CARE HOMES FOR OLDER PEOPLE
Dunster Lodge Off Manor Road Alcombe Minehead Somerset TA24 6EW Lead Inspector
Stephen Humphreys Unannounced Inspection 31st October 2006 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 Dunster Lodge DS0000016016.V315501.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. Dunster Lodge DS0000016016.V315501.R01.S.doc Version 5.2 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 MRS ANNE CLARKE Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Dunster Lodge DS0000016016.V315501.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. To accommodate one named person under the age of 65. Date of last inspection 17January 2006 Brief Description of the Service: Dunster Lodge is an established care home situated in a quiet part of Alcombe approximately one mile from the town of Minehead in Somerset. The care home is at the top of the hill accessed along a steep narrow drive leading off Manor Road in Alcombe. The home is set in approximately 3.5 acres of landscaped grounds with panoramic views of Minehead and the Bristol channel across to Wales. The home is registered to provide personal care for up to 19 people over the age of 65. The registered providers and managers are Mrs Margaret Hayes and Mrs Anne Clarke, both live within the grounds of the home and are hands on in the home. The accommodation is over three floors with access by stairs and a passenger lift. Accommodation is mainly single rooms with one room being a shared room at the present time. The providers intend to make this into a single room in the future. The communal rooms include two sitting rooms, a dining room and conservatory all on the ground floor and accessible for ambulant and people who use wheelchairs. Toilets are close to the communal areas. The communal rooms are spacious with comfortable seating for all people in the home. The conservatory is mainly used for group activities and provides a suitable environment for people to sit and socialise. People sitting in the communal rooms can listen to music or watch television or sit quietly and read if they choose. The current fees range from £350 to £ 475 per week. Extra charges are made for personal items, hairdressing and newspapers. The providers have established a stable staff group, many of whom live locally to the home. Dunster Lodge DS0000016016.V315501.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first inspection for 2006/2007 carried out by an inspector from the Commission for Social Care Inspection. The visit to the home was unannounced. The inspector used the Inspecting for Better Lives methodology which included talking to people receiving care, care staff, catering staff and the registered provider, Mrs Anne Clarke. The inspector was able to have detailed discussions with three relatives who were visiting during the day. The Commission for Social Care Inspection sent out service user surveys prior to the site visit however none had been returned at the time of writing the report. The survey information will be conveyed to the registered provider at a later date. The visit to the care home took place on the 31st October 2006. The inspector was in the home from 09:30 until 16:45. During the day the inspector was able to observe the carers carrying out their work, talk to the staff including the social therapist. Conduct a tour of the home with Mrs Clarke, looking at all the accommodation and communal rooms. The inspector was able to observe lunch being taken in the dining room and reviewed the medication system and all the statutory records. Three of the people receiving care in the home were considered to have complex care needs with two needing regular oxygen therapy. All three were self-caring and those who needed oxygen were able to administer their oxygen as needed. The care of the three people was looked at in depth. The inspector observed one-person self-administering oxygen whilst sitting in the lounge. The inspector was able to talk to all three people. Their individual care plans were reviewed and staff were able to convey detailed knowledge of the peoples needs. It was clear that all the care needs were being met. What the service does well: Dunster Lodge DS0000016016.V315501.R01.S.doc Version 5.2 Page 6 The registered providers have created a very warm and people orientated care home environment. The staff team are stable and have detailed knowledge of the peoples care needs. The environment is warm and homely with residents being involved in the running of the home. The registered providers are continually reviewing and evaluating the systems in the home to ensure comfort and a high standard of service delivery is maintained. The social therapist who is very experienced and qualified in social therapy organises social and recreational activities that the people want to do. She is able to support people to participate either in a group or one to one. The cook has a detailed knowledge of the peoples likes and dislikes and produces meals that are enjoyed by all. What has improved since the last inspection? What they could do better:
Dunster Lodge is a small family community with a stable staff group. The staff are very knowledgeable about the people who receive care however to move this forward the individual’s care plan could be more person centred. This would benefit new staff and the people receiving care as it would be a working record of the health and social well being of the person. The registered provider, Mrs Clarke is going to review the current system to develop further the person centred care practiced in the home.
