Care Home: The Dell Residential Care Home

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What the care home does well The home was an attractively furnished, comfortable and well maintained environment. The home was clean and free from offensive odours. There were several communal areas where residents could choose to sit and take part in activities, or just relax. The new bedrooms were of a high standard with ensuite facilities and excellent access. Residents we spoke to during the inspection said that they were comfortable in the home. Relatives were complimentary about the staff and the home. Their comments included: Very friendly. Give me support as well as my Mum. The place is always spotless. The home has a warm homely atmosphere and the staff are friendly and caring. Friendly, attentive, supportive, caring service. What has improved since the last inspection? The staffing levels of care and non-care staff have increased as the additional places have been filled. The levels on the day of the inspection should be sufficient to meet the varying needs of the current residents, and to maintain a pleasant and hygienic environment. A full-time gardener/handyman has been recruited to support the maintenance manager, as well as an administrative officer and a finance officer. Residents` meetings have been introduced to ensure their views on the home are taken into account, together with any suggestions for improvements, and any concerns they have. The recording of accidents and incidents affecting residents has improved, giving better information on which residents are most at risk. The recording of medication taken and refused has improved, to ensure that the doctor can be called if there is a pattern of refusals. A new conservatory has been added to the dining room, rooms have been upgraded with new carpets on a rolling programme, and a new shower has been fitted to an en-suite. The home has informed all families about an independent advocacy service which they could use for advice and help. An activities organiser has been introduced to provide a wider range of activities, both for groups of residents, and for those who prefer to be on their own. CARE HOMES FOR OLDER PEOPLE The Dell Residential Care Home The Dell Residential Care Home 45 Cotmer Road Oulton Broad Lowestoft Suffolk NR33 9PL Lead Inspector John Goodship Unannounced Inspection 25th June 2008 09:40 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 The Dell Residential Care Home DS0000066686.V366915.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. The Dell Residential Care Home DS0000066686.V366915.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Dell Residential Care Home Address The Dell Residential Care Home 45 Cotmer Road Oulton Broad Lowestoft Suffolk NR33 9PL 01502 572591 01502 572591 No e-mail address as at 14/5/08 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) Maria Assumpta Egan Peter John Egan Mrs Jean Spoor Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places The Dell Residential Care Home DS0000066686.V366915.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th July 2007 Brief Description of the Service: The Dell Residential Care Home is situated in Oulton Broad, Lowestoft. The home was first registered in 1985 to provide care for up to 27 older people, and was taken over by new proprietors Mr and Mrs Egan in March 2006. It now has accommodation for 41 people in single rooms and two shared rooms. Oulton Broad and the Oulton Broad South railway station is within walking distance and a bus service is available to Lowestoft. A variety of local shops and facilities are situated close by. The home is a large two storey Victorian House with a recent extension set in pleasant well maintained gardens, which provides seating areas for service users to enjoy if they choose. The majority of bedrooms are situated on the ground floor, with the remaining rooms on the first floor, which can be accessed by a stair lift or shaft lift. The home has a large dining room, two lounges and two conservatories. At the time of the inspection the standard charge for new residents was between £400.00 and £515.00 per week. The Dell Residential Care Home DS0000066686.V366915.R01.S.doc Version 5.2 Page 5 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 this service experience good quality outcomes. This inspection visit was unannounced and focussed on the outcomes for the residents covering the key standards which are listed under each section overleaf. This report includes evidence gathered during the visit together with information already held by the Commission. The visit lasted nine hours. The manager was present throughout. We toured the building, spoke to four residents in their room, two relatives by phone and two in the home, and interviewed two staff. We examined care plans, staff records, and maintenance records. We sent out a questionnaire survey before the visit to a sample of residents, relatives/friends, and staff. We received four replies from residents, six from relatives and four from staff. Their answers to the questions and any additional comments have been included in the appropriate sections of this report. We required the manager to complete an Annual Quality Assurance Assessment (AQAA). We have used information and comments from this document to inform our inspection, and reference is made to it throughout the report What the service does well: The home was an attractively furnished, comfortable and well maintained environment. The home was clean and free from offensive odours. There were several communal areas where residents could choose to sit and take part in activities, or just relax. The new bedrooms were of a high standard with ensuite facilities and excellent access. Residents we spoke to during the inspection said that they were comfortable in the home. Relatives were complimentary about the staff and the home. Their comments included: Very friendly. Give me support as well as my Mum. The place is always spotless. The home has a warm homely atmosphere and the staff are friendly and caring. Friendly, attentive, supportive, caring service. The Dell Residential Care Home DS0000066686.V366915.