CARE HOMES FOR OLDER PEOPLE
Hunter`s Lodge Church Lane Old Dalby Melton Mowbray Leicestershire LE14 3LB Lead Inspector
Ruth Wood Unannounced Inspection 7th February 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 Hunter`s Lodge DS0000001743.V280878.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. Hunter`s Lodge DS0000001743.V280878.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Hunter`s Lodge Address Church Lane Old Dalby Melton Mowbray Leicestershire LE14 3LB 01664 823064 01664 822769 office@hunterslodge.org www.hunterslodge.org Hunter`s Lodge Retirement Homes Limited 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 Heather Lillian Cowley Care Home 36 Category(ies) of Past or present alcohol dependence (36), Past or registration, with number present alcohol dependence over 65 years of of places age (36), Past or present drug dependence (36), Past or present drug dependence over 65 years of age (36), Dementia (36), Dementia - over 65 years of age (36), Learning disability (36), Learning disability over 65 years of age (36), Mental disorder, excluding learning disability or dementia (36), Mental Disorder, excluding learning disability or dementia - over 65 years of age (36), Old age, not falling within any other category (36), Physical disability (24), Physical disability over 65 years of age (24), Sensory impairment (24), Sensory Impairment over 65
Hunter`s Lodge DS0000001743.V280878.R01.S.doc Version 5.1 Page 4 years of age (24) Hunter`s Lodge DS0000001743.V280878.R01.S.doc Version 5.1 Page 5 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. No person under 55 years of age falling within Categories LD, A, D, PD or SI may be admitted into the Home. No person under 50 years of age falling within categories MD or DE may be admitted into the home. Service User Numbers. No person falling within categories PD, PD(E), SI or SI(E) may be admitted to the home when 24 persons in total of these categories/combined categories are already accommodated within the home. Date of last inspection 3rd October 2006 Brief Description of the Service: Hunter’s Lodge is a residential care home registered to provide accommodation and care for service users with a wide range of needs who are over the age of 50. The home was built from the conversion of stables in the grounds of a large house, and accommodation is on the ground and lower floors, accessed by stairs (with stair lift). There are twenty-two single and seven double bedrooms most having en-suite toilet facilities. There are four lounges and two dining rooms. Some lounges have been designated quiet areas, others are equipped with TV, stereo and video recorder. Access to the home is gained through the conservatory lounge, which also contains a pleasant water feature. The home is located in the quiet village of Old Dalby and is set within its own grounds. There are seating areas in the front garden for service users to enjoy as well as an enclosed garden to the rear of the home. Gardens are attractive and well kept, the rear containing some mature fruit trees. The home has three registered managers, one of whom is currently not actively involved in the running of the home; the remaining two share ongoing day-today responsibility. Hunter`s Lodge DS0000001743.V280878.R01.S.doc Version 5.1 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This Inspection took place on a weekday morning between 9.40am and 1.20pm. Discussion was held with the Registered Managers, service users and a visiting relative. Practice was indirectly observed and care plans and other documentation examined. There were no Recommendations or Requirements made at this or the previous Inspection. What the service does well: 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. Hunter`s Lodge DS0000001743.V280878.R01.S.doc Version 5.1 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 Hunter`s Lodge DS0000001743.V280878.R01.S.doc Version 5.1 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): EVIDENCE: Key Standards were assessed at the previous Inspection when no Requirements were made. Hunter`s Lodge DS0000001743.V280878.R01.S.doc Version 5.1 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 Residents are treated with respect their health and medication needs are exceptionally well met and needs are accurately reflected in comprehensive plans of care. EVIDENCE: Two care plans were examined. These confirmed details of changes in residents’ care discussed with the managers and observed within the home. Care plans, as at all previous Inspections, contained full details of residents’ needs, appropriate risk assessments together with evidence of regular review. Health care needs of residents were discussed. The Registered Managers have examined strategies to prevent unnecessary admissions to hospital; this has included extensive liaison with GPs and the Primary Care Trust. Detailed procedures are now in place to prevent unnecessary admissions as this can be contrary to their own and relatives’ wishes and detrimental to their long-term health. Aspects of terminal care were also discussed and the home continues to be well supported by GPs and District Nurses in this as in other areas. One of the Registered Managers accompanies all residents to hospital appointments to ensure continuity and appropriate levels of care are provided. Residents
