Care Home: Dolphinlee House

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What the care home does well The people spoken with during the visit to the home were very pleased with the care and support provided. The staff spoken with were committed to providing good quality care for the people at the home. The people who live at the home were very positive about the staff and felt that they did an excellent job in sometimes difficult circumstances. The Intermediate Care Unit provides an excellent service. Comments received included: `The home is very clean and comfortable.` `Its marvellous. What a change, I feel so much better having people to chat to. I exercise regularly and am improving every day. `I have enjoyed trips out for lunch but I think the food is better at Dophinlee!` `A high percentage of our service users return to their own home and the staff here enable them to go back to managing their own lives.` `The Intermediate care Unit provides an informal environment to meet the needs of service users rehabilitating after perhaps months in hospital. Giving time to adjust to a different way of life and become stronger both physically and mentally therefore ensuring that discharge to home will be successful.` There are thorough pre admission processes in place. This means that people living choosing to come and live at Dolphinlee have information and the opportunity to visit before making a decision, and the staff have a good understanding of how the person wishes to be supported and cared for. The personal care and health needs of people in all units of the home are regularly reviewed, and this ensures that staff understand the changing needs of people living at the home and involve other professionals, such as the district nurses or specialists when necessary. The people spoken with were confident that any health concerns they may have were acted on straight away by staff. The atmosphere of the home was friendly. People living at Dolphinlee felt like they were treated with respect. Efforts are made by the staff to make sure that everyone at the home feels welcome and well cared for, and this was appreciated by the people spoken with during the visit to Dolphinlee. What has improved since the last inspection? There has been a period of change over the past 12 months and this has been unsettling at times for staff members. The staff spoken with during this visit are happy working at Dolphinlee but all had felt under pressure over the past few months. The needs of the people being cared for have become more complex, and at times there have been staff shortages. A new manager has been appointed and staff spoken with feel that the staffing situation is now improving. At the time of the visit, new staff had been recruited to vacant posts. Additional staff are on duty at busy times, for example in the evening. A new system of care planning is being introduced. This has been used with people newly admitted to the home. The new system is sensitive to peoples needs and wishes and aims to gather information which will help care and support to be provided in the way in which the person would like. The individual preferences and lifestyle choices of the person are promoted by this way of care planning. The staff have been active in improving the activities and social opportunities on offer to people living at the home. There are efforts to make sure that all people living at the home can take part in activities and trips out. If a person is not able to take part, the reasons for this are discussed to see if anything can be done by staff to enable the person to take part. If a person does not want to join in organised activities this is respected. The new manager has improved the staff induction programme. New staff now benefit from having a planned induction and written information is provided which covers all aspects of their job role. What the care home could do better: The risk assessments that were seen on some files were no longer accurate. It is important that as a person`s needs change any information that is no longer relevant is removed from the plan of care that is currently in use, and archived. This is to avoid confusion and to make sure that people`s needs are clearly understood and staff offer support in a consistent way. With regard to medication the arrangements in place for auditing the number of tablets at the home should be improved. It is important that an accurate record of this is maintained. Over the past six months concerns have been raised over proposed staff changes for night time staff cover at the home. For the present these levels remain unchanged. It is important that the night cover provided is consistent with the needs of the people at the home. The manager understands the need to monitor staffing levels and the importance of working in ways which promote safety and good practice. CARE HOMES FOR OLDER PEOPLE Dolphinlee House Patterdale Road Ridge Estate Lancaster Lancashire LA1 3LZ Lead Inspector Mrs Felicity Lacey Unannounced Inspection 11th September 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Dolphinlee House DS0000032609.V367850.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dolphinlee House DS0000032609.V367850.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dolphinlee House Address Patterdale Road Ridge Estate Lancaster Lancashire LA1 3LZ 01524 37685 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Lancashire County Care Services Ms Carol Coleman Care Home 44 Category(ies) of Dementia (12), Old age, not falling within any registration, with number other category (23), Physical disability (9) of places Dolphinlee House DS0000032609.V367850.