Inspection on 27/01/06 for Durnsford Lodge Residential Home

This inspection was carried out on 27th January 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Durnsford Lodge Residential Home 07/07/08

Durnsford Lodge Residential Home 20/07/06

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 27th January 2006 07:00 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.V272398.R01.S.doc Version 5.1 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.V272398.R01.S.doc Version 5.1 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.V272398.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Uses from the age of 60 may be admitted to the Home. Date of last inspection 3rd November 2005 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 Residential Home DS0000003476.V272398.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection on Friday 27th January 2006 between 07h00 and 11h00. For part of this inspection Antonia Reynolds was present as a second inspector. The inspection included a tour of the premises independently by each of the inspectors, conversations with staff on duty during this time, and conversations with residents. Care plans and other documents were seen. Medication was observed being given to residents. The Deputy Manager, Robert Reed, who was on duty for the day shift explained the home’s medication policy and procedure. Paul Stewart, the home’s cook Monday to Friday, explained current reviews and plans for change of menus and other current practice for implementation in the kitchen in forthcoming weeks. He also spoke about training needs and planned courses to be attended by staff in the near future. As a consequence of this inspection there were two Immediate Requirements regarding the admission of individuals with mental health needs who are outside the categories for which the home is registered and that the Registered Provider must apply for a variation to the categories of this home. What the service does well: What has improved since the last inspection? The home looked and smelt clean and fresh. Durnsford Lodge Residential Home DS0000003476.V272398.R01.S.doc Version 5.1 Page 6 The exposed pipes and valves in the laundry room have been boxed in and lagged. Residents no longer get up as early as 05h00 although night staff still get up residents perceived to more vulnerable from about 05h45. The policy for cleaning commodes was prominently on display. Night staff could explain in detail their current working practice when cleaning commodes. Menu plans are under review. Kitchen staff have planned training on “Safer Food, Better Business”. Residents have written contracts and Terms and Conditions of Occupancy on their individual files. Liquid soap has been provided in all the communal toilets and bathrooms, and toilet roll holders have been fitted where required. Paper hand towels should be provided particularly in the Staff bathroom. A window restrictor has been fitted to the window in the Manager’s Office. Net curtains have been provided in bedrooms to ensure more privacy for wash hand basins near windows. Measures have been put in place by the Registered Manager to try to ensure the home does not smell of stale tobacco smoke in and around the “Smoker’s Lounge”. What they could do better: The Registered Provider must apply for a variation to the home’s registration with satisfactory evidence of staff training and qualifications to support such a variation. Currently the home is accepting residents who are “out of category”, that is, individuals who require 24 hour care because they have mental health issues. This practice must stop and an Immediate Requirement was issued at this inspection to this effect. The Registered Provider may accept only individuals who require care because: • They are over 60 years of age • They are physically frail And/or • They have dementia Durnsford Lodge Residential Home DS0000003476.V272398.R01.S.doc Version 5.1 Page 7 Durnsford Lodge is NOT registered with the Commission for Social Care Inspection to care for anyone who has a mental health need. A full pre-assessment must be completed before a prospective resident is accepted to live at the home. On the day of the inspection the front door was not locked hence it was possible for anyone to gain easy access to the inside of the building and for residents to go out unsupervised. The carpets in some areas of the home are stretched and need to be either refitted or replaced to prevent trip hazards for both staff and residents. It is particularly bad in the Manager’s Office and this was noted at the last inspection as dangerous. 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.V272398.R01.S.doc Version 5.1 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 Durnsford Lodge Residential Home DS0000003476.V272398.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4 Each individual resident has a contract with terms and conditions of residency. Individuals have been accepted into the home without proper and full assessment and assurance that their care needs can be met. The home is accepting individuals outside the categories for which the home is registered. EVIDENCE: Contracts and Terms and Conditions of Residency at Durnsford Lodge were seen on a random selection of residents’ files. Those residents who are funded by Plymouth City Council Social Services Department also had a Plymouth City Council contract on their files. The Individual Resident File was seen for the most recent admission to the home. Staff explained that they received little information from the Social Services Department referring this person and no time to properly pre-assess before the person arrived. The Social Services Care Plan (seen on the file) was faxed to the home after the individual had already moved in to the home. Durnsford Lodge Residential Home DS0000003476.V272398.R01.S.doc Version 5.1 Page 10 Apparently it was a hospital discharge so the individual arrived at the home without any personal belongings and staff had to find suitable clothes for an interim period. Staff stated that a Social Services’ Care Manager brought clothing and other personal items from the individual’s home several days later. Staff at Durnsford Lodge stated that they have been requested by the