Care Home: Dorrington House

What the care home does well The home reviewed and updated their service user`s guide. The admission process was checked through residents` documentation, through comments from a recently admitted resident and from the manager`s explanation. Now, with a better recording system in place, it was easier to plan and organise care for admitted residents. We checked the detailed residents files, observed care process, such as meal times, activity, moving and handling and spoke to residents, confirming that their needs were met and were met appropriately with their agreement. Very detailed recording of the needs, of the actions to meet these and corresponding information recorded in various documents was also a good indicator of how the needs were met. Activities were improved in such a way that staff had time to spend with individuals and engage them more through simple human and friendly contact. Medication process, records and management now exceeded minimum standards by appropriate procedure and individualised audits on a regular basis. The staff member showing us the medication was extremely confident, organised and in control of the process. Respect for privacy and dignity were seen both in practice and in documentation. Residents spoken to also confirmed: "They do respect us, they check me overnight, but they do not wake me up." Checked staff files showed that all recruitment requirements and checks of the new staff were appropriately carried out. Training was improved, as staff stated and files showed and the level of NVQ trained staff exceeded minimum standards. The stable, commited and capable manager introduced a new atmosphere in the home, where staff felt relaxed, they knew what they were doing and were motivated. The residents were given more individual attention and their protection measures were in place. What has improved since the last inspection? The main improvement was the changed atmosphere in the home. A much calmer, more relaxed atmosphere and much better engagement of residents improved the respect for their individuality and dignity. Staff were now engaging with all residents around them. The extra staff and reorganised meal times ensured not only better respect for residents, but also much better protection. The incidents of resident to resident conflict were significantly reduced and more safely managed. The assessment carried out by Social Services also helped calm the situation and address cases where particular attention to or prevention of an agitated state of a particular resident was appropriately managed and incidents were prevented. Medication process and proper and frequent audits ensured safe process and good protection of residents. Access to the garden, a new fence and attention to how the garden could be used now ensured free access with much better safety for residents. The consistent, motivating and supportive manager and his team ensured a stable, calm, relaxed and protective atmosphere where both the staff and residents felt comfortable and safe. What the care home could do better: The fire instruction for visitors at the entry to the home should give clear instruction to visitors what to do in case of a fire, as the current instructions related to staff and residents` actions only. The home`s quality assurance process, regular visits from the consultant and checks by the management team identified and acted on all aspects of care and provisions bearing residents in mind and thus ensuring improvements were made resulting in better outcomes for the residents. Key inspection report Care homes for older people Name: Address: Dorrington House 73 Norwich Road Watton Thetford Norfolk IP25 6DH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Dragan Cvejic     Date: 0 1 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Dorrington House 73 Norwich Road Watton Thetford Norfolk IP25 6DH 01953883882 01953889035 dhwatton@btinternet.com www.dorrington-house.co.uk Mr Steven Dorrington,Mrs Lorraine Dorrington care home 52 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) : Number of places (if applicable): Under 65 dementia Additional conditions: Any new admissions to the home must be in the category of Dementia (over 65 years of age). Eight (8) Older People who are named in the Commission`s records may be accommodated. Maximum number accommodated not to exceed fifty two (52). One service user under the age of 65 years, with a diagnosis of dementia, may be accommodated. Date of last inspection Brief description of the care home Dorrington House is a purpose built care home providing residential care for up to 52 older people including care for older people with dementia. It is situated close to the centre of the town of Watton and within easy reach of its amenities. The home comprises accommodation on two floors serviced by a shaft lift, stair lift and stairs, with 20 bedrooms on the ground and 32 on the first floor. All rooms have en-suite Care Homes for Older People Page 4 of 26 Over 65 52 0 1 1 0 5 2 0 0 9 Brief description of the care home toilet and hand basins in addition to the homes communal showers and bathrooms. There are other communal areas including hairdressing saloon, lounges and dining rooms that accommodate most service users at meal times. The home is one of three homes in Norfolk owned by the proprietors. The range of weekly fees is provided in homes documents. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This report is based on the latest site visit carried out on 01/10/2009. During the visit, we spoke to 6 residents 5 staff members, to the manager of the home and to the owner who visited the home at the same time. We checked residents documentation, staff files, some policies and procedures, we also toured the home and observed care processes. We used the homes own reports of the visits by the consultant who helped them progress and improve service and provisions for residents and checked how they implemented their improvement plan. As the home was rated poor on the last key inspection, they co-operatively worked with us, the regulators, with social services and with the adult protection team to overcome shortfalls and meet the requirements and to accommodate a full social Care Homes for Older People Page 6 of 26 services review of all residents. Several strategy meetings were attended by the management group of the home and various actions were undertaken to ensure improvements were consistent and protected residents. We carried out a random inspection on 07/08/09 where the two inspectors explored how the requirements were met and established the judgement that residents were safe. The home used the period between the random inspection and this key inspection to prove that the improvements were consistent. