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Inspection on 28/04/09 for White Lodge Residential Home

Also see our care home review for White Lodge Residential Home for more information

This is the latest available inspection report for this service, carried out on 28th April 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What has improved since the last inspection?

The care plans are now more person centred and reflect how service users wish their care needs to be met. Care plans are now signed by the service user as evidence of their participation and agreement with the plan.White Lodge Residential HomeDS0000043778.V374979.R01.S.docVersion 5.2Page 7Details of all medical visits or other consultations and the outcomes from the visits are recorded in the care plans. The home has employed an activities coordinator who now provides a wider choice and variety of activities to suit service users` needs and wishes. The management of medication is now more robust and the home has introduced a new system which is supplied by a pharmacy, who are supportive to the home to ensure the system is well managed. Risk assessments are now in place for the two residents who wish to manage their own medication and have been assessed as able to self-medicate. The home now provides locked environments for those service users who manage their own medication and this is audited at regular intervals as part of the risk assessment. The home now has a robust quality assurance system in place that monitors all areas of the home`s environment, systems and service users level of satisfaction. The home provides a safe environment for the service users that is regularly audited and risk assessments are in place.

What the care home could do better:

There were no requirements made from this inspection visit.

Key inspection report CARE HOMES FOR OLDER PEOPLE White Lodge Residential Home 67 Havant Road Emsworth Hampshire PO10 7LD Lead Inspector Jan Everitt Unannounced Inspection 28th April 2009 09:30 DS0000043778.V374979.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. White Lodge Residential Home DS0000043778.V374979.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) 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. www.cqc.org.uk Internet address White Lodge Residential Home DS0000043778.V374979.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service White Lodge Residential Home Address 67 Havant Road Emsworth Hampshire PO10 7LD Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01243 375 869 WLCareltd@aol.com Mrs Jill Cathryn Dowsett Mrs Kay Ellen Smy Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (0) of places White Lodge Residential Home DS0000043778.V374979.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: 2. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 25. Date of last inspection 16th July 2008 Brief Description of the Service: White Lodge is a residential care home providing care and accommodation for up to twenty-five service users aged 65 years and over; situated on the Havant Road, in Emsworth. The home is privately owned. White Lodge is a detached building set back from the main road. There are parking facilities and gardens to the front and rear of the home. The home has twenty-five single bedrooms, sixteen of which have an en suite toilet facility. The home’s weekly fees range from £550-£660 These fees do not include hairdressing, papers, chiropody, toiletries and other person items. White Lodge Residential Home DS0000043778.V374979.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The unannounced, inspection visit to White Lodge Residential Home, took place over a one-day period on the 28th April 2009. The acting manager and registered provider, Mrs. Dowsett, assist us (CQC) throughout the visit. This report details the evaluation of the quality of the service provided at White Lodge and takes into account the accumulated evidence of the activity at the home since the last inspection, which took place in May 2008. An Annual Quality Assurance (AQAA) had been completed by the home and the information from this and the last inspection report was used to inform this report. Evidence for this report was obtained from reading and inspecting records, touring the home and from observing the interaction between staff and service users. During this visit we spoke to most of the service users and a staff. In order to prepare for the visit, surveys were sent to the people living in the home, staff and other professionals involved with the home. Ten service users, (one of which was completed by a relative), eight staff and three health professionals surveys were returned. The outcome of the surveys indicated that there was generally a high level of satisfaction with the service and that people were pleased with the care the home provides. Staff indicated that they enjoyed working at the home and were supported in their role by the management team. The home is registered to provide support for 25 residents and at the time of the inspection there were 20 people in residence of mixed gender. Service users spoken to were generally complimentary about the home and the care they receive. What the service does well: White Lodge is clean and well maintained and is furnished to a good standard and has a homely atmosphere. Residents are able to personalise their bedrooms, several of which were noted to have numerous personal belongings. Service users have expressed their satisfaction with the service in comments made on surveys returned to CQC saying: White Lodge Residential Home DS0000043778.V374979.R01.S.doc Version 5.2 Page 6 ‘I feel the home is very pleasantly run and the staff are always very kind and compassionate’. ‘The owners have their eye on all matters and will go beyond their call of duty to help’. ‘This is a most excellent home and I find all the staff are very caring and helpful. We are never kept waiting when called. All meals are very varied and served hot. This is a