Care Home: Docking House

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What the care home does well People who were thinking of moving into the home received an information pack explaining about the service and what facilities they could expect. Before being offered a place, people were assessed to make sure that their needs were understood and the home was suitable for them. Staff supported residents to maintain their independence and to make decisions about their everyday lives. There was information on care plans about the residents` preferences, which helped staff to support people to make choices about their daily routines. There was a varied menu with a choice at every meal. Residents who returned surveys and those we spoke to said they liked the meals. One told us, "The food is good and the service is good." There was equipment around the home to assist people who were not independently mobile. Residents we spoke to said they liked their bedrooms. Several people had made their rooms more familiar and homely by bringing in ornaments and pictures. On the day of our visit the home was clean and fresh smelling and most of the residents who returned surveys said it was always like that. Over half of the care staff had an NVQ in health and social care, which is a nationally recognised qualification and helps staff to have the knowledge and skills needed to fulfil their role. What has improved since the last inspection? We made it a requirement after our last inspection for staff to have training and clear guidance in recognising and handling any cases where they suspected a resident was being abused. We found that a number of staff had received safeguarding training but new staff did not always have the opportunity to attend a course until they had been at the home for some time. Some of the communal areas and a number of bedrooms had been redecorated since our last inspection, which helped to make the home more comfortable. Two new baths had been installed to ensure that people who needed help to bathe, had appropriate facilities. This had been an outstanding requirement after the last two inspections. After the last inspection we required staff to improve their practices to prevent and control the spread of infection. The issues that we noted last time had been addressed. However, staff should review the way they use protective clothing to ensure residents` and their own health and safety. The planned staffing levels had improved since our last inspection. There was an extra care worker on duty in the morning to help people with personal care and with breakfasts. Staff told us that the staffing levels were sufficient to meet the current residents` needs and a resident told us they did not have to wait for attention. What the care home could do better: Care plans and associated records must address all the resident`s assessed needs, including those associated with dementia, such as memory loss. Staff must make sure that plans to minimise risks to residents` health focus on the right areas. They must also keep the use of bedrails under review and the rails must be checked regularly to ensure that they are safe and in good working order. Some of the records relating to medication must be improved in order to ensure residents receive their medicines as they are prescribed and to reduce the risk of medication errors. The staff must make sure that all aspects of the home and the care they provide, promote residents` privacy and dignity. Despite a recommendation we made after the last inspection, there were still no privacy curtains or blinds at the conservatory windows or at the windows of bedrooms overlooking the car park. This meant that people could see into the home from the main road through the village. There should be care plans to help staff to meet residents` individual social and recreational care needs. There were some regular activities but not all the residents we spoke with thought these were sufficient. There was also a lack of planned sessions for people who did not wish to, or were unable to, join group activities. Staff must carry out risk assessments with with regard to the windows that do not have restricted openings. Where any risk to residents` health or safety is identified, restrictors must be put into place. Training for new staff was too brief to ensure that they had the necessary knowledge and skills to fulfil their role. A new programme of induction training was to be introduced, which should improve the situation. The systems for monitoring and improving the quality of the service must include finding out the views of people who use the service and acting upon their suggestions. There must be clearer records of money held on behalf of residents. This is so that staff can audit the records and ensure that finances are being managed correctly. Key inspection report Care homes for older people Name: Address: Docking House Station Road Docking Kings Lynn Norfolk PE31 8LS     The quality rating for this care home is:   one star adequate 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: Jane Craig     Date: 0 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 33 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 33 Information about the care home Name of care home: Address: Docking House Station Road Docking Kings Lynn Norfolk PE31 8LS 01485518243 01485518436 care@dockinghouse.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): ARMS Associates Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Docking House is a residential home for 28 older people who have personal care or dementia care needs. The home is situated in the in the village of Docking, between the towns of Hunstanton and Fakenham. There is a post office and shop close by. The home is supported by two G.P. practices. The accommodation is all on the ground level. The home has shared and single bedrooms with hand wash basins. There are a number of lounge and dining areas for communal use. Information about the home, including the last inspection report, is available from the home. Up to date information about the fee structure is available on request. There was an extra charge of 5 pounds per week for toiletries and activities. Other extras included hairdressing, newspapers Care Homes for Older People Page 4 of 33 Over 65 18 10 0 0 1 2 0 1 2 0 0 9 Brief description of the care home and staff escorts and transport to hospital appointments. Care Homes for Older People Page 5 of 33 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: one star adequate 