Care Home: Douglas House Cheshire Home

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What the care home does well The home makes very well informed decisions about whom they will admit and then how they will deliver their care, with their full involvement and the involvement of other interested parties. They encourage people to be as independent as possible and, using a well trained and multi skilled workforce, improve upon the skills and abilities that people have already come to the home with to enable them to further their independence. The home has been progressively improved to provide as full a service to people as possible for them to lead a fulfilling life style. Staff selection and training is excellent and well supported both by the Registered Manager and the organisation. Where complaints have been received they have been investigated fully and appropriately responded to with changes made where this was necessary. The home operates as a team that includes the people who live there and the staff under the direction of the very capable Registered Manager. What has improved since the last inspection? There have been improvements in the premises such as general decoration. In addition to this there have been investments in equipment, such as bathing facilities and hygienic toilet facilities, which have benefits for the people who use them. We had more contact with the people who live in the home during this inspection and felt that they have been progressively more involved with the way it functions as a whole, and also for them as individuals. What the care home could do better: We have no comments to make in this area. CARE HOME ADULTS 18-65 Douglas House Cheshire Home Leonard Cheshire Foundation Services Douglas Avenue Brixham Devon TQ5 9EL Lead Inspector Douglas Endean Unannounced Inspection 10th January 2008 09:30 Douglas House Cheshire Home DS0000028666.V357194.R01.S.doc Version 5.2 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 Douglas House Cheshire Home DS0000028666.V357194.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 Adults 18-65. 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. Douglas House Cheshire Home DS0000028666.V357194.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Douglas House Cheshire Home Address Leonard Cheshire Foundation Services Douglas Avenue Brixham Devon TQ5 9EL 01803 856333 01803 859503 kay.taylor@LCDisability.org www.leonard-cheshire.org.uk Leonard Cheshire Disability 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) Miss Kay Louise Taylor Care Home 29 Category(ies) of Physical disability (29), Physical disability over registration, with number 65 years of age (29) of places Douglas House Cheshire Home DS0000028666.V357194.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. physically disabled - 29 nursing beds elderly physically disabled - 6 residential beds physically disabled - 6 residential beds A named first level Registered General Nurse with experience in the Younger Physically disabled field must be appointed to support the Manager 01/06/2006 Date of last inspection Brief Description of the Service: Douglas House is a purpose built care home with nursing for the disabled and first opened in 1973. It is one of the Leonard Cheshire Homes, a Charity providing services for people with a disability in the UK, and is located on the outskirts of Brixham in Devon. It is located at in a residential area and has some superb views from the first floor across the sea that is just a short distance away. The charity has recently changed its name to “Leonard Cheshire Disability”. The home is registered for up to 29 physically disabled people from 20 years old upwards who require nursing care. The home can also provide residential care if the need arises. There is always a registered nurse on duty who is supported by a team of health care assistants and others skilled in physiotherapy and activities that are therapeutic and entertaining. The Douglas House staff team are committed to enabling people to live as independent life style as possible whilst maintaining their dignity when care and support is provided. The home has been refurbished and bathrooms have received particular attention to update their equipment and décor. All accommodation is provided in single rooms, nine of which have en suite facilities. Everyone living at the home has access to hoists if needed, most of which are overhead track hoists. There are spacious communal rooms and wide corridors allowing easy manoeuvrability for wheelchair users throughout the home. This purpose-built accommodation provides environmental aids and also computer equipment with broadband connections for those who wish to use it. Douglas House also has a respite/holiday room for service users wanting shortterm care only who may or may not be a resident in another Leonard Cheshire Douglas House Cheshire Home DS0000028666.V357194.R01.S.doc Version 5.2 Page 5 Home in another part of the country. Emphasis is put on helping people to achieve their greatest potential level of independence and thus improving their quality of life. Douglas House also has a day-care service for local people that is shared by the resident. They can provide suitable transport for people to attend. The homes 2007/2008 fees commence at £463 for hotel services plus that which is individually assessed for the care needs to be met. Douglas House Cheshire Home DS0000028666.V357194.