Inspection on 09/11/06 for Somerset Lodge

This inspection was carried out on 9th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Somerset Lodge 05/01/06

Somerset Lodge 06/05/05

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 Paul Grey Unannounced Inspection 09:30 9 November 2006 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Somerset Lodge DS0000020289.V313998.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Somerset Lodge DS0000020289.V313998.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Somerset Lodge Address Perrett Way Ham Green Pill North Somerset BS20 0HE 01275 372224 01275 372424 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) admin@aspectsandmilestones.org.uk Aspects and Milestones Trust Mr Michael Robert Nunn Care Home 30 Category(ies) of Dementia (30), Dementia - over 65 years of age registration, with number (30), Mental disorder, excluding learning of places disability or dementia (30), Mental Disorder, excluding learning disability or dementia - over 65 years of age (30) Somerset Lodge DS0000020289.V313998.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 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 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 well-maintained garden. Charges range between £487 and £780 per week. Somerset Lodge DS0000020289.V313998.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted in the presence of the manager over one day. The Inspector conducted a tour of the premises, spoke with 5 staff members, 4 service users and 3 family members. The inspector observed care being delivered over the day both to individual service users and in small groups. To complete the inspection, the Inspector reviewed care documentation and policies and procedures to compare with practice at the home. Somerset Lodge has consistently maintained a high standard of care for service users with mental health or age related mental health issues. This inspection reflected well on both the service and the manager. Somerset Lodge continues to provide a high standard of expertise and innovative care to those who rely on it. What the service does well: 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. Somerset Lodge DS0000020289.V313998.R01.S.doc Version 5.2 Page 6 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Somerset Lodge DS0000020289.V313998.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Somerset Lodge DS0000020289.V313998.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, Quality in this outcome area is good. Admissions to the home only take place if the service is confident staff have the skills, ability and qualifications to meet the assessed needs of the prospective resident. EVIDENCE: Service users needs were assessed prior to admission to Somerset Lodge. Four service user’s care records were reviewed in conjunction with observation and staff feedback about care. The home completed a comprehensive assessments of service user’s potential needs. This included physical needs, a social/cultural history and an outline of risks to the service user. Feedback from family members suggests this process is thorough and sensitively applied. Documentation is good but the inspector would recommend the implementation of a more person centered documentation format throughout care planning and assessment. Somerset Lodge DS0000020289.V313998.R01.S.doc Version 5.2 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 the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. Each resident has a Plan that has been agreed with them. This is written in plain language, is easy to understand and considers all areas of the individual’s life including health, personal and social care needs. EVIDENCE: Service users at the home have a comprehensive plan of care. This is written from the home’s assessment of each service user’s individual needs. Four care plans were reviewed by the Inspector. All were regularly reviewed by staff and reflected the changing needs of the service users. Where service users are able, they are encouraged to be involved with drawing up of their plan of care. A range of physical health needs were identified for some service users. Care plans outlined the daily care provided to these service users with the desired goals of care provided. Some physical problems were quite complex as service users approached the end of their lives. However the Inspector noted that the home appears to manage this level of care well. At the time of inspection no service users had pressure sores. One service user was admitted with a pressure area which can occasionally become sore. This is well managed by Somerset Lodge DS0000020289.V313998.R01.S.doc Version 5.2 Page 10 the staff team. Specialist medical input can be obtained for service users when needed, for example support with reviewing medication, chiropody or more specialist nursing needs. The home has policies and procedures for the recording, storage and administration of medication. The Inspector reviewed medication records with the manager at the time of inspection. These were clear and well maintained. A particular strength of the home is the way in which service users are treated. The Inspector came across evidence from observation, talking with staff, talking with the manager and the homes documentation. Staff were kind and unrushed with the service users. Service users received individualised care that respected their privacy and dignity. Feedback from relatives regarding the staff at the home was very positive. Somerset Lodge DS0000020289.V313998.R01.S.doc Version 5.2 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 the following standard(s): 12,13,14,15 Quality in this outcome area was excellent. The routines of the home are planned around the residents’ needs and wishes. Staff listen to residents and make considerable effort to provide a flexible service, which enables them to enjoy a better quality of life. Family and friends feel welcome and know they can visit the home at any time. Staff always make time to talk to visitors and share information with the agreement of the resident. EVIDENCE: The home has a routine of daily living that is geared to the individual needs of the service users. Meals could be delivered to service users in their rooms or communal areas. Staff encourage service users to eat together where possible to foster a social interaction. Service users were given opportunity for stimulation in a creatively decorated activities room called the cottage. The staff team here deliver an innovative and individualised range of leisure activities. Staff have decorated this area and turned it into a small homely cottage type sitting room. Relatives who spoke with the inspector, described a relaxed open access policy run by the home. Relatives felt they could visit as they wished and have time either privately or in communal areas. General feedback from relatives was extremely good. Somerset Lodge DS0000020289.V313998.R01.S.doc Version 5.2 Page 12 Staff at the home will support the family or friends to contact an advocate if required. Service users can bring a limited range of personal items into the home. This would be dependent on health and safety and fire issues. Friends and relatives stated that the food at the home was pleasant and varied. During the inspection process the Inspector observed a mealtime and noted the food was