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 last key inspection on this service was completed on 12th January 2009. This key (main) inspection includes information gathered since the last inspection and an unannounced visit to the home. The visit was carried out on 2nd December 2009 by two regulatory inspectors. At the time of the visit there were 24 residents in the home. We met with a few of them and asked about their views of Docking House. We spent time observing daily routines in the home and how staff interacted with residents. Three residents were case tracked. This meant that we looked at their care plans and other records and talked to staff about their care needs. We talked to the registered provider, who is the person the company has nominated to take legal responsibility for the home. At the time of our visit he was managing the Care Homes for Older People Page 6 of 33 home on a day to day basis until a new manager could be appointed. The previous registered manager left the home a few weeks prior to our visit. We also talked to members of the care team. We looked around the home and viewed a number of documents and records. As part of the key inspection, surveys were sent out to residents and staff. Residents had been assisted to complete their surveys by a member of staff. Survey responses have been taken into account when making judgements about the service. This report also includes information from the annual quality assurance assessment (AQAA), which is a self-assessment report that the manager has to fill in and send to the Commission every year. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Care plans and associated records must address all the residents assessed needs, including those associated with dementia, such as memory loss. Staff must make sure that plans to minimise risks to residents health focus on the right areas. They must Care Homes for Older People Page 8 of 33 also keep the use of bedrails under review and the rails must be checked regularly to ensure that they are safe and in good working order. Some of the records relating to medication must be improved in order to ensure residents receive their medicines as they are prescribed and to reduce the risk of medication errors. The staff must make sure that all aspects of the home and the care they provide, promote residents privacy and dignity. Despite a recommendation we made after the last inspection, there were still no privacy curtains or blinds at the conservatory windows or at the windows of bedrooms overlooking the car park. This meant that people could see into the home from the main road through the village. There should be care plans to help staff to meet residents individual social and recreational care needs. There were some regular activities but not all the residents we spoke with thought these were sufficient. There was also a lack of planned sessions for people who did not wish to, or were unable to, join group activities. Staff must carry out risk assessments with with regard to the windows that do not have restricted openings. Where any risk to residents health or safety is identified, restrictors must be put into place. Training for new staff was too brief to ensure that they had the necessary knowledge and skills to fulfil their role. A new programme of induction training was to be introduced, which should improve the situation. The systems for monitoring and improving the quality of the service must include finding out the views of people who use the service and acting upon their suggestions. There must be clearer records of money held on behalf of residents. This is so that staff can audit the records and ensure that finances are being managed correctly. 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. Care Homes for Older People Page 9 of 33 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 33 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. The admission process helped to ensure that the home was suitable to meet the needs of the people who moved in. Evidence: People thinking of moving into the home were given a service users guide, which told them about the service and facilities they could expect. People were also able to visit the home before making a decision about whether they wished to move in. Following a recommendation we made at the last inspection, new residents were given a contract at the point of moving in, which helped to ensure everyone was clear about the terms and conditions and the fee structure. Anyone thinking of moving into the home was assessed by senior staff. This was to make sure that their needs were understood and could be met by the staff team at Docking House. The provider told us that he planned to ensure that staff were consulted about the results of the pre-admission assessments to ensure that they Care Homes for Older People Page 11 of 33 Evidence: were confident they would be able to provide the appropriate care before the placement was confirmed. Care Homes for Older People Page 12 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all of the written care records provided staff with the information they needed to meet peoples personal and health care needs. Evidence: We looked at three sets of care records as part of the case tracking process and others to check on specific issues. The standard of care plans varied. The provider told us that he was in the process of arranging a consultant to give some care plan advice and training to senior staff. There were some good examples of care plans to support residents to meet their personal care needs. For example, some instructed staff how to promote residents individual choice and independence. However, others we saw were less person centred and did not provide sufficient direction to ensure residents individual preferences were taken into account. None of the care plans we saw showed that the resident, or their relative, had been involved in drawing up or reviewing the plans. There were no records to show whether Care Homes for Older People Page 13 of 33 Evidence: relatives were invited to care reviews. The annual quality assurance assessment (AQAA) indicated that this was an area that the service planned to improve over the next twelve months. Earlier in the year there had been a gap in the monthly care plan reviews but this seemed to have been resolved. We saw that some care plans had recently been updated or re-written to reflect the residents changing needs. However, some of the new plans were not very detailed and some did not address the identified need. For example, one