Inspection on 29/01/07 for Dale Lodge Residential Home

This inspection was carried out on 29th January 2007.

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

Dale Lodge Residential Home 18/10/05

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 Key Unannounced Inspection 29th January 2007 11:00 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.V321137.R01.S.doc Version 5.2 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.V321137.R01.S.doc Version 5.2 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 - over 65 years of age (20) registration, with number of places Dale Lodge Residential Home DS0000023936.V321137.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. None Date of last inspection 18.10.05 Brief Description of the Service: Dale Lodge is one of two care homes on the same site who have the same registered manager and are 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 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 the Kentish Village of Southfleet. Public Transport is nearby as is the A2 providing links to Gravesend and Blue water. The fees range from £ 417 to £510 per week. Dale Lodge Residential Home DS0000023936.V321137.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key Inspection at Dale Lodge took place on 29th January 2007, between 11am and 4pm the link inspector was Sally Hall On the day of the inspection the Inspector agreed and explained the inspection process with the Registered Manager. Time was spent reading a sample of care plans, written policies and procedures and records kept within the home. Staff, service users and visitors were spoken with and a tour of premises was undertaken. 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. The home was ask to complete a pre–inspection questionnaire, the evidence from this was used along with the information gathered from the homes survey of service users, friends/families and other professionals that are involved with the service users at the home. What the service does well: What has improved since the last inspection? The manager has now been registered and has almost completed her R.M.A. The manager monitors the medication system in the home weekly to ensure all service users receive the medication they are prescribed. The bathroom on the ground floor is now fitted with a hoist. Dale Lodge Residential Home DS0000023936.V321137.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Dale Lodge Residential Home DS0000023936.V321137.R01.S.doc Version 5.2 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.V321137.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6. Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Service users and their families are given the information they need to make an informed choice about the home. Service users and their families can feel confident that the assessment undertaken prior to admission and the 28 day trial period will ensure the prospective service user’s needs can be met before a permanent placement is offered. EVIDENCE: Statement of Purpose and Service Users Guide are given out to all prospective service users and/ or their families. The information in the documents is as required and is reviewed annually. All prospective service users are visited and an assessment is undertaken. In files sampled it was evident that several different types of assessment are undertaken. This gives a comprehensive picture of the service users needs. It Dale Lodge Residential Home DS0000023936.V321137.R01.S.doc Version 5.2 Page 9 is started before the service users is admitted and completed fully during the 28days trial period. The home does not provide intermediate care. Dale Lodge Residential Home DS0000023936.V321137.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can be confident that their health and care needs will be provided in a way that preserves dignity, however documentation could be improved. The home has a robust medication procedure that is comprehensively monitored weekly by the manager to protect service users. EVIDENCE: The service users’ files sampled show that service users are being properly assessed. These assessments covers a wide range of service user needs and include for example cognitive assessment, communication and nutrition. The information from these is then used to formulate the care plan. However some of the care plans are not as individual as they could be. Part of the plans are pre-populated and staff only have to enter a service user’s name. For example, in the section relating to continence issues, it was not possible to tell if the service user concerned had a problem maintaining continence or, if they did Dale Lodge Residential Home DS0000023936.V321137.R01.S.doc Version 5.2 Page 11 were they doubly incontinent or not. The information could be found in the assessment but staff should not have to look through a lot of assessment information to find out what is normal for this service user. There was no evidence that service users and or families had been involved in the formation of the plans. The plans are reviewed but outcomes are not recorded. All these issues were discussed with the manager. The daily log does not cross reference with the care plans. Again it was evident that staff are fulfilling the service users’ needs but they are not recording this sufficiently well. The staff at the home call in the GP when service users are not well. Such visits are recorded in the daily log, however follow-up information regarding outcomes of treatment such as antibiotics are not