Care Home: Dovehaven Nursing Home

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What the care home does well The home presents with a very warm and friendly atmosphere. Visitors were seen popping in at various times of the day to meet with residents in their private rooms or the lounges. The home now has a well-established team and it was evident during the inspection that staff have a good knowledge of residents` individual care needs and wishes. Good lines of communication were observed and residents interviewed were complimentary regarding the standard of care they receive. Comment included, "You could not have better" and "Superb home". The manager completes a needs assessment for each resident prior to taking up residency. This information is then used to form the plan of care and residents and/or their relatives are involved with setting up the care provision. They are also advised of any changes to care or treatment. On occasion the home accepts emergency admissions and the necessary documentation is also received. With regards to the routine, residents interviewed confirmed that Dovehaven Nursing Home DS0000017231.V295775.R01.S.doc Version 5.2 Page 6they can have a bath when they want, choose within reason what they would like to eat and decide how they wish to spend their day. The home is very busy as staff care for residents with high dependency needs. Staff were however observed spending time chatting with residents and delivering care in an unhurried manner. Intermediate care is now available for residents for up to a period of 6 weeks. This service offers a rehabilitation programme for older people and an Intermediate Care Team supports the home`s staff. The Team comprises of a physiotherapist, occupational therapist, social worker, care staff and GP. An Intermediate Care Team meeting took place on the second day of the site visit and the Team were complimentary regarding staff communication and the standard of the premises. Information is displayed on notice boards and in the main hallways for the residents to view and this includes details of the new activities programme. All areas of the home were very clean and tidy. The home is subject to an ongoing programme of maintenance and decoration. New carpets and curtains have also been purchased. Bedrooms are pleasantly decorated and residents can bring in their personal items and pieces of furniture. A resident said, "I would like to move to another room and have a better view". This was brought to the manager`s attention and another room offered. The home offers a good training programme and this includes courses in safe working practice areas. New staff receive an induction with the manager and are provided with job description and contract. Staff interviewed were happy at the home and stated, "There is a good team of staff". The management and staff demonstrated an enthusiastic approach to their work and are motivated to meeting the needs of the residents and providing a pleasant home for them to live. Discussion with a number of residents, relatives and staff confirmed this. Residents` views of the home are obtained and feedback is given to staff with regard to any concerns raised or suggestions that can be implemented. What has improved since the last inspection? Medicines administered by residents are signed for on the medicine administration sheets. The chef is now meeting residents to ensure food is suited to their needs. Furniture is being replaced in bedrooms where required. Bathrooms are free from clutter and are being used by residents. A policy for the disposal of medicines following the most recent guidelines has been incorporated in the home`s medicine policy. What the care home could do better: CARE HOMES FOR OLDER PEOPLE Dovehaven Nursing Home 9 - 11 Alexandra Road Southport Merseyside PR9 0NB Lead Inspector Mrs Claire Lee Unannounced Inspection 09:00 31st July 2006 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 Dovehaven Nursing Home DS0000017231.V295775.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. Dovehaven Nursing Home DS0000017231.V295775.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dovehaven Nursing Home Address 9 - 11 Alexandra Road Southport Merseyside PR9 0NB 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) 01704 530121 Mr Mark J Gilbert Mrs Wendy J Gilbert Mrs Joanne Elizabeth Hart Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Dovehaven Nursing Home DS0000017231.V295775.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users to include up to 40 OP 1 named out of category service user under pensionable age Date of last inspection 7th March 2006 Brief Description of the Service: Dovehaven is a Care Home providing nursing care and accommodation for 40 older residents. The home comprises of 2 large houses that have been joined together and converted in to a care home. It is situated in a residential area of Southport close to local amenities and public transport. Mr and Mrs Mark Gilbert are the registered providers and the registered manager is Mrs Joanne Hart. Mr Luke Gilbert is now employed as the general manager for the Dovehaven group of homes. There are 25 single rooms and 4 double rooms; a double room was recently converted in to 2 single rooms. A number of bedrooms have an en-suite facility and the home is equipped with bathing aids to assist those residents who are less independent. The home has 4 bedrooms situated on a mezzanine level (a floor not accessible by passenger lift) and therefore a detailed assessment of need is undertaken by the home prior to placing residents in these rooms. One mezzanine level has the use of a chair lift. Stairs or passenger lift accesses other areas. Residents have the use of 2 dining rooms, a lounge and conservatory; these rooms are pleasantly decorated with comfortable furniture. The conservatory overlooks a spacious landscaped rear garden and there is ample car parking space to the front. Ramps are available for wheelchair access. The current rate for accommodation is £492.00 a week. Dovehaven Nursing Home DS0000017231.V295775.