Registered Manager to record anything they thought to be useful to enable a full care assessment and care plan to be written for this person. Documents and records seen by both inspectors were appropriate and starting to build a picture of this person’s character, likes and dislikes, and behaviour at different times of the day and night. Staff spoken to about the manner of this admission stated that it was difficult not having any information, and no one knew the reason or need for the speed of the discharge from hospital, “a place of safety”, to the home . Currently the home is accepting residents who are “out of category”, that is, individuals who require 24 hour care because they have mental health issues. Evidence was seen on individual residents files of admissions under Section 117 of the Mental Health Act 1983, and Pre-assessments with written remarks by qualified staff such as “I feel that as an MPE registered home Durnsford Lodge can give the care needed.” And “X has obsessional behaviour which I feel as Durnsford Lodge is an MPE home we would be able to handle X’s needs.” It was explained to the Deputy Manager why this practice must stop and he was asked to explain this to the Registered Manager and the Registered Provider. It was also explained to the Deputy Manager that the Registered Provider must apply to the Commission for a variation in registration and why. An Immediate Requirement was issued at this inspection to this effect. Durnsford Lodge Residential Home DS0000003476.V272398.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 The home’s policy and procedures for dealing with medication is thorough and protects residents. EVIDENCE: The Deputy Manager was observed throughout the morning medication procedure. His manner was systematic and unhurried. The Senior Carer, who was also in charge of this shift, assisted with giving individuals their medication. They were both discreet in taking medication to each resident individually and ensuring that it was properly taken. All medication was signed for as it was given and then when it had been taken. A tray with empty “secondary” pots, each with a labelled lid on it, was found in the Manager’s Office. One pot still had medication in it. The Deputy Manager explained that the home’s policy is that Senior Carer of the day “pots” up any night medication and this is then given to those residents by night staff. It was not clear why this secondary potting method is used at night when the Registered Provider has employed Senior Carers to work nights so medication can be dispensed to residents. Durnsford Lodge Residential Home DS0000003476.V272398.R01.S.doc Version 5.1 Page 12 The Deputy Manager also explained that the pot containing medication would be from a resident who had either not wanted/needed it or had refused. He (the Deputy Manager) would be responsible for disposing of this in a suitable way and recording it on the MAR sheets as the Senior Carer responsible for medication on the day of the inspection. The Deputy Manager confirmed that he had “potted up” the medication the evening before so he was aware what should be in the pot. Durnsford Lodge Residential Home DS0000003476.V272398.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 The residents receive a balanced diet and meals are unhurried with discreet assistance given if needed. EVIDENCE: During this inspection residents were observed having their breakfast in the dining room. This meal was unhurried and staff were seen encouraging individuals to eat and/or assisting when required. Staff were also seen taking breakfast trays to bedrooms for residents who prefer and are able to eat unsupervised in their rooms, or to residents who were unwell. One resident was seen to come down to the dining room feeling unwell but worried about missing breakfast. Staff suggested that this resident return to bed and gave assurance that breakfast would be brought up to the bedroom. The home’s cook, Paul Stewart, explained that he is making changes to the current menus and to the kitchen cleaning rotas. He is also trying to implement a system so that weekend kitchen staff use the same methods and routines as are used Mondays to Fridays. Mr. Stewart showed examples of changes to recent menus and stated that he had a list of each individual’s preferences and dislikes to hand in the kitchen. He stated that this made menu planning a lot easier for him. Mr. Stewart was aware that records must be kept of what residents actually eat in the home, and if someone eats elsewhere. Durnsford Lodge Residential Home DS0000003476.V272398.R01.S.doc Version 5.1 Page 14 Mr. Stewart stated that the Environmental Health Officer had visited the home on Monday 23rd January 2006 and some of the proposed changes are as a consequence of that visit. Mr. Stewart stated that he had received confirmation of a place on a Food Hygiene course on 8th march 2006. It is hoped that further places will become available for other staff to attend in the near future. This course will be based on the new Food Hygiene regulations and using the new training manual “ Safer Food, Better Business”. Mr. Stewart was positive and enthusiastic about his work, the proposed changes and the forthcoming training. Durnsford Lodge Residential Home DS0000003476.V272398.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were inspected on the previous inspection. EVIDENCE: Durnsford Lodge Residential Home DS0000003476.V272398.R01.S.doc Version 5.1 Page 16 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, 25, 26 The residents live in a home that is clean, pleasant and hygienic. There are still hazards around the home making it potentially unsafe for residents. EVIDENCE: Since the last inspection the carpets have been cleaned and during this inspection the “Handy Man” was seen vacuuming throughout the building. He was also seen cleaning all the communal bathrooms and toilets. Measures have been put in place by the Registered Manager to try to prevent lingering odours passing through the home from the “Smokers Lounge”. During a tour of the premises it was evident that new net curtains were up in bedrooms to provide more privacy for residents. There were no offensive smells anywhere in the home. Toilet roll holders had been fixed