Inspection on 02/03/06 for Dolphinlee House

This inspection was carried out on 2nd March 2006.

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

Dolphinlee House 25/08/06

Dolphinlee House 03/11/05

Dolphinlee House 25/10/04

Dolphinlee House 23/07/04

Dolphinlee House 11/03/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Dolphinlee House Patterdale Road Ridge Estate Lancaster Lancashire LA1 3LZ Lead Inspector Mr Ajam Auckburally Unannounced Inspection 2nd March 2006 10:30 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 Dolphinlee House DS0000032609.V285660.R01.S.doc Version 5.1 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. Dolphinlee House DS0000032609.V285660.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Dolphinlee House Address Patterdale Road Ridge Estate Lancaster Lancashire LA1 3LZ 01524 37685 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) Lancashire County Care Services Mrs Alison Pinch Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Dolphinlee House DS0000032609.V285660.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service should employ a suitably qualified and experienced manager who is registered with the NCSC. 3rd November 2005 Date of last inspection Brief Description of the Service: Dolphinlee House is situated on the Ridge Estate on Patterdale Road in Lancaster. The home is owned by Lancashire County Care Services (LCCS). The home is currently registered to take a maximum of 32 residents of both sexes who are 65 years or older. Dolphinlee House reopened in July 2005 after a long closure for major refurbishments. The home has now been extended to take up to 44 residents. LCCS is still deciding which category of clients to take when the registration is increased. The home has been tastefully fitted and decorated. There were twelve residents at the home at the time of the inspection. They said that they liked their new home. All the facilities are good and modern. Accommodation is provided in single bedrooms and the majority of them have an ensuite facility. A rehabilitation unit is also available. Although this is run separately, the manager of the home has the responsibility for it.. Dolphinlee House DS0000032609.V285660.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This statutory inspection was the second of two to be carried out this year. The inspection took place on 2nd March 2006 and was an unannounced one. It lasted for 3.5 hours. The inspection was carried out against the National Minimum Standards for Older People. The inspection was carried out in a relaxed atmosphere with the full cooperation of the manager, the staff and all the residents. The inspection took the form of looking at some of the records, talking to the residents and the staff and looking around the building. There were 12 residents living at the home and they said that they were well cared for and that all the staff were kind and helpful. What the service does well: What has improved since the last inspection? A new manager has now been registered with the Commission for Social Care Inspection (CSCI). The building has been extended and refurbished to a high standard. The number of care staff who has completed NVQ (National Vocational Qualification) has increased to well above the 50 recommended by CSCI. Dolphinlee House DS0000032609.V285660.R01.S.doc Version 5.1 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. Dolphinlee House DS0000032609.V285660.R01.S.doc Version 5.1 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 Dolphinlee House DS0000032609.V285660.R01.S.doc Version 5.1 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): Both of the key standards were assessed during previous inspections and were fully met. EVIDENCE: Dolphinlee House DS0000032609.V285660.R01.S.doc Version 5.1 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&9 The arrangements for assessing and meeting residents’ needs are good. The policies and procedures on medications are robust. Residents have good care plans and their medications are managed in a safe manner. EVIDENCE: Every resident has a personal file containing his or her assessments and care plans. The case files of two residents were examined and they showed that they have been assessed properly and that care provided is according to assessed needs. The records also show that care provided is recorded and that monthly reviews take place. The residents spoken to said that they receive good care and that the staff are kind. Dolphinlee House DS0000032609.V285660.R01.S.doc Version 5.1 Page 10 One resident said, “I like living at Dolphinlee. The place is very nice and everyone is so good.” The staff the inspector spoke to were fully aware of the needs of the residents and said that they were involved in providing care according to individual assessments. The records of medications were examined and they were found to be correct. An audit trail of the medications of two residents was done and they were found to be accurate. The manager was aware that following the death of a resident, medications should be kept for a week in the event that a post mortem is carried out. Residents who wish and have been assessed as able, can keep and take their own medications. In these circumstances, appropriate storing facilities are provided. Dolphinlee House DS0000032609.V285660.R01.S.doc Version 5.1 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): 14 & 15 There are good practices to encourage residents to remain active and provide them with choices. Food is an important part in the home’s daily activity. Residents are given choices in their daily activity and have good food. EVIDENCE: The residents said that they can have as much independence as they want and that the staff help them when they need assistance. The manager said that the policy of the home is to encourage residents to remain as independent as they want. Activities include regular bingo