Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Dovehaven Nursing Home 9-11 Alexandra Road, Southport, PR9 0NB Tel: 01704530121 Date of Inspection: 03 February 2014 Date of Publication: February 2014 We inspected the following standards as part of a routine inspection. This is what we found: Consent to care and treatment Care and welfare of people who use services Safeguarding people who use services from abuse Staffing Assessing and monitoring the quality of service provision Inspection Report Dovehaven Nursing Home February 2014 www.cqc.org.uk 1
Details about this location Registered Provider Registered Manager Overview of the service Type of service Regulated activities Mrs Wendy J Gilbert & Mr Mark J Gilbert Mrs. Sarah Joy Brookfield Dovehaven is a Care Home with Nursing and provides accommodation for up to forty elderly people. The home is situated in a residential area of Southport, close to the town centre and local amenities. The home has equipment and aids to assist people and different areas of the home are accessible for people who use a wheelchair or have limited mobility. The home is owned by Mrs Wendy J Gilbert and Mr Mark J Gilbert. There is a registered manager in post. Care home service with nursing Accommodation for persons who require nursing or personal care Treatment of disease, disorder or injury Inspection Report Dovehaven Nursing Home February 2014 www.cqc.org.uk 2
Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 More information about the provider 4 Our judgements for each standard inspected: Consent to care and treatment 6 Care and welfare of people who use services 8 Safeguarding people who use services from abuse 10 Staffing 11 Assessing and monitoring the quality of service provision 13 About CQC Inspections 14 How we define our judgements 15 Glossary of terms we use in this report 17 Contact us 19 Inspection Report Dovehaven Nursing Home February 2014 www.cqc.org.uk 3
Summary of this inspection Why we carried out this inspection This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection. This was an unannounced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 3 February 2014, observed how people were being cared for and talked with people who use the service. We talked with carers and / or family members and talked with staff. What people told us and what we found We spoke to different people about this service to gain a balanced overview of what people experienced, what they thought and how they were cared for. We spoke to two people using the service, a relative and three members of staff. We spent time observing people using the service, to see how they were cared for and how staff interacted with them. People said that they were "well looked after," and that the staff were, "very good and led by a good manager." People and their relatives told us that they were involved in planning and reviewing their care needs. Relatives said that staff always had time to talk to them and that all knew them well. We saw that staff were attentive and caring, knew the service users' needs and called people by name. We saw that there were enough, suitably trained staff on duty at all times. We saw that the provider regularly assessed and monitored the quality of the service provided. You can see our judgements on the front page of this report. More information about the provider Please see our website www.cqc.org.uk for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. Inspection Report Dovehaven Nursing Home February 2014 www.cqc.org.uk 4
There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report Dovehaven Nursing Home February 2014 www.cqc.org.uk 5
Our judgements for each standard inspected Consent to care and treatment Before people are given any examination, care, treatment or support, they should be asked if they agree to it Our judgement The provider was meeting this standard. Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements. Reasons for our judgement Staff told us that people and or their relatives were given information about the service before choosing the home. We saw that all service users' files included a 'consent to general care and treatment' form and that this was signed by people using the service. When people had lacked the capacity to consent, relatives or advocates had signed a 'mental capacity consent form'. Service users or their relatives had also consented to having their photograph taken for identification purposes and for the use of bedrails when necessary, following a risk assessment. We saw that one person lacked capacity to make major decisions because of short term memory loss and did not have any relatives. Details of the solicitor who had power of attorney and a social worker who helped to make decisions on the person's behalf were recorded. Staff discussed capacity to consent and told us how they used an advocate when appropriate. We saw that contact details for an advocacy service were available. People said that they had been involved in discussions about their preferences and care needs and had discussed their care plans with the nursing staff. We saw that best interest meetings had taken place. For example one meeting involved the service user and their spouse, a general practitioner, and the home manager. We saw that it was documented that a decision was reached that they all agreed on. People told us that they could choose at what time they got up in the morning and whether they ate in their bedrooms or in the dining room. People said that staff always asked them before delivering care. We asked staff if people consented to the care they received and they said that they always asked people before helping them and we saw staff asking people before helping them with personal care, or when feeding people who needed assistance. Staff discussed how people could agree or disagree to care using gestures and eye movements, even if they could not communicate verbally. This showed us that people consented to the care and support that they received and that staff understood Inspection Report Dovehaven Nursing Home February 2014 www.cqc.org.uk 6
non-verbal communication. Inspection Report Dovehaven Nursing Home February 2014 www.cqc.org.uk 7
