Care Home: Donnington House

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What the care home does well What has improved since the last inspection? The Statement of Purpose and Service Users` Guide have been updated. The home has developed its care plan procedures as recommended by the National Health Service `Gold Standards Care Planning.` The home is upgrading its environment. Additional equipment for care needs has been purchased. Improved systems for infection control have been adopted. Two new music therapy sessions are provided. The home continues to review and update its policies and procedures. Staff training opportunities have been developed. What the care home could do better: Storage space and lack of secure storage of records was evident during the visit. Cleaning chemicals were left out alongside a refuse bag and cleaning equipment outside a resident`s door for over one hour with no staff present. This posed a safety hazard. Clearer guidance in care plans is needed for the circumstances that staff administer occasional medication. One risk assessment needed to be expanded to show that relevant parties have been consulted and that the person`s needs have been fully assessed. CARE HOMES FOR OLDER PEOPLE Donnington House 12 Birdham Road Chichester West Sussex PO19 8TE Lead Inspector Ian Craig Unannounced Inspection 3rd March 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Donnington House DS0000058333.V359297.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. Donnington House DS0000058333.V359297.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Donnington House Address 12 Birdham Road Chichester West Sussex PO19 8TE 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) 01243 783883 01243 790174 donnington@waitrose.com Donnington House Care Home Limited Mrs Anne Elizabeth Bareham Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Donnington House DS0000058333.V359297.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. up to 28 male and/or female service users in the category old age, not falling into any other category Only persons over 65 years may be admitted Date of last inspection 10th October 2006 Brief Description of the Service: Donnington House is a registered care home able to up to twenty-eight people over the age of 65 years with nursing needs. The home is situated close to Chichester town centre, with a regular bus service nearby. Accommodation is provided over two floors, with access to the upper floor via a lift. All rooms are single occupancy, five of which have ensuite facilities. The registered provider is Donnington House Care Home Ltd. Mrs Anne Bareham is the registered manager of the home and Mr J Shippam is the named responsible individual for the organisation. At the time of the inspection the home was in the process of upgrading its facilities by the creation of 5 new bedrooms each with an en suite toilet with a wash hand basin. The home is not intending to increase the number of people it can accommodate. The home’s weekly fees range from £430.00 to £595.00. Donnington House DS0000058333.V359297.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 star. This means the people who use this service experience good quality outcomes. The inspection was unannounced and lasted approximately 5 hours. The inspection involved two persons: the CSCI inspector and an Expert By Experience. The Expert By Experience is a relatively new scheme, which involves an assessment of the service by someone who has an experience of the relevant care setting. At this inspection the Expert By Experience looked at the premises, talked to residents and relatives of residents, joined residents for the midday meal and spoke to and observed staff. The findings of the Expert By Experience are included in this report. Records were looked at including residents’ care records. The home’s policies and procedures were also viewed. Two staff were interviewed and discussions took place with the manager. A tour of the premises took place and several residents were spoken to. Staff were observed working with the home’s residents. Survey forms were sent to professionals involved in the care of the residents, residents themselves and their relatives to ask their views on the service provided by the home. Five surveys from professionals were returned including two from general practitioners. Six relatives of residents returned completed surveys. Seven residents returned completed surveys. Information in these surveys has been used as evidence for this report. Service providers are required to complete an Annual Quality Assurance Assessment, which is returned to the Commission. Information contained in this document has been used for this inspection report. What the service does well: Donnington House DS0000058333.V359297.R01.S.doc Version 5.2 Page 6 Those considering a move into the home are provided with information about the service. Residents state that their care needs are always met and that medical support is provided when needed. Professionals involved in the care of the residents report that the home seeks the advice of health care staff to improve the care of the residents. The following comments were made by the professionals who returned surveys: • Very caring environment. Patients are well cared for with good traditional nursing care and respect. • What I see is a good