Inspection on 17/01/06 for Dunster Lodge

This inspection was carried out on 17th January 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Dunster Lodge 26/06/07

Dunster Lodge 31/10/06

Dunster Lodge 29/09/05

Dunster Lodge 12/01/05

Dunster Lodge 14/07/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Dunster Lodge Off Manor Road Alcombe Minehead Somerset TA24 6EW Lead Inspector Judith Roper Announced Inspection 17th January 2006 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 Dunster Lodge DS0000016016.V271516.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. Dunster Lodge DS0000016016.V271516.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Dunster Lodge Address Off Manor Road Alcombe Minehead Somerset TA24 6EW 01643 703007 01643 703007 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) MRS MARGARET JOAN HAYES MRS ANNE CLARKE MRS MARGARET JOAN HAYES Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Dunster Lodge DS0000016016.V271516.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate one named person under the age of 65. Date of last inspection 29th September 2005 Brief Description of the Service: Dunster Lodge is registered to provide personal care to up to 19 people over the age of 65. The registered providers and managers are Mrs Margaret Hayes and Mrs Anne Clarke. Dunster Lodge received the Quality Rating from Somerset County Council in July 2004.The home is an interesting old building set in extensive grounds with views to Exmoor and the sea. Service user accommodation is set on three floors with a passenger lift between. All communal areas are on the ground floor. These include two sitting rooms, a dining room and conservatory. The proprietors also run a separate weddings event service, stageing wedding receptions on the lawns at Dunster Lodge. This is staffed separately from the home and is declared in the homes Statement of Purpose and Service Users Guide. Dunster Lodge DS0000016016.V271516.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was carried out by one inspector and took place over one day between the hours of 10:00 am – 4.30 pm. Fourteen residents were at the home on the day of the inspection. This included two people who were in hospital. Several of the residents have lived at the property for a number of years. There are vacancies at the home. The inspector was able to see most residents and speak with several. Prior to the inspection the inspector received ten feedback comment cards about the service from residents. There were not any visitors to the home during the inspection visit but the inspector has also received nine feedback comment cards from relatives about the service. The responses about the service from residents and relatives in feedback cards were in the vast majority of cases positive. All resident respondents said that the home provided good care and food and that they felt safe. Both residents and relatives praised activities provision. Relatives reported that the home communicates well in keeping relatives informed of the changing needs of their loved ones at the home. Relatives also reported that the home makes visitors welcome. One respondent wrote that the staff team, “combine professionalism with care, kindliness and warmth.” Staff on duty were able to give time to speak with the inspector. The proprietors Mrs. Hayes and Mrs. Clarke were available for comment during the inspection. The inspector would like to thank the staff for their time and hospitality shown to the inspector during her visit. The atmosphere at the home was relaxed, friendly and professional. Staff carried out their duties in an attentive manner taking time to support resident’s at their preferred pace. The focus of this inspection visit was to assess Standards not inspected at the previous unannounced inspection in September 2005. Some key Standards have also been inspected as part of this follow-up visit. Records examined during the inspection were one resident care and support plan, fire records, medication records, current staffing rosters, two sample resident contracts and records of resident finances managed by the home. The home also completed and submitted a CSCI pre-inspection questionnaire giving details of the current home environment, policies and procedures for the home, resident admission and discharge details, menus, staff recruitment and staff training and arrangements with community health care professional support in managing the health needs of residents. What the service does well: Staff and management work hard to create a harmonious and supportive atmosphere at the home for residents. The care needs of individual residents Dunster Lodge DS0000016016.V271516.R01.S.doc Version 5.0 Page 6 are known well by the staffing team and residents feel that they can approach any staff member for a chat and that they will be given time by staff. There is a very good range of purposeful, imaginative and interesting activities offered at the home. The daily routines are flexible and the home offers a pleasant environment in which residents live. What has improved since the last inspection? 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. Dunster Lodge DS0000016016.V271516.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 Dunster Lodge DS0000016016.V271516.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): 1, 2, 3, 4, 5. Standard 6 is not applicable. Information is available about the home that details the services offered at Dunster Lodge. This enables potential residents to make a balanced judgement to whether the home is suitable for them. Resident contracts give good detail about the terms and condition of stay but could be further improved by the addition of some information as recommended by the inspector. The admission procedure to the home is sufficiently detailed to ascertain whether the home can meet the health needs of residents. This is reviewed within the four week trial period. Staff receive appropriate job specific training in order to meet resident’s needs. Staffing levels are adequate in order to provide attentive personal care. EVIDENCE: The home has a Statement of Purpose and Service User’s guide. Both documents have been updated recently at the CSCI’s request to reflect that the home also runs a wedding reception service in the grounds of the home in order for prospective residents to be aware that events may take place close to the home. There have not yet been any wedding receptions held at the site. A sample of a resident contract for a social services funded admission and a privately funded admission were inspected. The information is detailed but the Dunster Lodge DS0000016016.V271516.R01.S.doc Version 5.0 Page 9 inspector has made three minor recommendations on how information provided for residents in contracts for their stay at the home could be clarified further. The recommendations are made in light of the Office of Fair Trading report published in 2005 following their study into contracts issued in care homes. The admission processes for the home were discussed with the management and records for assessment processes have been sampled. The owners assess potential admissions in person and offer the resident the opportunity to visit the home prior to admission. The first four weeks following admission are treated as a trial period. The owners also obtain a community health assessment from any placement authority before admission to assist them in determining the appropriateness of the placement at the home. One recently admitted resident was able to confirm this process to the inspector. Many of the current residents have lived at the home for several years. The mix of residents is good with staff knowing resident’s needs well and how individuals interact in order to plan their day to promote harmony and happiness at the home. There is a commitment demonstrated to staff training at the home focusing on the clinical, emotional, behavioural and social needs of individual residents. Dunster Lodge DS0000016016.V271516.