Care Home: The Dorothy Lucy Centre

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What the care home does well This single-storey building was purpose built in 1986 by Kent County Council, so it has a number of suitable design features. All of its bedrooms are said to be compliant with the National Minimum spatial standards. Its location is judged satisfactory, in terms of its access to community facilities. It is currently registered as a care centre for older people, which means it can offer much needed services such as respite care as well as an assessment and rehabilitation service - all of which combines to enable people to live as independently as possible in their own homes and community. The last key inspection found that this home`s strengths were in the care staff gave to residents and their families. Feedback from residents and their representatives (relatives, health and social care professionals) indicated a very satisfactory level of care was being given. Our expert by experience gave us her overall impression, "The units at the Dorothy Lucy Centre appear to be happy, homely units where service users are cared for short term but many attend for respite from time to time and also attend the day centre which is part of the same site. The management and staff were helpful and approachable". What has improved since the last inspection? The home`s AQAA told us about a number of improvements since the last key inspection, as a result of listening to people who use the service. Information for prospective service users. Kent County Council put a working party together to develop better information leaflets, and the Dorothy Lucy Centre has been contributing to that. The plan is to be able to supply information in different formats to meet people`s needs. Care Planning Care plans are being routinely monitored by team leaders to ensure they are kept up to date. The plan is to introduce pen pictures of each resident, which should help provide useful talking points and a basis for person centred care. This will be especially useful for residents with dementia and communication difficulties. Daily Life and Activities The introduction of a volunteer to lead activities has been appreciated, and staff have been finding out more about individuals` social needs. The plan is to set up a more structured activities programme. Complaints and Protection Formal training in complaints and adult protection, at induction level and as part of an ongoing programme, has ensured staff awareness is kept primed. And there is a monitoring system, so that the centre can be aware of any emerging issues. Environment By securing a "Dignity in Care" grant, the centre has been able to replace the flooring in one dining area, and to refurbish it. A generous donation from a familyhas enabled the centre to replace bedroom curtains and quilt covers in one unit A number of bedrooms have been redecorated, and enhanced with new lampshades and pictures. Flooring in one bathroom has been replaced. The garden areas have been improved, and the Green Gym volunteer group have been contributing to this. Televisions have been made available to every bedroom. The plan is to install s new power-assisted bath in one unit, which should be more comfortable and dignified for its users. And "Dignity in Care" grant funding will be used to replace carpets in two units. Staffing arrangements Staff competencies have been improved over medication, infection control, food hygiene, moving and handling, diversity and dementia care. Performance related pay awards have been linked to other mandatory training to encourage take up. All vacancies have been filled with staff who either have NVQ level 2 accreditation or are willing to undertake training. Six more staff have been registered for NVQ level 2 training. The plan is to promote personal development plans and introduce other training opportunities such as mental health capacity, and rehabilitation. What the care home could do better: Some matters have been raised in respect of the home`s Service User`s Guide to obtain full compliance with this standard. Person centred practice standards should be more evident in care planning tools, so that development and emerging issues can be tracked. Specialist training in catering for the range of assessed needs is recommended for catering staff to ensure intake meets special needs. Some matters have been raised for attention in respect of the property and facilities e.g. bedroom furniture, walk-in shower facility. A refurbishment programme is recommended. Staffing levels need to reliably meet the statement provided, so that people can know what to expect. Some aspects of recruitment checks require better accounting for. And the centre needs to demonstrate a sustained compliance with the detailed provisions of the standard for documented staff supervision sessions. