Care Home: Durham House Residential Home

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What the care home does well The residents benefit from a well maintained home that offers level access on both floors. Equipment and adaptations are available to help physically disabled and frail people with their personal care. The home is owned and managed by members of the same family, all of whom work in the home. This ensures their accessibility by residents or their families at any time and this has ensured that a good consistent service is offered. Both the owner and the manager played an active part in the inspection process and took a positive approach with regards to the advice that was offered by inspectors. Staff have a good rapport with residents and their visitors and this contributes to the welcoming atmosphere in the home. Discussions with staff and observations made confirmed that staff have a good understanding of residents needs, including those people with dementia. Staff deal with personal care tasks discretely and professionally and offer reassurance to those residents who at times become upset and unsettled. Attractively presented and nutritious meals are provided, which residents commented on in a complimentary manner. The home is managed in a way which keeps people safe and people recognised this was a safe environment to be in. Comments from residents and relative`s surveys stated, "I`m more confident because I feel safer." "I am very impressed with the care staff who work in Durham House". "Provision is made for my relative to receive regular communion which ensures that religious needs are met". "The care home is well maintained and it is remarkable that there are never any unpleasant smells". "My relative has dementia and she is physically well cared for and always clean and tidy". All of the surveys indicated that no one had any complaints about the service. What has improved since the last inspection? The new manager who was previously the deputy manager is in post and has the necessary qualifications to run a care home. The manager has continued to develop new records within the home, in particular the risk assessment documents and a form that is used when residents do not have capacity (e.g. an understanding of risks or the ability to make a decision). These forms are then used as part of the care process and to ensure that any risks are minimised. Families are encouraged to sign these forms to confirm their agreement with how care is provided. Care plans are continuing to be developed to include more information about resident`s social interests, in order that an activities plan can be implemented. Two new gas tumble driers, an industrial washing machine and a rotary iron have been provided and this ensures that good facilities are in place to deal with the laundering of residents` clothes. The owner has reinstated the disabled access shower facility and this has ensured that residents have a good choice of what bathing facility they want to use. As part of ensuring the ongoing health and safety of residents all sink units have been fitted with hot water valves to reduce the risk of scalding. CARE HOMES FOR OLDER PEOPLE Durham House Residential Home Mains Park Road Chester Le Street Durham DH3 3PU Lead Inspector Mr Clifford Renwick & Nicola Shaw Key Unannounced Inspection 10:00 27 ,30th June & 2nd July 2008 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Durham House Residential Home DS0000007465.V366567.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. Durham House Residential Home DS0000007465.V366567.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Durham House Residential Home Address Mains Park Road Chester Le Street Durham DH3 3PU 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) 0191 3871265 0191 3875916 oatesjp@aol.com Premier Care Homes Limited Jon Paul Oates Care Home 31 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (31) of places Durham House Residential Home DS0000007465.V366567.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 31 Dementia - over 65 years of age - Code DE(E) , maximum number of places: 20 The maximum number of service users who may be accommodated is 31. 20th April 2007 2. Date of last inspection Brief Description of the Service: Durham House is a family owned and run establishment that aims to provide care in a friendly and homely atmosphere. The home is registered to provide residential personal care for up to 31 older people. Up to 20 of these people may have dementia care needs. The home consists of a large period house that has been extended and improved to provide spacious and comfortable accommodation. The home is located in Chester-le-Street, close to the local high street with shops and amenities. The accommodation is arranged over two floors, with stair and lift access available to both. It consists of 14 single bedrooms with en suite toilet and washing facilities, and 17 single bedrooms without en suite facilities. Communal space is located throughout the home, with a selection of lounge areas, a conservatory, a quiet room, a smoking room and dining room. Residents also have access to an enclosed courtyard garden. Communal toilet and bathroom facilities, including specialist-bathing equipment, are located conveniently throughout the home. Fees at the time of Durham House Residential Home DS0000007465.V366567.R01.S.doc Version 5.2 Page 5 inspection ranged from £417.00 to £544.00. There are additional charges for hairdressing, chiropody, toiletries, personal newspapers and magazines and escorting outside of the premises. Durham House Residential Home DS0000007465.V366567.