Care Home: Drey House

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What the care home does well Residents who completed our surveys told us that they received enough information about the home before they moved in, that they received the care and support they required, and that staff were available when needed. One resident told us: `I like living here, it`s peaceful and quiet, that suits my needs`. Another `on my account this is a good place to live`. Staff told us they received a good induction to their job, that they received support from their manager, were given training relevant to their role and that there were enough of them to meets residents` individual needs. What has improved since the last inspection? A shower in the upstairs unit has been installed giving greater choice to residents as to how they wash themselves. A number of permanent staff have been recruited thereby reducing the use of agency staff by the home. This means residents receive consistent care from staff who know them well. The cleanliness of the kitchen has improved since the last inspection ensuring that residents receive food that is prepared in hygienic and safe surroundings. The home`s menu is much improved too, offering genuine choice between different dishes each day. Training for staff around specific psychiatric illnesses had improved, as had their knowledge of the Mental Capacity Act. CARE HOME ADULTS 18-65 Drey House Cambridge Road Eynesbury Hardwicke St Neots Cambridgeshire PE19 6SR Lead Inspector Janie Buchanan Unannounced Inspection 15th July 2008 09:30 Drey House DS0000064870.V369298.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Drey House DS0000064870.V369298.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Drey House DS0000064870.V369298.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Drey House Address Cambridge Road Eynesbury Hardwicke St Neots Cambridgeshire PE19 6SR 01480 880022 01480 880805 simon.belfield@psycare.co.uk 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) Psycare Hostels Limited Mr Simon Eric Belfield Care Home 33 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (33), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (33) Drey House DS0000064870.V369298.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th February 2008 Brief Description of the Service: Drey House is a large Edwardian House set slightly back from the main A428 Cambridge to St Neots road in grounds of over three acres. A detached house and outbuildings (formerly stables) form part of the property. The busy market town of St Neots is within a few minutes drive, the city of Cambridge is within 20 miles and there are good local road and rail links to London. Drey House was extended some years ago and accommodation is offered on two floors. In total there are 32 single bedrooms. There are two large lounges plus a visitors’ lounge and a dining room on each floor, as well as bathrooms and toilets. On the ground floor there is the main kitchen, laundry, and offices. There is a small domestic-style kitchen on the first floor, for the use of residents to prepare their own meals. The expansive gardens at the rear of the house back on to fields and offer a private and peaceful setting. All residents at Drey House are funded by local or health authorities. Fees for accommodation and care at the home range from £948 to £1287 per week. Inspection reports are made available for residents or their representatives in the reception area of the home, and in the residents’ lounges. Drey House DS0000064870.V369298.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. For this inspection we (The Commission for Social Care Inspection) looked at all the information that we have received. This included the annual quality assurance assessment (AQAA) that was sent to us by the home. The AQAA is a self-assessment that focuses on how well outcomes are being met for people living there. It also gave us some numerical information about the home. We received surveys from people using the service and from staff working there. We visited the home and talked with the deputy manager, members of staff and 9 residents and observed care practices. We checked medication recording, administration and storage. We undertook a brief tour of the premises and viewed a number of policies and procedures. Two requirements and six recommendations have been made as a result of this inspection. What the service does well: What has improved since the last inspection? A shower in the upstairs unit has been installed giving greater choice to residents as to how they wash themselves. A number of permanent staff have been recruited thereby reducing the use of agency staff by the home. This means residents receive consistent care from staff who know them well. The cleanliness of the kitchen has improved since the last inspection ensuring that residents receive food that is prepared in hygienic and safe surroundings. The home’s menu is much improved too, offering genuine choice between different dishes each day. Drey House DS0000064870.V369298.R01.S.doc Version 5.2 Page 6 Training for staff around specific psychiatric illnesses had improved, as had their knowledge of the Mental Capacity Act. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Drey House DS0000064870.V369298.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Drey House DS0000064870.V369298.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,4,5 Quality in this outcome area is good. Residents’ needs are thoroughly assessed before moving into the home so they can be assured they will be met there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a Service User Guide to give information to people about the service they should expect from the home. Each resident is also issued with a ‘Statement of Terms’, which they sign, giving them details of the terms and conditions of their stay at the home. Senior staff at the home undertake a through assessment of all prospective residents and visits are arranged so they can assess the facilities on offer. One resident told us: ‘ I remember my admission: I came to visit before I got here’ Drey House DS0000064870.V369298.