Inspection on 13/10/08 for Princess Lodge Care Centre

This inspection was carried out on 13th October 2008.

CSCI found this care home to be providing an Good service.

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

Princess Lodge Care Centre 13/06/07

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 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Princess Lodge Care Centre 17 Curie Avenue Off Okus Road Swindon Wiltshire SN1 4GB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Wendy Kirby     Date: 1 5 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Princess Lodge Care Centre 17 Curie Avenue Off Okus Road Swindon Wiltshire SN1 4GB 01793715420 01793715430 manager.princess@lifestylecare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Life Style Care (2005) Plc care home 85 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 85. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia (Code DE) maximum of 62 places Old age, not falling within any other category (Code OP) maximum of 33 places Date of last inspection Brief description of the care home These purpose built premises are situated on a new housing development just off Okus Road in Old Town, Swindon. The premises consist of a three-storey building with parking and level access to the ground floor. The home was opened in December 2006 and is registered to accommodate older people who need nursing care. The first and second floors are intended for older people who have dementia. The home registered provider is Lifestyle plc who have five other care services of varying types, across the UK; including services for people with dementia, physical disability and older people Care Homes for Older People Page 4 of 35 Over 65 0 33 62 0 Brief description of the care home with nursing needs. The registered manager is Mrs Patricia Anne Martin. The current range of fees is 447 pounds - 775 pounds per week. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced Key Inspection which included a visit to the home. The visit was completed by one inspector over two days and lasted approximately fifteen hours. Prior to the inspection we (The Commission) looked at various pieces of information to gather evidence in preparation for our visit, which included the following: The previous inspection report of June 2007. The homes inspection record, which gives us an account of any information we have received about the home since the last inspection. The Annual Quality Assurance Assessment, known as an AQAA. The home is requested annually to complete and Care Homes for Older People Page 6 of 35 return this assessment to us by a specified time. We received the AQAA on time, which contained detailed information about what the home considers it does well and what plans they have for further improvements in the coming year. We sent surveys Have Your Say to people who live in the home and staff, twenty-two were completed and returned. Comments received form the surveys will be referred to throughout this report. We were also given the outcomes from the homes own annual satisfaction surveys for people who live there and relatives and some of this information is also included in this report. During our visit we spoke with some of the people who live in the home, visitors, the manager, deputy manager and other staff members who were on duty. We also looked at how effectively staff engage with people in the home and how they were interacting and communicating with each other. We looked at six individuals care files, which included, pre-admission assessments, care plans and risk assessments. We also looked at a number of records and files relating to the day-to-day running and management of the home. We spent time in all communal areas of the home and some of the bedrooms. We finished the inspection with a feedback meeting between the manager and deputy manager who demonstrated a very caring, committed attitude to their roles and responsibilities in ensuring they provide quality of care to the people who use the the service. The inspector would like to thank everyone who took part in the inspection. Their enthusiasm and support was greatly appreciated. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 Care Homes for Older People Page 8 of 35 240 7535. Care Homes for Older People Page 9 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People looking for somewhere to live receive adequate information so that they can decide if this is the home for them. People are provided with a statement of terms and conditions and a contract giving basic information on what people who live in the home can expect to receive. Peoples needs are assessed prior to admission to determine the suitability of placement. They can be confident that staff will have the resources and skills to meet their assessed needs. Evidence: The homes Statement of Purpose contains the information necessary to enable people to make an informed decision about moving to the home. The format of the documents can also be accessed via a CD for those who have sight impairment. The home is Care Homes for Older People Page 11 of 35 Evidence: currently looking at producing these documents in an easier read format with a larger font and pictures to assist people, particularly those with dementia in understanding what the home has to offer. People are encouraged to visit the home either for the day or perhaps for lunch dependent on their wishes. Our surveys confirmed this and comments included, Senior staff were most accommodating in arranging visits for me and my family, We had plenty of information and a visit to the home was arranged for us and Our daughter decided that Princess Lodge was the best nursing home out of the other local homes in the area, we had adequate information made available