Care Home: Dovecote Care Home

What the care home does well The atmosphere in Dovecote is warm and caring. People who live there appear happy and relaxed and are well presented. They have good relationships with the staff who they relate to very well. In their survey one person said, "In my opinion the staff are very good." The service promotes a calm atmosphere. There is no television in the lounge and usually there is relaxing music playing. There are also regular aromatherapy and massage sessions. The home is careful to ensure that all staff who work there have taken training in dementia care so that they understand how to work appropriately with people with this condition. The manager and staff understand the importance of supporting and promoting the privacy, dignity and choice of people with dementia. Staff work in a way that supports and promotes each persons needs as an individual. The home carries out a careful assessment of people before they are admitted to the home so that it can be confident that it can meet their needs before admitting them. At the time of admission they provide prospective residents with written information about the way the home is run. They also tell them how to raise any concerns. People who were involved in the inspection told us that they knew how to do this and were confident to talk to the staff or the manager. The home has good working relationships with health care professionals and ensures that the health care needs of people living in the home are well met. The premises are clean and the home provides a safe and comfortable environment for the people living there. There is space within the home for those who like to walk around. The home has a stable staff group. After recruitment new staff follow a period of induction training that helps them to know how to work appropriately in the home. Once they have completed their induction staff enrol on NVQ training and the majority of staff in the home have completed or are in the process of taking this award. What has improved since the last inspection? The home has improved the way that it assesses people`s needs whilst they are resident in the home, in particular they are careful to make sure that they carry out this process with regard to their mood and sociability. They now carry out a monthly review of people`s progress whilst living in the home. The home has started to ask relatives for more comprehensive detail about peoples life history and interests before they became ill. This could form the basis of "life stories" or "life maps". An outside entertainment group now visits the home four times a year. They also have regular visits from a mobile library that provide books in large print. The new providers have started to upgrade the premises. By the time of the inspection there were new carpets in the home, a number of areas had been redecorated and the laundry equipment and dishwasher had been upgraded. There was also some signage on doors to help people orientate themselves in the home. Dovecote now employs a maintenance man for sixteen hours a week. Further upgrading is planned to the premises.The numbers of staff on duty have increased to three in the afternoon during the week and there are plans in place for this to implemented during the weekend afternoons as well. The programme of staff training is improving, e.g. all staff are taking a distance learning course on infection control, but there are some aspects of mandatory training that need attention as detailed below. There is also a new staff supervision and appraisal system in place. The number of dedicated hours for the manager to carry out the management function has increased. The manager has a significant amount of experience of working in the field of dementia care and has taken appropriate training to manage a care service so this should allow her to manage all aspects of the home more fully. What the care home could do better: Following on from the assessment that the home undertakes, it needs to prepare a written plan that provides the detail needed for staff to support people living in the home. Currently there is a dependence on information being passed on verbally. The home does not employ an activities organiser although they are considering doing so. Occupation for residents is mainly dependent on staff setting up activities when not involved tasks, usually in the afternoons. This should help the home to plan activities for people on a more individual or small group activity basis than is currently happening. Whilst people enjoy the food that is provided, the home should consider extending the menu so that there are some traditional roast dinners and a wider selection of foods at teatime. There are large gardens at Dovecote Care Home. Only the patio area is accessible to residents and some residents would enjoy increased access to garden areas. Generally staff are employed in a way that makes sure they are suitable to work with vulnerable people. There are some attentions to detail that should be made to make this process more robust. CARE HOMES FOR OLDER PEOPLE Dovecote Care Home Llangarron Ross-on-Wye Herefordshire HR9 6PB Lead Inspector Philippa Jarvis Unannounced Inspection 19th March 2009 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Dovecote Care Home DS0000072233.V374657.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dovecote Care Home DS0000072233.V374657.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dovecote Care Home Address Llangarron Ross-on-Wye Herefordshire HR9 6PB 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) 01989 770 240 www.dovecotecarehome.co.uk Dreamcare Homes Limited Mrs Anne Morgan Care Home 15 Category(ies) of Dementia (15) registration, with number of places Dovecote Care Home DS0000072233.V374657.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: Dementia (DE) The maximum number of service users to be accommodated is 15 This is the first inspection of Dovecote Care Home with the new service providers. 