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE (maximum number of places: 12) The maximum number of service users who can be accommodated is: 44 Date of last inspection 25th August 2006 Brief Description of the Service: Dolphinlee House is situated on the Ridge Estate on Patterdale Road in Lancaster. The home is owned by Lancashire County Care Services (LCCS). The home is currently registered to take a maximum of 44 residents in categories as described above. The home is divided in three units and each unit has its own lounge and dining room. The Intermediate Care Unit is staffed separately and also has input from other agencies like physiotherapists and occupational therapists. Accommodation is provided mainly in single bedrooms. Many of the bedrooms have an en-suite facility. The home is arranged over two floors, with some bedrooms on the ground floor. The home is staffed 24 hours a day and care is provided according to needs. An assessment is carried out to determine the level of needs of all the residents. There were forty residents living at the home at the time of the inspection. Nine residents were in the Intermediate Care Unit, ten people were in the dementia unit and 21 people were living in the main part of the home. A new manager has been appointed to the home, and she has been in post for 5 months. She is registered with the Commission. Dolphinlee House DS0000032609.V367850.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection included an unannounced visit to Dolphinlee House. Information about the service provided at the home has been collected since the last key inspection, which took place in August 2006. Information was provided by the manager of the home including the way in which the staff of the home meet the needs of the residents, the training and support staff receive and data about health and safety at the home. Four people who live at the home and two members of staff completed surveys. People who live at the home, a visitor, the manager and staff members were spoken with during the visit. Care and administration records were looked at. The premises were toured. What the service does well: The people spoken with during the visit to the home were very pleased with the care and support provided. The staff spoken with were committed to providing good quality care for the people at the home. The people who live at the home were very positive about the staff and felt that they did an excellent job in sometimes difficult circumstances. The Intermediate Care Unit provides an excellent service. Comments received included: ‘The home is very clean and comfortable.’ ‘Its marvellous. What a change, I feel so much better having people to chat to. I exercise regularly and am improving every day. ‘I have enjoyed trips out for lunch but I think the food is better at Dophinlee!’ ‘A high percentage of our service users return to their own home and the staff here enable them to go back to managing their own lives.’ ‘The Intermediate care Unit provides an informal environment to meet the needs of service users rehabilitating after perhaps months in hospital. Giving time to adjust to a different way of life and become stronger both physically and mentally therefore ensuring that discharge to home will be successful.’ There are thorough pre admission processes in place. This means that people living choosing to come and live at Dolphinlee have information and the Dolphinlee House DS0000032609.V367850.R01.S.doc Version 5.2 Page 6 opportunity to visit before making a decision, and the staff have a good understanding of how the person wishes to be supported and cared for. The personal care and health needs of people in all units of the home are regularly reviewed, and this ensures that staff understand the changing needs of people living at the home and involve other professionals, such as the district nurses or specialists when necessary. The people spoken with were confident that any health concerns they may have were acted on straight away by staff. The atmosphere of the home was friendly. People living at Dolphinlee felt like they were treated with respect. Efforts are made by the staff to make sure that everyone at the home feels welcome and well cared for, and this was appreciated by the people spoken with during the visit to Dolphinlee. What has improved since the last inspection? There has been a period of change over the past 12 months and this has been unsettling at times for staff members. The staff spoken with during this visit are happy working at Dolphinlee but all had felt under pressure over the past few months. The needs of the people being cared for have become more complex, and at times there have been staff shortages. A new manager has been appointed and staff spoken with feel that the staffing situation is now improving. At the time of the visit, new staff had been recruited to vacant posts. Additional staff are on duty at busy times, for example in the evening. A new system of care planning is being introduced. This has been used with people newly admitted to the home. The new system is sensitive to peoples needs and wishes and aims to gather information which will help care and support to be provided in the way in which the person would like. The individual preferences and lifestyle choices of the person are promoted by this way of care planning. The staff have been active in improving the activities and social opportunities on offer to people living at the home. There are efforts to make sure that all people living at the home can take part in activities and trips out. If a person is not able to take part, the reasons for this are discussed to see if anything can be done by staff to enable the person to take part. If a person does not want to join in organised activities this is respected. The new manager has improved the staff induction programme. New staff now benefit from having a planned induction and written information is provided which covers all aspects of their job role. Dolphinlee House DS0000032609.V367850.