Care Home: Dury Falls

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What the care home does well There is a pre- admission assessment process, to ensure the service can fully meet the needs of people admitted to the home and trial visits are offered to all prospective residents. Routine risk assessments are undertaken, to ensure residents are supported to take risks, as part of an independent lifestyle. On speaking to the representatives of residents, their comments evidenced that staff were very knowledgeable on the care needs of residents and on what they liked and disliked doing. Residents, relatives and professionals spoken to during the inspection, spoke very positively about the service. There is a wide range of indoor social activities available for residents to participate in. Meals in the home offer choice and variety. What has improved since the last inspection? At the last key inspection 10 requirements were made in the following areas; care planning; medication; environment; specialist equipment assessments; review of staffing arrangements; staff training and health and safety checks.At this inspection 10 of these requirements have been complied with. What the care home could do better: 7 requirements have been made at this inspection, in relation to the follow up of accidents and incidents at the home; medication administration records; recording of concerns and complaints; environment; to increase staffing levels, to ensure there are adequate staffing levels at the home to meet the needs of residents and the checking of water temperatures. Failure to act on requirements that relate to the care provided for the people living in the home impacts on the welfare and safety of service users and may lead to the Commission taking enforcement action against the registered person. CARE HOMES FOR OLDER PEOPLE Dury Falls 35 Upminster Road Hornchurch Essex RM11 3XA Lead Inspector `Harbinder Ghir Unannounced Inspection 22nd July 2008 10:00 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 Dury Falls DS0000027842.V368466.R03.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. Dury Falls DS0000027842.V368466.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dury Falls Address 35 Upminster Road Hornchurch Essex RM11 3XA 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) 01708 447786 01708 476555 june@duryfalls-carehomes.co.uk Mr Barry Stack Mrs Christine Ann Stack Ms Mary Ellen Leedham Linda Springall Care Home 28 Category(ies) of Dementia (28), Old age, not falling within any registration, with number other category (28) of places Dury Falls DS0000027842.V368466.R03.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 2. Dementia - Code DE The maximum number of service users who can be accommodated is: 28 10th July 2007 Date of last inspection Brief Description of the Service: Dury Falls is a privately owned care home for 28 older people situated in a residential area of Upminster. The home is currently managed by Maureen Leedham and Linda Springhall who job share this position and are registered as joint managers of the home with the Commission for Social Care Inspection. The property is a 16th Century, grade 2 listed, two storey building, with a garden to the front and side. Internally some of the original features, such as low ceilings, doorways and narrow corridors have had to be retained and this limits disabled access. There are two lounges and a dining room on the ground floor, as well as some bedrooms, toilets and a bathroom. The remaining bedrooms are on the first floor, which is accessed by a lift and stairs. There are 8 single and 10 double rooms, 6 of which are en - suite. The home is situated on bus routes, and within walking distance of a tube station. Personal care is provided on a 24-hour basis, with health care needs being met by visiting professionals, such as district nurses. There is a wide range of activities provided within the home although outings are limited. A hobby therapist is employed who is highly motivated and provides activities suitable for people with dementia. The current scale of charges range from £486 to £494 per week. Additional costs are for items such as hairdressing, chiropody and newspapers. Prospective service users are informed about the service via the Statement of Dury Falls DS0000027842.V368466.R03.S.doc Version 5.2 Page 5 Purpose and the Service User Guide as well as via a brochure. Dury Falls DS0000027842.V368466.R03.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 star. This means the people who use the service experience Good quality outcomes. This was an unannounced inspection undertaken by Regulation Inspector Harbinder Ghir. The inspection took place on the 22nd July between 10.00 am and 5.00 pm. The registered manager of the home was available throughout the day of the inspection and feedback was provided to the registered manager at the end of the inspection. During the inspection the inspector was able to talk to residents residing at the home and relatives and who were visiting. Staff on duty during the day were also spoken to. The London Borough of Havering, who is the host authority for the service was contacted, inviting their comments on the service they are commissioning. They did not provide any feedback. The Commission for Social Care Inspection received a completed Annual Quality Assurance Assessment prior to the inspection. The inspector would like to thank everyone involved in the inspection process. What the service does well: What has improved since the last inspection? At the last key inspection 10 requirements were made in the following areas; care planning; medication; environment; specialist equipment assessments; review of staffing arrangements; staff training and health and safety checks. Dury Falls DS0000027842.V368466.R03.S.doc Version 5.2 Page 7 At this inspection 10 of these requirements have been complied with. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Dury Falls DS0000027842.V368466.R03.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dury Falls DS0000027842.V368466.R03.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4, 5 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service completes comprehensive pre-admission assessments, to ensure they can meet the needs of residents. Trial visits are offered to all prospective residents, to ensure residents have information on the services and facilities provided at the home. Each resident has an individual written contract of the statement of terms, to ensure they agree to the services provided at the home. The service does not provide intermediate care. EVIDENCE: Three pre-admission assessments were closely examined. Records showed that comprehensive pre-admission assessments are completed before a prospective Dury Falls DS0000027842.V368466.R03.S.doc Version 5.2 Page 10 resident is admitted to the home. Assessments comprehensively covered the personal, healthcare and social care needs of residents. The likes and dislikes of foods and drinks were also identified. For example one resident’s assessment identified that they liked their coffee milky, which was observed being provided by the staff team. For residents with a diagnosis of dementia, their mental health needs were identified in detail and the care plan was devised accordingly. For Local Authority funded residents, the service had obtained care management assessments from the placing authority and the above pre-admission processes were also followed for any residents admitted for a respite stay at the home. Relatives visiting the home during the inspection were spoken to who also confirmed that they were given opportunities to visit the home before deciding whether they would like their loved ones to move in. “We looked at the home and met the staff and we were very pleased,” informed one relative. “I looked at the home before my mother moved in. We liked it because it’s a small intimate home,” said another relative. It was evident that prospective residents are given the opportunity to spend time in the home and staff give individuals the information and time they require to settle into the home. During the inspection one resident was observed moving into the home. Staff were seen sitting with the resident, giving them special attention to help them feel comfortable in their new surroundings and enabled the individual to ask any questions about life in the home. Other members of staff were also observed spending time with the individual’s family, giving them information on how the home is organised. All residents were provided with a statement of terms and conditions. This set out simply and clearly and in detail about what is included in the fee, the role and responsibility of the provider, and the rights and obligations of the individual. Dury Falls DS0000027842.V368466.R03.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 People using the service receive good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs are set out in individual care plans. Care plans are detailed, to ensure the needs of residents can be met effectively. There are clear medication policies and procedures to follow. However, there are some inconsistencies in the management of medication, which may result in unsafe practices. All residents can be assured that, at the time of their death, staff would treat them and their family with care, sensitivity and respect. EVIDENCE: Three care plans were closely examined. Care plans were comprehensive and clearly sets out residents’ health, personal and social care needs. Information covered the comfort and safety of residents, their communication needs, their Dury Falls DS0000027842.V368466.R03.S.doc Version 5.2 Page 12 nutritional needs, personal care, mobility and their hobbies and leisure. Care plans were person centred which focused on the needs of residents. One care plan examined stated, “ Y likes getting up when they want to. Y prefers to have a shower first thing in the morning.” It was evident from examining the individual’s daily case recording notes that this was put into practice. Care plans included each individuals likes and dislikes of foods and drinks and included information on what time they like to get up or go to bed. Care plan information informed staff of individuals’ abilities and the level of care they required. Care provided for residents with a diagnosis of dementia focused on meeting their specialist care needs. Each care plan examined included a psychological assessment of the individual, identifying their mental health needs. A detailed family tree was also completed with the individual and their family, specifying information on the individuals past employment, past times and life history. All members of staff were wearing a green uniform and their name badge, which may aid residents in identifying members of staff and large signage for each communal room, was displayed around the home. Staff