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 Quality in this outcome area is good. Residents’ care plans are detailed giving the staff the information they need to provide consistent care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the plans for three residents. These were good, giving clear details of people’s needs and providing guidance to staff in how to meet them. The plans contained detailed daily notes that gave a good picture of residents’ daily life, activities and mental state. Residents are involved in planning and reviewing their care and one resident told us: ‘I set my goals in my care plan. I want to move and live independently’. There was evidence that meaningful reviews had been carried out. The plans also contained risk assessments, identifying potential risks to residents and ways of minimising them. Residents are consulted about aspects of the home and there are regular community meetings where they can air their views. Residents are also going to be involved in redecorating their smoking room to make it more pleasant to be in. Drey House DS0000064870.V369298.R01.S.doc Version 5.2 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14,16,17 Quality in this outcome area is good. Residents have access to activity and opportunities for personal development. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An occupational therapist spends two days a week at the home helping staff provide therapeutic activities for residents and residents who completed our survey stated that there were some activities arranged that they could take part in. In addition to this, each resident has their own individualised activity plan. However, we received mixed views from residents about the quality and frequency of activities provided. One resident told us: ‘we have bingo but that’s it really. I do not think there are enough activities here for us’. Another: ‘activities are not bad. We have games, books and the library van comes sometimes.’ Others felt the activities were good and one resident told us ‘if we want to go out they take us. On Sunday we went to the river Cam and to the American cemetery near Cambridge. We went by car. If more than 6 people go somewhere, they arrange the bus for us’. One resident suggested that ‘the home should consider getting a computer for us. We can use the one in the office, but it is not nice to disturb the staff’. On the day we visited some Drey House DS0000064870.V369298.R01.S.doc Version 5.2 Page 11 residents were playing games, some went to tend the vegetable patch in the garden and five residents were getting ready to go our for a picnic. We observed a lunchtime meal (consisting of chicken and mushroom pie or cheese slice) served in the dining room. The food was well presented, served nicely and residents seemed to be enjoying their lunch. One resident we talked to told us; ‘ the food is lovely here. They have a menu on the wall, you can see it, it’s pretty wide, we have 3 cooked meals a day’. Drey House DS0000064870.V369298.R01.S.doc Version 5.2 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20,21 Quality in this outcome area is good. The health and personal care needs of residents living at the home are monitored well. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents told us the their health is maintained at the home. One stated ‘If I am unwell the staff call a doctor. Nurses here also help us a lot.’ The home employs a practice nurse who completes a monthly physical health report for each resident to monitor their well being. And there are regular healthy living sessions for residents to attend if they want. There have been on going problems with residents accessing local GP services, however the home is working hard to resolve these and has agreed to pay for a GP to visit those residents who do not want to attend the local practice. Residents’ health care needs were clearly documented in their care plans and the guidelines in place for staff to help one resident manage his diabetes were excellent. However we viewed a food and fluid chart for one resident. The information on this was poorly recorded with not enough detail to tell how much the person was eating and drinking. Without this staff are not able to check that someone is receiving adequate amounts. Storage for medication, including the storage of controlled drugs was appropriate and safe. Medication fridge temperatures were kept within the Drey House DS0000064870.V369298.R01.S.doc Version 5.2 Page 13 required range and records of administration were correct. One resident administers his medicine himself. A risk assessment had been completed for him to ensure he could do it safely. Drey House DS0000064870.V369298.R01.S.doc Version 5.2 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. Residents feel able to raise concerns about their care. This judgement has been made using available evidence including a visit to this service EVIDENCE: Most residents who completed our surveys stated that they did know how to make a complaint and felt staff would act on what they said. However, a number of residents told us that they had reported concerns about a particular residents’ behaviour again and again and they felt nothing had been done by the staff to resolve the situation. This issue was clearly causing a lot of concern for residents. We have received no complaints about the home since its last inspection. Training files that we viewed showed us that staff had received training in protecting vulnerable adults so that they are aware of the different types of abuse and reporting procedures. The home has a copy of the most recent local guidelines (March 2008) for protecting vulnerable adults and one member of staff was able to find the home’s policy very quickly. Drey House DS0000064870.V369298.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is adequate. The standard of furnishings, decoration and cleanliness give people a reasonably comfortable place to live, although some areas of the home are reminiscent of a large institution. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is situated in a remote area on a busy main road. The nearest town is not within walking distance and residents are reliant on a bus service or staff to get there. One resident told us ‘I feel a bit out here, I would prefer to live in a residential area’. The home itself has large lounges with high ceilings, fireplaces and big windows giving lots of light, on both floors. These rooms are pleasantly decorated and comfortably furnished to give a homely feel. Residents benefit from large grounds surrounding the home which, although mainly lawn, gives them access to fresh air, sunlight and a small place to grow vegetables, one resident told us he didn’t go out in the garden as the grass was slippery and the surface uneven. There is also an unsightly, disused and neglected swimming pool. We noted the following shortfalls, some of which were raised at the last inspection Drey House DS0000064870.V369298.R01.S.doc Version 5.2 Page 16 • • • • • There was a strong smell of urine at one end of the downstairs corridor Upstairs corridors in the home were long and uninteresting with bare walls, giving the home a bleak and institutional feel. External woodwork on windows and doorframes needed repainting Areas of the carpet in the upstairs corridor were worn and rucked up. The upstairs smoking room, where many residents spend a lot of time, had bare walls and minimal furnishings. Some residents told us that there were not enough seats in the smoking room for everybody to sit at the same time. The walls in this room are badly stained and the skirting boards are dirty Drey House DS0000064870.V369298.