Care Home: Dewdown House

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What the care home does well Dewdown House has a calm and friendly atmosphere. The main emphasis is on supporting residents in maintaining their independence, their faith and contact with family and the community. Outcomes from the surveys were all complimentary. Comments included " I am more than satisfied" and "The staff are cheerful and helpful". Staff and resident interactions were seen to be friendly and caring upholding the dignity of the residents. Residents spoken with stated that they felt well looked after and well cared for. They all felt they could exercise personal choice and control over their life. What has improved since the last inspection? Records reviewed did show that staff had received fire safety training. The member of staff making the entry signed medication charts. Regular supervision is carried out in the home. What the care home could do better: Monitor and record hot water outlet temperatures to ensure they do not pose a scalding risk.Consider introducing resident biographies, and night care plans as part of enhancing a person centred approach to care planning. The manager or delegated person should attend update sessions in load handling and the management of general Health and Safety matters. All resident valuables and unclaimed property should be recorded in a ledger and envelops signed and sealed. A policy for the disposal of unclaimed property needs to be written. CARE HOMES FOR OLDER PEOPLE Dewdown House 64 Beach Road Weston Super Mare North Somerset BS23 4BE Lead Inspector A Pollard Unannounced Inspection 10th February 2009 09:30 X10015.doc Version 1.40 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 Dewdown House DS0000008038.V373764.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 Older People. 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. Dewdown House DS0000008038.V373764.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dewdown House Address 64 Beach Road Weston Super Mare North Somerset BS23 4BE 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) 01934 417125 01934 631064 Salvation Army Social Services Jeanne Walker Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Dewdown House DS0000008038.V373764.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection January 2007 Brief Description of the Service: Dewdown House is a purpose built home, situated near the sea front of Weston-Super-Mare. The home provides non-nursing care for forty people aged 65 years and over. The home is close to local amenities and staff assists residents to maintain links with the local community. The accommodation is in single rooms over three floors, there is a lift providing access to all floors. The home operates with a Christian ethos. Dewdown House DS0000008038.V373764.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Current fees: £369 to £402 This inspection took place over one day. Resident and staff surveys were received and residents and visitors were spoken to. A review of records maintained by the home was carried out, including care records, staff personnel files, staffing rotas, medication policies and procedures, service records and the fire log. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. We came to this quality rating at the key inspection. What the service does well: What has improved since the last inspection? What they could do better: Monitor and record hot water outlet temperatures to ensure they do not pose a scalding risk. Dewdown House DS0000008038.V373764.R01.S.doc Version 5.2 Page 6 Consider introducing resident biographies, and night care plans as part of enhancing a person centred approach to care planning. The manager or delegated person should attend update sessions in load handling and the management of general Health and Safety matters. All resident valuables and unclaimed property should be recorded in a ledger and envelops signed and sealed. A policy for the disposal of unclaimed property needs to be written. 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. Dewdown House DS0000008038.V373764.R01.S.doc Version 5.2 Page 7 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 Dewdown House DS0000008038.V373764.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Admissions are made following a full needs assessment. Prospective residents are given the opportunity to spend some time in the home. EVIDENCE: The residents’ surveys returned stated that they had received adequate information to help them decide if Dewdown was somewhere they would like to live. They also confirmed that they had received a contract on admission to the home. Visits to the home by prospective residents are encouraged either for the day or perhaps for lunch dependent on their wishes. Dewdown House DS0000008038.V373764.R01.S.doc Version 5.2 Page 9 The home operates a robust admission procedure. The pre-admission assessments are comprehensive; covering activities of daily living. The prospective resident/relative are involved in the assessment and the information is used to determine the suitability of the placement. Where possible staff obtain assessments and care plans from other professionals involved for example, social workers and hospital staff. The information gathered forms the basis for temporary care plans, which are reviewed as staff get to know the resident. A month’s trial period on both sides is usually undertaken to ensure that everyone is happy with the arrangements and to ensure that the placement is suitable. In the files reviewed there was little evidence of formal assessments such as pressure risk, nutritional risk or handling and continence assessments. Dewdown House DS0000008038.V373764.