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Dorothy Lucy Centre Northumberland Road Maidstone Kent ME15 7TA     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: Jenny McGookin     Date: 0 8 1 2 2 0 0 8 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 35 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 35 Information about the care home Name of care home: Address: The Dorothy Lucy Centre Northumberland Road Maidstone Kent ME15 7TA 01622678071 01622762877 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Kent County Council Name of registered manager (if applicable) Mrs Julie Carol Parsooramen Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 28 The registered person may provide the following category/ies of service only: Care home only - 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 - OP Dementia - DE Date of last inspection Brief description of the care home The Dorothy Lucy Centre is a detached, purpose built property with accommodation on the ground floor only. It is owned and operated by Kent County Council. An integral part of the building comprises a day care facility offering services to older people and used by other organisations where appropriate. The Dorothy Lucy Centre itself comprises three units. Allington is a respite unit for older people. Mereworth is a respite unit for older people with mental health needs. Care Homes for Older People Page 4 of 35 care home 28 Over 65 0 28 28 0 Brief description of the care home Leeds unit offers older people an assessment and rehabilitation service to direct where their needs can be best met, such as a return home or to longer term care. The Dorothy Lucy Centre has capacity for 28 service users who generally stay for around a week in Allington and Mereworth or to a maximum of six weeks in the Leeds unit. The service is located on the outskirts of Maidstone where there are the usual facilities of a town. There is access to public transport close by. Space for car parking is available and there is a garden for service users to use. All bedrooms are for single occupancy and each is equipped with a staff call point. The Homes staffing team comprises the Manager, Team Leaders and care staff who work a roster to give 24-hour cover. The service also employs other staff for catering, domestic and maintenance tasks. A qualified Occupational Therapist employed by the O.T Bureau and an Occupational Therapy Assistant work at the service each weekday. Care Homes for Older People Page 5 of 35 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: This report is based on an unannounced site visit which was used to inform this years key inspection process; to check progress with matters raised from the last key inspection (December 2006); and to review findings on the day-to-day running of the home. The inspection process took nine and three quarter hours. It involved meetings with individuals representing a range of functions of the home - the manager, a team leader, a care worker and a cook. We met with a group of residents over lunch, and observed interactions between residents and staff at various stages throughout our visit. Care Homes for Older People Page 6 of 35 We asked an expert by experience to join us on our inspection visit. An expert by experience is a person who has experience of using services like this one. We recognise that people who live in or use the service may feel more able to talk to someone with a shared experience, and can help us get a picture of what it is like. We make several references to her findings throughout this report. We issued a selection of feedback questionnaires for distribution to residents, relatives and visiting professionals. Feedback was obtained from five residents, three staff, and a health care professional, in time for the issue of this report. Any others will be used to inform the Commissions intelligence in due course. Consideration was given to the Annual Quality Assurance Assessment submitted by the manager in October 2008, ahead of its due date. The AQAA is a self-assessment that focuses on how well outcomes are being mate for people using the service. It also gives some numerical information about the service. The inspection involved an examination of records, including three residents case files, to track their care and a selection of personnel files. Seven bedrooms, selected at random, were checked for compliance with the National Minimum Standards on this occasion, along with some communal areas. What the care home does well: What has improved since the last inspection? The homes AQAA told us about a number of improvements since the last key inspection, as a result of listening to people who use the service. Information for prospective service users. Kent County Council put a working party together to develop better information leaflets, and the Dorothy Lucy Centre has been contributing to that. The plan is to be able to supply information in different formats to meet peoples needs. Care Planning Care plans are being routinely monitored by team leaders to ensure they are kept up to date. The plan is to introduce pen pictures of each resident, which should help provide useful talking points and a basis for person centred care. This will be especially useful for residents with dementia and communication difficulties. Daily Life and Activities The introduction of a volunteer to lead activities has been appreciated, and staff have been finding out more about individuals social needs. The plan is to set up a more structured activities programme. Complaints and Protection Formal training in complaints and adult protection, at induction level and as part of an ongoing programme, has ensured staff awareness is kept primed. And there is a monitoring system, so that the centre can be aware of any emerging issues. Environment By securing a Dignity in Care grant, the centre has been able to replace the flooring in one dining area, and to refurbish it. A generous donation from a family Care Homes for Older People Page 8 of 35 has enabled the centre to replace bedroom curtains and quilt covers in one unit A number of bedrooms have been redecorated, and enhanced with new lampshades and pictures. Flooring in one bathroom has been replaced. The garden areas have been improved, and the Green Gym volunteer group have been contributing to this. Televisions have been made available to every bedroom. The plan is to install s new power-assisted bath in one unit, which should be more comfortable and dignified for its users. And Dignity in Care grant funding will be used to replace carpets in two units. Staffing arrangements Staff competencies have been improved over medication, infection control, food hygiene, moving and handling, diversity and dementia care. Performance related pay awards have been linked to other mandatory training to encourage take up. All vacancies have been filled with staff who either have NVQ level 2 accreditation or are willing to undertake training. Six more staff have been registered for NVQ level 2 training. The plan is to promote personal development plans and introduce other training opportunities such as mental health capacity, and rehabilitation. 