first class and happy social family’. ‘The care and support could not be found better any where in my opinion’. ‘Overall the home is very good’. ‘The staff are very cheerful and always willing to help with any problems we might have’. ‘It is a happy home and I am pleased to be living here, the staff are excellent’. ‘I am very content as things are’. Service users healthcare needs are recorded and how they are met. Staff have regular supervision and have access to a variety of training courses including NVQ levels 2, 3 and 4 in care. Staff surveys told us that staff are happy working in the home and the training and support provided and say: ‘The staff work well together as a team. There is always ongoing training and support for staff’. ‘Everyone is friendly and the home is a great place for staff and residents. The home is always clean and tidy and residents well cared for and great to be around’. ‘The tests we take with Red Crier training regularly keep us up to date’. ‘We follow all policies and procedures’. ‘The service does well to provide training, the standard of care for the residents and the support for staff’. ‘The management give us support and we give quality care to residents’. ‘It is a lovely home to work in and everyone works well together and cares very much’. A variety of activities are provided for service users to attend if they so choose. Residents have a wide choice each meal time of a variety of wholesome food that is well presented. What has improved since the last inspection? The care plans are now more person centred and reflect how service users wish their care needs to be met. Care plans are now signed by the service user as evidence of their participation and agreement with the plan. White Lodge Residential Home DS0000043778.V374979.R01.S.doc Version 5.2 Page 7 Details of all medical visits or other consultations and the outcomes from the visits are recorded in the care plans. The home has employed an activities coordinator who now provides a wider choice and variety of activities to suit service users’ needs and wishes. The management of medication is now more robust and the home has introduced a new system which is supplied by a pharmacy, who are supportive to the home to ensure the system is well managed. Risk assessments are now in place for the two residents who wish to manage their own medication and have been assessed as able to self-medicate. The home now provides locked environments for those service users who manage their own medication and this is audited at regular intervals as part of the risk assessment. The home now has a robust quality assurance system in place that monitors all areas of the home’s environment, systems and service users level of satisfaction. The home provides a safe environment for the service users that is regularly audited and risk assessments are in place. 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 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. White Lodge Residential Home DS0000043778.V374979.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection White Lodge Residential Home DS0000043778.V374979.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 People using the 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 pre-admission assessment is comprehensive and would allow the home and the service user adequate information to ascertain if the home could meet their needs. EVIDENCE: A sample of four service users’ pre-admission assessments was viewed. The records show that following a referral for possible admission to the home an assessment of need is carried out by the acting manager and the provider. The new deputy manager is to be trained to undertake these assessments with the current manager or provider. The assessments involve visiting the service user to carry out an assessment either in their own homes or in the clinical area. For those referred by social services, the home obtains a copy of the care White Lodge Residential Home DS0000043778.V374979.R01.S.doc Version 5.2 Page 10 manager’s assessment and care plan. Other relevant information is gathered from relatives and medical information from hospitals. The pre admission assessments contain information about the needs of residents including their personal preferences such as cultural and religious needs. The assessment tool was observed to be comprehensive and would allow the home and the service user adequate information to ascertain if the home could meet their needs. The Service User Guide and an information booklet has been updated and are supplied to prospective residents if they visit the home prior to their admission or at the time of the assessment. The booklet gives detailed information about the home. Opportunities are available for prospective residents and/or their relatives to come and have a look around the home to decide if it is the right choice This service does not provide intermediate care. White Lodge Residential Home DS0000043778.V374979.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans provide care staff with all information needed ensuring a service users needs are met. Health care needs are well documented with a range of services available to meet service users’ needs. Systems are in place to ensure that resident’s medication is well managed. Residents are treated with respect and their right to privacy promoted. EVIDENCE: The AQAA states that over the past year the home has developed a new person centred care planning system. A sample of four people’s care plans was viewed. These evidenced that care plans were based on risk assessments and needs. The care plans describe how resident’s activities of daily living are fulfilled. The care plans are written with the service user and their key worker and these were seen to be signed by the service user as evidence of their participation. White Lodge Residential Home DS0000043778.V374979.R01.S.doc Version 5.2 Page 12 The care plans state how service users wish their needs to be