new plan indicated that the resident was not eating well. The directions for staff were not adequate to provide appropriate support to improve the residents nutritional status. The nutritional risk assessment had not been completed appropriately and the records showed that the person had not been weighed for over three months. The lack of weight checks for residents with nutritional needs had been raised at the last inspection. Residents who used bed rails had risk assessments in place but one that we looked at had not been completed in full, which could result in the person being at risk of entrapment. There were no records to show that bedrails were checked regularly and remained safe. There was evidence that residents ongoing physical health care needs were monitored and people were referred to health care professionals. Records were in place to show when residents were being treated by their GP or district nurses and staff ensured that advice was carried out. For example, medication was given and staff reported back any changes. However, ongoing advice from professionals was not always transferred onto the residents care plans, which could result in it not becoming part of everyday practice. For example, we saw advice from district nurses with regard to the care of a resident with leg ulcers that was not included on the residents plan. Most residents had a brief mental health assessment that was reviewed each month. These assessments generally highlighted whether the resident had memory loss and disorientation. However, there were no plans to support people who had individual needs associated with these elements of dementia. Care plans tended to focus on the physical tasks that residents were no longer able to achieve because of their dementia. This issue had been raised at the previous inspection. A resident who exhibited aggressive behaviour had a detailed assessment and care plan in place, which helped staff to identify triggers and develop strategies to minimise the risk of harm to residents and staff. Residents surveys indicated that they received the care and medical support they Care Homes for Older People Page 14 of 33 Evidence: needed and on the day of our visit a resident told us they were cared for very well. There was a commitment to the promotion of core values, such as privacy, dignity, choice and independence, in the service users guide. During our visit we saw that staff were friendly and polite towards residents and treated them with respect. We observed staff providing encouragement in a kind and gentle way and a resident told us that staff were always very nice to him. Personal care was provided in private and staff did not enter bedrooms without knocking. However, there were some practices that compromised residents privacy and dignity. For example, some of the female residents had facial hair that was not removed, others were not wearing stockings or tights. We witnessed staff moving a female resident using the hoist. They had not checked that her clothing was in place and consequently her underwear was showing. However, other staff made sure they covered a lady whilst she was in the sling, which helped to maintain her dignity. At the last inspection we made a recommendation for net or privacy curtains in the bedrooms that overlooked the car park. This had not been actioned. On the day we visited, two residents in those rooms chose to have a lie down in the afternoon. They had not drawn the main curtains, and therefore, could be seen from anyone in the car park. The conservatory still did not have any blinds or curtains and anyone passing the home would be able to see in once the lights were on. This was of particular importance as a few of the residents were not able to maintain their own dignity, by, for example, recognising when their clothing was awry. One of the bathrooms did not have curtains or blinds. None of the residents managed their own medication. Senior staff with responsibility for handling medicines had received training. Medicines were administered via a monitored dose system. Storage of all medicines currently in use was safe and storage temperatures were monitored to ensure they remained at the recommended level. However, medicines for return to pharmacy were accessible to anyone who was able to enter the medication room, which increased the risk of mishandling. There were records of medicines received into the home and of any carried forward from the previous month. This helped to ensure that prescribed medication was always available. Records of medicines returned to pharmacy were completed at the end of the cycle rather than on an ongoing basis, which could increase the risk of mishandling. With the exception of one chart, there were no gaps on medication administration record (MAR) charts and appropriate codes were used when medication was omitted. However, records had not been completed to show that a tablet had been found on a residents floor and the MAR chart indicated that all medicines had Care Homes for Older People Page 15 of 33 Evidence: been taken. This meant that staff would not be aware to monitor any affects of the resident not having all their tablets, or to be extra vigilant when administering medication to this person in the future. We checked a random sample of medication not administered via the monitored dose system to check that the amount of tablets matched what was specified on the records. There were discrepancies in two lots of medicines, which could indicate residents are not receiving their medication as it is prescribed. A medication audit carried out the week prior to our visit had similar findings. We saw two handwritten entries on MAR charts, one had not been signed and there was no evidence that it had been checked to reduce the risk of transcribing errors. We made a good practice recommendation after the last inspection to ensure that staff had guidance as to when to administer medication prescribed when required. This had been acted upon. At the time of our visit no-one was prescribed controlled drugs. There was appropriate storage in place. Care Homes for Older People Page 16 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The level of activities and occupation did not meet the social and recreational needs of everyone living at Docking House. Evidence: Residents had personal profiles on their care files to help staff to get to know them and understand which people and events were important to them. The detail contained in these documents varied. For example, one that we saw gave a comprehensive