Care Home: The Dovecote

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What the care home does well People living in the home get a choice of holiday to go on and they go out on trips with staff. One person that lives in the home told us that they did what they wanted during the day, in the evening and at weekends. They said, ` I like going to the pub with staff`. Some people living in the home have jobs, go to college, go to day centre and some go to the local church on a Sunday. What has improved since the last inspection? The home has more activities than it used to. The staff have helped people to find their family. What the care home could do better: People living in the home could get more say in how the home is run. People could be more involved with their care plan. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Dovecote 69 Bagshaw Street Pleasley Mansfield Nottinghamshire NG19 7SA The quality rating for this care home is: one star adequate 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: Lynda Dyer Date: 0 6 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: 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 Adults (18-65 years) 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. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 31 Care Homes for Adults (18-65 years) Audience Further copies from Copyright 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 Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: The Dovecote 69 Bagshaw Street Pleasley Mansfield Nottinghamshire NG19 7SA 01623480445 01623480446 dovecotetrust@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : The Dovecote Trust Limited care home 18 Number of places (if applicable): Under 65 Over 65 18 0 learning disability Additional conditions: Date of last inspection 2 4 0 4 2 0 0 8 A bit about the care home The Dovecote is a care home that is run by a charity. Up to 18 people with learning disabilities or physical disabilities can live there. Care Homes for Adults (18-65 years) Page 4 of 31 The Dovecote is close to shops, pubs, the post office, a community centre and workingmans club The home has two buildings. One has two floors and there is a staircase and a stair lift for people to get upstairs. The other is a purpose built bungalow. Everyone has their own bedroom. The home has an enclosed garden and a nature trail in the grounds. The home also has a car park and a minibus. It costs between £380 and £1,007 per week to live in the Dovecote, depending how much help people need from staff. Care Homes for Adults (18-65 years) Page 5 of 31 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 31 How we did our inspection: This is what the inspector did when they were at the care home This report has been written using information we had been given before we visited the home and things we saw on the day of the inspection. The staff helped us on the day of the inspection. They gave us lots of information and were very helpful We sent out a survey to people that live in the home, staff that work there and people that visit. 8 people filled in the surveys and sent them back to us. We also asked the manager to fill out a form for us. We call this an Annual Quality Assurance Assessment (AQAA). All of this helped us to plan what we needed to look at when we visited the home. When we visited the home we spoke with four people who live there We spoke with three staff that work in the home. We looked at two care plans of people that live at the home. We looked at records that were kept in the home, which included staff Care Homes for Adults (18-65 years) Page 7 of 31 records and health and safety records What the care home does well What has got better from the last inspection The home has more activities than it used to. The staff have helped people to find their family. Care Homes for Adults (18-65 years) Page 8 of 31 What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Lynda Dyer Care Quality Commission CPC1 Capital Park Fulbourne Cambridge 01223 771 300 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. Care Homes for Adults (18-65 years) Page 9 of 31 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 Adults (18-65 years) Page 10 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 31 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 . Peoples are assessed before they move into the home and staff know what care and support to deliver. Evidence: The manager told us in the homes Annual Quality Assurance Assessment (AQAA) that the home has a descriptive brochure with photographs and a statement of purpose that is also available in an easy read format. They also said that the management discuss a persons needs before they are admitted to the home and decide how the needs can be met. A full assessment is completed and introductory visits are offered. We spoke with one person who lives in the home and they told us that they looked around the home and then had a trial visit before going to live there. We looked at the records of the most recent person admitted to the home and there was a full needs assessment that had been completed prior to admission. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living in the home are supported to make decisions and to take responsible risks to ensure they have some control over their daily lives. However, systems for managing peoples finances show their financial interests are not fully safeguarded. There is some slippage of monitoring the care planning of people. Evidence: The manager told us in the homes Annual Quality Assurance Assessment (AQAA) that people living in the home have a descriptive care plan and that 8 are person centred and the home plans to make all care plans person centred. We received completed surveys back from people that live in the home and they said they made decisions about what they did each day. When we asked a member of staff what they thought the service did well they said, They are becoming more person centred with options and choices available to people. Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: We viewed the care plans of two people living in the home and these held well documented assessments around the tasks of daily living and around health care needs. There was not any evidence of six monthly reviews being carried out with involvement from the person it was written for or their representative, nor was there evidence of them being happy with the contents of the care plan. However, one care plan that we viewed had an annual review in place from the previous year, which involved multi disciplinary agencies, the person it was written for and their representative. The review showed how the person it was written for had been involved with photographs of the pictures they had drawn to show how they had been involved in the process. The review had triggered an action plan and we randomly picked one action, which gave staff instruction for a communications book to be implemented and communication passed between the day centre and the home to monitor dietary issues. This book had not been maintained adequately by the day centre and discussions with staff showed that this had not been followed up by the home. The finances of people living in the home were only partially assessed on this inspection. We found evidence that the manager is acting as an appointee for some people living in the home. We discussed this with the manager and he also told us that the bank account where peoples benefits and allowances were paid is a pooled account in the name of the trust. Evidence in the care plans we viewed showed that people are supported to make choices around how they spend their own money. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living in the home are actively encouraged to develop and maintain social, emotional, educational and independent living skills. People are supported to make informed choices and maintain family and personal relationships. Evidence: The manager told us in the homes Annual Quality Assurance Assessment (AQAA) that activities include part time jobs, nature group membership, swimming, day centres, church and farm visits, work experience, walking group membership, bingo and an external disco run by the home. We received completed surveys back from people that live in the home and they told us that they did what they wanted during the day, in the evening and at weekends. One said I like going to the pub with staff. On the day of the inspection we saw lots of activity taking place with people attending Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: college, day centres, places of work and other activities. The home has access to a minibus and they described how people living in the home often went out in the minibus with the staff and chose where they would like to go. There is a local church next door to the home and some of the people living in the home attend the services. The manager described how links had been forged with the church and people there welcomed and assisted the people living in the home when they went to church. We spoke with two people living in the home and they described activities they took part in and a holiday they were due to go on. We also looked at the records of two people living in the home and they gave evidence of a daily activity schedule that was tailored around the individual. We saw evidence of weekly menu meetings held for people living in the home where picture symbols are used so that everyone in the home can choose meals for the following week. The menu is displayed in picture format each day and staff take the picture menus round to people living in the home and offer two or three choices of things to eat. We saw people being supported to eat an appetising and nutritious meal with times and places to eat being flexible. Staff told us how people are supported to make meals, snacks and drinks for themselves if they wish to and we saw evidence of people in the home making their own decisions on daily living and movement within the home. The home generally do their main food shopping using the internet. However people living in the home are regularly supported to visit local shops. We spoke with people living in the home and they told us of the contact they have with their family. A member of staff told us about a person living in the home who had lost contact with their family and the home had supported them to make contact and forge bonds with other members of the family. Care Homes for Adults (18-65 years) Page 16 of 31 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 . People living in the home have their health care needs met and they receive personal support and intervention from external health professionals. Medication procedures are safe. Evidence: The manager told us in the homes Annual Quality Assurance Assessment (AQAA) that peoples care plans identify any health problems and specify how they are to be dealt with. It also states that service users are involved in drawing the plan up and are supported in all areas to contact external health care support such as the GP. It also states that there is a medicines policy in place and that only qualified staff can administer medication. We viewed the care plans of two people living in the home and they showed how people liked to spend their days and how much support they needed with their care. There was also evidence of people being supported to have access to external health professionals. People living in the home are being weighed regularly but there is no nutritional screening tool in place to show when a person’s health becomes at risk due to their Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: weight or to tell staff what action to take. We looked at the homes medication systems and we found that the systems were being managed well with staff being trained to administer prescribed medication to people living in the home. There are designated staff for auditing medication each month and any medication errors that are found are recorded on the individual Medication Administration Records. However records are not kept of these audits. We saw written instruction for staff to follow which informed them to get advice from a GP if a medication dose was missed but no instruction to get advice from a GP if an overdose occurred. Care Homes for Adults (18-65 years) Page 18 of 31 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living in the home are safeguarded from abuse and people know how to make a complaint. Evidence: The manager told us in the homes Annual Quality Assurance Assessment (AQAA) that the home has a clearly displayed complaints system that is also displayed in easy read format and that all complaints are responded to within 28 days. It also states that there is a set of policies for staff to follow for safeguarding procedures. The complaints procedure was on display in a format that was easy to read. The details of how to contact the Commission were out of date. However, people living in the home told us in completed surveys and also on the day of the inspection that they knew who to speak to if they wanted to complain. Staff also told us that they knew what to do if people made a complaint to them. There have not been any complaints received by the Commission about this service. The home has received one complaint which was upheld and resolved within 28 days. The home has the current local safeguarding procedures in place and the more senior staff have received training in how to use the procedures. The manager told us that this training will be cascaded to the other staff in the near future. We spoke with two members of staff about safeguarding procedures and they both had a good level of understanding of what was required of them. Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: Care Homes for Adults (18-65 years) Page 20 of 31 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 home is clean and provides a safe environment, giving people a pleasant place to live. Evidence: The manager told us in the homes Annual Quality Assurance Assessment (AQAA) that shared spaces are varied and spread out, enabling service users to have a choice about where they go. They state that there is an infection control policy and that staff are trained in infection control practice. On the day of the inspection we found the home to be clean and free from odours. People’s bedrooms were well maintained and personalised and there were a number of communal areas for people to choose from. The houses are well lived in and inevitably are subject to wear and tear due to the complex needs of the people who live there. There were areas that looked in need of redecoration and the manager told us that the decorator was currently working their way through the home addressing these areas. One bedroom we visited had a carpet that was worn and stained. The garden is very spacious and attractive and offers the room for people to sit or to play outdoor games. There was