to us. Individuals files contained contracts and terms and conditions, which are signed on admission, although four surveys stated that they had not received a contract. During the first week in the home people and, or their families are invited to a meeting to discuss the terms and conditions in order to relieve any anxieties and to assist people to understand the contracts and what they mean. It was thought there could be two main reasons why people might think they hadnt received a contract. Some people had been at the home for a long time and may have forgotten that they had been given a contract on admission, other people may had had such affairs dealt with by family members and so may be unaware that a contract had been issued. We looked at the pre-admission assessments, which were comprehensive covering all activities of daily living, a full health screen and personal history background. The information gathered pre-admission should provide a sound benchmark of the persons ability, state of health prior to admission and subsequent needs when they move into the home. People wishing to live in the home, family and carers are involved in the pre-admission assessment wherever possible and all information is used to determine the suitability of the placement. Where possible the manager also obtains comprehensive assessments and care plans from other health and social care professionals involved, for example, social workers and hospital staff. All assessments are sent to the the new General Practitioner (GP) of their choice so that they have a good insight of their past and current medical history and care prior to any future GP visits. We spoke with the manager and her deputy who were able to clearly demonstrate the importance of pre-admission assessments in order to ensure that the home can meet Care Homes for Older People Page 12 of 35 Evidence: individuals identified needs. Care Homes for Older People Page 13 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Because they are consulted about their health and personal care needs people can be sure their views and expectations will be considered. The health and personal care that people receive is based on individual needs. Safe systems of practice are in place in receiving, storing, administering, and disposing of drugs which will help protect the health and wellbeing of people living in the home. People can be confident that staff have a good awareness of their needs and that they will be treated with dignity and respect. Evidence: From the pre-admission assessments the staff are able to develop a set of care plans based on identified needs. During the first months trial period the plans are reviewed weekly and developed accordingly. Care plans were completed with regards to health and social needs including, psychological, emotional, and cultural needs which demonstrates that the home takes Care Homes for Older People Page 14 of 35 Evidence: a holistic approach to the provision of care. All plans were detailed and person centered including personal preferences, likes and dislikes. The plans demonstrated that the homes philosophy centralises on empowering people and encourages them to maintain independence, autonomy and choice. All care records showed consistency in assessing, planning and evaluating care as required. The home conducts regular care review meetings for people, which includes the involvement of family members and key worker wherever possible. This allows the opportunity to discuss and evaluate care plans and any issues or concerns people may have. The homes satisfaction surveys said, Our relatives care is explained to us and we are given opportunity to discuss the care given by the homes staff and also by other health professionals, e.g. skin specialist nurse or consultant, We were involved in the care planning and had a good discussion, Yes I was involved but I am not aware of a recent update and We have not been involved yet but it is early days. The manager and her deputy do random monthly audits on the care files. Following each audit, written feedback is given to the staff member responsible for those care files and any action required is requested. The staff member must provide proof that the actions have been completed and these are signed off by the management team. The manager and deputy also provide staff support in care plan writing through training sessions. Records of the GP visits and the outcomes were documented. Specialist referrals and visits from other professionals including District Nurses, Chiropractors, Dentists and Opticians were also seen. Surveys we received stated that people always felt that they received the medical support they needed, comments included, I can give a number of incidences where staff and GP services have done that little bit extra, We have excellent care from the local surgery and from the mental health team and We are always informed straight away if there is any change in our relatives condition. Health Care needs are monitored and documented in the care files. People are weighed weekly for the first six weeks following admission and monthly thereafter. Nutritional assessments are completed on admission and reviewed monthly, care plans are written for people who are nutritionally at risk, these include personalised information such as likes and dislikes. Specialist health care support is sought and referrals are made to Community Dieticians and the Speech and Language Therapists at the local hospital. The home also seeks guidance and expertise of the community Tissue Viability Nurse (TVN). The home now has a lead nurse who attends monthly community TVN meetings; wound care training is accessed through the local Primary Care Trust (PCT) Care Homes for Older People Page 15 of 35 