Care Home: Dovedale Court

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What the care home does well The accommodation within the `memory lane` unit for people with dementia is very good, providing a safe and attractive environment.There are some very good organised systems in place, particularly in relation to maintaining safety, quality monitoring and staff training, demonstrating that the provider organisation is striving to provide a high standard of care. Risk management is taken seriously and health care is monitored, with good records being kept. Health concerns are responded to and relatives are kept informed of any health issues. The staff team receive training geared to their work role. Catering staff, maintenance staff and care staff all receive a good level of training to help them to perform well in their work. Staff show sensitivity and concern in their communication with those living at the home. What has improved since the last inspection? A new system for the recording of care plans has been introduced. Each area of need has a separate plan of care and care plans are being regularly reviewed. This means that any changes are being responded to. Alterations have been made to the home to create a separate unit for people with dementia. Separate enclosed garden areas have also been created. The `memory lane` unit provides very good accommodation as it has been adapted and decorated to suit the needs of people with dementia. Qualification training for staff continues to be promoted. Over 50% of care staff now hold an appropriate qualification in care work. This means that people are being supported by a competent team of staff. What the care home could do better: Medication arrangements are generally good. Dating medication when it is first opened and providing individual guidance regarding medication, which is to be given only when needed, would provide further safeguards. The planned alterations to the main dining room will greatly improve the facilities within the part of the home catering for older people. A new separate lounge will be created, providing a cosier room to sit and relax. The provision of activities needs to be reviewed, with a focus on more individual time being spent with those living at the home. Reviewing staffing and looking at how staff are being deployed will also help to ensure that more one to one time is spent with those living at the home. CARE HOMES FOR OLDER PEOPLE Dovedale Court Dovedale Avenue Ingol Preston Lancashire PR2 3WQ Lead Inspector Lesley Plant Key Unannounced Inspection 09:15 26th and 29 September 2008 th 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 Dovedale Court DS0000069259.V372655.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. Dovedale Court DS0000069259.V372655.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dovedale Court Address Dovedale Avenue Ingol Preston Lancashire PR2 3WQ 01772 761616 01772 760194 dovedale@barchester.com www.barchester.com Barchester Healthcare Homes Ltd 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) Mrs Edith Linda Ross Care Home 44 Category(ies) of Dementia (16), Old age, not falling within any registration, with number other category (28) of places Dovedale Court DS0000069259.V372655.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home only - code PC, to people of the following gender:- Either. Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP, (maximum number of places: 28). Dementia - Code DE (maximum number of places: 16). The maximum number of people who can be accommodated is: 44 Date of last inspection 17th November 2006 Brief Description of the Service: Dovedale Court is one of the nationwide group of homes in the Barchester Healthcare organisation. Dovedale Court provides personal care and accommodation for up to 28 older people and up to 16 people with dementia. The home is not registered to provide nursing care. The home is situated close to local amenities in a residential area of Preston and has good parking facilities. The home has its own hairdressing salon. The home is split into two distinct areas. The ‘Memory Lane’ unit for people with dementia is on the ground floor. Accommodation within this unit consists of a large lounge, a dining room/conservatory and individual ensuite bedrooms. The dining room has a small kitchen area where drinks can be made and access to an enclosed garden, with seating areas. The ‘memory lane’ unit has been adapted and decorated to suit the needs of people with dementia. The area of the home accommodating older people consists of a large dining room/lounge and a spacious entrance hall with additional seating. All bedrooms have ensuite facilities and are on the first floor, accessed by a lift. There is an enclosed garden with seating areas. At the time of this visit the information given to the Commission for Social Care Inspection showed that the fees for care at the home range from £376.00 to £560.00 with added expenses for hairdressing and chiropody. Dovedale Court DS0000069259.V372655.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key inspection focused on the outcomes for people living at the home and involved gathering information about the service from a wide range of sources over a period of time. Two days were spent at the home. The first day was mainly spent in the dementia unit and the second day was mainly spent in the unit providing care for older people. The visits to the home were unannounced and looked at all of the key national minimum standards, plus the standard relating to staff supervision. At the time of the visit there were 41 people resident at the home. The inspector spoke to a number of staff including the manager, the catering manager, the administrator, the maintenance worker and care staff. Information was gained from the Annual Quality Assurance Assessment completed by the manager. The Annual Quality Assurance Assessment is a self- assessment that focuses on how well outcomes are being met for people using the