Inspection on 09/08/05 for Downham Lodge

This inspection was carried out on 9th August 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

Downham Lodge 12/03/07

Downham Lodge 08/03/06

Downham Lodge 14/02/05

Downham Lodge 20/12/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Downham Lodge 29 St Edwards Road Southsea PO5 3DH Lead Inspector Ian Craig Unannounced 9 August 2005 11:15am 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. Downham Lodge H55-H03 S11735 Downham Lodge V220292 090805.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Downham Lodge Address 29 St Edward`s Road, Southsea, Hampshire, PO5 3DH 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) 023 9283 9816 Mr Narain Lingaloo and Mrs Balamanee Lingaloo Mrs Balamanee Lingaloo Care Home 12 Category(ies) of Dementia - over 65 years of age (5), Mental registration, with number disorder, excluding learning disability or of places dementia (5), Mental Disorder, excluding learning disability or dementia - over 65 years of age (5), Old age, not falling within any other category (12) Downham Lodge H55-H03 S11735 Downham Lodge V220292 090805.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Service users in the MD category must be over 55 years of age Date of last inspection 14/2/05 Brief Description of the Service: Downham Lodge is a detached building, situated in a residential area of Southsea, close to Southsea Common, the promenade and a shopping centre. The home provides accommodation to service users aged over 65 years who have dementia or a mental disorder. There are 4 double bedrooms and 4 single bedrooms, all of which have an ensuite toilet except one. Staffing is provided on a 24 hour basis. The two registered persons work in the home on a full time basis. Downham Lodge H55-H03 S11735 Downham Lodge V220292 090805.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector was assisted by the manager and the co owner. Two residents were interviewed. It was not possible to interview a number of the residents because of their mental health needs. What the service does well: What has improved since the last inspection? What they could do better: Downham Lodge H55-H03 S11735 Downham Lodge V220292 090805.doc Version 1.40 Page 6 Greater attention is needed in assessing residents’ needs both prior to admission to the home and when needs change. This includes assessing for risk for specific activities The home accommodates three residents with significant mobility needs. Whilst there is a stair lift it was noted that the steps in the split-level loungediner cause a degree of difficulty for these people and that this could be improved by the provision of a stairlift or ramp. Staffing hours need to be increased. Whilst residents stated that they were satisfied with the quality of the food the inspector formed the conclusion this is an area in need of improvement. 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. Downham Lodge H55-H03 S11735 Downham Lodge V220292 090805.doc Version 1.40 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 Downham Lodge H55-H03 S11735 Downham Lodge V220292 090805.doc Version 1.40 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 Whilst the home completes its own assessment on those referred for possible admission greater attention is needed to ensure that the home is fully aware of the needs of those admitted. Those considering a move to Downham Lodge are able to visit to see if it meets their wishes. EVIDENCE: The home’s manager completes an assessment on those referred for possible admission. This involves the completion of an assessment pro forma to ascertain if the home can meet the person’s needs. Records of these assessments were available in resident’s files. It was noted, however, that for those referred by social services the home had not obtained a copy of the care manager’s assessment and care plan, and that for one specific activity there was a lack of clarity about personal safety which needed to be discussed with those responsible for the placement. The inspector was informed by the manager that a copy of the care manager’s assessment had not been obtained for one person as he had moved into the home from another residential placement rather than from hospital or his or her own home. The manager acknowledged that the home should liaise with the community health and Downham Lodge H55-H03 S11735 Downham Lodge V220292 090805.doc Version 1.40 Page 9 social services team regarding the degree of risk for a resident’s daily activities. Residents confirmed that they were able to visit the home before deciding whether or not to move in. In one instance this also involved the person bringing along a representative. This was verified from discussions with residents and the manager, as well as from records. Downham Lodge H55-H03 S11735 Downham Lodge V220292 090805.doc Version 1.40 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 standard(s) 7, 8 and 9 Each resident has a care plan and the home try to involve individuals in the