were observed to be interacting positively with residents, talking to residents, maintaining eye contact, talking slowly and in a manner, which was appropriate to the communication, needs of residents. Risk assessments were routinely undertaken for all residents around nutrition, manual handling, continence, falls and pressure care areas and were reviewed on a monthly basis or when required. Monthly weight checks were undertaken for all residents and appropriate action being taken where necessary. Records indicated other health professionals such as the district nurses, optical, dental and chiropody services saw residents. The district nurse visiting the home was spoken to as part of the inspection. She spoke very highly of the home and stated, “ This is one of my favourite homes. When I have visited, the girls are singing with the residents, they really join in and there is a lot of staff interaction. If I had my mother, I would place her here, its like a family home. I have seen staff re-assure residents and talk to them when we are treating them. The staff are very good. They talk to me about other residents if they have any concerns. We very rarely get residents with pressure sores here. Patients do mobilise a lot here. Residents always look happy. I enjoy coming here and get assistance from staff who do work with me. There is always a lot of laughter here.” The home has also implemented the end of life care scheme. The scheme focuses on agreed practices to support people when they are terminally ill or who are at the end of their life. The main premise of this is to involve the resident and establish their needs and wishes and to ensure these are met by the service. The home is to be commended for implementing this programme. The accident and incident book was reviewed. Accidents were recorded in full, but there was no documentation to evidence that residents received follow up Dury Falls DS0000027842.V368466.R03.S.doc Version 5.2 Page 13 checks to ensure there were no further health-associated risks. A requirement in relation to these findings will be stated as Requirement 1. There are policies and procedures for the handling and recording of medicines. Guidelines have also been put in place on the action required in the event of a medication error occurring, meeting the requirement made at the last inspection. An audit was undertaken of the management of medicine within the home and a random sample of Medication Administration Records (MAR) charts were examined. The medication files on each floor included the signatures of staff with permission to administer medication. Each resident medication file included a photo card and a description of any allergies they have, which is good practice. However the following issues were highlighted and discussed with the manager of the home. • • On viewing the controlled drugs register, a second signed entry for the witness of administration was missing on two occasions. This does not ensure that the safety of residents is safeguarded. On examining the recording for the fridge temperatures for temperature-controlled drugs, entries were not recorded consistently. In total 4 entries were missing from March 2008 to July 2008. It is Requirement 2 that two members of staff sign the controlled drugs register to verify the correct administration of medication at all times and that fridge temperatures for the storage of temperature controlled drugs are recorded on a daily basis. There were hand written entries on the Mar chart, which were not always clearly signed and dated. A pharmacy inspector examined these charts. He advised that although staff had placed their initials on the chart but not in the actual medication details box, it is recommended that in addition to current practices that staff clearly sign and date in the medication details box when making a handwritten entry, to ensure accountability of those making the entries. This will be stated as Recommendation 1. • All care plans viewed contained information on the end of life wishes of residents and the contact details of relatives and representatives where appropriate. Relatives spoken to all spoke very highly of the care provided at the home and felt their loved ones were treated and cared for with respect and their rights to privacy were upheld. One relative said, “We are kept informed of everything. We are very pleased with the care provided here. I just cannot fault the care. I visit nearly everyday and I have seen residents been given sun hats when going out into the garden, its very personalised here. We wouldn’t change it for the world.” “My mum before she moved in here wasn’t eating. It’s the best things we’ve done, moving her here. She has put on a stone in weight. She herself has never looked back. I visit her every other day. The staff are lovely. Dury Falls DS0000027842.V368466.R03.S.doc Version 5.2 Page 14 They are genuine. You can come in here at any time and its never any different. It’s a home from home environment, I would say its perfect.” Dury Falls DS0000027842.V368466.R03.S.doc Version 5.2 Page 15 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 People using the service receive good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There is a varied programme of activities available and residents are given the opportunity to take part in a variety of activities within the home. However, the provision of activities outside the needs to be reviewed to ensure the recreational