CARE HOMES FOR OLDER PEOPLE
St Denis Lodge Salisbury Road Shaftesbury Dorset SP7 8BS Lead Inspector
Rosie Brown Unannounced Inspection 11:15 25 January 2006
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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 St Denis Lodge DS0000061609.V260914.R01.S.doc Version 5.0 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. St Denis Lodge DS0000061609.V260914.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service St Denis Lodge Address Salisbury Road Shaftesbury Dorset SP7 8BS 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) 01747 854596 St Denis Lodge Ltd Miss Patricia Butler Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places St Denis Lodge DS0000061609.V260914.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13th July 2005 Brief Description of the Service: St Denis Lodge is well-established care home situated on the outskirts of Shaftesbury town centre close to the Royal Chase roundabout. The home is registered to accommodate a maximum of 21 people aged 65 years and over in the category of Old Age (OP). The owner and registered individual (RI) is Ms Beverley Martin and the registered manager is Mrs Patricia Butler. St Denis Lodge residential home is a large Georgian property set in its own landscaped gardens. Accommodation for service users is arranged over the ground and first floors and all but one of the bedrooms have en-suite WC facilities. The accommodation is of a very high standard and provides a comfortable and attractive environment. Communal rooms include a lounge, dining room and separate conservatory: assisted bathing facilities are available on the first floor and a separate WC is situated close to communal areas. The home aims to provide a service to people who have low to moderate care needs, and is well-suited to people who retain a degree of independence. However, the homes environment is such that physically frail elderly people can access all parts of the house: there are two passenger lifts available for use. Service users are encouraged to remain at the home for as long as they wish with support from health care professionals. St Denis Lodge offers a good range of social activities and community contact is maintained: services include personal care, all meals, cleaning of rooms and laundry. There is a large off road car park to the side of the home for visitors convenience. St Denis Lodge DS0000061609.V260914.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 25th January 2006 and was undertaken by inspector Rosie Brown: it was the second of two statutory unannounced inspections planned to take place within a year. The inspection commenced at 11:15am and was concluded by approximately 3:00pm. The inspector was made to feel most welcome and would like to thank the staff and residents for their assistance with the inspection process. The inspector assessed 12 of the National Minimum Standards and the requirements and recommendations set out in the report of the previous inspection. The communal areas and a selection of bedrooms were viewed: residents’ care and medication records, staff training records and certain policies and procedures were examined. The inspector used observation skills to assess the interactions between staff and residents, spoke with Beverley Martin (RI) Patricia Butler (manager), four staff that were on duty, two visitors and three residents. During the inspection, comment cards supplied by the Commission were given to the inspector was given 9 cards from service users; the views expressed within them have also been used to inform this inspection report. What the service does well:
The home has an informative statement of purpose that has been updated to reflect that the home has limited company status. Each resident has a preadmission assessment before being accommodated in the home and plans of care are in place. Residents confirmed that the home promotes their independence and choice regarding their daily lives and routines. One resident said, “ This is a good home, I’m very happy here”. Comments cards received during the inspection confirmed that residents are satisfied with the personal and social care provided by the home. The social care provision achieves a consistently good standard and is central many residents’ lives and includes their choices. The food supplied to residents offers alternative options at each meal and also includes their choices and preferences: special diets are catered for. St Denis Lodge DS0000061609.V260914.R01.S.doc Version 5.0 Page 6 The interior and exterior of the home is extremely well maintained. Communal areas include; a lounge, a separate dining room and conservatory, all are comfortably furnished and appropriate for the needs of the service users accommodated in the home. Residents’ bedrooms vary in size and many are highly personalised by personal possessions and furniture. The lawn gardens and grounds are well tended and planted with a wide variety of mature trees, shrubs, rose boarders and seasonal plants. The gardens are easily accessed and garden furniture is plentiful: in the warmer weather gazebos provide shade as appropriate. Residents told the inspector they really appreciate their comfortable surroundings. Two passenger lifts at either end of the house provide level access throughout the home for those residents who cannot manage the stairs. Specialist equipment is accessed via the community health service while other equipment is provided by the home: some residents purchase individual items of their choice. Arrangements are in place to ensure that the health, safety and welfare of residents and staff are promoted and protected. What has improved since the last inspection? What they could do better:
The home’s brochure, which is readily available in the entrance hall, should be updated to reflect that the home is now a limited company, the registered managers name and make clear the home is registered with the Commission for Social Care Inspection (CSCI). Individual risk-assessments must be drawn up for residents whose medicines are left with them to take unsupervised, eg when on a breakfast or supper tray in their room. St Denis Lodge DS0000061609.V260914.R01.S.doc Version 5.0 Page 7 The staff team should be supplied with training concerned with Parkinson’s disease to ensure they fully understand a new resident’s mobility and communication needs. The home must be able to demonstrate that the electrician is satisfied there is no need to undertake minor upgrading to the electrical system as indicated by the home’s electrical certificate. Management should continue developing a quality assurance system and complete renew the Investors In People Award with the local County Council, as planned. 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. St Denis Lodge DS0000061609.V260914.R01.S.doc Version 5.0 Page 8 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 St Denis Lodge DS0000061609.V260914.R01.S.doc Version 5.0 Page 9 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): 1 The home’s statement of purpose is adequate and clearly describes the services available, but the home’s brochure is out of date and does not provide accurate information about registration, management and business arrangements for the home. Standard 3 was met at the previous inspection. EVIDENCE: The home has a statement of purpose and this has been updated since the previous inspection to reflect that the home is a registered company, that Mrs Butler is the homes’ registered manager and Mrs Martin the owner of the home is the Registered Individual (RI). As stated in previous reports, the home’s brochure which is readily available in the hallway should be updated: it states ‘the home is personally managed by Mrs Martin’ and that it is registered with Dorset County Council: the home is registered with the Commission for Social Care Inspection (CSCI). In addition, it does not contain the registered business number for the home, which is now an Ltd company. A solution must be found to permanently erase the incorrect details.
