Care Home: Dunsland House

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What the care home does well Dunsland House is a small, comfortable home where the manager and staff share the daily living experience with the residents, and where people feel comfortable and are supported by staff to live in the ways they prefer. The core staff team have worked at the home for many years and are clearly very happy in providing appropriate care. In the returned surveys , one member of staff wrote that they "look forward to coming to work each morning". Comments in the returned residents` surveys were all positive and there were no suggestions made for possible improvements to the home. During the inspection residents all indicated they are happy with the activities provided and enjoy the monthly trips out. They praised the staff and the manager and the Proprietor, who frequently visits the home. Residents said they enjoy the "home-cooked" food provided and we saw drinks offered and provided throughout the visit. Staff were clearly aware of the need to promote frequent hydration for the residents` continuing good health. It was also pleasing to see that the staff on duty eat their meals with the residents and people who use the service said that the staff are "part of the family". The residents are involved in their care planning and care staff are fully aware of the information documented in these plans. Staff demonstrated how individual choices and preferences are met and are clearly aware of all the individual needs of the residents. The care staff receive appropriate training and all are undertaking or have completed NVQ training, ensuring the continued professionalism of the staff. All staff training includes a basis of equality and diversity values. The manager has kept up to date with all the many changes which are currently being enforced, linked to good care practice and regularly records and monitors any trends or concerns in the home to ensure the continued quality of the service. What has improved since the last inspection? Activity provision has increased and one resident said there are "ample" activities provided in the home. Menus and meal choices are recorded in line with the statutory requirements and all radiators in the home have been risk assessed and covered where appropriate to ensure the safety of the residents. No hazardous substances were left accessible during the visit. An effective quality assurance programme has been implemented which ensures that the views of residents and stakeholders are used in all the planning for the home. What the care home could do better: The laundry facilities in the home need to be upgraded and a hand washing sink installed to ensure good infection control is maintained. Key inspection report Care homes for older people Name: Address: Dunsland House 5 Shrublands Road Berkhamsted Hertfordshire HP4 3HY     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Patricia House     Date: 0 9 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Dunsland House 5 Shrublands Road Berkhamsted Hertfordshire HP4 3HY 01442866703 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): dunslandhouse@aol.com Mrs Sheila Smyth,Mr R.J. Smyth Name of registered manager (if applicable) Catherine Louise Webb Type of registration: Number of places registered: care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Dunsland House is a home for older people who need support with their health care, personal care and social care. The home is registered for fifteen older people. Service users who have dementia or physical disabilities are not admitted to the home; however, the home will continue to provide a service to residents who, during their time at the home, become more dependent, for as long as the home can fully meet their needs. Input from relevant professionals is accessed for individuals via the G.P. referral process. Dunsland House is situated in the village of Berkhamstead. It is a large double fronted semi-detached family-style house built in 1898. The home has a lift and assisted bathrooms, a domestic style kitchen, lounge, dining room, en-suite bedrooms and attractive gardens. The house is situated close to the village shops and amenities. The Care Homes for Older People Page 4 of 26 0 Over 65 15 Brief description of the care home current fees range from £550 to £650 per week. The homes Statement of Purpose, Service Users guide and latest inspection report are displayed and copies are available on request. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The information in this report is based on an unannounced inspection of the home, which took place over one day, with one inspector carrying out the work of the Commission. For the purposes of this report the Commission will be referred to as we. The registered manager was present during the visit and staff and residents were spoken with. All parts of the building were visited and a selection of records was examined. The mid-day meal was served and observed during the inspection. Before the inspection the manager had completed and returned to the Commission an annual self-assessment quality review, the Annual Quality Assurance Assessment, (the AQAA). This document included statistical information about the home and confirmation of the policy reviews and equipment checks which had been carried out. Care Homes for Older People Page 6 of 26 We also sent out quality questionnaires to residents and staff at the home. Seven residents and three staff members completed and returned these surveys to the Commission. Comments from these documents are referred to in this report. We have also reviewed any other information we have received about the service since the last key inspection. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: The laundry facilities in the home need to be upgraded and a hand washing sink installed to ensure good infection control is maintained. Care Homes for Older People Page 8 of 26 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are provided with sufficient information to enable them to decide if the home is right for them and the completed full assessments ensure that the services provided can meet all their individual needs. Evidence: The home has a written Statement of Purpose and Service Users Guide and copies are displayed in the entrance hall and provided for residents and prospective residents. The manager has recently updated the Statement of Purpose and is currently updating the Service Users Guide. We checked a selection of residents records during the inspection and all contained a copy of the assessment made of the individuals needs before they entered the home and a copy of the referring agencys care summary where applicable. This information ensures that all parties can be sure the services provided in the home can meet individual needs and is used to complete an initial care plan showing how these needs Care Homes for Older People Page 11 of 26 Evidence: are to be met. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have their health needs met in the way they prefer and are protected from the risk of harm by the thorough procedures followed for the administration of medication. Evidence: We spoke with many of the residents during the inspection and also observed the interaction between residents and the staff. We tracked a selection of the care plans relating to some of the residents. Care planning is in a user friendly format which gives clear and appropriate information to staff and we saw evidence that residents are fully involved in completing the plans. We saw evidence of the health checks which take place, both routinely and when required and saw a wide range of completed risk assessments covering all appropriate areas. We looked at the records of residents weight checks and saw no areas of concern but the staff we spoke with were fully aware of the actions they will take if there are concerns about peoples nutrition and health. The care plans are person centred and include information about peoples wishes for death and dying. Peoples life histories and social interests are recorded in detail. We saw several records completed by family members showing staff their Care Homes for Older People Page 13 of 26 Evidence: relatives history and preferences and care staff demonstrated a good knowledge of individual interests and explained how they try to support and promote these in practice. Care planning documents have sections completed for future care options and residents also respond to the question What would you like to do if you could?. The care staff we spoke with said that the key worker for each resident includes these aspirations in the daily planning for the individuals they work closely with. We checked the system for administering, storing and recording medication in the home and watched a member of staff administer medication at lunch time. The procedures followed were thorough and we found no recording errors. The manager completes risk assessments for all the medication administered including PRN medication which is taken when required. Controlled drugs are appropriately stored and recorded and there is a dedicated medication fridge in the office. Two residents are supported to self-medicate and we saw the completed risk assessments and contractual agreements which are in place to ensure the safety of this procedure. One resident has insulin injections and we saw how care staff support this person with this process and noted that district nurses also check the procedure when in the home. The home has a written policy on medication which cover all appropriate areas and includes guidelines for the administration of covert medication. We saw the detailed training which all members of staff receive before they are able to administer medication and saw that their competency is checked on three occasions before being signed off by the manager. In addition the pharmacist from the Inta-care company provides certificated training for all staff and had provided this the previous month. The manager also completes annual staff competency checks for medication administration. In addition, care plans list the medication each resident is prescribed, and includes the reason for the medication, and how it works. This enables staff to be clear about any possible reactions and to be able to monitor the residents health in an informed way. Residents were well dressed and confirmed they choose their own clothes and have their hair done when they wanted. Those we asked said that staff always provide personal care in the way they wish and treat them with respect, observing their privacy at all times. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service enjoy their daily lives in the home and continue to feel part of the community. The meals provided are especially enjoyed by residents and help to ensure their continued good health. Evidence: We saw the two month activity programme displayed in the communal lounge and residents confirmed they also receive individual copies of these planned events. A wide range of activities is provided from Monday to Friday, in the afternoons. People we asked said they prefer doing things in the afternoon as they like to take their time getting up and ready in the morning. Residents are asked about the activities they would like at the regular meetings, and, currently, no one has asked for more structured activities at weekends. Staff said that several residents go out with families at weekends and families also visit the home. Staff also said they provide more one to one activities on Saturdays and Sundays. One resident told us that there are ample activities in the home. The manager plans the activity programme and the care staff implement many of the events including taking residents out on the monthly outings which take place. Residents said they really enjoy these trips and had recently been to Ashridge and Southend. We saw more trips planned including one to Dunstabloe Downs later this month. There was a cheese and wine event taking place on the Care Homes for Older People Page 15 of 26 Evidence: afternoon of the inspection and other planned activities included a beetle drive, an opera afternoon a sherry meeting and film afternoons. A physiotherapist visits the home on a regular basis to provide exercise to music to ensure people keep as fit as possible and there is a regular religious service held in the home. We saw people with newspapers and magazines which they said are ordered for them and there are shelves with books for the residents use as well as regular visits from the mobile library. Residents said they spend a lot of time in the garden in the summer and we saw people sitting on the patio during the visit. One resident has their own exercise bicycle in their room and we saw their daily routine of peddling one mile each day displayed. Those people we spoke with said that visitors are welcomed at all times in the home and that the residents are free to come and go as they choose and to get up and go to bed when they want. We heard one resident choose to have their midday meal provided in their bedroom and this was done. We saw the main meal of the day provided at lunch time and the residents we asked said they enjoy all the meals at the home. One resident said they always enjoy marvellous home cooked food. Others said the meals are excellent and fresh produce is cooked daily. There is a four week rolling menu but staff confirmed that people can choose to have a different meal on the day if they ask. Currently no special cultural needs are catered for but the cook said special needs would always be met. One resident has diabetes and the cook said that their meals are kept as near to the main meals as possible, whilst meeting the residents health needs, so that the resident enjoys the same food as the others . We saw jugs of water and glasses provided in all the bedrooms we visited and staff confirmed people are provided with drinks all through the day and evening to promote good hydration for the residents. The tables in the dining room were attractively set for the meal, with cloth napkins and condiments provided. It was also pleasing to see the staff on duty eat with the residents and people we asked said this always happened. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident that any concern they might have will be listened to and residents are protected by the policies and procedures followed in the home. Evidence: The home has written policies on Making a Complaint, Safeguarding and Whistle Blowing. The staff we spoke with were fully aware of these policies and their implications. The residents we asked all said they were aware of how to make a complaint and would not hesitate to voice a concern if they had one. The manager is fully aware of the Staffordshire policies on safeguarding adults and we saw evidence that all staff receive thorough training in this topic to ensure the continued protection of all the service users. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service benefit from living in a home which is well maintained and comfortable and where procedures followed for infection control help to protect people from the risk of harm. Evidence: All areas of the home were well presented on the day of the inspection. Communal areas are comfortably furnished and all the bedrooms we saw were pleasantly decorated and contained a range of peoples own possessions, making the rooms individual and personal. The garden looked very attractive and is fully accessible to residents including any wheel chair users. All bedroom doors have been fitted with locks and keys are available to all residents so that they can lock their own door if they wish. One bathroom is fitted with a ceiling tracking hoist and the home also has a portable hoist should any resident need the use of this equipment. The home was very clean and liquid soap and paper towels are provided in all communal bathrooms and toilets as recommended in guidelines for good infection control. Care staff confirmed that there are always supplies of disposable gloves and aprons available and that they use red alginate bags for washing any soiled laundry, as is also recommended. The washing machine has a sluice programme to appropriately deal with incontinent laundry. Care Homes for Older People Page 18 of 26 Evidence: However, the laundry room, which is sited outside the main building, is in urgent need of an upgrade. The paintwork on the walls does not cover the brickwork in all areas, making it very difficult to keep the walls clean. The walls are also not impermeable to the floor, as is recommended in guidelines for good hygiene and infection control. A wash hand basin is also required which staff should use when they handle laundry to minimise the risk of the spread of infection. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have their needs met by a well trained and professional workforce and the homes recruitment procedures are thorough and help to protect residents from the risk of abuse. Evidence: We spoke with most of the residents during the inspection and they confirmed there were always enough staff on duty in the home to meet their needs. People confirmed that their call alarms were always answered promptly by staff both in the day and at night. We checked the staff rosters and saw that fewer staff are on duty at the weekend but that there is an additional staff shift between 9 and 11am, which staff said was the busiest time. Residents also said that some of them regularly go out with their families at weekends. Residents praised the staff and we observed excellent interaction between all members of staff who were on duty and the residents. Two new care workers have recently been appointed to the home and one was attending for induction training on the afternoon of the inspection. However the majority of staff have worked at the home for many years and are therefore able to provide continuity of care for the people who use the service. The home has a staff training overview displayed and this shows that all staff receive all the training appropriate to their roles and have regular training updates. We saw the induction programme which new staff complete and this training is very thorough. Care Homes for Older People Page 20 of 26 Evidence: One new care worker was coming into the home on the afternoon of the inspection to undertake more of the induction programme with the manager. We met the NVQ training assessor during the inspection who was working with a newer care worker who is completing NVQ training. In addition, all the remaining members of staff have either completed or are currently doing NVQ training. Two care workers, who have achieved NVQ 2 are currently completing NVQ 3 training and three other members of staff are also working towards NVQ 3 training. We checked a selection of staff recruitment files and saw evidence that all appropriate checks had been in place before these employees started work at the home. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service live in a well managed home where the procedures followed promote the welfare of both residents and staff. Evidence: The manager is registered with the Commission and demonstrated a good understanding of all the latest changing policies and regulations associated with providing care. The residents and staff we spoke with praised the manager and said their views were sought and always listened to and said they felt involved in the decision making of the home. The home has a formal written quality assurance programme and we saw the returned questionnaires which had been sent out in February this year to residents, families and other professionals. The manager had completed a summary of the responses and we saw that the comments made were all positive. Monthly residents meetings take place and these are minuted. Staff meetings take place every two months and are also minuted. Care Homes for Older People Page 22 of 26 Evidence: Every member of staff has formal, one-to-one supervision at regular intervals and records are kept of these meetings. In the AQAA the manager confirmed that the homes policies are regularly reviewed and said at the inspection that a revised Infection Control Policy has just been revised, and the Essential Steps audit linked to this policy has been completed, ensuring good infection control procedures are in operation at the home. Residents or their families handle all their financial affairs but all residents have some of their personal allowance to use and have safes in their bedrooms to keep their money secure. We checked the homes fire safety records and these were all up to date. Fire training takes place at regular intervals and safety procedures were checked last year by the Fire Safety Officer. However, the manager said she will be introducing more practical fire drills and will now record outcomes and any changes which might be needed. The accident book was being properly documented and we also saw that the manager completes monthly reviews of the homes records to identify any trends or changes which might need implementing. We saw no hazardous substances left accessible to residents during the inspection and the manager has completed generic risk assessments for the home. Risk assessments have been completed for all radiators and, where a risk has been identified , these radiators have been covered. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 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 26 23 The laundry in the home 01/11/2010 must be upgraded to provide hand washing facilities for staff and to ensure all surfaces can be kept clean and hygienic. This is so that the risk of the spread of infection is minimised. 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 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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