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 35 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 35 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. Prospective residents and their representatives benefit by having access to most of the information needed to decide whether this centre would meet their needs. But funding authorities do not always provide all the information the centre needs. Prospective residents can feel confidant that their needs will be properly assessed before or on admission, and that they will be supplied with a contract, which clearly tells residents about their rights and responsibilities. This centre has the facilities and access to specialist input for rehabilitation and respite care. Evidence: This centre has a Statement of Purpose and Service Users Guide, which, in combination, usefully provide information about the centres range of services, Care Homes for Older People Page 11 of 35 Evidence: facilities and service principles. Both documents are written in plain English, in a font size and style we judged likely to suit most readers. We have, however, raised a number of matters to obtain further compliance with the provisions of this standard, most notably in respect of the Service User Guide - these were reported back to the manager separately, to ensure that prospective residents or their representatives could be confident that they have all the information they need to reflect on, in order to make an informed decision. The centre was not able to evidence whether other languages or formats (e.g.large print, tape, Braille etc) were warranted, but we understand this is being planned by a KCC working group. A checklist would compensate for residents not being able to recall having received this information with any accuracy when we asked them, and could identify any unmet needs. KCC has its own contract terms and conditions for centres such as this. We have assessed the format of this document and judged it generally comprehensive though one or two elements we were looking for were not in the sample we were shown e.g. full breakdown of costs, information about what the resident could expect in terms of bedroom furniture and fitments, or any special requirements. These were reported back to the manager separately, and we judged our recommendation about a checklist to evidence whether other languages or formats are warranted (see above), applied here. As is often the case, relatives and residents told us that the decision to apply to this centre was in practice influenced more by its locality (i.e. closer to where they lived), by its capacity to offer rehabilitation and respite care rather than by any public information produced by the home itself. Feedback from 4 out of 5 relatives confirmed that they had enough information to decide on this home. One told us, I was only too pleased to find a home at the time. However, I have never had any second thoughts on the matter, especially in view of the fact that my wife always appears happy. We selected three residents files for care tracking, to represent admissions over the past 12-18 months. We found evidence of pre-admission assessments carried out by funding authorities (social services care management or health authorities) in two of them, though there were some gaps, but the assessment was missing in the third. One health care professional told us, I do feel some of the rehab patients are inappropriately referred, do not meet rehab guidelines, then block a bed for a patient Care Homes for Older People Page 12 of 35 Evidence: who may have very good rehab potential. And a member of staff told us they sometimes need to consult with care managers to ensure (information) is up to date. On their admission the centre carries out further assessments of its own, including risk assessments. We found good evidence of that. In each case there is a four-week trial period, to establish whether the placement will meet the needs of all interested parties. We were satisfied that the centre has the facilities and access to specialist input for rehabilitation and respite care. See section on Health and Personal Care, and the section on Staffing for our findings in respect of staffing levels and deployment. Care Homes for Older People Page 13 of 35 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. Residents can be confident that the health and personal care they receive, is based on their individual assessed needs. But record keeping could be further improved to ensure it is more person centred, and to ensure care planning is more measurable. Residents can be confident that the principles of respect, dignity and privacy are generally put into practice. Evidence: People only come to this centre for short term rehabilitation or respite care stays (though there are one or two long term residents, and several residents