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. This unannounced key inspection took place on the 10th January 2007 beginning at 09:30 hours. It lasted for 5 hours plus an addition hour on the 14th January to verify further information that had been gathered. During this time we discussed the functions with the home with the Registered Manager, other staff, and also with people who live in the home. We interviewed 3 staff and 3 people who live in the home but spoke to several more whilst making a tour of the home. With regards to records we read 3 staff files and 3 files of people who live in the home, the people we had interviewed, as a case tracking exercise. We also looked at other records including quality assurance, maintenance, recruitment and medication. The Registered Manager produced a Annual Quality Assurance Assessment prior to this inspection that informed the commission about how the home has assessed its performance against the standards and what evidence they have to prove it. It also gives information about numbers of residents and staff and maintenance dates. What the service does well: The home makes very well informed decisions about whom they will admit and then how they will deliver their care, with their full involvement and the involvement of other interested parties. They encourage people to be as independent as possible and, using a well trained and multi skilled workforce, improve upon the skills and abilities that people have already come to the home with to enable them to further their independence. The home has been progressively improved to provide as full a service to people as possible for them to lead a fulfilling life style. Staff selection and training is excellent and well supported both by the Registered Manager and the organisation. Where complaints have been received they have been investigated fully and appropriately responded to with changes made where this was necessary. The home operates as a team that includes the people who live there and the staff under the direction of the very capable Registered Manager. Douglas House Cheshire Home DS0000028666.V357194.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? 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. Douglas House Cheshire Home DS0000028666.V357194.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Douglas House Cheshire Home DS0000028666.V357194.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The homes performance was assessed against Standards 1, 2, 3 & 5. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home provides an excellent level of information to people who may be admitted, in several professionally prepared formats. The assessment process is of a high standard, and provides very clear information about what they believe the holistic needs of an individual are. EVIDENCE: As you enter the home through the automatic sliding doors you find yourself in the reception area. There is a volunteer receptionist on duty during normal working hours who is also one of the residents. Everyone entering the building is asked to sign in, and then sign out on leaving the building. Visitor nametags are also provided. To the right of the front door there is seating, and a table that holds a wide variety of information about the home and the service that it provides. This includes copies of the Commission for Social Care Inspection, inspection reports, Statement of Purpose, quality assurance feedback questionnaires with a box for them to be posted into. There is information about the Leonard Douglas House Cheshire Home DS0000028666.V357194.R01.S.doc Version 5.2 Page 10 Cheshire Disability service and also their complaints procedure. A short distance from the reception area is a notice board that contains more information mainly for the residents of the home informing them again of the complaints procedure, when such events as the “Residents Committee” meeting is to be held, ands also about SUNA (Service Users Network Association. Many of these documents have been professionally prepared by the organisation and are of a high standard. The Statement of purpose is complete and we saw evidence from several sources, case files and letters from previous residents, to show that everyone does receive a copy before they are admitted to the home. In addition to the above the organisation does have a professionally developed website, which we have looked at, that provides a valuable insight into the organisation, its aims and objectives and how it intends to meet them. The Registered Manager, who is a Registered Nurse, told us that the admission procedure is followed on every occasion. A referral for admission is received, usually from a health or social services professional. The home sends an application form to the person who is being referred along with the admission pack that includes the Statement of Purpose. When they receive the completed application form they make arrangements to carry out there own assessment to establish whither they are able to meet the needs of the person being referred. We saw 3 of these completed assessments during the inspection. They were comprehensive in so much as they gathered information about an individuals health and social care needs from the individual themselves and other sources, such as a hospital where they were resident immediately prior to admission. The assessments included, mobility, nutrition/hydration, sleep patterns and nighttime behaviour. A second assessment form provided a dependency score that converted into a costing tool with charts that showed just how the figure had been achieved. There was a “hotel fee” that was the base figure. Added to this was the cost of social and nursing care, which was further broken down showing the time required for a variety of elements of care that needed to be provided. The assessments are carried out either at the persons place of residence or at the home itself giving them a greater opportunity to see what the home has to offer them. The benefit of the process to the person undergoing the assessment is that the home will be prepared to meet their individual needs from the point of their admission. All admissions are on a trial basis of between 6 and 12 weeks. We saw records that were made during the trail period by the home showing a continued assessment process involving professional staff, with the input of the individual and interested parties, until the trial period was completed and a decision made about continuing the placement. We also saw how the information that was gathered during the assessment processes is then incorporated in the contracts of residency that were in the files we read. Douglas House Cheshire Home DS0000028666.V357194.