Inspection on 20/07/06 for Durnsford Lodge Residential Home

This inspection was carried out on 20th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Durnsford Lodge Residential Home 07/07/08

Durnsford Lodge Residential Home 27/01/06

Durnsford Lodge Residential Home 03/11/05

Durnsford Lodge Residential Home 07/09/04

Durnsford Lodge Residential Home 14/04/04

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 Durnsford Lodge Residential Home 90 Somerset Place Stoke Plymouth Devon PL3 4BG Lead Inspector Megan Walker Unannounced Inspection 20th July 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 Durnsford Lodge Residential Home DS0000003476.V302389.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. Durnsford Lodge Residential Home DS0000003476.V302389.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Durnsford Lodge Residential Home Address 90 Somerset Place Stoke Plymouth Devon PL3 4BG 01752 562872 01752 562872 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) Mr Ernest Boyter Bertie Mrs Iris Emily Bertie Mrs Carole Diane Scott Care Home 28 Category(ies) of Dementia - over 65 years of age (28), Old age, registration, with number not falling within any other category (28), of places Physical disability over 65 years of age (28) Durnsford Lodge Residential Home DS0000003476.V302389.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service Uses from the age of 60 may be admitted to the Home. To accommodate five named persons in the category of MD(E) Date of last inspection 27th January 2006 Brief Description of the Service: Durnsford Lodge is situated in a residential area of Stoke close to local shops and other amenities and local transport links. The home provides accommodation and personal care for 28 residents over the age of 60 for reasons of old age, dementia and physical disability. There is 24hour staffing including night waking staff. The home is 2 large houses redesigned to become one home that has further been extended. The home provides 20 single and 4 double bedrooms, of which 5 and 1 respectively have en-suite facilities. There are 2 lounge rooms. One of these is designated as a smoking room although it also provides access to a number of bedrooms. A large dining room has the other lounge leading off it. A passenger and stair lift provides access to all floors. The garden is well maintained and accessible for residents by way of ramps. Some bedrooms overlook it and other bedrooms have a view of Plymouth Sound and the coastline of Mount Batten and Jenny Cliff. Residents are enabled to access any health and social care services they require. Parking is available at the front of the property and in the street. Durnsford Lodge is not registered to provide nursing care and it does not provide intermediate care. The fees at Durnsford Lodge are from £275 to £325. Extra costs include hairdressing and chiropody (information provided by the Registered Provider July 2006) . Durnsford Lodge Residential Home DS0000003476.V302389.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The fieldwork part of this inspection took place over two days in July and in August. It included a tour of the premises, observation of staff and residents in the home, talking to residents and staff about their views of the home, and looking at cares plans, staff files, medication, and other records and documentation. In addition other information used to inform this inspection included Comments’ cards from six health practitioners, including GPs, who visit the home regularly, nine relatives, five members of staff, and eight residents. Also any other information received by the Commission since the last inspection. Two requirements and two “Good Practice” recommendations were made as a consequence of this inspection. What the service does well: What has improved since the last inspection? What they could do better: Feedback from relatives suggests that the home needs to include relatives more in reviews and care planning for, in particular, residents who are not capable of making decisions for themselves. Feedback from visitors and observation during the two days at the home showed that at times staff need to be more aware of residents less able to do things for themselves, for example, putting drinks within easy reach and/or Durnsford Lodge Residential Home DS0000003476.V302389.R01.S.doc Version 5.2 Page 6 assisting individuals to drink, and to encourage and assist with personal hygiene those residents who have deteriorating mental capacity. 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. Durnsford Lodge Residential Home DS0000003476.V302389.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Durnsford Lodge Residential Home DS0000003476.V302389.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be confident that their needs will be assessed to ensure that these can be met when they move into the home. EVIDENCE: The care plans inspected had evidence of pre admission assessment including social services care plan and information gained from other sources such as family. The Registered Manager currently carries out pre admission assessment visits and she confirmed that if the home cannot meet the person’s needs then they do not take them. Each file seen for recent admissions had a copy of a letter offering a place at the home and confirming that the home could meet the person’s care needs. New residents are given a trial period to ensure that they find the home is meeting their needs and also for the home to further assess that it is able to meet the pre-assessed needs of that person. Durnsford Lodge Residential Home DS0000003476.V302389.