Dunster Lodge DS0000016016.V315501.R01.S.doc Version 5.2 Page 7 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. Dunster Lodge DS0000016016.V315501.R01.S.doc Version 5.2 Page 8 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.V315501.R01.S.doc Version 5.2 Page 9 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents will be provided with information about the home in brochure and other formats. All residents will have their individual care needs identified from a detailed assessment of care before admission to the home is agreed. EVIDENCE: The inspector spoke in detail to three relatives about the information they received about Dunster lodge. The relatives said they were provided with a brochure in the form of service user guide and a DVD disc. They all felt that they had enough information from this material to inform them about the home and the services offered. Each relative visited the home and were very happy with the reception they received from the registered providers. They expressed their gratitude to the
Dunster Lodge DS0000016016.V315501.R01.S.doc Version 5.2 Page 10 staff and the providers for being pleasant and affording them time during the visit. Only one of the residents spoken to said they had visited the home with their relative before moving in. Most of the residents said they were either unwell or in hospital when it was decided they could no longer live on their own. One relative said “I chose this home because it was friendly, the views are very pleasing and the managers are very nice”. “There is a homely feeling and welcoming staff”. “There was no pressure”. Other comments received included “I visited the home and felt it was homely, I spoke to Ann and Margaret who were very helpful and supportive”. The registered provider will visit all prospective residents before admission into the home. A detailed care needs assessment is agreed with the resident and each resident receives a contract of care. Staff said that the registered provider will always discuss with them the care needs of a prospective / new resident. The inspector looked at six care plans in detail. It was evident from the care plans that the residents received the care they needed. Dunster Lodge DS0000016016.V315501.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be assured that their individual health and personal care needs will be met and they will be treated with respect at all times. EVIDENCE: Each resident had a detailed care plan of their personal care needs. Health care needs are met by visiting health care professionals including doctors, district nurses and other para-medical professionals such as the optician. The inspector was able to speak to a group of residents in the conservatory about their care. One resident said “I see the doctor quite often” and “I went to the dentist recently”. Records to confirm doctors and other visits were seen in the individuals care plan. Dunster Lodge DS0000016016.V315501.R01.S.doc Version 5.2 Page 12 The inspector reviewed the receipt, administration, storage and disposal of medication in the home. Many of the residents are self caring and can carry out their own personal care. Some residents self administer topical creams. One resident was observed to self administer oxygen. Tablet medicine is received cassetted from the pharmacy and administered by trained carers. One carer said she had received training to administer the medicines and was still learning about the different types of medicines. The medicine administration records were checked and found to completed correctly. A pharmacist from the primary health care trust carries out a medicine inspection at six monthly intervals. The registered providers also carry out quality assurance checks at regular intervals. Storage and disposal of medicines is carried out as required. Residents and relatives confirmed that they are treated with respect and their dignity maintained during intimate tasks. One resident said “the girls are so good, they really look after you”. Another resident said “the staff are excellent, always respectful” “Anne is a wonderful lady – she will do anything for you”. The comments from residents and relatives were positive to inform the inspector that the staff are respectful and have the residents interests at heart. Dunster Lodge DS0000016016.V315501.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The registered providers have developed an ethos in the home that ensures flexibility and benefits the resident. The registered providers have developed a social environment that meets with peoples wishes. EVIDENCE: “I’m very happy here, the staff are wonderful and they will do anything for you”. The group of residents sitting in the conservatory echoed this comment. The inspector was able to spend time with them talking about the daily lifestyle in the home. There are no routines as such commented the carers. We are one happy family here and everyone mixes together. The group in the conservatory were busy knitting tea cosies, the social therapist Val said, “We do the knitting to raise funds”, the current project is to buy a data projector so that slides and pictures of interest can be shown in the home. Residents expressed their own benefits of knitting as, it keeps me active and I enjoy it.
Dunster Lodge DS0000016016.V315501.R01.S.doc Version 5.2 Page 14 The residents and relatives talked about the summer ball they had, on the large garden outside the home. One relative was very pleased with the social and recreational activities going on in the home. Two residents told the inspector of trips out to take tea along the coast in the nice weather. The social therapist talked about residents who prefer to be on their own. She works on a one to one with these people but respecting their individual wishes to be alone at times. One resident said “I am anti-social and prefer to stay in my room”. “I enjoy the views from my window especially looking at the lights.” “The staff are very friendly and you can always have a conversation with them”. The inspector observed the lunch time meal. All the residents took lunch at tables in the dining room. The residents were observed to talk to each other which made it a sociable event. Even the resident who said she was antisocial enjoyed the company of the others. The residents sat three to a table. The tables had very nice cloths and fully laid with cutlery and condiments. Menus were placed on the tables however most of the residents knew what was for lunch. The inspector visited the kitchen and talked to the cook. Menus are generally rotated every six weeks. The cook talks to residents to find out their likes and dislikes and build the menus around these. The menus appeared to be nutritious and balanced. No residents at this time required a special diet. Comments from residents included “ food is excellent”, “food is bland –but if you don’t like it they will find something else for you”. The meal was served by the carers, asking each resident what they liked from the trolley. The meal was hot and the vegetables fresh. The inspector was able to view the food stock that included frozen and fresh foods. The food temperature and other records were checked and found to be up to date. The environmental health officer last inspected the home on 3rd March 2006. No requirements were made. Dunster Lodge DS0000016016.V315501.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be assured they are protected by robust recruitment procedures and staff awareness of vulnerable adult issues. EVIDENCE: The complaints procedure is displayed and copies available in the statement of purpose and service user guide. One relative did say that they were not aware of the complaints procedure however if they had any concerns they would voice them to the registered provider. The Commission for Social Care Inspection has not received any complaints or concerns regarding this care home in the last twelve months. No complaints or concerns have been recorded in the homes complaints book. Residents were able to say who they would take their complaints to however most of the residents said they would not have any reason to complain. One resident said “If it wasn’t good here I would leave”. The general consensus amongst the group in the conservatory was “we have no grumbles”. The inspector checked the staff files to ensure the recruitment procedure was being followed. All the required security checks and information had been obtained prior to the staff commencing employment.