into communal toilets and bathrooms where needed. Liquid soap had also been provided although there were no paper towels. The staff bathroom had a hand towel. Durnsford Lodge Residential Home DS0000003476.V272398.R01.S.doc Version 5.1 Page 17 The pipe-work in the laundry room had been lagged and boxed as required at the last inspection. A care assistant stated that the Registered Provider intends to knock down and rebuild the laundry room because it has an asbestos roof. It is apparently also his intention to install a sluice facility as part of this rebuild. There were still some carpets that were rutted and stretched and could be a trip hazard particularly for those residents observed walking with the aid of a zimmer frame or who shuffle their feet. Cleaning materials had been left unattended in a resident’s bedroom. No domestic or other staff responsible for cleaning bedrooms were seen around the building. The Registered Provider has not supplied the Commission with a programme of planned redecoration and refurbishment as required in the last inspection report. Durnsford Lodge Residential Home DS0000003476.V272398.R01.S.doc Version 5.1 Page 18 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): These standards were inspected at the previous inspection. EVIDENCE: Durnsford Lodge Residential Home DS0000003476.V272398.R01.S.doc Version 5.1 Page 19 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): 35, 38 Residents’ financial interests are safeguarded by the home’s procedures. EVIDENCE: Receipts of outgoing monies were seen on individual residents’ files. On the day of the inspection the front door and the inner front door were open allowing easy access inside and outside the home. Night staff stated that this door is kept locked for security of the premises as well as for the protection of residents who may wander, however, early morning night staff open the doors to allow day staff access to the building. A district nurse called to the home later during the morning and walked in to the home in such a manner that indicated she would not expect to knock and wait for the door to be opened. Durnsford Lodge Residential Home DS0000003476.V272398.R01.S.doc Version 5.1 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 3 1 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 1 X X X X X 2 3 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 1 Durnsford Lodge Residential Home DS0000003476.V272398.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? YES 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 OP3 Regulation 14(1abc) 17(1a) Sch3.1 14(1d) Requirement Timescale for action 2. OP3 3. OP4 4, Sch1.3 4. OP4 4 5(1a) The Registered Provider must ensure that no one is admitted to the home without a full 27/01/06 assessment prior to arrival at the home. The Registered Provider must ensure that all new residents or their family/representative 27/01/06 receive written confirmation that her/his needs can be met by the home. The home must provide mental health training for staff so that service users with those needs know that they will be properly cared for by appropriately trained staff. 28/02/06 Staff informed the inspector that they are expecting to attend a Mental health Awareness Workshop in March 2006. If this is done, this requirement will be partially met by its deadline. This requirement is from the previous inspection and still within its timescale. Currently the home is accepting residents who are “out of DS0000003476.V272398.R01.S.doc Version 5.1 Page 22 Durnsford Lodge Residential Home Sch1.6 5. OP4 4 16.1 23.1a Sch1.6 6. OP7 15, Sch1.15 7. OP15 Reg17 (2) Sch4 (13) 8. OP19 23(d) 13(4ac) 16(2c) category”, that is, individuals who require 24 hour care because they have mental health issues. This practice must stop and an Immediate Requirement was issued at this inspection to this effect. The Registered Provider must apply to the Commission for the additional category MD (E) if the home is to continue providing care for service users with mental health needs. This requirement is outstanding from the previous two inspections and an Immediate Requirement to this effect was issued at this inspection. The home must maintain a permanent record of service users care plan reviews and the extent to which service users contribute to the process. The home must ensure that all service user care plans readily identify the service users current care needs. This requirement is outstanding from the previous three inspections the timescale has been extended. Records of food provided for service users must show more detail particularly when an alternative has been offered. This requirement is outstanding from the previous inspection however the timescale has been extended because it is under review. All carpets must be free of rucks or other trip hazards or replaced. This requirement is outstanding from the previous two inspections and DS0000003476.V272398.R01.S.doc 27/01/06 28/02/06 31/03/06 31/03/06 31/01/06 Durnsford Lodge Residential Home Version 5.1 Page 23 9. OP25 12(1a) 12(3) 13(4c) 10. OP25 12(1a) 13(4ac) 12(1a) 13(4) 16(1) 11. OP38 at the time of this inspection was still within its deadline. The Registered Provider must 28/02/06 ensure that appropriate fire safety door closures are fitted to rooms where service users prefer their bedroom door to be kept open. This requirement is outstanding from the previous inspection and at the time of this inspection was still within its deadline. Staff must take care to ensure 27/01/06 that hazardous substances are not left unattended in residents’ bedrooms. The premises must be kept 27/01/06 secure at all times. 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 OP25 Good Practice Recommendations Paper hand towels should be supplied in a fitted container in communal toilets and bathrooms, including the staff bathroom. Durnsford Lodge Residential Home DS0000003476.V272398.R01.S.doc Version 5.1 Page 24 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. Extracts may not be used or reproduced without the express permission of CSCI Durnsford Lodge Residential Home DS0000003476.V272398.R01.S.doc Version 5.1 Page 25 - 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. 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