come back for respite time and time again). The centre will also supply transport to day centres for people staying with them, to enable them to continue getting the benefit of these outlets. A checklist questionnaire is used in the first instance for these residents, to establish whether more detailed care plans are warranted for identified health and personal care Care Homes for Older People Page 14 of 35 Evidence: needs. And the files we looked at also included funding authorities own care plans as their basis. The emphasis is on supporting and promoting individuals daily living skills like personal care, mobility, continence, skin integrity, medication, night care, nutrition etc. And these care plans are supplemented by daily reports, assessments (including dependency, fire safety and other risks) and records of contact with health care professionals. The aim is, in each case, to enable people to return to their own homes and community and to continue living there safely. In a number of cases there was good detailed practical instruction for staff, likely to obtain positive, measurable outcomes. In other cases, however, the documented staff instruction we saw was more generic (i.e. likely to apply to everyone in every setting) and less measurable, or objective focused. The principles of person centred care planning need to be more evident in recording. Notwithstanding variable standards of recording, however, feedback indicates a high level of satisfaction with staff practice standards. One resident told us, everyone looks after me very well One relative told us, this is the best respite centre that **** has ever been to in the last 20 years. Another said, my wife enjoys her stays at the Dorothy Lucy. She has been staying there for a week or so at different times. Sometimes she cannot wait to go again, she enjoys it so much. And I am glad she likes it, as it gives me peace of mind. I think its great, friendly, helpful and well run. And when asked what she thought the service did well, one health care professional told us it provides good, individualised care for patients. Any pre-existing health needs are identified as part of the centres admission process, and arrangements are made to access local medical services, to ensure there is continuity. The centre has established a good working relationship with its local GPs, district nursing team, and mental health team, all of whom visit as required. Unless subject to a GP referral, residents would need to pay for additional medical treatment or medication themselves. There is regular input from an Occupational Therapist and OT assistant from 8am till 4.30pm Monday to Friday All the bedrooms are single occupancy, which means health and personal care can always be given in privacy. We were satisfied that the homes medication is kept properly secured when not in Care Homes for Older People Page 15 of 35 Evidence: use. Some matters were raised for attention, however, to further improve of the homes medication room. The detail was reported back to the manager separately. There were no gaps or anomalies in the medication records we spot checked on this occasion, and records confirm there are weekly in-house checks and follow-up sheets to ensure queries are properly accounted for. The unit has also adopted an auditing tool from guidance issued by the Royal Pharmaceutical Society to ensure recommended practice standards are maintained. The last such audit was in November 2008 and found a sound level of compliance, except in respect of daily records of the medication room temperatures. We were told that all staff have been trained in safe medication practice, to keep people safe. Our own records confirm that no errors have been reported to the Commission since the last inspection visit. See section on Daily Life and Social Activities for our detailed findings on supporting and promoting individuals social skills. Care Homes for Older People Page 16 of 35 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. Residents are able to exercise choices over their daily life style, accepting their need for rehabilitation or respite would place some constraints on their abilities at least initially. The social, cultural and recreational activities offered by the home were judged modest but will meet some expectations. Residents can be confident that they will be supported to keep in contact with family and friends. Residents can be confident that they will receive a healthy, varied diet according to their assessed requirements. Evidence: Our expert by experience told us, The centre is in three units and I visited all three and observed staff and service users. Members of staff I was able to speak to were helpful and although they were Care Homes for Older People Page 17 of 35 Evidence: sitting in the unit or writing up notes, there did not appear to be any interaction between service users and staff, apart from Mereworth the unit for mental health needs where the staff were helping service users with drinks and meals. Many service users were restless and walked round and round most of the time. I was able to speak with several service users and two visitors. The service users said they were very happy with the care they received at the centre and the visitors I spoke with were very positive and complimentary of the care their relatives receives at the home. One visitor said her mother had been there on several occasions - usually during an emergency situation at home. There did not appear to be any activities for service users during my visit. However, there was a well equipped hairdressing room and service users confirmed this was