Hunter`s Lodge DS0000001743.V280878.R01.S.doc Version 5.1 Page 10 continue to have regular access to dental, optical, chiropody and physiotherapy services. The medication system was examined. Excellent arrangements are in place for monitoring and administration, and records were accurate. There is evidence of continuing liaison with the GP practice with regards to medication policy and practice. Staff undergo rigorous training, both external and in-house, including direct supervision of practice, before they are deemed competent to administer medication. Interaction between care staff and residents was observed. At all times residents were treated with dignity and respect. Discussion with a resident’s relative indicated that this was the general situation within the home. Residents appeared to be well supported to maintain their physical appearance thereby ensuring their dignity. Hunter`s Lodge DS0000001743.V280878.R01.S.doc Version 5.1 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): 14 Residents are supported to make choices in their day-to-day lives. EVIDENCE: Discussion with one resident’s relative, the managers and observation of practice in the home indicated that residents are able to exercise choice in many aspects of their day-to-day lives including times to get up and go to bed and the kind of food eaten and at what times. Residents can bring personal items into the home. Information about the Age Concern Advocacy Service is made available to residents and their relatives. All other key standards were assessed at the previous Inspection when no Requirements were made. Hunter`s Lodge DS0000001743.V280878.R01.S.doc Version 5.1 Page 12 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 Good procedures and practice ensure residents are protected from abuse and any expressed concerns by residents or relatives are taken seriously and acted upon. EVIDENCE: The Complaints Procedure is clearly displayed on the home’s notice board and a pro-active approach is taken to ensure that residents and their relatives feel comfortable about raising any concerns. One relative said that they were very happy with the standard of care but if they had any concerns they felt confident to tell the staff straight away and knew that things would be rectified. The Registered Manger outlined the importance of their direct involvement in admitting new residents as it ensured that from the beginning they had a direct relationship with each resident; subsequently that resident knew who to raise any concerns with. Staff have received training in the Protection of Vulnerable Adults; training for working with adults who present challenging behaviour is being explored. Information gathered at the previous Inspection demonstrated that staff have undergone the necessary Criminal Records Bureau checks. A full range of policies relating to Adult Protection is in place including whistle blowing; staff are made aware of their responsibilities in relation to these during induction training. Hunter`s Lodge DS0000001743.V280878.R01.S.doc Version 5.1 Page 13 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): EVIDENCE: Key Standards were assessed at the previous Inspection when no Requirements were made. Hunter`s Lodge DS0000001743.V280878.R01.S.doc Version 5.1 Page 14 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): 30 Staff are very well trained enabling them to meet residents’ needs effectively. EVIDENCE: Recent training undertaking by the staff team was discussed with the Registered Managers and training documentation was examined. All staff have undertaken a course in Person Centred Dementia care and this is now being implemented within the home. Fifty per cent of staff have achieved National Vocational Qualifications at level 2 or above. Registered Managers endeavour to undertake training alongside staff members so as to enable ongoing discussion and clarification, and ensure that training is implemented. All Standards, including those relating to training, were assessed at the previous Inspection and no Requirements were made. Hunter`s Lodge DS0000001743.V280878.R01.S.doc Version 5.1 Page 15 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): 33,35 Excellent quality assurance ensures that the home is run in residents’ best interests. EVIDENCE: There is an ongoing quality assurance programme in place which includes an annual written survey of residents’ and their relatives’ views together with those of external stakeholders such as General Practitioners and commissioning social workers. An additional questionnaire has been added to the process this year to seek the views of relatives’ of past residents. Discussions with the Registered Managers and documentary evidence demonstrated that Policies and Procedures are reviewed at least annually but in practice are kept under ongoing review and modified according to updates in practice or legislation. Regular liaison with external professionals and bodies takes place to ensure that current best practice is reflected in the way care is delivered to residents. Specific examples of this are in relation to dementia
Hunter`s Lodge DS0000001743.V280878.R01.S.doc Version 5.1 Page 16 care and prevention of falls, although this ethos is evident throughout all areas of care within the home. Residents’ monies are not administered by the home. Any charges are initially met by the home and relatives are subsequently invoiced. Hunter`s Lodge DS0000001743.V280878.R01.S.doc Version 5.1 Page 17 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 4 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 4 X 3 X X X Hunter`s Lodge DS0000001743.V280878.R01.S.doc Version 5.1 Page 18 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. Refer to Standard Good Practice Recommendations Hunter`s Lodge DS0000001743.V280878.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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