Inspection on 05/07/06 for Madeira Lodge

This inspection was carried out on 5th July 2006.

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

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

Other inspections for this house

Madeira Lodge 11/11/09

Madeira Lodge 11/12/07

Madeira Lodge 30/11/05

Madeira Lodge 20/09/05

Madeira Lodge 13/01/05

Madeira Lodge 07/06/04

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Madeira Lodge 38/40 Birnbeck Road Weston Super Mare North Somerset BS23 2BX Lead Inspector Barbara Ludlow Unannounced Inspection 5th July 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 Madeira Lodge DS0000008049.V296469.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. Madeira Lodge DS0000008049.V296469.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Madeira Lodge Address 38/40 Birnbeck Road Weston Super Mare North Somerset BS23 2BX 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) 01934 621846 01934 414688 Mr Derek Herbert Butler Mrs Christine Anne Rich Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Madeira Lodge DS0000008049.V296469.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To admit one named service user aged less than 65 years for respite care. 30th November 2005 Date of last inspection Brief Description of the Service: Madeira Lodge is registered to accommodate up to 40 people who are in the category Older People over 65 years. The home comprises of two adjacent properties overlooking Weston Bay, there are panoramic views across the bay from the communal areas at the front of the houses. All rooms have en-suite facilities and a number have attractive sea views. There is limited parking on a short sloping driveway. Madeira Lodge is owned by Mr and Mrs Butler, Mrs Butler has management input into the overall running of the business. Madeira Lodge DS0000008049.V296469.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key standards inspection was carried out by B Ludlow for CSCI. Mrs Rich Registered Manager, and Mrs Butler Proprietor were available throughout the inspection day. This was a very positive inspection, service users asked and the three that responded in writing to CSCI were complimentary about the care and service they receive at Madeira Lodge. The inspector discussed the previous inspection report and the home generally. Mrs Rich and Mrs Butler were updated with the changes to the CSCI inspection process. A tour of the premises was made and the inspector spoke with service users and staff. Lunch and tea were observed being served in the dining rooms. Twenty-six service users were in residence, although twenty-seven service users places accounted for, which included one service user reported to be in hospital. Three service users were respite stay only. All were seen. Service users were seen and spoken with in the communal areas and in private in their rooms. Staff were spoken with during the day. Lunch and tea was seen served in the homes two dining rooms during the day. A selection of records was sampled, these included contracts, maintenance and servicing, recruitment and staff training; the homes administrator assisted the inspector with these records. Care plans were sampled as linked to case tracking. Feedback was given to the Manager at the conclusion of the inspection. Pre inspection information supplied by the Manager and written responses to CSCI service user and GP feedback forms are included in the report. What the service does well: All accommodation seen in use was pleasant and homely. The home was clean and well presented and has a dedicated maintenance person, repairs and redecorating work was seen to be ongoing. Staff have a friendly and caring approach to the service users. All service users asked confirmed that they are happy with the care and service they receive at Madeira Lodge DS0000008049.V296469.R01.S.doc Version 5.2 Page 6 Madeira Lodge. The Manager is very committed and has a good level of contact with service users and staff. 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. Madeira Lodge DS0000008049.V296469.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 Madeira Lodge DS0000008049.V296469.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): 1,2,3,4,5, NMS 6 is not applicable. The outcome for this area was good. Sufficient information is available for prospective service users. Pre admission assessments were carried out to ensure that identified care needs can be met at Madeira Lodge, contractual arrangements were clear and were in place. EVIDENCE: The home has the statement of purpose and information about Madeira Lodge in the entrance hall close to the visitor’s book. The Statement of Purpose is displayed. The pre inspection questionnaire indicated the change in management arrangements at the home (previously managed by a company on behalf of Mr and Mrs Butler), this is no longer the case and the statement of Purpose may need to be amended to reflect this. The home has an A to Z of services that is used as the Service User Guide. A copy of this document is kept in a file in each service users room. The files contain a copy of the terms and conditions of residence, complaints procedure and an inventory of any personal