met and identify their preferences for times of going to bed and rising, dietary preferences and what they like to do for their leisure activities and how they wish to spend their day. The care plans are reviewed monthly with the service user and signed by them at the time of review. Daily records are maintained and were viewed and detail how the service user has spent their day. Comments from service users returned on surveys indicate that they are very happy with their care and daily lives. Comments say: ‘I feel the home is very pleasantly run and the staff are always very kind and compassionate’. ‘The owners have their eye on all matters and will go beyond their call of duty to help’. ‘This is a most excellent home and I find all the staff are very caring and helpful. We are never kept waiting when called. All meals are very varied and served hot. This is a first class and happy social family’. ‘The care and support could not be found better any where in my opinion’. ‘Overall the home is very good’. ‘The staff are very cheerful and always willing to help with any problems we might have’. ‘It is a happy home and I am pleased to be living here, the staff are excellent’. ‘I am very content as things are’. Comments from the service users spoken to at the time of this visit told us that they were very happy living in the home and the staff were familiar with their needs and were very kind. The AQAA states that the home ensures that all health care needs are met with the support of the appropriate professionals. The care plans contain a separate record of any visits the service user has from the primary care team. It documents who has visited and the outcome of the visit. The daily notes also document if the service user has been visited by a medical professional. The district nurse visits the home when requested and the continence advisor also visits the home to assess and review those service users who are in need of continence aids. Service users have access to dentist, opticians and the chiropodist who visits the home at regular intervals. These visits are also recorded in the care plan notes. Comments on surveys returned from visiting professionals were very positive and told us that: ‘I think White Lodge is a well run residential home that delivers a high standard of care’. White Lodge Residential Home DS0000043778.V374979.R01.S.doc Version 5.2 Page 13 ‘Managers very caring and knowledgeable about residents. Always helpful and will put themselves out. The home is reliable to contact GP appropriately and show good judgement when necessary’. ‘Residents are treated with respect and are clean and well cared for. The majority appear very happy in the home. I think the standard of care is very high’. ‘The team have developed good working relationships with the community team and the home acts on any advice that is given to them. The home is keen is have onsite training from the community team on various subjects’. The previous key inspection of a year ago and the pharmacy inspection in July 2008 highlighted short falls in the management of the medication in the home. The requirements made from these inspections have now been complied with and the home had reviewed policies and procedures and has since changed suppliers and now uses the monitored dosage system (MDS) for the management of service user’s medication. The home has also obtained a copy of the Royal Pharmaceutical Society guidelines for the management of medication in care homes. The current manager and her deputy coordinate the ordering, checking and returning of medication. The medication is kept in the medication trolley, which is housed in the office and is attached to the wall for security. This was seen to be clean and well organised. The controlled drug cupboard is also housed in this room and the door is locked when not in use. The controlled drug register was checked and seen to be recorded appropriately. The medication fridge is housed in a large store cupboard next to the office, which is kept locked. The temperature of the fridge was observed to be monitored daily. The medication administration records (MAR) sheets were examined and these evidenced that they had been completed appropriately. The records of these being audited weekly were seen and any action to take is recorded if something is highlighted as not correct. We viewed records that evidenced that medication not used and for return to the pharmacist is recorded monthly. Two of the service users were choosing to manage their own medication. There was evidence of risk assessments being undertaken and that a locked environment within their rooms was provided. The manager told us that she checks the stock of their medication monthly but that both residents are very able to manage their own medication and alert her if they need more stock. One comment on a survey returned by a resident said: ‘I am self medicating and the staff can always be contacted if I need top up’. Staff undertake medication training and there were certificates in the personnel files to evidence this. Only carers who have received this training can administer medication and there is always one on duty throughout the twenty four hour period. White Lodge Residential Home DS0000043778.V374979.R01.S.doc Version 5.2 Page 14 We discussed with the manager that if a medication has been transcribed onto the MAR sheet by a staff member, that this must be signed by a second person to ensure correct information is transcribed and to ensure safe procedures. The AQAA states that the resident’s privacy is upheld and staff are reminded that this is extremely important that this is respected. The AQAA said that the staff training on the issues of privacy and respect has been well received by staff and has impacted on care practices. We observed throughout this visit that staff were treating residents in a courteous manner and knocked on doors before entering their rooms. Staff and residents appeared to have a good rapport with each other and staff were observed to be familiar with the residents care needs and how they like ‘things done’. All bedroom doors have locks fitted and some service users do choose to have their own key and keep their door locked when not in their bedroom. Service users spoken with and surveys returned to CQC from service users and relatives say: ‘The care and support could not be found better any where in my opinion’. ‘This is a most excellent home and I find all the staff are very caring and helpful. We are never kept waiting when called’. White Lodge Residential Home DS0000043778.V374979.