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 Quality in this outcome area is good. Staff in the home are trained and in sufficient numbers to support residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Training records showed that staff had completed a full induction at the start of their employment and that they had undergone of training including challenging behaviour, epilepsy, meaningful activity and diabetes in addition to mandatory training. Staff told us they had received some training in psychiatric illnesses from the deputy manager, including bi-polar disorders and schizophrenia that they found useful in understanding specific residents’ needs. A consultant psychiatrist also visits regularly to give staff advice and information on mental illnesses. We received a number of positive comments from residents about the staff including: ‘staff seem very professional. Key workers know about illnesses, especially the nurse, but it would be nice if all staff, including kitchen staff, knew more about our conditions’. Residents told us that there were enough staff on duty to help them and staff reported they do have the opportunity to spend individual time with residents. Drey House DS0000064870.V369298.R01.S.doc Version 5.2 Page 18 We checked the personnel files of two recently recruited members of staff and appropriate references and POVA first checks had been completed. However one person had started working before the home had received his CRB check. Department of Health guidelines state that employing someone before a full CRB is obtained should be in ‘exceptional circumstances only’ and it is not good practice to do so. Unfortunately residents are not involved in the recruitment of staff who will be supporting them. One resident commented; ‘they do not even check with us if we like new staff’. Staff told us they felt supported; that their morale was good and they worked well together as a team. Staff receive supervision which they clearly find useful. One member of staff told us it was a great opportunity ‘to air all my concerns and vent my gripes’. Another told us: ‘supervision keeps me in check’. However, not all staff have been receiving it as frequently as recommended by the standards. Drey House DS0000064870.V369298.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,42 Quality in this outcome area is good. Residents live in a well managed home where their views are sought. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has appropriate training and qualifications to run a home for people with mental health problems. He is a Registered Nurse (Mental Health), has a Diploma in Higher Education (Nursing) and a BA in health Care Management. We spent most time, however, talking with the deputy manager who was helpful, knowledgeable and clearly committed to providing a good service for residents. The home handles the money for a number of residents. Records are kept but these are complex and difficult to follow. Information in some of the records needs to be more detailed so it is explicit what money has been spent on what items. We were also concerned that large amounts of money were kept on behalf of residents (in one case over £900). This money should be out in a Drey House DS0000064870.V369298.R01.S.doc Version 5.2 Page 20 bank account so that it can be held more securely and also accrue interest. Residents we talked to seemed happy with how their money was handled. One commented; ‘staff keep my money locked in the office and I also have a post office account. I can my money form staff or the post office whenever I want. I know exactly how much I have in my accounts’. Another told us ‘I don’t know how much money I have, but I sign every time I take money out and I trust them’. Regular feedback from residents about the quality of the service they receive is obtained at weekly community meetings, minutes of which we viewed. Residents’ concerns such as the unsafe handles on a grill pan that they regularly used had been addressed by the home. Records of fire drills held showed that these take place during the day, thereby excluding night staff from practising this important procedure. We also found a badly frosted up freezer in the home’s kitchen that could impair its performance. Drey House DS0000064870.V369298.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 x 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 2 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x LIFESTYLES Standard No Score 11 x 12 3 13 x 14 3 15 x 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 x x x 2 x Drey House DS0000064870.V369298.R01.S.doc Version 5.2 Page 22 no Are there any outstanding requirements from the last inspection? 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 YA19 Regulation 12(1) Requirement Residents’ food and fluid charts must be detailed and accurate so there is a clear record of what they have eaten and drunk Night staff must undertake regular fire drills so they know what to do in the event of a fire. Timescale for action 01/08/08 2. YA42 23(4) 31/08/08 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 Refer to Standard YA24 YA24 YA34 Good Practice Recommendations The home’s long and bleak corridors should be made more homely and interesting for residents. More seating should be provided in the smoking room so that all residents who want to smoke have somewhere to sit Criminal record bureau checks should be obtained for all prospective employees before the start working in the home so that only the right people are employed to work with vulnerable adults. The home should involve residents in recruiting staff so they have an active role in choosing the people who are to support them. DS0000064870.V369298.R01.S.doc Version 5.2 Page 23 4 YA34 Drey House 5 6 YA36 YA41 Supervision for staff should be more frequent so that their working practices can be discussed and their training needs identified The home should not hold large amount of money for residents. Money should be banked in the residents’ personal account where it can be held more securely and also accrue interest. Drey House DS0000064870.V369298.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Drey House DS0000064870.V369298.R01.S.doc Version 5.2 Page 25 - 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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