Evidence: and other community resources. It is hoped that this training will increase the knowledge and skills of the trained nurses particularly in assessing and evaluating wound care. Wound management care plans were clear and detailed, each wound was marked on a body map and pictures of the wounds are taken on a regular basis to assist with identifying any improvements or deterioration. A written evaluation is recorded following any redressing of a wound. We spoke with some staff who demonstrated good relationships with individuals and were knowledgeable about the care needs of those living in the home. Our surveys ask people if they receive the care and support they need, comments included, Staff always do that little extra which helps to establish relationships based upon mutual respect, There is a quality service provided by Princess Lodge and They have built up an excellent team. The homes satisfaction surveys asks, How would you rate the standard of care delivered in the home?. Comments overall were very positive and included, I get looked after very well, I cant grumble at all, You are all I have got, I am very happy here and They are all very kind and nothing is too much trouble. Policies and procedures for receiving, storing, administering and disposing of medications were examined and discussed with the deputy manager. All systems in place are effective and well managed. The home operates a monitored dosage system for the administration of medication, which is supplied at regular intervals by the local pharmacist. Six monthly medication reviews are completed by GPs. People who receive anti psychotic drugs and sedations, have their medication reviewed every five weeks by a hospital Consultant who visits the home. Fridge temperatures are recorded daily. The administration charts were legible and continuity of administration was shown with a signature from the person dispensing. There is an extensive monthly audit of medication systems in the home, which includes, administration of medication, storage and stock control and accurate record keeping. The home promotes privacy and dignity to all people who use the home. Staff attend training on promoting privacy and dignity on induction, which covers the importance of closing doors and pulling curtains when delivering personal care and knocking on peoples doors and waiting for an invitation to enter before going into their rooms. People also have do not disturb signs that they can put on the outside of their bedroom doors. We saw staff knocking on bedroom doors before entering, members of staff spoke Care Homes for Older People Page 16 of 35 Evidence: respectfully about individuals needs and referred to them in the term of address that they preferred, this information was documented in the care files. All rooms have a telephone point from which people can make and receive calls. The homes annual satisfaction survey asks people if they feel their privacy, dignity and choice is respected. Comments received included, We feel our relative is treated with respect at all times, Sometimes more care is needed when hoisting residents, They do what I want and they keep the door shut and your dedication and professionalism allows my relative to live in peace and dignity. Care Homes for Older People Page 17 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although support is given to people with their social opportunities, they will welcome and benefit from the additional daily variation when the activity co coordinators are in place following their induction. Encouragement from staff enables people who live in the home to maintain good contact with family and friends. The home actively promotes individuals to exercise choice and control over the lives they choose to live. People receive a varied and wholesome diet that they are able to influence. Evidence: There does not appear to be any unnecessary rules in the home and it was clear that the manager and staff are working towards empowering people and encouraging them to maintain independence, autonomy and choice. Daily routines are flexible within the home, people can get up and go to bed when they Care Homes for Older People Page 18 of 35 Evidence: like, have their meals in their bedrooms, they can go out when they wish and participate in activities they have a particular interest in. This was confirmed through documentation in care files, in discussion with individuals and through observation during our visit. The activity coordinator recently left the home and it has been difficult to find a suitable replacement. Peoples comments indicate that this has had an effect on the range and availability of activities in the home. Comments included, There used to be lots when I first came to the home, but it has got less recently, I would like to do more and Activities could be improved. The home has now recruited a new activities coordinator who was on induction during our visit. Princess Lodge are also in the process of recruiting an additional staff member for activities to increase the range on offer. The manager told us that they want to incorporate normal patterns of daily living into leisure pursuits aiming to promote independence and confidence in individuals abilities. People have expressed a wish to do things like, Make my own bed, Dust my own ornaments and I want to lie in bed and watch television all day. Various new ideas around activities and providing stimulation for people in the home are being explored. Books have been purchased about providing activities to increase staff awareness and training has been accessed through Age Concern about therapeutic activities for older people. Useful information is shared by having several notice boards throughout the home notifying everyone of any news, current