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Routines are flexible, allowing residents to exercise control over their lives. Family contact is encouraged, and activities and diet are well managed, offering variety and a choice of a nutritional diet. EVIDENCE: The AQAA states that the home provides a regular programme of activities which is a response to the requests and needs of the residents through an activities co-ordinator and staff. The home has now employed an activities co-ordinator who attends the home four times a week. The home has an activities programme displayed on the wall which all staff become involved in and that demonstrated a variety of activities taking place to suit most preferences. The activities co-ordinator was spoken with and she told us that she talks to individual residents and finds out about their social history and the recreational things they would like to do and White Lodge Residential Home DS0000043778.V374979.R01.S.doc Version 5.2 Page 16 this is recorded and contributes to the planning of appropriate activities for the service users. She was observed to be playing a board game with two residents, who told us they thoroughly enjoy it and the quizzes that take place. Activities reports are recorded by the activities co-ordinator and this document what activities have taken place on a daily basis and who attended the activity and their level of participation. Service users spoken with say they enjoy the activities, some saying they choose to not always join in but enjoy observing. A relative told us in the survey returned that ‘staff have advised me that mother is always happy to participate in the organised activities and she enjoys listening to music. The home had planned to decorate Easter bonnets and also a trip to the theatre’. The surveys returned to CQC by service users indicate that there is ‘always’ or ‘usually’ activities arranged that they can take part in if they choose. On the previous Sunday the home had put on a ‘Sunday High Tea at the Ritz’ for service users and relatives were invited to tea. It was a great success and service users were keen to talk about it and told us they wish to have a repeat of this. They told us that the food was wonderful with a variety of cakes and sandwiches and that a person had played old songs on the piano. The proprietor told us that she had organised this theme as something the residents would relate to and enjoy and that she would do this at regular intervals. The home does have outside entertainers in once a month and a person attends the home for service users to participate in musical movements once a week. The AQAA told us that the home has, over the past year, recruited a small group of volunteers who help with the activities. The home does have visiting clergy every week that attend the home to give communion to those service users who wish to take it. The Roman Catholic priest also attends the home to give communion. One service user goes to the community church and is transported to it by the people from the church. Outings for the service users are usually via relatives taking the residents out with the occasional trip out organised by the home. Two residents attend the stroke club weekly. The visitor’s book demonstrated that the home does have regular visitors and this was supported when talking to a number of service users who said they have regular visits from family and friends who are made welcome in the home. The home promotes family involvement with the home and invites relatives to various parties and celebrations throughout the year. White Lodge Residential Home DS0000043778.V374979.R01.S.doc Version 5.2 Page 17 A relative spoken to at the time of this visit expressed his satisfaction with the care his mother was receiving and said that he visited every day and was always informed of any changes or relevant information about his mother. She was well able to communicate with us and said she was as happy as she would be anywhere that was not home. Records are now maintained of the preferred rising and going to bed times of the individual residents and residents spoken with confirmed that they are able to exercise choice in this area and that ‘staff are very kind’. Personal preferences and religious needs are recorded. The AQAA states that the home provides a high standard of food consistent with the aim to provide a high quality service. The home continues to ensure that food is served at a time which is individually convenient to each resident in the place of their own choosing and that dining facilities are well maintained and of a good quality. The ethos of the home is to ensure that residents eat their meals at the pace they prefer and in the company of those residents they choose, They are assisted with their meals as requested with sensitivity and discretion. The menus were viewed and were observed to be on display and demonstrated that they are changed on four weekly basis and the content of the menus described wholesome meals that elderly people would enjoy. The proprietor told us that the menus have been reviewed with the new chef who has a catering training and he and the proprietor have comprised the menu to have more choice. The proprietor has undertaken food surveys and distributed questionnaires to the service users and has discussed there preferences at the resident’s meetings. The outcome is that