service. It also provided some numerical information. CSCI survey forms inviting feedback about Dovedale Court were received from 10 members of staff and 2 relatives. Records were viewed and a tour of the building took place. Time was also spent observing staff and the people living at the home, as they went about the day’s activities. Since the last key inspection in November 2006, a ‘random’ inspection and a service review have taken place. (Random inspections are conducted to look into particular areas of service provision and do not look at all the key national minimum standards.) Reports regarding these are held at the CSCI office and would be made available if requested. Since the last key inspection the registration for the home has changed. The home now has a separate unit for up to 16 people with dementia. What the service does well: The accommodation within the memory lane unit for people with dementia is very good, providing a safe and attractive environment. Dovedale Court DS0000069259.V372655.R01.S.doc Version 5.2 Page 6 There are some very good organised systems in place, particularly in relation to maintaining safety, quality monitoring and staff training, demonstrating that the provider organisation is striving to provide a high standard of care. Risk management is taken seriously and health care is monitored, with good records being kept. Health concerns are responded to and relatives are kept informed of any health issues. The staff team receive training geared to their work role. Catering staff, maintenance staff and care staff all receive a good level of training to help them to perform well in their work. Staff show sensitivity and concern in their communication with those living at the home. What has improved since the last inspection? What they could do better: Medication arrangements are generally good. Dating medication when it is first opened and providing individual guidance regarding medication, which is to be given only when needed, would provide further safeguards. The planned alterations to the main dining room will greatly improve the facilities within the part of the home catering for older people. A new separate lounge will be created, providing a cosier room to sit and relax. The provision of activities needs to be reviewed, with a focus on more individual time being spent with those living at the home. Reviewing staffing and looking at how staff are being deployed will also help to ensure that more one to one time is spent with those living at the home. Dovedale Court DS0000069259.V372655.R01.S.doc Version 5.2 Page 7 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. Dovedale Court DS0000069259.V372655.R01.S.doc Version 5.2 Page 8 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 Dovedale Court DS0000069259.V372655.R01.S.doc Version 5.2 Page 9 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 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good assessments take place, prior to anyone moving into the home. This helps to ensure that the persons’ needs can be met. EVIDENCE: A service user guide, welcome pack and brochure are made available to anyone interested in staying at the home. It is the manager, who is qualified and experienced in this area, who usually carries out the assessment of new people. The manager explained the assessment process and the documents used. Dovedale Court DS0000069259.V372655.R01.S.doc Version 5.2 Page 10 The individual and/or their relatives are invited to visit the home. The manager will then visit the person in their home/hospital, gather relevant information and complete the pre admission assessment. Discharge information completed by hospital staff is also used to inform the assessment. The pre admission information addresses all the main areas of need and relatives are involved in the process. Information includes details of health and social care needs and highlights any areas of risk. This pre admission assessment means that individuals are not admitted to the home if their needs cannot be met. Assessment information was viewed on files. A relative spoken to confirmed that they had been involved in providing information regarding the support required and an individual living at the home spoke of the manager visiting her in hospital and discussing her needs. Further more detailed information is gathered during the settling in period and cares plans are then developed. Dovedale Court does not provide specialised intermediate care or short-term intensive rehabilitation. Dovedale Court DS0000069259.V372655.R01.S.doc Version 5.2 Page 11 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. This judgement has been made using available evidence including a visit to this service. Personal and health care needs are met and people are treated with dignity and respect, promoting a feeling of wellbeing. EVIDENCE: Since the last key inspection a new system of care planning and recording has been introduced. Each person has a written plan of care. The care plans for six people were viewed. Care plans address different elements of need, such as communication, mobility, personal hygiene, nutrition and social interests. The care plans viewed were all being reviewed regularly, with changes being made if necessary. For one person, whose mobility needs had changed, the care plan was changed to show that the person now needed to use a tripod walking aid and not her walking stick. The individual was observed using this walking aid, showing that this change in need was being supported. Dovedale Court DS0000069259.V372655.R01.S.doc Version 5.2 Page 12 For another person the care plan regarding sleep and nighttime routines detailed a preference for a certain drink in the evening and this was being provided. Care planning information also looks at how people express their sexuality with their preferred styles of clothing being recorded. For one lady it was recorded that she likes to wear a particular type of dress and cardigan and would rather wear socks than