Care Home: The Dales Care Home

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What the care home does well People told us they had a positive experience when moving into this service, and one person said "the staff were very supportive, I was not rushed into making any decisions straight away, I was given plenty of time to make my mind up about my future". People told us the service had a `good reputation in the area`, and this was one of the main reasons they chose to us this service. People are consulted about their plan of care to ensure this meets their preferences and requirements. People told us they had `plenty to do` and that the recreational activities `met their preferences`. People made the following comments about the service they received: "The staff are lovely and they are very good at their job, I feel well cared for". "The staff are excellent and very caring, they support me with dignity and respect at all times, I cannot fault them". "This is the best place, as everyone is friendly, and the staff are kind, caring and competent in the work they do". People are supported by a trained staff team who have been recruited to ensure they are protected and kept safe. People are consulted about the service they receive, and are given the opportunity to provide feedback and suggest areas which they think could be improved. People live in a homely and relaxed environment, which has the required aids to support them with their mobility and independence. People spoke positively about the manager and the management team. Comments include: "All the managers are really good and they always come and say hello". "The manager is excellent, she is a diamond, so nice and approachable and she manages the service very well". "The managers are good and very responsive to any of our requests". People told us they were "happy and satisfied with living at this service", which they said "meets all of our needs" What has improved since the last inspection? There was no requirements made following our last key inspection. What the care home could do better: We have not made any requirements following this visit. We have made some good practice recommendations, which if addressed will enhance the service people receive. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Dales Care Home Fisher Close Repton Derbyshire DE65 6GS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Claire Williams     Date: 2 6 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: The Dales Care Home Fisher Close Repton Derbyshire DE65 6GS 01283238200 01283238203 yvonnemccomish@derbyshire.gov.uk www.derbyshire.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Derbyshire County Council care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 22 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 Date of last inspection Brief description of the care home The Dales provides personal care and support for up to twenty-two older persons, both male and female. It is located in a residential area in the village of Repton, close to local amenities. The building is purpose built and the accommodation is provided on the ground floor. There are two wings, each providing a lounge and dining area, and toilets are located Care Homes for Older People Page 4 of 27 Over 65 22 0 Brief description of the care home close by along a corridor. There are twenty-two single bedrooms, although none of these have en-suite facilities. There are suitably adapted bathroom facilities located on each wing, and equipment is provided to assist people with their mobility. The building provides level access and is therefore accessible throughout to assist those people with mobility problems. There are emergency call systems located in all private and communal areas accessed by people who live at the home. The building has several garden areas that people can access. A resource centre is attached to the building, and people living in the home are able to make use of the facilities provided. A copy of the most recent inspection report is openly displayed in the reception area, along with the Statement of purpose and Service user guide. Fees charged currently commence from £108.10 min to £344.82 per week per person. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was unannounced and involved a visit to the site on 26th May 2009 which lasted for a period of a day. The focus of inspections undertaken by the Care Quality Commission is upon outcomes for people who use the service and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. Where possible, we include evidence from other sources, such as District Nurses and Social Workers. We also use information gathered since the last key inspection which was undertaken on 22nd August 2007, to support our judgements. This may include notifications from the provider, complaints or concerns and the pre-inspection annual quality assurance questionnaire, which the provider is required to complete prior to a Care Homes for Older People Page 6 of 27 visit to the service. The main method of inspection used during the visit to this service was case tracking. This involved selecting three people who use the service and tracking the care they receive through the review of their records, discussion with them where possible, the care staff and observation of care practices. We looked at all of the key standards during our visit. What the care home does well: What has improved since the last inspection? There was no requirements made following our last key inspection. Care Homes for Older People Page 8 of 27 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to information, which enables them to make an informed choice about moving into this service. Evidence: The manager told us in the information supplied about the service they encourage trial visits which would include taster activity sessions, meals, experiences on both wings and the people within them. They undertake comprehensive assessments to determine if they can meet the individuals needs. She told us they intend to improve in this area by implementing the Personal Profile form, in addition to their assessment tool in order to detail family history and personal preferences. The manager intends to implement the findings from the My Home Life focus group which she attends whose theoretical base outlines the importance of relationship-centered care. She feels that if these principles are implemented from admission, it will maximise the chances of a care home placement making life secure, significant and fulfilling. Care Homes for Older People Page 11 of 27 Evidence: The discussions held with people and looking at three people care files, demonstrated that people are assessed before their admission to this service. People told us they were provided with information about the service, and encouraged to visit the service before they make a decision about their future. People who spoke with us about their admission told us: I was poorly when I came in for respite and I was looked after very well. When I was feeling better only then did I start deciding what to do about my future. The staff and manager were very patient and supportive to me during this time. People told us my needs are met by the service, and I had a positive transition when I moved in. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person has a plan of support which covers their personal, health and social care needs. This ensures support is provided based on their preferences. Evidence: The manager told us in the information supplied about the service that they conduct written risk assessments for health monitoring and review as necessary for maximising health. She undertakes on-going assessments of peoples needs to ensure both individual and communal needs provided for by the home staff are at a manageable balance. The manager told us they communicate effectively about all health changes of people among staff and families for the purposes of positive, healthgiving outcomes. We looked at three peoples care more closely and looked at their care files. Each file contained an updated plan of care which was completed in sufficient detail to inform the delivery of the persons care. Additional information was provided within the care plan to reflect peoples preferences on how they would like to be supported. This included information about peoples preferred daily living, personal care routines, and Care Homes for Older People Page 13 of 27 Evidence: their support needs throughout the night. This ensures people receive individualised care which meets their expectations. Each care plan that we sampled contained the required risk assessments that should be undertaken to monitor peoples mobility, pressure areas, nutrition and falls. These were reviewed as required. The care records that we sampled and discussions with people confirmed that contact with external health care services is routinely made. There was evidence in the files to support that the plan of care is reviewed on a regular basis. However the format for this is a date recorded against the specific document that has been reviewed, no other explanation is recorded to make it clear if any of the persons needs have changed. There was evidence to support that people have a formal review on an annual basis. We had the opportunity to speak with some visitors who were at the service during our visit. They made the following comments about the service; My relative is very well looked after and we now have piece of mind that they are safe and have all their needs met. The staff are excellent and so is the manager. We feel very lucky our relative is living in this service. We think the service is great and my relative receives the best care. The staff are really good and very caring, it is the best home in the area, and we are very happy. All of the people we spoke to told us they receive support which is provided in a safe, respectful and dignified manner, and our observations, supported this. When we looked at the arrangements for the handling and management of peoples medicines by the service, we found these to be satisfactory and people were receiving their medication as prescribed. The manager undertakes regular checks on the systems in place in order to ensure safe practices are followed. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People find the lifestyle experienced in the service meets their expectations and preferences. Evidence: The manager told us in the information supplied about the service they have a designated activity worker who is also a trained care assistant, so she knows the people who live in the service and what their interests are. She told us they encourage people to join in with group sessions and those who do not wish to receive one-to-one sessions. The manager told us they involve people in the newly re-formed Amenity committee- the Friends of the Dales. This has served to re-forge the links with the local community. An example of this was provided by the manager; she told us how the service made a contribution towards a Repton Church Flower Festival for a display on remembrance in honor of past residents of the Dales and this provided a trip to the church. The records we looked at and the discussions we had with people confirmed the information provided in the self assessment. People told us they were happy with the provision of activities provided, and they confirmed they were consulted about what activities they would like to participant in. This ensures their social needs and Care Homes for Older People Page 15 of 27 Evidence: preferences are met. People told us they particular enjoy a game of bingo, where they can win prizes, and the trips and meals out. We spoke with the activities staff member, who demonstrated a good knowledge of peoples support needs and interests. She also showed us some of the art work and craft items people have made ready for the summer fete, which they will be selling to raise funds for the amenities. People told us they were able to choose how they wished to spend their day, and if this resulted in them remaining in their room, this decision was respected. During our visit we observed people playing bingo, and a group of men was sitting together discussing recent football results. We joined people for their lunch-time meal. The tables were set with tablecloths and condiments so people could help themselves. People told us they have choices, at each meal time and observations supported this. We visited the kitchen and spoke with the catering staff who were able to show us records of peoples dietary requirements. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems in place ensure people have confidence to raise their concerns, and are safeguarded from harm. Evidence: In the self assessment we received, the manager told us the service receives few complaints as they try to operate all the care systems with transparency and in an informative way. She said they have had a number of commendations from families and friends of the people who live at the Dales and these are now recorded. She told us they have a complaints procedure in place, and any issues raised are responded to as swiftly as possible. The manager said they try not to be defensive about remarks or criticisms made about the care provided, as they wish to offer as high a quality of care as possible. During our discussions with people they told us they knew how to complain and they said they would not hesitate to raise any issues with the staff team or manager. The feedback provided in the surveys also confirmed that people was aware of how to raise any concerns. The relatives we spoke to told us they would go straight to the manager or speak with a staff member if they had anything to raise, but one person said we have no cause to complain this is a good home. Both people and their relatives commented that if they did raise any issues they had confidence that action would be taken straight Care Homes for Older People Page 17 of 27 Evidence: away. One comment made was, the manager is very pro-active and is very responsive to anything we say. People told us they have access to the complaints procedure in the information they have been provided with and it is displayed in several areas of the home. As stated in the self assessment the service has had one complaint which was made by a person who lives in the service. This was investigated but not upheld due to it being a misunderstanding. The staff we spoke to demonstrated their awareness of both the complaints procedure and their role and responsibilities concerned with dealing with any potential abusive incidents. The staff and the records we looked at demonstrated they had received training in this areas. The service have not had any safeguarding incidents since our last visit. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a clean, and safe building that is homely in design and meets their needs. Evidence: The manager told us in the information supplied about the service they provide clear, level-access, and a homely environment with newly furnished bedroom and communal areas. She said they have a homely atmosphere and individuals feel able to express themselves and move about freely. The manager provided us with an example of how they respond to individual needs; one person felt cold even though the radiator was constantly on full during last winter, therefore a larger radiator was installed to ensure their comfort. We undertook a brief tour of the building and all areas we visited were found to be clean, comfortable, homely, warm and well lit. All areas were furnished and decorated to a good standard. People told us they really liked the layout of the building, in particular the small lounge areas which they said make it really homely and cosy. They told us they were encouraged to personalise their bedrooms and those visited reflected peoples preferences. People told us the building suited their needs, and they confirmed they had access to equipment which encouraged and promoted their independence. Care Homes for Older People Page 19 of 27 Evidence: People confirmed they were offered a key when they moved into this service to enable them to lock their bedroom door. They also told us they thought the garden areas were well maintained and looked very pretty with all the different colours. People told us some volunteers from the local community visit regularly and help them to maintain the front garden area. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a competent staff team, who have been recruited to ensure they are safeguarded from any harm. Evidence: The manager told us in the information supplied about the service, they have a dedicated and committed care staff team who seek high standards and have covered all vacant shifts to afford continuity of care in the last 12 months. Many of our Care staff have worked at the service for some time; they are, therefore, well trained and happy to develop their role towards high quality care. She said the whole staff group are flexible and often cover different job roles to the benefit of the home. During our visit we observed that sufficient staff members were on duty in order to meet peoples dependency needs. We were told by staff and people that the service has experienced periods of staff shortages. However as stated in the self assessment and as demonstrated by the staff rotas, all vacant shifts have been covered by the existing staff in order to prevent any impact on the people who live in this service. Evidence in the self assessment demonstrated that additional hours have now been allocated for a laundry person. This means care staff will no longer have the responsibility of these tasks, and therefore they will be able to spend more time with people. Staff spoken to told us they were happy with these arrangements and looked Care Homes for Older People Page 21 of 27 Evidence: forward to spending more quality time with individuals. People, and their relatives commented positively about the standard of care provided and comments made included: The staff are brilliant they do difficult jobs to a high standard. The staff are very welcoming and informative, they show they care and are committed to their job. This is the best home in the area, I cannot fault it, I am well looked after. Discussions with staff members confirmed that the staffing levels are sufficient to enable them to meet peoples needs. They spoke about the recent difficulties of covering vacant shifts and said they looked forward to the new staff starting employment. Staff and relatives told us they are kept informed about this process and said its the recruitment that takes so long, so we have to be patient. Discussions with the staff team demonstrated their enthusiasm, commitment and motivation to ensuring they support people to a good standard. Staff told us they have access to positive training opportunities and the records confirmed this. The staff recruitment information is now started centrally. We requested evidence to support the recruitment of three staff members recently recruited to this service. The evidence provided demonstrated that all of the required checks had been undertaken to ensure these individuals were suitable for their role. We were also provided with information to support that new staff members are provided with an induction to assist them to gain the required skills and knowledge for their role. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a service which keeps them safe and is managed in their best interests. Evidence: The manager told us in the information supplied about the service how they take a safe and considered approach to managing the service. She said that although the management team has been affected by long term sickness, progress with management projects has taken place, just more slowly. She told us they ensure they undertake on-going assessment of peoples needs and scrutiny of how these balance with the staffing complement. The manager told us procedures for supervising staff, monitoring staff performance and attendance management have been exercised fairly and equitably. The records we looked at and discussions with staff confirmed they have access to regular supervision and team meetings. People their relatives and feedback provided in the surveys told us that the service Care Homes for Older People Page 23 of 27 Evidence: was managed well and people were consulted about the running of the service. We looked at evidence to support regular meetings are facilitated and various topics discussed, to enable people to provide feedback and comment on any improvements. People spoke positively about the management team who they described as approachable, kind, and accessible. The staff team told us they felt supported in their role, and told us the managers are always available, and the office door is always open, we only have to ask. People and their relatives told us they receive surveys on an annual basis, asking for their feedback about the service. The findings of which were displayed around the service and this demonstrated peoples satisfaction. People said they were happy with the way their personal money was managed. We looked at the systems in place and these were satisfactory. A delegate of the provider undertakes monthly visits and completes a report of their findings. This is to monitor the standards in the service and ensure it is meeting peoples needs. The reports cover the required areas and indicated that standards have been maintained on a monthly basis. The service continues to keep us informed of any significant events in the service. They completed their self assessment within the timescale provided and the information provided was detailed and comprehensive. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 7 8 A written outcome would be beneficial to support the monthly review of the care plans. Action that is taken in relation to peoples pressure areas should be recorded on the tissue viability form. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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