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The homes performance was assessed against Standards 6, 7 & 9. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The care plans are very through and the level of involvement by the person they are about is excellent. The home promotes and develops the independence skills of those who live in it. EVIDENCE: We saw the records of 3 people who live in the home. During the inspection we also spoke several people who live in the home on a number of subjects, obtaining from them information about their life in the home and their involvement in its running. The person centred care plans were very comprehensive, covered a very wide range of subjects such as care, medical, psychological, nursing and social. Where one was indicated, a risk assessment had been carried out and a care plan drawn up from the information that had been gathered. The plans included input from health and social care individuals both working in the home and visiting such as General Practitioner and Douglas House Cheshire Home DS0000028666.V357194.R01.S.doc Version 5.2 Page 12 Physiotherapists as well as the nurses employed by the home. There was evidence that the person they were about had also been involved in the planning of care and making decisions, and that they had signed the plan or had it signed in their presence. Each person in the home also has a key worker who is involved in the process of planning care and then seeing that it is delivered. The homes aim is to promote and develop independence skills of the people who live there. The progressive care plans showed how people had met the challenge under this supportive environment and changed the way that they had viewed themselves as their independence has grown. We saw that the plans are formally reviewed at least monthly and that people who are in some way involved are part of the review such as family and social care workers. We met 2 residents who are also volunteers in the home, one managing the shop and one on reception when she is not working as a volunteer in a charity shop in town. The roles they play are covered in their care plans as well as them having completed the full vetting process, including Criminal Records Bureau checks in line with the volunteers policy and procedure. The staff are very committed to helping the people who live in the home experience a full and eventful life. The risk assessments are used to identify the risk a situation may involve, the staff then use their skills to eliminate the risks rather than avoid the event. This was seen in how people are enabled to go swimming and on holidays in this country and abroad. Douglas House Cheshire Home DS0000028666.V357194.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The homes performance was assessed against Standards 11, 12, 13, 14, 15, 16 & 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home provides a high level of physical and psychological support to the people who live there. The people maintain their independence, and an appropriate degree of control over their lifestyle as a result of this. EVIDENCE: The people who live in the home are supported to maintain relationships within the community, and to make more. People may leave the home to visit family and friends, go shopping, have holidays or trips to places of interest, go to work, etc, with or without a member of staff. One person we spoke to said that she was actively being encouraged to have more involvement in the community so that she develops greater independence from the home. The Registered Manager told us that the local towns people will make contact with Douglas House Cheshire Home DS0000028666.V357194.R01.S.doc Version 5.2 Page 14 the home if they see someone that they think is from it who may be experiencing difficulty. One individual has used a specialist travel company to travel the globe over the last 4 years whilst another said that she travels with another travel company within Europe once a year, and also holidays to other homes within the organisation. Family are invited to visit and take part in any activity or event if they wish. They can have a meal whilst they are at the home for a small charge. We saw this happening during the inspection. We were also told that the home does provide transport to encourage individual independence. Where an appointment is for a health reason there is no charge. Transport for social reasons such as to the cinema, theatre or trips to places of interest is charged for. As the people manage their own money in most instances they have finances for these things, many of which include discounts that the home has negotiated for the people who live in the home. Some people do attend the local college and have skills training including computer training. The home does have a quiet room where 4 computers, owned by individual’s living in the home, have been set up to share with everyone in the home and do not have a fee involved in their use. They are all on a broadband connection and people have there own passwords and email addresses. In addition to this every bedroom has a telephone, broadband connection, and satellite television connection, which is individually charged for if used. The facilities, and others may be adapted to overcome an individual’s disability. We saw this in practice with automatic doors at the entrance and on the lift, large print keyboards on the computers, and specialist hoists into ensuite facilities. Where people have religious beliefs that they wish to maintain the home does assist them to do this. One person travels abroad every year with friends to a place of worship that she wishes to attend. The home helps with the arrangements where they can to make the journey and its purpose a success for the individual. Three of the people living in the home, as mentioned, are volunteers in the home and also outside of it. One is also the “Chairman of the Residents Committee” that