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means that the people who use this service experience good quality outcomes. Before the visit: We looked at: • • • • • • Information we have received since the last visits in April 2007. How the service dealt with any complaints & concerns since the last visit. Any changes to how the service is run. The provider’s view of how well they care for people. The provider in the annual quality assurance assessment (AQAA) submitted information to confirm what they are doing in the service. We looked at information we received in surveys from staff, residents and their relatives and other professionals who use the service. The Visit: An unannounced visit was made on the 27th June 2008, and announced visits were carried out on 30th June and 2nd July 2008. During the visit we: • • • • • • • • • • • Talked with people who live in the home and also staff who were on duty. Held discussion with the Registered Manager and registered provider. Observed staff working practices. Looked at information about the people who live in the home & how well their needs are met. Looked at other records, which must be kept in relation health and safety and staffing. Checked that staff had the knowledge, skills & training to meet the needs of the people they care for. Looked around the home to make sure it was well maintained, safe and free of any hazards. Checked what improvements had been made since the last visit. Spoke with staff. Spoke with a social worker who was visiting the service. One inspector carried out an observational exercise known as SOFI (Short Observation Framework for Inspectors). This involved one inspector spending a minimum of 2 hours observing life in the home. And Durham House Residential Home DS0000007465.V366567.R01.S.doc Version 5.2 Page 7 • also gathering information from looking at care records as to how staff support the residents with their assessed needs. We also focused upon looking at care files for 5 residents as a part of the inspection we refer to this as “case tracking”. And this involves looking at all records of the care for a named individual. We told the manager and registered provider what we had found. The people who live in this home prefer to be known as residents therefore this term of reference is used throughout the report. What the service does well: The residents benefit from a well maintained home that offers level access on both floors. Equipment and adaptations are available to help physically disabled and frail people with their personal care. The home is owned and managed by members of the same family, all of whom work in the home. This ensures their accessibility by residents or their families at any time and this has ensured that a good consistent service is offered. Both the owner and the manager played an active part in the inspection process and took a positive approach with regards to the advice that was offered by inspectors. Staff have a good rapport with residents and their visitors and this contributes to the welcoming atmosphere in the home. Discussions with staff and observations made confirmed that staff have a good understanding of residents needs, including those people with dementia. Staff deal with personal care tasks discretely and professionally and offer reassurance to those residents who at times become upset and unsettled. Attractively presented and nutritious meals are provided, which residents commented on in a complimentary manner. The home is managed in a way which keeps people safe and people recognised this was a safe environment to be in. Comments from residents and relative’s surveys stated, Durham House Residential Home DS0000007465.V366567.R01.S.doc Version 5.2 Page 8 “I’m more confident because I feel safer.” “I am very impressed with the care staff who work in Durham House”. “Provision is made for my relative to receive regular communion which ensures that religious needs are met”. “The care home is well maintained and it is remarkable that there are never any unpleasant smells”. “My relative has dementia and she is physically well cared for and always clean and tidy”. All of the surveys indicated that no one had any complaints about the service. What has improved since the last inspection? The new manager who was previously the deputy manager is in post and has the necessary qualifications to run a care home. The manager has continued to develop new records within the home, in particular the risk assessment documents and a form that is used when residents do not have capacity (e.g. an understanding of risks or the ability to make a decision). These forms are then used as part of the care process and to ensure that any risks are minimised. Families are encouraged to sign these forms to confirm their agreement with how care is provided. Care plans are continuing to be developed to include more information about resident’s social interests, in order that an activities plan can be implemented. Two new gas tumble driers, an industrial washing machine and a rotary iron have been provided and this ensures that good facilities are in place to deal with the laundering of residents’ clothes. The owner has reinstated the disabled access shower facility and this has ensured that residents have