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans detail residents care needs and are clearly written and give clear directions to staff but need expansion. The staff provide appropriate personal and nursing care to maintains residents’ health and well being and dignity. Proper arrangements are in place for residents to access primary healthcare services. The staff properly store, administer and record medication on behalf of residents. EVIDENCE: Care plans reviewed gave clear guidance for staff to meet the needs of residents. A key worker system is in place. Dewdown House DS0000008038.V373764.R01.S.doc Version 5.2 Page 11 Care records showed evidence of resident involvement care planning and regular reviews. The development of a more person centred approach to writing plans was discussed, as was the development of mini biographies of residents developed over time. There are end of life plans in place that could benefit from further development. There are no formal night care plans in place. The documentation for each resident is held in a number of different files and formats and it is intended to review the whole process on return of the manager. A system is in place for care review meeting to be arranged every six months for each resident, involving their relatives and key worker although this is not consistently applied. However there was evidence of periodic evaluations taking place. The home enables residents to access primary care services and attend appointments with the chiropodist, dentist, optician and outpatient clinics. District nurse input is sought when necessary. General Practitioner (GP) and Para-medical visits and their outcomes were well documented. The residents surveys evidenced that they receive the care and support they need Resident’s surveys said they received the medical support and care they required and that staff were always polite and respected their privacy. Comments were complimentary of the staff and the care they provided. All the residents spoken with said, “They were satisfied with the overall level of care being provided”. They spoke highly of the staff saying they were, “Friendly and caring”. Policies and procedures for receiving, storing, administering and disposing of medications are in place. The administration charts were legible up to date and in order. Proper arrangements are in place for the storage and recording of controlled drugs and drug disposal. Dewdown House takes into account resident’s personal and religious preferences when considering the end of life. It was suggested that further training be sought from a hospice about “gold Standard” or “Liverpool care pathway” approaches to end of life care planning. Dewdown House DS0000008038.V373764.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A range of social and recreational activities is arranged that seek to enhance the quality of life for the residents. Resident’s families are involved and informed of issues related to their relatives and are able to maintain close contact with families and friends. The food is of a high standard and provides a balanced diet for residents. Links with the church and local community are maintained. EVIDENCE: Meaningful activities are carried out on a daily basis. The activities coordinator continues to provide a varied programme of activities for the residents, who are knowledgeable of the residents’ needs and wishes. Dewdown House DS0000008038.V373764.R01.S.doc Version 5.2 Page 13 In conjunction with the residents the activities coordinator develops a monthly timetable of activities and forthcoming events. A copy of this is placed in communal areas throughout the home, to ensure that all residents and visitors are aware of the planned activities. Those surveyed stated that there are always or usually activities arranged that they could take part in. People are asked to suggest their own ideas at a resident meeting. Residents are also included in meetings such as the health and safety group. They have a representative say in the running of the home. Residents spoken to said they were encouraged to maintain choice and control over their own life. Residents continue to enjoy minibus trips on a regular basis to places including: garden centres; chew valley, and various pubs and cafes. The home runs a four weekly menu, which is displayed in the dining room. Residents make their choice at mealtimes so they are not expected to remember a choice made earlier in the day. The menus offered a choice of nutritious and wholesome meals. Resident’s comments on the food were all positive and commented on the high standard of food provided. An area for making tea/coffee and snacks is provided on each floor. Residents are supported to engage with their religious preferences. Different denominations visit the home for communion. One resident told the inspector “I always enjoy the service and the hymns we sing”. The home holds morning prayers daily and transport is provided on Sunday to take residents to Church, Chapel or Citadel There are no residents with other than Christian faith backgrounds. Dewdown House DS0000008038.V373764.