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A site visit took place as part of the unannounced inspection and this was conducted over 2 days for approximately 16 hours by an inspector. At this time an investigation into a complaint and some concerns that had been brought to the attention of the Commission also formed part of the inspection process. A partial tour of the premises took place and a number of the home’s care, staff and health and safety records were viewed. Discussions were held with 8 residents, 6 staff, the manager, Mrs Joanne Hart and the general manager, Mr Luke Gilbert. During the inspection 4 residents were case tracked (their care files were examined and their views of the home were obtained). This process was not carried out to the detriment of other residents who also took part in the inspection process. Discussion also took place with 2 relatives. All the key standards were inspected and also previous requirements and recommendations from the last inspection in February 2006 were discussed. Satisfaction survey forms “Have Your Say About …” were distributed to a number of residents prior to the inspection and some were also left for relatives to compete at the time of the visit. Comments included in the report are taken from the survey forms and also during the site visit. What the service does well: The home presents with a very warm and friendly atmosphere. Visitors were seen popping in at various times of the day to meet with residents in their private rooms or the lounges. The home now has a well-established team and it was evident during the inspection that staff have a good knowledge of residents’ individual care needs and wishes. Good lines of communication were observed and residents interviewed were complimentary regarding the standard of care they receive. Comment included, “You could not have better” and “Superb home”. The manager completes a needs assessment for each resident prior to taking up residency. This information is then used to form the plan of care and residents and/or their relatives are involved with setting up the care provision. They are also advised of any changes to care or treatment. On occasion the home accepts emergency admissions and the necessary documentation is also received. With regards to the routine, residents interviewed confirmed that Dovehaven Nursing Home DS0000017231.V295775.R01.S.doc Version 5.2 Page 6 they can have a bath when they want, choose within reason what they would like to eat and decide how they wish to spend their day. The home is very busy as staff care for residents with high dependency needs. Staff were however observed spending time chatting with residents and delivering care in an unhurried manner. Intermediate care is now available for residents for up to a period of 6 weeks. This service offers a rehabilitation programme for older people and an Intermediate Care Team supports the home’s staff. The Team comprises of a physiotherapist, occupational therapist, social worker, care staff and GP. An Intermediate Care Team meeting took place on the second day of the site visit and the Team were complimentary regarding staff communication and the standard of the premises. Information is displayed on notice boards and in the main hallways for the residents to view and this includes details of the new activities programme. All areas of the home were very clean and tidy. The home is subject to an ongoing programme of maintenance and decoration. New carpets and curtains have also been purchased. Bedrooms are pleasantly decorated and residents can bring in their personal items and pieces of furniture. A resident said, “I would like to move to another room and have a better view”. This was brought to the manager’s attention and another room offered. The home offers a good training programme and this includes courses in safe working practice areas. New staff receive an induction with the manager and are provided with job description and contract. Staff interviewed were happy at the home and stated, “There is a good team of staff”. The management and staff demonstrated an enthusiastic approach to their work and are motivated to meeting the needs of the residents and providing a pleasant home for them to live. Discussion with a number of residents, relatives and staff confirmed this. Residents’ views of the home are obtained and feedback is given to staff with regard to any concerns raised or suggestions that can be implemented. Dovehaven Nursing Home DS0000017231.V295775.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Dovehaven Nursing Home DS0000017231.V295775.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 Dovehaven Nursing Home DS0000017231.V295775.