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The training of staff in the protection of vulnerable adults should be clearly recorded and regularly updated. This will increase the assurance that allegations of abuse will be recognised and reported in the proper way. Induction checklists should be completed for all new starters and retained in their files, to show that the relevant training and information has been given to them. The Dell Residential Care Home DS0000066686.V366915.R01.S.doc Version 5.2 Page 7 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. The Dell Residential Care Home DS0000066686.V366915.R01.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 The Dell Residential Care Home DS0000066686.V366915.R01.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): 1,2,3,4. Standard 6 is not applicable to this home. Quality in this outcome area is good. Prospective residents can be assured that they will have sufficient information to decide if this home is where they wish to live. The home will also collect information about the person to assure them that the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the inspection visit, there were thirty-seven residents, out of a total capacity of forty-one. One resident was due to be assessed that day by the manager of another home as they wished to live in a smaller home. The Statement of Purpose was examined and it contained all the information required by regulation, such as the organisation of the home, the staffing structure, the admission criteria and the number and sizes of rooms. The fees The Dell Residential Care Home DS0000066686.V366915.R01.S.doc Version 5.2 Page 10 charged were clearly stated, and the additional charges that would be payable for items such as hairdressing, and non-NHS professional services. The Service Users’ Guide included the names of the owners, details of the complaints procedure, and the fire procedures. It was produced in large print for easier reading. It included a helpful directory of local services. The home’s position on the laundering of residents’ personal clothing should be made clear in the admission information. The Contract of Care set out the Conditions of Admission and the terms of business. It stated the number of the room to be occupied and the fees to be charged. Residents who were fully supported by a local authority received a similar document but it was called ‘Client Information’. One resident wrote on their survey form that their daughter had looked at several homes in the area and had felt that The Dell offered the best care for their needs. A relative wrote in their survey that they had been advised by the hospital social worker of a suitable home when it was time for their relative to be discharged. A resident said that the home was very obliging and welcoming. A relative sitting in the lounge with their family member told us that they had looked at several homes before choosing The Dell. The care plan for a person recently admitted for long-term care contained a full pre-admission assessment covering all aspects of personal, social, and physical care needs. There was also an admission checklist to ensure that all information was gathered necessary for the care, and that the appropriate information was given to the resident and their relatives. One of these items covered the wishes of the resident when they died. The manager described in the AQAA that the home used a Customer Enquiry Form to ascertain at an early stage whether the applicant would fit the home’s admission criteria. The Dell Residential Care Home DS0000066686.V366915.R01.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. Quality in this outcome area is good. Residents can expect staff to identify and review their care needs to ensure appropriate care is given. Their safety is protected by the home’s medication procedure. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We examined three care plans, one for a recent admission, and two for residents who had been living in the home for over two years. They were both split into similar sections of care need. One had a care plan which identified needs by listing them under a spreadsheet with the headings “Problem, Aim, Action, By whom”. These included clear guidance for staff on how to support the resident to overcome the ‘problem’. For example, checking the hearing aid regularly, spending time with the resident to reduce their sense of isolation due to their communication difficulties, and reminding about personal hygiene. The Dell Residential Care Home DS0000066686.V366915.R01.S.doc Version 5.2 Page 12 Two of the plans contained evidence that the person’s care needs were reviewed regularly but the third one did not. The key worker was not able to explain this although they showed us that there was a monthly dependency assessment. This noted changes in, amongst other things, behaviour, in their ability to self-care and in mobility. The record for the most recent admission included the notes of the six week review after admission held with relatives. One file for a person who had been in the home over twelve months contained the notes of a review meeting with the resident, their daughter, the keyworker and the manager. The keyworker told us that it was usual to invite relatives. One resident had written in their survey that this was not so but we found no evidence that the policy had been changed. We noted that the frequency of completing the daily record was still intermittent in some cases. One person had no entries for three consecutive days in June 2008. It would be good practice, and helpful to reviewing care needs, for there to be at least an entry each day, and preferably at the end of each shift. All the plans