Inspection on 22/06/07 for Revelstoke Lodge

This inspection was carried out on 22nd June 2007.

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 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

Revelstoke Lodge 16/06/09

Revelstoke Lodge 24/06/08

Revelstoke Lodge 17/05/06

Revelstoke Lodge 17/02/06

Revelstoke Lodge 02/12/05

Revelstoke Lodge 05/07/05

Revelstoke Lodge 01/12/04

Revelstoke Lodge 16/06/04

Revelstoke Lodge 24/02/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Revelstoke Lodge Boringdon Road Plympton Plymouth Devon PL7 4DZ Lead Inspector Mandy Norton Unannounced Inspection 10:15 22nd June 2007 X10029.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 Revelstoke Lodge DS0000003603.V318730.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 and Care Homes for Adults 18 – 65*. 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. Revelstoke Lodge DS0000003603.V318730.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Revelstoke Lodge Address Boringdon Road Plympton Plymouth Devon PL7 4DZ 01752 343001 01752 345575 revelstoke.lodge@ashbournehomes.co.uk 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) Ashbourne Homes Limited Vacancy Care Home 65 Category(ies) of Old age, not falling within any other category registration, with number (55), Physical disability (16), Physical disability of places over 65 years of age (12) Revelstoke Lodge DS0000003603.V318730.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Physically disabled (aged 18 years and over) (both) OP Maximum registered 55 service users (both) Date of last inspection 17th May 2006 Brief Description of the Service: Revelstoke Lodge is registered to accommodate a maximum of 65 service users. The home provides care for up to 55 service users of either gender over the age of 65 years requiring nursing or personal care with physical illness, disability or frailness and a maximum of 20 service users aged 18-65 years with physical disability. Accommodation is provided on two floors, there is level access both internally and externally via ramps and a passenger lift. Bedrooms are mainly single though several doubles are available. Some bedrooms offer the added benefit of en-suite facilities. The communal rooms offer space for dining and recreation. The home is owned by Southern Cross Healthcare which operates a large number of care homes nationally. The current fees range from £325.71 to £935.57 (July 2007)). All people living in the home are issued with a contract breaking down the fees so people can see who is paying what. The last inspection report is on display in the entrance foyer. The manager was advised to ensure that the Service Users Guide /Statement of Purpose includes information about how people who cannot visit the home or have access to the internet can access the report. Revelstoke Lodge DS0000003603.V318730.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on Friday 22nd June 2007 from 10.15 am until 4 pm and was conducted with the manager, with input from the regional manager, who happened to be visiting on the same day. A tour of the home was carried out. (Some Service Users seen were not always able to fully express themselves fully or comment on the care they received). This report also contains views from 5 completed care workers surveys and 14 relatives surveys reflected throughout, information taken from the completed Annual Quality Assurance Assessment (submitted prior to the inspection) and discussion with staff and people living in the home on the day of the inspection. We case tracked 4 people (looked at information about how their care needs are to be met and any other information held about them in the home and met with the person to discuss their experience of living in the home. This includes talking to staff who are familiar with caring for them and other health professionals involved in their care if at all possible) in detail. What the service does well: Revelstoke Lodge is homely and comfortable. The staff are welcoming and approachable. When possible, prior to admission, the manager and / or senior trained nurses visit the person in their current setting to perform a full needs assessment in addition to receiving care plans from other social and health care professionals. Once admitted to the home peoples needs are set out in a care plan, the plans provide sufficient information for care staff to be able to meet the individuals’ health, social and psychological needs. Regular training for the staff, on clinical issues, helps to assure the people living in the home that they are well looked after. People are able to maintain contact with family and friends and exercise some choice and control over their lives. The service offers a comprehensive activities schedule. This is organised by 2 competent activities co-ordinators and offers activities in and outside of the home for all ages. The home presented as clean and hygienic. Revelstoke Lodge DS0000003603.V318730.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Revelstoke Lodge DS0000003603.V318730.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Revelstoke Lodge DS0000003603.V318730.