Inspection on 05/07/05 for Revelstoke Lodge

This inspection was carried out on 5th July 2005.

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

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

Other inspections for this house

Revelstoke Lodge 16/06/09

Revelstoke Lodge 24/06/08

Revelstoke Lodge 22/06/07

Revelstoke Lodge 17/05/06

Revelstoke Lodge 17/02/06

Revelstoke Lodge 02/12/05

Revelstoke Lodge 01/12/04

Revelstoke Lodge 16/06/04

Revelstoke Lodge 24/02/04

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Fairfields Country Rest Home

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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 PL7 4DZ Lead Inspector Mandy Norton Announced 5 July 2005 th 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 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 D52-D04 S3603 Revelstoke Lodge V224135 050705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Revelstoke Lodge Address Boringdon Road, Plympton, Plymouth, Devon, PL7 4DZ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01752 343001 Ashbourne Homes Limited Miss Irene Jasper Care Home 65 Category(ies) of Old age, not falling within any other category registration, with number (55), Physical disability (12), Physical disability of places over 65 years of age (12) Revelstoke Lodge D52-D04 S3603 Revelstoke Lodge V224135 050705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 01.12.05 Brief Description of the Service: Revelstoke Lodge is registered to accommodate a maximum of 65 service users. The home provides care for up to 53 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 12 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.The Commissions understanding is that a dedicated environment and staff team is to be provided for the care of the 12 younger service users although approval of this plan has yet to be received from the registered provider.Bedrooms are mainly single though several doubles are available. Some bedrooms offer the added benefit of en-suite facilities; most rooms are individually decorated. The communal rooms offer space for dining and recreation.The home is owned by Ashbourne Homes Limited, which operates a large number of care homes nationally. Revelstoke Lodge D52-D04 S3603 Revelstoke Lodge V224135 050705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection took place over 7 hours and 20 minutes between 9.50am and 5.10pm and was conducted with the general manager and regional manager. The inspector spoke to 9 patients and observed several others taking part in a variety of activities in a group and individually. A number of completed comment cards were received from relatives /representatives prior to the inspection. One of the purposes of this inspection was to follow up requirements and recommendations made following the last inspection. On the day of the inspection there were 45 patients, 39 requiring nursing care, 12 of this number are young physically disabled people (including 2 people with MS whose beds are funded by the MS Society) and the remaining 27 are elderly and have general nursing needs, the remaining 6 residents require personal care only. A tour of the premises took place and a variety of records were inspected. There has been a recent change in the general manager and the regional management of Ashbourne Homes Ltd., this has created some changes within the homes routines and in the staff group and some initial communication difficulties resulting in a number of complaints from relatives, care managers and service users. Ashbourne are aware of these concerns and have introduced some working practices designed to improve communications and the general service provided. What the service does well: What has improved since the last inspection? Ashbourne have an audit process that deals with specific issues at each audit. A questionnaire is sent out to residents and/ or their representatives to seek their views. The younger adults have a different choice of menu to the older people. Revelstoke Lodge D52-D04 S3603 Revelstoke Lodge V224135 050705 Stage 4.doc Version 1.40 Page 6 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. Revelstoke Lodge D52-D04 S3603 Revelstoke Lodge V224135 050705 Stage 4.doc Version 1.40 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 Standards 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 D52-D04 S3603 Revelstoke Lodge V224135 050705 Stage 4.doc Version 1.40 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 to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards were assessed during this inspection. EVIDENCE: Revelstoke Lodge D52-D04 S3603 Revelstoke Lodge V224135 050705 Stage 4.doc Version 1.40 Page 9 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 to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for standard(s) OP 8 (YA19) The health needs of patients are met, with evidence of multi disciplinary working taking place on a regular basis. EVIDENCE: A tour of the home confirmed that there is equipment necessary for the promotion of tissue viability and prevention or treatment of pressure sores within the home. Many patients have specialist equipment