contained weight charts, with monthly monitoring of their weight. There were no recent recordings. There were contacts sheets in the care plans recording all contacts with NHS services. Needs assessments included dependency, moving and handling and pressure area care. A keyworker described to us how they always checked a resident’s skin during bathing for signs of it breaking down. They would record this in the daily record, which we saw, and was evidence of the monitoring of resident’s health. Three of the four residents who replied to the survey said that they usually received the medical support they needed. “I find the staff very aware of any medical issues I have and act on them very promptly.” Another wrote: “Following a bad fall, I received a lot of help.” Over the previous twelve months, the home had bought profiling beds for three residents, to improve their comfort, and to assist staff to care for them safely. Three people mentioned in the survey that they sometimes had to wait to get assistance in their room. “I often have to wait but the staff are willing to help. Sometimes I have to ring the bell more than once to get help.” We noted that during the morning two rooms rang the call bell at the same time. The second one was not cancelled for seven minutes. However a few minutes later, another call bell was answered within one minute. The call system had an intercom facility so that residents could be told when there would be a delay in reaching them. The lunchtime medication round was observed. This was done while residents were seated at the tables ready for their meal. It was noted that the senior carer followed the correct procedure by signing the Medicine Administration The Dell Residential Care Home DS0000066686.V366915.R01.S.doc Version 5.2 Page 13 Record (MAR) sheet after they had seen the resident take their medication. The senior carer asked some residents if they needed any pain relief tablets in a discreet and quiet way. The MAR sheets were correctly completed, with photos of each person and a clear warning of any allergies. We noted that there was now a thermometer in the room where the medication was stored, and one for the drug fridge. There was a log of the temperatures which showed that both room and fridge were at a safe level for the medication. We noted that the eye drops for one resident had not been dated on opening. Another bottle had been dated. We checked the safety of the cabinet for controlled drugs. This was metal and screwed to the wall. The contents were checked against the records and were in order. We observed that staff treated residents with respect. They knocked on residents’ room doors before entering, and they told us that personal care and medical care was given in the privacy of residents’ rooms. All rooms were able to have a telephone fitted. One relative had written to the home to thank the manager and staff for the care of their family member to the end of their life. The Dell Residential Care Home DS0000066686.V366915.R01.S.doc Version 5.2 Page 14 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. Residents can expect to be offered a choice of activities, to be supported to maintain family and other contacts and to be offered a choice of nutritional meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An enlarged communal lounge had been built at the rear of the home at the same time as the extension. This was a light and well furnished area, with the chairs placed in groups to encourage a more homely look. Fourteen residents were sitting there during the morning. Two relatives were sitting with their family members. The recently appointed activities organiser was setting up to play Bingo. They had the help of a volunteer carer who had come in on their day off. The organiser started off by ensuring that everyone had a drink. They had previous experience as a carer in the home and were employed for three days a week. They told us that on Mondays they go through a programme of exercises with residents, Wednesday is Bingo, and on Friday they visit residents who cannot, or who are unwilling, to leave their rooms to talk to The Dell Residential Care Home DS0000066686.V366915.R01.S.doc Version 5.2 Page 15 them about their own interests. They recorded what activities took place, and who participated, in the Activity log book. We also saw an entertainment schedule on the notice board. Seven events had taken place in June, covering music in the home and visits to community activities outside. Three of the four residents who replied to the survey said there were sometimes activities they could take part in. one said that “in spite of entreaties to take part, I am happy to keep my own company.” Another said: “Although I cannot see to play Bingo, I enjoy all other forms of entertainment and mental stimulation”. Several residents who were visited by the inspector in their room said that they preferred to stay there most of the day except for their meals. A relative, who was visiting the home, said they were pleased that an activities organiser had been appointed, as they were concerned about the lack of stimulation for their family member. A carer told us “The minibus takes residents to shops and goes out on outings usually once a week. Staff take residents out for meals and shopping trips if they have no immediate family.” The minibus is a twelve seater with a rear wheelchair lift. It was driven by the maintenance man. We noted that two residents went out for lunch to the local Masonic Club. One of them came to see the manager, worried that they could not find £20. Two carers went and searched their room with permission and found the money in a glasses case. The manager explained what was in their purse now and that they had enough money to pay for their lunch. Another resident returned to the home during the morning with a church worker after going to Holy Communion. Two relatives were taking their family member out for the day. Three of