Care Home: Dunsfold

What the care home does well The home was clean and fresh smelling. The atmosphere of the home was pleasant and on arrival at 09:10 am service users were having breakfast in the two eating areas 3 in one area and 5 in the other, one service user was in bed being fed by a carer. The care plans for three service users were viewed and have improved in their detail and information and are more person centred. An activity person has been employed and there were entries in the care plan of activities undertaken. Care plans are now more readily available to staff and are kept in a lockable filing cupboard in the dining area. The medication systems have been attended to with the support from a new pharmacy provider which will provide training and regular audits. There is a new medication trolley clinical fridge and controlled drug cupboard. The appointed manager is working hard to meet the requirements set at the last key inspection. She appears to be dedicated and demonstrated a willingness and understanding of what is necessary. What the care home could do better: All admissions to the home need to be appropriately assessed so as to ensure the home has the necessary skills, equipment and staffing levels to meet the service users needs. The admission procedures need to be followed and the staff to be confident in declining a re admission until assessed by their own staff. There needs to be a care plan in place to guide staff in providing a consistent approach to meeting the service users needs. This needs to be in place based on the preadmission assessment so the home have the necessary equipment waiting for the service user. The care plans need to include appropriate risk assessments that identify and monitor the service users health needs in particular the correct use of pressure relieving equipment. All input requested and given by the district nurses and G.P`s needs to be clearly documented and kept up to date to provide key information to the staff team. Risk assessments in relation to pressure areas, moving and handling and nutrition need to be updated regularly to ensure the safety, health and well being of the residents. Daily records are in place for 2 hourly turns fluid balance and food intake however these are not all fully completed and staff should record when fluids and food are offered in addition to when taken. The care plans seen did not reflect psychological or mental health needs and this needs to be included to ensure the safety and well being of the residents. The staffing levels at this time do not reflect the needs of the residents and this needs to be reviewed to ensure the safety and well being of the residents. The management of the home needs to ensure that there is support for the appointed manager during this time the current staffing skill mix does not provide a strong support for the appointed manager as there is no senior carer in post to support her. She has a job description for her previous role as deputy manager but not for her current role and she needs to have written confirmation of her current role to ensure clarity. Formal supervision needs to be recorded and kept in her file and this needs to be performed regularly as a form of support and guidance. The appointed manager was not aware of the Regulation 26 visits and these need to be discussed and any areas for improvement documented. Inspecting for better lives Random inspection report Care homes for older people Name: Address: Dunsfold West End Road Herstmonceux East Sussex BN27 4NX zero star poor service 15/09/2008 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Deborah Calveley Date: 1 9 1 2 2 0 0 8 Information about the care home Name of care home: Address: Dunsfold West End Road Herstmonceux East Sussex BN27 4NX 01323832021 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Paul Hughes,Mrs Indra Hughes care home 20 Number of places (if applicable): Under 65 Over 65 0 dementia Conditions of registration: 20 The registered person may provide the following category of service only: Care home providing personal care (PC) to service users of the following gender: Either M/F Whose primary care needs on admission to the home are within the following categories: Dementia (DE) The maximum number of service users to be accommodated is twenty (20). Date of last inspection Brief description of the care home Dunsfold is registered to provide a home for twenty older people with dementia. The home is a large detached property situated in the small village of Herstmonceux. The home is set within its own grounds and is approximately half a mile from the main road, which includes local amenities such as shops and local transport links. Resident accommodation consists of twelve single rooms and four shared rooms. Some of the room sizes are below the New National Minimum Standard and there is not level access throughout the home although the home is exempt from these regulations as it was Care Homes for Older People Page 2 of 15 1 5 0 9 2 0 0 8 Brief description of the care home first registered before April 2002. Communal areas comprise of a lounge, dinning room and library/second dining area. There are three bathrooms and five additional toilets in the home. The home welcomes pets and some residents keep cats in their rooms. The external grounds include a large rural garden, and a large parking area, including courtyard tables/chairs. An alarmed gate separates the garden from the road and allows residents freedom of movement as well as ensuring their security. The home does not provide level access internally or externally and there are some steps out to the garden from some exits. The home is better suited for those without mobility needs particularly as upstairs rooms are only accessible by stairs. Care Homes for Older People Page 3 of 15 What we found: This random inspection was undertaken on the 19 December 2008 by Debbie Calveley and Melanie Freeman - Regulation Inspectors. The reason for this random inspection was to review the staffing levels, management arrangements and the care plans in place for a specific service user recently re admitted to the home as a result of concerns raised since the last key inspection. On arrival to the home, the inspectors introduced themselves and explained the reason for this unannounced visit to the deputy manager who is currently working as appointed manager. At the time of the visit there were 11 service users living in the home, the staff on duty consisted of the appointed manager who was on an office day, two carers, a cleaner and the cook. The inspection visit focused on viewing the care plans of two residents,with their associated risk assessments, the staffing rota and discussion with the appointed manager and registered