understanding of residents’ feelings. • I think Donnington House is a good clean home. It appears well staffed with the staff having good people skills. • I consider this the best run residential/nursing home in the area. The staff are well-led, conscientious and caring - the patients are very happy, the atmosphere is relaxed and friendly, but the levels of care and catering for all needs is constantly high. I would have no hesitation in placing a relative of mine here, or being admitted here myself if and when the time came. • My impression is that staff at Donnington House consider it a priority to support individuals to live the life they choose. Residents’ relatives also made many favourable remarks about the home’s standards. Comment was made that the home communicates well with the relatives and that the staff are always welcoming to visitors. The following comments were made by residents’ relatives: • As I visit my husband every other day for at least 2 hours I have no problems getting information. Matron & the staff could not be more helpful and sympathetic and are wholly supportive of me. • I cannot fault the standard of care given to my friend. • All staff are friendly and show genuine concern for the residents. They are always welcoming when I visit and are approachable to discuss any issues. I feel that they do their best to make the residents feel that it is their home, and that they are people not numbers. • All the family are happy with the love and care our relative has in Donnington House. He appears to be very contented there and is allowed to follow his hobbies etc. We feel that we could not have found a better home for him. The home assesses each person’s needs before they are accommodated. This helps ensure that the home admits those whose needs it can meet. Donnington House DS0000058333.V359297.R01.S.doc Version 5.2 Page 7 Each person is supplied with documentation about their stay at the home in the form of information about the home, contracts and terms and conditions of residence. Care plans are of a good standard with care needs comprehensively recorded. There is a variety of entertainment and activities for the residents including arts and crafts, and musical performances. A mobile library visits the home. Staff receive a variety of training for their work including courses in palliative care, bereavement, clinical governance, Parkinson’s disease, pain study, dementia, wound care and nutrition. The home’s approach to care and staff training is forward thinking and innovative, adopting recent developments in care of those with a terminal illness and new approaches to care planning. More than 50 of the care staff are qualified at level 2 in the National Vocational Qualification in care. A registered nurse is on duty at all times. Newly appointed staff have a structured induction using nationally recognised standards. Nursing and care staff spoken to during the visit showed a commitment and motivation to their work. There is a low turnover of staff. Appropriate checks are made on newly appointed staff such as references and criminal record bureau checks. Improvements are being made to the environment. The home seeks the views of residents and relatives regarding the service provided. These are available to residents and visitors in the hallway along with a copy of the latest CSCI inspection report and a copy of the home’s financial accountants. The home’s management is open and transparent. The home recognises diversity and equality by providing staff training in disability awareness. Visits are made to the home by a variety of priests from different religious denominations. What has improved since the last inspection? The Statement of Purpose and Service Users’ Guide have been updated. Donnington House DS0000058333.V359297.R01.S.doc Version 5.2 Page 8 The home has developed its care plan procedures as recommended by the National Health Service ‘Gold Standards Care Planning.’ The home is upgrading its environment. Additional equipment for care needs has been purchased. Improved systems for infection control have been adopted. Two new music therapy sessions are provided. The home continues to review and update its policies and procedures. Staff training opportunities have been developed. 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. Donnington House DS0000058333.V359297.R01.S.doc Version 5.2 Page 9 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 Donnington House DS0000058333.V359297.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Potential residents are give information about the home so that can make an informed decision about whether or not to move in. Comprehensive assessments of need are carried out so that the home and resident know that the person’s needs can be met. EVIDENCE: Referrals are made to the home via local hospitals, or privately, or from social services. At the time of the visit there was a waiting list of those wishing to move into the home. When a referral is made, a customer enquiry form is Donnington House DS0000058333.V359297.R01.S.doc Version 5.2 Page 11 completed which acts as an initial assessment of whether or not the person might be suitable to live at Donnington House. The manager or deputy matron visit the person at their home, or hospital, and carry out an assessment. This is entitled, Daily Living Assessment and Needs Assessment