the four residents who completed a survey form said they always or usually liked the meals. “The cooks are the best people. They come and see what I thought of my dinner.” “ Lunch is invariably good, breakfast and tea OK.” On the day of inspection, the lunch was roast beef and Yorkshire pudding, with carrots, cabbage and swede. Ham salad was the alternative. The dessert was rhubarb crumble and ice cream. Residents in the main dining room told the inspector that they liked the food and most cleared their plates. Six residents were eating in the small lounge and one was in the conservatory attached to the dining room. There were tablecloths on each table with a small vase of flowers. Pepper and salt was also on the tables and drinks for each person. There were sufficient staff on duty to support residents during lunch. The manager said that the menu was changed regularly in response to comments from residents’ meetings. We saw the minutes of a recent residents’ meeting where the provision of a more varied breakfast menu was discussed. The home operated a two-week rotating menu including vegetarian alternatives. The cook showed us their diary with notes of all special orders. We also saw that special diets, either for medical or religious reasons were The Dell Residential Care Home DS0000066686.V366915.R01.S.doc Version 5.2 Page 16 catered for. The catering staff were following the “Safer Food, Better Business”(SFBB) system of catering documentation recommended by Environmental Health Officers (EHO). At the inspection by the EHO in January 2008, the only comment made was that some of the SFBB documentation needed completing. This would evidence that residents were protected by safe food and from which source. The Dell Residential Care Home DS0000066686.V366915.R01.S.doc Version 5.2 Page 17 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. Residents can be assured that their views will be listened to, taken seriously and acted upon. . They are protected by the staff’s awareness of how to recognise and deal with abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two out of four residents who completed the survey said they did not know how to make a complaint. Five of the six relatives replying said they did know how to complain. One resident wrote that they did not know who their keyworker was so did not know who they should talk to if they were not happy. One relative wrote: “It is always easy to get information or to talk about any issues with the manager.” The home issued a Clients Handbook which was given to residents on admission. This included the complaints policy. The home’s complaints policy was displayed in the home and was accessible to residents and visitors. One relative wrote that their relative had raised a few concerns at the residents’ meeting and these had usually been responded to positively. All relatives who replied to the survey said the home always or usually responded appropriately if concerns were raised. The Dell Residential Care Home DS0000066686.V366915.R01.S.doc Version 5.2 Page 18 The home had recently advertised the Care Aware service which is an independent advocacy service. All families had been given information about this service and notices about it were displayed in the hall. We were shown an application form which had just been completed ready to be passed to the service. We were shown the home’s record of complaints. There had been seven complaints raised with the home since March 2008. Two relating to cold food and discoloured underwear had been upheld. The record showed how the complaint was investigated, the action taken and the result/reaction of the complainant. One of the seven complaints was still being dealt with. In addition, the CSCI had received an anonymous complaint from a relative concerned at low staffing levels at a weekend. This is dealt with under the Staffing section. CSCI had also been made aware of a potential safeguarding issue regarding fee charges, but after investigation by Social Care Services, it was agreed that no safeguarding issue was involved. The manager told us that staff had received training in the protection of vulnerable adults (POVA) during induction and then through their NVQ courses. There was no reference to POVA training in the Induction checklist we were shown. The manager was unable to show us a copy of the home’s policy on the protection of vulnerable adults. The home did have a copy of the latest policy of the Suffolk Vulnerable Adults Protection Committee. However this was not adequate as a policy and procedure for the home. The staff we spoke to could not recall when they first received POVA training, but they were able to describe how they would recognise possible abuse and what action they would take. It would be good practice to ensure that this training is properly recorded. The cash held by the home on behalf of two residents was checked. Entries were seen in the receipt book and the balance reconciled with withdrawals by the resident. The Dell Residential Care Home DS0000066686.V366915.R01.S.doc Version 5.2 Page 19 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): 19,20,24,26. Quality in this outcome area is good. Residents live in a safe and comfortable environment that is well-maintained, with rooms which they can make their own by their own possessions, and space to receive visitors. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the building was undertaken and it was found to be attractively furnished, well maintained and clean. There were no unpleasant odours identified in the home. One resident wrote in their survey: “It always smells lovely and fresh.” A relative wrote: “It is always spotless.” We spoke to one of the domestic staff who was proud of “my corridor”. They were able to describe one room where they were trying to eliminate an unpleasant odour. They felt that eventually the room would need a new carpet. One resident who spent The Dell Residential Care Home DS0000066686.V366915.R01.S.doc Version 5.2 Page 20 most of their time in their room told us that the room was cleaned every day and thoroughly cleaned once a week. We noted that in three of the communal bathrooms, bars of soap had been left in the soap dishes of the baths. These were removed as soon as we pointed them out. These bars were personal to a resident and there should be no possibility of them being used by someone else, for the prevention of crossinfection. The home’s full time maintenance manager confirmed that they did minor repairs required in the home and undertook regular water temperature checks. Residents’ rooms contained items of their own which made them more homely. There were two lounges and a conservatory where residents could choose to sit and there was a large well-maintained garden with seating which residents could enjoy if they chose to. A ramp had been installed to make access easier for residents. Paper towels and soap dispensers were provided in all communal washing facilities. The temperature of two hot water outlets was taken. Both were within acceptable levels. All visitors were asked to rub an alcohol gel on their hands when entering the home, as a precaution against cross-infection. Adverse comments about the quality of the home’s laundry service were received by us, from one resident and one relative in the survey, and from two residents when we spoke to them in their rooms. Their comments concerned the amount of clothing that they felt had been discoloured or shrunk in the laundry. One resident and one relative also said that nightwear was returned unironed. We noted that there were two complaints on the home’s record regarding laundry matters, one of which, about discoloured underwear, had been upheld and the items replaced. The manager explained to us that the owners did not feel that the home could undertake handwashing of items and that these should be taken away to be done by relatives. The home would however always provide a full service for those with no relatives living nearby. Staff explained to us that there was no dedicated laundry staffing. Day staff took dirty clothing and linen to the laundry and fed them into the two washing machines and tumble driers as they could. Night staff were expected to do the ironing. Day staff then took the cleaned items to each room. The Dell Residential Care Home DS0000066686.V366915.R01.S.doc Version 5.2 Page 21 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. Residents are cared for by trained staff, in sufficient numbers to meet their needs. Residents can expect that they will be protected by the home’s policy on recruitment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We noted from the staff rotas that the staffing levels at the home were as follows: five carers and a senior on both daytime shifts, with three waking night staff. During the day, there is also a cook and two dining room assistants on duty, with three domestic staff, an activities organiser, on three days, and a full time maintenance man and gardener. The AQAA told us that staffing had been increased during the year as the home filled its additional places, and this was confirmed by our inspection of the rotas. Only half of the residents, according to the AQAA, needed help going to the toilet and two thirds required help with dressing/undressing. The manager told us that there was sufficient care staff for the needs of the residents, taken together with the other staff on duty. Survey responses gave a mixture of views about the staffing levels. Comments from two residents were: “The response to the call bell is not always very The Dell Residential Care Home DS0000066686.V366915.R01.S.doc Version 5.2 Page 22 prompt. It appears that the home does not always have sufficient staff on duty. This applies to day and night staff.” “To me there seems to be insufficient staff and help but we are assured that the Dell is fully staffed.” However two others said in the survey that there were always or usually staff available when they needed them. All the relatives and friends who completed the survey agreed that the home always or usually met the needs of residents, and gave the support and care they would expect. One wrote: “In need of more trained staff. Staff not got the time to have a quick chat to residents which I think they need.” Two of the four staff completing the survey said that there were always or usually sufficient staff on duty, but two others commented that: “More staff so you have more time for the residents.” “ Don’t have time to converse with the residents as always rushing about to get things done.” We examined the staffing rotas for the current week and for a weekend at the end of May 2008. The shifts were fully staffed during the week but not always at weekends. On one Saturday there were five staff off sick, but the manager pointed out that she was able to staff the early shift fully and have only one carer short for the late shift. On one night, there were only two staff on duty after 23:00 hours when one person went off sick. However the manager stressed that staff were willing to help out and had come in earlier than normal for the early shift. The home did not use agency staff as they could normally cover from their own staff, which the manager considered to be more beneficial to residents, to be cared for by staff they knew. We observed during our visit that staff were usually busy attending to residents. It was not appropriate to accompany staff into residents’ rooms for personal care, but we noted how staff chatted in a friendly way to residents in the communal areas. A relative told us that “the home has a warm homely atmosphere and the staff are friendly and caring.” Another said that the home “employs good carers who really care about the residents.” The home employed 33 carers, with a wide age mix, half of them over 45. They had no male care staff. Fourteen staff had achieved NVQ Level 2 or above and nine