furniture items brought into the home. Madeira Lodge DS0000008049.V296469.R01.S.doc Version 5.2 Page 9 Pre admission assessments are made by the homes Manager and the first month of residence is treated as a trial period, to ensure that care needs can be met at the home. The home has requested minor variation where a potential service user admission has fallen outside the registration category. Care needs assessment demonstrated that the requests made were within the capacity of the homes staff to meet the service users needs appropriately. Visits to view the home are welcomed, one service user responded to CSCI stating that the home was visited without an appointment and was chosen as a place to live and has been the right choice, they were ‘happy’ at Madeira Lodge. The home has information available for visitors and service users. Some updating of events and activities used to demonstrate what happens socially at the home is needed. Contracts were sampled, these were clear and were satisfactory. The current fee rates stated on the pre inspection information being: £348.00 to £380.00 per week in line with North Somerset’s Social Services residential care fee level. Additional charges were declared as hairdressing and chiropody. Where care needs can no longer be met at the home advice is taken from Care Managers / Social Workers in the service users best interests. Madeira Lodge DS0000008049.V296469.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The outcome for this area is good. Care plans were in place. Attention to falls assessment is required. Health care needs were seen to be addressed. Medications management was generally satisfactory. All service users asked confirmed they are treated kindly. EVIDENCE: Service users commented they are well cared for, staff answer call bells quickly and that they receive ‘good attention’ and ‘the care is excellent’. Service users all had care plans and information is recorded in a day / night handover diary, each day. Care plans were sampled; Initial assessments and care plans with the exception of a specific falls assessment where indicated in one case, were in place. All GP contacts were recorded, the feedback received from one GP practice indicated satisfaction with care and communication with the home. Where catheter care was required fluid balance charts were kept, these were up to date. The care practices around catheter management by staff were seen to be well managed. Madeira Lodge DS0000008049.V296469.R01.S.doc Version 5.2 Page 11 Creams were labelled with opened on dates, this is good practice. Hoist equipment was seen to be labelled with current servicing dates, 05/06. Where service users health and condition change very little day to day, a progress record entry is made each week. Monthly reviews are made for all service users. Monthly weights are recorded. It was noted that at one care plan the review was not explicit about an identified risk and on another where the dietary needs had changed it was updated, this was brought to the attention of the Manager at the inspection. Care must be taken where risks have emerged or changed or where practice has changed that this is assessed / reviewed and fully recorded. The home may need the input of the Community Nurses to assist with these particular reviews. Self-medication risk assessment had been introduced in one care plan sampled. Medication Administration Records were examined and were seen to be fully recorded, neat, and to a good standard. Medications are securely stored; a medications fridge is available for cold storage. The medications fridge temperature had been recorded daily as a minimum/maximum however the temperature was seen to be widely ranging; on investigation the probe was under a box and the recording was inaccurate. The fridge temperature was found to be 3 degrees Celsius, which is satisfactory. Care must be taken to ensure the medications fridge temperature is measured accurately and that it is maintained within the safe range for medications (2 to 8 degrees Celsius) with particular attention paid to ensure that insulin stock is safely stored at all times. Madeira Lodge DS0000008049.V296469.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The outcome for this area is good. The home offers a range of communal activities and supports service users independence in a dignified and supportive way. Less able service users may benefit from a more person centred approach to their social care. EVIDENCE: Service users were spoken with during the inspection and this and the written feedback was very positive. The majority of the service users are independent and are able to choose how they spend their time. Hobbies are encouraged and the service users were seen to know each other well and were supportive of each other. One service users said of the home that ‘It’s a lovely place’ and ‘like your own home’. Communal activities such as the bingo, invited musicians, knitting group are well supported optional and regular events run at the home. The home had held a summer fete with barbeque for service users and their families the weekend before the inspection, an event that was given support by the staff team. Visitors are welcome