stockings. This person was seen wearing the clothing of her choice. Risk assessments are in place and these too are being reviewed regularly. Each person has an individual moving and handling assessment and risk assessments were also seen that address skin care, in order to prevent bed sores. Some people require the use of bed rails to prevent falling from the bed. The risk management plans for the use of this equipment are thorough and include the need to always use protective padding and the importance of having the equipment checked regularly. The maintenance worker carries out these checks and keeps good records. Risk management plans such as this help to keep people safe and reduce the risk of accidents. Each file contains a sheet for staff to sign to confirm that they have read the care planning information. This helps to ensure that all the team are aware of individual needs and how they are to be met. Not all care plans and risk assessments have been signed by the individual concerned or by their relative or representative. A number of files contained notes to ask relatives to sign in their agreement to the plans in place. It was explained that some people are not able to agree their plan of care and their relative may live out of the area, making it difficult to discuss plans and for the relative to sign records in agreement. Whilst understanding the difficulties involved, a concerted effort needs to be made to ensure that where an individual is not able to agree to their plan of care, their representative does so. Behaviour assessments are also in place and, when required, guidance is sought from mental health professionals. Records showed that one person was experiencing changes in her emotional and mental well-being and a referral to the community psychiatric nurse had been made. Records are kept of all health care appointments and their outcome. There were also references on files of health concerns, such as weight gain, being discussed with the persons family. A relative who was visiting during the inspection stated that she was kept informed of any health issues and had been notified when her relative had had a fall. Staff keep good daily records and handover sheets are used to pass on important information to staff coming on duty. Dovedale Court DS0000069259.V372655.R01.S.doc Version 5.2 Page 13 The arrangements for handling medication are generally good. Medication is safely stored. The medication for each unit is kept in a separate medication trolley, and administered by staff working in that unit. The majority of medication is supplied in cassettes cartridges by the pharmacist. The medication administration records viewed had been completed appropriately. Only staff who have completed specific training administer medication. Medication records include a photograph of the individual. A fridge is available for any medication requiring cold storage. All medication received into the home is checked by two people, which helps to reduce any errors and allows for efficient stock control. Medication practices could be improved by staff dating any medication not supplied in the cassettes, such as liquids, when it is first opened. This would help to ensure that medication is not used after its use by date and would allow for effective auditing. The use of medication prescribed to be given when required was discussed with both the manager and a senior member of staff. Such medication is often prescribed for pain relief and the staff spoken with both confirmed that the current residents, including those with dementia were able to express if pain relief was needed. A pictorial chart of facial expressions is also available for staff to use. It is still felt that personalised information should be in place, giving clear guidance regarding when medication such as this is to be given. Privacy and dignity are promoted at Dovedale Court. Policies and procedures in respect of privacy and dignity are available to guide staff to make sure that these values are not compromised. All staff receive guidance in maintaining privacy and dignity during their induction period and this is also covered within NVQ (National Vocational Qualification) programmes. During lunch a member of staff was seen providing support in a quiet and sensitive way, so as not to cause embarrassment to the individual concerned. Files contain information regarding preferred ways of dressing and this guidance was being followed. The records for one person state that she wants to wear sunglasses, which she was seen to be wearing. All bedrooms are single with ensuite faculties, giving good privacy for when personal care needs are attended to. Dovedale Court DS0000069259.V372655.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Although activities are provided, these do not always meet individual needs and expectations. Decision-making is supported and people clearly enjoy the meals provided at the home, which are health and nutritious. EVIDENCE: A weekly programme of activities is in place and this includes trips out, bingo and dominoes. A hairdresser visits two days each week, with the home having its own hair salon. One person explained how she enjoyed playing dominoes and competing in the monthly challenge cup competition held on the residential side of the building. On the first day of the inspection staff were supporting individuals in the dementia unit to play bingo and those involved appeared to be enjoying this. Although activities are taking place, improvements do need to be made. Dovedale Court DS0000069259.V372655.R01.S.doc Version 5.2 Page 15 Responses in the CSCI surveys completed by staff indicated that staff do not always have time to talk to people or for activities to take place. This view was endorsed by feedback from relatives. One person explained that her mother would like to go out for short walks but that this did not happen. Another relative explained that although trips out were arranged and were enjoyed, only small groups were