Inspection on 09/01/07 for Dower House

This inspection was carried out on 9th 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

Dower House 14/08/09

Dower House 04/07/07

Dower House 26/09/05

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 Keith Salmon Key Unannounced Inspection 10th January 2007 09:30 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 Dower House DS0000020753.V313819.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. Dower House DS0000020753.V313819.R01.S.doc Version 5.2 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.V313819.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th September 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. Set in the village of Henley, within the grounds of Henley Hall, the Home benefits from being situated amidst beautiful surroundings, close to the town of Ludlow, making it is well placed for access to all local amenities. Originally built as the ‘Dower House’ to the country estate the property has been sympathetically converted to provide accommodation on one level, comprising 5 single bedrooms (3 with en-suite facilities), spacious communal living areas of lounge / dining room, with access through French windows to an attractive and well-maintained garden. The registered ‘Responsible Person’ is Mrs Elizabeth Owen, and her Daughter, Mrs Linda Williams, being the Registered Manager has day-to-day operational management responsibility for the Home, with on-site support from Mrs Owen. They are ably assisted by a small, but long established staff group. Dower House DS0000020753.V313819.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This ‘Key’ Unannounced Inspection commenced at 9.30am, concluded at 1.00pm (a duration of 3.5 hours), and was conducted by Mr Keith Salmon. The main objective of this Inspection was to review all of the ‘Key’ Standards, as set out on the National Minimum Standards for Care Homes for Older People. Present throughout the Inspection, was Mrs E. M Owen, Registered Owner of the business. This Report is a product of observations made during a tour of the Home, a review of care related documentation, staff duty rotas and staff files, plus a range of documents/records reflecting the general operation of the Home. The Inspector also held discussions with Staff and 4 Residents, all of whom were ‘case tracked’. No Relatives/Representatives were present at the time of the Inspection. Weekly fees range from £420.00 to £474.95. What the service does well: What has improved since the last inspection? At the previous Inspection five ‘Requirements’ were cited. Three specifically related to the management/administration of medicines, with two appertaining to shortfalls in staff recruitment and training, i.e. The provision of an appropriate format to record the administration of medicines effectively Dower House DS0000020753.V313819.R01.S.doc Version 5.2 Page 6 The return of all ‘out of date’ medicines to the pharmacy 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 The Inspector found the Home had fully addressed the five ‘Requirements’ issued and all are now met. 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. Dower House DS0000020753.V313819.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 Dower House DS0000020753.V313819.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): 2 & 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Processes to ensure appropriate and thorough care needs assessment, prior to admission, are effectively applied. The findings are applied to ensure appropriate placement. EVIDENCE: All residents are given a statement of terms and conditions, confirmation of which was observed in their personal files. Review of care plans, and related documentation, provided evidence that appropriate and thorough care needs assessment is undertaken by the Registered Manager, prior to admission. Information gathered is utilised in enabling an informed decision regarding the Home’s capability of meeting the individual care needs of each prospective Resident. Dower House DS0000020753.V313819.R01.S.doc Version 5.2 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. 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. The model of Care Plan utilised by the Home is comprehensive, easy to follow and up-to-date. The care provided by the Home is effective in meeting the Residents’ assessed care needs, and is delivered considerately and effectively. Residents are treated with respect, their privacy and dignity upheld. The storage, administration, and disposal of medicines are in accordance with accepted good practice. EVIDENCE: Care Plans/Files relating to the four ‘Case Tracked’ Residents were reviewed, discussions held with the respective Residents, the Owner and other Staff, plus observation by the Inspector. Dower House DS0000020753.V313819.R01.S.doc Version 5.2 Page 10 Care Plans were found to be current and easy to follow; provided evidence of involvement of the Resident, Relative or Advocate; made direct reference to ‘risk assessment in respect of ‘moving and handling’, nutritional status/needs, pressure areas. Evidence of regular audit of Care Plans by the Manager was observed. At the previous Inspection three Requirements were cited in respect of the management/administration of medicines; specifically: The provision of an appropriate format to record the administration of medicines effectively To return all out of date medicines to the pharmacy To ensure that specific medication procedures are recorded in the individual’s care plan A review was undertaken of the policies/procedures relating to the management/administration of medicines, i.e. records relating to the supply, storage, and disposal of medicines (including records of ambient and medicine refrigerator temperatures), the maintenance of medicine administration records (MAR Sheets). The Inspector also reviewed the contents of the medicine trolley. All were found to be satisfactory and the three ‘Requirements’ are met. Dower House DS0000020753.V313819.