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Dolphinlee House DS0000032609.V367850.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dolphinlee House DS0000032609.V367850.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2,6 Quality in this outcome area is excellent. The admission process helps people make an informed decision based on good information. The intermediate care at the home is provided by a range of skilled staff, this ensures that people have a positive experience of recovery, which enables them to maintain their independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All people who come to live at the home have their needs assessed prior to admission. This ensures that the persons support needs are understood and the staff of the home have the skills to meet the identified needs. The pre admission assessments cover all areas of personal and health care and also includes information about the persons preferences, culture, interests and beliefs. Pre admission visits for service users and their families helps them make an Dolphinlee House DS0000032609.V367850.R01.S.doc Version 5.2 Page 10 informed decision. The home produces a Service User Guide and Statement of Purpose which outlines the services offered at the home and highlights the rights of people living at the home. Currently a small brochure is being developed, this will be of particular use to people coming to the Intermediate Care Unit who may come straight from hospital or be admitted in an emergency. A brochure will provide an opportunity to become familiar with the home and what can be expected. People spoken to during the visit to the home had found that the care home had more than lived up to their expectations. One lady, who had recently been admitted to the Intermediate Care Unit, commented that she had not known what to expect and was very pleased with what she has found. The admission assessments in the Intermediate Care Unit are completed by the persons allocated social worker. The assessment identifies the areas of support that are required, to help the person regain their independence and skills. The case files looked at showed that this assessment forms the basis of the persons care plan, which is agreed by the person receiving support and their key worker. The key worker system ensures that all people living at the Intermediate Care Unit, and in the main care home, have an identified member of staff who will take a particular interest in that persons care needs. The Intermediate Care Unit of Dolphinlee is a dedicated space where people can access therapy programmes. The unit has specialised facilities and equipment which enables the staff to provide short term intensive rehabilitation for people. The care staff working on the unit receive regular training opportunities and work closely with the units therapists to support service users. There is an occupational therapist and a physiotherapist provided for intermediate care service. The people spoken with during the visit to the home found the service to be very good. One lady commented ‘Its marvellous. What a change, I feel so much better having people to chat to. I exercise regularly and am improving every day.’ Another lady commented that the equipment had made a huge difference to her independence, whilst in hospital she had not been able to mobilise on and off the bed, but in the Intermediate care Unit, the bed height was just right for her to be able to do this independently. Dolphinlee House DS0000032609.V367850.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. The health and personal care needs of people living at the home are understood, and personal preferences are respected in this way well being and choice are promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All people living at the home have comprehensive assessments regarding health and personal care needs. The home is on the process of transferring all care plan information on to a new system. Examples of the previous care planning system and the new system were seen during the inspection. The plans contained sufficient detail to ensure that people were supported in line with their assessed needs, and with their own choices. The care plans contain sections which gather relevant details and contacts, and other sections which record the persons interests and wishes, for example war time memories are discussed and how the person views these, whether a person wants to celebrate birthdays or other significant events and personal Dolphinlee House DS0000032609.V367850.R01.S.doc Version 5.2 Page 12 preferences such as style and colour of clothing. The care plans also have sections for day and night. The right to privacy is promoted and people are given a choice about how often they wish to be checked at night, or whether they wish to be left undisturbed. Risk assessments were seen on people’s records, which addressed any areas that require extra care and attention. Mobility assessments are completed and risk strategies are put in place to prevent falls. It is important that when risk assessments are no longer accurate, because the needs of a person have changed, that they are removed from the working file and stored, this will avoid any confusion and will promote consistency. The daily notes seen related to the identified care needs of the people living at