able to go out at any one time and therefore it could be many weeks before everyone who wanted to had the opportunity to go out. Assessment and care planning information does address social activities and preferences. However the more detailed profiles and life stories have not been completed for some people. It was explained that relatives who live out of the area have not yet provided this information, but more effort should be made to fill in the gaps regarding peoples past history. This would help to identify activities, which would be meaningful to the individual. When reviewing the provision of activities it is important to look at how staff are deployed within the home and how more one to one time can be spent with residents. Each person should receive some individual attention, perhaps just chatting, looking at photographs, being helped to tidy their bedroom or being supported to take a walk in the garden. Small activities such as these should be built in each person daily life and information from the profiles and life stories will help to guide staff. Visitors are made welcome as seen during the inspection visits. There are some links with the local community, as church ministers visit the home. People are able to bring personal possessions into the home and so make their bedroom homely and more familiar. People are encouraged to maintain control of their financial affairs for as long as they wish to and have capacity to do so. For most people, a family member takes on this responsibility. Details of advocacy services are made available. People are supported to make decisions about their day-to-day lives, such as what to wear and what to eat. The catering manager explained the arrangements for meals at the home. At lunch time there is a choice of two hot meals. The teatime meal consists of a hot meal or sandwiches, with a choice of starters, one being soup. The menus viewed showed a good range of nutritious meals. The menu for the day is displayed in both sides of the home. The catering manager orders the food for the home, confirming that although he is given a budget, that this is plentiful and not restrictive. Dovedale Court DS0000069259.V372655.R01.S.doc Version 5.2 Page 16 Both dining rooms are attractively furnished, with the tables being set with tablecloths, table decorations and a cruet set. Staff were observed showing each person the options available, allowing individuals to choose the meal they liked the look of. Care plans are in place to address any particular nutritional needs. A hot trolley is used to take meals from the kitchen to the dining room in the dementia unit. The two meals eaten during the inspection visits were both hot and tasty and the atmosphere on both days was calm, with no one being rushed to make a choice or to finish their meal. People appeared to enjoy the meals provided and feedback from relatives confirmed the view that the meals are good. Aids are provided, which help people to retain independence at mealtimes. One person, who is blind, uses a lidded cup and others use plate guards to make it easier to eat their meal. Dovedale Court DS0000069259.V372655.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are able to raise any concerns they may have. Policies, procedures and staff training help to promote the protection of those living at the home. EVIDENCE: A copy of the Barchester complaints procedure is included in the service users guide and in the welcome pack given to all those staying at the home. Relatives of two people living at the home completed CSCI surveys on their behalf. Both responded that they did not know how to make a complaint, although one person had stated that they had raised a concern about a blocked toilet, which had been dealt with. This indicates that relatives know how to raise concerns within the home, but may be unaware of the formal complaints procedure. The manager is advised to re distribute a copy of the complaints procedure to all relatives. The manager keeps a record of all formal complaints, with details of the outcome of the complaint investigation. Within the last year two formal complaints have been addressed through the written procedure and one safeguarding referral has been made. The manager and senior staff are aware of how to respond should any concern about personal safety or protection be raised. The written procedure was seen. Dovedale Court DS0000069259.V372655.R01.S.doc Version 5.2 Page 18 Staff undertake training regarding the protection of vulnerable people and issues regarding protection and vulnerability are addressed during the induction of new staff and also within NVQ (National Vocational Qualification) programmes. Dovedale Court DS0000069259.V372655.R01.S.doc Version 5.2 Page 19 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. This judgement has been made using available evidence including a visit to this service. The home is clean and well maintained, with a good standard of decoration and furnishings. EVIDENCE: The home is split into two distinct areas. The ‘Memory Lane’ unit for people with dementia is on the ground floor. There is a large lounge, a dining room/conservatory and individual ensuite bedrooms. The dining room has a small kitchen area where drinks can be made. This area has been fitted with a cooker and a hot water tap for making drinks. Both have features, which make them safe for the residents to use. There is good easy access to an attractive, enclosed garden, which has tables and seating areas. Dovedale Court DS0000069259.V372655.R01.S.doc Version 5.2 Page 20 Bedroom recognition pictures are in place for some rooms, with plans to have these on all bedroom doors. These pictures contain a photo of the person and images or small models of items the person can associate with. For one person, who used to enjoy cooking, the picture by her bedroom door reflects this past interest. Attractive and interesting collages have been put in the hallways. These provide stimulation and act as prompts for