2. Date of last inspection Brief Description of the Service: Situated in a rural area on the outskirts of a village between Monmouth and Ross-on-Wye, Dovecote Care Home offers care for up to 15 people with dementia related care needs. The setting is peaceful and promotes a tranquil atmosphere, which the provider and registered manager believe is important for the comfort of people with the cognitive and behavioural difficulties associated with dementia illnesses. People are accommodated in single, and one double, rooms on two floors. Some bedrooms have en suite facilities. There is no mechanical means to help people who develop mobility problems access their bedrooms on the first floor. The communal rooms comprise one lounge and a dining room on the ground floor. There are also communal bathroom and toilet facilities. There is a large garden with a rural outlook. The patio area is enclosed and can be used by the people living in the home to walk around independently. To use the remaining garden, residents need to be escorted. The information provided in the Service User Guide indicated that there is a weekly fee of between £480.00 and £525 a week with additional charges made for hairdressing, chiropody, massage and aromatherapy. Dovecote Care Home DS0000072233.V374657.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this home is 2 stars. This means that the people who use this service experience good outcomes. We spent a day at the home talking to people who use the service, their visitors, staff and the manager. We looked at some records that must be kept by the home to show that it is being run properly. These included records relating to the care of people who live in the home. We looked at the experience of care for three people in detail. This is called case tracking. Before we visited the home had completed an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that tells us how the home thinks they are performing, what they think they are doing well and what they think they could do better. This helped us to plan how to do the inspection, and some information from the AQAA is included in this report. We also received completed surveys from people who use the service (some of these were filled in by their relatives), from staff and from health care professionals who work with the home. The information in these helps us to understand how well the home is meeting the needs of the people who live there. What the service does well: The atmosphere in Dovecote is warm and caring. People who live there appear happy and relaxed and are well presented. They have good relationships with the staff who they relate to very well. In their survey one person said, “In my opinion the staff are very good.” The service promotes a calm atmosphere. There is no television in the lounge and usually there is relaxing music playing. There are also regular aromatherapy and massage sessions. The home is careful to ensure that all staff who work there have taken training in dementia care so that they understand how to work appropriately with people with this condition. The manager and staff understand the importance of supporting and promoting the privacy, dignity and choice of people with dementia. Staff work in a way that supports and promotes each persons needs as an individual. The home carries out a careful assessment of people before they are admitted to the home so that it can be confident that it can meet their needs before Dovecote Care Home DS0000072233.V374657.R01.S.doc Version 5.2 Page 6 admitting them. At the time of admission they provide prospective residents with written information about the way the home is run. They also tell them how to raise any concerns. People who were involved in the inspection told us that they knew how to do this and were confident to talk to the staff or the manager. The home has good working relationships with health care professionals and ensures that the health care needs of people living in the home are well met. The premises are clean and the home provides a safe and comfortable environment for the people living there. There is space within the home for those who like to walk around. The home has a stable staff group. After recruitment new staff follow a period of induction training that helps them to know how to work appropriately in the home. Once they have completed their induction staff enrol on NVQ training and the majority of staff in the home have completed or are in the process of taking this award. What has improved since the last inspection? The home has improved the way that it assesses people’s needs whilst they are resident in the home, in particular they are careful to make sure that they carry out this process with regard to their mood and sociability. They now carry out a monthly review of people’s progress whilst living in the home. The home has started to ask relatives for more comprehensive detail about peoples life history and interests before they became ill. This could form the basis of “life stories” or “life maps”. An outside entertainment group now visits the home four times a year. They also have regular visits from a mobile library that provide books in large print. The new providers have started to upgrade the premises. By the time of the inspection there were new carpets in the home, a number of areas had been redecorated and the laundry equipment and dishwasher had been upgraded. There was also some signage on doors to help people orientate themselves in the home. Dovecote now employs a maintenance man for sixteen hours a week. Further upgrading is planned to the premises. Dovecote Care Home DS0000072233.V374657.R01.S.doc Version 5.2 Page 7 The numbers of staff on duty have increased to three in the afternoon during the week and there are plans in place for this to implemented during the weekend afternoons as well. The programme of staff training is improving, e.g. all staff are taking a distance learning course on infection control, but there are some aspects of mandatory training that need attention as detailed below. There is also a new staff supervision and appraisal system in place. The number of dedicated hours for the manager to carry out the management function has increased. The manager has a significant amount of experience of working in the field of dementia care and has taken appropriate training to manage a care service so this should allow her to manage all aspects of the home more fully. What they could do better: Following on from the assessment that the home undertakes, it needs to prepare a written plan that provides the detail needed for staff to support people living in the home. Currently there is a