provided for them individually from a variety of sources. Revelstoke Lodge D52-D04 S3603 Revelstoke Lodge V224135 050705 Stage 4.doc Version 1.40 Page 10 The regional manager said that more pressure relieving mattresses could be purchased as necessary by the general manager, in response to a concern in a complaint received that there were insufficient mattresses. Discussion with the general manager and patients confirmed that patients are registered with a GP of their choice, have regular eye and dental checks and that specialist medical and therapeutic services are organised as appropriate. Patients spoken to said that the carers attend to their needs appropriately and allow them to ‘do things for themselves’ when they can. Care managers and the lead physical disability manager for the local PCT are in regular contact with the home and review their clients on a regular basis. The assessments have increased during the period of instability that the home is currently going through. Revelstoke Lodge D52-D04 S3603 Revelstoke Lodge V224135 050705 Stage 4.doc Version 1.40 Page 11 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 asssistance 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) OP 12, 13 and 15 ( YA 11,12,13, 14, 15 and 17) The staff have an understanding of the patients needs and preferences in terms of activities and leisure pursuits. The meals in the home are satisfactory, offering choice and variety and catering for special dietary needs. EVIDENCE: The patients and relatives spoken to had high praise for the activities coordinators within the home (1 for the older patients and 1 for the younger adults, both part time) and said that they tried hard to accommodate everybody’s needs. The relatives would like to see them able to provide Revelstoke Lodge D52-D04 S3603 Revelstoke Lodge V224135 050705 Stage 4.doc Version 1.40 Page 12 activities more often. Some of the patients have one to one care and have their day structured to suit their needs and abilities. Up to date information about activities was seen displayed within the home. Relatives were seen coming and going freely throughout the day. The patients spoken to said that they can see relatives in their rooms or the lounge if they like. The meals are provided by an outside catering company called Compass. The staff are responsible to the general manager in the home. The cook said that the older people and younger adults have a different menu to cater for their individual needs. She said that the food hygiene training is up to date. Following a recent complaint about the food that was offered (biscuits only) when a patient was admitted after tea time, the care staff have been advised that a more substantial meal of at least sandwiches should be offered. Patients spoken to said that the most meals are ‘ok’. Revelstoke Lodge D52-D04 S3603 Revelstoke Lodge V224135 050705 Stage 4.doc Version 1.40 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) OP16 and 18 (YA 22 and 23) The home has a satisfactory complaints system with some evidence that residents and relatives feel that their views are listened to and acted upon. Staff have a knowledge and understanding of adult protection issues which protects the residents. EVIDENCE: The general manager has had a number of complaints to deal with since she came into post. Some of these have been satisfactorily resolved and some are still ongoing. The company have a laid down criteria for accepting and dealing with complaints and once the manager was familiar with the process she has followed it appropriately and kept detailed records of investigations that have taken place. The complaints procedure was seen displayed in the home. The home has robust procedures for responding to suspicion or evidence of abuse or neglect. The manager used the correct procedures when an incident was reported to her recently. The matter has since been resolved. Revelstoke Lodge D52-D04 S3603 Revelstoke Lodge V224135 050705 Stage 4.doc Version 1.40 Page 14 Revelstoke Lodge D52-D04 S3603 Revelstoke Lodge V224135 050705 Stage 4.doc Version 1.40 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) OP 19, 20, 22 and 26 (YA 24,28,29 and 30) The standard of the environment within the home is good providing residents with a comfortable place to live. The younger adults beds do not yet have a dedicated unit and although this does not pose a risk to the residents it does not create a suitable environment for them to live in. EVIDENCE: Revelstoke Lodge D52-D04 S3603 Revelstoke Lodge V224135 050705 Stage 4.doc Version 1.40 Page 16 A tour of the home confirmed that the home is suitable for the care of older people and younger adults although they are not looked after in separate units yet. Some minor general maintenance was outstanding. The manager said that the maintenance man had been trying to complete a number of jobs. She has asked him to report directly to her so that she can ensure he is carrying out priority jobs. Communal space consists of a lounge and dining room and an activities room. These areas have suitable furnishings and fittings. Some subsidence has occurred outside the activities room, Ashbourne