a good choice of what bathing facility they want to use. As part of ensuring the ongoing health and safety of residents all sink units have been fitted with hot water valves to reduce the risk of scalding. Durham House Residential Home DS0000007465.V366567.R01.S.doc Version 5.2 Page 9 What they could do better: Each resident has an individual written plan of care and though detailed, these should contain more information about their individual preferences, particularly with bathing. The use of the bound book to record bath records should be withdrawn from use and any records included in the residents care plans and daily records. This will then demonstrate how individual care is person centred (individual to each resident). Also more detail should be included in the care plans as to how people with dementia are supported by staff. The current system of storing all of the residents information in files that are grouped by room numbers should be developed into an individual file for each resident. Not only will this make the retrieval of information easier, it will also ensure that records are personal centred and give one single point of reference, where information is stored that is used in the care process. Consideration should be given as to how the menus could be made available in different formats and made more prominent to the residents by having them in the dining room. The staff application form must be amended to include a full employment history and also a signed declaration by the applicant that they are physically and mentally fit for the position they are applying for. Upon appointment of the activities coordinator, an activities plan should be developed that lists all planned activities. This should then be on display as well as being circulated to all residents. This will ensure that all residents are kept up to date on what activities are on offer in the home. Consideration needs to be given as to how developments can be made to the environment to offer additional support those residents with dementia. Please contact the provider for advice of actions taken in response to this Durham House Residential Home DS0000007465.V366567.R01.S.doc Version 5.2 Page 10 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. Durham House Residential Home DS0000007465.V366567.R01.S.doc Version 5.2 Page 11 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 Durham House Residential Home DS0000007465.V366567.R01.S.doc Version 5.2 Page 12 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A full pre-admission assessment of needs ensures that new residents are offered the right type of care at the home. Furthermore, residents are aware of what service they will receive, through the issuing of a written contract/statement of terms and conditions. EVIDENCE: Information received in 11 surveys from residents confirmed that all but one person had been given a good range of information about the home before deciding whether to move in. Opportunities had been made available to visit the home where possible and staff had carried out an in depth assessment of residents’ needs, to ensure that no one was admitted to the home inappropriately. Durham House Residential Home DS0000007465.V366567.R01.S.doc Version 5.2 Page 13 For the one person who stated that they did not receive any information about the home prior to moving in, they went on to state, “I did not receive information about the home but I am sure I could not have done better”. Other comments included the following:“My son and daughter visited the home before I moved in, and explained what was available for me”. “The owner came to my house and explained everything about the home”. Resident’s files contained assessment information which confirmed that an individual assessment of need had been carried out prior to admission into the home and from this the staff had developed written plans of care. Durham House Residential Home DS0000007465.V366567.R01.S.doc Version 5.2 Page 14 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. While clear improvements have been made to the care planning process, this needs further development to ensure that people receive care in a way that they prefer. Nevertheless, health care needs are effectively met and medication administration follows good practice. These ensure that residents’ general health and wellbeing are safeguarded and promoted. Furthermore, excellent staff interactions with residents confirms that residents are treated with dignity and respect at all times. EVIDENCE: Durham House Residential Home DS0000007465.V366567.R01.S.doc Version 5.2 Page 15 As identified in the last inspection report, the care files are structured in such a way that there is not one single access point for each individual’s care records. Records are grouped into themed files (by room numbers) rather than individualised care files. This system of record keeping continues to be in use and discussions were held with the manager about the development of individual files for each resident. Some records of individual care are kept centrally in one record and could potentially compromise the requirements of the data protection act. Records of bathing are kept in a bound book and are secured in a lockable storage facility. Information that is recorded in this book is then transferred into resident’s individual daily records. However for one entry, information was not fully transferred and as such there was an