the home. Each month these notes are summarised by the person’s key worker, and the care plan is reviewed if necessary. In the main monthly reviews have been taking place, but due to staff vacancies and pressure on staff time some of these have not been completed since July. The manager is aware of this and now that staff vacancies have been filled reviews should happen on a monthly basis. In the Intermediate Care Unit the review process is reflective of the intensive rehabilitation care provided. The care plan is reviewed as needed and this could be on a daily or weekly basis. All people are discussed at a weekly multi disciplinary meeting, which is attended by staff of the unit, the social work coordinator, the occupational therapist and the physiotherapist. The people spoken with during the visit were clear about their reasons for being at the unit and felt they were making good progress to being able to return home. The people spoken with during the visit were confident that their health care needs were being monitored and met. Records seen provided evidence of involvement of a range of health professionals. The home benefits from having a link nurse for people with dementia who is able to give advice and provide training. The people at the home have access to specialist and routine health support, for example hearing and sight tests. The manager hopes to improve access services by involving a mobile optician for those people who would prefer this. Medications at the home are administered by trained staff. People are able to keep control of their own medicines if they wish, and if it is safe for them to do so. Staff spoken with had received training in the safe administration of medications. The medication was stored securely and as prescribed. The home has a good relationship with the local pharmacist who provides advice when needed. There are systems in place to document the receipt and return of medication. The Medicine Administration Record was completed, but this could Dolphinlee House DS0000032609.V367850.R01.S.doc Version 5.2 Page 13 be improved by ensuring that the reason when medication is not given is always clearly documented. There were some accounting errors evident when looking at the medication stocks, these appeared to be errors made in adding up when medication is provided outside of the blister pack system. It was difficult to find out where the error had occurred, regular audits which check the number of tablets held at the home would make it easier to identify errors and provide an audit trail. It is important that each label is checked when medication is received to ensure it is accurate and matches the number of tablets provided. The arrangements in place for the storage and accounting of controlled drugs are satisfactory. The people spoken with felt that their privacy was respected. Staff induction and training includes consideration of the values of good care including privacy and dignity. Individual bedrooms are treated as private space, some rooms with en-suite facilities. The home has adaptations and equipment which help promote independence and privacy, allowing people who live at the home to do as much as possible without assistance. Consultations are carried out in the privacy of a person’s own room. Letters are passed on unopened and arrangements are in place for those people living at the home who are no longer able to manage their own correspondence. Dolphinlee House DS0000032609.V367850.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. People living at the home have the opportunity to take part in activities and to socialise in line with their own personal preferences; in this way individual cultural and social needs are respected and promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager and staff have a flexible approach to daily life and encourage people using the service to make their own choices especially around times for getting up and going to bed, what food to eat, clothes to wear and activities to join in. The people spoken with felt that they could make their own choices and their preferences were respected. Staff members realise the importance of social activities and opportunities to socialise. One staff member spoken with described some activities that she had recently arranged, and some of the people spoken with had taken part in the activities and really enjoyed them. The in door activities include crafts and reminiscence sessions, outdoor activities have included gardening. There have Dolphinlee House DS0000032609.V367850.R01.S.doc Version 5.2 Page 15 been regular trips out. Several people commented they had recently enjoyed a meal out at a local pub. One person said although she had enjoyed it, she thought the food was better at the home but she had enjoyed the drive out. Another person spoke about her recent birthday celebration organised at the home, she had thoroughly enjoyed the day and really appreciated the efforts made by staff to make it a memorable occasion. The manager has provided extra staff during the evening to make sure that activities can take place. The people who live in the dementia unit have opportunities to take part in outings and activities and the manager is keen to develop further opportunities. Some people from this unit also enjoy spending time in the older persons part of the home. When a person is not able to give information about their likes and dislikes, hobbies and interests, the staff try to get this information from family members, this is a good way of trying to ensure that the activities provided may be of some interest. The religious preferences of people at the home are respected, and those people who wish