Inspection on 18/04/05 for Dower House

This inspection was carried out on 18th April 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

Dower House 14/08/09

Dower House 04/07/07

Dower House 09/01/07

Dower House 26/09/05

Dower House 14/09/04

Dower House 15/04/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE DOWER HOUSE HENLEY LUDLOW SHROPSHIRE SY8 3HB Lead Inspector TERRY WOODS 18 TH UNANNOUNCED APRIL 2005 10.00 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 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. DOWER HOUSE E56 S20753 Dower House UAI V217028 180405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service DOWER HOUSE Address HENLEY, LUDLOW, SHROPSHIRE, SY8 3HB. Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01584 873456 MRS ELIZABETH MARY OWEN MRS LINDA ANN WILLIAMS CRH 5 Category(ies) of 5 OP registration, with number of places DOWER HOUSE E56 S20753 Dower House UAI V217028 180405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14TH SEPTEMBER 2004 Brief Description of the Service: The Dower House is a privately owned Care Home registered with the Commission for Social Care Inspection to provide a service for 5 older people. It is a well established home set in elegant and comfortable surroundings in the grounds of Henley Hall. The village of Henley is situated close to the town of Ludlow. The Home is owned by Mrs E. M Owen. Mrs Linda Williams is the registered manager and has day-to-day management responsibility for the Home. The accommodation, originally the ‘Dower House’ to the country estate, has been converted and fully equipped to provide a 5 bedroomed care home facility all on one level. The Home offers extremely spacious living facilities with a large lounge / dining room providing access through french windows into the attractive and wellmaintained garden. There is a small but established staff group providing service users with consistency in a warm comfortable atmosphere. DOWER HOUSE E56 S20753 Dower House UAI V217028 180405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on the 18th April 2005 over four and a half hours and was carried out as a routine unannounced visit. A full tour of the premises took place and a sample of three staff files and three residents’ care records were inspected. Three of the staff on duty, all five of the residents and one visitor were spoken to at length. What the service does well: What has improved since the last inspection? The management team are continually working hard to improve formal working procedures at the home that have previously been weak. For example staff are now benefiting from formal supervision and further training which is having a positive affect on their professionalism. Health and safety documentation is also being reviewed and expanded upon. For example the COSHH data sheets and risk assessments are now complete ensuring that hazardous items are used in a safe manner within the home. DOWER HOUSE E56 S20753 Dower House UAI V217028 180405 Stage 4.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DOWER HOUSE E56 S20753 Dower House UAI V217028 180405 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection DOWER HOUSE E56 S20753 Dower House UAI V217028 180405 Stage 4.doc Version 1.20 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 standard(s) 3 and 5 The home has a satisfactory and functional admissions procedure providing an effective needs assessment and suitability evaluation for both privately funded residents and those placed by the local authority. EVIDENCE: Generally prospective residents at the Dower House are admitted via a private arrangement with no social worker involvement. In such cases, and confirmed in two of the three residents’ files inspected in detail, the comprehensive structure of the home’s plan of care for the daily living of each person forms a natural assessment process to identify their individual needs. The third resident’s file inspected confirmed the completion of a community care assessment 12/10/04 prior to admission, followed up by a review on 08/02/05. The individual’s assessed care needs including deteriorating mobility and frequent fall episodes are reflected in her care plan. The inspector received positive comments from the resident and also her visiting relative on the day. The relative specifically reported her satisfaction with the process of admission for her mother. DOWER HOUSE E56 S20753 Dower House UAI V217028 180405 Stage 4.doc Version 1.20 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 standard(s) 7,8,9,10 There is a clear and consistent care planning system in place which provide staff with the information they require to satisfactorily meet residents’ needs The process employed for recording the administration of medication is not acceptable and could potentially place residents at risk. EVIDENCE: Within the three care plans inspected there is good evidence of maintained health care for residents with clear notes being kept. Staff on duty reported confidently and knowledgeably about the nutritional needs of one resident with diet controlled diabetes. Her file contains relevant information including recorded monitoring of her blood pressure and sugar levels. One resident reported that he was awaiting the arrival of his Physiotherapist who provides a regular treatment and exercise programme for him. The Physiotherapist was very complimentary of the home and reported that residents were always noticeably happy and supported by attentive staff. She added that she is able to carry out her work at the home in private and is always made welcome. The