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, 11. Residents have a personalised care and support plan that is reviewed regularly to accurately reflect current care needs. Health care needs are met with routine appointments to monitor health needs anticipated and planned systematically. Community health specialists are contacted where clinical need dictates this. Palliative and terminal care is handled sensitively. The routines of the home are flexible; residents were relaxed and reported satisfaction with the care received at Dunster Lodge. EVIDENCE: A care and support plan for a recently deceased resident was inspected. Two plans for current residents were inspected at the previous unannounced inspection in September. The care plan for palliative and terminal care was detailed, person centred and showed that risk assessments had been carried out for clinical or environmental risks. The plan was reviewed at least monthly. Daily reports of general care given were completed and contact with community health care professionals for routine or emergency health appointments were clearly recorded. No current have pressure ulcers or are receiving wound care from the community nurse team. Although the home is not a registered nursing home, Mrs. Clarke is a registered nurse and therefore has the clinical knowledge and additional expertise to advise and assist care staff in the home with. Dunster Lodge DS0000016016.V271516.R01.S.doc Version 5.0 Page 11 Advocacy services from Age Concern are advertised in the home. Medication management was inspected and was managed generally well. Mrs. Clarke promptly addressed minor recording issues requiring attention on medication administration charts when brought to her attention by the inspector. Staff need to be reminded to record the variable dose of a medicine every time. This was noticed in relation to analgesia and aperients. It is recommended that the home include in its policy on medications advice to staff on the acceptance into the home of appropriately packaged prescribed medicines. One recently admitted respite client had brought into the home medicines dispensed into a compliance aid, (out of the original prescribed packaging). The home had taken sensible steps in identifying the medicines but it is advised that the home be clear in not accepting or administering medicines brought into the home that is not in its prescribed original packaging. It is recommended that a letter go out to prospective respite stay bookings stating this in order to ensure that the home keeps a safe and robust system of medicine management in identifying medicines prescribed to individuals. Residents spoken with said that the staff were kindly and treated them with respect. Residents also confirmed that the home’s routines are flexible and accommodating to personal choices of rising and retiring times of the day/night. Dunster Lodge DS0000016016.V271516.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. Activities in the home are organised very well and are imaginative, purposeful and stimulating. Individual attention for activities is provided for less able or withdrawn residents. The home has flexible visiting times and makes relatives feel welcome. EVIDENCE: The home has had a full time activities organiser in post since July 2005. The inspector was able to spend some time with the activity organiser and residents in a post lunch activity session held in the home’s conservatory. The conservatory has been decorated with items made in the arts and crafts activity sessions at the home. The activities offered meet the needs of residents who are outgoing, more reserved, confident or withdrawn, are seeking intellectual stimulation or want to work with their hands. The types of activities offered include needlecraft and sewing, scrabble, personal shopping choices via mail order clubs or a quiet reading corner where classical music was unobtrusively playing. The activity organiser provides attention when required. Visitors are welcome at the home and residents said that staff greet their family members hospitably. Residents can see relatives in their private bedrooms or the conservatory or lounges if privacy is needed. A holy communion is held regularly at the home. Dunster Lodge DS0000016016.V271516.R01.S.doc Version 5.0 Page 13 The home holds bi-annual resident meetings where agenda items such as menus and activities are routinely discussed. Residents spoken with confirmed the flexibility of routines at the home. One comment card from a resident stated, “Activities are very good. This is a very happy home.” Dunster Lodge DS0000016016.V271516.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): These Standards were not inspected on this occasion. Standards 16, 17 and 18 were inspected and met at the unannounced inspection of the home in September 2005. EVIDENCE: Since the last inspection the CSCI has not been approached directly with any complaints about the home and the home has not received any formal complaints. The home’s complaints procedure with the local CSCI address is displayed in the ground floor hallway at the home. Dunster Lodge DS0000016016.V271516.