Inspection on 18/10/05 for Dale Lodge Residential Home

This inspection was carried out on 18th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Dale Lodge Residential Home 29/01/07

Dale Lodge Residential Home 02/06/05

Dale Lodge Residential Home 17/11/04

Dale Lodge Residential Home 23/06/04

Similar services:

Deepdene Care Centre

Ferndale Residential Care Home

David Gresham House

Elizabeth House

Elvy Court Nursing Home

Fontenay Nursing Home

Clairmont Residential Home

Cornford House

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

CARE HOMES FOR OLDER PEOPLE Dale Lodge Residential Home Dale Road Southfleet Gravesend Kent DA13 9NX Lead Inspector Sally Hall Unannounced Inspection 18th October 2005 10:00 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 Dale Lodge Residential Home DS0000023936.V254070.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. Dale Lodge Residential Home DS0000023936.V254070.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Dale Lodge Residential Home Address Dale Road Southfleet Gravesend Kent DA13 9NX 01474 834877 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) Nicholas James Care Homes Ltd Miss Rosalyn Ester Kelly Care Home 20 Category(ies) of Dementia (20) registration, with number of places Dale Lodge Residential Home DS0000023936.V254070.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd June 2005 Brief Description of the Service: Dale Lodge is one of a group of care homes managed by Nicholas James Care Homes Limited. The home offers 24-hour care to 20 people over the age of 65 years, who have a diagnosis of dementia. The accommodation is split between 2 floors in four double and twelve single bedrooms. One double room has an en-suite facility. All rooms are spacious, airy and bright. They all have hand basins, TV points and a call system. The home is close to local services and facilities within Kentish Village, South fleet. Public Transport is nearby as is the A2 providing links to Gravesend and Bluewater shopping centre. Dale Lodge Residential Home DS0000023936.V254070.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced Inspection at Dale Lodge took place on 18th October 2005 at 10.00am. The Inspector agreed and explained the inspection process with the Registered Manager. Documentation and records were read, including care plans. Time was spent reading a sample of written policies and procedures, reviewing care plans and records kept within the home. A full tour of premises was not undertaken during this inspection. The focus of the inspection was to assess Dale Lodge in accordance with the National Minimum Standards for Older People. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. What the service does well: What has improved since the last inspection? What they could do better: The home needs to complete the new care plan format for all service users to ensure that they receive the care provision they need. Staff need to record in more detail the care they have provided, the way they have promoted independence, and also record any follow up information with regard to medical treatment or illness. The reviews of the care plans need to show an outcome, and service users should have a full re-assessment of their needs Dale Lodge Residential Home DS0000023936.V254070.R01.S.doc Version 5.0 Page 6 carried out at least six monthly. Service users and the families should be encouraged to take part in the care planning process. 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. Dale Lodge Residential Home DS0000023936.V254070.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 Dale Lodge Residential Home DS0000023936.V254070.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): 1-6 The home’s Statement of Purpose and Service User Guide is adequate and provides sufficient information for prospective residents to be clear about the services the home provides in order to meet their needs. The admissions procedure ensures that only service users whose needs can be met are admitted to the home. Services users have the advantage of staying in the home for a trial period to assist them to decide if they want to stay on a permanent basis. EVIDENCE: The Statement of Purpose and Service Users Guide viewed during the inspection had been reviewed. The contents were discussed with the manager; both documents needed updating to include the qualifications of staff, the numbers of staff and service user’s category information. The Statement of Purpose and Service Users Guide are to be made available in the home. All service users are provided with a contract/terms and conditions of their stay. The contracts seen contain much of the information required; the manager said that these documents were being reviewed. The manager visits prospective service users, either at home or in hospital prior to moving in. During this visit she does her initial assessment to ascertain if the service Dale Lodge Residential Home DS0000023936.V254070.R01.S.doc Version 5.0 Page 9 user’s needs can be met at the home. The new pre-admissions assessment that has been devised, gives all the required information when complete. These are now being used for all new admissions. The home has been actively encouraging their staff to do the required training, NVQs in care and courses on understanding dementia, so that all staff will have the skills and knowledge to provide for the care needs of the service users. Residents and their families are encouraged to visit the home prior to admission and residents are admitted to the home on a temporary basis for 4 weeks. Intermediate care is not provided at the home. Dale Lodge Residential Home DS0000023936.V254070.R01.S.doc Version 5.0 Page 10 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): 7-11 The care planning system is not clear and consistent to provide staff with the information they need to meet resident’s needs, however these are now to be addressed thus reducing the risk. The service users’ health care needs are identified and met; however documentation needs to be more detailed. The medication procedures in the home are not robust and could put service users at risk. EVIDENCE: Individual plans of care are available but information in relation to aspects of health, personal and social care needs is still as generalised, brief and basic as at the last inspection. The manager has now received the new format for the assessments and plans of care, which she is about to introduce. Once the new documentation is completed the assessments and plans will identify the needs and detail the staff action to meet those needs. It was noted however, that these new formats have their ‘roots’ in nursing care, and although detailed, do not lend themselves completely to residential and dementia care. To