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 The quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Pre admission assessments help ensure that the home can meet the needs of the residents. Intermediate care provision is now provided with the support of the Intermediate Care Team to enable residents to return to their own homes. EVIDENCE: Residents’ contracts were not viewed at the site visit however several residents confirmed that they signed a contract when taking up residency. Residents have an assessment of need which is carried out by the manager. An initial enquiry form (these forms were not available at this time) is also completed and this information transferred to the assessment documentation. As part of the case tracking process 3 assessments were viewed and these had been completed in detail with regards to health, personal and social care. This information had been used to form the basis for the plan of care. Transfer letters from hospital and social care assessments also provide further information to assist staff when writing the plan of care. It was noted that Dovehaven Nursing Home DS0000017231.V295775.R01.S.doc Version 5.2 Page 10 religious beliefs are not always recorded and this was brought to the manager’s attention. This information was then added to the relevant files. Intermediate care provision started earlier this year at the home. 4 single rooms are allocated to residents to help maximise their independence with a view to returning to their own home either independently or with a care package. The manager and staff are fully supported by the Intermediate Care Team, which comprises of a social worker, GP, physiotherapist, occupational therapist and care staff. At the time of the site visit the home had 3 residents receiving this care and weekly meetings are held at the home. These are conducted by members of the Intermediate Care Team with Mrs Hart to determine each resident’s rehabilitation programme, to review their progress and plan possible discharge. A meeting was held on the second day of the inspection and the inspector was able to meet with the Intermediate Care Team. Members of the team stated that they were very pleased with how the service was progressing and the good communication that exists between the team and the home. The Intermediate Care Service enables residents to see an appointed GP each Monday. The four beds allocated are not in a separate unit but in a dedicated space at the rear of the home. Access to this area is via stairs, a chair lift or side entrance. The Intermediate Care residents have full use of the home and also their own designated washing/toilet facilities, dining room and lounge. Following completion of the necessary risk assessments a small kitchen facility is also going to be available within the dining room to assist residents with their rehabilitation programme. A resident receiving intermediate care was case tracked and their assessment and care plans were viewed. The resident stated, “I am happy with the care I am getting and want to go home as soon as I am able. Everyone is so helpful. The food is good, I like my room and the staff are kind”. The Intermediate Care Team arrange and accompany residents for ‘home visits’ and also provide intensive physiotherapy and occupation therapy sessions. Equipment such as zimmer frames are available. The team have their own documentation that they complete and this is left at the home for staff to refer to. The home has a good system for recording care provision and some documentation was seen to support the Intermediate Care paperwork. The manager was advised that residents should be fully involved with the assessment and care plan process to ensure all care needs are identified. The home should look to implement in full the care documentation available to other residents. This was agreed at the time of the meeting with the Team. A staff member said, “I enjoy looking after the residents as they can return home and this is great to see”. Dovehaven Nursing Home DS0000017231.V295775.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 The quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents’ health, personal and social care needs are by the home. Residents are treated with respect and dignity. EVIDENCE: As part of the case tracking process 3 resident care files were viewed and these evidenced a detailed plan of care. As previously stated a care file of a resident receiving Intermediate Care was also seen (Standard 6). Four residents were case tracked in total. The care files are accessible for staff, they are organised and the information is easily read. A staff member said, “We write up the daily care and this is countersigned by the registered nurses” Care documentation seen had been reviewed regularly to ensure it was accurate and reflected any change in care or treatment. Information was recorded regarding maintaining a safe environment, communication, personal care, food and nutrition, mobilising, social needs and sleeping. Risk assessments are in place where a risk has been identified and this was discussed in relation to nutrition and mobility. The care files seen evidenced a summary of care, which had been agreed and signed by the resident and/or their representative. A relative said, “I know the care my wife receives and I am very pleased”. Dovehaven Nursing Home DS0000017231.V295775.R01.S.doc Version 5.2 Page 12 A record is kept of GP visits or external health professionals and residents who require specialist would care receive input from the wound care nurse. Evidence of her visits and prescribed treatments were recorded on the wound care charts and care plans. A chiropodist visits the home regularly. Several completed survey form refer to residents always receiving the medical support needed. A resident reported that they required a dentist and this was passed to the manager to arrange a visit. The home’s policy for medicine administration now includes the latest guidance for disposal of medicines. The home has 2 locked medicine trolleys which are kept in a clinical room on the first floor. The medicine sheets of the residents who were case tracked were viewed and these evidenced staff signature following administration of their medicines. Good recording systems were in place with a code completed where medicines had been refused or omitted. Photographs of residents are kept at the front of each medicine chart for easy identification and a list of registered nurses and their signatures/initials was evident. At this time there were no residents who wished to self-administer their own medicines. The temperature of the medicine fridge is checked daily