Inspection on 28/09/05 for Cavell Lodge

This inspection was carried out on 28th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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.

Other inspections for this house

Cavell Lodge 30/10/07

Cavell Lodge 29/05/07

Cavell Lodge 11/05/06

Cavell Lodge 20/05/05

Cavell Lodge 07/03/05

Cavell Lodge 25/10/04

Cavell Lodge 02/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Cavell Lodge 5 Blenheim Chase Leigh On Sea Essex SS9 3BZ Lead Inspector Ray Burwood Unannounced Inspection 28th September 2005 9.45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cavell Lodge DS0000015423.V249653.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cavell Lodge DS0000015423.V249653.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Cavell Lodge Address 5 Blenheim Chase Leigh On Sea Essex SS9 3BZ 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) 01702 480660 01702 474316 Corvell Health Care Limited Mrs Lisa Patricia Aitken Care Home 36 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (36) of places Cavell Lodge DS0000015423.V249653.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Total number of service users for whom personal care is to be provided shall not exceed 36. Personal care can be provided for up to 36 older people over the age of 65 years of age, Personal care can be provided for up to 6 older people who have dementia and are over 65 years of age. 20th May 2005 Date of last inspection Brief Description of the Service: Cavell Lodge provides care and accommodation for thirty-six older people of whom up to six may suffer from dementia. The home particularly caters for residents with medium to low dependency needs. The home is purpose built and provides a high standard of accommodation. There are thirty-two single rooms and two double rooms situated on three floors of the home. All rooms have en-suite facilities. There is access to all floors via a passenger lift. Residents have a choice of several pleasant lounges plus an attractive dining room. The home also has a small quiet lounge, a visitors’ room and a hairdressing salon. There is a large well-maintained garden for residents to use and a large summerhouse. Off road parking is available. The home is situated close to a bus route, in a residential area, and is close to local parks and woodland. Cavell Lodge DS0000015423.V249653.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection of Cavell Lodge was undertaken on the 28th September 2005 with the assistance of the residents, manager, administrator, and care staff. The inspection was carried out between the hours of 9.45am and 4.00pm. A tour of the building was undertaken and both care and staff records were inspected. Staff spoken with, were from the morning and afternoon shifts. The home has 36 residents one of whom has dementia. The home has no vacancies. Residents, relatives and visitors were spoken with individually and collectively and praised the care and support offered by the home. A total of 13 standards were inspected with all meeting or exceeding the standards. What the service does well: Cavell Lodge provides a welcoming and homely environment, is decorated and furnished to an excellent standard. Personal healthcare needs are well supported and residents are encouraged to maintain regular contact with external agencies and professionals. Relatives and visitors strongly commended the staff on their caring and communication about their relatives. Residents benefit from a stable, experienced and qualified team of carers together with a manager who motivated, experienced and qualified to meet the ever-changing needs of residents. Residents spoken with confirmed that staff respected their privacy and dignity and they were well looked after. Training needs are highlighted at staff meetings and supervision and are an important issue regarding staff development. Cavell Lodge DS0000015423.V249653.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cavell Lodge DS0000015423.V249653.R01.S.doc Version 5.0 Page 7 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 Cavell Lodge DS0000015423.V249653.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2. The contracts of residency seen clearly identified what the service provided to residents. EVIDENCE: Contracts of residency sampled were seen to detail what the home was providing on admission, together with the level of fees for the service to which they were to receive. An advocate who had requested from the resident permission to have access certain information in particular, was dealing with one contract of terms and conditions. A disclaimer was seen to support the initial request to go ahead for the advocate. Cavell Lodge DS0000015423.V249653.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 10. Residents healthcare needs are well supported by the home and they are treated with genuine respect and dignity maintained by staff. EVIDENCE: Care plan records inspected were sufficiently up to date, detailed and contained clear information to support staff in meeting individual healthcare needs. Some minor adjustments were discussed with the manager, and advice offered in terms of reducing paperwork and staff time in reviewing care plans. Records were seen to support the involvement of primary care services through appropriate referrals. Outcomes are clearly recorded individual residents files. Residents spoken with were aware of the care planning process and confirmed in some cases, a certain amount of involvement in drawing up the plan and recognised there changing circumstances, as they got older. One gentleman in a wheelchair discussed how staff would encourage him to be more mobile whenever possible and exercise when the opportunity was right. The privacy and dignity of residents was discussed with them, they confirmed that they were always addressed in the correct manner and staff are always on Cavell Lodge DS0000015423.V249653.R01.S.doc Version 5.0 Page 10 hand to discuss any problems they may have. Residents confirmed that any discussions with staff were always kept confidential. Relatives and visitors spoken with felt fully involved in and aware of their relatives care. Cavell Lodge DS0000015423.V249653.