needs of people who use the service are met. There is a wide choice of meals in the home, to ensure they meet the needs and choices of all residents. Visiting times are flexible and people are made to feel welcome in the home, so that residents are able to maintain contact with their family and friends as they wish. EVIDENCE: The service employs a hobby therapist who provides a wide range of activities for residents and provides activities specific for those individuals with dementia. Activities included music and movement, exercises, arts and hobby crafts, food tasting, games, quizzes and reminiscence sessions. There were Dury Falls DS0000027842.V368466.R03.S.doc Version 5.2 Page 16 also a range of books, music cds and war memorabilia available to residents. Each resident’s spiritual and religious needs were identified on their care plan, and a monthly church service was provided to residents who wished to attend at the home. During the day of the inspection residents were participating in an arts and crafts session, which they all seemed to be enjoying very much. One relative said, “ The hobby therapist is wonderful. When I visited one time the residents were all doing a buffet and playing hops- scotch. They have had entertainment and they also have a church service here.” The district nurse informed, “ I came in one day and the residents were having cheese and wine and the hobby therapist had all the residents’ attention. I have seen them go out into the garden and all sitting around the pond. The therapist is very good with them.” “ My mother couldn’t do some of things she does in here now. The hobby therapist is marvellous. One day I came in and played all the games with them, the residents were really enjoying themselves. I would recommend this home to anybody,” informed another relative. Although residents have the choice to participate in a range of activities within the home, there was very little evidence to suggest that residents also participate in activities within the community or go out on regular outings. It is Recommendation 2 that the provision of outdoor activities is reviewed, to ensure all residents have the opportunity to be part of the community. The inspector joined residents during the lunchtime meal in the main dining room. Residents had a choice to eat in the dining room, in the lounge or in their room. Tables were set and were well presented. Each table had their own set of condiments and all residents were offered a selection of drinks. The main menu for the day was steak and onion pie or mushroom pie with potatoes, cabbage and mixed vegetables. Dessert was crème caramel or ice cream. The meals were well presented and looked and smelt appetising. All residents were asked individually if they wanted gravy and were later asked if they would like seconds. All residents were observed to be enjoying their meals. One resident when asked what she thought of the food said, “It is very nice, it is worth eating.” Another resident informed, “ I enjoyed it that very much. I’ve had two lots. Other comments from residents included “this is tasty”, “very nice”, and “ovely.” The meals were not rushed and there was a very relaxed atmosphere in the dining room, and residents if required were supported to eat. One resident who was being supported to eat was supported to eat at her own pace. On speaking to the cook, she was able to demonstrate her knowledge of those residents requiring special diets, for example diabetic and pureed diets. A tour of the kitchen was taken, which was kept clean and in good working order. There was a wide range of fruit and vegetables and meats. Fridge, freezer and food temperatures were taken daily and food was correctly labelled with date of opening. Dury Falls DS0000027842.V368466.R03.S.doc Version 5.2 Page 17 Visiting times were flexible and visitors could visit at any time convenient to residents. Relatives, family and friends were seen to visit residents throughout the time of the inspection and were made to feel welcomed by the staff at the home. Dury Falls DS0000027842.V368466.R03.S.doc Version 5.2 Page 18 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 People using the service receive good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users can be assured their views are listened to and acted on. However, the service needs to broaden its way of recording complaints to include concerns, to ensure any dissatisfaction is recorded and acted upon regardless of source. Training in Safeguarding adults is made available to all staff. However, the service needs to ensure all staff also attends regular refreshers to ensure staff are equipped with any updates to procedures and practices to ensure they have the skills and knowledge to protect the safety of people who use the service. EVIDENCE: The home has an open culture that allows residents to express their views and concerns in a safe and understanding environment. Residents and others involved with the service informed that they are happy with the service provided, feel safe and well supported by the service. The complaints procedure is clear and easy to follow and was displayed at the home. Timescales within which a complaint would be investigated were stated on the complaints procedure and included the contact details for the Commission for Social Care Inspection. The complaints file was viewed. Dury Falls DS0000027842.V368466.R03.S.doc Version 5.2 Page 19 Since the last inspection