discussion. Some areas are still to have these finishing touches. The toilets and bathrooms in this part of the home have pictures on the doors to help with recognition. The ‘memory lane’ unit provides very good accommodation as it has been adapted and decorated to suit the needs of people with dementia. The area of the home accommodating older people consists of a large dining room/lounge and a spacious entrance hall with additional seating. All bedrooms have ensuite facilities and are on the first floor, accessed by a lift. There is an enclosed garden with seating areas. At present part of the large dining room is being used as a lounge area. The manager explained that very soon work will start to split the dining room into two rooms and this will mean that a separate lounge will be provided. This will improve the current temporary arrangements, by providing a more cosy and homely living room. Some changes are also planned for the office accommodation. The home has a hairdressing salon, which is regularly used by the visiting hairdresser. Dovedale Court is well maintained and has a maintenance worker who works full time at the home and has some responsibility for carrying out routine safety and maintenance checks. The home appeared clean and fresh. A relative who was spoken to mentioned that although the home has domestic staff, there are no cleaners on duty at the weekend. The manager is currently recruiting part time cleaners for this role, which will help to ensure that the home is clean at all times. Staff undertake infection control training and appropriate policies and procedures are in place. Dovedale Court DS0000069259.V372655.R01.S.doc Version 5.2 Page 21 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. This judgement has been made using available evidence including a visit to this service. Staffing arrangements do not always allow for much one to one time to be spent with those living at the home. The staff team are well trained and experienced, meaning that the people living at the home are supported by competent staff. EVIDENCE: The manager explained that she aims to have seven care staff on duty each morning, split between the two units. It was clear, from viewing rotas and feedback from CSCI surveys, that staff vacancies and staff absences are making it difficult to consistently provide these levels of staffing, particularly at weekends. Agency staff are used when permanent staff are unable to cover any gaps in the rota. The majority of staff who completed CSCI surveys responded usually to the question; are there enough staff to meet the individual needs of all the people who use the service? Two members of staff commented that higher staffing levels would allow for more time with residents. A relative spoken with over the telephone also felt that there were times when not enough staff were on duty and two relatives spoken to during the inspection visits raised concerns about staffing levels at weekends, although one person did say that this had improved lately. Dovedale Court DS0000069259.V372655.R01.S.doc Version 5.2 Page 22 The current staffing arrangements are not allowing for much individual time to be spent with those living at the home. Records show that people who would like to be accompanied on short walks outside the home are not very often able to do this. The problem may not be due to the number of staff on duty, but due to how staff are deployed within the home. It is recommended that the deployment of staff as well as the number of staff on duty be reviewed. A robust key worker system could also help in this area and result in more one to one time being spent with those living at the home. There are separate catering, maintenance, laundry, domestic and administrative staff employed at the home, with new part time domestic and laundry staff due to commence in the near future. Some new care staff have also been appointed and will start work when all satisfactory checks have been received. Excellent progress has been made with qualification training for staff, with 14 of the 21 care staff having achieved a NVQ (National Vocational Qualification) award at level 2 or above. Three more staff are working towards this award, with the area training manager carrying out the NVQ assessments. This means that staff have their work practice assessed and will lead to the staff team gaining skills in care work. Equal opportunities are evident in the recruitment of staff of both sexes, of mixed ages and different ethnic backgrounds. The recruitment records for two recently appointed members of staff were viewed and discussed with the manager of the home. Records include an application form, a contract, two references, a Criminal Records Bureau clearance plus a check against the Protection of Vulnerable Adults list, a list of staff who it is deemed should not be working in care services. Written references are followed up by a telephone call to check that the details in the reference are correct. These references and checks help to ensure that only suitable people are employed and that people living at the home are protected. Feedback from the CSCI surveys completed by staff confirms that staff have received a good induction and have received appropriate training. New staff are given an induction workbook, with each section being signed when completed. Records were seen of staff signing to confirm that they had read and understood key policies and had received a fire safety induction and a manual handling induction. All staff undertake a comprehensive training programme regarding working with people with dementia, entitled Yesterday, Today and Tomorrow. Dovedale Court DS0000069259.V372655.R01.S.doc Version 5.2 Page 23 The area training manager co ordinates the staff training at the home, with records kept of when any refresher training is due. The training manager spends at least one day each week at the home. Some training is carried out using a computer programme and videos, with a written assessment are also used. These courses all help to give staff knowledge and skills for their work and help the people living at the home to receive a good standard of care. Training was discussed with a member of staff who had been in post for 8 months. Although very experienced, induction training and refresher training had been provided. Dovedale Court DS0000069259.V372655.