dependence on information being passed on verbally. The home does not employ an activities organiser although they are considering doing so. Occupation for residents is mainly dependent on staff setting up activities when not involved tasks, usually in the afternoons. This should help the home to plan activities for people on a more individual or small group activity basis than is currently happening. Whilst people enjoy the food that is provided, the home should consider extending the menu so that there are some traditional roast dinners and a wider selection of foods at teatime. There are large gardens at Dovecote Care Home. Only the patio area is accessible to residents and some residents would enjoy increased access to garden areas. Generally staff are employed in a way that makes sure they are suitable to work with vulnerable people. There are some attentions to detail that should be made to make this process more robust. Dovecote Care Home DS0000072233.V374657.R01.S.doc Version 5.2 Page 8 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. Dovecote Care Home DS0000072233.V374657.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dovecote Care Home DS0000072233.V374657.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 5. The home does not offer intermediate care. Quality in this outcome area is excellent. The assessment of people who hope to move into the home is carried out carefully and people are encouraged to visit the home to help them decide whether the home is the right place for them to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are well written documents including a Statement of Purpose, Service User Guide and complaints procedure. These provide information about the specialist services provided by the home and help people understand how the home is run and the facilities and services available. In their surveys people told us that they received sufficient information to help them make a decision about whether the home was the right place to come and live. The manager Dovecote Care Home DS0000072233.V374657.R01.S.doc Version 5.2 Page 11 told us that people are welcome to come and look round to help them make this decision. We looked at two files of people who have recently been admitted, or are about to move into the home. On both these there was an assessment of the persons needs carried out by the home as well as information provided by the person who made the initial referral. This information ensured that the home was able to make a decision about the prospective residents suitability to live in the home. In their surveys people confirmed that they are provided with a contract of residence. The manager reported that these are prepared at the time of admission and confirm that the first four weeks of residence are on a trial basis. Dovecote Care Home DS0000072233.V374657.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10. Quality in this outcome area is good. People living in Dovecote feel well looked after by the staff and have their health care needs reliably attended to. The care planning process that underpins the provision of reliable and consistent care needs to continue to develop to ensure peoples’ care needs are fully identified and appropriate guidance provided for care staff at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the day we spent in Dovecote, we spent time observing the care people received in the home. We found that the residents were well presented and that the staff spent time with them promoting their dignity and independence as much as possible. We saw many examples of kind, sensitive and patient Dovecote Care Home DS0000072233.V374657.R01.S.doc Version 5.2 Page 13 interactions with the residents. We spoke to one visitor to the home and we had information in surveys written by relatives. All the feedback we received was that people who live in the home were treated appropriately and with respect. We examined the records of three people living in the home in detail. We found that there was a file available for each person that contained a significant amount of relevant and appropriate information that had been gathered and assessed. Since the last inspection the home takes care to assess people’s behaviour, mood and sociability. There were also details about people’s preferred daily routine. There were some areas that needed more careful risk assessment such as manual handling. One person that we looked at needed significant manual handling needs but there was no written guidance for staff in how to carry this out in a way that was safe for both the resident and the staff. The information that had been gathered had not been transcribed into plans of care so that staff have ready access to written information about how to meet the care needs of each person living in Dovecote. It is a relatively small home where there is little staff turnover so staff tend to know each resident well and a considerable amount of information is passed on verbally. Nonetheless, people living there should have a clear plan of care so that they, or their representative, can read and agree the care being provided and staff have this as a point of reference. There were also some gaps in the information such as how their needs for chiropody, optical and dental care were to be met. We found that in practice care needs were met but they were not documented. For example we found that a chiropodist and an optician visit the home on a regular basis, and that the home applies emulsifying ointment to the skin of each resident to help keep it in good condition, but there is no guidance/information about these practices. The home has adopted the practice of reviewing each person on a monthly basis and writing a summary of the happenings over that month. Any changes to care plans or risk assessments should follow on from this monthly review. A local GP visits the home every 6-8 weeks to see residents who are in need of attention. The home does take some people to visit the GP surgery, which is good practice. They make an assessment of whether people are able to do this but this information is not detailed in their care plan. We received very positive comments from health care professionals about the care that the people living in the home receive; “I am very impressed by the care provided by the staff at Dovecote. Privacy