events, dates for your diary and a weekly activities programme. We saw photographic displays of memorable days and events and Life Story books which people are completing with help from staff. Both are popular and provide memories and topics of conversation for people where they are able to reminisce and tell stories about their life. Lounges in the home provide good entertainment systems including televisions, videos, DVD players and musical systems. There is also a piano in the home which people enjoy listening to and we saw one person who lives in the home playing the piano during our visit. The home operates an open door policy for visitors and people are able to see visitors in the privacy of their own rooms and there are several semi-private seating areas around the home and in the gardens. The home has recently appointed a receptionist to greet visitors on arrival to the home Care Homes for Older People Page 19 of 35 Evidence: and assist with general enquiries. This is a positive move and the first point of contact for visitors to the home. We saw the receptionist greet people in a warm friendly professional manner throughout our visit. The size and layout of the dining rooms makes it possible for everyone to enjoy the social advantages of dining together. The dining rooms are light and spacious with the tables attractively laid. Staff members supported people that required assistance with eating their meals in a respectful sensitive manner. Staff sat at the same level and assisted them without rushing. The local community dietician visits the home and provides training for staff on How to feed people with dignity. When we were in the dining room at lunch time we saw jugs of juices, beakers and glasses and these were being handed to people whilst waiting for lunch. Later when we visited people in their rooms we saw that jugs of fluid had also been provided for individual use. We did notice that not all people had been given this, we told the manager and deputy who agreed that all individuals should have fluids provided in their rooms and that they would ensure that this happened. A lot of care and planning has been put in place to further ensure that people at risk in maintaining adequate nutrition levels are monitored. Food is served on coloured trays each, colour signifies how high the level of risk and reminds the staff of the importance to encourage people to eat and drink adequate amounts. The colour also indicates if people need to have their daily fluid and food intake recorded. Intake charts were looked at and had been completed consistently detailing amounts of fluid and what size portions of food had been eaten. We were told that to increase calorific intake for individuals, bowls of nibbles throughout the day, these included, crisps, fruit, and chocolate are provided in the communal areas. We saw people helping themselves to these and a supply of stock was seen in the kitchenettes for staff to refill the bowls when required. This initiative has been particular successful on the dementia unit where some people are reluctant to sit down for long periods of time and will often not finish a meal. The kitchen was well organised and seemed to run efficiently and effectively. The chef was able to demonstrate an awareness of individual requirements and needs including special dietary requirements and personal preferences. The food is home cooked offering various choices of hot and cold alternatives and fresh fruit is available at all times. The four- week menu rota displayed traditional meals and menus are reviewed to reflect seasonal trends and availability of produce. Extras are ordered on request for birthdays and special occasions. Any visitors to the home are Care Homes for Older People Page 20 of 35 Evidence: welcome to stay for lunch. The kitchen was very clean, well equipped and spacious. Stores exhibited a good range of foods. Food hygiene training was up to date for staff. Documentation was provided to show that the required temperature checks were being carried out on fridges and freezers and that food was also being probed after being cooked. Risk assessments were in place and up to date. People told us that they usually liked the food offered to them. The home satisfaction surveys included comments, I see nothing wrong with the food I enjoy it all especially the fish, Not bad at all but I dont like big meals and Very good I like the food very much. Relatives told us, All meals and snacks appear excellent and appetising and The food is good and they will get in favourite foods for people, One relative said, There is not enough selection of soft food availability for people who cannot eat much solid food. There needs be more meals like cottage pie and more variety of soups and puddings. We looked at the menu rota for week one which showed a different soup on offer for the whole seven days including, Potato, Carrot and Coriander, Leek, Mushroom, and Pea and Ham. We saw that the menu does provide soft diet meals for example, Cottage Pie and Cod in butter sauce. The menus also say that all the meals prepared are available as a soft alternative by liquidising the food. This means that people still have the choice and variety on offer with the same taste. Care Homes for Older People Page 21 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are comprehensive policies and procedures in place to manage complaints and people can be confident that their concerns will be listened to and acted upon. There are good arrangements in place for staff training and awareness of protecting vulnerable adults so that people living in the home are further protected from abuse. Evidence: The complaints policy and procedure is detailed and contains all the required information, which can be found