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, 3 & 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service or are prospective Service Users have good information about the home in order to make an informed decision about whether the service is right for them. The personalised needs assessment means that people’s diverse needs are generally identified and planned for before they move to the home. The home is not registered to provide intermediate care, but do provide respite care for a variety of people. Revelstoke Lodge DS0000003603.V318730.R01.S.doc Version 5.2 Page 9 EVIDENCE: The home accommodates older people on the first floor and a maximum of 20 younger adults on the ground floor. The home is also used by the continuing care team for long stay and respite care; they fund people with complex physical needs, palliative care needs and conditions such as MS. The continuing care team and the local care managers provide the manager with information about people who they would like to place at Revelstoke Lodge. The manager or her deputy then visit the person in their current situation to carry out an assessment to ensure the home can meet the persons needs. The person and or their representative are encouraged to look around the home to decide if it will suit their needs. Care managers spoken to confirm that people are given the opportunity to look around the home. See Standard 8 also. A number of people (or their representatives ) have raised concerns about their perceived care and actual care when being admitted for short term care. Contracts are issued for everybody that moves into the home whether they are publicly or privately funded. They contain information about the terms and conditions of residency and the complaints procedure. The last inspection report is displayed in the entrance foyer along with information about local services, upcoming events and a complaints procedure. Revelstoke Lodge DS0000003603.V318730.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager promotes and maintains peoples health and ensures access to health care services to meet assessed needs. The homes medication systems protect the welfare of Service Users. People are treated with respect and their right to privacy is upheld. Revelstoke Lodge DS0000003603.V318730.R01.S.doc Version 5.2 Page 11 EVIDENCE: Ten (10) of the fourteen (14) completed relatives surveys indicated that the home usually meets the needs of their relative and three (3) indicated that they always meet their needs and one (1) indicated that the home only sometimes met their relatives needs. Comments included ‘basic care needs are generally catered for but individual needs are not well understood’ and ‘very good communications have been established’. A number of concerns/complaints raised since the last inspection have been about the quality of the service received by people who are admitted for short term and /or respite care. They have been around staff not appearing to be expecting them, waiting for some time to be ‘admitted’ and made welcome and then not always receiving the service they were expecting. This was discussed with the manager and regional manager during the inspection and ideas about how the situation could be improved were talked about. They said the situation would be reviewed and improvements put in place to address these concerns. The completed Annual Quality Assurance Assessment (self assessment document required to be completed prior to the inspection) states that improvements over the last 12 months have included individualised care plans, key worker system and more one to one care (this level of care is reviewed and paid for by the continuing care team). One completed relatives survey however stated that although there is supposed to be a key worker system no evidence has been seen of it in practice. The manager showed the inspector 2 letters that had been received recently commenting on the good care and compassion that had been received. All five (5) completed staff surveys indicated that staff are not asked to look after people outside their area of expertise and two (2) indicated that they were expected to. The Annual Quality Assurance Assessment states that resident, relatives and social services feedback has pointed to more training being needed and as a result a training package is planned for care assistants working in the younger person unit. The medication system is generally well managed. Each floor has its own drugs trolley. Disposal of unused/ out of date medication is safe, well recorded and removed by a licensed contractor. A concern was raised about the use of a tablet crusher that was not cleaned after use with medicines for one person before using it with medicines for another person. The manager was aware of this situation and has already had a number of medicines reviewed and changed to liquid form, those that still have to have medicines crushed are under review and the nurses have been reminded that if used the tablet crusher should be cleaned between clients. Revelstoke Lodge DS0000003603.V318730.R01.S.doc Version 5.2 Page 12 Audits required to be carried out by Southern Cross Healthcare ensure that the senior staff are regularly checking medicines procedures and management to ensure consistent and safe practice. Appropriate interactions between staff, people living in the home, and visitors, were heard during the inspection. People were heard knocking on doors before entering rooms. Some completed relatives surveys indicated that the poor English of some staff in the home sometimes prevents messages ‘getting through to people’ especially if they are hard of hearing. People spoken to (and/or their relatives) said that they have a choice of where to spend their day and what time they get up. Revelstoke Lodge DS0000003603.V318730.