Care Home: Dorcas House

What the care home does well Due to the nature of this visit we only examined evidence in respect of specific areas of practice. We did however note that Mr Danquah felt that the home had over the years taken individuals in that other homes were unable to provide a service to and in his own assessment felt that the home offered them a service that they and their representatives were happy with. What the care home could do better: We did not review the requirements from the last key inspection at this random visit. The providers have forwarded a response to the requirements and recommendations and these will be reviewed by us at the next key inspection. The providers have been reminded that a failure to address requirements by the date we identify may lead to enforcement action. Following the visit we consider that the service needs to give serious consideration to the points detailed below: The provider needs to carry out a risk assessment to identify whether current first aid training and qualifications are sufficient to fulfill the emergency aid requirements of the service and the likelihood of first aid been needed by service users. This risk assessment needs to consider the specific needs of the people using the service, are accidents and injuries prevalent amongst people using the service, how close is the service to the ambulance station, what kinds of activities are people using the service involved with, the layout of the premises, history of accidents, fluctuating needs at different times and the expectations of customers such as social services commissioning. The risk assessment should identify the proposed content of the training and the competence of the trainer. If this risk assessment is not available we will expect the home to provide at least one available staff member throughout the day with a 4 day HSE (Health and Safety Executive) approved first aid at work qualification. In addition the management need to consider the need for training staff in changes to mental health legislation. In addition training and guidance is needed in respect of report writing, this to address issues such as unclear incident reporting, ensuring records are dated and signed and how to ensure records are factual and descriptive of actual events. Inspecting for better lives Random inspection report Care homes for older people Name: Address: Dorcas House 56 Fountain Road Edgbaston Birmingham West Midlands B17 8NJ one star adequate service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Jonathan Potts Date: 1 5 0 1 2 0 0 9 Information about the care home Name of care home: Address: Dorcas House 56 Fountain Road Edgbaston Birmingham West Midlands B17 8NJ 01214294643 01214294643 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Pan Danquah,Mrs Kate Danquah care home 11 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Conditions of registration: 11 The registered person may provide the following category of service only: 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: Mental disorder, excluding learning disability or dementia (MD) 11 The maximum number of service users who can be accommodated is: 11 Date of last inspection Brief description of the care home Dorcas House is an adapted domestic property that accommodates up to 11 people who are users of mental health services. The home has three floors with accommodation for the people who live in the home on two of these. The third floor is for staff use. One lounge has a door out onto the rear garden and contains a large screen television and comfortable seating. Communal space is also provided in the Care Homes for Older People Page 2 of 10 Brief description of the care home form of a lounge/diner. People who live in the home were seen to sit here to eat, to play games at a dining table and to watch television. The home has both single and shared bedrooms situated on the ground and first floor. A stair lift is available for individuals to access the upper floor. There are shower, toilet and bathing facilities on both floors but none of these provide an assisted bathing facility. Laundry facilities are provided at the neighbouring house owned by the Danquah family. At the front of the home is a steep drive on which three cars can be parked. The side gate to the property permits further parking for up to three vehicles this leading to a rear garden with a private patio area to the side of the home. The current fees stated by the proprietor at the time of this inspection for a new admission were £440. Care Homes for Older People Page 3 of 10 What we found: We visited the home to discuss events relating to the death of a resident last year due to choking and the implications this has for the home at present. The provider (Mr Danquah) recounted the events that led to the resident choking (as told to him by the staff on duty). Based on what we were told the care plan stated that staff were to supervise the resident whilst they were eating due to the risk of his rushing his food and dropping it on the floor, the concern been that they would have a poor diet, and could possibly choke. The care plan that we saw the following day (that the police had seized) stated that the resident must be supervised by staff at meal times, he is at risk of choking on his food if feeds self and would rush his food, being unaware of the risk of choking. The meal that the resident choked on was not theirs but one a staff member had placed on the dining table for another resident and subsequently left whilst she went to find him. If the meal had not been left unattended then the resident who choked would presumably not have had access to it, although we were told that eating other peoples meals was not a behavior that they had previously manifested. As stated in the care plan, the directive was for staff to supervise at mealtimes, this not specific as to when he individually ate or whether it meant mealtimes in general. Discussion with Mr Danquah on the telephone after this visit indicated that residents are now always supervised at mealtimes and a procedure has been introduced to inform staff, a copy of this he said to be provided to us for reference. When a staff member found the resident eating the others meal he was rushing to eat it, and subsequently choked. Mr Danquah told us that there were two staff on duty with first aid training which included how to respond to choking (we saw certificates for these two staff, this training provided by first response in January 2008) and some instruction in how to use the Heimlich procedure. Despite the staff members efforts they were unable to dislodge the food. They had called 999 and the paramedics took over on arrival (about 5 -10 minutes after) at which point we were told the resident was still alive. We were told that the resident died after leaving Dorcas house. As discussed we did state that we were to examine the case file for the resident that died during the choking incident. This did raise some issues that we discussed with Mr Danquah on the telephone after this random visit (on the 20/1/09). The issues we discussed with Mr Danquah included the following: The incident report completed by the staff member that we saw was not dated nor signed. There are issues in respect of the accuracy and quality of the recording in the account of the choking incident, examples including D tried to stop (let) him (stop) eating. It did not state how she tried to stop him eating. D tried to press his stomach and gave him another method to help the foods come out. This does not clarify whether the Heimlich procedure was used as we were led to believe was the case. before their arrival (this reference was to paramedics) they taught D on phone the first aid she should give him. This seems to suggest that D was unfamiliar with what action to take, this due to the reference to taught. If she had received training and knew the Care Homes for Older People Page 4 of 10 procedure then we would question why she would need to be taught. This was not the case based on Mr Danquahs account. As mentioned to Mr Danquah it is unfortunate that we do not have the ambulances services account of this telephone discussion. We discussed the