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can feel confident that a staff team that is respectful and also reliable will meet their care needs. EVIDENCE: All the care plans inspected had an initial assessment, a full assessment of need and a comprehensive care plan. In one instance there was a family history and a family tree. This information had been gathered over a period of time and was used to inform the current care plan. Health Professionals and Visitors Comments’ Cards received by the Commission, and observation during the two days at the home, showed that staff need to be more aware of residents less able to do things for themselves, for example, putting drinks within easy reach and/or assisting individuals to drink. Also it was discussed with the Registered Manager that some relatives had commented that on occasions staff could do more to encourage and assist with personal care those residents who have deteriorating mental capacity. This included ensuring that residents’ hearing aids were in working order and that residents were wearing them. Durnsford Lodge Residential Home DS0000003476.V302389.R01.S.doc Version 5.2 Page 10 Although each care plan had been reviewed regularly, the review was uninformative. In some cases relatives had signed on behalf of residents who were unable to do so for themselves. Some families who returned Comments Cards to the Commission commented that they would like to be more involved or at least informed about any changes to care plans. This was discussed during this visit with the Registered Manager. It was agreed that she would revise current practice so that reviews for stable residents would be less frequent (unless there was a significant change that required a care plan review). Also families/resident representatives would be invited to attend. The Registered Manager also agreed to revise the format of the review template in order that staff could write more than a couple of words. As part of the care plan there was a diary sheet to record health issues and action taken regarding this. When required advice was sought from the Continence Support Nurse and this was incorporated in to the care plan, as was other specialist advice such as the chiropodist. Medication is supplied in blister packs that are kept in a lockable cupboard, and controlled drugs were seen kept locked securely and separate from the other medication with a separate book that was signed and up to date. As on previous inspection visits it was observed that at times all the medication is left unattended and out of view whilst individual doses are being given. Staff explained that this area of the home was used for dispensing medication during meals because then the process did not interrupt or distract residents as they were eating. Also staff were confident that there was always sufficient staff around the dining room and kitchen areas to be aware if anyone was near the medication. GP and Nurses’ Comments cards received by the Commission confirmed that medication is managed appropriately by the home. Staff were observed being courteous and respectful towards residents at all times. Residents spoken to by the inspector during this visit, and those who returned Residents’ Surveys said that staff were caring, supportive and friendly. Families who returned Comments Cards to the Commission confirmed that they could visit their relative in private, although two would have preferred somewhere other than the resident’s bedroom. Durnsford Lodge Residential Home DS0000003476.V302389.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents find the home offers a lifestyle that satisfies their expectations. EVIDENCE: During the site inspection residents were seen around the home, some sitting in the lounges, others in their rooms, one resident chose to sit outside in the garden and enjoy the sunshine. Two residents spoken to by the inspector said that they preferred to stay in their rooms and they were comfortable with their own televisions and radios. One resident who was seen in her room said that she could choose to stay in her room or join the other residents in the lounge. She also confirmed that her family visit regularly and that she goes out with them on occasions. A resident was found sitting in a corridor by a window. She told the inspector that she liked to watch the cars and people coming in and out of a nearby public car park, and passing by in the street. Several residents stated that they were happy living at Durnsford Lodge, and that staff were “friendly”, “helpful” and “caring”. One relative appreciated that staff had a sense of humour. A couple of residents also commented that Durnsford Lodge was “homely”. Durnsford Lodge Residential Home DS0000003476.V302389.R01.S.doc Version 5.2 Page 12 The Registered Manager explained that staff were encouraged to chat with residents and if they were told by a resident of any particular interest or something that the resident would like to do, etc, then staff would either write it in the Daily Report or verbally inform the Registered Manager for further action. Observation of one to one interactions between staff and residents showed that staff had an understanding of individuals’ preferences and they endeavoured to facilitate these wishes and whims where possible. The formal programme of activities showed little evidence that it would be appropriate group activity for residents who have dementia care needs. Some residents stated that they chose not to join in with any activities organised by the home. Staff said that they encouraged residents to join in, however they were aware that some residents preferred not to take part, whilst others would join in if they felt like it at the time of the activities. Residents’ Meetings have proved to be unsuccessful and some residents confirmed in their surveys that they would not be interested in attending such a meeting. Durnsford Lodge Residential Home DS0000003476.V302389.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are protected from abuse by robust policies and staff practice. EVIDENCE: The Commission has not received any complaints since the last inspection of Durnsford Lodge. Complaints and suggestions from residents, relatives or other visitors to the home, are treated seriously. The Registered Manager confirmed that she tries to ensure that any issues brought to her attention are resolved promptly. An Adult Protection case, due to its complexity, is still outstanding since last year, and with which the Registered Manager is involved. Through out this period the Registered Manager has shown herself to be capable of dealing with all the subsequent matters arising from it in a competent and discreet manner. The home has adult protection documentation and staff receive appropriate training in this area. . Durnsford Lodge Residential Home DS0000003476.V302389.