at any reasonable time and service users spoke of their individual enjoyment of seeing their visitors and of going out with them. No visitors were met during this inspection. Madeira Lodge DS0000008049.V296469.R01.S.doc Version 5.2 Page 13 The home has a small shop facility for purchasing essentials such as toiletries. The hairdresser visits once per week on a Monday and there is a designated hairdressing room. Lunch and tea were served; meals are social events with service users eating together in the dining rooms. Praise was heard for the catering and the service was seen to be very nicely managed, tables were well presented and individual teapots are served at teatime. It was evident that individual tastes are catered for and choices are offered. Comment included: ‘Food is very nice’ and ‘food is wonderful’. The home allows smoking but only in the designated area, the conservatory. A small number of service users meet together here to smoke. Service users were heard to be treated respectfully and confirmed when asked about the care and attention they receive at the home. Comment included:’ ‘take good care of me’; staff are ‘very obliging, nice to you’ and ‘all very good here’. Less able service users care needs are met. Social care needs may need to be more tailored (a person centred approach) for the individuals who require more assistance and are less able to prompt social interaction. No one commented that they did not have anything to do. Madeira Lodge DS0000008049.V296469.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The outcome for this area was adequate. Complaints policy is available and service users confirmed they would be able to raise their concerns. Recruitment was weak in two areas and was brought up to standard before the close of the inspection period. EVIDENCE: The home has a complaints policy and recording log. The complaints policy is clearly stated in the homes service user guide. Two service users spoken with were asked if they would feel able to raise any concerns at the home and the response was in both cases a clear ‘yes’. One complaint was in hand and this was discussed and is being appropriately addressed. Service users are protected by the policies and procedures in place for managing the home. Two areas were identified with recruitment practice which overall was very good. This was rectified before the close of the inspection period. CSCI received an anonymous concern via the helpdesk that there was rubbish outside the back of the home and the grounds of the home were untidy. This was followed up at the time and was discussed at this inspection. This claim appears to have been unfounded and the exterior of the home was deemed tidy at this inspection. No further contact by the complainant was made to CSCI or reported to the home. Madeira Lodge DS0000008049.V296469.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19.20.22.23.24.25.26 The outcome for this area was good. There is ongoing repair and redecoration of the home. The home provides a comfortable spacious environment for service users to live. It is not purpose built but has been suitably adapted to meet the residential care needs of personal care only. EVIDENCE: The premises are positioned to provide outstanding views across Weston Bay but were not purpose built for care. Not all accommodation has level access; there are small three stair flights to sixteen bedrooms. The premises have been adapted to meet residential care needs. Service users in residence are satisfied with their home and many have personalised their own rooms. All rooms have en-suite facilities of a wash hand basin and a toilet; some have either a bath or shower. The double rooms are provided as self-contained flat-lets with a lounge, bedroom and separate bathroom. This was seen to allow a more independent living style for the married couples in residence. Madeira Lodge DS0000008049.V296469.R01.S.doc Version 5.2 Page 16 A pleasant lounge, overlooking the sea, is available in each area of the home; these are both well used by residents. The Cove is used for activities and has a piano and an organ, there is a pool table and plenty space to comfortably accommodate the service users. Some seating is quite low. A large conservatory at the front of the building offers further communal space and is a designated area for those wishing to smoke. A large central dining room is situated next to the kitchen. The laundry service is managed with towels and sheets being sent to a laundry service and clothing being managed in house. No concerns/comments were heard about the service. Personal clothing was well cared for and nicely ironed. Infection control measures were well managed. Staff have access to hand washing facilities and protective clothing such as gloves and aprons as required. Madeira Lodge DS0000008049.V296469.