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, 21, 25, 26. Dunster Lodge is a period property full of character that is situated in a stunning elevated position offering impressive views across Minehead and Exmoor. The home is decorated and furnished in a homely domestic style but is also adapted to meet the needs of physically disabled residents. There is a good choice of communal space. The home is clean and pleasant, creating a comfortable environment in which to live. EVIDENCE: The home is located in an elevated position on the outskirts of Minehead. It has views across Exmoor and to the sea. The inspector toured the building, which appeared well maintained. Rooms are decorated in an individual style giving each room personality. The furnishings are domestic and homely. Outside there are extensive grounds accessible for residents. There are two large ground floor lounges and a conservatory. The home has a cat, two birds and some tropical fish. There is a dining room for meals. There are two shared bathrooms adapted to meet the physical needs of residents. There are separate toilets suitably provided in the building. The physical environment has been adapted appropriately to meet the needs of disabled residents. Dunster Lodge DS0000016016.V271516.R01.S.doc Version 5.0 Page 16 There is a shaft lift to all upper floors, a mobile patient hoist, bath seats, grab rails and a loop system installed into the main lounge for the hard of hearing. Several bedrooms have en-suite facilities. On this occasion two bedrooms were seen. Residents are offered a lock for their bedroom and may choose to carry their room key, although none of the current residents choose to do so. Hot water temperatures are controlled at source to prevent scalding injuries. Bedroom temperatures can be individually thermostatically controlled in the room. Laundry is done on site and suitable washing machines and equipment is provided for the management of cross infection and infection control. During the inspection there was some out of date toiletry and emollient cream stock from past residents stored in a laundry cupboard in one communal bathroom. These items were brought to the attention of the managers, who arranged for the items to be disposed of. The home is clean and attractive and warm. An open fire in the main lounge supplements the central heating on chilly days. There is an on-going programme of redecoration to enhance the physical environment. During the inspection the conservatory and ground floor lounge were being decorated. The second smaller ground floor lounge had been decorated shortly before the inspection visit. There is carpet replacement for the ground floor hallways and stairs planned as the next stage for upgrade in the home. Dunster Lodge DS0000016016.V271516.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. The staff in the home appeared motivated and enthusiastic about their work. Staffing levels are sufficient to meet resident’s needs. Residents spoken to were complimentary about the staff describing staff as kindly and hard working. The owners demonstrate a commitment to investing into appropriate staff training in order to provide a professional service for residents. EVIDENCE: There are two care staff on duty each morning and afternoon. In addition to this there are two domestic staff in the morning, a cook and kitchen assistant and a manager. The activities organiser works mainly Mondays to Fridays. During the nights there is one waking night staff and one of the proprietors, who both live in the grounds, is always on call. No current residents require more than one member of staff to attend to personal care or mobilising assistance. Residents and staff on duty spoken with during the inspection said that the staffing levels in the home were adequate to manage the needs of the current residents. Care staff are encouraged and supported to attain NVQ care qualifications to a minimum level of 2 and then to level 3. The current percentage of care staff holding a minimum level 2 NVQ qualification is 60 . Training for staff in 2005 included in-house sessions on dementia care. Training in first aid, infection control and medication training were also provided. Dunster Lodge DS0000016016.V271516.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, 32, 33, 34, 35, 36, 37. The home benefits from experienced managers who give clear direction to the home. There are both formal and informal quality assurance processes in order for the service to improve from resident and relative feedback. Residents are protected from financial abuse by good recording of monies handled by the home on behalf of residents. There is a relatively low staff turnover at the home. This gives rise to the calm atmosphere with confident staff working with residents whose are relaxed in one another’s company. EVIDENCE: Dunster Lodge is jointly managed by the two proprietors of the home. Between them they have a wealth of experience of caring for older people, including nursing and administrative management skills. They also employ a full-time assistant manager, who is undertaking the Registered Manager’s award. The home has a nice atmosphere; residents spoken with seemed to have no fear and interacted naturally with staff. Dunster Lodge DS0000016016.V271516.R01.S.doc Version 5.0 Page 19 The home displays an appropriate certificate of employers liability insurance and the owners continue to invest into the upkeep of the environment in order to provide a pleasing place in which to live. The handling of residents’ monies by the home was inspected. Some advice was given regarding the management of a resident account and the proprietors are considering whether to continue with this account in the present form or to change account type or close the account altogether. The proprietors said that they would inform the inspector if they amend the way that resident’s small amount of cash is banked. Supervision at the home is recorded both formally in an annual appraisal and in informal chats. It was suggested that the home should consider more arranged planned supervisions/job chats where records are maintained and that observed clinical supervision needs to be recorded. This would demonstrate good practice of supervision recording. Health and safety issues were not inspected in detail apart from fire records and servicing records for equipment in the home provided as part of the home’s pre-inspection questionnaire. Dunster Lodge DS0000016016.V271516.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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 3 3 X X X 3 3 STAFFING Standard No Score 27 3 28 4 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 X Dunster Lodge DS0000016016.V271516.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP2 Good Practice Recommendations It is recommended that in the resident contract be stated; 1/ the room to be occupied 2/ that a room change due to changing health needs is verified and concurred with by community health care professional 3/ that the statement in the current pro-forma contract regarding resident security/freedom of movement is altered to state that this includes the grounds of the premises. It is recommended that the home updates it’s own policy on medications and considers writing to planned admissions to state that the home only accepts medicines brought into the home for resident use in the original packaging dispensed by the pharmacy. DS0000016016.V271516.R01.S.doc Version 5.0 Page 22 2 OP9 Dunster Lodge Dunster Lodge DS0000016016.V271516.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Dunster Lodge DS0000016016.V271516.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. 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!