meet monthly. They actually met on the day of this inspection and the Chairman talked to the manager before the meeting and also arranged a feed back session with her for after the meeting. The Registered Manager is invited to attend the meetings bi-monthly. Minutes are taken and actions recorded. The Chairman is also the Regional Representative for SUNA, Service Users Network Association, and attends meetings, the next one being in Blackpool. He will be supported by the staff to enable this to happen. Douglas House Cheshire Home DS0000028666.V357194.R01.S.doc Version 5.2 Page 15 The home also has activities every day that include people from the local community who attend the day care centre on the first floor. This includes such things as physiotherapy by the in house physiotherapist aide, and horticultural activities assisted by a local interest group. A number of the residents have formed their own music group and produced their own music disc. The group meets weekly to play instruments and enjoy themselves. The bedrooms have doors that can be locked and all the residents have access to keys. A number of bedrooms have automatic door openers and these are lockable. Staff are aware that they should enter a bedroom only after permission has been given by the resident and they were seen to knock before entering bedrooms. The Registered Manager gained the permission of individual for us to look inside their bedrooms, which were personalised to their own taste and adapted to their own needs. We saw that lockable boxes are provided for people to store medication if they are self-administration, and valuables. The people living in the home have the right to their privacy and do choose to spend time alone in their rooms. However the staff are aware of those people who may be in need of emotional support or encouragement to join in with other individuals or groups in the home or outside of it. The home has a hotel styled kitchen and employs its own catering staff. Food is prepared fresh with a selection of food being available each day. Fresh fruit was also available and there was a drinks dispensing machine being used by residents for hot and cold drinks as they wished. People were happy with the standard of food they are served. One said, “It was nicely cooked and the right kind of food” whilst another said that the food was good and that they have been involved in the recent review of the menu’s. Another person said the food was good but that there are occasional problems as a result of her special dietary needs. The more active people also have the use of a resident’s kitchen on the ground floor where they can prepare snacks and use a microwave to heat up food. They also have the use of a washing machine and dryer to keep so that they may do their own laundry. Meals are unhurried and staff provided support to those who needed it. All the people living in the home have a nationally recognised tool for nutritional assessment completed and held in their file. We saw the result s of this in the three files that we read during the inspection. The home does involve the people in menu planning as individuals in care planning reviews, and as a group in the residents meetings. The staff monitor individual’s choices of meals so that they do not become nutritionally compromised. The importance of adequate fluids is also something that we were told was an important issue, which the staff monitors where this is necessary. Douglas House Cheshire Home DS0000028666.V357194.R01.S.doc Version 5.2 Page 16 Douglas House Cheshire Home DS0000028666.V357194.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The homes performance was assessed against Standards 18, 19, 20 & 21. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home operates efficiently to meet its aims and objectives, with the people who live in it being its priority. The people who live in it have a large say in the way it operates on a day-to-day basis. The way staff enable people in the home, has long-term benefits to them. EVIDENCE: The nursing and social care provided at the home is carried out in collaboration with the people who live there. They have taken an active part in the planning of their care, or have had an advocate involved such as family, or a health/social care professional. The care plans are signed by the person they are about, or signed in their presence, agreeing with the way care and support is to occur. This includes how they will be lifted and moved from place to place, how their hygiene needs will be satisfied and how their appearance, and that of their personal space, will be dealt with. The files also show what the person’s wishes are about the person who will be supporting them, i.e. the gender and Douglas House Cheshire Home DS0000028666.V357194.R01.S.doc Version 5.2 Page 18 possibly individual if there has been an issue. This approach addresses issues such as independence, dignity and respect and gives the person control over their life. We saw that every person has a key worker and on discussion with the people who live in the home they have agreed who their key worker will be. The daily routine of the home is clear such as when cleaning and laundry occur, or what the normal meal times are. This is necessary for the home to function. However, the home does operate a flexible approach that does meet the changing needs and desires of the people who live in it such as early or late meals for individuals who may have an appointment, or late cleaning of their room if they generally have a lay in. The home is fully adapted to provide for the physical are of people. A continuing program of equipment maintenance was seen when the service records were read, and also the information was provided in the homes Annual Quality Assurance Assessment return that tells the Commission for Social Care Inspection how the home feel they are functioning. There have also been improvements to equipment such as the automatic opening doors on the lift, new baths and upgrading of bath and shower rooms. Individual