Inspection on 29/09/05 for Dunster Lodge

This inspection was carried out on 29th 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 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 17/01/06

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 Unannounced 29 September 2005 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. Dunster Lodge D53 - D02 S16016 Dunster Lodge V247148 080905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Dunster Lodge Address Off Manor Road, Alcombe, Minehead, Somerset, TA24 6EW 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) 01643 703007 01643 703007 Mrs Margaret Joan Hayes. Mrs. Anne Clarke. Mrs Margaret Joan Hayes Personal Care Home Only 19 Category(ies) of Old Age (19) registration, with number of places Dunster Lodge D53 - D02 S16016 Dunster Lodge V247148 080905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate one named person under the age of 65. Date of last inspection 12th January 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 D53 - D02 S16016 Dunster Lodge V247148 080905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one inspector and took place over one day between the hours of 09.20 am – 3.00 pm. 14 residents were at the home on the day of the inspection. There has been one respite admission since the last inspection. 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 interact all residents and speak with most. There was one visitor to the home during the inspection visit but the visitor’s book at the home indicates that visitors are spending time with relatives living at the home frequently. 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. This is the first inspection using the new CSCI reporting format, which focuses on outcome statements for National Minimum Standards. The inspector’s aim on this inspection visit was to seek views on the quality of the service from as many service users as possible and to speak to staff and any visiting relatives. Records examined during the inspection were 2 resident care and support plans, resident risk assessments, activity records, 2 staff recruitment files, fire records, complaint’s policy, menus, kitchen cleaning schedules and fridge/freezer temperature records; other records will be examined at subsequent inspection visits. 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 resident’s 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 kitchen is managed well and staff find the managers at the home approachable. Both staff and residents said that the managers are open and receptive to suggestions or ideas on how to improve the service. Dunster Lodge D53 - D02 S16016 Dunster Lodge V247148 080905 Stage 4.doc Version 1.40 Page 6 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 D53 - D02 S16016 Dunster Lodge V247148 080905 Stage 4.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 Dunster Lodge D53 - D02 S16016 Dunster Lodge V247148 080905 Stage 4.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) 1,3,4.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. The admission procedure 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. There have been no permanent admissions to the home since the last inspection. The most recent admission for a respite stay came from overseas and information was ascertained about the resident via telephone. Usually the owners assess potential admissions in person and offer the resident the Dunster Lodge D53 - D02 S16016 Dunster Lodge V247148 080905 Stage 4.doc Version 1.40 Page 9 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. Evidence for this was seen in the care plan inspected for a permanent resident. 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 D53 - D02 S16016 Dunster Lodge V247148 080905 Stage 4.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) 7,8,10. Residents have a personalised care and support plan that is reviewed regularly to accurately reflect current care needs. It was reported that care plans are discussed with residents and relatives and the inspector suggested that this be recorded when this occurs if the resident does not sign their care plan. Health care needs are met with routine appointments to monitor health needs anticipated and planned systematically and community health specialists accessed where clinical need dictates this. The routines of the home are flexible; residents were relaxed and reported satisfaction with the care received at Dunster Lodge. EVIDENCE: Two resident care and support plans were inspected. Both were detailed, person centred and showed that risk assessments had been carried out for clinical or environmental risks. Plans are 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 residents 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 D53 - D02 S16016 Dunster Lodge V247148 080905 Stage 4.doc Version 1.40 Page 11 Advocacy services are advertised in the home as is professional counselling offered for bereaved residents. One resident with sight loss receives visits from the befriending service of the RNIB. This was initially arranged by the home. Medication management was discussed but not inspected as the standard was inspected and met at the previous inspection. Care staff receive medication training via a local college using an open learning training course. The home is likely to receive a routine community pharmacist inspection soon. Residents spoken with said that the staff were kindly and treated them with respect. One room is shared at the home and screening is provided in this room when staff attend to personal care tasks. During the inspection some residents were observed going into the manager’s office or kitchen to speak to staff and this was treated as normal by the staff and management. This demonstrated that the residents view the home as accessible and welcoming should they need to speak to someone to express their views. Residents spoken to 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 D53 - D02 S16016 Dunster Lodge V247148 080905 Stage 4.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) 12,13,15. 