to ensure it is within a safe range. Medicines liable to misuse are checked, counted and administered by 2 nurses. Those records seen were accurate. During the site visit staff were seen knocking on bedrooms doors, politely talking with residents and also offering assistance with care in an unhurried manner. A resident said, “The staff are always polite with me”. Residents were seen appropriately dressed. Dovehaven Nursing Home DS0000017231.V295775.R01.S.doc Version 5.2 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 The quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents are able to exercise choice and control over their lives and are offered a choice of well balanced and nutritional meals. EVIDENCE: The home presents with a welcoming relaxed atmosphere and residents interviewed were generally fine with the home’s routine. Dovehaven is a very busy home and staff care for residents with high dependency needs however staff interviewed were able to demonstrate how they assist residents to make choices. This was discussed in relation to time of retiring at night, washing and choosing meals. A staff member said, “We try and make sure the resident wears what they want each day”. A number of residents go out with friends and family and a resident said she was going out for lunch this weekend. Visitors were seen at various times of the day and made welcome by staff. A number of residents have lived at the home for a long time and therefore staff know their friends and families very well. The home would arrange visits to community clubs if required but not one has requested this at present. Dovehaven Nursing Home DS0000017231.V295775.R01.S.doc Version 5.2 Page 14 The home has implemented a social programme for residents, details of which are displayed on the notice boards on each floor. This includes music, manicures, hair styling, reminiscence therapy and exercise to music. A number of residents do not wish to join in and staff respect their wishes. Comments include: “There is a notice up listing the activities available but I have never done any of them. I would like to do something to break the day up and give me something to think about”. “Medical conditions does not allow for these activities” “I love the hairdressing and the girls come and sit with me” “I don’t want to join in as I have my own TV and visitors” The home has 2 chefs; one has overall responsibility for the catering department. The menu was seen and this is based over 2 weeks. There is a choice at breakfast, lunch and tea and meals are served to residents in their own rooms or in the dining room. Discussion with a number of residents and staff confirmed that generally the quality of the food served is good however on certain days the food is not as “tasty” and is on occasions bland. The following comments were made: “The food is excellent” “The meals are very good” “Sometimes can be ok and other times not to my liking” “There is plenty to eat” “I would like to have more salad” “Restricted diet” “The meals are ok” “Meals can differ day to day” “Cooking first class” It would be beneficial to conduct a food survey to enable residents to choose what foods they would like added to the menu. Both chefs talk with residents to discuss their dietary preferences the home caters for special diets, for example diabetic, low fat, low fibre and vegetarian. Fridge and freezer temperatures are recorded daily however the freezers should be defrosted in the near future. Requirements and recommendations from the most recent Environmental Health inspection are being met. The home had a good supply of fresh fruit and vegetables. Dovehaven Nursing Home DS0000017231.V295775.R01.S.doc Version 5.2 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents and relatives have confidence that their concerns will be dealt with. Abuse policies and procedures are in place to protect the residents. EVIDENCE: The home has a complaint policy and the complaint log evidenced any concern or complaint raised and the subsequent investigation and any action required. Staff interviewed were aware of what to do should a resident or visitor wish to complain. An adult protection meeting was held prior to the inspection in response to a complaint logged with the adult protection team. This resulted in a complaint investigation being undertaken as part of the inspection. The complainant had raised concerns with regard to a resident’s general health care needs and the environment. The inspector conducted the investigation with the manager and discussion also took place with the complainant. The investigation found the environmental issue upheld and it was agreed that the manager and complainant would conduct an in depth review of the resident’s care file to ensure all aspects of care were recorded in sufficient detail, with particular reference to diet and fluids and skin care being monitored. A meeting also took place with both chefs to address a number of dietary concerns. The complainant was satisfied with how the investigation was undertaken and the agreed action. A subsequent call was made to the home to ensure the meeting had taken place. Social Services were conducting their own investigation as well. Dovehaven Nursing Home DS0000017231.V295775.R01.S.doc Version 5.2 Page 16 At this time general concerns raised by another relative were also addressed when assessing a number of standards. Staff receive training in abuse awareness and the training matrix evidences course dates. Staff interviewed were knowledgeable regarding the various types of abuse and what to do should an alleged incident occur. The home has a whistle blowing policy for staff referral. The manager should obtain the latest copy of Sefton’s Guide for Protection of Vulnerable Adults which is now available. Dovehaven Nursing Home DS0000017231.V295775.