Inspection on 26/09/05 for Dower House

This inspection was carried out on 26th September 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Dower House 14/08/09

Dower House 04/07/07

Dower House 09/01/07

Dower House 18/04/05

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 Announced Inspection 26th September 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 Dower House DS0000020753.V251948.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. Dower House DS0000020753.V251948.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Dower House Address Henley Ludlow Shropshire SY8 3HB 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) 01584 873456 Mrs Elizabeth Mary Owen Mrs Linda Ann Williams Care Home 5 Category(ies) of Old age, not falling within any other category registration, with number (5) of places Dower House DS0000020753.V251948.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th April 2005 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 well-maintained garden. There is a small but established staff group providing service users with consistency in a warm comfortable atmosphere. Dower House DS0000020753.V251948.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on the 26th September 2005 over a four-hour period and was carried out as a routine announced visit. A full tour of the premises took place and a sample of one staff file and two residents’ care records were inspected. The two staff on duty and all five of the residents were spoken to at length. There were no visitors on this occasion. What the service does well: What has improved since the last inspection? What they could do better: More attention to detail in a number of areas identified throughout the report, which include medication, recruitment procedures and food hygiene training. Dower House DS0000020753.V251948.R01.S.doc Version 5.0 Page 6 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. Dower House DS0000020753.V251948.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 Dower House DS0000020753.V251948.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4 & 6 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 residents’ files inspected, 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. All residents are given a statement of terms and conditions, confirmation of which was seen in their individual files. There has been no new admissions since the previous inspection, however one resident has been re-assessed as requiring nursing care by the local community team. This was in response to the home’s concern for the resident’s deteriorating condition and their inability to continue to meet her needs at the Dower house. The individual’s deteriorating mobility is reflected in her care plan. She reported being comfortable at the Dower House and is looked after well however she also spoke of the difficulties she is now Dower House DS0000020753.V251948.R01.S.doc Version 5.0 Page 9 experiencing as a result of her condition and confirmed that she was waiting to move to a nursing home nearby. The home does not provide an intermediate care facility. Dower House DS0000020753.V251948.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, 8, 9 & 10 There is a clear and consistent care planning system in place to adequately provide staff with the information they require to satisfactorily meet residents’ needs. The process employed for recording the administration of medication has improved but requires further attention to detail to avoid the potential to place residents at risk. EVIDENCE: Within the care plans inspected there is good evidence of maintained health care for residents with clear notes being kept. One resident reported that he had experienced a further incidence of stroke leaving his left side weak. He spoke of receiving physiotherapy twice a week now, which was helping to get him mobile again. This information was crossreferenced with his case files and good notes are being kept. 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. Case tracking demonstrated an effective review process together with the home’s ability to meet changing needs as they occur. One situation reviewed Dower House DS0000020753.V251948.R01.S.doc Version 5.0 Page 11 at the previous inspection was concerned with the increased care being received by the individual due to the ageing process and deteriorating mobility. This has now resulted in a clear improvement in her health and well-being. The skin care programme in place, in conjunction with the community nurses, also provides continual relief and treatment for this person. Waterlow skin condition assessments are completed and available for reference in the individual’s file. Another resident who was recovering from a cold reflected on her care and the management of her asthma and a recent chest infection. Good notes are being kept concerning GP intervention and additional medication and extra care given throughout this time. Five staff have now completed a Certificate in the Safe Handling of Medication course at the Ludlow College. Record sheets are now being completed at the time of the administration of medication, however there is no space for recording the time of day at which medication is administered which still has the potential for mistakes to go unnoticed and may place residents at risk. Two Ventolin evohalers and one Seritide accuhaler were seen to be out of date by several months. Another resident has her medication mixed into yoghurt to enable her to swallow this more easily. The resident is aware of this however there was no formal reference to this procedure in her care plan. Dower House DS0000020753.V251948.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, 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. One resident who moved up from the south of England two years previously spoke of how she has settled down and how she is able to enjoy having her family visit regularly now that she lives locally to them. Residents have a unique lifestyle at The Dower House, which from their comments received, matches their expectations and preferences. 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. Residents continue to report on how much they enjoy the peaceful and relaxed atmosphere at the home within the calm and quiet of the countryside. Dower House DS0000020753.V251948.R01.S.doc Version 5.0 Page 13 One resident said that he enjoys a daily paper and completing the crossword whilst another said that her television played a big part in her life, which she finds stimulating and enjoyable. 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 DS0000020753.V251948.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 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. 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 DS0000020753.V251948.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): 19, 20, 23, 24, 25 & 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, although in reality three of the five residents by choice have their meals served in their rooms. A French window leads out from the lounge into the garden. The easily 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. Dower House DS0000020753.V251948.R01.S.doc Version 5.0 Page 16 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 and the ‘fire Log’ is completed following these 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. The home is clean and well maintained throughout. Dower House DS0000020753.V251948.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 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 and during the afternoons this may include either the owner or manager. One staff member has recently been 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 suggesting that they ‘worked extremely hard’ and are ‘very caring’ towards them. A staff member employed during the last six months reported on her induction and is keen to continue with the NVQ2 programme started in a previous employment. She also spoke of the recruitment process, which includes an application form, CRB check and the provision of two references. Her file however showed that only one reference had been received. There are now five staff that have completed NVQ Level2 and one has attained Level 3. Two further staff members will be enrolling shortly on the level three programme. The manager is aware that not all staff involved in the preparation of food at the home has attended a food hygiene course. Dower House DS0000020753.V251948.R01.S.doc Version 5.0 Page 18 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, 33, 35, 36 & 38 The systems for resident consultation are good with evidence suggesting that their views 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: The Home is run by Mrs E. M Owen, the owner and her daughter Mrs Linda Williams, the registered manager. Both have demonstrated their competence in recent years in continually making improvements to all areas of the home for the benefit of those in residence. Residents at the Dower House are extremely articulate and able to voice their Dower House DS0000020753.V251948.R01.S.doc Version 5.0 Page 19 views and opinions. Residents said that staff and management listen to them and issues acted upon to their satisfaction. The home also regularly receives 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. A record of accidents is kept. There were three recorded since the previous inspection, which were appropriately managed. 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. There are three issues concerning the administration of medicines (See Standard 9) Dower House DS0000020753.V251948.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 3 X N/A 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 Standard No Score 16 3 17 X 18 3 3 4 X X 4 4 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Dower House DS0000020753.V251948.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? YES 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 OP9OP9 Regulation 13.2 Requirement The home is required to provide an appropriate format to record the administration of medicines effectively The home is required to return all out of date medicines to the pharmacy The home is required to ensure that specific medication procedures are recorded in the individual’s care plan The home is required to ensure that two references are received in respect of all new staff prior to starting work The home is required to ensure that all staff involved in the preparation of food at the home has attended a food hygiene course Timescale for action 28/09/05 2 3 OP9OP9 OP9OP9 13.2 13.2 28/09/05 28/09/05 4 OP29OP29 19.1.c 28/09/05 5 OP30OP30 18.1.c.1 28/09/05 Dower House DS0000020753.V251948.R01.S.doc Version 5.0 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Dower House DS0000020753.V251948.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Shrewsbury Local Office 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 DS0000020753.V251948.R01.S.doc Version 5.0 Page 24 - 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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