ensure that they are completely suitable some adjustments are advised. Some older Dale Lodge Residential Home DS0000023936.V254070.R01.S.doc Version 5.0 Page 11 files viewed contained out of date information and the manager was asked if just current information could be kept in the files used by care staff. The daily reports seen in sampled service user files, were generalised, repetitive and very brief. This was discussed with the manager, as more detailed records of the care provision are required. The time that events happen and care is provided has also been omitted, the manager was reminded that these reports are legal documents and must contain relevant information. Records viewed indicated that residents were able to have access to appropriate health care professionals as and when required. All service users have their own GP, often keeping the doctor they previously had at their own home when possible. Regular visits by the chiropodist; optician and dentist were recorded in the service users’ individual files. The medication administration, recording and storage was audited. The medication in this home is stored in a clinical room. The room was well lit, tidy and well ordered. The manager explained that a drug fridge had been ordered. The medication is taken to the service users in a trolley that is fit for the purpose and was seen secured to the wall when not in use. The home uses a blister pack system supplied by the pharmacy. The Medication Record Sheets viewed did not document the doctor’s name or if the service user had any allergies. One service user with a known allergy did not have this information highlighted on the Medication Record Sheet, this omission could put that service user at risk. Some medication had not been recorded when it was delivered to the home and no medication left in stock from the month before was shown on the new sheet, this made auditing difficult. The sample check of medication against the Medication Record Sheets was found to be correct except in one case, this was brought the manager’s attention. The staff were observed giving out the medication; this was done in the correct manner. Staff were seen to be very considerate of the age and dignity of service users and treated them with courtesy. Some staff were seen offering choices and showed that they had a good understanding of the communicational difficulties and needs of service users with dementia. The funeral wishes of the service user or their family has not been recorded in all cases. The manager said that this aspect of care would be covered in the new plan of care format. The manager confirmed that they do offer a home for life. Although the home is not a nursing home, with the support of the GP and district nurses they would endeavour to look after service users who became terminally ill. However, this would only happen with full agreement of the family, care management and the health care professionals. Dale Lodge Residential Home DS0000023936.V254070.R01.S.doc Version 5.0 Page 12 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): 12-15 Activities and stimulation for service users are now being introduced back into the home on a regular basis. However, there is little contact with the local community by way of outings. The home offers a good choice of meals and caters for special diets. EVIDENCE: Service users were not being offered any programmed activities, however, on the day of inspection a new activity co-ordinator was being inducted, and had started to find out about the past lives of the service users so that she could formulate a programme of activities for the future. The staff have and will continue to provide sing-a-long and bingo for the service users but the activity co-ordinator will do more by way of games and crafts etc. She will be in the home two afternoons a week to start with. The home also has some outside entertainers coming in from time to time. There are still no outings happening on a regular basis and this needs to be reviewed. Relatives were welcomed to visit at any reasonable time. There is not a designated visitor’s room within the home, so for privacy the service user must take people visitors to their bedroom. Dale Lodge Residential Home DS0000023936.V254070.R01.S.doc Version 5.0 Page 13 Some evidence of staff offering service users choice was observed during the inspection process but there was little documentary evidence to show that this was promoted in the home via care plans etc. Several service users spoken with said that they enjoyed the meals provided. The menus showed a good choice at lunchtime, the new cook has been devising new menus. The home does provide special diets for service users when required. They also liaise with the dietician if they need advice on special diets. The home keeps a record of the meals served and records in the daily record the amount service users have eaten. The home plans to use a board in the dining area to highlight the choices available each day. During the lunchtime meal, observation of the staff showed that on some occasions service users could have been encouraged or prompted to eat their meal, this was discussed with the manager at the time. Also discussed, was the closeness of the meals times as there is more than twelve hours elapsing between teatime and breakfast the following day. Dale Lodge Residential Home DS0000023936.V254070.R01.S.doc Version 5.0 Page 14 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): 16,18 The way complaints issues are monitored after the initial complaint is raised could leave service users at risk. The adult protection protocols and whistle blowing policy used in the home should protect the service users. EVIDENCE: The complaints procedure was seen in the Service Users Guide, the timescales need to be reviewed to ensure they are realistic. The complaints record was in a book form and contravened the data protection act. The last complaint was dealt with quickly, but will need staff to monitor and record the situation if the complaint is made again. The records showed that after the initial investigation the staff stopped recording an outcome daily, this was discussed with the manager. The home has a copy of the local authority protocols, however they now need to adjust their policy/procedure to match this document. Dale Lodge Residential Home DS0000023936.V254070.R01.S.doc Version 5.0 Page 15 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): These standards were not fully inspected but progress has been made on the issues raised during the last inspection EVIDENCE: The downstairs bathroom has been refurbished, a new floor has been laid and on the day of inspection a new hoist was being fitted over the bath. The gardens have now been tidied up so that service