appreciated. I was told that the Occupational Therapist was carrying out assessments that day. Feedback from three residents told us there were always or usually activities at this centre, but they were not not, individually, able to give us many examples. Participation is, quite properly, always a matter of personal choice. It could be difficult to extend the centres programme of recreational activities, given the short term nature of the respite and rehabilitation stays. But we were interested to hear there are regular Asian group meetings. And residents are supported to attend Dorothy Lucys own day centre facility or another local day centre which caters for mental health needs. Those with rehabilitation needs would also have structured sessions with a trained occupational therapist. These sessions involve the setting of objectives and a scoring system to measure progress. And they are used to develop individuals mobility, their ability to use stairs, and light cooking. Each unit has its own activities cupboard. We were told by one resident s/he participated in everything I can join in with. Another told us the staff ensure that I attend the Motivation Kent activity class that is held in the day centre. I really enjoy this class because I can understand what is said and can enter into the quizzes. I think that everyone should have a Motivation Kent class. They also allow me to attend the church service. But another told us, I dont like organised activities. And a relative told us, I do not think my wife is aware of any activities. Perhaps it is because of her disabilities she would not be able to take part We looked at one of the activities books maintained by the units, over a two month Care Homes for Older People Page 18 of 35 Evidence: period, so we were able to build up a picture. The range of activities was judged modest. Music sessions and group conversations featured most regularly. There were games (Bingo, cards, picture games, puzzles, naughts and crosses, crosswords, jigsaws), drawing and doodling sessions, and reminiscence. There were occasional walks in the garden and trips to a local garden centre for refreshments. There were cookery classes in one unit where they made sweets. And our expert by experience told us, a church service is held on the first Sunday in the month in on of the units and all service users are able to attend if they wish. There are also visitors to the units from the local church and also local schools from time to time, especially at Christmas. One source told us, I think they take great care with the people who come in here. They take time to sit down and talk to them. There is always someone to chat to. Residents also have their own hairdressing, nail care and chiropody sessions sessions on site. The home has four communal TVs with DVD and video players, and most bedrooms have TV sets, so there would always be scope for individual choice of viewing. But none is linked to any special channels or connected to loop system (for use with hearing aids). Our expert by experience told us, Most lounges had the television on but no one appeared to be watching it. Residents are able to have visitors at any reasonable time and they can stay for meals (a small charge is payable). See section on Environment for our findings in respect of this homes location and access to community resources. There is a communal pay phone in the dining room of one unit. Although not a private arrangement (there is no kiosk), we were assured that the dining room in question is separate from the lounge and hardly used once meals are over. There is also a mobile phone for communal use. Unless other arrangements have been made, we were assured that residents receive their mail unopened. We met with the homes chief cook during our visit. Records had already shown us that nutrition and catering needs are properly identified as part of the admission process and updated or amended thereon. The cook told us how she drew up menus Care Homes for Older People Page 19 of 35 Evidence: every week but went round to each unit every day to see what residents would like. One resident confirmed, I can choose what I like to eat. The cook also told us that she provides packed lunches when residents return to their homes if there is no one there for them. Feedback confirmed that residents always or usually liked the meals. Records are kept of what individuals eat and drink, as required, so that their intake can be monitored. Some special diets (e.g. diabetic, no/low salt) can be catered for, though we were surprised to hear that the cook had not had any formal training in catering for the wide range of conditions of residents coming into this centre. This is recommended. There is some adapted equipment available such as plate guards, angled and large handled cutlery. In one unit residents are able to choose whether to self serve but meals are otherwise served to them from hot trolleys. We were told that where liquidised meals were called for, the components are liquidised separately, so that people could enjoy their individual tastes, textures and aromas. We joined a group of residents for lunch and judged the meal tasty and well presented. Our expert by experience told us, I met and spoke with the cook who gave me a tour of the kitchen and store rooms. This is a very well organised department and the cook and her two assistants have been in post for many years. The cook informed me that she meets with each new service user and ascertains their dietary needs, likes and dislikes. These are all taken into consideration. The kitchen was very clean and strict hygiene practices