appetising and well presented. Hot and cold drinks were provided at regular intervals throughout the day. Specialist cultural or therapeutic diets are available on request . The menu is regularly reviewed by the staff team, due to the level of disability on the part of the service user group there is only limited input from them . During the inspection process, staff sensitively and discreetly supported service users to eat and remain independent as long as possible. Somerset Lodge DS0000020289.V313998.R01.S.doc Version 5.2 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 the following standard(s): 16, 18 Quality in this outcome area is excellent. The home promotes an open culture where residents feel safe and supported to share any concerns in relation to their protection and safety. Policies and procedures regarding protection of adults are of a very commendable quality, which are fully inclusive of all the latest developments. At all levels the service is very clear when an incident needs external input, and is open in discussing incidents with external bodies (CSCI, local adult protection) to clarify difficult judgements. EVIDENCE: The home has a clear and accessible complaints procedure. At the time of inspection there were no outstanding complaints the manager informed the Inspector that a record was kept of all complaints including details of the managements action. The home has robust procedures for reporting any suspicions of abuse, neglect or degrading treatment. The home has whistle blowing policies and procedures outlining the home’s action in the event of reported abuse. A whistle blowing incident had been reported to the commission by the manager. The inspector and the manager discussed the incident during the inspection. The inspector noted that the trust had dealt appropriately with the issue. The home’s recruitment policy protects service users from those who may be and suitable to work with vulnerable adults. Somerset Lodge DS0000020289.V313998.R01.S.doc Version 5.2 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 the following standard(s): 19, 26 Quality in this outcome area is good. The provider and manager have ensured that the physical environment of the home provides for the individual requirements of the residents who live there. The living environment is appropriate for the particular lifestyle and needs of the residents and is homely, clean, safe and comfortable. EVIDENCE: The home is well maintained and well decorated internally. Whilst the home’s clinical origins are obvious, the staff team have gone to some lengths to make the environment as homely as possible. The home is in the process of being extended and aims to offer support to an additional 5 service users. The home was clean and hygienic throughout. There was evidence of risk control measures in practice and appropriate laundry facilities on the premises. During the unannounced inspection the premises were clean and pleasant throughout. Somerset Lodge DS0000020289.V313998.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, 30 Quality in this outcome area is good. Residents have confidence in the staff that care for them. Rotas show well thought out and creative ways of making sure that the home is staffed efficiently, with particular attention given to busy times of the day and changing needs of the residents. EVIDENCE: During the inspection there were sufficient staff on duty to meet the needs of the service user group. The Inspector saw staff frequently interacting with service users and when needed were able to respond rapidly to their needs. The service continues to use additional part time staff to create the activities team. This team provides an individually tailored programme of events for the service user group. The activities team consists of 4 part time staff making up a total of 2 full time posts. This arrangement seems to work very well for service users who benefit from a flexible and varied input. This was good practice. The home runs a thorough recruitment package through the Trust’s Human Resources Department. Staff employed had a CRB, POVA check and appropriate references. Staff employed all had a statement the terms and conditions. The Inspector noted the homes documentation was generally robust. New staff complete a comprehensive induction process. The manager said Staff usually work through the induction in 4 to 6 weeks after starting that the home. The induction process met TOPS standards. Staff signed to confirm Somerset Lodge DS0000020289.V313998.R01.S.doc Version 5.2 Page 16 they completed each stage of the induction process. Training records indicated that staff would receive in excess of 3 paid training days a year. Somerset Lodge DS0000020289.V313998.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 38 Quality in this outcome area is excellent. The registered manager has the required qualification and experience, is highly competent to run the home and meets its stated aims and objectives. The manager has sound knowledge of both strategic and financial planning and review, and provides value for money through effective management. All the working practices in the home are safe and there are no preventable accidents. The home has a full range of policies and procedures to promote and protect residents’ health and safety. EVIDENCE: The manager is qualified both as a 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. Somerset Lodge DS0000020289.V313998.R01.S.doc Version 5.2 Page 18 The Inspector noted clear evidence of strategies in place by the manager to allow staff and service users to affect the way in which the service is delivered. The Inspector noted evidence of thoughtful touches throughout the service, such as the cottage. Staff spoken with gave positive evidence about the service. The impression the Inspector received was that there was a clear sense of direction and leadership throughout the home. The manager demonstrated the application of an effective quality assurance and quality monitoring system at the home. The most recent quality assurance review had been released to families and other interested parties. A number of minor changes had been initiated based on replies to the quality assurance questionnaire. Five staff files were sampled. Staff files sampled showed up-to-date training in manual handling, fire safety, and first aid. During the inspection of the premises the Inspector noted electrical goods had been subject to appliance testing by a contractor. The Inspector noted maintenance records covering the homes heating and electrical systems were also up to date. Somerset Lodge DS0000020289.V313998.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 4 3 x x x x x x 4 STAFFING Standard No Score 27 4 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 x x x x 3 Somerset Lodge DS0000020289.V313998.R01.S.doc Version 5.2 Page 20 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 OP3 Good Practice Recommendations The inspector would recommend the implementation of more person centred documentation through out the care files. Current documentation meets national minimum standards. Somerset Lodge DS0000020289.V313998.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Somerset Lodge DS0000020289.V313998.R01.S.doc Version 5.2 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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