picture of the persons social history, as well as their personality, likes and dislikes in a wide range of issues. Another one we looked comprised a brief few lines and did not give any insight into the residents life before they came to Docking House. We made a good practice recommendation after the last inspection to draw up individual plans to meet residents social and recreational needs. Although this had been partly acted upon, the plans we saw were not adequate. For example, one plan identified that the resident did not like joining activities, however, the first instruction for staff was to encourage the resident to join activities. The plan went on to acknowledge that staff should also provide one to one time but did not specify how the resident preferred this to be spent. One resident told us that they liked to be outside Care Homes for Older People Page 17 of 33 Evidence: but they did not have a social care plan to support them to do this. The AQAA indicated that the service planned to provide more person centred activities in the future. Residents who returned surveys indicated that there were not always enough activities for them to join. We found that the person responsible for organising activities had been absent for a while. Care staff told us that they did regular games if they had time. During our observations we noted that there were periods of time, especially in the morning, when there was little stimulation. At one point, half of the residents in one lounge were asleep. Staff remained in the lounges to have their morning drink, which we thought was good practice, however, there was little interaction with residents at that time. Residents who sat in another lounge seemed to appreciate that staff regularly walked through. Residents were always acknowledged if they spoke to staff and they were always provided with anything they requested. However, staff were usually too busy to initiate conversation, which meant that some residents only received staff attention when they were being assisted with personal care. Care files generally included some information about residents preferences with regard to daily routines and care. For example, night care plans told staff when residents generally preferred to go to bed, what drink they preferred and how they wanted their room. One plan indicated that the person preferred to sleep in an armchair and, while staff encouraged them to go to bed, they respected their choice. Another plan directed staff to consider what the resident might previously have liked when they were helping them to make a choice. One resident told us that they preferred to eat on their own in the lounge and that staff were happy to let them do that. Residents who completed surveys indicated that they liked the meals. We also received some positive comments during our visit. One resident said, The food is good and the service is good. Another told us, The food is all right but there is too much stew. There was a rotating menu and the cook had the flexibility to make changes. On the day of our visit there was a choice of two main meals and one resident asked for beans on toast, which she was given. We were told that residents were asked to choose their meals the day before but this would not be particularly helpful for the large number of people who had short term memory loss. The provider told us that, in reality, there were enough meals prepared for residents to be able to change their mind on the day if they wanted to. There were appropriate stores of food and the cook told us that they have a regular delivery of fresh fruit and vegetables. There had been improvements in the way the lunchtime meal was served since our Care Homes for Older People Page 18 of 33 Evidence: last inspection. Residents were not seated at the table for a long time before being served and they did not have to wait too long between courses. This meant that less residents became restless and wandered away from the table. There were enough staff to help residents who needed it. People who remained in the lounge for their lunches were assisted in a dignified way. Staff sat down with them and there was some interaction between the member of staff and the resident. However, a member of staff who helped a resident in the dining room did so whilst standing up. The member of staff spooned food into the residents mouth without making eye contact or conversation. She left part way through helping and the resident was left alone, making no attempt to eat by herself. This was repeated twice more by different members of staff. The lack of individual time and attention could be seen as undignified and disorientating. Care Homes for Older People Page 19 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure ensured that formal complaints would be investigated and acted upon. The lack of clear guidance in safeguarding could result in suspected abuse being mismanaged. Evidence: The complaints procedure had been reviewed and included all the necessary information. It was clear and would assist relatives and visitors to make a complaint. The procedure was on display in the foyer, which was an area rarely used by residents. We discussed with the acting manager about making the procedure available in a format that would be more accessible to some of the residents, which would enable them to make a complaint if they wish. Complaints records showed that there had been one verbal and one written complaint to the home since our last inspection. The verbal complaint was about missing items and had been resolved. The second complaint, about care issues and the environment, had not been resolved. The complainant had been asked to provide further information in order to aid the investigation but had not done so at the time of our visit. The complaint remained open. Several staff had received training in safeguarding vulnerable adults. New staff received some written information about safeguarding during their induction, however, they did not always receive training until several months into their employment. This Care Homes for Older People Page 20 of 33 Evidence: should be improved with the implementation of the new induction training programme. The procedure for the home had been reviewed and it gave clear information about definitions and recognition of abuse. However, it was still not completely clear about the role of social services as the lead agency, or about how to report suspected or actual abuse. The provider told us that the local social services procedure had been obtained but it