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25 and 26 The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Residents live in comfortable pleasant surroundings. The temperature of the hot water in some bathrooms is too hot and this poses a health and safety risk to residents. EVIDENCE: A partial tour of the building took place and the home presented as airy, bright and clean. The home comprises of 2 buildings joined together with accommodation on the ground, first and second floors. Bedrooms seen were comfortable and had personal items of furniture. A resident said, “It is nice to bring my things from home, it makes it easier when moving in”. One bedroom could do with redecoration however the manager confirmed that the resident did not wish this to take place. A number of bedrooms have new carpets and curtains. Bathrooms seen had bath chairs to help those less able and one bathroom has a specially adapted bath. The temperature of the hot water to the sinks was high and caution hot water signs were placed over the sinks at the time of the site visit. Hot water to baths is regulated however the following Dovehaven Nursing Home DS0000017231.V295775.R01.S.doc Version 5.2 Page 18 temperatures were recorded at 52°C, 49°C and 50°C. The temperature is to be maintained at 43°C to ensure the health and safety of the residents. The maintenance book evidenced that the hot water is tested regularly and the manager confirmed that the temperatures have been high of late. This was discussed with the general home manager and new safety valves are going to be fitted to the taps. A radiator on a landing and also in the lounge on the first floor were ‘fully on’ and with the warm weather at present the temperature of the home may be too high. Radiators being turned on was an element of the complaint investigation undertaken at this time. The temperature of the home should be monitored to ensure the comfort of the residents. The home has spacious lounges, dining rooms and an attractive conservatory overlooking a landscaped garden to the rear of the premises. The furnishings are comfortable. A resident said, “It is an attractive home”. Certain parts of the home are only accessed by the use of a chair lift or staircase therefore the home assesses the mobility needs of residents prior to placing them in these rooms. Residents have the use of manual handling hoists and zimmer frames to help them with their mobility. Emergency lighting is provided throughout the home and subject to monthly in house checks and an annual safety check. Records seen were in date. The laundry service was described by a number of residents as “Efficient”, “Very good”, “Clothes really well cared for”. Staff stated they have received infection control training and they were seen using gloves and aprons as needed. Dovehaven Nursing Home DS0000017231.V295775.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Sufficient numbers of well trained staff are employed to care for the resident. Recruitment practices are not robust to protect and the welfare of the residents. EVIDENCE: The staffing rota for the month of July 2006 was seen and this evidenced the number of staff on duty each day. The home employs registered nurses, care assistants, domestics, kitchen staff, maintenance, garden and administrative staff. The general home manager supports the registered manager on a daily basis either by visiting the home or by telephone contact. Staff interviewed stated that the home’s staffing levels are maintained and agency staff are brought in to fill in any gaps. This was evidenced during the second day of the inspection as a member of the kitchen staff called in sick and the shift was covered. The home has 2 registered nurses on duty each day and 1 at night. During the morning 7 care staff are employed, 6 for the afternoon, 5 for the evening and 3 at night. There are 3 domestic staff including a housekeeper. Details of registered nurses’ registration with the Nursing Midwifery Council were provided as part of the pre inspection questionnaire. Registration dates are current to enable them to practice. Care staff are appointed the role as senior carers (extra responsibilities are assigned for a number of residents) and a member of the care staff has also been appointed this role for the intermediate care unit. The home was fully staffed at the time Dovehaven Nursing Home DS0000017231.V295775.R01.S.doc Version 5.2 Page 20 of the inspection and staff were seen delivering care in a professional manner. A staff member said, “We write up the daily care and this is countersigned by the registered nurses” Comments from residents and relatives regarding the staff are as follows: “The staff are good” “Staff are very experienced” “Occasionally slow to respond to requests” “The staff are cheerful and helpful” “The staff are always very busy” “Fewer staff available during the night” A training matrix was displayed in the office and this evidenced dates of courses attended and planned for the staff. 4 staff files were viewed to ensure staff receive training in safe working practice areas. The home offers a rolling training programme for abuse awareness, infection control, health and safety, first aid, fire awareness, working in care and manual handling. Care staff are not involved with the preparation or cooking of any food however they do receive informal instruction in food hygiene as part of their induction and supervision. A staff member said, “The training is good and courses are arranged regularly”. Staff have access to NVQ courses in care at Level 2 and Level 3 and the home is working towards achieving the required 50 . 