the service users now have a choice of five starters, three main meals and a selection of desserts and the choice of menu extends to every mealtime. Snacks and beverages are available throughout the 24 hours. Care plans recorded service users’ likes and dislikes in food preferences and where they would prefer to eat their meals. Most residents choose to eat in the pleasant dining room but those wishing to stay in their bedroom are able to do so. The lunch time meal was observed. Service users were observed to have chosen a variety of different meals from the menu. The food was presented well and was wholesome. One resident said ‘the food is very good but I have a small appetite and they do put too much on the plate’. Another lady completely finished her meal and told us ‘it was very enjoyable’. Surveys returned to the CQC indicated a high level of satisfaction with the food and comments made were: ‘The quantity of food provided for mother is just right and she enjoys it’. ‘All meals are very varied and served hot. This is a first class and happy social family’. White Lodge Residential Home DS0000043778.V374979.R01.S.doc Version 5.2 Page 18 ‘The menus are pretty good’. ‘If the meals are not to our taste there is always an alternative’. The service users were seen to be interacting well with one another at the meal time which appeared to be quite a social occasion. A carer was observed to be helping one resident with her meal and this was being undertaken in a courteous respectful manner. The kitchen was visited by us and was found to be clean and well organised with appropriate cleaning schedules in place and records of fridge/freezer temperatures and safe and correct storage of foodstuff. The chef was knowledgeable when spoken to about the diabetic diets that are catered for, and told us that he is about to attend a training course on healthier foods and special diets. He has undertaken his food handling and hygiene update certificate recently and is keen to undertake further training. He told us that all food is cooked from fresh and he communicates with the service users as to their likes and dislikes. The store cupboard evidenced that food is fresh and stored correctly and that fresh vegetables are delivered to the home regularly. Nutritional risk assessments on residents are undertaken and regular weights are recorded in care plans. White Lodge Residential Home DS0000043778.V374979.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the 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 has a complaints procedure, which service users felt they would use if necessary. Service users are protected from abuse by the robust policies and procedures in the home and staff training. EVIDENCE: The AQAA stated that there are notices around the home inviting residents to make complaints. Residents meetings are held regularly and this gives residents another opportunity to voice their issues. The AQAA records that the home has received 4 complaints in the last twelve months 3 of which has been upheld and all resolved within stated timescales. The home has a complaints procedure. This is given to residents and their relatives in either the contract and/or the Service Users’ Guide. The surveys returned from service users confirm that they are aware of the complaints procedure and would know who to go to if they had concerns or issues. Comments said White Lodge Residential Home DS0000043778.V374979.R01.S.doc Version 5.2 Page 20 ‘The staff are always helpful and approachable and I would feel able to raise any issues relating to mums health and welfare with them if necessary on her behalf. ‘There are notices all over to tell us who to talk to if we wanted to complain’. ‘The staff are very cheerful and always willing to help with any problems we might have’. We viewed the complaint’s record book, which evidenced a description of the complaint and the action and outcome and how the complaint was resolved. As a result of a safeguarding issue that was investigated last year the home has procedures in place that show a clear system for staff to report concerns about colleagues and managers which ensures that concerns are investigated in line with local policies and procedures. All staff and mangers are aware when an incident needs to be referred to the Local Authority as part of the safeguarding procedures. The home has introduced a new induction programme that ensures that new staff engage with abuse and the safeguarding issues as soon as possible. The AQAA states that the home will continue to monitor the systems to ensure that they continue to provide a robust safeguard for residents. An induction work book was observed and contained a section on abuse and safeguarding issues. The manager told us that she delivers training to all newly recruited staff before the work book is completed and this tests their knowledge. All staff have received training on safeguarding and how any issues in relation to this must be reported. Staff surveys returned to CQC told us that staff are aware of the procedures to deal with any concerns they have or concerns expressed by residents to them. White Lodge Residential Home DS0000043778.V374979.