Inspection on 06/05/05 for Somerset Lodge

This inspection was carried out on 6th May 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

Somerset Lodge 09/11/06

Somerset Lodge 05/01/06

Somerset Lodge 15/09/04

Somerset Lodge 27/04/04

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

CARE HOMES FOR OLDER PEOPLE Somerset Lodge Perrett Way Ham Green Pill, North Somerset BS20 0HE Lead Inspector David Francis Unannounced 6th May 2005 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. 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. Somerset Lodge D53 - D02 S20289 Somerset Lodge V225454 060505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Somerset Lodge Address Perrett Way, Ham Green, Pill, North Somerset, BS20 0HE 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) 01275 372224 01275 372424 Aspects and Milestones Trust Mr Michael Robert Nunn Care home with nursing 30 Category(ies) of Dementia (30) registration, with number Dementia - over 65 (30) of places Mental Disorder (30) Mental Disorder - over 65 (30) Somerset Lodge D53 - D02 S20289 Somerset Lodge V225454 060505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Staffing Notice dated 16/05/2000 applies. Manager must be a RN on Parts 3 or 13 of the NMC register. May accommodate up to 30 persons aged 50 years and over. Date of last inspection 15th September 2004 Brief Description of the Service: Somerset Lodge is registered to accommodate up to 30 people aged 50 years and over with severe mental disorder. The home is a single storey building set in the grounds of the old Ham Green Hospital. Somerset Lodge consists of two units one catering for service users with higher nursing needs; the other catering for 8 service users with severe mental illness, but a lower level of nursing needs, who are encouraged to have more autonomy in the running of the unit. All service users have their own rooms and access to a secure wellmaintained garden. Somerset Lodge D53 - D02 S20289 Somerset Lodge V225454 060505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place during one morning (when the home knew the inspector was coming) and one evening ( 9/5/04, which was an unannounced visit). The inspector spent much of his time in communal areas, communicating with residents and directly and indirectly observing the care given by staff. The inspector interviewed four staff and spent time with the manager reviewing a range of the home’s records. This was a very positive inspection. The home clearly provides high quality, specialist care to residents with complex needs What the service does well: What has improved since the last inspection? The manager has been developing new assessment and care planning documentation which helps staff to focus on overcoming the effects of cognitive impairment. Somerset Lodge D53 - D02 S20289 Somerset Lodge V225454 060505 Stage 4.doc Version 1.30 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. Somerset Lodge D53 - D02 S20289 Somerset Lodge V225454 060505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Somerset Lodge D53 - D02 S20289 Somerset Lodge V225454 060505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3-5 Residents are appropriately assessed and placed. Care is taken with the admission process. EVIDENCE: The inspector looked in detail at one recent admission and noted that the manager and two members of staff had visited the person in hospital to undertake an assessment. Although the admission had taken place in the previous 48 hours, clear documentation was already in place including a preliminary assessment and a plan of care. It was positive to note that the home was trialling an assessment structured around eight “domains of care” and considered how the person could be supported with their cognitive difficulties. The manager told the inspector that during the assessment he wanted to ensure that that the person would be happy at Somerset Lodge and anticipate any significant risks. The inspector spoke to the resident concerned, She told the inspector that staff had been kind and her daughter had made the decision for her to come to the home. Somerset Lodge D53 - D02 S20289 Somerset Lodge V225454 060505 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7-10 Residents’ needs are fully met. The documentation is comprehensive and staff are aware of the needs of individual residents. EVIDENCE: The inspector noted that all the residents looked well cared for with clean clothes, glasses, faces and hands. Throughout the inspection staff were seen to be taking the initiative to ensure residents were cared for. The inspector looked at a sample of four care plans. They were detailed and included special advice to staff on aspects of care (e.g. supporting residents who hear voices). The home is experimenting with a system for evaluating care outcomes by assessing signs of “well being and monitoring involvement in activities”. A comprehensive and up to date record of basic care tasks was evident in the care plans. Documentation for reviews and risk assessments were also in place. A number of very frail residents were in bed and had air mattresses to prevent pressure sores. Staff are vigilant in monitoring any wound care using digital photographs to record monitor the progress of treatment. The inspector found that the system for medication management was robust and records were clear. He commended the use of photographs of residents alongside their respective records and the clarity of special instructions, e.g. Somerset Lodge D53 - D02 S20289 Somerset Lodge V225454 060505 Stage 4.doc Version 1.30 Page 10 advice if resident refuses medication. The records also included the GP’s signature if the drug is being given in the non-designated form; e.g. crushed. During the course of the inspection staff were observed both directly and indirectly on a number of occasions. They displayed warmth and reassurance when attending to residents. When interviewed staff were able to explain the needs of individual residents and said that they read the care plans. Somerset Lodge D53 - D02 S20289 Somerset Lodge V225454 060505 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12-15 Residents are encouraged to engage in activities and are offered one to one attention. The daily routine is adapted to suit the wishes and needs of residents. The food provided is nutritious and residents are sensitively supported when they need assistance with feeding. EVIDENCE: The inspector spent a lot of time with residents in communal areas. It was very positive to see staff constantly go up the residents, spend time talking to them and offering physical comfort, e.g. gently rubbing hands. The home has an activities co-ordinator and an activities room (The Cottage) which offers opportunities for sensory stimulation. The inspector noted two residents in the room who spent time listening to bird song and enjoying the peaceful atmosphere in the room. At most times a sense of calmness prevailed in the home, although