St Denis Lodge DS0000061609.V260914.R01.S.doc Version 5.0 Page 10 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, 9 and 10 Each service user has a care plan that identifies the care being provided to meet identified needs. The home’s medication storage and administration arrangements are satisfactory and some service users continue to take care of their own medicines. Service users confirmed their privacy is protected and that their known wishes are respected. Standard 8 was met at the previous inspection. EVIDENCE: The care plans and records for two residents were examined. Each care plan included details of personal hygiene, elimination, nutrition, mobility, sleeping, communications, safety, social activities, health, foot care and oral hygiene. Care related risk-assessments are also documented: all records seen noted regular monthly review. It was noted that for one resident with Parkinson’s disease, information about the condition had been included in the care records. It is recommended that staff be supplied with training in this medical condition.
St Denis Lodge DS0000061609.V260914.R01.S.doc Version 5.0 Page 11 Two residents confirmed that they are consulted about their care needs and records evidenced residents and/or their relatives’ signatures on care related paperwork. Since the previous inspection care plans have been developed to include more detail regarding each residents wishes and anticipated needs for their care when dying and in the event of death. Each of the 9 comment cards received from residents noted that they feel well cared for and that their privacy is respected. Residents’ medicines are stored in a locked trolley or cupboard and a controlled drugs cupboard is available for use if needed. The inspector checked four resident’s Medication Administration Record (MAR) charts: staff record when medicines are received, given and returned. However,the record also noting that some medication was not seen as taken. Discussion revealed that at times some residents medicines are left for them to take with their meal. It is a requirement that risk-assessments are drawn up for each person when administration of medicines is shared. Risk-assessments are in place for residents who manage all or part of the prescribed medication and all rooms have lockable storage facilities for keeping medicines securely. All staff have completed training on the safe handling and administration of medication. St Denis Lodge DS0000061609.V260914.R01.S.doc Version 5.0 Page 12 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): Standards 12, 13 14 and 15 were met at the previous inspection. EVIDENCE: St Denis Lodge DS0000061609.V260914.R01.S.doc Version 5.0 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): 18 The home has a policy concerned with adult protection to ensure that allegations or suspicion of abuse to a resident would be properly responded to. Standard 16 was met at the previous inspection. EVIDENCE: The home’s adult protection policy has been shared with staff as part of their induction into the expected working practices of the home. Copies of the local ‘No Secrets’ and Protection of Vulnerable Adults (POVA) guidance are held in the staff office. The manager confirmed that all staff have now completed local training in the ‘No Secrets’ referral process and the recognition of abuse. The staff recruitment procedures are robust to ensure that residents are protected. St Denis Lodge DS0000061609.V260914.R01.S.doc Version 5.0 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 and 24 The home is safe, clean and maintained to a high standard, it is well equipped has level access throughout and provides a comfortable, attractive, homely environment for the residents. Service users rooms are safe and furnished in a manner that is suitable to their individual needs. Standards 20, 22 and 26 were met at the previous inspection. EVIDENCE: A selection of bedrooms and all communal areas were viewed. The home is well maintained and in excellent decorative order. The home has previously exceeded this Standard but written confirmation that four minor matters identified in a recent electrical certificate have been addressed should be supplied to the Commission. St Denis Lodge DS0000061609.V260914.R01.S.doc Version 5.0 Page 15 Residents’ bedrooms are available on the ground and first floor of the home, many rooms are generously sized and all but one have en-suite facilities. Most bedrooms are highly personalised with resident’s belongings and furniture and an inventory of items brought into the home is kept for each person. There is a large entrance hall and all corridors are wide allowing residents with walking aids plenty of space. There is a communal lounge with separate dining room and conservatory thus providing a variety of comfortable sitting areas indoors. The communal rooms and corridors have been re-carpeted since the previous inspection. Two passenger lifts provide level access throughout the home. Alternative access to the first floor is via the main staircase, which has handrails on either side of the stairs. There is a ground floor cloakroom, with a disabled showering facility, and three assisted bathrooms are available: all the bathrooms have non-slip floor covering and one has a shower facility. Since the previous inspection the manager has drawn up individual riskassessments concerning the use of freestanding cooling fans and residents personal safety. St Denis Lodge DS0000061609.V260914.R01.S.doc Version 5.0 Page 16 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, 28 and 30 The home is properly staffed by management, care assistants, domestic and ancillary workers to ensure that service users needs are met at all times. Staff recruitment processes and checks ensure the protection of residents living in the home. A training programme has been set up in the home to ensure