in the service user guide and individual contracts, terms and conditions. A copy of the complaints procedure is also on display in the main reception area and on every floor in the home displayed on notice boards. People told us in our surveys that they knew who to talk if they were not happy and how to make a complaint, comments included, Staff are always eager to respond and The staff are happy to listen and help in any way. Relatives were asked in the home satisfaction surveys about approaching the manager with concerns and the effectiveness when staff deal with any concerns. Comments received were mostly positive and stated, The staff are always willing to speak to us about any anxieties we may have, They are willing to spend time with us, The manager or nurse in charge is always ready to listen to any concerns and The Care Homes for Older People Page 22 of 35 Evidence: manager is always the best to sort out my problems, staff are approachable and pleasant. One relative stated, No one knows anything and the answer from staff is always I have just started my shift. Unfortunately this relative chose to remain anonymous so it is impossible for the manager and her staff to relieve any frustrations and anxiety that this may pose to this particular relative. We receive details from the home about any internal complaints investigations and safeguarding referrals, the outcomes have shown us that these have been dealt with openly and effectively. The manager and deputy told us that they are committed to encourage an open culture within the home in that people feel comfortable and able to make a complaint or a suggestion without fear of reprisals. There are policies and procedures as well as a range of guidance information on the topic of protection of vulnerable adults from abuse. The availability of this information should increase staff awareness and the understanding of their role in protecting vulnerable adults who live at the home. We were told that the home actively promotes staff training and education in the protection of vulnerable adults on induction and on an annual basis the staff receive an update. We spoke with staff who confirmed that they had received this training and they were able to demonstrate its effectiveness when discussing the content of the training. A number of staff are also enrolled on the National Vocational Qualification in care award, and a component of the award addresses issues around the topic of the protection of vulnerable adults from abuse. Care Homes for Older People Page 23 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, comfortable, well decorated and furnished. It provides a safe, peaceful and well-maintained environment for everyone. The bedrooms, communal rooms and facilities are suitable and well presented for their purpose and meet the needs of people living in the home. Evidence: The home is purpose built and as such it is fully accessible and has a number of aids and adaptations throughout the premises to enable physically disabled people to maximise their independence. This includes wide corridors and pathways, passenger lifts, specialised bathing facilities, grab rails and assisted toilet facilities. The home has car parking to the rear of the building and gardens to one side and to the rear. There is a garden and several patio areas with seating for people to use. We walked around the inside of the home and viewed some of the bedrooms and the communal areas including the dining rooms, lounges and bathrooms. Room sizes are spacious for their stated purposes, particularly the lounges and bedrooms. Bedrooms have en suite facilities provided and communal bathing areas, showers and toilet facilities are located throughout the home. Care Homes for Older People Page 24 of 35 Evidence: People living in the home are involved with choosing decor for the home. We were told that they are currently working with the staff and discussing ideas for making the bathrooms less clinical and creating a warmer feel by adding colour on the walls, radios and aromatherapy candles. All areas of the home were tastefully decorated, clean and well maintained. Attention has been given to ensure that all areas are homely. People had been supported to personalise their bedrooms with pictures and ornaments and they are able to bring items of furniture should they wish. Rooms are lockable so that they can maintain their privacy and keep their personal possessions secure. All rooms had profiling beds, and good quality matching bedroom suites, lounge chairs and a small table. Various lounge areas allow for people to be seated together enjoying the entertainment systems on offer, these lounges are decorated either traditionally or contemporary to suit the age range and individual tastes. The home also has a salon whereby people book their own appointments and enjoy the socialisation of this service and the independence it provides. There is also a large well equipped activities room and a sensory room, where they provide therapeutic relaxation through lights, optics and sound. There are kitchenettes throughout the home, which are well equipped and enable people the facilities to make drinks and snacks at any time of day. One larger kitchen has a good size dining room attached to it. We were told that families often book this facility to organise private parties and also book a table so that they can have a meal in private with their relative. The main laundry room is large and well equipped. Staff were wearing gloves and aprons whilst working and told us about effective infection control procedures in place when handling soiled linen. People living in the home also have access to domestic laundry facilities should they wish to do their own laundry. People said that the home was always