people in the home have specialist equipment that has been specifically obtained, sometimes by them, to improve their independence and provide care safely. We saw new toilet systems that operate automatically to wash and dry the user, a special entry and exit bath and ceiling hoists. Also the home does operate as advocate for the people when accessing the services of other specialist in care should they be needed. This includes working with the General Practitioner’s who do make regular review visits to the home, one does this monthly and one quarterly. The community services are obtained to meet the needs of people who live in the home, such as occupational therapy assessments, speech therapists, tissue viability expert advice, and other health care professional advice and support. Transport is available at the home to take service users to any health care appointment that has been made by them or the home and includes visits to their dentist of choice. Complimentary therapists are also used if requested. The arrangements for the supply, storage, administration, and disposal of medication was looked and found to be good. The medication storage room is air conditioned to maintain a correct storage environment for some medications that do not require to be refrigerated. The Registered Nurse on duty is always responsible for the administration of medication to the service users. The administration records were looked at and found to be good and the reference material held at the home about medications was sufficiently up to date. Where it has been requested service users can self medicate providing the homes risk assessment finds this to be a safe arrangement. There is suitable Douglas House Cheshire Home DS0000028666.V357194.R01.S.doc Version 5.2 Page 19 lockable storage in bedrooms for this arrangement. There are increasing numbers of people who live in the home that now self medicate. The home is suitably equipped and prepared to provide good care to any resident’s who are reaching the end of their life. This is done both in a professional and emotional sensitive way including and supporting those individuals that are to be a part of the final caring experience. They will receive this care in the privacy of their own room unless it is not medically possible. Douglas House Cheshire Home DS0000028666.V357194.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The homes performance was assessed against Standards 22 & 23. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The way that the home has managed complaints has been open and honest. The Safeguarding People training update arrangement is good. EVIDENCE: The home has many ways of informing the people of their rights including their right to complain. The information on how to do this is held in the complaints procedure that is displayed in the entrance of the home and also held in documentation such as the Residents Guide and Statement of Purpose. In addition to this there are professionally printed leaflets that are in the front lobby entitled “Have your say” regarding complaints, “Protecting Vulnerable Adults” guidance for anyone to read. In addition to this people who live in the home can take part in the Residents meetings that occur monthly or speak to the Chairman of the committee about concerns. In the front reception area there are feedback forms for people in the home, or those who visit, to write a compliment or complaint about the service and place it in a secure post box in reception, anonymously if they wish. We saw records of the complaints that have been handled at home level and the outcomes. We have also been involved in one complaint that was investigated and reported upon in a very through way by the home who Douglas House Cheshire Home DS0000028666.V357194.R01.S.doc Version 5.2 Page 21 provided clear evidence about what had occurred and how it had been addressed. There are procedures in place to protect the people who live in the home from abuse that include the vetting of staff, and also any contractor who work at the home. We saw evidence of the Criminal Records Bureau checks on all these personnel that are kept in a secure place. The staff files provided evidence of Safeguarding People training having taken place for staff employed at the home. The staff I spoke to told me that they had the initial training when they started working at the home and have also had regular updates every year to 18 months. This training is supported by the homes policies and procedures on Safeguarding People that included the Joint Pan Devon Alerters Guide. Douglas House Cheshire Home DS0000028666.V357194.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The homes performance was assessed against Standards 24, 25, 26, 27, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean, well maintained, and suitably equipped to meet the needs of the people who live there. EVIDENCE: The home was purpose built by Leonard Cheshire in 1971 to care for Young Physically disabled. It has been up graded and further adapted since that time and was registered to provide nursing care July 1997. It has good access for wheel chair users and the disabled from the large car park at the front of the home and a slowly rising ramp up a small gradient to the front automatic door. It has a functional floor design having wide corridors, automatic doors in the corridor, large bathrooms with suitable hoisting and bathing equipment particularly since they have just been completely refurbished. One bathroom on the first floor that has a specialist bath installed also has hairdressing Douglas House Cheshire Home DS0000028666.V357194.R01.S.doc Version 5.2 Page 23 facility, and facilities to allow chiropody to take place in the room. There are new specialist bathing facilities on the ground floor with side entry bath and a wheel in shower. There are up to date toilet’s off the main corridors that provide automatic clean and dry facilities thus increasing the dignity, independence and control of infection measures for everyone