observed. I ate a meal with service users in one of the units. The food was plentiful and tasty. Staff confirmed that hot and cold drinks and snacks were always available on request. Care Homes for Older People Page 20 of 35 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. Residents can be confident that their complaints will be addressed properly through the homes complaints procedure. Residents can feel confident that they are protected from abuse. Evidence: KCC has a clear complaints procedure, which is displayed in the homes reception area and issued to residents in an information pack. The centre keeps a register to summarise complaints. We judged this a sufficiently confidential arrangement, as fuller details are kept on individual residents files. This arrangement is subject to regular audits and findings are included in KCCs own unannounced monthly inspections, so that it should always be aware of emerging issues. See also section on Management and Administration for our findings in respect of KCCs own inspection visits. We judged the range of complaints a realistic reflection of communal living. And feedback questionnaires from five sources (residents or relatives) indicated they had confidence that the home would take any concerns and complaints they had seriously, should this apply. Care Homes for Older People Page 21 of 35 Evidence: One told us, I am never unhappy. I love being at Dorothy Lucy Centre. A relative said, I can talk to anyone. And another said, there is usually somebody in authority to speak to. The centre is rightly proud of the larger number of thank you letters and cards it receives, though we have suggested it dates these so that their reader can judge their currency. KCC has a range of procedures designed to ensure that residents are safeguarded from abuse in all its forms. The AQAA told us that staff are formally trained in complaints and safeguarding principles and protocols at their induction and at team meetings thereon. In our meetings with staff they confirmed their commitment to challenge and report any incidents of abuse, should they occur. In the event, we were told safeguarding protocols had not been warranted. We can confirm that no formal complaints or adult protection alerts have been brought to the attention of the Commission against this home since the last inspection. Care Homes for Older People Page 22 of 35 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. Residents benefit from living in a safe, well-maintained environment, which encourages freedom of movement as far as they are individually assessed able. The non-provision of some furniture and fittings will require properly documented and consulted justification. Evidence: Our expert by experience visited all three units and told us, the units were all nicely decorated for Christmas and were clean, tidy and odour free. This single-storey building was purpose built in 1986 by Kent County Council as a residential care home, so it has a number of suitable design features. Its location is judged satisfactory. There is a bus stop on the main road at the top of the drive. The bus route goes into to Maidstone, with all the community and transport links that implies. Maidstone East and Maidstone West train stations are about 5-10 minutes drive away. There is a cluster of shops within walking distance, which includes a bakery, haberdashery, supermarket store, chemist and card shop. We judged the external fascias would benefit from attention as they were flaking and Care Homes for Older People Page 23 of 35 Evidence: showing wear. On-site parking facilities are good (something like 13-15 car parking spaces including three spaces designated for people with disabilities at the front). The home has attractively landscaped secure garden areas on all sides, and these are accessible from all units. Interesting focal points include a fish pond. Credit must go to the Green Gym volunteer group for their contributions to the improvements made to the garden facilities. Measures are in place to keep the premises secure against unauthorised access. We were assured that residents could come and go freely, though most tend to rely on families and friends to escort them. The property is level throughout. All corridors and most doorways are wide enough to allow the passage of wheelchairs and mobility aids. All areas are linked with a call bell system, to keep people safe. Some specialist provision is in place but it is not overly conspicuous and includes adjustable beds throughout, grab rails, adapted baths, bed trays, and some adapted cutlery and crockery. A day care facility was created out of what used to be office space, and this is also used by the centres occupational therapists, though it is not ideal (insufficient for assessment, rehabilitation programmes or storage). This facility can be accessed from the units and externally, so it maintains some element of separation. This centre has three units, each with its own identity. There is a lounge/dining area in two units and a separate lounge and dining room in the third. By securing a Dignity in Care grant, the centre has been able to replace the flooring in one dining area, and to refurbish it. This centre has a communal bathroom in each unit (including adapted baths) and two communal WCs, all of which are judged reasonably close to bedrooms and communal areas, but there are no walk-in shower units. This is recommended, so that people can exercise some choice. Since the last inspection, the flooring in one bathroom has been replaced, and more refurbishment is planned. We raised a few matters for attention. This centre is currently