provider regarding the staffing levels, admission assessments and evidencing the management arrangements for the home since the last key inspection. Admission process: A resident was admitted to hospital for treatment, the needs of the the resident had increased and therefore a updated assessment should have been performed so as to ensure that the home had the necessary skills, equipment and training to meet the new needs. This did not happen, due to the rapid discharge of the resident and therefore the home did not have the necessary equipment in place to meet her needs when she arrived. Staffing The staffing levels have not been increased despite the increased needs of the residents. When the two carers are attending to the resident currently confined to bed, the other residents are not supervised. Management arrangements: The deputy is the acting manager in the absence of the registered manager. She has a job description for a deputy manager only. She has no written confirmation of her current role. When asked about any formal supervision that she has received since her acting up role. she said that she had had one supervision with the registered provider but the record of this was not in the home. The registered provider said that the appointed manager knew her role and that it had been discussed with her and that she met regularly with her. Evidence of objective setting and review was however not available. The current staffing skill mix does not provide a strong support for the appointed manager There is no senior carer in post to support her at this time. Care plan: A care plan was not formulated for the resident on her return from hospital until a week later, this was confirmed by the appointed manager. Care Homes for Older People Page 4 of 15 The care plan seen was detailed and person centred and the format was found good. There were shortfalls identified and these were discussed. The care documentation did not identify when the District Nurse first visited. Records indicated that her first visit was the 8/12/08. Both the appointed manager and provider said that she had visited before this but there was no documentation to support this. The care documentation did not clearly record when a pressure-relieving mattress was provided and what was in place before this. The documentation did not record what the mattress should be set on. It was noted that the Alpha Excel was set on 100kg when the resident is clearly not this weight. The manager was asked to follow this matter up with District Nurse. Risk assessments in relation to pressure areas, moving and handling and nutrition had not been completed following the return to the home. There were no records in the home from the district nurse for staff to follow in respect of wound care and dressings. Although daily records are in place for 2 hourly turns, fluid balance and food intake these are not all fully completed and these should record when fluids and food are offered in addition to when taken. The care plan did not reflect psychological or mental health needs. What the care home does well: What they could do better: All admissions to the home need to be appropriately assessed so as to ensure the home has the necessary skills, equipment and staffing levels to meet the service users needs. The admission procedures need to be followed and the staff to be confident in declining a re admission until assessed by their own staff. There needs to be a care plan in place to guide staff in providing a consistent approach to meeting the service users needs. This needs to be in place based on the preadmission assessment so the home have the necessary equipment waiting for the service user. The care plans need to include appropriate risk assessments that identify and monitor the service users health needs in particular the correct use of pressure relieving equipment. All input requested and given by the district nurses and G.Ps needs to be clearly Care Homes for Older People Page 5 of 15 documented and kept up to date to provide key information to the staff team. Risk assessments in relation to pressure areas, moving and handling and nutrition need to be updated regularly to ensure the safety, health and well being of the residents. Daily records are in place for 2 hourly turns fluid balance and food intake however these are not all fully completed and staff should record when fluids and food are offered in addition to when taken. The care plans seen did not reflect psychological or mental health needs and this needs to be included to ensure the safety and well being of the residents. The staffing levels at this time do not reflect the needs of the residents and this needs to be reviewed to ensure the safety and well being of the residents. The management of the home needs to ensure that there is support for the appointed manager during this time the current staffing skill mix does not provide a strong support for the appointed manager as there is no senior carer in post to support her. She has a job description for her previous role as deputy manager but not for her current role and she needs to have written confirmation of her current role to ensure clarity. Formal supervision needs to be recorded and kept in her file and this needs to be performed regularly as a form of support and guidance. The appointed manager was not aware of the Regulation 26 visits and these need to be discussed and any areas for improvement documented. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 15 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action 1 3 14 That the registered person 02/12/2008 ensures that all prospective service users have a full needs assessment performed before admission to ensure that the home can meet their identified needs. To ensure that all admissions to the home are suitable. 2 4 14 That the registered person 02/12/2008 confirms in writing to the service user that having regard to the assessment the care home can meeet the needs in respect of their health and welfare. To ensure that the home can meet the needs of the service user and it is agreed. 3 7 15 That the registered person 02/12/2008 ensures that a comprehensive plan of care is in place to meet the heath, welfare and social needs of the service users in a consistent manner. That service users and/or their representatives are consulted regarding the formation of the care plans To ensure that the service users needs are met in a consistent and discussed Care Homes for Older People Page 7 of 15 with the service user and family. 