provision of first aid training to staff with Mr Danquah. Whilst there were two staff trained in emergency first aid at the home at the time of the incident guidance from us (available on our website) states that the provider needs to carry out a first aid risk assessement (this described in more detail later in this report). Whilst there have been two other deaths at the home within days of the aforementioned choking incident, these discussed with the registered providers, we are not aware that these are due to any other reason beyond natural causes and the timing of the deaths is to be seen as most unfortunate. Having discussed events around these other deaths we have not changed our view on this. Mr Danquah did state however that he had some concerns as to finding GPs for residents at the home as many are reluctant to take on board people with mental health difficulties, this resulting in the home having to use NHS search services to locate a GP for residents in the past. We looked at the homes staff training plan and saw that most staff have training in mandatory areas this including health and safety, first aid (see above), moving and handling, adult protection, Fire, COSSH, challenging behavior and dementia. Three staff are also stated to have NVQ level 2, with three completing this training. We looked at the certificates for first aid training and have since the inspection checked the training providers website to see what this training involved. From what we have seen the training was 3 hours long (as Mr Danquah confirmed) and included responding to emergencies and choking as part of this. Whilst we did ask Mr and Mrs Danquah as to whether the resident had been checked out by health services for difficulties with swallowing he told us that following a previous incident when he was having difficulty Mrs Danquah sent him to accident and emergency and the doctors informed Mrs Danquah that his swallowing reflex was intact. When we saw the case file there was no record of this however. Mr Danquah stated that he will try to locate these records. We did ask as to whether the person usually crammed or bolted their food. It was said that he rushed food. The case file stated that he was eager to eat his food in a rush and was not aware of the risk of choking. In summary it is possible that the incident where the resident choked could have been better managed with the benefit of hindsight although some of the information we have seen indicates areas where there is some lack of clarity as to the exact sequence of events and what first aid procedures were applied based on the information we have seen to date. We saw the homes training plan and sampled some of the certificates of training (these related to first aid). Based on the training plan the majority of staff have training in mandatory areas of practice including health and safety, first aid, moving and handling, infection control, adult protection, fire, COSSH and challenging behavior. There are three staff NVQ qualified and three that are undertaking the training at present. We would consider that as the home offers a service to people with a mental health condition that training in this area could be better, this including training in the Care Homes for Older People Page 5 of 10 mental capacity act, the mental health act and the implications for the home in light of recent changes in mental health legislation and guidance. Mr Danquah said he is having training in the mental capacity act as a trainer so that he can cascade this knowledge to staff. We advised he may wish to consider this approach in respect of other areas of training, or look to bring in external trainers. We discussed with Mr and Mrs Danquah the concerns we had as to the suspension of purchasing that was currently in place and the impact this may possibly have on the funding of the home, and residents security of tenure. Mr Danquah was very aware of this as an issue, and in discussing possible outcomes said that he would not want to see any resident at risk and would consider a planned closure rather than run the unit to the point where they could not afford to provide an adequate standard of service. It was telling that Mr Danquah is funding the home from his paid employment. We advised the Danquahs that if looking for additional funding for the residents they would need to justify an increase in care needs and therefore funding on an individual basis and not think a generic request for more funding from commissioning could be expected to be successful. We noted that there has been some decrease in staffing ratios, this reflecting the decrease in the number of residents living at the home. We are not aware that this raises any risk to residents at present. What the care home does well: What they could do better: We did not review the requirements from the last key inspection at this random visit. The providers have forwarded a response to the requirements and recommendations and these will be reviewed by us at the next key inspection. The providers have been reminded that a failure to address requirements by the date we identify may lead to enforcement action. Following the visit we consider that the service needs to give serious consideration to the points detailed below: The provider needs to carry out a risk assessment to identify whether current first aid training and qualifications are sufficient to fulfill the emergency aid requirements of the service and the likelihood of first aid been needed by service users. This risk assessment needs to consider the specific needs of the people using the service, are accidents and injuries prevalent amongst people using the service, how close is the service to the ambulance station, what kinds of activities are people using the service involved with, the layout of the premises, history of accidents, fluctuating needs at different times and the expectations of customers such as social services commissioning. The risk assessment should identify the proposed content of the training and the Care Homes for Older People Page 6 of 10 competence of the trainer. If this risk assessment is not available we will expect the home to provide at least one available staff member throughout the day with a 4 day HSE (Health and Safety Executive) approved first aid at work qualification. In addition the management need to consider the need for training staff in changes to mental health legislation. In addition training and guidance is needed in respect of report writing, this to address issues such as unclear incident reporting, ensuring records are dated and signed and how to ensure records are factual and descriptive of actual events. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action 1 9 13(2) The registered manager 05/07/2008 must ensure that all prescribed creams are stored safely and appropriately. This is to ensure that access is restricted to these by the person using (if self medicating) or the member of staff administering. 2 22 23(2) The registered providers 31/08/2008 need to review the premises in respect of its on going suitability for an ageing resident group through a robust risk assessment process, this to identify adaptations /changes that will benefit residents independence as they arise, such as provision of handrails on the landing and so on. Care Homes for Older People Page 8 of 10 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 30 13 The registered persons must 16/02/2009 ensure that the level of first aid training for staff is appropriate to the needs of the service users. This is to ensure that where first aid intervention is required staff are able to respond appropriately and individuals safety is ensured. 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 30 The registered persons should ensure that all staff receive training in current mental health legislation such as the mental capacity act, deprivation of liberty etc. The registered person should provide the staff within the home clear guidance as to how to record incidents and reports accurately and factually, with training given to them to support this guidance. 2 37 Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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