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. This judgement has been made using available evidence including a visit to this service. Quality monitoring systems help to ensure that a good standard of care is provided at Dovedale Court. Policies, procedures, good practice and staff training promote the health and safety of those living and working at the home. Dovedale Court DS0000069259.V372655.R01.S.doc Version 5.2 Page 25 EVIDENCE: The manager of the home holds relevant qualifications, is registered with the CSCI and has also completed a five-day leadership programme regarding person centred dementia care. Having just returned from a period of leave the manager is focussing on filling any staff vacancies and establishing continuity within the team. At present the manager is supported by a deputy manager and senior care assistants, with administrative staff also carrying out certain office based duties. Some management changes are planned. The deputy manager will be focussing on staff training and activities and there are plans to appoint team leaders for the two units in the home. Barchester Healthcare has established a range of quality monitoring systems and has a Director of Quality Care based at the organisations head office. Each month the manager completes an audit, which focuses on one particular element of the service. The last three audits have addressed activities, person centred care and infection control. Each audit concludes with an improvement plan. The organisations clinical development manager carries out monitoring audits approximately every three months, and a senior manager from Barchester Healthcare conducts monthly visits to the home and compiles a report of the findings. Dovedale Court has gained the Investors in People award. This is a national quality standard which sets a level of good practice for improving an organisations performance, with effective management being a key factor. Questionnaires are distributed to relatives and this includes a questionnaire asking for views about the admission process. The responses go to the organisations headquarters, with feedback then being given to the manager of the home. The home has a system whereby any expenses incurred, such as for hairdressing are recorded, with monthly bills being sent to the appropriate person. For most people, a relative or a nominated solicitor usually handles their finances. Dovedale Court DS0000069259.V372655.R01.S.doc Version 5.2 Page 26 The manager or the deputy manager of the home carries out supervision meetings with staff. The deputy manager was on leave at the time of the inspection visits resulting in some supervision records not being available. However the records viewed indicate that staff receive formal supervision at least six times each year. Feedback from the CSCI surveys completed by staff also confirmed that regular supervision meetings take place. One person commented, My manager has always been helpful and supportive if any problems have arisen. Minutes were viewed of staff meetings, which take place, with a representative from each department at the home. The maintenance worker at the home keeps very good records of the regular checks he has to carry out as part of his work role. There is a very well organised system of daily, weekly and monthly checks and a number of these records were seen. Bed rails, water temperatures, fire alarms and the call bells are all checked. A senior manager from the companys head office also carries out maintenance audits. The maintenance worker has done specific in depth, fire safety training and provides fire safety training to other members of staff. Records of fire safety checks were seen, which include the checking of fire doors. An external company also carries out regular checks on the fire equipment at the home. The catering staff take responsibility for monitoring fridge/freezer temperatures and also record the temperature of food to ensure that meals are always of a safe temperature when served. The catering manager explained the system of using coloured stickers on food stored in the fridge, which helps to ensure that unused food is disposed of when it should be. Staff training records show that staff undertake basic health and safety training such as infection control, moving and handling, fire safety and food hygiene. Dovedale Court DS0000069259.V372655.R01.S.doc Version 5.2 Page 27 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Dovedale Court DS0000069259.V372655.R01.S.doc Version 5.2 Page 28 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. 1. Refer to Standard OP9 Good Practice Recommendations Medication not supplied in the cassettes should be dated when it is opened. This will help to ensure that medication is not used after its use by date and would allow for effective auditing. There should be clear individualised guidance regarding when medication, prescribed to be given when required, should be administered. The provision of activities should be reviewed and improved, to ensure that individual needs and expectations are met. It is recommended that the deployment of staff as well as the number of staff on duty is reviewed, to make sure that people are receiving some individual one to one time with staff. 2. OP9 3. OP12 4. OP27 Dovedale Court DS0000069259.V372655.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection North West Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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 Dovedale Court DS0000069259.V372655.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. 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