Form and includes assessment of the following: • Carers and family involvement • Personal care and well being • Communication • Mobility and dexterity • Personal safety and risk assessment • Medication • Mental health and cognition • Diet and weight including the person’s individual preferences • Food and meal times • Dental and foot care • Religious observance • Daily living and social activities Health and personal care details are also obtained for the referring social services department and/or the hospital ward. Copies of hospital nursing discharge letters and hospital continuing assessment tools were seen. Relatives are provided with information about the home in the form of the Service Users’ Guide and/or Statement of Purpose once the person is admitted to the home. This was confirmed by the residents and their relatives. There are opportunities for prospective residents and their relatives to visit the home to have a look around. The Expert by Experience commented that each resident has a copy of the Service Users’ Guide in their bedroom. Once the person decides to take up residence an acceptance form is completed which details the fees and contact details. A contract and a terms and conditions of residence are also issued and these are signed by the interested parties. Donnington House DS0000058333.V359297.R01.S.doc Version 5.2 Page 12 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 and 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs are met. Care plans are of a good standard. The home is receptive to implementing recent models of care for residents demonstrating a commitment to improving the care of the residents. Residents are treated with respect and their privacy is promoted. EVIDENCE: The Expert by Experience made the following observations about the standard of personal care: All but one of the residents seen were very content and all looked well cared for. Their clothes were clean and well pressed, and they looked well nourished. Donnington House DS0000058333.V359297.R01.S.doc Version 5.2 Page 13 Professionals involved in the care of the residents commented on the home meeting the care and health needs of the residents. Care needs were said to be either ‘always’ met or ‘usually’ met. Health professionals also comment on the benefits to the residents of staff following the advice of medical staff and that joint working with the home’s staff is effective. A general practitioner commented that the standard of care is constantly high. Each of the resident’s relatives who returned a survey state that the care needs are ‘always’ met. Relatives also comment that the care staff ‘always’ have the right skills and experience to look after the residents. Care plans cover residents’ health and personal care needs such as the following: • Moving and handling • Pressure care and pressure sore assessment • Catheter care • Feeding and nutrition • Personal care • Risk assessments and corresponding care plans for the use of cot sides, the risk of falls going out and other activities • Hobbies, interests and activities It was noted that one of the risk assessments does not include the details as described by the manager, particularly the involvement of the family and general practitioner in the decision making. The risk assessment needs to be expanded to include these details as well a full assessment of the person’s capabilities Health care needs are closely monitored by the use of continence monitoring forms, fluid balance charts and well maintained daily running records. Records show that oral hygiene is addressed and that residents have access to eyesight checks. The home uses the Liverpool Care Pathways End of life Model of Care for the care of those with a terminal illness. Staff receive training in the care of the dying. One of the staff has attended a 4-day course on the Health Service initiative for care planning called the Gold Standard Framework for Care. This has been implemented and the staff member will be attending seminars for updates. Staff are also trained in specific care procedures such a wound care, pain, Parkinson’s disease and dementia. The home has specialist equipment for care, such as electric profile beds, pressure relieving mattresses, and hoists. Donnington House DS0000058333.V359297.R01.S.doc Version 5.2 Page 14 Care plans are signed by the resident or their relative to acknowledge their agreement to the care arrangements. Care plans are reviewed each month. It was noted that the care plans for social needs such as hobbies and interests could be improved by including more detail. The preferences and choices for residents are recorded including the name that the person wishes to be called. Medication procedures were looked at. Medication is administered by one of the registered nurses who completes a record each time this takes place. Staff receive training in clinical governance and in specialist procedures such use of syringe drivers. Procedures for the storage, handling and administration of controlled medication meet Royal Pharmaceutical Society guidelines, with the exception of the storage of records. Where medication is administered ‘as required’ it was noted that for two medications for mental health, that the care plans do not include details of the symptoms and circumstances when it should be given. This was discussed with the manager and deputy