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a clear and robust complaints procedure and policies and procedure to protect residents from abuse EVIDENCE: The home has a robust complaints procedure, which outlines the process to follow. The complaints book was available for inspection and is kept up-to-date. A recent complaint related to late commencement of medication it was properly investigated and resolved to the satisfaction of the complainant and steps taken to ensure the problem did not recur. Residents spoken to said that they felt at ease talking to the staff if they had any concerns. Surveys indicated all respondents knew how to make a complaint if they wished. A large print copy of the complaints procedure is displayed in the hall and the dining room. The home has written procedures for adult protection and whistle blowing, The Local Authority ‘No Secrets’ document was available. The manager and the organisation actively promotes staff training and education in these areas, all staff attend training in protection of vulnerable Dewdown House DS0000008038.V373764.R01.S.doc Version 5.2 Page 15 adults and the manager is expecting update sessions to be run in the near future. All staff are instructed in adult protection and prevention of abuse as part of their induction. There have been no allegations of abuse. Staff surveys indicated that they knew what to do if they had concerns or another raised concerns with them. The management of money on behalf of residents was in good order and clear records made. The safe keeping of valuables and unclaimed property needed improvement to ensure items were properly stored labelled and logged in the ledger. A policy needs to be written for the disposal of unclaimed valuables after 5 years. Dewdown House DS0000008038.V373764.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,22 24 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of furnishing and décor is good to the benefit of residents. The home provides a safe and well-maintained environment for the residents. The bedrooms and communal rooms and facilities are suitable and well presented for their purpose and meet the resident’s needs. The standard of cleanliness is high. EVIDENCE: Dewdown has a total of 40 beds. It provides care over three floors. There are passenger lifts, which give level access to all parts of the home. Dewdown House DS0000008038.V373764.R01.S.doc Version 5.2 Page 17 All areas in Dewdown House are accessible to wheelchair users. Specialist facilities are provided for disabled residents and visitors. Mobile and fixed hoists, bed rails and pressure relieving equipment are available if needed. The home is in good order and well maintained and is fit for its purpose. The standard of décor is good. There were no malodours and the home was cleaned to a high standard. There are several lounge, dining and quiet areas throughout the home The home is smoke free environment. The bedrooms were personalised and reflected individual tastes and many people had personalised their rooms, indicating that choice and independence are promoted in this respect. Residents spoken to said that they liked their rooms and could use any of the communal areas throughout the home. The surveys stated that the home is always fresh and clean. There are sufficient toilets and bathrooms and facilities for disabled people, which include rails, hoists and slings to assist with bathing. The maintenance man works full time and drives the minibus at the home and can be available for emergency repairs as required. Proper arrangements are made for the disposal of clinical waste. The home has written guidance for infection control. Dewdown House DS0000008038.V373764.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 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 well staffed with appropriately trained and experienced staff for the number of residents. Staff receive training relevant to the care needs of the current resident group. The organisation encourages staff to obtain their NVQ in care for the benefit of residents. The home has a good recruitment procedure that clearly defines the process to be followed. EVIDENCE: Rotas for the past month showed that the home is adequately staffed. Extra staff can be rostered in to cover activities, hospital appointments or to meet extra needs required by a resident. At present there are no carer vacancies. The home uses very little agency staff as the existing staff cover gaps. The domestic, catering, admin and laundry staffing levels are satisfactory. The administrator post is a full time post as is the maintenance man. The activity organiser works 20 hours per week. One staff member indicated that on occasions staffing levels have been stretched. Dewdown House DS0000008038.V373764.R01.S.doc Version 5.2 Page 19 The organisation encourages staff to obtain their NVQ’s level 2 and 3 in Care. The majority of the workforce has obtained this qualification. Staff are encouraged to obtain training appropriate to meet the needs of the resident group. Staff personnel files hold records of training and mandatory training such as food hygiene, first aid moving & handling, protection policies and fire safety There are good induction programmes for new registered nurses and care staff. All new staff are linked with a mentor during their first two weeks and on supervised shifts. The staff spoken to felt they received good training, which was relevant to the care needs of residents. Staff surveys indicated that people feel that they have good relevant training. A review of staff personnel files showed that they contained all the required information. All new staff had a CRB or POVA notification before they commenced work. All new staff work supervised until the full CRB is received. New recruits are issued with the General Social Care Council code of conduct. Resident’s surveys indicated that usually or always staff were available when they need them and they are always listened to and staff act on what they say. Dewdown House DS0000008038.V373764.