the service has not received any complaints and the Commission for Social Care Inspection has not been informed of any complaints. However, evidence was not seen of verbal concerns recorded by the service or how they are actioned. It is Requirement 3 that all concerns about the care of service users, regardless of source or how they are made, are recorded and responded to. The service has comprehensive safeguarding adults procedures and protocols in place and give clear specific guidance to those using them . There are also clear systems for staff to report concerns about colleagues and managers. Staff are ensured that “blow the whistle” on bad practise is supported by the service. The service has obtained safeguarding adult protection procedures devised by The London Borough of Havering. Some staff have had training in safeguarding adults but others require updated training in the area. One member of staff whose file was examined had attended training in safeguarding in 2005. A recommendation in relation to staff training has been made under staffing in the report. We were pleased to note other training around dealing with physical and verbal aggression is also made available to all staff, which are all staff have attended. Dury Falls DS0000027842.V368466.R03.S.doc Version 5.2 Page 20 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, 20, 21, 22, 23, 24, 25, 26 People using the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The standard of the environment within the home was satisfactory but needed redecorating in some parts of the home, to ensure residents live in a wellmaintained environment. EVIDENCE: The home provides a environment which is bright and airy. The home is a traditional listed building and some of the original features of the building such as narrow corridors and low doors do restrict the use of wheelchairs. The home has two main lounges, a dining room, which is homely and adequately furnished. All of residents’ bedrooms were seen. Bedrooms were personalised by furniture residents had brought with them when moving to the home and by personal family photographs, pictures, televisions and radios. Residents and Dury Falls DS0000027842.V368466.R03.S.doc Version 5.2 Page 21 relatives informed that the home is clean, warm and well lit. Toilets are appropriately located within the home, are easily accessible and in sufficient numbers. The service provides suitable aids and adaptations where required. There were hoists and other aids available at the home. Currently there are ten double rooms and eight single rooms and six rooms have en-suite facilities. Due to the high number of double bedrooms at the home, residents are not always able to have the option of a single room. This has led in an increased number of vacancies at the home and the registered manager informed that they are currently exploring the idea to convert all double bedrooms into single bedrooms. Although shared rooms do have screens, which afford some privacy, they cannot fully maintain or promote a residents dignity especially when using the commode. Relatives spoken to during the inspection all spoke very positively about the care provided at the home and informed that they were given the opportunity to look around the home and bedroom available, and where their loved one was sharing a room this was done with the agreement of the individuals involved. During the tour of the premises, it was identified that some residents’ bedrooms had loose wiring, which could be serious trip hazard. Bars of soap were provided in two communal bathrooms, which can increase the risks of infection. Some bedrooms were also malodorous and overall the premises were in need of re-decoration, for example needed painting in some areas. All parts of the home to which residents have access to must be so far reasonably practicable made free from hazards to their safety and unnecessary risks to residents are identified and so far as possible eliminated, this will be stated as Requirement 4. Dury Falls DS0000027842.V368466.R03.S.doc Version 5.2 Page 22 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 People using the service receive good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Recruitment practices are robust and ensure residents are in safe hands at all times. Adequate staff training is provided to all care staff, to ensure they are equipped with the skills and are competent to do their jobs. However, training in safeguarding adults needs to be reviewed to ensure staff receive refreshers where required, to ensure they are provided with updates to their practice and skills. There is good skill mix of staff but the service must ensure that there are adequate staffing levels at busy times to meet the needs of residents and ensure their safety. EVIDENCE: The staffing levels at the home consist of four members of staff during the day, (including a senior) and two waking members of staff on duty at night. There is also support of a cook in the mornings, a domestic, a laundry assistant and a maintenance man. The cook does not work in the afternoons and one member of staff has the responsibility to prepare the tea. Staff in addition also prepares and put drinks in residents rooms. This can take staff from approximately 3.30 Dury Falls DS0000027842.V368466.R03.S.doc Version 5.2 Page 23 to 6 pm as tea is served at 5 pm, only leaving three members of staff to care for 24 residents, 28 if the home is fully occupied. At the last