sessions and other board games. Outings and concerts are arranged regularly. The staff spoken to said that although residents are encouraged to retain their independence, they are not forced to do anything they don’t want. They can choose when to go to bed and when to get up. Dolphinlee House DS0000032609.V285660.R01.S.doc Version 5.1 Page 12 The records of meals served were examined and they show that a variety of food is provided. A choice of food is provided at lunchtime when the main meal of the day is served. A wide choice of food is also provided for breakfast and teatime. The residents said that the food is good and that they get plenty to eat and drink. Dolphinlee House DS0000032609.V285660.R01.S.doc Version 5.1 Page 13 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): 18 Policies and procedures on abuse are comprehensive. Residents feel safe and protected. EVIDENCE: The authority has produced a detailed written policies and procedures on adult abuse. The manager and some of the staff have had training on adult abuse. The manager is fully aware of the steps to take in the event of an abuse taking place to a resident. The staff spoken to said that they would never abuse any resident in their care and that they would report if they saw any form of abuse. The residents said that they feel safe and secure living at the home and that everyone treats them well. Dolphinlee House DS0000032609.V285660.R01.S.doc Version 5.1 Page 14 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): 26 Residents live in clean environment. EVIDENCE: During a tour of the building, the home was found to be clean and free from unpleasant smell. All the bedrooms were found to be clean and free from hazards. The residents said that the domestic staff clean and tidy their rooms on a daily basis. They give the rooms a thorough cleaning once week or as required. One small lounge on the ground floor is dedicated as a smoking lounge. However the people who use it, like the door to be left open and this causes the stale smoke to escape in the corridor and the surrounding area. The fitting of an extractor fan in this lounge should be considered to protect other residents and staff from smoke inhalations. Dolphinlee House DS0000032609.V285660.R01.S.doc Version 5.1 Page 15 The manager said that the cleaning of the home and bedrooms takes place to fit in with residents’ activity. No one has to leave his or her room when cleaning is in progress. Dolphinlee House DS0000032609.V285660.R01.S.doc Version 5.1 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): 28 & 29 The recruitment policy and procedures are stringent. Staff training plays an important part in staff development. Residents are cared for by a team of well chosen and trained staff. EVIDENCE: LCCS has produced a well written recruitment policy for its staff. The Human Resource Department of the authority is responsible for advertising and selecting new staff. When there is a vacancy for a job, it is advertised locally and interested parties are given application forms to complete. From information received, prospective staff are selected for interviews. Once a new staff has been selected, two written references are taken and POVA (Protection Of Vulnerable Adults) and CRB (Criminal Records Bureau) checks are done. No staff starts work until satisfactory checks have been done. The manager of the home is involved in the recruitment of her staff. Once a new member of staff starts work at the home, she undertakes an induction training programme involving orientation of the home, meeting residents and staff. Training also include, Fire Procedures, Moving and Handling and many other relevant courses Dolphinlee House DS0000032609.V285660.R01.S.doc Version 5.1 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): 35 & 38 Care practices promote residents’ best interest and their health and well-being. Residents live in a safe home and they are well cared for. EVIDENCE: The residents said that the manager is kind and helpful and that she is always available to see them. The residents said that they feel safe living at the home. They said that the staff are very caring. Staff training such as Moving and Handling, Fire Safety, First Aid, Food Hygiene and Infection Control are given to ensure the health and well being of the residents. Dolphinlee House DS0000032609.V285660.R01.S.doc Version 5.1 Page 18 Risk assessments of the building are carried out to ensure that the home is safe and that there are no hazards that could hurt the residents. Every resident is risk assessed to ensure that care provided is tailored and safe. The residents said that all the staff have their best interest at heart. They said that they are all kind and encourage them to be independent and live as good a life as possible. Residents or their families are encouraged to deal with their own finances. In the event where the staff of the home deal with residents’ finances, appropriate records are kept. These were examined and found to be current and accurate. Dolphinlee House DS0000032609.V285660.R01.S.doc Version 5.1 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 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X 2 STAFFING Standard No Score 27 X 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 3 Dolphinlee House DS0000032609.V285660.R01.S.doc Version 5.1 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. 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. 1 Refer to Standard OP26 Good Practice Recommendations Stale smoke from one of the lounges should be prevented from spreading onto the main corridor. Dolphinlee House DS0000032609.V285660.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ 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 Dolphinlee House DS0000032609.V285660.R01.S.doc Version 5.1 Page 22 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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