matron who agreed that this needed to be implemented. Care and medication records were not securely stored when not in use. Residents reported that they are treated with kindness, consideration and respect. These views were also reflected in the comments made by residents’ relatives and by professionals involved with the home. Comments include reference to care being provided in the way that the resident prefers and that the care service meets the differing needs of the people who live at the home. There was one exception when a resident commented, There is always an excuse for not responding to patients simple requests such as being too busy talking. Surveys from professionals state that the service respects residents’ privacy and dignity. Donnington House DS0000058333.V359297.R01.S.doc Version 5.2 Page 15 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, and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a variety of activities and stimulation. Choice is available for the residents in how they spend their time and at meal times. Residents are able to contribute to decision making in the home. EVIDENCE: The Expert by Experience reported the following: All the residents I spoke to were very happy with the number of activities on offer. There had recently been a Clothes Party for residents. On Tuesdays there are ‘Activities with Sharon’ (an outside entertainer) including themed Donnington House DS0000058333.V359297.R01.S.doc Version 5.2 Page 16 discussions such as Mothering Sunday and reminiscence therapy. A singer/keyboard player entertains on Fridays and stays for lunch whilst mingling with the residents. A lady harpist/singer visits regularly. I observed a notice, albeit half-hidden behind a chair, about Voice Movement Therapy. A priest comes in to offer Communion regularly. One of the residents said that she does a jigsaw from time to time. She said, ‘One of the carers will lay it out for me in the Red Lounge.’ She also mentioned, ‘We have a lovely Christmas here, it’s wonderful, it really is with presents off the tree for everyone.’ She also told me about the carol singers who come in at Christmas. The Matron told us that the local community is very good to Donnington House and treat them as its own. I saw one a resident using a recently acquired word-processor, so that he could communicate with people in case he could not be understood. He was also watching a Cricket International on Sky TV in his room, as he had his own satellite dish. A number of residents have their own newspaper delivered daily and like to do the crossword or soduku. All the residents I spoke to are used to having visitors coming at various times. The Visitors’ Book certainly endorses this. One resident who was more mobile than other residents went off to a Whist Drive in Chichester while I was there. He said he went out every day. One resident took the bus or walked into Chichester regularly. Several attended church services at the local Parish Hall. One lady had been taken out by Sister Margaret to attend and help at a lunch at her church. The Matron said that outings to the local Amateur Dramatics’ Dress Rehearsals weren’t too successful, as some didn’t like going out at night or didn’t feel too well at the actual time. One resident I saw had her own telephone in her room. Two residents had visitors during the time of the inspection. Residents have choices for each meal and can decide where to eat them. They are given a sheet to fill in once a week, normally on a Friday about what they want for meals for the following week. These sheets were on view in a folder in the entrance-hall. Most residents say that their only complaint was there was too much on the plate. One said, ‘There is far too much (food).’ One said, ‘We have nice afters. We can always have jelly and ice-cream as an alternative’. One said, ‘There is fresh fruit and yoghurt offered every night.’ Another said, ‘On Fridays we have fish and chips or fish pie.’ The meal I sampled at lunch was chicken breast in a sweet and sour sauce with two rounds of mashed potato and mixed vegetable pilaf rice followed by fruit berry crumble. The meal was well presented and well cooked. Fruit squash and water was readily available on each table. There were two pepper pots on our table, but one of the helpers found some salt for us on request. As a result of one of the Donnington House DS0000058333.V359297.R01.S.doc Version 5.2 Page 17 residents’ meetings last summer a new type of yoghurt (probiotic) has been introduced. There are greetings cards on sale for residents, and some toiletries can be purchased at the home. A mobile library visits the home and residents have access to books. Three residents were observed reading in the lounge, one of whom had a large print format book. Hairdressing is available. There is a public telephone for residents to use and many have a private phone in their bedroom. Surveys from professionals state that residents are able supported to lead the lives they choose. The majority of residents who completed a survey state that there are activities that they can take part in. Most said that they like the food, although one person said, A little more in the way of fresh vegetables & green salads would be nice. Donnington House DS0000058333.V359297.R01.S.doc Version 5.2 Page 18 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives are confident that any complaints they make will be acted on. Residents are protected from possible abuse. EVIDENCE: The home’s complaints procedure is provided to each resident in the Service Users’ Guide and in the terms and conditions of residence. Residents confirmed that they know what to do if they are “unhappy,” and each of the resident’s relatives who completed a survey stated that they are aware of what to do if they have a complaint. The home has not received any complaints in the last 12 months. The home has a training link with West Sussex Social Services Department regarding adult protection procedures. This involves a nominated staff member attending a training course in adult protection procedures. This person then Donnington House DS0000058333.V359297.R01.S.doc Version 5.2 Page 19 coordinates training for the staff at the home, which involves each staff member completing a questionnaire on the subject. This is sent to the local social services department who award a certificate of completion for each person if the training has been successful. Training in adult protection is also confirmed from training records and from the staff. The home’s staff induction procedure also includes staff being made ware of the home’s policy on the subject; the staff member signs a record to say that they understand the procedures. Donnington House DS0000058333.V359297.R01.S.doc Version 5.2 Page 20 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, 20, 21, 2, 23, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is in the process of refurbishment. It is generally clean and well maintained although storage is clearly a problem. Residents are able to express themselves in their rooms. Communal areas are comfortable and conducive to relaxation and interaction. EVIDENCE: Donnington House DS0000058333.V359297.R01.S.doc Version 5.2 Page 21 Communal areas consist of a large lounge and dining room, which has a conservatory style area. There is also another sitting area. The Expert by experience made the following comments: The Home has a number of different well-lit rooms where residents can choose to sit. There is a conservatory area at the front of the building where residents were reading or snoozing or listening to a nearby radio. There is a smaller area where a couple of residents were watching a large TV, and there is a large room, called The Red Lounge, with lots of tall-backed red chairs where residents can take their visitors for more privacy and where Residents’ Meetings are held several times a year. (I observed the minutes of the July 07 meeting in one of the resident’s rooms.) Although the communal areas had some clutter about, like wheel-chairs stowed in the dining-area, yellow warning-notices and medicine pots drying on a radiator, the home did feel homely with large print and talking books on display for the residents, a budgerigar in a cage left by a former resident and lots of flowers about after Mothering Sunday. Several communal areas were noted to be used for storage, such as a filing cabinet in the lounge. Cleaning chemicals and equipment were not always stored when not in use. It was understood that the upgrading of the environment will resolve the storage problems. Residents’ bedrooms are single, several of which have an en suite toilet with a wash hand basin. Specialist equipment is provided such as electric profile beds, hoists and pressure relieving mattresses. There is a call point system for residents to use when they require staff assistance. Bedrooms have been personalised by the residents. Residents are able to have their own telephone line in their room. The home has a passenger lift. The home was found to be clean and free from any odours. Staff receive training in infection control, which was confirmed from records and discussions with staff. The home has used a new infection control procedure for deep cleaning to prevent the spread of infection. The home employs a maintenance person for repairs and upgrading. Toilets and bathroom are clean and contain adaptations for those with mobility needs such as specialist baths. Privacy is promoted by residents being able to have a key to their bedroom if this is appropriate. Staff were observed to knock on doors before entering bedrooms. There are slice and laundry facilities. Donnington House DS0000058333.V359297.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home has a well-trained and motivated staff team deployed in sufficient numbers to meet the needs and wishes of the residents. Recruitment procedures ensure that residents are safeguarded. EVIDENCE: A registered nurse is on duty at all times. In addition to this, there are between 4 and care staff on duty. 6 or 7 care staff are on duty for the 7am to 1.30 pm shift. At night time 2 care staff and a registered nurse are on ‘waking’ duty. This was evidenced from the duty rota, observation and discussions with staff. In addition to the above nursing and care staff, the home employs cleaning, laundry and kitchen staff. Donnington House DS0000058333.V359297.R01.S.doc Version 5.2 Page 23 Surveys show that the residents and their relatives, as well as professionals from outside the home, consider that staff are available to respond to care needs. There was one exception to this when a resident stated staff do not always respond. Staff expressed the view that the home is “well