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run taking into account the views and wishes of the residents and relatives as they are able. The staff supervision and appraisal arrangements are properly arranged. The home has good Health and Safety arrangements. The arrangements to maintain and service plant and equipment are good. EVIDENCE: The manager has been on extended leave but is expected to return in the near future. Satisfactory arrangements have been in place to cover the manager’s absence. Dewdown House DS0000008038.V373764.R01.S.doc Version 5.2 Page 21 Residents and staff spoken to all said that they felt they could approach the staff at any time. Both resident surveys and residents spoken to said they felt well supported and listened to. The home carries out an annual residents survey and they hold regular resident meetings. A resident representative is also on the health and safety and interview panel. Staff surveys indicated that residents were given a very good quality of life All staff have regular supervision and appraisal, which facilitate personal development planning. However some staff indicated that they would like more support, this could be related to the recent extended leave of the manager, which should now be concluded. The implementation of health and safety within the home was satisfactory. The home has a safety action group, which continues to include all levels of staff and a resident representative. This group carries out an audit of the home and advises the manager of any needs identified. It was suggested that the manager should attend a health and safety management update as she carries the delegated responsibility. The bathing areas had thermostatic controls fitted. However regular monitoring hot water outlet temperatures have not been taking place to reduce the risk of scalding. The maintenance man carried out testing of temperatures during the visit to ensure they were within the safe limits. The kitchen and laundry areas were clean and tidy and staff showed awareness of appropriate infection control guidelines. The Environmental Health officer awarded the home a 5 star rating for food safety. The fire log showed fire alarm tests and drills are carried out on a regular basis. All other required checks are also being carried out at the appropriate times. Staff have annual fire training provided by an accredited trainer followed by regular in-house updates through the year. The fire alarm system provides warning for residents with sensory impairments. This includes red lights for the hearing-impaired and vibrating pillows for visually impaired. There was a system for monitoring the risk of Legionella disease. A record of hot water outlet temperatures is now being maintained. The lifts had been serviced and there were load test certificates for the hoists. The boilers have recently been replaced and the gas safety certificate has not yet arrived, a copy will be sent to the Commission in due course. Electrical equipment is properly maintained. Dewdown House DS0000008038.V373764.R01.S.doc Version 5.2 Page 22 Accident records and Reg 37 reports are written. The certificate of registration and a current insurance certificate were displayed. Dewdown House DS0000008038.V373764.R01.S.doc Version 5.2 Page 23 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 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X x 3 3 3 X 4 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Dewdown House DS0000008038.V373764.R01.S.doc Version 5.2 Page 24 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. 1. 2 Standard OP38 OP38 Regulation 13.4 13.4 Requirement Submit a copy of the gas safety certificate for the boilers. Monitor hot water outlet temperatures to ensure they do not pose a scalding risk. Timescale for action 10/03/09 14/02/09 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. 2. 3. Refer to Standard OP7 Good Practice Recommendations Consider introducing resident biographies, and night care plans as part of enhancing a person centred approach to care planning. The manager should consider update training in health and safety management and arranging update training for the load handling assessor/trainer. All resident valuables and unclaimed property should be fully recorded in a ledger and envelops signed and sealed. A policy for the disposal of unclaimed property needs to be written. OP30 OP18 Dewdown House DS0000008038.V373764.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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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