staff are appropriately trained to meet residents’ needs. Standard 29 was met at the previous inspection. EVIDENCE: There are 23 staff employed to work in the home, these include; the manager, two senior staff (one of whom is the training co-ordinator), care assistants, three cooks, two domestics/cleaners, laundry assistant, administrator, maintenance worker and gardener. On the day of the inspection the manager was on duty with a senior care assistant, two carers, a cook, laundry assistant and a cleaner. During the past year the home’s recruitment procedures and practice have been improved particularly in relation to Criminal Records Bureau disclosure and POVA First checks. St Denis Lodge DS0000061609.V260914.R01.S.doc Version 5.0 Page 17 The staff training matrix evidenced that five of the fourteen care staff hold NVQ 2 qualifications while a further five are currently undertaking this training. In addition one member of care staff qualified as a general nurse but has ceased working in this field. The training co-ordinator, manager and RI have completed NVQ Assessors training (unit D32). During the past year staff have taken part in the following training, supervision, manual handling, food hygiene, basic food hygiene, basic first aid, health & safety, risk-assessment, NVQ, induction, infection control, safe handling of, POVA and understanding dementia. Each of the nine comment cards received from residents stated that they are treated well by staff. Two visitors on the day told the inspector that staff are friendly and helpful and take particular care to ensure residents’ are offered ‘a good social life’. St Denis Lodge DS0000061609.V260914.R01.S.doc Version 5.0 Page 18 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, 33 and 38 The registered manager is suitably qualified and experienced and is ably assisted by the RI and senior staff. The home provides a good standard of care to residents, and regular meetings enables residents to express their views about the home. Arrangements are in place to ensure that the health, safety and welfare of residents and staff are promoted and protected. Standard 35 was met at the previous inspection. EVIDENCE: St Denis Lodge became a limited company during late 2004: Mrs Beverly Martin who had been the owner and registered provider for the home since 1989 became the Registered Individual (RI) and Mrs Patricia Butler became the registered manager.
St Denis Lodge DS0000061609.V260914.R01.S.doc Version 5.0 Page 19 The manager is experienced in residential care work, holds an NVQ 4 qualification in care and management, is an NVQ assessor and takes part in regular training concerned with the care and protection of residents. The (RI) visits the home at least once a week and provides monthly reports of her visits that assess the conduct of the home. Mrs Martin explained that the home has applied to update their Investors in People Award as part of the home’s quality assurance system. The home undertakes residents’ surveys on an annual basis and those residents who are interested attend regular meetings so that their views about the way the home is run are aired. It was evident that residents’ views are considered when arrangements are made for social entertainment and activities. Comment cards noted that the home provides suitable activities and that residents are involved in decisions made about their care and in matters concerning the daily life of the home. Management need to ensure that the quality assurance system continues to be developed. The home’s fire records demonstrated that the regular in house tests and routine servicing of the fire safety system and equipment are up to date. The home has a fire risk-assessment in place and this has been updated. A number of risk-assessments are in place regarding the safety of the environment, eg the security of the home. Other maintenance records evidence that routine checks/servicing of the central heating system, passenger lifts, safety checks for the risk of Legionella, PAT testing for electrical installations and certificated servicing documents for moving and handling equipment used in the home. The home has an insurance certificate in place to cover a level of £5 million and this is displayed in the home and up to date. St Denis Lodge DS0000061609.V260914.R01.S.doc Version 5.0 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X 3 X X STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X X X 2 St Denis Lodge DS0000061609.V260914.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 28/02/06 1. OP1 Schd1& Reg 4 & 5 2. OP9 13(2) 3. OP38 13(4) The registered persons must ensure that the out of date information in the home’s brochure/guide is ‘deleted/covered’ by an amendment that notes that the home is registered with the CSCI, provides the name of the registered manager and the registered number of the Ltd Company. (Previous timescale of 30/4/05 and 31/8/05 not met). Individual risk-assessments must 28/02/06 be drawn up for residents whose medicines are left with them to take, eg on their breakfast or supper tray. The home must provide written 28/02/06 evidence/confirmation that the recommended improvements to the electrical system have either been rectified (as detailed in the homes inspection certificate dated 10/6/05) or that the electrician is satisfied with the system in place. (Previous timescale of 31/8/05 not met). St Denis Lodge DS0000061609.V260914.R01.S.doc Version 5.0 Page 22 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. 2. Refer to Standard OP30 OP33 Good Practice Recommendations Staff training concerning the understanding of Parkinson’s disease should be provided. The home’s quality assurance system should continue to be developed and updated. St Denis Lodge DS0000061609.V260914.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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