clean and smelled fresh and pleasant throughout. Comments included, The cleaning staff are keen to please and have a positive attitude to their work, My bedroom is always kept nice and clean, Lovely like a hotel, nice and clean looking and The home is bright, cheerful and nicely coordinated. Care Homes for Older People Page 25 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home promotes staffing levels and skill mix of staff in order to help ensure that people needs can be met. The recruitment policies and procedures set up in the home should help ensure that people living in the home are supported and protected. The training provided to staff should help ensure that staff have the skills and resources to meet peoples needs. Evidence: The manager and deputy ensure that staffing levels are indicative of the needs and levels of care required and confirmed that levels of staff would rise should dependency levels increase. We saw that the manager had applied successfully for additional funding in order to provide one to one support for two of the people in the home. Surveys agreed that staff were always usually available when they needed them. There had been a turnover of staff when the home initially opened. Relatives told us, It is a shame there is such a turnover of staff one just gets used to a staff member and then they are missing, elderly people like to see familiar faces and The staff are pleasant and polite, there sometimes feels like there is a shortage of staff, but most Care Homes for Older People Page 26 of 35 Evidence: are truly dedicated to their jobs. We were told by the manager and deputy that there had been recruitment problems when trying to find staff suitable for the home in order to fulfill the roles and responsibilities expected of them. They are vigilant in taking their time in this process to find the right person for the job, where they have the right skills and attitudes to look after people who have complex needs particularly around dementia care. Recruitment has improved and most vacancies have been filled, it is hoped that by taking their time and recruiting the right people for the job will help ensure that staff stay committed and remain in the home. When there have been staff vacancies, regular agency staff have been used to provide continuity and the permanent staff in the home often cover extra shifts. Unfortunately there will be occasions when staff phone in sick at short notice and it is not always possible to get cover. Staff expressed in their surveys that there were usually enough staff to meet the individual needs of all the people in the home. Staff comments included, We have not been short staffed since I started working here, I understand we can use agency and I have been told that the manager and deputy will also come and assist on the floor if we need them and We provide the care according to the care plans, if we are short staffed we always manage to give the same care, the carers we have are good at their job. One staff member said, CSCI always comment that we have enough staff but are they aware that some of the people need almost one to one support to meet their needs. As mentioned previously we know that the manager has identified people requiring one to one support and additional funding has afforded those people with this provision of care. This staff member was asked if she would like to speak to an inspector but declined and remains anonymous. A sample of staff recruitment records were looked at and showed us that the home follows a good recruitment procedure. This will help ensure that the right people are employed to work at the home, and people living in the home will be further protected. Records contained completed application forms with a full employment history, two written references and Criminal Records Bureau (CRB) disclosures. Qualified staff nurses, are required by law to register annually with the Nursing and Midwifery Council (NMC) to be able to practice, these registrations are checked annually by the manager to ensure that the staff have done this. All of our staff surveys confirmed that these checks had been completed before starting work at the home. There is an induction programme, which covers all mandatory training, including Fire, Care Homes for Older People Page 27 of 35 Evidence: Manual Handling, Health and Safety and the Protection of Vulnerable Adults. The home has a mentor system where all new staff are linked with and shadow a senior staff member during each shift to enable continuity and continued training throughout the induction process. One staff member told us, The training in the classroom covered all mandatory basic parts of my role. I was supernumerary when I joined the team I was allocated to work with, I was also able to work with senior staff that helped me with my practical training that couldnt be learnt in a classroom. I was never made to do anything that I didnt feel ready to do. The home provides the staff at the home with training and development opportunities tailored to individual needs. The manager and all staff are conscientious in attending training relevant to the care needs of the people they are caring for and those relevant to the roles they perform. All staff surveys told us that they received training relevant to their roles in order to understand the needs of individuals and to keep them up to date with current practice. We were told by staff that monthly staff meetings give the opportunity to discuss where staff have identified any further training requirements. One staff member said, Any training I ask for I have been able to attend and staff members teach us a lot through practical supervision whilst we are on duty. The home has accessed many courses to assist staff in understanding