and dignity are paramount.” Another told us that they had no concerns. The home keeps a record of contacts that the people living there have with health care professionals. District nurses visit Dovecote Care Home DS0000072233.V374657.R01.S.doc Version 5.2 Page 14 the home regularly and people who need pressure-relieving equipment are provided with this through the district nurses. Each person’s medication is listed in their file. We watched medication being administered to some residents and found that this was done carefully and professionally, with a record kept of each administration. On one file we read, the resident had one or two of a particular medication at each administration. Whilst the staff were signing to confirm administration they did not record the number of tablets actually given on each occasion. In future care should be taken to record the amount. Only staff who have received appropriate training are allowed to administer medication. Dovecote Care Home DS0000072233.V374657.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. The home provides a limited range of activities for people to take part in but needs to assess people’s interests on a more individual basis. There are nutritious meals available but more consideration could be given to making them more varied. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We sat in the lounge for part of the day and watched daily life in the home. There was relaxing music playing. People also enjoyed the rural aspect and the varied birds that visit the feeders placed near the windows. There is a patio area outside the lounge that residents can access in the summer. The main gardens are not readily accessible for people living in the home unless they are escorted. We sat with one lady for some time, then we observed her and were not aware of any stimulation offered to her for a significant part of the day. Dovecote Care Home DS0000072233.V374657.R01.S.doc Version 5.2 Page 16 Most people who live in the home could not tell us what they had been doing recently. There have been some organised activities that have taken place that have included a visiting theatre company. There was a photo display in the hall of residents at this last occasion. There is also music and movement weekly and regular aromatherapy for those who choose to take part in this provision. Some people choose to have a daily newspaper although there were none available on the day we visited. In their AQAA the home told us that they also receive large print and talking books from the library. They also told us that they have plans to employ an activities organiser for part of the week. Some residents choose not to take part in organised activities. In the surveys some relatives told us that they thought there was a limited range of activities for the people living at Dovecote. The home is aware that they have a limited range of activities and in the AQAA said that they would like to offer more variety. The manager is in the process of obtaining life histories for each person living in the home that provides detail about their past life and about their interests and hobbies before they became ill. We saw one that provided useful information. At the time of the inspection this history had not been written for most residents. The home therefore did not have good information about people’s background and interests to incorporate into their plan of care. This meant that staff did not have guidance about particular interests of the people living in the home. It would be good practice for the home to prepare “life maps” for each person living there. We did not read information about people’s spiritual needs on their files although we were told that a local vicar visits residents at the home on an individual basis if they wish. We spoke with one visitor to the home who confirmed that he was able to visit as often as he wished and was always made welcome. He told us that at a time when his friend was unwell he was offered the opportunity to stay overnight, which he found very reassuring. We saw lunch of liver and bacon casserole with fresh vegetables and mashed potatoes being served during our visit. This was followed by bananas in custard. The food looked appetising and most people seemed to enjoy their meal. Three people had a soft diet. All components of the meal were liquidised together, not in individual components, as we would expect, so that they get a variety of tastes and can choose which they like or dislike. A number of people needed some level of assistance with their meal and this was carried out appropriately on a one to one basis. People could choose a second helping if they wished. The dining room is a small pleasant room, and people can choose to eat in their room or in the lounge if they prefer. The menus are on a four-week rotating basis and showed a selection of meals. They are based on traditional cooking and mainly casserole dishes, which are easy to eat. We found that there were no roast meals included. There is no cook employed at the weekend and casseroles are pre-prepared for Saturday Dovecote Care Home DS0000072233.V374657.R01.S.doc Version 5.2 Page 17 and Sunday. Also tea each day comprises sandwiches, with no warm alternative even on an occasional basis, and cake that is not home made. Consideration should be given to providing a more varied diet. Drinks were offered at regular intervals during the day. Dovecote Care Home DS0000072233.V374657.