inspector spoke at length with the five residents all of whom commented positively about their care and considered that they have everything that they need. DOWER HOUSE E56 S20753 Dower House UAI V217028 180405 Stage 4.doc Version 1.20 Page 10 Case tracking demonstrated an effective review process together with the home’s ability to meet changing needs as they occur. One situation reviewed covered the increased care being received by the individual due to the ageing process and deteriorating mobility. A skin care programme in place and the home is currently working with the community nurses to provide continual relief and treatment for this person. Waterlow skin condition assessments are completed and available for reference in each individual’s file. Mrs Owen and one member of staff have completed a Certificate in the Safe Handling of Medication course at the Ludlow College. Record sheets however are not being completed correctly at the time of the administration of medication. A staff member described a system of using individual diaries for recording purposes with this information being transferred to MAR sheets by Mrs Owen at a later time. DOWER HOUSE E56 S20753 Dower House UAI V217028 180405 Stage 4.doc Version 1.20 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 standard(s) 12,13,14,15. The Dower House provides a good quality and unique lifestyle for the people in residence. Meals at The Dower House are of a good homely type offering both choice and variety and catering for special dietary needs. EVIDENCE: All residents reported that they are in touch regularly with friends and family members and spoke about their visitors and of ‘entertaining’ them throughout their daily routine. The visitors book showed considerable activity. Residents have a unique lifestyle at The Dower House, which from their comments received, matches their expectations and preferences. A visiting relative confirmed that this was a deciding factor when placing her mother at the home. Residents are all very articulate and remain clear about the service that they require from the home. All agree that their individual needs are being met and that they receive care and support to a high standard. Observations showed that the home has a family style routine that is also based around each individual. All meals are cooked by the staff on duty. The evening meal is provided to a set menu following residents’ consultation and preferences. The remaining meals are arranged by individual choice on the day. The dining room is used by two residents and laid out formally. The remaining people are served meals in their rooms. All services received are by choice. Special diets to meet individual health care requirements are provided and identified within the needs assessment and care planning process. DOWER HOUSE E56 S20753 Dower House UAI V217028 180405 Stage 4.doc Version 1.20 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 standard(s) 16 and 18 The home has a satisfactory complaints system and there is evidence that residents feel that their views are listened to and acted upon. The arrangements for the protection of residents from abuse are satisfactory. EVIDENCE: The home has a complaints procedure, which is referred to for information in the Service User Guide. There is a system of recording complaints and it was noted that there were no entries. There have been no complaints directed to the Commission for Social Care Inspection within the previous 12 months. Residents reported however that their views were always listened to by both management and staff. The home has a policy in place with regard to the protection of residents from abuse. This policy includes whistle blowing and ‘bad practice’ issues. The policy is supported with procedures concerning physical and / or verbal aggression by residents and the Shropshire County Council Multi Agency Adult Protection Procedure. A member of staff spoke confidently on issues concerning the protection of residents at the home in the areas of health and mobility. The home also has a policy concerning residents’ money and financial affairs. Residents either manage their own financial affairs or rely on family members for support. Lockable storage is available in the form of residents’ own writing desks or similar furniture. A copy of the Codes of Practice issued by the General Social Care Council has been given to all staff. Staff have attended moving and handling training. A new staff member reported that she would also be attending this course shortly. DOWER HOUSE E56 S20753 Dower House UAI V217028 180405 Stage 4.doc Version 1.20 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 standard(s) 19,20,23,24,25 and 26 The home continues to provide a high quality, comfortable and safe environment for those in residence. EVIDENCE: The home is set in the grounds of Henley Hall. Residents reported that the setting was a key factor in their initial care home selection. There is a large communal lounge where residents can relax alone, with friends or family, or sit and enjoy the views of the garden and surrounding countryside. The dining room is also within the lounge area. A French window leads out from the lounge into the garden allowing for eased access. The accessible level grounds extend to three sides of the property. The walled gardens are well kept and attractive for residents’ pleasure. All residents’ rooms are spacious and are furnished with their own possessions. Residents confirmed that they were very comfortable in their rooms and had everything that they needed. The Home was observed to