registered to provide care for up to twenty eight residents. All the bedrooms are used for single occupancy so that health and personal care can be given in privacy. The AQAA told us that a generous donation from a family has enabled the centre to replace bedroom curtains and quilt covers in one unit; and that a number of bedrooms have been redecorated, and enhanced with new lampshades and pictures. Care Homes for Older People Page 24 of 35 Evidence: The Statement of Purpose tells us that all the bedrooms comply with the national minimum spatial standards, but some bedroom space could constrain the use of larger wheelchairs, for example. Seven bedrooms, selected at random, were inspected and judged clean and personalised, but most did not have a table to sit at, and some wooden furniture looked scuffed and in need of attention or replacement. One had crude blocks to raise a chair and we judged the replacement of obvious commodes with more discreet models would accord people with more dignity. The detail was reported back to the manager separately. All bedrooms have lockable facilities and we were assured that residents are routinely offered bedroom door keys but tend not to want them. The reader is advised that nonprovision must be justified by a properly documented risk assessment or opt out consultation. All bedrooms are linked to a call bell system, to keep people safe. We judged the centre generally well maintained, and feedback from residents confirmed this was representative. One relative told us, This home always smells nice (never smells of urine). And another said it was always very clean. We were told that that the centre had been given a 5-star rating by the local borough council in 2008, which means its food safety standards were judged excellent but the certificate was still awaited. We judged the main kitchen should have a dishwasher and more fridge/freezer space. And that catering staff should have there own dedicated WC facilities. Comfortable temperatures and lighting levels were being maintained throughout our visits, and the home was odour free in all areas inspected. Some matters were raised for attention in respect of the homes medication room and a sluice room to improve their capacity to resist cross contamination. All the maintenance records we looked for were on site, up to date and systematically arranged Care Homes for Older People Page 25 of 35 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. The numbers and deployment of staff may not always be enough to reliably meet the aims of the home and the changing needs of the residents. Staff and residents benefit by the training investments in staff, which help ensure expected practice standards are embedded. Evidence: This homes staffing arrangements are designed to ensure that (excluding the manager) one should expect to find: - 7.00am to 2.30pm - a minimum of 5 care staff and 1 team leader - 2.30pm to 10.00pm - 5 care staff and 1 team leader There should be capacity for staff to work between two units at a time, and for staffing levels to be increased, to meet emerging needs. See, however, below for feedback comments. At night (i.e. from 10.00pm to 7.00am) there should always be 2 carers on waking duty (one source felt this was not enough, as some residents could be quite challenging) and 1 team leader on site, sleeping but on call. Care Homes for Older People Page 26 of 35 Evidence: In the absence of the manager this arrangement should ensure that there is always someone in charge, with an on-call system as a back up, to keep people safe. Each unit has a member of staff to carry out domestic duties (i.e. 3 though this is reduced to 2 over the weekends) and the cook has two assistants every day. The centre does not have a refurbishment plan as such, but it has a dedicated maintenance man and can call on KCCs maintenance department. We can confirm that no concerns have been raised with the Commission since the last inspection visit (December 2006) about the centres capacity to maintain these staffing levels. Feedback questionnaires from residents told us staff were always or usually available when they needed them and that they listened and acted on what they had to say. One said, I get on very well at Dorothy Lucy Centre. Feedback questionnaires from staff was not so unequivocal. One told us, staff shortages can be a problem. One source told us they felt that one team leader was not enough, given their range of duties (admissions, discharges, medication) and the expectation that they cover staff shortages. And one member of staff identified the level of paperwork an obstacle. Feedback from staff confirmed our assessment of personnel files, selected at random, that this home has a systematic recruitment process to comply with the key elements of the standard. We were satisfied that a range of checks was routinely being instigated to keep people safe, such as identity, criminal records. Notable exceptions to this, however, were references in respect of two staff, who only had one reference each (at least two are more usual). Records confirmed feedback from staff that they receive a range of relevant training, both mandatory and specialist. Examples include: manual handling, infection control, food hygiene, medication, safeguarding adults, 1st aid, control of substances hazardous to health (COSHH), mental capacity and dementia care. This list is not exhaustive and the AQAA told us 28/48 staff have NVQ level 2 accreditation or above, with another 6 in prospect. The AQAA told us the introduction of performance related pay awards has proved an incentive. One member of staff told us there