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 and 14. Residents are encouraged and supported to make choices about their lives through a range of activities with visitors encouraged into the home. EVIDENCE: Visitors to the home explained how they were always made welcome by the home and how well the home was run. All of the residents spoken with said they had regular visits by family and friends. The home provides a comfortable visitors room where visitors are able to talk in private if they wish. As previously reported, residents and families are able to access the services of an advocate to assist them with private matters if they cannot be resolved elsewhere. The manager was in the process of organising a regular advocacy clinic (S.E. Essex Advocacy) in the home, to support residents who did not have family or friends to support them. Staff are able to undertake some activities with the residents both individually and as small groups. Residents are able, through their meetings, to discuss activities and request their favourite pastimes. Residents are able to access a range of activities both in the community and within the home through fashion shows, a visiting library for those unable to go to the local library, and regular visits from the local church. Most of the residents spoken with felt that they are able to remain as independent as possible and are supported by staff in maintaining this. Cavell Lodge DS0000015423.V249653.R01.S.doc Version 5.0 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Arrangements for dealing with complaints, together with appropriate policies and procedures, help ensure the protection of residents. EVIDENCE: Staff spoken with confirmed that they have completed the home’s induction programme and are aware of the policies and procedures regarding complaints, furthermore, training has been completed in relation to the Protection of Vulnerable Adults. There have been no recorded complaints and there are no current adult protection alerts relating to the home. Cavell Lodge DS0000015423.V249653.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 and 26. Residents live in an environment that is warm, comfortable, clean, safe and maintained to a high standard. EVIDENCE: The home continues to be presented ton a good standard of hygiene and cleanliness. The décor and furnishings are maintained to a high standard and provides residents with a comfortable and homely environment. There is a lounge area and a private room together with a hairdressing salon for residents to use when they wish. Outside of the home there are attractive accessible gardens that are maintained to a good standard. Residents and staff confirmed that the barbeque area had been used on several occasions during the summer. Bathrooms and toilets are in sufficient numbers and contain appropriate disability equipment to meet the different needs and lifestyles of residents. Cavell Lodge DS0000015423.V249653.R01.S.doc Version 5.0 Page 14 The residents’ bedrooms looked homely, well decorated and furnished. Some residents had personalised their rooms with items of their own furniture and possessions. All rooms had en-suite facilities. The laundry area was clean and fresh but remains small in size. Discussions took place with the registered person on how this could be resolved and possibly re-siting the room elsewhere. Sluicing facilities are available on each of the home’s three floors. Cavell Lodge DS0000015423.V249653.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29. The home operates recruitment practices that are robust and helps to ensure the protection of residents. EVIDENCE: The files of two members of staff were sampled and inspected during this visit and were found to contain the relevant information laid down in the Care Homes Regulations (Schedule 2). New staff had been confirmed in post following the satisfactory checks being in place. Cavell Lodge DS0000015423.V249653.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 and 38. Personal preference, support and care needs are encouraged through registered manager leadership and promotion of a safe home and working environment. EVIDENCE: The home’s manager has the experience and qualifications to ensure the smooth running of the home. Staff spoken with said the manager was approachable, has a hands on approach to caring, supports staff training and understands the problems that staff care duties sometimes present. Staff also confirmed that regular meetings take place and supervision is regularly carried out. Residents and visitors were also complementary about the management of the home. Records relating to the health, safety and welfare of residents and staff were inspected and found to be correct. Staff spoken with confirmed that they had completed health and safety training in safe working practices. Cavell Lodge DS0000015423.V249653.R01.S.doc Version 5.0 Page 17 The home’s registered provider discussed the work being carried out regarding the replacement of water pipes and the upgrading of the water system from central heating to the provision of hot water to individual bedrooms. Records relating to the servicing of equipment and checks carried out in the home were in place and up to date. Cavell Lodge DS0000015423.V249653.R01.S.doc Version 5.0 Page 18 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 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 X 3 X X X X 3 STAFFING Standard No Score 27 X 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X x 3 Cavell Lodge DS0000015423.V249653.R01.S.doc Version 5.0 Page 19 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 Cavell Lodge DS0000015423.V249653.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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