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Excellent effort is made by the home to provide an activities programme and social interaction/stimulation for people who live in the home. People are able to maintain contact with family and friends and exercise choice and control over their lives. People receive a wholesome appealing diet and are not rushed at mealtimes. Revelstoke Lodge DS0000003603.V318730.R01.S.doc Version 5.2 Page 14 EVIDENCE: The 2 activities co–ordinators were engaged in a variety of activities with people living in the home throughout the inspection. They work with the younger and older people in groups and individually. There were people knitting and making cards (including relatives) in the afternoon and in the morning hand and nail care had taken place. The co-ordinators try to use colour and touch to stimulate peoples interest and much of the work is displayed on the walls in activities room and lounge. They are currently making the courtyard area more attractive for use by the Service Users and are already growing some plants and herbs with them to stimulate the senses by smell and touch. Many of the completed relatives surveys commented on how good the activities are now. Two (2) of the comment cards stated that it is a shame the garden is not yet finished and so cannot be used by people living in the home. Two (2) said that activities for the younger people could be better. The inspector was provided with the Activities and Leisure Guide for residents, families and friends for May 2007 and the March/April 2007 Revelstoke Review newsletter both of which were informative and easy to read. Minutes of the residents and relatives meeting from May were also seen. Some of the things discussed were meals, activities and staffing levels. The manager said that trips out in the mini bus are now more frequent and are enjoyed by those able to go. There is a computer and printer in the activities room for use by the Service Users and they are welcome to bring in their own for use providing it has been electrically tested (PAT tested). The Annual Quality Assurance Assessment states that as a result of listening to people living in the home a sensory garden is being planned. Some of the completed relatives surveys said that the food ‘is of a poor standard’ and could be ‘better cooked’. The chef has recently left and feedback during the inspection indicated that the meals have now improved. The manager said she has the situation under review and Southern Cross Healthcare continues to audit the catering service as part of their ongoing process Revelstoke Lodge DS0000003603.V318730.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home and their relatives/friends know how to make a formal complaint. People are safe living in this home. EVIDENCE: There have been 3 formal complaints made to the Commission over the last 12 months and a number of concerns raised that people did not want to make into a formal complaint. These have all been investigated by the provider using their internal complaints procedure. A complaint was received just prior to the inspection which was given to the provider to investigate on the day of the inspection. All of the complaints are around issues of poor basic care practices for both long term and short term people. The organisation investigates complaints Revelstoke Lodge DS0000003603.V318730.R01.S.doc Version 5.2 Page 16 thoroughly and implements changes where they have been found to be substantiated. The level of complaints to the Commission from Service Users, relatives and social services has reduced over the last 12 months. Care managers and continuing care staff spoken to said that they take any concerns to the manager and work with the staff to make the package of care right for the person living in the home. The Annual Quality Assurance Assessment states that 15 complaints have been received in the last 12 months (this includes the 3 stated above). Two of these complaints were upheld. The complaints procedure is displayed in the home, although it was advised that they should be lower down in order that people using wheelchairs are able to read it, and is also in the Statement of Purpose given to all people when they move into the home. Only one (1) of the fourteen (14) completed relatives surveys said they did not know how to make a complaint. The manager said that she is introducing ‘relatives surgeries’ which will be advertised in the home so that people know when she will be available to discuss any concerns they may have. The manager submits information to the Commission about any incidences where concerns about adult protection are raised and any subsequent actions taken. There are no ongoing adult protection issues at the time of this report. All five (5) of the completed care workers surveys indicate that they are aware of adult protection procedures. All staff have training about adult protection during their initial induction and on an ongoing basis. Evidence of this was seen when examining the training matrix in use in the home, to identify when statutory training is due. Revelstoke Lodge DS0000003603.V318730.