have had their estates department review the problem and are looking at what is required to avoid further occurrences. This does not affect the use of the room. There is an outdoor patio area that is accessible to those in wheelchairs or with other mobility problems. Equipment to meet the assessed needs of the residents was seen in the home such as grab rails, assisted baths and other aids in toilets and bathroom and lifting and handling equipment. The younger adults area of the home is not required to have an assessment of the area to ensure suitable adaptations are in place. The older persons area should have an assessment carried out to ensure the environment has suitable adaptations for their needs. A call bell system is fitted throughout the home. The home was clean and hygienic. Domestic and laundry staff were busy during the inspection. Hand washing facilities were prominent throughout the home. The laundry had suitable equipment able to wash at appropriate temperatures to thoroughly clean linen and control risk of infection. Revelstoke Lodge D52-D04 S3603 Revelstoke Lodge V224135 050705 Stage 4.doc Version 1.40 Page 17 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, 29 and 30 (Older People) and Standards 34 and 35 (Adults 18-65) the key standards to be inspected at leat once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) OP 27 (YA 33) Limited progress has been made in addressing staffing shortages and as a result residents do not always receive consistent care. EVIDENCE: Recent complaints have pointed to the fact that the skill mix and levels of staff are not satisfactory to meet the assessed needs of all of the residents. The company is actively trying to recruit more staff to avoid using agency staff so often and has some incentives for staff if they introduce a friend who is ultimately suitable for a role as a carer. Residents spoken to said that the staff were kind and they didn’t have to wait for long if they rang the bell, another described it as ‘home from home’. The 3 completed relatives/visitors comment cards all indicated that in their opinion there were not always ‘sufficient numbers of staff on duty’. Two indicated that there are a lot of inexperienced staff working together resulting in inconsistent standards. Revelstoke Lodge D52-D04 S3603 Revelstoke Lodge V224135 050705 Stage 4.doc Version 1.40 Page 18 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 polies 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 33, 35 and 38 (Older People) and Standards 23, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) OP 31 (YA37) The manager is beginning to provide clear leadership throughout the home with staff being reminded of their roles and responsibilities. Revelstoke Lodge D52-D04 S3603 Revelstoke Lodge V224135 050705 Stage 4.doc Version 1.40 Page 19 The manager has a good understanding of the areas in which the home needs to improve. Planning is in place for how the improvements are going to be managed. EVIDENCE: The manager was working as a clinical manager within the home before being promoted to general manager. She is a first level registered nurse with many years of experience. Recent complaints have resulted in the manager being aware of the areas in which the home needs to improve and action plans have been devised in collaboration with Ashbournes regional manager in order implement the changes required. The manager said that a clinical manager has recently been appointed and that clear lines of accountability exist within the home. Revelstoke Lodge D52-D04 S3603 Revelstoke Lodge V224135 050705 Stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 x 3 x 4 x 5 x 6 x HEALTH AND PERSONAL CARE ENVIRONMENT Standard No 19 20 21 22 23 24 25 26 STAFFING Score 2 3 x 2 x x x 3 Score Standard No 7 8 9 10 11 Score x 3 x x x Standard No 27 28 29 30 2 x x x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No 16 17 18 Score 3 x 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 x 33 x 34 x 35 x 36 x 37 x 38 x Revelstoke Lodge D52-D04 S3603 Revelstoke Lodge V224135 050705 Stage 4.doc Version 1.40 Page 21 Yes 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. 1. 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 OP19 (YA 24) Good Practice Recommendations The provider should supply the commission with a written plan outlining the improvement to be made to the environment to provide a dedicated unit for the 12 beds registered for younger physically disabled people. This should include timescales. An assessment of the older persons environment should be carried out by a suitably qualified person to provide evidence that suitable adaptations are in place to meet their assessed needs. The staffing levels and skill mix within the home should be such that it meets the assessed needs of the Service Users at all times 2. OP22 3. OP27 (YA 33) Revelstoke Lodge D52-D04 S3603 Revelstoke Lodge V224135 050705 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Revelstoke Lodge D52-D04 S3603 Revelstoke Lodge V224135 050705 Stage 4.doc Version 1.40 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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