Care Home: Dial House Nursing Home

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What the care home does well The way that management respond to complaints they receive is very good. Each complaint was investigated thoroughly, comprehensive records kept of any findings, and the detailed responses are sent to the complainant. Management are very open when they have not met people`s expectations, they apologise and then change things to try and prevent it happening again. The home continues to have very good links with local family doctors and other health care professionals. Staff know about how to look after people with special health needs. The home is chosen locally to provide a large amount of the End of Life care programme. Comments made to us from local health teams indicated that the nursing staff were dedicated and competent. Two people are still employed to try to make sure people living at the home can carry on with their lives in the way they want to, and get the most from living at the home. The amount of opportunities to participate in social activities is very good, and people living at the home feel this is beneficial for them. Activities available include, shopping, theatre trips, cooking, gardening, quizzes and handicrafts. The home has its own designated transport for this. Comments from people living at the home about the staff include, "They are just wonderful", "They can`t do enough for you" and "Since moving here my health has improved so much, that`s thanks to the staff". Families continue to be made feel welcome at the home, and they are asked to tell the home about what they think by filling in questionnaires. We spoke with with the relatives of four people when we visited, all were complimentary about the care provided at the home. One person said, "I would be quick enough doing something if the care wasn`t right, but I have never had to, its a really good home". What has improved since the last inspection? We did not make any requirements at the last inspection. What the care home could do better: Just before this visit the home had changed the templates they use as care plans. Some people living at the home had one type of document and others had the new revised document. It does not matter what template a home uses, what is important is the standard of entries made on them. Staff need to improve how they write these care plans and other care documents. If for example a person is diabetic, then a care plan must be in place for this need with sufficient guidance to know everything staff have to do to meet their needs in this area. Key inspection report Care homes for older people Name: Address: Dial House Nursing Home 7 - 9 Dynevor Road Bedford Bedfordshire MK40 2DB     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Katrina Derbyshire     Date: 2 2 1 2 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 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. 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 Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Dial House Nursing Home 7 - 9 Dynevor Road Bedford Bedfordshire MK40 2DB 01234356555 01234402444 vanessa.simic@dialhousecare.com www.dialhousecare.com Dial House Care Limited care home 50 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability terminally ill Additional conditions: No one falling into the category of younger adults (40-65 years) may be admitted to the home when there are already 5 persons in this category. No one with a diagnosis of dementia may be admitted to the home when there are already 20 persons in this category. No one with a diagnosis of mental disorder may be admitted to the home when there are already 10 persons in this category. No one with a diagnosis of Terminal Illness may be admitted to the home when there are already 10 persons in this category. The home can accommodate a maximum of 50 service users of either sex. Care Homes for Older People Page 4 of 26 Over 65 20 0 50 0 0 0 10 0 5 5 Date of last inspection Brief description of the care home Dial House has been developed from two large Victorian properties to provide care for 50 service users over the age of 65 years who require care with or without nursing. The registration also allows for up to 20 of the service users to have a diagnosis of dementia and 10 a mental health condition. Five service users over 40 years but under 65 years can also be cared for. Those service users under the age of 65 years have been assessed by the manager as having similar needs to those service users already being cared for. The home is situated a short walk away from the town centre of Bedford, and close to its rail and bus services. There are a number of residential properties in the area that have been converted into care establishments. The home has an area at the front that can be used for parking as the road outside has zoned parking. The home also has attractive well-maintained gardens and sun terraces to the rear, which can be accessed easily by service users. The following information about fees was obtained at the home in December 2009 Lowest fee £485.00. Highest fee £750.00 Further information about this home can be obtained by phoning or visiting. There are also email and website addresses. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. This was an unannounced key inspection carried out on the 22nd December 2009. The care of four people was looked at in detail and this is known as case tracking. Tracking peoples care is the methodology we use to assess whether people who use social care services are receiving good quality care that meets their individual needs. Through discussion, observation and reading records, we track the experiences of a sample of people who use a service. During the visit the communal areas of the home were seen alongside some of the individual rooms. Time was spent with many of the people who live at the home in one of the sitting areas. Care Homes for Older People Page 6 of 26 Observations of care practise and communication between the people living at the home and staff was also made at the inspection. Prior to the visit taking place the Care Quality Commission had sent to the home an Annual Quality Assurance Assessment (AQAA). This was returned prior to the visit and provided information on how the service self assess their own performance. During the visit we checked some of this information to make sure that what had been submitted was accurate. In addition we sent out a number of surveys to people that live in the home and staff, their comments have been used as part of this inspection. The focus of this inspection was to look at the key standards Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 