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 &15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The Dower House provides a unique lifestyle, which closely matches each Resident’s individual expectations and preferences. The Home facilitates achievement of desired social, religious, cultural lifestyle through Resident’s conducting the pattern of their day as they wish, including contact with family and friends, and continuation of religious practices. Meals at The Dower House are of a good, homely style, offering both choice and variety and catering for special dietary needs. EVIDENCE: All Residents reported they are in regular touch with family and friends, stating the Home encourages and enables them to ‘entertain’ visitors as part of their daily routine. There is a strong feeling of the unusual social setting of the Home, i.e. a very small and longstanding Resident group and a stable Staff group, which has generated a feeling of ‘close family’ amongst Residents and Staff. Dower House DS0000020753.V313819.R01.S.doc Version 5.2 Page 12 Residents are all very articulate and remain clear about the service they require from the Home. All agreed their individual needs are being met and the care and support they receive is of a high standard. Residents reported on how much they enjoy the calm and relaxed atmosphere at the Home, set within the peace and quiet of the countryside. One Resident stated he enjoys the daily paper and completing the crossword, whilst another said her television played a big part in her life, which she finds stimulating and enjoyable. Observations clearly demonstrated the Home has a ‘family style’ routine, which is based around each individual. This was reflected in comments, made to the Inspector, such as… “The staff really understand what I like”; … “I spend my time exactly as I wish, sometimes I join the others, sometimes I like to be by myself”. Meals, which include fresh vegetables grown in the Home’s garden, are freshly prepared by Care Staff, all of whom have received appropriate ‘food-handling’ training. The evening meal is provided to a set menu following consultation with Residents with the remaining meals arranged by individual choice on the day. Two of the Residents choose to eat their meals in the dining room, which is formally laid out, whilst the remainder prefer to take their meals in their bedrooms. Special diets to meet individual health care requirements are provided and identified within the needs assessment and care planning process. Dower House DS0000020753.V313819.R01.S.doc Version 5.2 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. 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. The Home has a satisfactory complaints system in place. Communication with Residents and Relatives is excellent. Arrangements for the protection of Residents from abuse are satisfactory. EVIDENCE: A review of relevant documentation demonstrated Complaints Procedure details are included in the Service User Guide and are displayed prominently for the benefit of all interested parties. There are policies and procedures in place intended to provide protection for vulnerable people. All Staff receive ‘Adult Protection’ training at induction, and through on-going staff training, confirmation of which was forthcoming through 1:1 discussions with Staff, and from Staff Records. There have been no complaints received by the Commission for Social Care Inspection during the past twelve months. Dower House DS0000020753.V313819.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,23,24,25 & 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. 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, a factor Residents reported as a key feature in their initial care home selection. There is a large, well-furnished communal lounge where Residents can choose to relax alone, or with each other, entertain visitors, or simply sit and enjoy the views of the garden and surrounding countryside. There is access to the gardens through a French window. The dining room is incorporated within the lounge area, although in practice three of the five Residents prefer to have their meals served in their rooms. Dower House DS0000020753.V313819.R01.S.doc Version 5.2 Page 15 The attractive walled, and well-kept gardens, extend to three sides of the property and are easily accessible. All bedrooms are spacious, well-furnished, and personalised with Resident’s possessions. Residents confirmed they were very comfortable in their