could not be found on the day of our visit. Staff we spoke to were aware of their role and responsibility in reporting and the acting manager was aware of who to contact. There had been one safeguarding referral since our last inspection. This had been prompted by concerns about the lack of staff and a decline in the standards of care, particularly at weekend. The allegations were investigated. Where they were found to be substantiated, actions were put into place to improve the situation. All staff had been made aware of the concerns raised and the action plan. Staff had received training in the mental capacity act some time ago and may not have the most up to date information about related legislation. We discussed with the acting manager that further training or guidance should be sought to ensure that residents rights under the act are being upheld by staff. Care Homes for Older People Page 21 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to the environment helped to make the home comfortable but the lack of window restrictors could create risks for some residents. Evidence: There had been further improvements in the environment since our last inspection. A number of bedrooms and other areas had been, or were in the process of being, refurbished. Most of the draughty, metal windows had been replaced. However, the windows did not have restrictors and there were no risk assessments to show that residents safety was not compromised by this decision. There was a brand new kitchen, which had more storage and work space. There were new, low surface temperature radiators and the old, inefficient pipework had been replaced. There was a new staff call system and all bedroom doors were linked to an alarm, which could alert staff when residents were up. This helped staff to support people who were at risk of falls. The provider was aware that there were still some areas in need of upgrading and had an ongoing plan for redecoration and renewal. There was discreet signage throughout the home to assist people to find their way around independently. Each resident had a sign with their name and a photo on their bedroom door to aid recognition and ownership. Some people brought in small items of furniture, pictures and ornaments, which helped to familiarise their rooms and Care Homes for Older People Page 22 of 33 Evidence: make them homely. Residents that we asked said they liked their rooms. One person said he loved his room and the bed was very comfortable. People in shared rooms had privacy curtains in place. Following previous requirements there were two new assisted baths. One was suitable for people who needed to be transferred using a hoist. Staff told us, The new bath is lovely and the residents love it. There was other equipment around the home to assist people with restricted mobility. Staff said that they have enough hoists and a new one had just been purchased for heavier residents. There had been improvements in the cleanliness of the home. Residents who completed surveys indicated that the home was always, or usually, clean and fresh smelling. Some staff had received training this year in prevention and control of infection. The current induction programme did not cover the topic in depth and as a consequence, some may not receive training until they had worked at the home for several months. The implementation of the new induction programme should improve this situation. The requirements we made at the previous inspection with regard to not sharing personal items and not using the laundry room to wash crockery had been actioned. However, the infection control procedures were still not completely safe. Staff wore disposable gloves when providing personal care to residents. However, we observed a member of staff did not remove their gloves before entering the kitchen. A number of staff did not wear aprons, either when providing personal care or when serving food and wore the same uniform for both tasks. Care Homes for Older People Page 23 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home were protected by the recruitment practices. There were sufficient staff, with appropriate training, to meet the needs of people currently using the service. Evidence: Planned staffing levels had improved since our last inspection. The target was for one senior carer and three care staff on each shift. There was also a floater between 7am and 10am to assist with personal care and serving breakfast. Staff told us that the senior staff had the flexibility to increase the floater hours on a temporary basis if needed. However, the staffing rotas we looked at indicated that the target staffing levels were not always met because the 7am to 10am shift was not always covered. Staff told us that there were enough staff to meet current needs because none of the residents were falling on a regular basis and none were displaying complex behaviour. A resident told us that they never had to wait for staff attention. We looked at two staff files. Both staff had started work before their full CRB disclosures had been obtained. They had been checked to ensure that they were not on the list precluding them to work with vulnerable adults but there were no records to show that they were supervised throughout this period. Both had two written references, one of which was from a previous employer. The current application form did not make it clear that anyone applying to work at Docking House must declare any Care Homes for Older People Page 24 of 33 Evidence: previous offences, even those considered to be spent. A new application form was being introduced, which would make that position clearer. The current induction training programme for new staff did not cover all the topics of the common induction standards and did not provide new staff with sufficient training. One member of staff, who had no previous experience as a carer, told us that their induction took place over one day. This meant they did not have sufficient knowledge and skills before they were providing personal care to residents. The provider had put together a new, more in-depth programme, which he planned to implement in the next few weeks. We were told that the central training record may not accurately reflect all the training that has been done in the past year, as some of the certificates were not available. The record showed that some staff had done refresher training in the mandatory topics over the past year. Some of the staff we spoke to confirmed that they had received training in moving and handling, safeguarding and