4 staff files were viewed for recruitment purposes. The files contained completed job application forms, completed induction forms and a health declaration. Not all files evidenced the necessary police checks and 2 written references that are required prior to commencing work at a home. Two references were also not dated. An employee can only start work pending receipt of the CRB check (CRB’s are not portable) if a POVA check has been received and 2 satisfactory references obtained. The references must also be dated. Contracts are given to staff though copies of these are not kept in all files. Dovehaven Nursing Home DS0000017231.V295775.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35, 36 and 38 The quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The management of the home ensure residents’ views are taken into account, and the health and safety of the residents is promoted. EVIDENCE: Mrs Joanne Hart is the registered manager. She completes mandatory training with her staff and has completed NVQ Level 4 in Management and Mentoring. Staff interviewed were complimentary regarding the overall management of the home and a staff member said, “I can come to Jo at any time”. A resident said, “Jo is the very best”. Residents are asked to complete surveys to give their opinions of the home. A number of surveys were seen for June 2006. Following an audit of completed surveys an activities programme has been introduced as residents felt this was lacking. There was mixed response to the food and as previously stated a food Dovehaven Nursing Home DS0000017231.V295775.R01.S.doc Version 5.2 Page 22 survey would be beneficial to enable residents to be more explicit regarding the catering service. It was evident during the inspection that good channels of communication exist, the registered nurses spend time with the residents and any concerns or ways to improver the home are brought to the manager’s attention. A relative said, “Jo works well with the staff to ensure the care is good. I can bring anything to her attention if I am not satisfied”. Residents are able to take responsibility for their money either independently, with relatives or with the assistance of the home. The home is responsible for the safekeeping of a number of pocket monies and 6 financial records were viewed. These evidenced a balance total, receipts for expenditures and staff signature. A discrepancy was found for one record and this was rectified at this time. Staff receive regular supervision and dates of meetings had been recorded in staff files. A staff member said, “We meet every few months to discuss how we are doing and what training is going on”. General staff meetings are held, the last one being in June 2006. Senior care staff meetings and intermediate care meetings with the intermediate care team are also arranged. The home has a good range of policies and procedures. The policy for abuse awareness, management of falls and medicine management was viewed. All polices and procedures are reviewed by the manager to ensure they are updated in line with current legislation. A policy on continence promotion could be not found and the manager is in the process of accessing this information. A review of the home’s risk assessments of the building was conducted in July 2006. Any areas of concern are brought to the maintenance man’s attention. This was discussed in relation to the hot water supply. Maintenance contracts were seen for the gas, lift, electrical equipment, fire prevention equipment and hoisting equipment; these were all in date. The home’s electrical certificate was not available however the details of the certificate were checked with the administrator after the inspection; the certificate was in date and a copy forwarded to the Commission’s office. The fire engineer last gave fire prevention training to staff on 28th July 2006 and the manager gives in house training most months. Fire alarms are being tested weekly and the annual check of the fire prevention equipment took place in June 2006. The home’s accident book was viewed as part of the complaint investigation and incidents affecting the well being of the residents had been recorded. Dovehaven Nursing Home DS0000017231.V295775.R01.S.doc Version 5.2 Page 23 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 2 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 x 3 3 x 3 Dovehaven Nursing Home DS0000017231.V295775.R01.S.doc Version 5.2 Page 24 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. 2. Standard OP25 Regulation 23/13 19 Timescale for action The home must ensure hot water 31/08/06 temperatures are delivered to a safe temperature The home must undertake a CRB 31/08/06 for all new staff employed and ensure 2 written references are received prior to commencing employment. References must be dated Requirement OP29 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. 2. 3. 4. 5. Refer to Standard OP15 OP15 OP15 OP18 OP25 Good Practice Recommendations The home should implement its own care documentation for residents receiving intermediate care (Refer to Standard 6 for Intermediate Care) The home should complete a food survey to enable resident to give their opinions regarding the menu The freezers should be defrosted in the near future The home should obtain Sefton’s Guide for the Protection of Vulnerable Adults (latest edition) The home should ensure the overall temperature of all DS0000017231.V295775.R01.S.doc Version 5.2 Page 25 Dovehaven Nursing Home 6. OP28 areas is monitored to ensure the comfort of the residents The home should continue with the NVQ training to achieve the required 50 of staff with a qualification in care Dovehaven Nursing Home DS0000017231.V295775.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 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 Dovehaven Nursing Home DS0000017231.V295775.R01.S.doc Version 5.2 Page 27 - 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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