assessment and care planning. Whilst these care plans are reviewed, it was noted that changing needs had not been reassessed and the care plan updated for one person. The system of assessment and care planning has been developed since the last inspection. Procedures for the handling and administration of medication were satisfactory. The home liaises with community health professionals to ensure that health needs are addressed. EVIDENCE: The assessments of need and care plans have been developed since the last inspection. Social and recreational needs are now recorded although the inspector commented that these were somewhat sparse in detail. For instance, “likes watching the TV. He enjoys going for a walk and reading the newspaper” was a typical entry. This should be expanded as it lacks detail about the person’s preferences, interests and background. A record was also maintained of daily activities being completed by each person. The home has its own re admission assessment pro forma and these were generally completed to a good standard. Downham Lodge H55-H03 S11735 Downham Lodge V220292 090805.doc Version 1.40 Page 11 Care plans were recorded for each person and included personal care needs and mobility. Specific details of the staff intervention required were recorded and these were reviewed on a regular basis. For one resident whose needs had recently changed, the care plans had not been updated, especially regarding mobility. The home had liaised with the relevant health professionals about this, although it was unclear whether or not a nursing assessment would be completed to determine if the person requires nursing care. Records were maintained of the district nurse attending to one resident with a pressure sore. A risk assessment was needed for one resident undertaking an activity involving significant risk; this should involve consultation with relevant individuals such as those responsible for the person’s supervision, namely the placing authority and any relative. Two residents were asked about the care provided by the home and both responded that this was “very good.” Procedures for the handling and administration of medication were checked and found to be satisfactory. Downham Lodge H55-H03 S11735 Downham Lodge V220292 090805.doc Version 1.40 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 standard(s) 12, 14 and 15 Progress has been made to improve the range of activities available to the residents. The home promotes residents exercising independence and choice in daily life and activities. Whilst the residents stated that they were satisfied with the quality of the food, the inspector concluded that this could be improved. EVIDENCE: At the time of the inspection activities were being provided by an ‘outside’ agency. This involved residents engaging in suitable games. The person facilitating the activities was skilled in motivating the residents to join in. These activities are provided for two afternoons a week. Residents are also free to undertake activities of their choice such as going out, reading, visiting friends etc. A resident was observed reading a book in the garden. Two residents were able to say how they were enjoying watching a television programme about the police force. The inspector asked two residents if they were satisfied with the level of activities available and both replied “yes.” Residents are free to go out from the home and risk assessments are completed for this although there was an absence of this for one resident recently admitted to the home who takes part in an activity involving significant risk. The home has a menu plan showing a varied and nutritious diet. The inspector observed the serving of the midday meal. All the residents ate at dining tables and were assisted by staff. The meal consisted of minced beef and onion pie Downham Lodge H55-H03 S11735 Downham Lodge V220292 090805.doc Version 1.40 Page 13 with mashed potato and cabbage. Dessert was a choice of either chocolate mousse or crème caramel. The pies were a budget purchase cooked from frozen which the inspector commented were of a quality that could be greatly improved upon. The home’s management stated that the pies were provided as a quick way of preparing food because of the inspection. The home should also seek to provide nutrition as recommended by the provision of at least five portions of fruit and vegetables per day excluding potatoes. Residents stated that the food quality was “good.” Downham Lodge H55-H03 S11735 Downham Lodge V220292 090805.doc Version 1.40 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 standard(s) Neither of the two standards in this section were assessed at this inspection. EVIDENCE: Downham Lodge H55-H03 S11735 Downham Lodge V220292 090805.doc Version 1.40 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 standard(s) 19, 20, 21, 22, 23, 24, 25 and 26 The home is maintained to a good standard and there is reinvestment by the owners in updating the environment. Rooms are bright and airy. Cleanliness is