recorded. Service users are also visited at the home by chiropodists, opticians and dentists. This can be arranged by the home or privately by the service user or family. The home weighs the service users on a regular basis and the records are kept in service users file. If nutritional needs are identified then a detailed record of what a particular service user eats and drinks is kept by staff. District nurses are also visitors to the home. Two had responded to the survey sent and both agreed that the home informs them quickly of any changes. They also stated that service users are treated with respect and dignity. Visitors spoken to said that service users are well cared for and are treated with dignity and respect. Service users spoken to said that staff treat them with respect and nothing appeared to be too much trouble. Observation of the staff interacting with the service users also confirmed that staff approach service users in a respectful manner and that staff preserved service users’ dignity. Staff follow a robust procedure when administering ordering and storing medication. The manager undertakes a comprehensive audit of medication weekly to ensure all service users are given the medication as prescribed. Dale Lodge Residential Home DS0000023936.V321137.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The service users cannot be confident that they will be offered a programme of activities throughout the week, or have trips out available regularly. Service users can be confident that their relatives are encouraged to visit them in the home. Service users benefit from being offered a choice of home cooked nutritious meals. EVIDENCE: Activities take place just two afternoons per week with some entertainers coming in approximately four times a year. There is no activity programme although the activity co-ordinator does cater for a range of activities to suit most interests. A recommendation has been made to review the way that activities in the home are recorded as the present system compromises confidentiality and data protection. A requirement of more activity time for service users is essential to ensure all service users have access to a form of motivation several times during the week. A trip out to the coast in the Dale Lodge Residential Home DS0000023936.V321137.R01.S.doc Version 5.2 Page 13 summer was enjoyed by service users and remembered by one particularly for the fish and chip meal she enjoyed. More could be done to ensure service users have the opportunity to access the community. Staff were seen promoting service users’ independence. For example service, users are encouraged to eat meals themselves by staff cutting the food up and prompting. The manager has NVQ Level 3 in promoting independence and encourages staff in this ethos. The home is currently changing the menu. The service users are offered a choice at each meal time, including the main meal. The service users said that the food is nice and second helpings are available. The staff record what meal service users have chosen individually and have a nutritional chart showing how much is eaten and drunk if a risk has been identified. Service users are weighed weekly. Mainly fresh ingredients are used and most dishes are home cooked. Dale Lodge Residential Home DS0000023936.V321137.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There are robust policies and procedures regarding complaints and adult protection. EVIDENCE: Different versions of the complaints procedure were located in the home. It is recommended that this practice be reviewed and that the version of the complaints procedure containing all the stated time scales be the one used throughout the home. There are no complaints recorded, and staff said that if service users or families express concern they address the problem immediately. Most complaints have been about things that staff or the manager has concluded straight away. Staff questioned had a very good understating of their role regarding identify potential abuse and reporting it. The home has the local authority adult protection protocol to hand, as well as a their policy and procedure. Not all staff however have completed the adult abuse awareness training. It is a requirement for all staff to undertake this training every three years. Dale Lodge Residential Home DS0000023936.V321137.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21,25,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can be confident that the standard of cleanliness throughout the home is maintained to a high level. EVIDENCE: Whilst most areas are well presented, homely and clean the toilets and bathrooms are not maintained to the same standard. These were clean but did not look it and they are in need of redecoration. They lack colour and do not have a homely feel in comparison to the rest of the home. It was noted that all rooms are painted with magnolia and it is only the fixtures and fittings that lift the atmosphere. Individual bedrooms were spacious, bright and airy. Rooms were adequately furnished, and had sufficient space to accommodate the required furniture. The home has two lounge areas and a dining area which join together. Communal areas in the home benefited from good natural light. Dale Lodge Residential Home DS0000023936.V321137.R01.S.doc Version 5.2 Page 16 Furnishings and fittings are of reasonable quality, domestic and unobtrusive. The cook said the kitchen is due a make over and the introduction of stainless steel work surfaces. The bath on the ground floor is now in working order and has a hoist. The gardens to the rear of the home are now being well maintained. The manager now tests the temperature of the hot water regularly every month. Dale Lodge Residential Home DS0000023936.V321137.