinking, and a strong those of being open and transparent in all areas of running of the home. The manager was able to demonstrate an awareness of current legislation and developments and plans the service accordingly. The returned AQAA (annual quality assurance assessment) was clear and contained relevant information supported by a wide range of evidence seen during the inspection. The service has sound policies and procedures which are regularly reviewed, and the manager ensures that staff follow the policies and procedures. The home works to a clear health and safety policy and regular audits take place to ensure they are working. The manager and her staff have a good understanding of risk assessment processes which is underpinned by promoting independence, choice and autonomy. Maintenance records are up to date as evidenced through the AQAA and in discussions with the manager and other staff. We are also satisfied that the financial interests of residents are safeguarded, and that their best interests are protected by the administration record keeping. Monthly internal audits are undertaken as directed by Barchester’s Director of Quality of Care, and these are in addition to the monthly visits required under Regulation 26 of the Care Home Regulations 2001. The service continues to inform us of incidents as required under Regulation 37 of the Care Home Regulations 2001. Currently there have not been any referrals to the local authority under the deprivation of liberty safeguards. The general atmosphere at Derham House has improved, and residents and staff appear much happier and relaxed. We would like to commend the new manager on the improvements made during the past few months, and also her recognition of those still to be achieved. Derham House DS0000069403.V375471.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 Derham House DS0000069403.V375471.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The registered person must ensure that care plans include end of life/preferred place of care wishes. This will ensure that all of the needs of residents are identified and staff will know how these important areas of care are to be met to the benefit of the residents. Timescale for action 31/08/09 2 OP9 16 3 OP30 18 The registered person must 31/08/09 ensure that protocols are in place for the administration of PRN (as required) medication. This is in the interests of residents and staff so that all are aware of when this needs to be given. The registered person must 30/09/09 ensure that all staff receive training in the implications of the Mental Capacity Act 2005. This will ensure that care continues to be given in accordance with the wishes of the individual resident. Derham House DS0000069403.V375471.R01.S.doc Version 5.2 Page 27 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 OP14 Good Practice Recommendations It is not good practice for people to remain in a general wheelchair for long periods. It is therefore, recommended that unless a resident specifically requests to remain in such a wheelchair (within a risk assessment process), then residents should be transferred to a comfortable lounge chair. It is recommended that arrangements are made for the ongoing cleaning/maintenance of the fish pond to be delegated to a particular member of staff. 2 OP19 Derham House DS0000069403.V375471.R01.S.doc Version 5.2 Page 28 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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