during the evening visit a radio in a resident’s room was playing loud distorted pop music which would be disturbing to those in the nearby corridor and lounge. The home takes activity provision seriously and monitors and records individual’s involvement. One resident told the inspector he had helped out at the home with planting in the garden. A cat was brought in for a resident to stroke which she clearly enjoyed. Somerset Lodge D53 - D02 S20289 Somerset Lodge V225454 060505 Stage 4.doc Version 1.30 Page 12 A lot of thought has been given to food provision and choice of food. This can be a problem because of short-term memory loss. The manager has engaged an outside caterer and places emphasis on wholesome, freshly cooked nutritious food. Rather than providing daily options, standard meals are provided with alternatives for those who have other preferences. One resident has weekly Afro-Caribbean meals. Should residents not like the option available, staff prepare a simple alternative. Around half the meals are prepared in a soft form to assist with eating. The inspector was particularly pleased to indirectly observe staff feeding residents, offering reassurance and maintaining a caring interaction throughout, (“is that nice?”). Residents are able to eat with their fingers if they prefer. Three residents were taken to the polling station at the recent election. Somerset Lodge D53 - D02 S20289 Somerset Lodge V225454 060505 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16-18 Residents welfare is safeguarded. EVIDENCE: The home has an open ethos and the manager spends time “on the floor” monitoring practice. All residents are observed closely and staff are alert to any resident being distressed or unhappy. The inspector noted a complaint having been acted upon and staff dealt with it appropriately. Somerset Lodge D53 - D02 S20289 Somerset Lodge V225454 060505 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19-26 Somerset Lodge offers a very pleasant environment well suited to residents’ needs. EVIDENCE: On both days the home impressed as light, bright, airy and very clean. Although the home is functional, e.g. lino floor coverings in corridors, it is very homely with personalised bedrooms and a variety of chairs available in lounges. The overall design creates separate wings and residents are clustered according to needs. The home provides a range of communal rooms and residents were free to move around. In two lounges wall paint was peeling on small areas of the walls. It is a safe environment with key pad entry systems. The home is single storey so stairs are avoided and no particular hazards were noted. The use of stable bedroom doors for residents who were bed bound enabled them to be aware of life outside their rooms. The garden is secure and easy accessible. Somerset Lodge D53 - D02 S20289 Somerset Lodge V225454 060505 Stage 4.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 29 There are sufficient staff at the home. Permanent staff are properly trained and supported. There is a problem with the use of agency bank staff. EVIDENCE: On both visits there seemed to be plenty of staff on shift which meant there was time available for staff to attend to residents and to spend time talking to them. Dependency levels in the home are high and at busy periods some service users had to wait before receiving attention. Neither the registered manager or community services manager could provide evidence that staff from outside agencies had had any recruitment checks. Two separate references were made to problems with agency staff not being trained in dementia care and not being trained or prepared to undertake personal care. A new bank system had been introduced and teething problems were evident. The inspector interviewed a member of Aspects and Milestones own bank staff. She had been appropriately recruited and had ID which had been checked at the home. She was well trained and felt supported by the Trust. Aspects and Milestones are in the process of ensuring that the staff records required by regulation are available at their homes. This has yet to be achieved at Somerset Lodge. Somerset Lodge D53 - D02 S20289 Somerset Lodge V225454 060505 Stage 4.doc Version 1.30 Page 16 The inspector spoke to a number of staff about their work. They impressed as motivated and interested in the residents. They told the inspector they were supported by the manager who was always on hand and very approachable. Somerset Lodge D53 - D02 S20289 Somerset Lodge V225454 060505 Stage 4.doc Version 1.30 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31-33 & 35-38 The manager offers the home postive leadership. The home is well run. EVIDENCE: The manager is qualified both as an general nurse and a mental health nurse. He has had a wealth of training and experience in the field of dementia and keeps up to date with new developments and practice. This was evident with some of the thoughtful initiatives that the home was trialling, e.g. assessment and care planning documentation, wellbeing monitoring. These were commended by the inspector. The documentation and record keeping was found to be up to date and detailed although with different systems being tried there is a need to ensure consistency and consolidate new processes. The homes does not keep staff records on site as required by regulation. The inspector noted the home had developed ready access resident profiles and looked at half of these. They provide a good induction tool for bank staff and include suggestions for effective communication. There is a strong presence of the manager and other trained staff on the floor, working Somerset Lodge D53 - D02 S20289 Somerset Lodge V225454 060505 Stage 4.doc Version 1.30 Page 18 alongside care staff as equals. Even the community services manager had recently undertaken an early shift to assess the quality of life in the home. Somerset Lodge D53 - D02 S20289 Somerset Lodge V225454 060505 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 4 3 3 x 3 3 2 3 Somerset Lodge D53 - D02 S20289 Somerset Lodge V225454 060505 Stage 4.doc Version 1.30 Page 20 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 OP29 Regulation 19 Requirement Timescale for action 2. OP37 Reg 17 -2 There must be a robust proceedure to both ensure and Immediate demonstrate that any agency 9/5/2005 staff used at the home have been properly recruited and appropriately trained. Records as required by Sched 4- 9/6/2005 6 in respect of staff must be kept at the home. 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 Good Practice Recommendations Somerset Lodge D53 - D02 S20289 Somerset Lodge V225454 060505 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Riverside Chambers Tangier Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Somerset Lodge D53 - D02 S20289 Somerset Lodge V225454 060505 Stage 4.doc Version 1.30 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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