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. The service users can be confident the robust recruitment procedures protect them. The staffing levels are sufficient and reviewed to ensure they meet the service users needs. Whilst half the staff at the home have an NVQ Level 2 or above, and other training is provided to give the staff the skills and knowledge to care for service users, not all staff have undertaken all the courses required. EVIDENCE: Staff files indicate that the home has a robust recruitment procedure, with all the required documentation and checks being available. The newly recruited staff completed an induction programme, which meets the NTO workforce training targets. The home has sufficient staff on shift to attend to the service users’ needs, and this is reviewed when service users numbers change or their dependency increases even if this is only for a few days. There are service user vacancies at the home. The staff training matrix shows that there have been a large Dale Lodge Residential Home DS0000023936.V321137.R01.S.doc Version 5.2 Page 18 number of courses undertaken since the last inspection. Whilst this is to be commended, it is important that all staff undertake all the required training. Staff are encouraged and supported to undertake NVQ’s in care at Level 2 and 3. Currently the home has achieved the 50 target of staff with an NVQ. Dale Lodge Residential Home DS0000023936.V321137.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35,36, 38. Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Service users benefit from an experienced manager who understands the complexities of dementia and who runs the home in the best interests of the service user. Service users would benefit from staff who have regular formal supervision and are all fully trained in health and safety related courses. Service users do benefit from a home that is safe and regularly monitored. EVIDENCE: Dale Lodge Residential Home DS0000023936.V321137.R01.S.doc Version 5.2 Page 20 The manager is about to complete her R.M.A. She has previously completed and NVQ Level 4 award in management, NVQ level 3 in care (promoting independence) and VRQ level 2 in dementia care. The manager and some staff at the home have also completed NCFE Level 2 certificates in safe handling of medication. The manager has a very good understanding of the needs of people with dementia and runs the home with there best interests paramount. There is a system in place for staff to report any maintenance issues. The fire log is kept up to date with checks happening with in the home as recommended, for example weekly sounding of the fire alarms. The manager checks the temperature of the rooms and water form sinks etc., She records the rooms chosen at random each month. There is a COSHH file available for staff to use in an emergency. The completed pre-inspection questionnaire confirmed that all the maintenance certificates have been obtained and continue to be in date. Staff training in health and safety is now being arranged; however not all staff have had all the required training to date. Staff are not yet having supervision on a regular basis at least six times per year. Dale Lodge Residential Home DS0000023936.V321137.R01.S.doc Version 5.2 Page 21 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X x X 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 Dale Lodge Residential Home DS0000023936.V321137.R01.S.doc Version 5.2 Page 22 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. 1. Standard OP7 Regulation 15,13 Requirement A service user plan of care generated from a comprehensive assessment (see Standard 3) is drawn up with each service user/family and provides the basis for the care to be delivered. That these are individual to that service user and the daily log records how staff have met the care provision as detailed in the care plan. Staff are recognising when a service users need medical attention, however the outcomes of the treatment etc. have to be recorded in the daily log as a follow up. An activity programme is required for service users, there also needs to be more staff time made available for the provision of activities through the week. The registered manager ensures so far as is reasonably practicable the health, safety and welfare of service users and staff. Continue providing the necessary training so that all DS0000023936.V321137.R01.S.doc Timescale for action 01/04/07 2. OP8 12,13 01/03/07 3 OP12 16(n) 01/03/07 4 OP38 25, schedule 4.1 01/06/07 Dale Lodge Residential Home Version 5.2 Page 23 staff have all the required training by :7. OP36 18(2) Regular formal staff supervision is carried out six times per year 01/04/07 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 Refer to Standard OP26 Good Practice Recommendations The decoration in bathrooms and toilets needs to be reviewed, as the state of the decoration does not look clean, and an injection of colour may make the areas look more inviting. Service users are enabled to have trips out, accessing the local community etc. 2 OP13 Dale Lodge Residential Home DS0000023936.V321137.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V321137.R01.S.doc Version 5.2 Page 25 - 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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