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents live in a pleasant, maintained clean home that is comfortable and provides sufficient facilities to meet their needs. EVIDENCE: Since the last inspection a keypad has been fitted to the inner front door, and four bedrooms, the halls and stairways have all been redecorated and refurbished. All fire safety equipment is routinely checked and records signed and dated, and the Fire Risk Assessment Action Plan was seen as completed, signed and dated. Risk assessments for all windows without window restrictors and top opening windows have been done. Durnsford Lodge Residential Home DS0000003476.V302389.R01.S.doc Version 5.2 Page 15 Plans for rebuilding the laundry have been submitted to the Local Authority Planning Department for approval. A tour of the premises found it to be in good order, and clean through out, although there were still some carpets that were stained or badly marked from “wear and tear”, and were stretched causing potential trip hazards. These have been identified on previous inspections. Durnsford Lodge Residential Home DS0000003476.V302389.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are cared for by trained and motivated staff in sufficient numbers to meet the needs of those currently living in the home. EVIDENCE: Since the last inspection a domestic assistant has been employed and the Maintenance Person is now able to concentrate solely on routine maintenance as well as dealing with emergencies as they arise. The home’s recruitment procedures were good. All staff files inspected had relevant checks. The home had a rolling training programme in operation. Staff files inspected showed evidence of regular supervision taking place. Staff were observed carrying out their duties in a professional, sensitive manner. Residents verbal and written comments, as well the visitors feedback, was complimentary regarding the care and attention given by all members of the home’s staff team. Durnsford Lodge Residential Home DS0000003476.V302389.R01.S.doc Version 5.2 Page 17 Durnsford Lodge Residential Home DS0000003476.V302389.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health, safety and welfare is promoted and protected by a competent and capable manager who is keen to raise standards and work with the Commission to achieve positive outcomes for residents and staff. EVIDENCE: The Registered Manager is popular and approachable. This was shown in staff and residents’ Comments’ cards, conversations with staff and residents, and observation on the site visits. She has worked hard to meet all the requirements of previous inspections, and generally to make certain that the home meets the National Minimum Standards. Issues identified during the site visit were rectified immediately. The owner visits the home at least twice a week and has regular phone contact with the manager and other staff between his visits. As noted at other inspections, the home is run in an open and transparent way with responsibilities delegated appropriately amongst staff. Durnsford Lodge Residential Home DS0000003476.V302389.R01.S.doc Version 5.2 Page 19 Staff training is taken seriously and a rolling programme ensures mandatory training is kept up to date for all staff as well as offering individual staff members opportunities to go on courses that may more relevant to their post and/or be of interest to them. The Registered Manager also has an ongoing commitment to up date her own skills through training as well as those of her staff. A questionnaire has been devised for residents (or their representative) to give their opinion about the home, although this has not yet been extended to include the wider community and relevant stakeholders. The manager or owner will deal anything resulting from these questionnaires accordingly. Informal feedback is also encouraged from residents and their families. Residents’ Meetings have been tried however they proved to be unpopular with residents so were discontinued. The home is responsible for the personal finances of approximately 50 of the residents. The Local Authority holds a receivership for at least three of these, and some families have similar arrangements with the home. A sample of residents’ financial records was inspected. All the accounts balanced. Receipts were kept for all transactions. Inspection of relevant records found that the home has good records of all the work undertaken to keep the home safe and meet Health & Safety legislation, and as well as maintenance of all essential systems such as electrical wiring and appliances, the hot water system and hoists. Also certificates for fire training of staff and other fire safety records were seen as evidence that this is up to date. Durnsford Lodge Residential Home DS0000003476.V302389.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 x 18 4 2 x x x x x x 2 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 4 x 3 x 4 x x 4 Durnsford Lodge Residential Home DS0000003476.V302389.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 12(1a) Requirement Care plans must set out in detail any action needed to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the resident are met. This refers in particular to residents with limited mental capacity that may require additional supervision with e.g., drinks, and personal hygiene. Paper hand towels must be supplied in a fitted container in the staff toilet to prevent in the spread of infection in the home. Timescale for action 31/08/06 2 OP26 13(3) 31/08/06 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 OP7 Good Practice Recommendations Current practice and format for Care Plan Reviews should continue to be revised, as discussed during this inspection, DS0000003476.V302389.R01.S.doc Version 5.2 Page 22 Durnsford Lodge Residential Home 2 OP19 and either include families as well as the individual resident or measures put in place to ensure that families are kept up to date with any revision of a care plan. Replacement of carpets identified on previous inspections should continue to be part of the rolling maintenance programme. Durnsford Lodge Residential Home DS0000003476.V302389.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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. 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