also a large summer house that offers a place for Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: people living in the home to use. It has a ball pool and a pool table and staff said that it was used mainly during the summer. We spoke with staff and looked at their records and saw evidence that staff are trained in Infection control and have the correct equipment to maintain infection control procedures. Care Homes for Adults (18-65 years) Page 22 of 31 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 home operates a safe staff recruitment process and staff are trained effectively in most areas to enable them to support people living there. Evidence: The manager told us in the homes Annual Quality Assurance Assessment (AQAA) that all staff receive a recognised induction and they all have a training plan that is agreed at supervision. They also state that the home has a thorough recruitment procedure. We received completed surveys back from people that live in the home and they all said that staff always treated them well and always listened and acted on what they said. One said, Staff are nice to me, they talk to me and cook me nice meals. The two staff files we viewed also contained evidence of the required safety checks being completed before staff commenced working at the home. They also contained evidence of regular supervision taking place to address the way staff were working and what their training needs were. We received surveys back from staff and they all said that there was usually enough staff on duty to meet the needs of the people living there. One member of staff told us, There is regular training available and one said, There are some residents that have special needs due to behavior, illness and abilities and not all staff have the Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: abilities to deal with this. We looked at the files of two staff living in the home and there were training certificates in areas of health and safety and also some specialist care needs. There was evidence that some staff had not completed training in epilepsy and in dealing with challenging behavior. We spoke with one member of staff and they said that they always spoke with their supervisor or the manager about any training needed and this would be addressed. Care Homes for Adults (18-65 years) Page 24 of 31 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home is run in the best interest of the people living there, with health and safety systems monitored effectively. However people living in the home and the staff that care for them are not fully enabled to be included in voicing how the service is delivered in the home. Evidence: The manager told us in the homes Annual Quality Assurance Assessment (AQAA) that the Trustees of the home have an established monitoring system that is checked every three weeks. They also state that the health and safety officer completes risk assessments on all known hazards and that the home has a fire risk assessment in place. The home has a board of Trustees and the Chairperson of the Trustees visits the home regularly and completes a full report at least monthly. There are monthly meetings held between the manager and the supervisors but the rest of the staff do not have meetings. The manager told us that he communicates with staff through the bulletin board and annual appraisals. Some staff told us in Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: surveys that they do not always feel they are listened to and that communication between them and the manager could be improved on. Weekly meetings are held in the home for people living there to discuss the next week’s menus and the activities in the home and the manager told us that key workers are trained to work closely with people living in the home and encourage them to give input. The manager told us that there is an annual survey that is sent out for friends and family of people living in the home as part of the homes quality monitoring. However this survey is not extended to people living in the home or to the staff. The health and safety systems in the home are well maintained and safe. Care Homes for Adults (18-65 years) Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes  No  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 Adults (18-65 years) Page 27 of 31 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 Description 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 Description Timescale for action 1 6 15 30/07/2009 Care plans should be reviewed every six months in consultation with the service user and/or their representative and a record kept of the review and the service user/representative involvement. This will ensure people are having their care delivered the way they wish. 2 7 20 Money belonging to a service 18/11/2009 user must not be paid into a bank account unless the bank account is in the name of the service user or service users to which the money belongs. To ensure peoples finances are safeguarded. 3 7 20 The registered person should 27/08/2009 make sure that neither he Page 28 of 31 Care Homes for Adults (18-65 years) nor any person working at the home act as an agent or appointee for service users. To meet requirements surrounding peoples finances. 4 19 17 There must be written 30/07/2009 information for staff on what action to take if a nutritional risk assessment deems a person at risk. To ensure staff know what action to take if a person becomes at risk with regard to nutrition. 5 19 17 A nutritional screening tool 30/07/2009 must be used for people living in the home to identify any specific risks to their health as a result of their weight. To ensure risks around peoples health care needs are met. 6 39 24 People living in the home 01/07/2009 must be included in the annual survey carried out by the home. This will ensure people living in the home are able to have their say about how the home is run. 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 Care Homes for Adults (18-65 years) Page 29 of 31 improving their service. No Refer to Standard Good Practice Recommendations 1 6 Where an action has been formulated as the result of a review, the action plan should be implemented and followed up as part of the care plan. The instructions for staff to follow in the event of a medication overdose should be changed to include gaining advice from the GP and notifying the Commission of the overdose. When medication errors arise they should be recorded in a way that can be audited so that trends in errors can be identified. This could be achieved by recording it on the monthly audit record or by having a designated error record with details of action taken as a result of the error. When staff carry out a monthly audit of medication they should made a written record of this audit and any action taken as a result of the audit. The complaints procedure must include the correct details of how to contact the commission. There should be an up to photograph of staff members on their personal file. People living in the home would benefit from all staff being trained in epilepsy and in managing challenging behaviors. Staff should be included in the annual survey carried out by the home. Staff meetings should be introduced to the home and minutes kept of the meetings. 2 20 3 20 4 20 5 6 7 8 9 22 34 35 39 39 Care Homes for Adults (18-65 years) Page 30 of 31 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. 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