opportunity to lose valuable information. Each resident has a number of risk management and care plans. The care plans and risk management plans are evaluated each month, generally updated as a person’s needs change and are used as a working document. They are written in plain English and easy to understand. There is some evidence of person centred care, such as the number of pillows each individual prefers at night, where people prefer to eat their meals. However, this needs to be developed further, to include all aspects of the person’s personal care needs. For example, instead of the care plan for bathing which refers the staff to the home’s bathing policy, this should focus upon each person’s individual preferences. In addition to this, the record that is kept for bathing in a bound book should be withdrawn from use and records kept in the resident’s daily records sheet and care plan. Care plans also need to be developed further for people with dementia. For example, where it has been identified that a person is at risk to others because they like to engage in tasks around the house and at times this may compromise safety. Information needs to be in the care plans about the most positive way of supporting the person when this happens. Care plans identify situations where residents may become agitated and the actions staff should take when this occurs. This information was clear and easy to follow. Durham House Residential Home DS0000007465.V366567.R01.S.doc Version 5.2 Page 16 Some care plans would benefit from more detailed information, so that staff know exactly what to do, for example, if a resident has an epileptic seizure or where and when prescribed creams are to be administered. It was good to note that the manager has introduced a comprehensive nutritional assessment tool. This positive work needs to continue and where it has been identified that a person is at risk, a nutritional care plan be developed. As a further example of good practice, the manager has also begun to complete a mental capacity assessment tool for each individual, to help the home decide if a person is unable to make decisions for themselves. He has also begun to collate information about each individual’s social history that is very important in person centred care. There was also comprehensive information in the care plans about how each person’s health care needs are met. For example, some residents have regular contact with the district nurse for pressure sores, GP’s if unwell and speech and language therapists for difficulty with communication and eating. Observed good care practices included, when staff spoke to residents they always made sure that they bent down to their height and made eye contact. When assisting people who needed support with walking they made sure that they did not hurry the person, helping them to walk at a pace that was comfortable for them. Residents were well dressed with tights, slippers and socks and if a resident accidentally spilled food, then staff were quick to ask them if they wanted assistance to change their clothing. Staff constantly interacted with residents and it was clearly evident that the culture within the home is one which promotes the well being of the residents. For example, if a resident asked a question of staff or asked for support with an aspect of their personal care that they could not manage for themselves, staff took time to listen to them. Staff asked people if they wanted to go to the dining room for lunch, as opposed to instructing people that lunch was ready. The atmosphere was quiet, relaxed and there was an obvious warmth between the residents and staff. Residents said about staff “I think they are marvellous”. Medication is dealt with in accordance with the appropriate guidelines. The manager has also implemented a regular audit of the medication systems to ensure that staff follows the correct guidelines. Durham House Residential Home DS0000007465.V366567.R01.S.doc Version 5.2 Page 17 This is good practice and ensures that the chances of a medication error occurring is minimised. The storage and record keeping for those medicines referred to as “controlled drugs” are in good order and an audit of the medication confirmed that the records were correct. Durham House Residential Home DS0000007465.V366567.R01.S.doc Version 5.2 Page 18 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents lead fulfilling lifestyles through exercising choice and control over how they spend their day. People’s lifestyle is good with regular contact being maintained with relatives and friends and the residents receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. EVIDENCE: Residents are able to have their meals in the lounge or dining room. Those who need support are offered this in a discrete, sensitive unhurried way. Staff interacted with residents who needed help and this was a very positive experience for the residents. Durham House Residential Home DS0000007465.V366567.R01.S.doc Version 5.2 Page 19 There are two sittings for lunch with the first sitting being for those residents who require support from staff. The position of the dining room to the kitchen means that residents could smell the food cooking. This is excellent and very important in dementia care as not only does it act as a prompt for people that lunch or tea is coming but it helps to stimulate their appetite. Dining tables were beautifully presented with tablecloths and condiments so