Dunster Lodge DS0000016016.V315501.R01.S.doc Version 5.2 Page 16 Staff were able to voice the actions they would take should an incident of abuse occur. They confirmed their awareness of the homes vulnerable adults policy and the training they had attended. Dunster Lodge DS0000016016.V315501.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be assured of warmth and a safe environment to live. EVIDENCE: The inspector did a tour of the home with Mrs Clarke. The internal environment is pleasant and well maintained. Some refurbishment of toilets is planned and replacement carpets have been fitted since the last inspection. The décor in the communal rooms is tranquil and pleasing to the eye. The furnishings are comfortable however two chairs were showing signs of wear. One resident sitting in the lounge said “I like listening to the music”. There are single seats and a two seater sofa for residents and visitors. Dunster Lodge DS0000016016.V315501.R01.S.doc Version 5.2 Page 18 The décor through out the accommodation is pleasing with residents able to choose decoration of their room. Heating is via radiators that are protected and hot water outlets from baths and wash- basins are regulated to the required temperature set for the safety of the residents. The inspector was talking to one resident who was in the conservatory about her room. The resident said she liked to have a hot bath when living at home. The water in the care home was not to her liking however the resident accepted it being aware of the requirement to regulate the flowing hot water temperature to 43c. The home was clean, warm and considered to be safe through out. Externally the home looks very nice with a safe tarmaced area leading up from the drive to the front entrance. The guttering to the rear especially near the kitchen would benefit from deforestation to prevent overspill from heavy rain. There is a large flat grassed area at the front of the home were people can sit and take in the panoramic views over Minehead and across the Bristol channel. This area has fencing around to ensure the peoples safety. Dunster Lodge DS0000016016.V315501.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered providers have established a stable and well trained staff group to meet the needs of the residents. EVIDENCE: On the day of the visit care staff on duty were working from 8am until 5pm therefore no other staff were spoken to. There are three staff on duty during the day and one at night with one of the proprietors on-call. The level of staff in the home is considered to be adequate for the current dependency of the residents. The staff spoken to were very knowledgeable of the residents care needs and their respective lifestyles. Residents comments included “staff are quite good and helpful”, “ staff are excellent”. The residents benefit from the strengths of the registered providers in building a staff group that works together as a team. This includes the carers, catering staff, social therapist and domestic. Dunster Lodge DS0000016016.V315501.R01.S.doc Version 5.2 Page 20 The registered provider encourages staff development and provides opportunities for training. Most of the care staff and the cook have completed the NVQ training. Staff have completed all statutory training as recorded on their training record. The inspector reviewed six staff files. All were completed satisfactorily. Dunster Lodge DS0000016016.V315501.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is (excellent, good, adequate or poor). This judgement has been made using available evidence including a visit to this service. Residents and staff benefit from experienced management who provide clear direction to the home. EVIDENCE: Dunster Lodge is managed by Margaret Hayes and Anne Clarke, there is also a care manager Janice. Mrs Clarke is a registered nurse with a wealth of experience in caring for older persons. The residents benefit from the experience and strong leadership of the home. The registered providers run the home for the benefit of the residents, there are no fixed routines. Staff interact with residents in a family orientated way helping, assisting and supporting each other.
Dunster Lodge DS0000016016.V315501.R01.S.doc Version 5.2 Page 22 The registered providers have a quality assurance system in place that includes staff appraisals and monitoring of risks. Each individuals care plan has risk assessments that are evaluated and updated as part of the quality monitoring system. Staff meetings are held at which staff are encouraged to voice any suggestions. There is also a suggestion box sited near the main entrance for residents and visitors. Formalisation of staff supervision was discussed with the registered provider who said she would be reviewing her current system to formalise the records. The inspector reviewed all the statutory records kept by the registered provider. All health & safety records were checked and up to date. Dunster Lodge DS0000016016.V315501.R01.S.doc Version 5.2 Page 23 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 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 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 3 3 X X 3 X 3 Dunster Lodge DS0000016016.V315501.R01.S.doc Version 5.2 Page 24 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. 1 Refer to Standard OP36 Good Practice Recommendations The registered provider should keep records of staff supervision sessions. Dunster Lodge DS0000016016.V315501.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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
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