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 The outcome for this area was adequate. Recruitment practice deficits were detected; these were rectified before the inspection was closed. Staff levels were being maintained. The home has 50 care staff with NVQ Level 2 or above. EVIDENCE: The home has experienced staff shortages however the service user numbers had been lower too. The homes deputy is taking maternity leave; the inspector was informed that this position has been temporarily allocated. The domestic and catering teams have been short staffed due to illness and reallocation of duties had been recently made to ensure the home is maintained at a good level of cleanliness. The inspector was informed that these problems prompted poor CRB application practice when and a known reliable person was recruited to help in the kitchen before a POVA check was completed. This was considered an acceptable risk by the management but was unacceptable practice. All other CRB / POVA First checks were seen to be in place. Two references were missing in two files; these were also followed up and confirmed as received by the homes administrator prior to the close of this inspection report. Agency staff are used infrequently but may be used to provide cover during the summer holiday period. Madeira Lodge DS0000008049.V296469.R01.S.doc Version 5.2 Page 18 Duty rotas demonstrated sufficient staff number on duty to deliver personal care. Staff were spoken with and it was confirmed that there are usually four staff on duty during the daytime and the night staffing is unchanged from previous inspections. Night staffing is two care staff and when the resident number exceeds 30, a third member of staff sleeps on the premises. This person is available to help in the evening, early morning and in an emergency during the night if required. Madeira Lodge DS0000008049.V296469.R01.S.doc Version 5.2 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): 31,32,34,35,36,37,38 The outcome for this area was good. The home is well managed. Policies and procedures are in place and equipment is maintained. EVIDENCE: Mrs C Rich, is an experienced Registered Care Homes Manager and holds a level 4 NVQ in management and is also a qualified NVQ assessor. Mrs Rich has a professional approach to the management of the care home and is sensitive to the needs of the service users in her care. There is an open door management style with Mrs Rich working some shifts each week in the home; this keeps her in direct contact with day-to-day issues that arise for staff and service users. Madeira Lodge DS0000008049.V296469.R01.S.doc Version 5.2 Page 20 Staff receive mandatory training and updating as required and supervision. 50 of care staff were declared as holding NVQ Level two and above on the pre inspection questionnaire submitted to CSCI. Staff asked confirmed to the inspector that they have received fire training. There are safe systems in place for the handling small amounts of service users money on request if required. The storage and management of records is safe and access is appropriately restricted. Records for servicing and maintenance checking were sampled: The fire alarm and equipment was serviced on 26.06.06 Weekly in house fire alarm tests were completed. Fire extinguisher checks and service was dated 02.03.06 Fire Drill was held on 06.02.06 and drill with evacuation on 05.03.06 The inspector was informed that a premises risk assessment was undertaken recently for the whole premises and that the premises fire risk assessment was carried out by a specialist three years ago, this should be checked to ensure that changes if any within the home are accounted for. The last visit by the Fire Safety Officer was 23.06.05. The CSCI registration certificate was displayed and the current certificate of Employers Liability. Madeira Lodge DS0000008049.V296469.R01.S.doc Version 5.2 Page 21 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 2 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 3 17 X 18 3 3 3 X 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X 3 3 3 3 2 Madeira Lodge DS0000008049.V296469.R01.S.doc Version 5.2 Page 22 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 OP29 Regulation 19 (1)(b)(i) Sch 2 13(4)(c) Requirement All staff must have a CRB/ POVA First check before commencing work at the home. Action must be taken to eliminate the Health and Safety Hazards as identified by the EHO and as stated in letter dated 08/09/05. This requirement was carried forward from the last inspection, 09/09/05 3. 4. OP9 OP1 13(2) 4 Staff must be aware of how to 18/08/06 use the medications fridge thermometer accurately. The Statement of Purpose must 31/08/06 be updated and a copy of changes forwarded with the inspection response. Service user risk assessment: 18/08/06 Where there is a history of falls a risk assessment must be undertaken. Where a nutritional risk has been identified any changes to that condition must be documented. Timescale for action 18/08/06 2. OP19 08/08/06 5. OP7 15(2)(b) Madeira Lodge DS0000008049.V296469.R01.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP33 OP38 Good Practice Recommendations Residents meetings should be held. This was not checked at this inspection. It is good practice to review the homes fire risk assessment to ensure it remains current. Madeira Lodge DS0000008049.V296469.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Madeira Lodge DS0000008049.V296469.R01.S.doc Version 5.2 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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