were working towards that qualification. We examined the files of three staff. All contained the required recruitment checks, application forms, references and identification documents. POVA First checks had been received before employment, with Criminal Record Bureau certificates arriving later. The manager showed us the Induction checklist for new staff. However there were no completed ones in the three files we inspected. Staff who we interviewed confirmed the training that they had recently done, covering moving and handling and medication. One of them had completed a The Dell Residential Care Home DS0000066686.V366915.R01.S.doc Version 5.2 Page 23 course on dementia awareness and was hoping to attend a palliative care course. All the staff who replied to the survey said that they had been given training which was relevant, met residents’ needs and kept them up-to-date with new ways of working. The Dell Residential Care Home DS0000066686.V366915.R01.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): 31,33,35,36,38. Quality in this outcome area is good. Residents and relatives can expect the home to be well run, by competent staff. Their safety is assured by the home’s health and safety practices. Residents can be assured that there is a system for obtaining their views on the running of the home to ensure it is run in their best interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager was experienced in the care of older people. She was registered with the Commission and held the Higher Diploma in the Management of Care Services. She had also had experience working in palliative care, which helped the staff to offer continuing care to residents at the end of life. We noted that The Dell Residential Care Home DS0000066686.V366915.R01.S.doc Version 5.2 Page 25 residents and relatives felt able to go into the manager’s office whenever the door was open, to ask questions or just have a chat. An administrative officer was appointed last year to assist the manager. The home had started holding residents’ meetings on a monthly basis with the notes of each meeting displayed on the notice board. We saw the minutes of the meetings held in April, May and June 2008. Topics included breakfast arrangements, the introduction of the activities organiser, and suggestions on how to spend the residents’ amenities fund. The manager said that she made special arrangements for those residents with communication difficulties. For example one resident was linked to a local group called the ‘Hand in Hand Group’, which was a support group for the visually impaired. The home asked for residents’ views on the home in an annual questionnaire. The last one was sent out in December 2007. The manager was not able to find the analysis of the results. Staff told us that no staff meetings were held. The manager said this was because of the difficulties of getting staff to attend. The provider told us later that the manager had an open door policy where staff could go into the office at any time to discuss matters. In addition, the home had recently conducted a staff survey, which we saw a copy of. For the most part staff were positive in their responses. Staff confirmed that they had an annual appraisal, and supervision sessions although not on a regular basis. We saw some records of these that took place in March, April and May 2008. The home had a procedure regarding service users’ money and financial affairs management. A finance officer had been appointed since the last inspection. The manager and proprietors did not act as appointee for any resident. A random check on cash held on behalf of residents was described under ‘Complaints and Protection’. Although records were generally complete, we have described some gaps in daily records, training and induction records, and not all care plan documents were dated. It would be good practice to have a system of auditing of records by senior staff to ensure residents’ needs were fully recorded and up-to-date. We inspected the accident report forms. The recent ones covered three residents mainly, but for different types of incident. The manager had done a course on falls prevention, and had used the Falls Adviser to assist the home with some residents. She described how one resident who had a history of falls had been helped to reduce their falls and now walked safely with a frame. All fire exits were clearly marked and free of obstructions. One fire exit was indicated to be through a resident’s room. A special break glass lock had been fitted to allow privacy for the resident, but to allow access in an emergency. The Dell Residential Care Home DS0000066686.V366915.R01.S.doc Version 5.2 Page 26 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 3 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 X X X 3 X 3 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 3 X 3 The Dell Residential Care Home DS0000066686.V366915.R01.S.doc Version 5.2 Page 27 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. Standard Regulation Requirement Timescale for action 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. 2. 3. 4. Refer to Standard OP7 OP26 OP27 OP30 Good Practice Recommendations The home should consider introducing a system of auditing care plans, daily records and medication Information about the home’s laundry service should be made clear in admission information for the benefit of residents and relatives. The home should find ways to discuss the level of staffing with residents and staff to ensure that staff are used to the maximum benefit of residents. Induction checklists should be completed for all new starters and filed in each person’s training record. The Dell Residential Care Home DS0000066686.V366915.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 The Dell Residential Care Home DS0000066686.V366915.R01.S.doc Version 5.2 Page 29 - 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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