inspection a requirement was made for the registered persons to review the staffing levels at the home and the deployment of staff in order to ensure that there are sufficient numbers of staff to meet the needs of residents at all times. The registered manager informed that they have employed one member of staff and are waiting for references and are looking into employing a cook to work in the afternoons. The service is registered to care for individuals who have dementia and some individuals who have a high level of care needs. There have also been incidents at the home were some residents have attacked other residents. Increased staffing levels would provide more support to staff and residents at peak times and if an incident placing the safety of residents at risk occurs. Therefore the service must ensure that the needs of people who use the service are met by adequate numbers of care staff. It is Requirement 5 that the registered persons ensures that staffing levels are increased during busy times of the day to ensure the home is staffed efficiently and consults the guidance on staffing levels in care homes by the Department of Health. Three staff files were closely examined, two files were of recently recruited members of staff, which were all in good order. References and Criminals Records Bureau checks had been obtained for all three members of staff. Both newly recruited members of staff had received comprehensive inductions and had worked through an induction pack. All staff receive relevant training that is focused on delivering improved outcomes for residents. Staff have received training in Advanced Dementia, which included module on dealing with challenging behaviour, provided by the Havering training development programme, food safety, medication administration, first aid, food hygiene, Mental Capacity Act, and infection control. Although the staff team had received training in safeguarding adults, some members of staff required further refreshers as one member of staff had been on training in safeguarding adults in 2005. It is Recommendation 3 that that training in safeguarding adults is reviewed and refresher training is provided accordingly. As informed by the Annual Quality Assurance Assessment completed by the service, 76 of the care staff team are NVQ qualified exceeding the requirements made by the National Minimum Standards. As discussed throughout the report, very positive comments were received from relatives and professionals spoken during the inspection regarding the staff at the home. Dury Falls DS0000027842.V368466.R03.S.doc Version 5.2 Page 24 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, 36, 37, 38 People using the service good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from experienced managers who recognise their needs and adequately manage the home. The safety of residents is not always protected as the management within the home have sometimes failed to follow policies and procedures, which are in place to ensure the safety of people who use the service. Systems for service user consultation have been implemented, to ensure residents’ views underpin all self-monitoring, reviews and developments by the home. Residents can be confident that the staff team who care for them benefit from regular supervision. Service users’ financial interests are safeguarded Dury Falls DS0000027842.V368466.R03.S.doc Version 5.2 Page 25 EVIDENCE: The managers’ post is a job share position and both managers are registered with the Commission for Social Care Inspection. One manager holds the registered managers award. Both managers train and develop staff who are generally competent and knowledgeable to care for people who use the service. The service works in partnership with families or close friends, as appropriate and professionals. Feedback from both residents and relatives as highlighted in the report has been positive about the way the home is run. The management are aware of the need to promote safeguarding and has developed policies and procedures to meet requirements and legislation, but there are gaps in following these protocols. On examining the service’s incident and accident record book it was evident that the service had not followed safeguarding procedures. The homes policy on abuse states “This home believes that all service users have the right to live their life with privacy, dignity, independence and choice in a safe, non-threatening and abuse-free environment. The home will work in collaboration with all legal and caring agencies to uphold this right and to ensure that our residents are protected from harm through abuse or exploitation at all times. The policy further states, “The home manager is also responsible for informing and co-ordinating contact with external agencies.” Two incidents where one resident hit another resident on the left hand with their walking stick and another incident where a resident slapped another resident on the back of her head should have been reported to the London Borough of Havering safeguarding adults’ team and reported to the Commission for Social Care Inspection through a Regulation 37 notification in line with safeguarding protocols. The incidents were recorded in full in the home’s incident and accident book and the care plans for the individuals concerned were reviewed on a regular basis. However, as discussed under the standard of staffing, increasing staffing levels at the home would also provide