staffed.” Staff are described by relatives as caring and attentive to residents’ needs, that they readily respond to any requests and that they are approachable to discuss any issues. Care professionals such as general practitioners also describe the staff as competent and caring. Records show that the home caries out the necessary checks on newly appointed staff including criminal record bureau (CRB) and protection of vulnerable adults (POVA) checks. At least 2 written references are obtained. The home’s staff and manager state that the home has a low turnover of staff. Staff spoken to during the visit described an organised and methodical approach to their work. Each staff member has a name badge. Staff were observed to interact with the residents in a caring way. The home has an induction procedure incorporating nationally recognised standards in care. Completed induction records for a staff member were seen. More than 50 of the care staff are trained at National Vocational Level 2 or above in care. Each staff member completes the following training as a minimum: adult protection, fire safety, first aid, food hygiene, health and safety, infection control, and moving and handling. This was conformed from records, staff and the manager. Training records for 2 of the home’s registered nurses show that the following training has been attended in the recent past: palliative care, Parkinson’s disease, bereavement, syringe driver, clinical governance, End of Life care, pain study, wound care, dementia awareness, motor neurone disease, nutrition, caring in the community, and law, ethics and legal documents. Regular staff supervision and team meetings take place, which was confirmed from records, staff and the manager. Donnington House DS0000058333.V359297.R01.S.doc Version 5.2 Page 24 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, 34, 35, 36, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and run in the best interest of the residents. The home’s management and accounts are open and transparent. The manager is qualified and competent to run the home. Improvements are needed regarding the storage of records to ensure records are safe and confidential. Cleaning chemicals and storage of equipment needs to be improved for safety reasons. Donnington House DS0000058333.V359297.R01.S.doc Version 5.2 Page 25 EVIDENCE: The manager is a qualified nurse registered with the Nursing and Midwifery Council at level 1. She has completed the National Vocational Qualification level 4 in care and has the Registered Manager’s Award. Staff, relatives and professionals from outside the home, report the management to be approachable and effective. The home is introducing a quality assurance system and already has a business plan for the year ahead. Surveys are given to residents and their representatives and are collated into a folder and left in the hall for anyone to read. Residents are able to contribute to decision making in the home by attending the residents’ meetings. Residents and their relatives are also able to make representations to the home’s decision making at the organisation’s committee. The home’s financial accounts are available for all to read on a table in the entrance hall. The home does not handle or look after residents’ personal allowances but occasionally holds valuables for safekeeping. Appropriate records are made when this takes place. Residents’ records and medical records were not securely stored when not in use. The office door was open when unattended and the records had been left on top of cupboards and in open files. This was discussed with the manager, who acknowledged there is storage problem, which will be addressed with the refurbishment. The home’s equipment and appliances are serviced and tested by suitably qualified persons. The fire log book shows that the fire safety equipment is tested in accordance with fire safety requirements. A fire safety risk assessment is completed. Staff receive training in fire safety. Fire drills take place on a regular basis. Cleaning chemicals were not securely stored when not in use. A tray with cleaning chemicals and a black refuse bag were left outside a bedroom door for over an hour. Donnington House DS0000058333.V359297.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 4 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 2 2 Donnington House DS0000058333.V359297.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Care plans must be based on full assessments of need where risk is identified. The persons involved in this should be included and their agreement confirmed if appropriate. This refers to residents leaving the building independently where risk has been identified. Residents’ confidential care and medication records must be securely stored when not in use. The following must be addressed: • Risks posed by cleaning chemicals not being secure when not in use. • Tripping hazards from refuse sacks and cleaning equipment left in hallways when not in use. Timescale for action 30/04/08 2 OP37 17 15/04/08 3 OP38 13(4) 15/04/08 Donnington House DS0000058333.V359297.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Donnington House DS0000058333.V359297.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South East Region The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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