Rooms and had everything they needed. The Home was observed to be clean and well maintained with a high standard of furnishings and décor. The Owner reported fire safety checks are regularly made and the ‘fire log’ is completed following each check. General maintenance of the building, which is underpinned by a programme of regular assessment and action, is carried out by the Landlords from Henley Hall and ensures a safe environment for Residents, Visitors, and Staff. Staff were observed to be carrying out infection control procedures, correctly utilizing equipment, protective clothing, and hand washing facilities. The Home is clean and well maintained throughout and is to be commended for the efforts in this area. Dower House DS0000020753.V313819.R01.S.doc Version 5.2 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. 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. There is an effective and well-supported staff group with the skills and knowledge to ensure Residents enjoy a quality of life, which meets their individual requirements and aspirations. EVIDENCE: Staffing numbers, though small, and skill-mix, enable a service provision, which meets the care needs of the Service Users. Specifically there is always a minimum of two staff members on duty, which, during the afternoons may include either the Owner or the Manager. Whilst the Home has no ‘waking’ night staff, the Owner lives on site and responds to calls as required. Given the client group there is no evidence to suggest this is not a satisfactory arrangement, and should the Owner not be available alternative arrangements for cover are put in place. Staff were observed to carry out their duties in an enthusiastic yet professional manner. Residents informed the Inspector they were …”Very fond of the Staff. They work extremely hard and are very caring towards us.” Records demonstrated the proportion of Staff having attained NVQ Level 2 is in excess of the 50 required level. In addition, one member of Staff has achieved Level 3 and one is currently undertaking Level 3. Staff are subject to a thorough and relevant orientation/induction programme with evidence of Dower House DS0000020753.V313819.R01.S.doc Version 5.2 Page 17 on-going training. Much of the training is conducted ‘in-house’, is well documented, and includes lifting and handling, fire safety, and health and safety. Infection control training is provided through the auspices of the SPIC organisation (Shropshire Proprietors in Care). A Requirement cited at the previous Inspection: “The home is required to ensure that all staff involved in the preparation of food at the home has attended a food hygiene course”. Review of staff training files showed evidence that three staff have completed the relevant course at Ludlow College and this ‘Requirement’ is met. Dower House DS0000020753.V313819.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, & 38. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Operationally, the Home is very well organised, with the central purpose being ‘the best interests of Residents’. All Staff are subject to effective support with regular supervision by the Manager and appear involved and happy in their work. The systems for consultation with Residents are good. Their views are sought and acted upon. COSHH requirements were satisfactory, with maintenance and servicing of equipment regularly undertaken, and appropriately documented. Records are maintained for hot water supply to baths, and water temperatures tested during the Inspection were satisfactory. COSHH data sheets were found to be current. Dower House DS0000020753.V313819.R01.S.doc Version 5.2 Page 19 EVIDENCE: The ‘Responsible Person’, Mrs Elizabeth Owen, is very ‘hands on’ in the day to day operation of the Home, and her Daughter, Mrs Linda Williams, is the Registered Manager. Both have clearly demonstrated their competence and commitment in recent years in continually making improvements to all areas of the Home for the benefit of Residents. Residents stated Staff and Management actively sought their views and issues were acted upon to their satisfaction. The Home regularly receives complimentary letters from Residents’ family and friends, which forms a further part of the Home’s quality assurance system. All Residents manage their own personal monies. Records in Staff files demonstrated regular supervision, together with on-going support, is provided to all Staff. The Home ensures general health and safety is monitored through the regular completion of a signed and dated inspection and test record. Dower House DS0000020753.V313819.R01.S.doc Version 5.2 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 x X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 3 3 X 4 4 3 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 4 X 3 3 X 3 Dower House DS0000020753.V313819.R01.S.doc Version 5.2 Page 21 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. 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. Refer to Standard Good Practice Recommendations Dower House DS0000020753.V313819.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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 Dower House DS0000020753.V313819.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!