to practice their faith are enabled to do so. The home has good links with local churches. There is regular service held at the home. The local Church of England vicar and the Catholic priest are regular visitors to the home. The information provided by the home in preparation for this inspection states that staff follow council policy and procedures around equality & diversity, and ensure inclusion for all in activities. Care plans address individual preferences, cultural needs and promote self expression. The home has an open visiting policy. People who live at the home are asked if they wish to see visitors who are not familiar to staff. Visitor access is managed by the need to ring for access to the building. Relatives and friends can visit in private in service users own bedroom if they wish to. A visitor spoken with during the visit to the home said that she was always made welcome and the staff were very helpful. The people spoken with during the visit to the home thought the quality of the meals provided was good. Individual preferences are taken account of. The home offers choice of menu daily with 4 meals provided. Alternatives are offered if needs change right up to point of meal service. Special diets are catered for. Assistance is given with meals if required. A mealtime was observed in the dementia unit, people where offered assistance when needed, and individual likes were recognised by staff. Staff have completed training in food hygiene. The homes cooks follow good practice guidelines. Dolphinlee House DS0000032609.V367850.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. The people living at the home and the staff understand the complaints and safeguarding policies in place and are confident any concern or complaint will be dealt with properly. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a clear structured complaints procedure which is stated in the Service User Guide and discussed with people on admission. All people spoken with and who completed surveys knew how they could make a complaint if they wished to do so. People felt that any concern that they may raise would be sorted out without any problem. The manager has introduced a complaint and compliments book, this shows that when issues are raised they are dealt with. It is important that any personal information is removed from the public folder. Lancashire County Council have a multi-agency policy and procedure for safeguarding adults. All staff have had awareness training in vulnerable adult protection. It is planned that all staff will attend Safeguarding training. This will promote the importance of recognising the signs of abuse and the need to follow safeguarding procedures to ensure people are properly protected. Staff spoken with understood the procedures of the home. Dolphinlee House DS0000032609.V367850.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. All parts of the home are clean and well maintained and this provides a pleasant and safe environment for people to live in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is arranged over two floors. It is well presented and clean. The Intermediate Care Unit has its own separate entrance and is operated as a dedicated unit. The main building is separated into named areas, ‘Damson’, ‘Cedar’ and ‘Beech’. The building is designed to enhance the independence of people living at the home, for example by having fixtures and fittings, equipment and access points that meet the individual personal and mobility needs of the residents. The home has several small lounge areas equipped with TV and music centres, wide space corridors with hand rails, single bedrooms which meet or exceed recommended sizes some have en-suite facilities. There is a conservatory that opens on to the garden area. Dolphinlee House DS0000032609.V367850.R01.S.doc Version 5.2 Page 18 The garden has been improved and provides a pleasant seating area. There are several raised flowerbeds and these have proved popular with people who use wheelchairs and who have restricted mobility, as they are able to continue to enjoy and take part in gardening activities. There are 4 kitchen/dining areas which are large enough to offer a comfortable dining experience and yet small enough to be homely. The home has dedicated domestic staff. There have been some staff vacancies and these have recently been filled, this will ease the pressure on existing domestic staff. The people living at the home thought it was clean, safe and well maintained. There are individual laundry facilities for each named area of the home. Staff have undertaken training in infection control. There are hand washing facilities/ gel rub available to minimise cross infection and protective clothing is provided. There are rubbish removal contracts for domestic and hazardous waste in place. Dolphinlee House DS0000032609.V367850.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. People living at the home are supported by a competent and caring staff team and this means that their health and personal care needs are understood and met at Dolphinlee. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There has been a period of change over the past 12 months and this has been unsettling at times for staff members. At the time of the visit, new staff had been recruited to vacant posts. Additional staff are used at busy times. The staff spoken with during this visit are happy working at Dolphinlee but all had felt under pressure over the past few months, as the needs of the people being cared for have become more complex, and at times there have been staff shortages. Many staff have worked at the home since it opened. The people who live at the home were very positive about the staff and felt that they did an excellent job. There has been a period of consultation about night time staffing arrangements through out the group of homes operated by Lancashire County Council, and for the present time the staffing arrangements at night are to remain unchanged. There are 2 or 3 staff on duty at night, and although in some instances it is clear why additional staffing is provided the rational between varying numbers of night staff was discussed with the manager. It is to the homes credit that additional staff are available to watch over people Dolphinlee House DS0000032609.V367850.R01.S.doc Version 5.2 Page 20 who are very poorly and when additional staff are needed to meet a persons needs. Currently night staff are also supported by a member of staff sleeping in who provides additional support when needed. Staff who work at night find that they are always busy and at times can be very stretched because of the needs of people at the home. It is important that the manager continues to monitor the numbers of staff on duty at night and that staffing levels are reflective the needs of people living at the home. Staffing levels must also include consideration of the lay out of the building and the complexity of providing a service to older people, people with dementia and those people who are receiving intermediate care. 75.6 care staff have NVQ level 2 or above and this exceeds the National Minimum Standard. Evidence was seen on staff files that staff receive induction training and are offered regular opportunities to up date and add to their skills. The manager has recently improved induction procedures that include Skills For Care Workbooks these ensure that staff have an understanding of good care practices. There is separate induction guidance for senior staff. There is corporate induction that includes the aims and objectives of the care service. The staff recruitment files showed that robust recruitment procedures are followed. All new staff have satisfactory enhanced Criminal Record Bureau disclosures and 2 written references verified before commencing work. Staff have opportunities to discuss their professional development during supervision and can request to attend specific training. All staff must complete mandatory training. Other training which has been completed by some staff members includes Dementia Awareness and Palliative care. There appeared to be some confusion about attendance at training that is not mandatory and if staff were paid to attend this training, the manager is to clarify this. Dolphinlee House DS0000032609.V367850.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. The manager of Dolphinlee provides clear direction, she is committed to working in ways that involve the people living at the home and the staff in shaping the way in which the home is run. This approach ensures that the home is run in the best interests of people living there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager at Dolphinlee has 10 years management experience in care services for older people which includes intermediate care, dementia care, day care and long/short stay residential care. She has completed the registered managers award and holds a level 4 National Vocational Qualification in care practice. The people living at the home and the staff spoken with during the visit found the manager to be approachable and supportive. The manager is Dolphinlee House DS0000032609.V367850.R01.S.doc Version 5.2 Page 22 supported in her role by a senior team who are qualified and experienced. The staff follow corporate policies and procedures relating to financial transactions and most of people who live at the home control their own finances or families/friends do this on their behalf. Where money is held on behalf of a person, this is accounted for and then receipted. The management team have an open door policy and people who live at the home, friends and relatives are encouraged to express their views. The people living at the home felt that their views where listened too. Staff felt supported in their roles. There are regular staff meetings. There is an annual survey carried out by the County Council. There are also satisfaction surveys carried out at the home following admission. The manager is looking at ways of gathering views from people who have spent time in the Intermediate Care Unit, by getting feedback from people who use the service areas for improvement and new ideas can be implemented. The health and safety of people living and working at the home is promoted through regular maintenance checks, the provision of mandatory training and health and safety audits. Risk assessments are completed for safe working practices and any equipment that is used in the home. Accidents are recorded and reported in line with legal requirements, and any necessary improvements to working practices or facilities are made. Dolphinlee House DS0000032609.V367850.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 4 X X X 4 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Dolphinlee House DS0000032609.V367850.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations The audit trial in place for ensuring accurate numbers of medications held at the home should be strengthened, to ensure that accounting errors do not occur. Dolphinlee House DS0000032609.V367850.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Preston Local Office Unit 1 Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Dolphinlee House DS0000032609.V367850.R01.S.doc Version 5.2 Page 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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