Care and welfare of people who use services People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was meeting this standard. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Reasons for our judgement People using the service said that they were well taken care of by the staff and that if they needed anything, "you only have to ask and it's done." A relative told us that he was very happy with the care his relative received, that they were always clean and comfortable, and that staff frequently checked their needs. Staff told us that when people first came to the home, their needs and preferences had been discussed with them and or their relatives. We saw that people's needs and preferences for food and drink, activities and personal hygiene were clearly documented in their care plans. The manager told us that an activities co-ordinator was employed in the home and we saw records of communal activities such as armchair exercises, quizzes, and a film club. The co-ordinator also spent time with people who chose to stay in their bedrooms. A service user told us that in the summer they spent time in the large garden. Staff told us that people with mobility problems were taken into the garden in wheelchairs if they chose to go. A hairdresser visited the home once a week. When we arrived at the home at 0700, the night staff had helped three people to wash and dress and sit in chairs in their bedroom or in the dining room. We spoke to the service user in the dining room who told us that they chose to get up early. The staff told us that some other people had been bed-bathed early because they were awake and needed personal care. Many service users were unwell or unable to get out of bed and we saw that staff frequently checked on them and turned those who needed help to do so. During our inspection we saw that when staff spoke to people they were kind and cheerful in manner and called people by name. Staff expressed genuine concern and care for people using the service; for example, a member of staff talked about the difficulty that some people experienced adapting to living in a home. They said they needed to be, "supportive and help them to adapt and give them something to look forward to." Staff were able to describe the action they would take in an emergency situation to maintain people's safety. They were able to locate relevant policies which were all up to date. Staff showed us where emergency telephone numbers were located. This showed us Inspection Report Dovehaven Nursing Home February 2014 www.cqc.org.uk 8
that procedures were in place, that staff knew about to deal with emergencies. All of the people using the service had an individualised care plan and most had photographic identification of the service user. Photographic identification helps to ensure the safe administration of medicines particularly if a service user is confused or has impaired capacity to communicate. One of the care files that we looked at did not have a photograph of the service user and staff told us that there was no photograph on the person's medication records. The service user was able to give their full name and had been at the home for several months. The provider may care to note that in order to ensure the safety of service users,photographic identification should be available to staff within an appropriate timeframe, unless a service user refuses consent to photography. We looked in depth at pre-admission assessments, risk assessments and care plans for three people. The manager told us that they or another manager had visited people and discussed their needs and preferences before they had come to live at the home. Some people had been assessed by social services before coming to the home and had then been re-assessed by a nurse at the service. Assessment included moving and handling, risk of falls, risk of malnutrition and risk of developing pressure ulcers. We saw that a booklet entitled, 'Personal care Book' was in each person's file. This was person centred, including details of significant life events and personal preferences in relation to activities of everyday living and dependency. The planned care matched the assessed needs of people and plans were in place to prevent or minimise risk from falls, moving, pressure ulcers and malnutrition as well as specific person centred or mental health related risks when required. Care plans included a summary of care plans for each person. Care plans were reviewed annually unless there were changes and updated twice a day. One person had been admitted with a pressure ulcer which was gradually improving and this was recorded in the daily care record. This showed us that service users were protected from risks and that care was planned according to individual needs with the involvement of service users. Inspection Report Dovehaven Nursing Home February 2014 www.cqc.org.uk 9
Safeguarding people who use services from abuse People should be protected from abuse and staff should respect their human rights Our judgement The provider was meeting this standard. People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Reasons for our judgement People and relatives told us that staff were always kind and gentle when caring for them. Staff told us that they protected people's dignity when delivering personal care, for example when bed-bathing people, keeping the door shut and covering them with a towel. We talked to staff about how they safeguarded vulnerable people using the service from abuse. All of the staff said they had received training about safeguarding and we saw records that confirmed this annual training. All staff were able to identify the different types of potential abuse. This included financial abuse and one member of staff told us that this included taking property or sweets from a service user demonstrating an in depth understanding. Staff told us about signs, such as bruising or withdrawal that might lead them to suspect abuse of a service user. Staff said that if they witnessed abuse they would intervene and report it to their line manager. Equally, if they were to suspect abuse they would report it immediately. None of the staff had ever witnessed or suspected any abuse in the home. When we visited the home, no deprivation of liberty standards (DOLS) were in place. All staff understood the legal principles relating to restraint and one member of staff had seen it in use in a previous employment. Staff pointed out a 'whistleblowing' poster on display in the nurse's station that included contact details for the local authority and the Care Quality Commission. They told us that, although they were sure that the manager would deal appropriately with any allegations of abuse; they would contact their local authority or the Commission if they felt they needed to. This all evidenced that people using the service were protected from the risk of abuse. Staff told us that they had read a service policy about safeguarding vulnerable adults from abuse and that it was available in the manager's office. A member of staff referred to the 'No Secrets' publication but on the day that we visited we were unable to see either this or the policy of the service. The provider may care to note that this policy should be easy for all staff to locate, together with details of who to contact if abuse is suspected. Inspection Report Dovehaven Nursing Home February 2014 www.cqc.org.uk 10