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. Residents and relatives know how to raise any concerns and feel confident that the staff will listen to them and take any necessary action to put things right. Staff understand how to protect residents from abuse or neglect. Some attention to staff recruitment practice is needed to make it more thorough and thereby provide further protection for people who live in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People are provided with information about how to make a complaint. This is in the Service User Guide and on display in the hall. Everyone who responded to our survey said they knew how to make a complaint. Some also told us that because of the “open door” approach to the senior staff in the home they could discuss any issues at an early stage and be confident they would be dealt with. The home keeps a log of complaints and this showed that there have been none made over the last 12 months. The home uses the services of Careaware. This organisation provides advocacy services and the home informs them about all people newly admitted to the home, together with contact details of their relatives. Dovecote Care Home DS0000072233.V374657.R01.S.doc Version 5.2 Page 19 There was training in the home about how to protect vulnerable people from abuse in July 2008. Staff employed since that time have trained in this area at induction level. We talked to a member of staff who knew what to do if she had any suspicions of abuse. The manager confirmed that there is a safeguarding and whistleblowing policy and that the attention of all staff is drawn to these policies. We asked to read three staff files, two of which were for staff who have been employed in the last year. When a home employs new staff, there are checks that must be carried out to ensure that unsuitable people are not employed. These include a Criminal Records Bureau (CRB) check and two written references. In the files we read we found that most of the pre employment procedures were in place but we drew the attention of the manager to some shortfalls in practice, such as one incomplete employment history and one application form that had not been signed. Dovecote Care Home DS0000072233.V374657.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. The home provides a homely and comfortable environment for the people who live there. There is continuing work to upgrade the premises. It is kept clean and hygienic and is a pleasant place for people to live in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Dovecote is a detached house, with extensions, in a rural location in the village of Llangarron. Particular features are the tranquillity of location and extensive views over the surrounding countryside. We looked round some areas of the home and found that they were clean and generally fresh. In their surveys the residents told us that they found the home was always clean. We talked with Dovecote Care Home DS0000072233.V374657.R01.S.doc Version 5.2 Page 21 the domestic who told us that she has enough hours to keep the home clean and that she has sufficient stacks of cleaning materials for this task. Attention has been paid to improving the premises since the new owners took over: a number of areas have been recarpeted and repainted, a new dishwasher and laundry facilities installed, there is a sink designated for sluicing in the laundry and two new bedrooms have been created. There was also recently installed signage in the home to help people to orientate themselves. In addition there is now a handyman employed for 16 hours a week who has responsibility for minor repairs in the home, decorating and gardening. The manager told us of further plans to upgrade the premises. The furniture in the lounge is worn for example we sat with one lady and noticed that the arms of her chair were ripped. There were two new chairs in the room that were being trialled for suitability in the home. The service providers intend replacing more furniture. People who live in the home are encouraged to bring their own items in to personalise their rooms. We saw some rooms that looked homely. One room we visited had few contents because of certain behaviour of the person living there. There was some explanation of this in the care plan but it would benefit from fuller explanation and risk assessment in the care plan to explain the situation. Whilst the kitchen was generally clean and tidy we found that there were some tiles above the work surface that needed grouting and the vinyl floor covering by the kitchen units needed attention. We were told that the maintenance man had beading ready to install on the floor. The manager showed us a certificate from the local Environmental Health Department showing that it had achieved a rating of four stars (very good) for food hygiene. The house is secure and there is space internally for those who like to walk around. There are large gardens. A patio is accessible to the people living in the home in the warmer months. Access is available to the larger gardens where people can go when escorted. Greater access to these gardens would improve the amenity of the home. Care staff showed a good understanding of the principles of infection control. A number of staff are enrolled on an infection control course that they are taking as a distance-learning package over a number of weeks. They told us that there are good supplies of materials such as gloves and aprons to help prevent spread of infection. Dovecote Care Home DS0000072233.V374657.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. With the proposed increases in staffing levels there will be sufficient staff to meet the needs of people who use the service. People who use the service can be confident that the staff are kind and caring. Staff receive training but there are some shortfalls in health and safety related training that might place residents at risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing rotas showed that there are clear staffing arrangements in place. On the day of the inspection there were three members of care staff on duty, one of whom was designated at a senior level, and the manager. In addition there was a cook and a domestic in the morning. The home has recently increased staffing levels. The number of staff on duty on weekday afternoons has gone up from two to three and there are plans to increase the care staff on duty on weekend afternoons from two to three. In addition the manager has additional hours dedicated to the management function. People who use the service told us that most of the time there were people available to assist them and the staff also said that they thought the Dovecote Care Home DS0000072233.V374657.R01.S.doc Version 5.2 Page 23 staffing levels were satisfactory to meet the needs of the residents. With the proposed changes at the weekend there now appear to be sufficient staff to meet the needs of the residents. People told us that they liked the staff and one person said, “In my opinion the staff are very good.” We talked to members of the staff team and they told us that they enjoy working at Dovecote. We watched the staff working with the residents and found that