prevention and control of infection. Courses in all topics were booked over the next three months to try to address any shortfalls. Dementia care was considered to be a mandatory topic and most staff had attended a course. However, it was not clear about the content and depth of the course, which we were told was completed in a day. The AQAA told us that over half of the care staff held a National Vocational Qualification (NVQ) level 2 or above in health and social care. This helped to ensure that the staff team had the knowledge and skills to provide care to people in the home. Care Homes for Older People Page 25 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems were being put into place to improve the organisation and management of the home for the benefit of the people living and working there. Evidence: The responsible individual for the company had been managing the home since the departure of the registered manager a few weeks prior to our visit. Because he does not have a background in care, he was working closely with senior care staff in relation to direct care issues. He was in the process of employing a new senior member of staff to manage the home temporarily. Part of their brief would be to recruit an appropriate person to take on the role permanently. Staff were clear about the management arrangements and they all said they felt supported. Senior care staff were having weekly meetings. Minutes showed that the acting manager was aware of areas that needed improvement and was putting plans into place to bring about changes. He told us that completing the annual quality assurance assessment (AQAA), had helped him to audit the current service with a view to making improvements. Care Homes for Older People Page 26 of 33 Evidence: A new quality monitoring system was being implemented across the company. At the time of our visit a number of policies and procedures were being reviewed. Internal audits had commenced with a medication audit and it was planned that other audits would be carried out. We discussed the need to extend the audits of accidents to try to identify any patterns or trends with regard to individual residents or times of the day. This would help staff when drawing up plans to minimise falls. We were told that residents and relatives would be invited to complete questionnaires about their experiences of the service but this was on an ad hoc basis. There were no formal ways of capturing and publishing the views of people involved with the service. We checked records of money held on behalf of residents. Although the records matched the amounts of money held, we discussed the need for clearer records, particularly when money was given back to residents or spent on their behalf. The fire risk assessment had been reviewed. The fire system and equipment had been tested and staff had received annual training. The monthly fire safety audits carried out by staff in the home had not been completed since September and the weekly tests had stopped at the same time. The acting manager confirmed that the maintenance person had received training on how to carry out the tests and would take on the role. We saw evidence that other equipment and installations were maintained. There were environmental risk assessments and we noted that potentially hazardous items, such as cleaning chemicals were stored safely. Care Homes for Older People Page 27 of 33 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 28 of 33 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, 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 1 7 15 Care plans must address residents needs associated with mental health and dementia. This is to ensure that all residents health care needs are met. 31/03/2010 2 8 13 Appropriate strategies must be put into place to address potential risks to residents health. For example, risks associated with poor nutrition. This is to ensure that all residents health care needs are met. 31/03/2010 3 8 13 Bedrail assessments must 31/12/2009 be completed and they should be checked regularly to ensure that they remain in a state of good repair and are safe to use. Care Homes for Older People Page 29 of 33 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 To protect the health and safety of people using the service. 4 9 13 There must be accurate and complete records of medication administered to residents. This is to ensure they receive medication as it is prescribed. 5 10 12 Residents privacy and 31/01/2010 dignity must be promoted at all times. This would include, ensuring that they are always dressed and groomed appropriately and ensuring that there are privacy blinds or curtains in communal areas and bedrooms. To promote residents privacy and dignity 6 19 13 Risk assessments must be carried out to ensure that possible risks of accidental injury linked to unrestricted window openings are controlled. This is to protect residents safety 7 33 24 The systems for monitoring and improving the quality of the service must include the 31/03/2010 31/01/2010 31/12/2009 Care Homes for Older People Page 30 of 33 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 views of people using the service and other stakeholders. To ensure that the service is run in the best interests of people living there. 8 35 17 The records of money held 31/12/2009 on behalf of residents must be improved to ensure there is a complete audit trail of money received or returned to them. This is in order to safeguard residents. 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 3 9 12 18 Recording and storage of medicines awaiting return to pharmacy should be made safer. Everyone should have a care plan to support them to meet their individual social and recreational needs. Staff should have further training about the Mental Capacity Act and Deprivation of Liberty Safeguards to ensure that residents rights are upheld. The safeguarding policy should have clear information about how safeguarding incidents should be handled. The new induction training which meets the Skills for Care common induction standards should be implemented as soon as possible to ensure that new staff receive essential training in a timely manner. The central training record should be brought up to date and any shortfalls in mandatory training should be Page 31 of 33 4 5 18 30 6 30 Care Homes for Older People 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 addressed. Care Homes for Older People Page 32 of 33 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. 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