and caring for people with dementia. Staff told us, I have been given the opportunity to do the Dementia Care Mapping Training and I really enjoyed the Yesterday, Today and Tomorrow training with Help the Aged. The home displays handouts for visitors to the home about health related matters to assist with educating people to gain a greater understanding about what is wrong with their relative and how they can be cared for. Relatives are also offered to attend some of the courses that are arranged for staff particularly around dementia awareness. Two relatives told us, I was thankful for furthering my knowledge about dementia when I was able to take part in the Yesterday, Today, Tomorrow course and I am pleased that a Medical Consultant from the local Trust will be giving a lecture in dementia next month and that we are welcome to attend. Staff confirmed that they value the training they had received and what courses are available to them, comments included, Training facilities are very good and the budget is generous. The home continues to support staff with their NVQ training. Staff records and the homes training matrix confirmed that training was up to date and future courses had been arranged. Care Homes for Older People Page 28 of 35 Care Homes for Older People Page 29 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs and best interests are central to the management approach in the home. Good accounting methods are adopted and policies and procedures are followed correctly when handling peoples personal money so they can be sure their finances will be managed correctly. The health and safety of people who use this service is protected. Evidence: During our visit we spent a lot of time speaking with the manager and deputy who consistently demonstrated effective leadership skills within their roles and management that relates to the aims and purpose of the home. The management teams and staff are establishing a stable workforce that supports a Care Homes for Older People Page 30 of 35 Evidence: commitment to providing quality care for the benefit of the people living in the home. The management encourages innovation within staff teams and ideas that are generated are respected and actioned, which demonstrates an open and inclusive atmosphere. The staff were positive about Lifestyle as a company and told us, The company is flexible and allows us to try new ideas after weve been on training courses, Everyone is friendly even the Directors, this is the first time I have worked somewhere where feedback from the Directors visits are shared and Working with Lifestyle Care is very good, the company empowers staff and helps them achieve good quality care delivery, the company is forward thinking and looks after the staff. We received a high degree of satisfaction expressed by many of people who use the services at the home including, The staff are kind and respond to their needs, I visit daily and I am very impressed by the high standards maintained in the care home, I have been here for eighteen months and my care has been excellent and I have been extremely pleased with the caring service provided at Princess Lodge. As mentioned throughout the report the home completes an annual audit to assess the satisfaction of people with regards to the service that the home provides by asking them to complete surveys. The results and comments from the surveys were generally very positive. Information from the surveys is collated and documented effectively, this information is on display for people to see. The results have enabled the home to identify strengths and weaknesses within the service they provide and are acted upon in their development plan for the coming year. Progress of any outcomes are discussed with the people living at the home and relatives at their meetings. Meetings are held every three months for people living in the home, family and friends. Meetings have an agenda and people are asked to contribute anything they would like to discuss. On occasions guest speakers are invited to talk, in July a consultant attended the meeting and gave a lecture on Person Centered Care and the Mental Capacity Act. Besides staff meetings the home has regular SWOT Sessions, whereby all staff are invited. The topic of these meetings vary and have included, Examining opportunities for staff development, Our strengths and weaknesses, Do we communicate effectively and Do we show our appreciation and give enough praise. This is a relatively new initiative and staff said that they are enjoying the sessions and finding them valuable. The policy and procedure for holding peoples personal money was examined and four Care Homes for Older People Page 31 of 35 Evidence: individual accounts were looked at. We could see that good accounting methods are adopted and receipts for sundries were available. Some of the Health and Safety records in the home were examined. Documentation showed that relevant checks were maintained correctly and at the required intervals including all fire alarms, equipment and emergency lighting. The homes records showed all necessary service contracts were up to date including, gas and electrical services and the passenger lift. The fire logbook evidenced compliance to the weekly, monthly and annual checks alongside records of staff training and drills completed, records showed us that all staff have been present during fire drills as recommended, all night staff undertake this on a three-monthly basis, and day staff six-monthly. Care Homes for Older People Page 32 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 33 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 34 of 35 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 35 of 35 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!