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People using the 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 provides a clean, safe, pleasant and well-maintained environment for the enjoyment of service users. EVIDENCE: The AQAA states that there have been various improvements in the environment over the last year and half of the home has been redecorated and re-carpeted and bedroom furniture has been replaced in many rooms. The kitchen floor has been replaced and the laundry has been refurbished with new lockable cupboards and a new system for clothes storage. The AQAA states that the home now employs a full time maintenance man who is also responsible for the upkeep of the surrounding gardens. The home has White Lodge Residential Home DS0000043778.V374979.R01.S.doc Version 5.2 Page 22 a logging system to report any repairs or maintenance issues. The AQAA said that the home has a commitment to update and replace furniture in consultation with residents which can reflect their tastes and appropriate needs. The home avoids any institutional furnishings. Rooms are regularly redecorated and colours are chosen in conjunction with resident’s wishes and choices. We looked in all areas of the home. It was observed to be very clean with no offensive odours. The home has two lounges, one is called the television lounge and the other is known as the quiet lounge. Both are decorated to a good standard and have access to the gardens, which are large and maintained by a gardener. The surrounding grounds are pleasantly situated and used by the residents in the finer weather. The residents’ bedrooms were observed to be decorated to a good standard and contain numerous personal possessions. Residents are able to bring their own furniture to their rooms. On the ground floor the home has a wet room which has been converted from a bathroom and which is proving very popular with the residents. Another separate bathroom and a further bathroom on the first floor are also available. The home has separate laundry, which has recently been refitted with new flooring and a new system for clothes storage installed. The home has a passenger lift which residents were seen to use. Hoists are available for those with mobility and lifting needs. Infection control training is provided for staff and updates are undertaken yearly as part of the mandatory training. The manager told us she regularly monitors staff in their practices. Disposable gloves and aprons were observed to be available as so were hand washing facilities in all areas. Service users and staff spoken with expressed how they enjoy living and working in the home and that everyone supports each other. They consider the home to always be fresh and clean and comments on surveys returned said; ‘The home is always fresh and clean and no detection of odours and carpets are cleaned properly’. ‘The home is well kept, the grounds are well kept and the gardener keeps the pathways as safe as possible for us to walk in’. ‘The care and food is good and the home is always clean’. White Lodge Residential Home DS0000043778.V374979.R01.S.doc Version 5.2 Page 23 ‘Everyone is friendly and the home is a great place for staff and residents. The home is always clean and tidy and residents well cared for and great to be around’ White Lodge Residential Home DS0000043778.V374979.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service user’s needs are met by sufficient numbers of staff who have received training to enable them to meet service users care needs. Recruitment policies and practices ensure that service users are supported and protected EVIDENCE: The AQAA tells us that the home has increased the kitchen staff hours to provide cover in the evening and this has freed up care staff to support residents with their meals and better meet their needs in the evening. At the time of this visit there were twenty people in residence. The staffing levels were stated to be 3 carers in the morning and 2 in the afternoon, with the manager on duty until 17:00. The chef stayed on duty until 18:00 to prepare and clean up after supper and therefore carers were not involved with the kitchen duties. A week end chef was in the process of being recruited, but carers do not get involved in the kitchen duties if they are on carers duty. From observing the routines of the day it would appear that at the time of this visit there was sufficient staff on duty for the number of residents and to meet their needs. This was discussed with the proprietor as to this being reviewed if White Lodge Residential Home DS0000043778.V374979.R01.S.doc Version 5.2 Page 25 the home was accommodating more residents and the dependency levels were increased. Service user spoken to spoke highly of the staff and the care they receive. Comments on surveys returned from service users said: The staff are always helpful and approachable The care and support could not be found better any where in my opinion’. ‘This is a most excellent home and I find all the staff are very caring and helpful. We are never kept waiting when called. I feel the home is very pleasantly run and the staff are always very kind and compassionate’. ‘I generally get the care and support as needed It is a happy home and I am pleased to be living there the staff are excellent’. ‘I am very content as things are’. ‘The staff are very cheerful and always willing to help with any problems we might have’. The AQAA states that the manager has introduced internal rotation between day and night staff to ensure the night care team are well trained and informed. The night staff are working one session a month on days and the manager hopes this will address some of the inherent difficulties with communication between day and night staff, thus improving the quality of care experienced by residents at night. The provider told us that 75 of staff are now working on days and nights and this has resulted in more information being shared and better communication between day and night staff. Senior staff are working on nights and take the opportunity of undertaking supervision of the night care staff and at which time senior staff can discuss training needs. The AQAA reports that the home employs 15 permanent care workers of which 8 have achieved their NVQ level 2 or above. Three carers have achieved NVQ level 4 and 1 level 3. This represents over 50 of care staff have a National Vocational Qualification (NVQ). The home has a programme of training and this is undertaken internally by staff or the district matron, who said that home had developed good working relationships with her. She says the home is keen is have onsite training for catheter care, hand hygiene, and further subjects which she is willing to provide. Other training is provided by outside