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. The kitchen is organised and managed well and residents spoken with liked the food offered but also valued being able to request alternatives or the opportunity to suggest changes in menus. EVIDENCE: The home has had a full time activities organiser in post since July. The inspector was able to spend some time sitting in on the morning group 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 activity organiser had skilfully arranged the activity session so that the five residents who were in the session were able to spend time on a range of activities of their choice. There was 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 was giving individual attention when required and was stimulating conversation with residents. There were a number of finished arts and crafts products displayed on a board in the room. As the activity organiser is full time she is able to plan group and individual sessions as well as outings for residents. It is commendable that the owners have put such a premium on the value of activities in the home in Dunster Lodge D53 - D02 S16016 Dunster Lodge V247148 080905 Stage 4.doc Version 1.40 Page 13 enhancing the lives of residents by providing a full time activities post for this medium size home. 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. Lunch was observed at the home. Most residents chose to take their main meals in the dining room at the home. There is a chalet in the grounds of the home occupied by a retired couple that also take their meals with the home’s residents. The inspector spent some time with the chef, who showed her around the kitchen and stores. The management of the kitchen and menus is planned well with home cooked meals that reflect individual likes and dislikes. Residents spoken with confirmed that choice and alternatives are available to the printed daily menu. The home was last inspected by the EHO approximately 18 made in the inspector’s report. This recommendation has been met. The kitchen was refurbished in 2004. Appropriate records in respect of cleaning schedules, food hazard analysis, fridge and freezer temperatures and food labelling were observed. The home holds bi-annual resident meetings where menus are routinely discussed as part of the agenda. Dunster Lodge D53 - D02 S16016 Dunster Lodge V247148 080905 Stage 4.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) 16,17,18. There is an open atmosphere at the home supporting residents to raise their views or worries to any staff member. Residents said that they would be comfortable in doing this. Several residents chose and were supported to vote in the 2005 general election indicating that the home promotes residents to be active in the civil process. Appropriate policies and practices are in place to detect resident abuse or report concerns in order to protect residents. 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. Residents asked confirmed that they would be comfortable to approach a member of staff or management if they had any concerns or worries. Residents’ details are entered onto the electoral roll and several residents participated in voting in the May general election. The home has a Whistle Blowing procedure and staff spoken to were aware of the home’s policy and the concept of raising concerns to third parties by ‘Whistle Blowing’. Staff receive training in abuse detection via the NVQ training award and in-house training. Dunster Lodge D53 - D02 S16016 Dunster Lodge V247148 080905 Stage 4.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) 19,20,21,22,23,24,25,26. 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. Advice was given to the cleaning of the underside of the fixed bath seat, that attracts residue from the use of emollient bath products. Several bedrooms have enDunster Lodge D53 - D02 S16016 Dunster Lodge V247148 080905 Stage 4.doc Version 1.40 Page 16 suite facilities. There are separate toilets suitably provided in the building. The physical environment has been adapted appropriately to meet the needs of disabled residents. 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. Most bedrooms were seen and 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. The home is clean and attractive. The owners reported that the ground floor hallway and lounge carpets would be replaced soon as part of on-going routine upgrades and maintenance. Dunster Lodge D53 - D02 S16016 Dunster Lodge V247148 080905 Stage 4.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) 27,29,30. 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. Recent in-house staff training has included dementia care. First aid, infection control and medication training are also booked or are in progress via open learning courses. Two staff recruitment files were inspected. The files are systematically organised and were generally satisfactory. The inspector talked with the owners regarding the importance of maintaining a robust staff recruitment procedure in order to protect vulnerable residents from potential abusers applying for care positions. Dunster Lodge D53 - D02 S16016 Dunster Lodge V247148 080905 Stage 4.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) 31,32,37,38. The home benefits from experienced managers who give clear direction to the home. Staff report feeling supported and supervised by the management team, giving then job satisfaction. Hence, 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 D53 - D02 S16016 Dunster Lodge V247148 080905 Stage 4.doc Version 1.40 Page 19 Health and safety issues were not inspected in detail apart from fire records. The inspector was able to evidence that the home is servicing its fire systems equipment and is carrying out recommended fire safety systems routine checks, but the filing and recording of these records is not in one place and therefore not easily accessible to inspection agencies. It is therefore, recommended that the proprietors review their system of recording fire safety records and store such records in one immediately accessible file. Dunster Lodge D53 - D02 S16016 Dunster Lodge V247148 080905 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 x x x x 3 3 Dunster Lodge D53 - D02 S16016 Dunster Lodge V247148 080905 Stage 4.doc Version 1.40 Page 21 N/A 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 Regulation Requirement No requirements were identified at this inspection. 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. 2. Refer to Standard OP37 OP38 Good Practice Recommendations The proprietors proposal that they develop a policy on resuscitation and sudden death at the home in order to support and guide staff is supported and recommended. The homes fire records and details of fire systems safety checks should be recorded in one file for accessibility of inspection agencies. Dunster Lodge D53 - D02 S16016 Dunster Lodge V247148 080905 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier 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 D53 - D02 S16016 Dunster Lodge V247148 080905 Stage 4.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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