that uses them. Every person living in the home has a single bedroom. These had been personalised by the occupants who also have a nurse call system, ceiling track hoists and wash hand basins in a vanity unit, some of which are height adjustable and a large mirror that tilts to provide a suitable reflection for the user. There are shaver points and light switches in the units, and the water temperature is controlled by thermostatic mixer valves. Most beds are electrically operated for height and position and the power points are in at a suitable height for wheel chair users. The bedrooms are generally large and doors can be locked with the service users having a choice of being a key holder. Each room has a large double glazed window area covering the full length of one wall that offer a view from either a seated position in a chair or from the bed. The rooms have telephone, broadband and satellite television points that can be connected and are individually charged for. One person has the satellite television so that he can watch football, an interest of his. There are four computers in the quiet room where anyone can access the internet via broadband free of charge. The home also has a large communal lounge with flat screen television, a tuck shop and dining room on the first floor. There is a garden area to the side of the building and some off street parking at the front. A 13-man lift with automatic opening doors provides access for everyone between the ground and first floor of the home. There is a complete laundry service at the home that is housed in a suitably designed room with 2 washing machines with a sluicing cycle, and 2 commercial dryers. Appropriate infection control procedures are in place through out the home and not just in the laundry room. There are also washing and drying facilities for the people who live in the home to use independent of the laundry service. These are located on the ground floor in the resident’s kitchenette. The home employs a full time maintenance man who has his own workshop and is conversant with the home and its equipment. We saw information about the maintenance of the home and its grounds and good records of the planned and unplanned work that occurs. The records of work carried out by outside contractors were up to date. The home was clean, well decorated and generally odour free. Areas such as the bathrooms and stairwell have been improved with the help of some of the volunteer workforce who come to the home. Douglas House Cheshire Home DS0000028666.V357194.R01.S.doc Version 5.2 Page 24 Douglas House Cheshire Home DS0000028666.V357194.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The homes performance was assessed against Standards 31, 32, 33, 34, 35 & 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has good recruitment procedures. The standard of induction, and subsequent training, is excellent. Staff are well prepared for the role that they play in the home. EVIDENCE: The home employs Registered Nurses, Social Care staff, ancillary staff, and volunteers. Each has roles that are very clearly defined in their job descriptions that have been produced by the organisation. We saw copies of the individual job descriptions in the 3 staff files that were read during the inspection. We also spoke to 3 staff who described what they do as part of their work, the roles compared with the job descriptions. Staff act as key workers for the people who live in the home and in this role they monitor that the care that is planned is delivered, even when they are not Douglas House Cheshire Home DS0000028666.V357194.R01.S.doc Version 5.2 Page 26 on duty. This relationship also provides the people who live in the home with someone that they can negotiate there needs with, and who will assist in them achieving their goals that might entail the skills of another person such as a nurse or the General Practitioner. All the staff that are employed by the home go through the full recruitment procedure, even volunteers. The home employs an individual who is responsible for the recruitment and training of volunteers who come from many sources, including the home itself. We saw how there recruitment is carried out and the co-ordinator discussed the benefits that are gained by both parties in the arrangements. The home is very grateful to them for their input into the running of the home that has included improving the gardens and professional tiling work in the wet areas as well as reception work and running the tuck shop. All contractors are also vetted and Criminal Records Bureau checks are undertaken and held securely at the home. Contractors have been very co-operative in this arrangement and only send workers who have been vetted to undertake work at the home. We read 3 staff files that showed that among the normal recruitment arrangements everyone has an interview by 2 people who record the responses to set questions as part of the equal opportunities arrangements and also have references and Criminal Records Bureau checks. The files also include evidence of the 3 stage induction process for all staff that is signed off at each stage when individuals have completed a task. The first stage is the giving of information to all new staff in a pack that includes Leonard Cheshire information, including policies and procedures, and the General Social Care Council pack. This is followed by a 2-day induction covering such things as fire and Health & Safety issues. Care staff have a further day that covers communication and practical care such as catheter care. They then shadow a senior for 3 days before they actually work in a “hands on” role. The standard of induction is in line with the Skills for Care guidance. The Registered Manager provided evidence that all the staff have received sufficient training, from a list of 54 different training events, to enable them to work safely with people who live in the home. We saw evidence of safeguarding people training, practical care training such as moving and handling and infection