Staffing There should be enough members of staff to keep people safe and meet their health and welfare needs Our judgement The provider was meeting this standard. There were enough qualified, skilled and experienced staff to meet people's needs. Reasons for our judgement People that we spoke to and staff all said that there were enough staff to care for people using the service. On the day that we visited the service there were six carers and two trained nurses on duty as well as domestic and catering staff. There were 37 people using the service. Relatives said that there was always someone around to ask for help, talk to or ask questions of. They said that all of the staff knew their relative and their needs and that staff had time to talk to them. People using the service told us that if they used the call bells at all, they were answered quickly. We saw that the call system in place sounded at the nurses' station on the first floor. All care staff carried a 'pager' which sounded and alerted them to the location of the call. Staff said this was a really good system which helped them know who needed assistance and minimised the disturbance to service users that a noisy public system might cause. The manager told us that the dependency needs of service users was calculated when they were first assessed, before they came to the home and when their care was reviewed and this information was analysed and used to decide required staffing numbers. One service user had additional care for each afternoon and early evening. This had been agreed after their needs were assessed. We looked at records of duty rotas for different days of the week in July and September 2013 and January 2014 and saw that staffing numbers were always consistent during the day and at night. This showed us that there were sufficient numbers of staff at all times. Staff told us that they received an induction when they first started working at the home and that they believed they had received enough training to care for the people who used the service. The care staff that we spoke to had either completed, or were working towards a level three National Vocational Qualification in care. Staff told us that they were supported by their manager to complete NVQ training and had annual training updates, regular supervision and annual appraisals. We saw training records that showed that all staff received training in manual handling, health and safety, control of substances hazardous to health (COSHH), infection control and in preventing abuse and that this was updated annually. Fire safety training had taken Inspection Report Dovehaven Nursing Home February 2014 www.cqc.org.uk 11
place twice each year. Staff told us that they were confident that if they suggested any additional training, it would be sourced and made available by the provider. The manager told us that they had recently received additional safeguarding training provided by the local authority which included DOLS training. They told us that they planned to roll out this training to the trained staff early in 2014 and eventually to all care staff. This showed us that staff were suitably trained to care for the service users in the home. Inspection Report Dovehaven Nursing Home February 2014 www.cqc.org.uk 12
Assessing and monitoring the quality of service provision The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care Our judgement The provider was meeting this standard. The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others. Reasons for our judgement All service users who lacked the capacity to make decisions themselves had included in their files, the name and contact details of a relative, advocate, solicitor or social worker who was able to assist them and help to make decisions in their best interests. We saw that this protected service users from the risks associated with managing their care and welfare. One of the service users that we spoke to said that they had been asked to complete a survey about the quality of care at the home. We saw that an annual survey was undertaken by an independent quality assessor who analysed the results. We looked at the report for the previous year and saw that it included suggestions and recommendations with the results. The area manager told us the report was read by the provider and the manager of the home and that suggestions were implemented if appropriate. Questions on the survey related to the facilities available at the service, the cleanliness of the home and the provision of care and support. We saw that most of the questions on the survey had been answered as good to excellent in early 2013. Staff told us that regular audits relating to the management of medicines and of service users' care plans and documentation took place. We saw records that confirmed this. We saw records of regular audits relating to the kitchen and food hygiene, and cleaning and maintenance. Maintenance checks included emergency lighting and other safety elements. Staff told us that fire safety drills took place twice a year. The service employed two compliance managers, who we met when we visited. They showed us records documenting that they had reviewed audits completed by staff each month and that they completed other audits. They told us that although immediate action was taken if any serious risk was found, this was not clearly documented on the assessments and audits. They said that in future an action plan would be detailed and kept with audit or assessment records, together with details of any action taken to prevent problems re-occuring or to improve safety. This all showed us that the provider had systems in place to monitor the quality of service provision. Inspection Report Dovehaven Nursing Home February 2014 www.cqc.org.uk 13
About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report Dovehaven Nursing Home February 2014 www.cqc.org.uk 14
How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report Dovehaven Nursing Home February 2014 www.cqc.org.uk 15
How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact. Minor impact - people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact - people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact - people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report Dovehaven Nursing Home February 2014 www.cqc.org.uk 16
Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report Dovehaven Nursing Home February 2014 www.cqc.org.uk 17
Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report Dovehaven Nursing Home February 2014 www.cqc.org.uk 18
Contact us Phone: 03000 616161 Email: enquiries@cqc.org.uk Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: www.cqc.org.uk Copyright Copyright (2011) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Inspection Report Dovehaven Nursing Home February 2014 www.cqc.org.uk 19