Care Home: Diamond House Care Home

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What the care home does well The home has a core of staff who have worked at the home for a long period of time and are dedicated to the care of the residents. What the care home could do better: Staffing levels need to be sustained with permanent staff recruited and trained to give the staff team the skills they require to be able to offer the care for residents that this service is registered for. The meal time experience must be improved upon to make this time of day stimulating, timely and enjoyable. It should be offered with choice, with the correct support and given by staff who know how to assist with mealtimes. The care plans still need to be improved upon. Records that should be held that can track events relevant to the individual that ensure health issues etc can be followed through and that changes that occur are updated as required. Clear pathways/audit trail should be seen to make sure the correct and most up to date care is being provided and that risk assessments show how the risks are acted upon to minimalise as much as possible the potential risk. Medication administration practises need to be robust and any potential risk with prescribed medication identified and managed appropriately. Medicine cabinets kept locked, creams and lotions stored safely and medication charts completed fully. The home needs to collate information gathered from stakeholders and internal quality audits to develop and improve the service delivered. All outstanding requirements listed in this report need to be acted upon. Random inspection report Care homes for older people Name: Address: Diamond House Care Home Bennett Street Downham Market Norfolk PE38 9EJ zero star poor service 01/04/2010 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Ruth Hannent Date: 0 1 0 9 2 0 1 0 Information about the care home Name of care home: Address: Diamond House Care Home Bennett Street Downham Market Norfolk PE38 9EJ 01366385100 01366385600 diamondhouse@schealthcare.co.uk www.southerncrosshealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ashbourne (Eton) Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 42 Number of places (if applicable): Under 65 Over 65 42 42 dementia old age, not falling within any other category Conditions of registration: Date of last inspection Brief description of the care home 0 0 1 0 0 6 2 0 1 0 Diamond House is a care home providing residential care for up to 42 older people including service users with dementia. It is situated on the edge of the town of Downham Market and is within easy reach of local facilities including shops, pubs and other community facilities. Diamond House is purpose built with accommodation provided on two floors. Stairs and passenger shaft lift service floors. There are 38 single rooms and 2 shared rooms. There are patio and garden areas that are visible from a number of service users bedrooms. Diamond House is one of several homes in Norfolk owned by the proprietors. The range of weekly fees at the home is £275 to Care Homes for Older People Page 2 of 11 Brief description of the care home £550. Care Homes for Older People Page 3 of 11 What we found: This Random Inspection was carried out on the 1st September 2010 by 2 Compliance Inspectors that took place over a period of 5 hours. This home is rated as a poor service and was asked for an improvement plan following the last Key Inspection. This inspection along with the Random Inspection carried out on 10th June 2010 was to check that the requirements set at the Key Inspection on 1st April 2010 were met. The inspection was assisted by the manager Pat Collins who is yet to be registered with the Commission. We were informed that on duty that day were 5 carers upstairs, that included the senior, and 3 carers downstairs, that included a senior (reducing to 2 down in the afternoon). The home at present has 22 residents upstairs and 15 downstairs. On walking the home there appeared to be no activities taking place and people were sitting, sleeping or wandering with very little to occupy themselves with. Old time music was on in the lounge upstairs and a television was playing downstairs. The garden to the back of the building appeared untidy and uninviting with no colour or stimulus to encourage people to sit outside. The outside paintwork is flaking with beading around the windows missing in some areas. On moving upstairs at 12 midday we found a number of residents sitting in the dining room waiting for lunch that did not arrive until 12.20. The dining room had nothing to stimulate residents such as items or visual aids like bright menus, pictures, drinks or small nibbles to encourage appetites. One staff member was noted to be inappropriately standing while assisting with the meal and another was seated appropriately. The main meal was either cottage pie of poached fish but although residents were asked which they would like they were not shown the plated food. There was only orange squash to drink and no opportunity to say how much they would like, as it was just poured out. This was the same pattern for the amount of vegetables and gravy which was just placed on the plate. Plate guards were suitably attached for residents who needed them. A pureed meal was noted to be offered in individual portions to enable taste, smell and texture to be experienced by the resident. The manager did inform us that the home had tried to cover the meal with 2 sittings but this had not worked due to people wanting it at the same time. Although the dining room could not seat all residents if they wished to use this room at the same time, it was not an issue on this day as some people were remaining in their bedrooms for their lunch. An improvement on the mealtime experience was a requirement set at the last inspection that has not been met. The home employs 2 domestics who work from 8am to 2pm. The home did not have an unpleasant odour but some areas were noted to be in need of better cleaning. Some of the carpets appear stained, what appears to be faecal smears were noted on a sitting room chair and hard floors in a couple of bedrooms on the top floor were sticky from spilt liquids. The manager informed us that the home is going through a big change with staffing and that the home has seen a number of staff leave with more leaving shortly. This has meant the home has had to rely on agency staff to cover shifts. Noted in the communication book is a comment that only 3 staff are on this morning dated the Care Homes for Older People Page 4 of 11 29/08/10. There should be 5 as mentioned by the manager. It was also noted from the matrix that the training for staff has not been kept up to date for