26 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information available about the services on offer is good, and provides assistance to people when making a choice to move into the home. Evidence: Care files examined included Prue-admission assessment. Assessments included information from visiting the person at the hospital, or wherever he or she was living prior to admission and information from any referring social worker or health professional. There were sections covering the social, psychological and physical needs of the person. Assessments seen at this visit were comprehensive and clear, the Acting manager and staff through discussion also demonstrated an awareness of their contents and purpose. We spoke with four people about their admission to the home. Everyone confirmed that information was available to them when they moved. One person advised that their relative had visited several homes and it was their view that this would be more Care Homes for Older People Page 11 of 26 Evidence: subtable, they had been unable to visit as they did not lived in the local area at the time. They went on to explain that they had felt apprehensive when they came into the home as they did not know what to expect, however the staff had made sure that everything was explained to them, and for the first few weeks gave them additional support. The statement of purpose was examined. The document provided information on the staffing, accommodation and services available at the home. Alongside the service user guide a range of information was available, including services available. All comment cards indicated that people had received sufficient information about the home. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Access to health care support is good so people benefit from this advice and care to improve their overall well being. Evidence: Care documentation was seen to be in place within the care records for people living at the home. Care plans, monthly reviews and risk assessments had been undertaken.Just prior to this inspection the home had commenced a change to the type of templates they use to document care. We observed that the home was still in a transition phase in regards to this. However the standard of entries needs to improve in either of the types of documents being used. A care plan has to be in place for every assessed need, one person was a diabetic but there was no plan in place for this. Information submitted by the home stated that everyone was registered with a General Practitioner and received medical support through referrals from them. Records seen at this visit and people spoken to confirmed that this was correct. Staff if needed would escort people to appointments at the local hospital for example. Care Homes for Older People Page 13 of 26 Evidence: Health care at the home is well organised with regular input from a family doctor, and close liaison with many health care professionals including Parkinsons disease nurse, diabetes specialist, dietitian, skin care nurse, stoma care nurse, and Macmillan nurses. The services of a dentist, chiropodist, and optician are also provided. Accident forms had been completed following any accident or incident. Documents and staff demonstrated that follow up had taken place and when needed medical attention had been sought in a timely manner. Observations of care delivery were that people are treated with dignity and respect. We observed the lunch time meal and saw several staff providing assistance to people to eat their meals. All staff engaged in a positive way and provided verbal encouragement. People in the home all appeared well cared for and content, and staff were observed taking short periods of time to sit and chat briefly with people. The general atmosphere was friendly and relaxed. The storage of medication was seen to be secure and met the guidelines in this area. Medication stocks and records were examined, alongside the ordering and disposal of unused medication. A full audit was not possible as the balances of medication had not always been entered onto the medication administration records, and this needs to be addressed. All other areas were satisfactory. Only Registered nurses administer medication in the home, and it is only the nurses that have access to the keys for this area. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities for social activities are excellent and meet peoples individual preferences and needs in this area. Evidence: As assessed previously the home employs two experienced activities organisers, both work 4 days a week with some overlap. This allows for a structured approach to the provision of individual attention for some people as well as group activities for others. Alternate Saturdays are also covered. On speaking with one of them they demonstrated an understanding and commitment to providing a varied service. There is an activity programme of activities and events at the home. On the day of the inspection visit a Christmas event was taking place. On speaking with people living at they home they advised that everyday there is something going on. There continues to be links with local organisations such as a nursery school and local churches. The activities organiser also has knowledge regarding dementia care, and she trains staff in this area. Information about peoples lives which would help to develop meaningful occupation for people with dementia is sought from relatives in an efficient Care Homes for Older People Page 15 of 26 Evidence: way. One person we spoke with had adopted a stray cat. The cat stayed with the person in their room and the home supplied the food and water. They explained the joy it had brought them and how much they liked the company. All comments from the survey were positive in relation to the food. We observed the lunch time meal and saw that it was home cooked. Liquidised meals were presented so that component parts could be identified, and where necessary special equipment was used to help people maintain their ability to feed themselves. Menus showed that people were offered a meal that included protein, carbohydrates and vegetables. The chef speaks to people to gain their views on the standard of food. People questioned said that their visitors are made to feel very welcome indeed, and that they can come to the home at any time. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The response to complaints has been excellent so people can be assured their concerns are listened to and acted upon. Evidence: Within the statement of purpose there was information on whom to contact if you wished to make a complaint. All comments from surveys and when we spoke to people, indicated that they all knew how to complain and would feel comfortable doing so. In addition we looked at the past five complaints received by the service. The documents in place were of a good standard. They evidenced that acknowledgement had been given within 48 hours and then an investigation had commenced. Written records were kept on the findings and response to the complainant. In addition the home then showed how they made changes to prevent a similar concern to arise again. The former Registered Manager had kept all other parties up to date, this would include social services. In addition there was evidence that she would check after a period of time to ensure any changes made to improve, were actually still in place. On speaking with relatives at this visit, all stated they would not hesitate to complain if they felt the need. It was their view that staff would act on any concerns. The home had in place a policy on abuse and a copy of the most recent guidance for Care Homes for Older People Page 17 of 26 Evidence: the Safeguarding of Vulnerable Adults that contained the correct reporting of any alleged abuse. Training records showed staff had received training in this area. During the interviewing of staff they were able to demonstrate that they knew how to report any concerns. Care Homes for Older People Page 18 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of accommodation is sufficient to provide a homely environment for people to live in. Evidence: As assessed previously the home is comfortable, and all areas seen on the day of inspection were clean. Housekeeping staff are employed. Feedback from people living at the home was that they are happy with the accommodation, and with their rooms. People had personal possessions displayed in the bedrooms visited. The home also employs two maintenance men to undertake ongoing maintenance and decorative duties in the home, and also to maintain the large, well kept garden. The garden has hard paths so that the different sections of it can be easily accessed, and there is good quality garden seating situated within the different areas. There is an on going redecoration programme at the home, through observation this appears to work well in ensuring a good standard of decoration. Cleaning schedules were in place. Clinical waste contracts were also in place and equipment was seen to be used by staff for the purposes of managing cross infection. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are very well trained, supervised and supported. Therefore people living at the home can be very sure that they are in safe hands Evidence: The induction and training of staff was recorded in the individual records of all employees. Staff through interviewing confirmed that they had undertaken a variety of courses these included health and safety, moving and handling and national vocational qualifications in care. Several of the people living at the home made positive comments on the skills of the staff team. In addition returned surveys from staff indicated that they had received training and support to enable them to carryout their role. References are taken prior to staffs commencement and the relevant Criminal Records Bureau check is also carried out and evidence of this having been undertaken was seen. Certificates of qualifications are present within staff files. Registered Nurses, care assistants, catering and housekeeping staff are employed at the home . The rotas supplied by the home show that there are sufficient numbers of staff on duty throughout the day and night to meet the needs of the residents at this Care Homes for Older People Page 20 of 26 Evidence: time. People confirmed that staff were available to help and assist them when they need help. Training records examined that were supplied by the home show that staff had undertaken statutory training, including moving and handling, fire safety and food hygiene. In addition staff confirmed that they had attended a variety of courses including dementia awareness. People living at the home who were spoken with felt that the staff had a satisfactory level of knowledge and felt confident in their abilities to meet their needs. Staff were questioned on the individual needs of some of the people who live at the home, through this they demonstrated a good level of understanding of the needs of the person. One staff member had a very good level of knowledge relating to one person, and was able to describe their individual likes, dislikes, family history and the level of care and support needed. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and safety systems are well managed and they help reduce risks in this area. Evidence: Just several weeks prior to this inspection the Registered manager left her post. The previous training manager had now been appointed as the manager and was processing her application to become Regis red. The Acting Manager has many years experience both in hospitals and homes, and has previously been a Registered Manager of another home. In view of the limited amount of time it is not possible to make an assessment on her. However our review is the management of the service since its last key inspection, therefore this standard is assessed as being met. Regular quality audits of the service were carried out by sending questionnaires to residents and families. Feedback from these surveys were then used to make changes to the service to improve the standards of care. In addition other audits were undertaken by senior staff and included looking at medication, hygiene and record keeping. Care Homes for Older People Page 22 of 26 Evidence: The home has a Health and Safety policy. There was evidence within the training records that staff had undertaken fire, manual handling, food hygiene and first aid training. Risk assessments had been undertaken and were seen within care files. Records evidencing that maintenance and checks were undertaken relating to fire prevention and electrical and gas equipment was seen. Staff were observed to follow safe practise in the following areas, moving and handling, risk assessment, first aid, food hygiene, infection control and COSHH. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 7 15 Entries within care records 05/03/2010 must be sufficient to guide staff on how a person should be supported. This is to ensure continuity of care. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 The balances of all medication should be entered on to each new record. Care Homes for Older People Page 25 of 26 Helpline: 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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