were regular training days and bi-monthly personal development sessions. Another said training (is) good but not able to get on courses for months. See section on Management and Administration for our findings in respect of staff Care Homes for Older People Page 27 of 35 Evidence: supervision. Care Homes for Older People Page 28 of 35 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. Residents and their representatives can be confident that this is a well run home. Residents have benefited from the refurbishment programme, which should be maintained. Evidence: The Commissions registration process has established that the manager, Mrs Julie Parsooramen, has the relevant training and experience for her role. The Statement of Purpose told us she is NVQ Level 5 qualified, has the NVQ Assessor Award and a Diploma in Management and over twenty years experience in the field. Our expert by experience told us staff confirmed that they are well supported by the manager and find her approachable. There are clear lines of accountability within the home and within KCC on a wider level. We were satisfied that KCC is able to evidence sustained compliance with its duty to Care Homes for Older People Page 29 of 35 Evidence: carry out formal unannounced documented inspection visits of its own every month (Regulation 26), to ensure people are safe. We found some evidence of quality assurance feedback exercises, designed to test whether the service is meeting its objectives. Our own feedback has indicated that residents, their relatives and visiting professionals have confidence in the manager and her team. We were told, I only work in the rehabilitation service which has been very successful in enabling service users to reach their maximum potential with becoming more independent with everyday tasks such as personal care, transfers and mobility - staff member I have only been with the service for *** months but feel Dorothy Lucy Centre is a very valuable part of the community, who understands and meets the needs of the service users, and gives above and beyond to do that. KCC has formal annual business planning processes, including the Maidstone District Plan, which the centre contributes to with its own formal development plan. The centres own plan also properly makes reference to overarching policy directives, aimed to support people to continue living in their own homes, to prevent social isolation. We wanted to know about the composition (ethnicity and gender) of the residents and staff group. The homes AQAA told us the resident group is white British. 20 are female and 6 are male. The staff group is female and predominantly white British, though other ethnic backgrounds are represented. We were aware of the regular Asian group meetings. Periodic checks against regional demographic information should be made, to ensure the service is representative. The AQAA told us diversity issues feature in induction and staff training opportunities thereon. We were satisfied that staff were being given individual supervision sessions with their line managers but the frequency of these was variable. This will require attention, to ensure staff practice does not become variable and to ensure developmental needs are being met. All the homes property maintenance certificates seen were up to date and systematically arranged to facilitate access. There are regular spot checks, to keep people safe. Care Homes for Older People Page 30 of 35 Care Homes for Older People Page 31 of 35 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 32 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 36 18 The centre must be able to evidence sustained compliance with its duty to carry out formal documented staff supervision sessions at the required frequency, to meet the detailed provisions of this standard. To ensure practice does not become variable; and to identify developmental needs, concerns. 30/04/2009 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 1 The centre should be able to evidence the issue of its Statement of Purpose and other key information such as the contract, and whether other languages or formats (e.g.large print, tape etc) were warranted. The centres terms and conditions should: Page 33 of 35 2 2 Care Homes for Older People - give a detailed breakdown of charges and who is responsible in each case - commit KCC to compliance with the National Minimum Standards in the provision of furniture and fittings. Non provision must be justified by documented risk assessments or opt out consultation. 3 7 Person centred practice standards should be more evident in care planning tools, so that development and emerging issues can be tracked. Specialist training in catering for the range of assessed needs is recommended for catering staff to ensure intake meets special needs. A refurbishment programme is recommended for the site and property. A walk in shower facility is recommended, so that residents have some choice. The centre should look for opportunities to replace obvious institutional commodes with more discreet models, to accord people more dignity. Bedroom furniture and fittings should be checked against the detailed provisions of the National Minimum Standards. Nonprovision should be justified by documented risk assessment or opt out consultation. Some matters have been raised for attention in respect of the homes medication room and a sluice room to improve their capacity to resist cross contamination. 4 15 5 6 7 19 21 22 8 24 9 26 Care Homes for Older People Page 34 of 35 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. 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