all staff. The home is registered for people who have dementia yet the statistics show only 61 have attended challenging behaviour, 66 have dementia awareness and no staff have the Yesterday Today and Tomorrow training that is meant for (Dementia Homes Only) as stated on the matrix. A requirement set at the last key inspection regarding competent and trained staff to be working in the home has not been achieved. Staff observed throughout the day were appropriate in the manner in which they assisted residents and always knocked on the bedroom doors before entering. Conversations were respectful of those overheard. During the afternoon it was noted residents were left alone while 2 staff were busy with a resident requiring hoisting and the other 3 were putting laundry away. This was an inappropriate use of time. No activities were provided and people were just sitting or sleeping in the lounge. A number of care plans were looked at with two studied in more detail. A requirement set at the last inspection was for care plans to be both person centred and also to reflect and record fully any changing needs. An attempt has been made to improve the care plan information with details seen that appear more personal. There are now pen pictures placed at the front of the care plans to give a quick picture of the person the care plan belongs to. Some of these have been worded well and some are inappropriate with comments such as I play people up sometimes written by a key worker. Information that should be important for a pen picture was found to be missing such a person who is diabetic and someone who has had health changing needs. There are also noticeable gaps in the information recorded within the care plan. For example a note in the continence advisor book talks of problems with bowels yet nothing is recorded in the persons daily notes or on the health professional recording sheet within the care plan. In another care plan pressure sore risk assessment shows a low risk yet the daily notes talk of concerns of pressure areas and for the person to be turned every 2 hours. A care plan around mobility was stating this person walked around by herself yet during this inspection the person was being cared for in bed and being turned regularly and we are informed that she has not walked for a long time. Another concern is around the recording of injuries on body maps were it was noted one person had a number of these maps completed over a 2 month period with injuries around the same area of the body and yet nothing has been recorded of how these were followed up or investigated. There was also noted in the daily records that there is a big sore on the right cheek that looks painful which had not been placed on a body map. There was no evidence found of referrals to the district nurses regarding pressure areas and nothing logged in the health professional notes. Another person had been given thickener due to swallowing problems but this had not been recorded on the relevant care plan. During the lunchtime medication administration round the staff member responsible for this task left the trolley unlocked as medication was taken in to bedrooms or the dining room. The pills were noted to be pierced from the blister pack after the chart had been checked and signed for when returning to the trolley. In the en suites it was noted that prescribed medication (creams/lotions) had not been locked away and that they were easily accessible to the residents. There were no recording charts in the rooms for completing on cream administration, and medication administration charts held with the trolley showed a number of blank sheets where application of creams should have been initialed for. A person also was noted to be prescribed Lorazepam but nothing had been initialed for and the medication had not been stopped by a GP. Care Homes for Older People Page 5 of 11 The home still needs to gather the comments and information from all stakeholders and other quality measuring systems to create an improvement and progressive action plan that will aid the development and delivery of a quality service. To date the home has circulated comment/questionnaires to people involved with the home but collated information has not been seen. What the care home does well: 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 set out on page 2. Care Homes for Older People Page 6 of 11 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans need to reflect the changing needs of residents with the correct action recorded as needs change. To ensure that any concerns or changing needs are dealt with and outcomes for residents are improved. 01/06/2010 2 12 16 The home needs to provide 01/06/2010 stimulation and occupation to all residents that is suitable for them as an individual. To ensure that all efforts are made to occupy at all times residents who may challenge the service. 3 15 16 The way meals are presented 01/06/2010 and the way people are supported to eat the meal needs to be improved. Meals need to be served with choice, at a suitable temperature and that residents are helped in a manner that is relaxed supportive and observed to ensure a good diet is eaten. 4 27 18 The home must ensure that at all times qualified, competent and experienced 01/06/2010 Care Homes for Older People Page 7 of 11 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action staff are working in the home in such numbers as are appropriate. To ensure the health and welfare of residents is upheld. Care Homes for Older People Page 8 of 11 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 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 All creams/lotions prescribed 01/10/2010 are locked securely in ensuites. To eliminate any potential risk of substances being ingested. 2 9 13 All medication administration 01/10/2010 charts must be completed by the administering staff member or marked with the correct code when not administered. To ensure safe management of the administration of medication has clear accountable records. 3 9 13 Staff administering medication must ensure the trolley used for transporting the medication around the home is kept locked at all times To ensure procedures of safe adminstration of medication is followed. 01/10/2010 Care Homes for Older People Page 9 of 11 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 26 27 The home should ensure that the cleaning of the home is of a high standard. Staff need to be deployed to ensure residents receive the full support for all their needs and not carrying out laundry tasks when residents are left for long periods without staff support/stimulation. Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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