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, 24, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is safe and well maintained and clean and hygienic ensuring the people living in the home live in a satisfactory environment. EVIDENCE: Revelstoke Lodge DS0000003603.V318730.R01.S.doc Version 5.2 Page 18 A lot of redecoration has been ongoing since the last inspection and this has resulted in an improved environment as it makes the home look lighter and brighter. The corridors are different colours to indicate different areas of the home and the room doors are being painted bright colours and have individual names on them to help people remember where there room is. The courtyard is an ongoing project and the activities co-ordinators make good use of the space whilst trying to make the area more attractive. The garden is better than it was at the last inspection but it has not yet been completed. Two (2) of the completed relatives surveys indicated that the garden is not yet finished and as a result cannot be used by Service Users. There is one large lounge, 2 activities rooms and a large dining room on the ground floor which are used by all of the people living in the home. There is space for the younger adults and the older people to be in different rooms if they wish. The manager said they find that when they ask the people living in the home where they would like to eat the younger and older people are happy to mix with each other. A tour of the home showed that peoples rooms have furniture, ornaments and pictures that reflect their personality and interests. The Annual Quality Assurance Assessment states that en-suite shower rooms for the younger persons unit are planned and 2 new baths are being fitted in the home. Lifting and handling equipment and wheelchairs were stored appropriately when not in use. A variety of equipment examined during a tour of the home had up to date servicing records on them. Southern Cross Healthcare provide people from the estates team to carry out major work and the full time maintenance man based at Revelstoke Lodge carries out the ongoing maintenance and redecoration. He also has responsibility for testing fire alarms, water temperature checking and health and safety issues. There is a call bell system fitted throughout the home. The manager said they she is aware of concerns by some relatives and Service Users about the time it sometimes takes to answer the bell. The system now allows for print outs to be done that show the time the bell has rung and how long it has taken to be answered. Some of the he completed relatives surveys indicated that people seem to wait a long time to have the bell answered but are aware of the new system and hope to see an improvement in the situation. The laundry is a suitable size for the amount of washing the home produces. Clean laundry was being delivered to peoples’ rooms during the inspection. The home was clean and hygienic. There were a variety of hand washing facilities prominently placed around the home. All ‘work’ trolleys seen around the home had a supply of disposable gloves and aprons on them. Revelstoke Lodge DS0000003603.V318730.R01.S.doc Version 5.2 Page 19 Revelstoke Lodge DS0000003603.V318730.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are sufficient numbers of staff with generally appropriate skills and knowledge to meet the needs of the people living at the home. The homes recruitment procedures protect people living at the home from being placed at risk of harm or abuse EVIDENCE: Duty rotas supplied with the pre inspection questionnaire indicate that the manager works full time. She said that either herself or the deputy are on call at all times when not on duty and she sometimes visits the home unannounced Revelstoke Lodge DS0000003603.V318730.R01.S.doc Version 5.2 Page 21 at night or weekends to observe the service being provided. She is supported by trained nurses and carers, administration, catering, domestic and maintenance staff. Southern Cross Healthcare supply a regional manager who provides support when needed and carries out the regulation 26 visits (the provider is required to make monthly unannounced visits to the home each month to check the quality of the service being provided). The home is staffed according to the needs of the people living in the home. Some people have a number of hours of ‘one to one’ time contracted to them each week, others need a member of staff to go out with them during the day therefore the staffing level changes from day to day and during different periods of the day. Four (4) of the completed relatives surveys said that staffing levels could be better and one (1) stated that new staff need ‘longer to train properly’. The training matrix examined during the inspection shows who has received which training and who is due for updating. The home looks after people with a variety of complex needs and conditions and accesses outside training as necessary to ensure the staff have the skills to meet their needs. Some of these courses were seen advertised during a tour of the home. Three (3) staff files were examined – they had all of the required documents in them including 2 written references, a CRB check, application form, contract of employment and job description. The staff files are stored securely. The file also included training certificates that confirmed that a variety of training is undertaken by staff. Four (4) of the five (5) completed staff surveys indicated that they don’t have regular meetings with the manager or supervision (one to one) sessions and one (1) said meetings held are at inappropriate times. The manager said that meetings are being planned more regularly and at times that staff can access them. In the Annual Quality Assurance Assessment the manager has stated that they could improve on their absence management, which will include an absence management policy. Other plans include more NVQ compliance – ensuring people studying for the qualification continue to work towards it. The home are also encouraging all staff to undertake ‘Yesterday, today, tomorrow’ (YTT) training –a training package developed by the Alzheimers Society that focuses on trying to see the world from the point of view of somebody with dementia (www.alzheimers.org.uk). The manager and the regional manager said that people who have already had the training have found it to be of great benefit, even though the home do not specialise in caring for people with dementia. Revelstoke Lodge DS0000003603.V318730.