trainers and staff attend outside venues for this training. Training files evidenced that staff are undertaking appropriate training that relates to their job. The AQAA states that the induction programme has been improved over the last year that meets current guidelines and is easy to follow. There is an added recording process to ensure that all staff induction is evidenced and checked. White Lodge Residential Home DS0000043778.V374979.R01.S.doc Version 5.2 Page 26 The home has also introduced a mentoring system for new staff to be supported by more experienced staff and this enable more experienced staff to gently guide members of staff to ensure that residents are treated with respect and care in a person centred way. The induction programme that is based on the Skills for Care Induction Standards was evidenced in a staff file but was not completed to date. A new member of staff was being mentored at the time of this visit and she as shadowing a carer who was more experienced. She told us that she has been well supported throughout her induction period. Staff training needs are identified through the yearly appraisal system and two monthly supervisions sessions. Records of these were observed by us. The AQAA states that the coming year the home will undertake more staff training in the aspects of diversity and equality and to link into Hampshire Social Services training provision. A sample of three of the more recently recruited staff files was viewed. These evidenced that all the necessary checks from the Criminal Record Bureau (CRB) and the Protection of Vulnerable Adults (POVA) were received along with two references, one being from the previous employer, and proof of identification documents. Induction, supervision and training records were also observed in the records. White Lodge Residential Home DS0000043778.V374979.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People using the 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 deputy manager is currently managing the home, with the support of the proprietor. The home is run in the best interests of service users and there is a formal quality assurance system in place to measure the outcomes for service users against that stated in the Statement of Purpose. The health and safety of service users and staff is promoted. White Lodge Residential Home DS0000043778.V374979.R01.S.doc Version 5.2 Page 28 EVIDENCE: The registered manager is on long term leave and the deputy manager is managing the home in her absence. The proprietor has inform CQC of the management arrangements during this period and has agreed to inform CQC if these arrangements change in the interim period until the registered manager‘s due date of return. The acting manager has worked at the home in the role of deputy manager for four years, has worked at the home for eleven years and has been involved with the changes made in the home over the past year. She has achieved her NVQ level 4 and is about to undertake her management qualification. She has the support of the proprietor who lives on site and who is actively involved with the home on a daily basis. The AQAA describes a new quality assurance system that has been introduced with the tools being used to monitor the quality of the service. This includes collecting opinions from residents, relatives, having relatives and residents meetings and monitoring the complaints records, auditing medication and ensuring all related records are maintained. The AQAA states that the quality assurance system would ensure that staff are directly involved in ensuring that care id delivered with due regards to diversity and equality issues and that health and safety guidelines are followed. Monthly resident’s meeting are held and three monthly staff meetings, all of which records of the minutes are kept and were seen by us. The records of the quality audits undertaken were seen by us and demonstrated that all areas of the home are checked daily for health and safety issues. The service users’ satisfaction questionnaires are distributed every 6 months and the results have been analysed and demonstrated a high level of satisfaction with the service. The medication system is audited to ensure the home has robust system for the management of medicines. The home does not manage any service user’s finances. Not all radiators have been covered. There was evidence of risk assessments for all rooms and if a radiator cover is needed it will be put on. More radiators have been covered since last year and this programme is ongoing. Window restrictors have been fitted to sash windows and the remaining windows on the first floor have been risk assessed. White Lodge Residential Home DS0000043778.V374979.R01.S.doc Version 5.2 Page 29 A sample of servicing certificates was viewed and these demonstrated that equipment and systems are serviced at appropriate intervals and were current. The fire log was viewed. This evidenced that they system and equipment is tested at appropriate intervals and that staff training and fire drills take place three monthly. The home has a fire risk assessment. The accident recording log was seen. These were recorded in detail and have been analysed to identify emerging themes. The home is in discussion with the community matron to discuss the emerging themes in relation to falls. Mandatory health and safety training is provided for all staff and a training matrix evidenced this. White Lodge Residential Home DS0000043778.V374979.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A 3 x x x x x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 3 White Lodge Residential Home DS0000043778.V374979.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations White Lodge Residential Home DS0000043778.V374979.R01.S.doc Version 5.2 Page 32 Care Quality Commission Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 03000 616161 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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