users can access them. The organisation has employed a maintenance team who work in the homes. The home’s staff are now recording the water temperatures around the home on a regular basis. Equipment is now being stored appropriately. Dale Lodge Residential Home DS0000023936.V254070.R01.S.doc Version 5.0 Page 16 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): 27,30 Staffing levels and skill mix are able to meet the current needs of the service users. The training available in the home ensures that staff have the skills to meet the service users’ needs, however there are still some staff who do not have all the necessary skills. EVIDENCE: The staff levels in the home have improved and the manager confirmed that there were now more staff in the kitchen. The manager explained that the staff turnover had now stabilised and new staff continued to be recruited to ensure the home remained fully staffed. The manager explained that the training the staff receive has increased, the home is working to ensure that staff have all the skills that are required. A number of certificates for training were seen on the staff files. The training matrix in the home was not up to date and the manager agreed to send the up to date matrix to the Commission for Social Care Inspection. A list of future dates for training was seen. The manager also showed details of an in depth course on dementia that some staff have undertaken and others are starting; the course content was comprehensive. Dale Lodge Residential Home DS0000023936.V254070.R01.S.doc Version 5.0 Page 17 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, 34, 35,36, The manager has many of the skills and knowledge required to protect the service users, however she is required to complete the Registered Manger’s award. The procedure for handling service users’ money protects them. The staff are going to receive regular formal supervision which will benefit the service users, by improved care provision. EVIDENCE: The registered manager manages two homes on the same site. The organisation has now ensured that there are deputy managers in both homes to support her. The manager has an NVQ level 4 in management and an NVQ level 3 in promoting independence. The manager said that she was about to start her NVQ registered manager’s award. Dale Lodge Residential Home DS0000023936.V254070.R01.S.doc Version 5.0 Page 18 The home does not hold service users’ personal monies. They pay for items and services and then each month invoice the persons responsible for the service users’ finances, whether that be the family or the local authority etc. The home has a current insurance certificate for employers liability. Certificates were not available for buildings and contents, or business interruption costs. The manager is to ensure that these are made available. Staff at the home do attend regular staff meetings. The formal supervision has started but this is not on line to be completed six times this year. The manager explained that the deputies will be assisting with supervision in future and they have only just been appointed. The format for the supervision seen ensures that all the required topics will be covered. The home’s health and safety certificates, i.e. hoist etc., were not all available during this visit and the manager is to forward to the Inspector the ones not available. The home has a COSSH file that the manager said covered all the chemicals used in the home. Staff showed that they knew where the file was located and how to use it. Dale Lodge Residential Home DS0000023936.V254070.R01.S.doc Version 5.0 Page 19 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 2 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 X X X X X X X X STAFFING Standard No Score 27 3 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X 2 3 2 X X Dale Lodge Residential Home DS0000023936.V254070.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? 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. 1 Standard OP1 Regulation 4,5, schedule 1 Requirement Timescale for action 31/12/05 2 OP7 15,13 3 OP8 12,13 The registered person produces and makes available to service users an up to date statement of purpose setting out the aims, objectives, philosophy of care, services and facilities, and terms and conditions of the home; and provides a service users’ guide to the home for current and prospective residents. The statement of purpose clearly sets out the physical environmental standards met by a home in relation to standards 20.1, 20.4, 21.3, 21.4, 22.2, 22.5, 23.3 and 23.10: a summary of this information appears in the home’s service user’s guide. A service user plan of care 01/12/05 generated from a comprehensive assessment (see Standard 3) is drawn up with each service user and provides the basis for the care to be delivered. The registered person promotes 01/11/05 and maintains service users’ health and ensures access to health care services to meet assessed needs. Recording progress and outcomes. DS0000023936.V254070.R01.S.doc Version 5.0 Dale Lodge Residential Home Page 21 4 OP9 13(2) 5 OP11 12(2)(3) 6 OP16 22(7) 7 OP36 12,13,17, 23,25 The registered person ensures that there is a policy and staff adhere to the procedures for the receipt, recording, storage, handling administration and disposal of medicines, and service users are able to take responsibility for their own medication if they wish, within a risk management framework. Service users spiritual needs, rites and funeral arrangements are documented to ensure when the time comes staff have the information required. The registered person ensures that there is a simple, clear and accessible complaints procedure which includes the stages and time-scales for the process, and that complaints are dealt with promptly and effectively. The registered person ensures that the employment policies and procedures adopted by the home and its induction, training and supervision arrangements are put into practice. 01/11/05 31/12/05 01/11/05 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP18 OP31 OP34 Good Practice Recommendations Ensure the homes policy and procedure is reviewed and reflects the information in the new local authority’s protocol. The registered manager informs the Commission for Social Care Inspection once her RMA is successfully completed. Ensure copies of all the required insurance policies are available in the home, plus a copy of the business plan. Dale Lodge Residential Home DS0000023936.V254070.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. Extracts may not be used or reproduced without the express permission of CSCI Dale Lodge Residential Home DS0000023936.V254070.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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