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Revelstoke Lodge DS0000003603.V318730.R01.S.doc Version 5.2 Page 23 31, 32, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed by an experienced Registered Nurse. There is a formal quality assurance system in place and the regional manager is regularly involved in the process. Personal money held by Southern Cross Healthcare on behalf of Service Users is managed appropriately. The registered provider shows a responsible attitude toward promoting and protecting the health, safety and welfare of people living in the home. EVIDENCE: The manager is a first level registered nurse with many years of experience. This is her first managers job and she has now been in post for over a year. She was the deputy manager before becoming the manager and has built on her experience since getting the role with support form the regional operations manager and Southern Cross Healthcare. She has applied to do a registered managers award. She holds formal meetings for residents and relatives (May 2007 minutes examined) and intends to continue this approximately every 3 months. She is also to hold ‘relatives surgeries’ within the home so anybody can see her during these periods if they have any queries or concerns. She does this as she is not always in the home and when she is she is not always free to see people. The surgeries are allocated time that people know she will be available to them. The manager said that staff meetings are held to disseminate information about changes or any concerns that have been raised, there is also a staff newsletter. The manager said that formal and informal supervision of staff takes place and on the Annual Quality Assurance Assessment she stated that this has improved over the last 12 months but plans to increase it over the next 12 months. Three (3) of the five (5) completed care workers surveys indicated that no meetings or supervision take place and one (1) stated that meetings are at inappropriate times. Revelstoke Lodge DS0000003603.V318730.R01.S.doc Version 5.2 Page 24 The company has a robust quality assurance system. As part of this system audits are carried out on a different area on a weekly basis such as medicines, care plans etc. A recent audit on the kitchen and catering found shortfalls that have led to appropriate action being taken to improve the situation. The regional manager was in the home on the day of the inspection carrying out an unannounced monthly visit as required by Regulation 26 of the National Minimum Standards. The Southern Cross estates team carry out large jobs on the building and in the home and the home has a full time maintenance man who carries out general maintenance and checks such as fire alarms tests and water temperature checks. A variety of documents were seen during the inspection to support this. Health and safety risk assessments/ audits are carried out regularly. The Annual Quality Assurance Assessment and documents examined during the inspection confirm that maintenance of equipment is carried out as required. The administrator manages the Service Users personal allowances, which are stored securely in the home. The amounts held are checked weekly by him and the manager and receipts are kept for cross referencing purposes. The manager picks 3 records at random on a monthly basis as part of the audit process to ensure ongoing accuracy of records. The fire log - book and accident books examined and were up to date and completed as required. Revelstoke Lodge DS0000003603.V318730.R01.S.doc Version 5.2 Page 25 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 3 2 3 3 3 4 2 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 2 20 3 21 X 22 3 23 3 24 3 25 3 26 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 3 33 3 34 X 35 3 36 X 37 X 38 3 Revelstoke Lodge DS0000003603.V318730.R01.S.doc Version 5.2 Page 26 No Are there any outstanding requirements from the last inspection? 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. 1 Refer to Standard OP4 OP8 2. OP19 Good Practice Recommendations Delivery of service and care to people who are being admitted for short term care should be improved and monitored in order that the expectation of what the service offers and the actual experience are satisfactory. The garden at the back of the home needs to have continued improvement to allow access for service users and a better outlook for those whose rooms look out over this area. (Carried over from previous inspection in February 2006) Revelstoke Lodge DS0000003603.V318730.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 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 © 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. Revelstoke Lodge DS0000003603.V318730.R01.S.doc Version 5.2 Page 28 - 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!