control, and specialist training as undertaken by the Registered Manager, in resuscitation. Further to this more than 50 of the care staff, who do not hold a nursing qualification, hold a National Vocational Qualification at level 2 or above. We spoke to 3 staff members, having read the files of 2 of the individuals. Each felt that they had been well prepared for their job and that they do receive very good support from the home. The staff files had proof that formal supervision takes place. The supervision began at the beginning of the employment and throughout the probation period identifying needs from both sides that had to be addressed. The staff plan for the event and records are kept on the sessions. There are cascading Douglas House Cheshire Home DS0000028666.V357194.R01.S.doc Version 5.2 Page 27 responsibilities for who is responsible for the supervision of individuals with the Registered Manager having an over view of the total arrangements. Staff appraisal is an annual event and records were kept about this also. The home has satisfactory numbers of staff on duty at all times who are skilled in the role that they play. During the office hours of a working week there are substantial levels of staff that are involved in care, administration, and ancillary services, including volunteers, The duty rotas substantiated the observations that we made during the inspection. Douglas House Cheshire Home DS0000028666.V357194.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The homes performance was assessed against Standards 37, 39 & 42. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The management arrangements for the home are excellent, which enables it to surpass its aims and objectives. EVIDENCE: The Registered Manager is a Registered Nurse, and also possesses the necessary management qualifications obtained since the last inspection. She is also experienced in the role of management. This has been evident during the inspection. We saw first that she is knowledgeable about the organisation she works for and its aim and objectives, policies and procedures and developmental plans. She has a very good knowledge of the needs of the people who live in the home and how to use the resources she has available to Douglas House Cheshire Home DS0000028666.V357194.R01.S.doc Version 5.2 Page 29 her to meet them. She also has an excellent staff group that have been appropriately recruited and trained to deliver a service that satisfies the aims and objectives. She is supported in the home by her team, and externally by an internationally recognised organisation/charity that is known for its work with the disabled community. The Registered Manager was able to show that she has an excellent understanding of the day-to-day functioning of all areas of the home, and this is helped by the quality assurance arrangements that are in place. These include feedback from the people who live in the home and visitors to the home, including health care professionals, using the feedback forms that are in the reception. There are also feedback form meetings such as the monthly residents committee meeting, nurses meeting, Care Team Leaders meeting, Health & Safety meeting, etc. We saw evidence that there are minutes for all meetings. Further to this the home has a Regulation 26 inspection every month and a report is sent to the Commission. At the time of a person’s annual review the Registered Manager has taken the opportunity to also send a quality assurance questionnaire to relatives. The result of all the feed back that is obtained is published and we saw last year’s information on display on the notice board nearest the lounge. Finally the Registered Manager produced a well written Annual Quality Assurance Assessment for the Commission that holds good levels of information about how the service views its own performance against the standards and regulations, what evidence they have to support their findings and where they can improve. The amount and standard of training provided to staff from the point of induction, and the maintenance of the building and its equipment, ensures that the their health, safety and welfare, and that of the people who live in the home, is well provided for. We saw evidence of the training in staff files and also how the Registered Manager manages this using the training matrix. We also saw how maintenance, regular and unplanned occurs with dates provided on certificates and invoices. We also saw how the regular Health & Safety checks of the premises are recorded by a person who is competent in this task and employed by the organisation to carry it out every six months. In addition to the checks, fire procedures are practiced regularly and we saw safety leaflets around the home to assist in people’s knowledge of the procedure. The home employs its own maintenance man who is supported in some of his work by skilled volunteers who have tiled bathrooms and managed the gardens around the home. He has his own workshop and records of work to do, and that has been done. The Annual Quality Assurance Assessment provided information about maintenance that was verified during the inspection such as hoists, gas, and electrical appliances. Douglas House Cheshire Home DS0000028666.V357194.R01.S.doc Version 5.2 Page 30 Douglas House Cheshire Home DS0000028666.V357194.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 4 2 4 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 4 28 3 29 4 30 3 STAFFING Standard No Score 31 3 32 4 33 3 34 3 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 X LIFESTYLES Standard No Score 11 4 12 4 13 4 14 4 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 3 4 X 4 X X 4 X Douglas House Cheshire Home DS0000028666.V357194.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Douglas House Cheshire Home DS0000028666.V357194.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Colston 33 33 Colston Avenue Bristol BS1 4UA 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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