people could help themselves. Menus are on display on the wall outside of the dining room and these listed a range of meals that are available. A good range of meals are available, though the menus do not show the alternatives to the main meal, other than on a Friday. Discussions with the cook confirmed that an alternative meal is always available and records were in place to confirm that this does happen. A record is always kept when an alternative meal is taken and which is not shown on the menu. The cook also confirmed that some meals are prepared differently for those residents who have diabetes and a record of this is kept in the kitchen. Discussions were held with the manager about developing the menu, to reflect the alternative meals available. And also, by having menus in the dining room, on the table, it would make them more prominent and assist residents in reminding them of what is being served. Lunch was well presented, tasty and of sufficient quantity. In all of the surveys returned by the residents, they confirmed that they are always satisfied with the food that that is provided in the home. On the first day of the inspection, a musical entertainer was present. This was well attended by the residents who joined in with the singing and dancing. Activities are an area that the manager is continuing to develop within the home. An activities coordinator has been appointed and is in the process of commencing work, subject to all of the relevant documentation being returned as part of the recruitment process. The manager is also in the process of developing records that staff can use to obtain personal information from residents about their interests, previous and present, so that these can be incorporated into an activities plan. Durham House Residential Home DS0000007465.V366567.R01.S.doc Version 5.2 Page 20 A number of surveys from residents, their relatives, staff and visitors to the service identified that more activities could be provided in the home. This was discussed with the manager who, as previously stated, is aware of the need to develop activities and is taking active steps in this area. A book is available to record the range of activities that have taken place and also who was invited to take part and also if they chose not to. However at present there is no activity plan to show what is happening on any particular day. The manager is aware of this and confirmed that this will be developed once the activities coordinator is in post. Residents are encouraged to follow their own routines and this is supported by staff. Records available confirmed that people can get up when they want and choose what time they go to bed. And when activities are organised people have chosen whether to become involved or not. Durham House Residential Home DS0000007465.V366567.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A clear accessible complaints procedure gives residents and their relatives confidence that they will be listened to and taken seriously. Furthermore it provides information that is effectively used to improve the service. The manager and staff have a good understanding of local adult protection procedures, which helps to ensure the protection of residents from abuse. EVIDENCE: The manager has completed training in the protection of vulnerable adults and in turn has ensured that staff have received “in house” training, as part of their work. Good policies and procedures are in place for dealing with any potential incidents of abuse and also procedures that are known as “whistle blowing”. This is a policy that enables and encourages staff to report any concerns they have. Durham House Residential Home DS0000007465.V366567.R01.S.doc Version 5.2 Page 22 Discussion with one member of staff confirmed that they are aware of the whistle blowing policy and explained how it can be used by all staff. In the last 12 months one safeguarding alert was dealt with through an alert being made to the owners by a staff member using the homes whistle blowing policy. This was dealt with professionally and satisfactorily and involved the owner and manager liaising with appropriate representatives in the Local Authority. And this demonstrates the effectiveness of the homes systems in relation to safeguarding adults. The manager is very open with regard to dealing with complaints and any issues related to protection. A list of relevant people to contact in the event of any concerns is on display on the office wall and also a flow chart of what to do. Staff can refer to this at any time and in discussion with a staff member, they confirmed that they are aware of the chart and also the home’s procedures. The manager is currently in receipt of the Local Authority procedures on safeguarding adults. And as part of the ongoing development in the service confirmed that these will be discussed with staff and included in their training plan. From all of the surveys that were received from relatives and residents they confirmed that there were no concerns about the service that is provided. Some of the comments made were:“If necessary I would speak to the manager” “I have not needed to complain but if I did I would speak to the person in charge” “Information is in the homes brochure about how to complain” No formal complaints have been received by the commission regarding this service. The complaints procedure is on display and information is also given out to residents and their