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: The fire instruction for visitors at the entry to the home should give clear instruction to visitors what to do in case of a fire, as the current instructions related to staff and Care Homes for Older People Page 8 of 26 residents actions only. The homes quality assurance process, regular visits from the consultant and checks by the management team identified and acted on all aspects of care and provisions bearing residents in mind and thus ensuring improvements were made resulting in better outcomes for the residents. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home updated their service users guide and informed potential residents of provisions in the home. Their assessment process was appropriate and now residents needs were met. Evidence: The home reviewed and updated their service users guide. They added a section FAQ-Frequently Asked Questions that addressed most common questions of potential new residents and their families. Admission details were checked in four files. One of them, for a recently admitted resident, showed that the process was conducted with attention to detail and with existing residents in mind. Such an approach ensures the least disturbance to existing residents. Carrying out this assessment in detail, the home ensured that once admitted, a residents needs would be incorporated into the care plan and the home would have the capacity to meet these needs. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was managed in a consistent way which ensured that care plans and other residents recorded details helped the staff meet their needs and monitor and discuss with residents and their relatives how these needs could be met. Respect for dignity of residents was significantly improved. Evidence: Four residents files were checked. Care plans were detailed and organized in 16 sections, addressing all assessed needs on admission and those identified during regular reviews. The home introduced a Resident of the day programme that ensured monthly reviews for each resident covered all assessed needs and any new sign of needs that needed addressing in care plans. One of the files showed how the home reacted when the need to monitor a residents weight due to constant loss was organized. Another one explained the action the home undertook to address the issue of a missing electric shaver charger. Details of health care were also appropriately addressed in relevant sections. Examples of good care resulting from well-recorded care plans were seen during the site visit. A confused resident was helped to recognize his room when the picture of Care Homes for Older People Page 12 of 26 Evidence: his beloved dog was displayed on the bedroom door. Another example was when a resident with tendency to stay up for a long time at night and become agitated was offered a sandwich and a cup of tea at 22.30 and then settled without further problems. The manager re-arranged for a chiropodist to review all residents and to start planning this treatment from the beginning, as chiropody was an issue in the home during the previous year. The owners and the manager reported an occasional inappropriate response from the local GP surgery, but the manager had arranged the meeting with the surgery managers to address the problems and find the solutions that would protect residents. Medication storage, records and administration were checked. Four residents records were checked. The senior staff member who showed us the medication was very knowledgeable and confident and very well organized. This resulted in accurate records, appropriate storage and safe administration of medication. Any errors were reported straight away, such as one that was reported a few days after the site visit and the manager and his team first ensured safety for the resident and then investigated the case with the intention of preventing any similar further occurrence. Extra training was introduced for staff, through assessment of staff competence to deal with medication on a yearly basis. This was done as medication refresher training. Apart from regular monthly audits, the seniors were conducting a daily audit, thus reducing the potential for mistakes. The main progress the home had made was in the area of respect for residents dignity. Evidence for this was presented in the next section covering meal times too, but the example here also showed how an improved atmosphere encouraged residents to express their wishes and preferences. A resident told us: I dont like make up, but love my nails painted. Her nails were painted nicely by staff. As a part of case tracking her file was checked and it contained the same note of her preference and when the staff painted them in her daily notes. One resident held the key of his bedroom. Another residents preference was to wear trousers and she was seen in trousers and looked happy and relaxed. In the residents files the last wishes and funeral arrangements were recorded and checked with residents relatives, thus ensuring that the home not only promoted their wishes, but included families into the care process. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A reorganised daily routine with an increased staffing level brought significant improvements to the atmosphere in the home and helped residents relax and enjoy themselves. Evidence: The home reorganised meal times, employed extra staff to cover this peak period and the results were a much calmer atmosphere, more enjoyable meal times and much better safeguarding of residents. The number of conflicts between residents was significantly reduced, but also much better managed, reported and discussed with the Adult Protection Team. Obvious improvements in respect for dignity were seen during the site visit in the dining room: three staff were helping three residents to eat, while the other three were serving the other 8 present people in a friendly and respectful manner. All residents seemed relaxed and settled. New picture menus increased the residents choices. At lunch time, the staff offered two dishes and even residents that were not vegetarians occasionally would opt for a vegetarian dish. The kitchen staff knew residents preferences and any limits to diet, as for one of the case tracked residents who had diabetes. The lounge also looked much livelier that at previous inspection, as three staff were Care Homes for Older People Page 14 of 26 Evidence: engaging 8 present residents. One was playing backgammon with a staff member, another was watching pictures from the past with the support of a staff member, one was talking to the staff and two residents initiated discussion between them. The manager reported that the home offered more varied in-house entertainment and also increased outings for residents. Recent bonfire, visit to the main rehearsal to the theatre and a visit to an Air show were some of these activities. The home did not handle residents money, but when it was appropriate initiated a Mental Capacity assessment to ensure protection of residents rights. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were much better safeguarded and protected with the new safeguarding procedure and staff training. Evidence: The manager reported two received complaints; both were appropriately investigated and resolved. There were no POVA referrals, but several incidents of conflict resident to resident were discussed with the Adult Protection Team. However, the number of these incidents was significantly reduced and now appropriately managed, thus protecting residents much better. The complaints procedure was part of the introduction pack for all new residents. It was also visibly displayed throughout the home. The home reacted appropriately, investigated the complaints and reach the outcomes within the timescale and provided answers to the complainants. They also recorded complaints and considered how the service and provisions could be improved as the result of the investigations findings. Three residents asked confirmed that they know how to complain and would complain if they had any concerns. Protection of residents was improved not only by changed working practices, but also with consultation with the Adult Protection Team. The home arranged extra training for staff provided by the external protection team that included Adult protection and police. Staff reported that this training was particularly good in terms of recognizing potential issues in cases of conflicts of residents between themselves. The home also carried out full staff checks during their recruitment process to ensure Care Homes for Older People Page 16 of 26 Evidence: appropriate protection of residents. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was safe, comfortable and bright and residents were free to go to any part of it, apart from the garden, which was in the final stage of being redesigning and was due to re-open soon. Evidence: The home was carefully furnished in communal areas to evoke pleasant feelings for residents. Many old items were there to invoke memory. Residents were allowed to bring in their own pieces of furniture, ornaments or memorable items. The home was clean and the majority of residents spoken to emphasized how clean and bright it was: It would not be better at home, stated one resident. A new kitchenette on the first floor also increased provisions for residents. The tour of the home with the manager provided an opportunity to experience the same feelings as residents do. A resident briefly showed us his room, which contained some personal items and pictures and then continued walking through the corridors, enjoying this freedom. The front door was secure and coded, thus protecting users from uncontrollably exposing themselves to the busy street nearby. A resident stated that she could go out with staff when she wanted. The garden was in the final stage of being re-designed. New access, a new fence and a new part of the garden allocated for residents who enjoyed gardening was a significant improvement that residents would start enjoying as soon as it re-opens; the manager stated this would be in a couple of days. Care Homes for Older People Page 18 of 26 Evidence: Infection control measures were in place and the design of the home helped ensure good infection protection. The laundry room was clean and organized. A member of laundry staff stated that she had good conditions to work in. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The improved staffing level and staff commitment and motivation exceeded basic standards and contributed to a much happier and safer atmosphere for residents. Evidence: The home employed extra staff- support workers, to cover peak periods and to improve activities for residents. This was observed during meal time in the dining room and during the day in the lounge. The 5 staff members spoken to, stated: - there is a very nice atmosphere in the home now - it is much easier to focus on what we do, as there is no pressure now - we are much more motivated now - the management of the home is very good - we are regularly supervised and supported - we have more training now that is relevant to our jobs - We feel that residents are happier, calmer, and the atmosphere in the home is more relaxed. The NVQ trained staff level was also improved and exceeded the expected 50 . Four staff files checked showed that all checks were conducted prior to staff starting work with residents. The training plan was displayed in the office and showed regularity, allowing the management team to plan and control the training programme. Extra sessions arranged with the Adult Protection team helped staff clarify their role in different safeguarding situations and better protect residents. Care Homes for Older People Page 20 of 26 Evidence: Residents spoken to about staff praised them: They are very good. If they check me overnight, they do that carefully and dont wake me up. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A stable and approachable management team brought stability to the home in general. Evidence: The owners should be praised for conducting proper checks on the manager before offering him this post, thus ensuring that the right person was employed in this important position. The promotion of the former administrator to the deputy managers post also contributed to the good management style, stabilizing the home. Giving the manager the responsibility to deal with risks and measures to reduce risk also helped promote staff creativity and safer and better operation of the home. A contingency plan for a potential flu outbreak developed together with the owners reduced further this general risk. An important part in the improvements to the home was also played by the consultant. She conducted an appropriate quality assurance review, published her findings and supported the management team move the operation of the home to a safe and protective level. Care Homes for Older People Page 22 of 26 Evidence: The new ethos introduced into the home benefited residents who were now well protected, well cared for and generally happier. Supervision, cascaded through the staffing structure and carried out regularly helped improve staff motivation, commitment and satisfaction. The home did not deal with service users money. Another factor that helped the home stabilize the atmosphere was the presence of Social Services staff who conducted reviews of all residents and had recently been regularly present in the home. Safe working practices were in place. Good training and regular refresher courses helped staff feel more confident and consequently improved outcomes for residents. Accidents/incidents were carefully monitored, analysed and used to reduce risk, reoccurrence and to better protect residents. Fire procedure displayed in the entry hall area instructed staff and residents what to do, but did not mention visitors, although they were asked to sign the procedure. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 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 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 38 The instruction for visitors on what to do in case of fire should be contained in the procedure they were asked to sign. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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