be clean and well maintained with a high standard of furnishings and décor. A programme of assessment and action ensures a safe environment for residents. The owner reported that fire safety checks are regularly made however the ‘Fire Log’ had not been completed following these DOWER HOUSE E56 S20753 Dower House UAI V217028 180405 Stage 4.doc Version 1.20 Page 14 checks. General maintenance of the building is carried out by the owners from the Hall. The inspector observed staff carrying out infection control procedures, utilizing equipment, clothing and hand washing facilities. DOWER HOUSE E56 S20753 Dower House UAI V217028 180405 Stage 4.doc Version 1.20 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 and 30 There is a stable staff group working positively and enthusiastically to provide the residents with a quality of life that meets their individual requirements and aspirations EVIDENCE: A staff rota is on display and reflects the actual staff on duty that day. This demonstrates that there should always be a minimum of two staff members on duty including either the owner or manager. Two additional staff have also been recently recruited. There are no waking night staff however the owner lives on site and responds to calls as required. Staff were observed carrying out their duties in an enthusiastic and professional manner. Residents spoke highly of all the staff with one suggesting that they ‘worked extremely hard’ and are ‘very caring’ towards them. A visiting family member stated that she thought that the home has a good balance between the professional approach and a homely caring environment A staff member employed during the last six months reported on her induction and of the completion of the NVQ2 programme. She also spoke of the recruitment process, which includes an application form, CRB check and the provision of two references. She has also been provided with a copy of the home’s terms and conditions. A sample of three staff files were inspected for such content and found to be satisfactory. Staff on duty confirmed that they all attend mandatory training including moving and handling and food hygiene. One staff member however was observed assisting in the kitchen without having food hygiene training. DOWER HOUSE E56 S20753 Dower House UAI V217028 180405 Stage 4.doc Version 1.20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35,36, 37 and 38 The systems for resident consultation are good with evidence suggesting that their views are sought and acted upon. The management team are developing and maintaining a well-supported staff group in the home’s quest to constantly improve the service to meet residents’ aspirations. The home continues to make progress towards raising the standard of record keeping. EVIDENCE: Residents at the Dower House are extremely articulate and able to voice their views and opinions. Residents said that staff and management listen to them and issues acted upon to their satisfaction. The home also regularly receives DOWER HOUSE E56 S20753 Dower House UAI V217028 180405 Stage 4.doc Version 1.20 Page 17 complimentary letters from family members and friends of residents concerning the quality of their relatives care which forms a futher part of the quality assurance system. Residents choose to have control over their own money and the home has no involvement with residents’ finances. Formal and recorded supervision together with on going support is carried out with all staff to assist them in their roles. Records are kept signed and dated by both parties and cover workload, performance and personal development and informs the home’s training plan. Documents and records viewed include supervision, training, recruitment, staff and residents’ files and health and safety and were seen to be consistently improving. There is evidence of risk assessments being reviewed, which includes COSHH documentation. The home also ensures that general health and safety in the home is monitored through the regular completion of a signed and dated inspection and test record. DOWER HOUSE E56 S20753 Dower House UAI V217028 180405 Stage 4.doc Version 1.20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 4 x x 4 4 3 x STAFFING Standard No Score 27 3 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x 3 3 3 3 DOWER HOUSE E56 S20753 Dower House UAI V217028 180405 Stage 4.doc Version 1.20 Page 19 no 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 9 Regulation 13(2) Requirement Timescale for action Immediate 2. 9 13(2) 3. 19 23.4(c)(i) (iv)(v 18(1)(c) (i) 4. 30 The home is required to ensure that record sheets are completed correctly at the time of the administration of medication The home is required to provide 01/08/05 all staff involved in the administration of medication with appropriate and accredited training The home is required to ensure Immediate that the ‘Fire Log’ is completed correctly at the time that safety checks are carried out The home is required to ensure 04/07/05 that all new staff attend food hygiene training as part of their induction programme. 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 Good Practice Recommendations DOWER HOUSE E56 S20753 Dower House UAI V217028 180405 Stage 4.doc Version 1.20 Page 20 Commission for Social Care Inspection 1st Floor, Chapter House South Abbey Lawn, Abbey Foregate SHREWSBURY SY2 5DE 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 DOWER HOUSE E56 S20753 Dower House UAI V217028 180405 Stage 4.doc Version 1.20 Page 21 - 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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