families when first moving into the home. In addition to this, the home carry out annual surveys with relatives and residents, asking them for their views on the service. This ensures that they can continue to develop the service in the best interests of the residents. Durham House Residential Home DS0000007465.V366567.R01.S.doc Version 5.2 Page 23 Durham House Residential Home DS0000007465.V366567.R01.S.doc Version 5.2 Page 24 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean, well maintained and has a good range of facilities. This promotes a positive image for residents and furthermore ensures that they remain safe and well. EVIDENCE: Within the inspection, all communal areas and a number of residents’ bedrooms were viewed. Durham House Residential Home DS0000007465.V366567.R01.S.doc Version 5.2 Page 25 There are two assisted bathrooms and one disabled access shower room, which offers residents a choice of bathing facilities. In addition to this, the baths also have a shower facility attached. Some bedrooms have special guards fitted (“Dorguards”) and these enable residents to keep their bedroom doors open without compromising fire safety. All areas of the building were clean and maintained to a good standard, with no noticeable defects or safety hazards. There were no unpleasant smells anywhere in the building. Cleaning charts are in place in bathrooms and toilets and these are signed by staff and dated when these areas are cleaned. This demonstrates a high standard of housekeeping within the home. Discussions were held with the manager about the potential to develop some areas of the home in such a way, that it assists those residents with dementia, to find their way around. At present there are pictorial symbols on toilet doors and numbers on bedroom doors and all corridors are decorated in similar colour schemes. This could be developed further with clearer signs on toilet doors and placed at a height so people can see them. Other options as to how signs, photographs or different colours on doors could be used, will also assist with orientation. Also consideration needs to be given to providing grab rails in one ground floor corridor area leading from library to lounge/conservatory area. In discussion with the manager we discussed the use of these additional methods and by the close of inspection the manager had taken steps to develop this further. This has involved the manager sourcing local photographs of the area and town that can be used in the home. Durham House Residential Home DS0000007465.V366567.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are sufficient to ensure that residents’ needs are met. Furthermore staff receive sufficient training to support them in their work, to ensure residents receive good quality care. Robust recruitment procedures are in place though an amendment is required to the application form. This will further ensure that all of the relevant information is received during the recruitment process, to prevent unsuitable people being employed. EVIDENCE: During the inspection there were sufficient staff on duty to meet the needs of the residents. In discussion with the manager he confirmed that many of the staff have worked in the home for a long time and this has created stability within the staff team. Durham House Residential Home DS0000007465.V366567.R01.S.doc Version 5.2 Page 27 The manager also confirmed that the recruitment process involves receiving the necessary police record check, two satisfactory references, before being invited for interview. Upon commencing work in the home all new staff undergo a standard period of 20 hours induction and this ensures that they are familiar with the homes policies and procedures. All staffing files are kept in a central file and information for the three most recent employees was looked at. For all three persons the record of previous full employment history was not recorded in detail. And for one person there was no date to confirm when their employment had commenced and ended for one employer. The application form asks that any applicant list employment history for the last 5 years only and this would make it difficult therefore to have a full employment history since leaving full time education. In addition to this, the application form asks questions about an applicants health but does not contain a declaration form the applicant, stating that they are physically and mentally fit for the post they have applied for. For one person there was only 1 reference but a list of dates to confirm the manager had attempted on numerous occasions to obtain the second reference from a previous employer. A lot of work is carried out before employing someone to work in the home and there was a recognition that the application form needed to be developed further. This would further tighten the process of staff recruitment. It was agreed that this would become a requirement of this report. Following the inspection the manager submitted a specimen application form to the commission showing the proposed changes to meet the requirements of the Care Home Regulations. Good training opportunities exist for staff and records are available to confirm the training that has taken place. Some discussion was held about the need for ongoing training in safeguarding adults, now that the home is in receipt of the Local Authority new procedures and guidance. It was agreed that a way to develop this further, in the