4 8 12 That the registered person 02/12/2008 ensures that suitable risk assessments are completed in all areas of risk and cover the use of bedrails, risk of choking and risk of falls to promote resident safety. THat risk assessments in respect of continence, nutrition, dementia and moving and handling are in place. That appropriate risk assessments are in place with an action plan for those residents that do not have the capacity to ring the call bell. To ensure the safety of all service users in respect of risks. 5 9 13 That the registered person ensures that there are suitable arrangements in place for accurate recording of medicine administration and supply of medicines. To ensure the service users health needs are met in a safe manner. 6 10 17 That the registered person 02/12/2008 ensures that all staff recieving appropriate training in interacting with people who suffer from dementia: comunicating with respect. To ensure service users are treated with dignity and respect. 7 12 16(m) & (n) That the Registered Person ensures that activities must be individually tailored to meet the needs of each resident to provide a 01/02/2008 02/12/2008 Care Homes for Older People Page 8 of 15 stimulating and interesting environment. (Timescale 0f 01/04/07 not met.) 8 12 16 That the Registered Person ensures that activities must be individually tailored to meet the needs of each resident to provide a stimulating and interesting environment. To ensure that the service users social and recreational needs are met. 02/12/2008 9 14 12 That the registered person ensures that the service users are are involved in making decisions with respect to the care they are to recieve and their health and welfare. To ensure that service users are helped to exercise choice and control over their lives. 02/12/2008 10 16 22 That the registered person 02/12/2008 ensures that there is a clear and accessible complaints policy and procedure in place for staff to follow. To ensure service users and their families are confident that their complaint is listened to and acted upon. 11 18 12 That the registered person ensures that there are clear policies and procedures in place for staff to refer to in respect of safeguarding adults. To ensure service users legal rights are protected. 02/12/2008 12 19 13(4)(a) That the Registered Person 01/02/2008 Page 9 of 15 Care Homes for Older People ensures that a written programme of refurbishment and redecoration is in place with realistic time scales. That the bathrooms are redecorated to provide a comfortable environment for bathing. 13 19 23 That the registertred manager ensures that the home is suitable for its stated purpose in that it is well maintained. That the home is well maintained. 02/12/2008 14 22 16 That the Registered Provider 02/12/2008 ensures that the specialist equipment in the home is maintained and in good working order. This pertains to: Call bell facility to be in reach of service users, staff and visitors. To ensure the service users safety at all times. 15 26 13 That the Registered Provider 02/12/2008 ensures that the necessary repairs are made to the laundry floor to prevent cross infection.That all staff follow the homes policies and procedures in the standard of cleanliness and infection control measures.That the soap dispensers and paper towels are full and ready for use. That the home is kept clean and hygenic. 16 27 17 The registered person must 02/12/2008 ensure that at all times suitably qualified, competent and experienced staff are Page 10 of 15 Care Homes for Older People deployed in the home in such numbers to meet the health and welfare needs of residents. That a copy of the duty roster of persons working in the care home and a copy of whether the roster was actually worked. To ensure that the service users needs are met by a appropriate number of staff. 17 29 19 That the registered person operates a thorough recruitment procedure and ensuring the protection of service users. To ensure that service users are supported and protected by the homes recruitment policy and practices. 18 30 18 That staff receive regular 02/12/2008 training to ensure that they are appropriately qualified and competent and have the skills to meet all the needs of residents in the home. To ensure that staff are trained and competent to do their jobs. 19 31 10 That the registered person 02/12/2008 ensures that the home is well managed and run efficiently to meet its stated purpose, aims and objectives. To ensure that the residents are protected by the management structure. 20 37 17 That the registered person 02/12/2008 ensures that records required for the protection of service users and for the the effective and efficient running of the home are maintained, up to date and Page 11 of 15 02/12/2008 Care Homes for Older People accurate. This pertains to care records of individual service users and the homes policies and procedures. To ensure the health, safety and welfare of service users. 21 38 12 That the registered person 02/12/2008 ensures that there are suitable arrangements are put in place to promote residents and staff health and safety. This will include appropriate staff training and monitoring of staff practices. To ensure that the health, safety and welfare needs of service users are promoted. Care Homes for Older People Page 12 of 15 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 That the registered person 09/03/2009 ensures that any readmission to the home have a needs assessment performed prior to their arrival, so the home have the necessary equipment in place. That the staff have the confidence to decline an admission if the identified needs have increased. To ensure that the service users needs can be met competently. 2 7 15 That the registered person 09/03/2009 ensures that all care plans reflect the mental health and psychological needs of the service users.needs To ensure that their mental health and psychological needs are met. 3 8 13 That the registered person ensures that the food and fluid charts are completed fully. 09/03/2009 Care Homes for Older People Page 13 of 15 That all risk assessments are updated regularly. To ensure the service users health and well being. 4 8 13 That the registered person ensures that all documentation regarding pressure damage and the involvement of specialist input is kept up to date To ensure the service users health and well being. 5 31 21 That the registered provider ensures that the management of the home is effective and that there are support systems in place for the appointed manager. To ensure that the service users are protected by the management structure 6 36 18 That the registered person ensures that all senior staff recieve formal supervision. That all staff are appropritely supervised. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 09/03/2009 09/03/2009 09/03/2009 Care Homes for Older People Page 14 of 15 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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