more support to staff and residents at peak times and if an incident placing the safety of residents at risk occurred. The registered persons must ensure safeguarding protocols are always correctly followed, to ensure the protection of people who use the service. The Commission for Social Care must be informed of any Safeguarding alerts through the completion of Regulation 37 notification forms. This will be stated as Requirement 6. Dury Falls DS0000027842.V368466.R03.S.doc Version 5.2 Page 26 Services users’ records of finances were viewed and the inspector tracked the amount of money the service held for three service users. All amounts were accounted correctly and were in order. Staff supervision records evidenced that staff were supervised at least six times a year, ensuring staff are provided with the skills, training and knowledge to perform the tasks required by their employment role. Staff supervision records were very detailed and clearly recorded action points and the discussion that took place. Staff also discussed the policies and procedures of the home at these sessions, which is very good practice. There is an annual quality assurance programme and the results of the surveys completed in 2007 were viewed. These results had been analysed and actioned. The service is also in the process of analysing the results from surveys completed with people who use the service this year. All sections of the annual quality assurance assessment were completed. Overall the information gave a good picture of the current situation within the service. The evidence to support the comments made was satisfactory, and supporting evidence was provided to illustrate what the service has done in the last year, or how it is planning to improve. Health and Safety records were inspected. The gas and safety certificate, gas safety inspection, fire system and emergency lights were all in good order and appropriately completed. Water temperature checks throughout the home were only checked annually. The temperatures are thermostat controlled. The Health and Safety Executive in their Health and Safety in Care Homes, guidance informs that water temperature checks must be completed on a weekly basis. Water temperatures checks must be completed weekly to ensure the safety of people who use the service. This will be stated as Requirement 7. Dury Falls DS0000027842.V368466.R03.S.doc Version 5.2 Page 27 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 3 3 3 3 3 2 STAFFING Standard No Score 27 2 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 3 2 2 Dury Falls DS0000027842.V368466.R03.S.doc Version 5.2 Page 28 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 Regulation 13 Requirement The registered persons must ensure that when accidents occur, documentation must evidence that residents receive follow up checks to ensure there are no further health associated risks. The registered persons must ensure that two members of staff sign the controlled drugs register to verify the correct administration of medication at all times and that fridge temperatures for the storage of temperature controlled drugs are recorded on a daily basis. The registered persons must ensure that all concerns or complaints about the care of service users, regardless of source or how they are made, are recorded and responded to. The registered persons must ensure that all parts of the home to which residents have access must be so far reasonably practicable made free from hazards to their safety and unnecessary risks to residents DS0000027842.V368466.R03.S.doc Timescale for action 31/10/08 2 13 (2) 31/08/08 3 OP16 22 31/10/08 4 OP19 13 (4) (a) 31/10/08 Dury Falls Version 5.2 Page 29 5 OP27 18 (1) (a) 6 OP18 13, 22 7 OP38 13, 17 are identified and so far as possible eliminated. The registered persons must ensure that staffing levels are increased during busy times of the day to ensure the home is staffed efficiently and consults the guidance on staffing levels in care homes by the Department of Health. The registered persons must ensure safeguarding protocols are always correctly followed, to ensure the protection of people who use the service. The Commission for Social Care must be informed of any Safeguarding alerts through the completion of Regulation 37 notification forms. The registered persons must ensure that water temperatures checks are completed weekly to ensure the safety of people who use the service, in line with guidance from the Health and Safety Executive in their Health and Safety in Care Homes. 30/11/08 31/08/08 31/08/08 Dury Falls DS0000027842.V368466.R03.S.doc Version 5.2 Page 30 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 OP9 Good Practice Recommendations It is recommended that addition to current practices that staff clearly sign and date in the medication details box when making a handwritten entry, to ensure accountability of those making the entries. It is recommended that the provision of outdoor activities is reviewed, to ensure all residents have the opportunity to be part of the community. It is recommended that training in safeguarding adults is reviewed and refresher training is provided accordingly. 2 3 OP13 OP30 Dury Falls DS0000027842.V368466.R03.S.doc Version 5.2 Page 31 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Dury Falls DS0000027842.V368466.R03.S.doc Version 5.2 Page 32 - 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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