absence of any training courses, would be to cover safeguarding as a topic in the regular staff meetings. A member of staff recently employed confirmed that they were very satisfied working in the home. They also confirmed that they had received induction Durham House Residential Home DS0000007465.V366567.R01.S.doc Version 5.2 Page 28 training, appropriate to the work and received good support from the manager and the owner. They also were able to talk in detail about the home safeguarding procedures and what they would do if they had any concerns about the care of the residents. The member of staff went on to say that the home was a good place to work, compared to where they had worked previously. And they stated that as this was a family run home, they felt that staff was treated well by the owners and that they felt valued as a worker. Throughout the visits there was a good atmosphere and staff engaged in conversation with any visitors who came to the home. This contributed to the positive atmosphere. Durham House Residential Home DS0000007465.V366567.R01.S.doc Version 5.2 Page 29 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An experienced and qualified manager is in post, who ensures that the service is effectively run in the best interests of the residents; that they are safe and well cared for and their rights are safeguarded. EVIDENCE: The registered manager is experienced and holds the Registered Managers Award and also NVQ Level 4 in care. As part of their professional development the manager has continued to undergo training that is relevant to the work. Durham House Residential Home DS0000007465.V366567.R01.S.doc Version 5.2 Page 30 The manager has continued to operate a quality assurance file, which incorporates the views of residents and their relatives. The residents have the opportunity to express their views in surveys and in day-to-day conversations with staff and the manager. Good health and safety procedures are in place and the fire records in staff files were up to date and confirmed that staff receive and take part in appropriate fire drills and fire instruction training. The manager was advised that the fire log sheets should also be used to list the fire instruction and fire drills that have taken place, as this would offer a central point of information to refer to. Discussion with one staff member as to what action to take in the event of the fire alarm sounding confirmed that they were clear as to what they should do. An accident book that complies with the Data Protection Act is in place and this records any accidents in the home and what actions staff have taken. Temperatures of bathing water are tested before any residents use the bathing facilities. The book that is used to record this confirmed that hot water temperatures did not exceed the safe maximum temperature of 44 degrees centigrade. However, the temperatures that were recorded were listed as 37/38 degrees centigrade. This was discussed with the manager as this temperature is slightly lower than the recommended temperature and as such may not be hot enough for the residents. The manager was advised to keep this under review and also to seek comments from the residents, as this would ensure that their comfort was being maintained during bathing. Small amounts of money are held on behalf of the residents and records are in place to confirm this is dealt with satisfactorily. Some advice was offered as to how receipts are maintained for transactions. Discussion with the manager confirmed that as part of the auditing system, social services regularly carry out an independent audit of monies held on behalf of residents. Durham House Residential Home DS0000007465.V366567.R01.S.doc Version 5.2 Page 31 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 4 X 3 X X X X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 3 3 Durham House Residential Home DS0000007465.V366567.R01.S.doc Version 5.2 Page 32 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. Standard OP29 Regulation 7, 9 & 19 Schedule 2 Requirement All information and documents in respect of persons working in the home must be kept in accordance with the requirements as set out in Schedule 2 of the Care Homes Regulations. (Immediate) Timescale for action 27/06/08 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. Refer to Standard OP7 Good Practice Recommendations Care plans should include more detail in order to reflect individual’s preference and choice. Particularly in relation to dementia and also personal bathing. Steps should be taken to look at how the menus could be made available in different formats. Be displayed in the dining room and also include information about the alternative meals available. Consideration should be given to having individual care files where all records for a person are kept. This DS0000007465.V366567.R01.S.doc Version 5.2 Page 33 2. OP15 3. OP37 Durham House Residential Home reinforces the information as belonging to the individual and demonstrates how care is personal centred. It will also offer a single point of access for all staff with regard to care information including care planning and delivery. Durham House Residential Home DS0000007465.V366567.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Durham House Residential Home DS0000007465.V366567.R01.S.doc Version 5.2 Page 35 - 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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