maintained and there is an absence of any unpleasant odours. The split-level arrangements of the flooring make it difficult for those with mobility problems to move between certain areas. EVIDENCE: The home was found to be clean and hygienic with an absence of any unpleasant odours. Decoration is also of a satisfactory standard. Bedrooms are light and airy. Residents described how they like their bedrooms. All bedrooms, with one exception, have an en suite toilet facility. A first floor bathroom has been refurbished and redecorated to a high standard. This includes a specialist bath with a hoist. There are two lounges, one of which is connected to the dining area via several steps. There is no stair lift or ramp for residents to use and even with the help of staff residents were observed to have difficulty negotiating these steps. The manager explained that there are plans to install a stair lift in this area in Downham Lodge H55-H03 S11735 Downham Lodge V220292 090805.doc Version 1.40 Page 16 2007. In view of the increasing age and frailty of the residents the inspector felt that this should be implemented sooner. There is a stair lift to the first and second floors, but not to the mezzanine levels leading to certain bedrooms. The home is not suitable for those with any significant mobility problems. Patio doors open from the lounge onto a pleasant back garden, which has tables and chairs for residents to sit at. The garden has shrubs, plants and a lawn. Downham Lodge H55-H03 S11735 Downham Lodge V220292 090805.doc Version 1.40 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 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 Whilst there has been an increase in the provision of staff during the period of the preparation of the midday meal the home does not deploy sufficient staff to meet the needs of the residents. EVIDENCE: The staff rota was examined for the week commencing 8th. August 2005. This showed the provision of at least two care staff with a third person on duty from 11am to 1pm each day. These staff complete all the duties in the home including cooking and cleaning. There are two night staff: one ‘waking’ and one ‘sleep in.’ This gives a total of 280 staff hours. The home’s management acknowledged that there is a need for additional staffing and stated that 2 extra care staff and a cleaner will shortly be employed. Residents described the staff as “very good” and “helpful.” Downham Lodge H55-H03 S11735 Downham Lodge V220292 090805.doc Version 1.40 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 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) 38 The home’s management take steps to ensure that the health and safety of the residents. EVIDENCE: Residents are protected from possible burns from radiators buy the installation of covers. Temperature control devices are installed on baths and wash hand basins to protect residents from possible scalding. All staff have received training in the following in the last 12 months: first aid, manual handling and lifting, food hygiene and infection control. Downham Lodge H55-H03 S11735 Downham Lodge V220292 090805.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 2 COMPLAINTS AND PROTECTION 3 3 3 3 2 3 3 3 STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x 3 Downham Lodge H55-H03 S11735 Downham Lodge V220292 090805.doc Version 1.40 Page 20 yes 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 3 Regulation 14(1)(b) Requirement The home must obtain a copy of the care managers assessment and care plan before the person is admitted. When a residents needs change a reassessment must takeplace and the care plan must be updated. Risk assessments must be completed where any resident undertakes an activitiy involving identified risks. A plan must be devised to show how the residents safety is to be maintained. If necessary, this should involve those agencies responsible for the persons placement such as local health and social services. The home must provide food that is of a good quality, is nutritious and wholesome. The home must assess the physical environment where residents have difficulty negotiating the stairs between the lounge and the dining room. Suitable adaptations must be made so that residents can move safely in this area. Written confirmation must be sent to the Timescale for action 9th. September 2005 9th. September 2005 9th. September 2005 2. 7 15(2)(b) 3. 7 13(4)(b) 4. 5. 15 22 16(2)(i) 23(2)(a)( n) 9th. September 2005 9th. September 2005 Downham Lodge H55-H03 S11735 Downham Lodge V220292 090805.doc Version 1.40 Page 21 Commission outlining plans to address this. 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 Downham Lodge H55-H03 S11735 Downham Lodge V220292 090805.doc Version 1.40 Page 22 Commission for Social Care Inspection 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Downham Lodge H55-H03 S11735 Downham Lodge V220292 090805.doc Version 1.40 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. 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