the interactions with the residents were kind and appropriate. It was evident that they know the residents well and understand how to support them in a way suited to their individual needs. There is a stable staff group with many staff having worked at the home for a number of years. The homes recruitment procedures need some attention, as detailed in the previous section, to make sure that full information is obtained before employing new staff at the home. After recruitment staff follow a structured induction programme. This includes a period of time shadowing experienced carers to ensure they know how to work with each person living in the home. We spoke to a new member of staff and she told us that she found the support and training she received at this time was appropriate. There is also a staff training programme. This aims to ensure that all staff receive mandatory training. All staff are taking training in infection control and have done fire safety training. Most have also taken training in dementia awareness with plans for new staff to take this soon. However we found that there were some gaps that needed to be addressed, for example we spoke to one person who had not taken training in manual handling although they were carrying out this task with the residents. The manager is aware that she needs to review the status of staff training in first aid so that she can be sure that there is someone with training in this area on duty in the home at all times. Shortfalls in staff knowledge in key areas could place the residents at risk. Once staff have completed their induction training they are enrolled on to NVQ training. Apart from newly employed staff all staff have completed or are taking an NVQ award. In addition the manager has completed a management training course and is currently working towards a degree in dementia studies. The manager has also taken training about the Mental Capacity Act and following this provided all staff and relatives with a booklet to inform them of the implications of this new piece of legislation. Dovecote Care Home DS0000072233.V374657.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is good. The home is being managed in a way that promotes the health and safety of the people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is experienced in managing this care home and is well respected by staff and professionals. She is committed to providing a good quality of life for the people who live in the home and professional leadership for the staff working there. She is developing her knowledge of current thinking and approaches to dementia care through the training she is taking. The staff and Dovecote Care Home DS0000072233.V374657.R01.S.doc Version 5.2 Page 25 residents who were involved in this inspection expressed their confidence in her management style. She is supported by the new service providers who visit the home at least once a week. The responsible individual also writes a report each month to present to the board to inform them about how the home is performing. Copies of this are held in the home. An increase in the hours that she has available for the management task should help her keep abreast of the management role more fully. The manager completed the AQAA and in this she gave us relevant information about the service. The home also carries out a quality monitoring process by sending surveys to people who live in the home/or their representative on an annual basis. Any comments are acted upon and an analysis is carried out of the information received. Most people who live at Dovecote do not carry personal money. Their representatives are sent an invoice each month to inform them of items purchased on their behalf. In this way residents’ financial interests are protected. There is some staff supervision taking place. In the files we examined we saw evidence of this, although not as regularly as the recommended minimum of four times a year. The service provider intends to carry out the staff annual appraisals but this process has not yet started. Equipment in the home is regularly serviced and maintained and we asked for a sample of certificates to provide evidence of this. The home employs a maintenance man to carry out minor repairs. We also looked at a sample of health and safety checks and tests such as the fire log and checks to temperatures of bath water. These were all done routinely. We also saw the accident log. This was completed appropriately and accidents audited on a monthly basis. The home has recently arranged for a test to be carried out for legionella. Dovecote Care Home DS0000072233.V374657.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 4 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 3 Dovecote Care Home DS0000072233.V374657.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1)(2) Requirement Care plans must be in place and must be sufficiently detailed to enable staff to understand how to meet the health and personal care needs of the people who live in the home. Timescale for action 30/04/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations The home should record the number of tablets provided to residents at each medication administration. This will ensure that the home and health care professionals have full information about the medication received by each person. It would be good practice for the home to further develop activities taking into account the dementia specific research and guidance that is available. The home should review the menus and ensure that people living in the home are provided with a more varied diet. It would be good practice for the home to ensure that a DS0000072233.V374657.R01.S.doc Version 5.2 Page 28 2 3 4 OP12 OP15 OP15 Dovecote Care Home 5 OP30 soft diet is provided in its different constituent parts so that people are able to distinguish the elements of what they are eating. The home should have a system in place to ensure that all staff are suitably trained in mandatory areas so that people who use the service are not placed at risk of harm or injury because of unsafe staff practices. Dovecote Care Home DS0000072233.V374657.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Dovecote Care Home DS0000072233.V374657.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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