Inspection on 17/08/07 for The Dene Lodge

This inspection was carried out on 17th August 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Dene Lodge 06/10/09

The Dene Lodge 08/04/09

The Dene Lodge 05/07/06

The Dene Lodge 02/12/05

The Dene Lodge 19/01/05

The Dene Lodge 01/07/04

The Dene Lodge 24/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE The Dene Lodge Bircham Road Alcombe Minehead Somerset TA24 6BQ Lead Inspector Shelagh Laver Unannounced Inspection 16th August 2007 09:30 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 The Dene Lodge DS0000016025.V341931.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. The Dene Lodge DS0000016025.V341931.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Dene Lodge Address Bircham Road Alcombe Minehead Somerset TA24 6BQ 01643 703584 01643 708550 info@thedenelodge.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Hazelgate Ltd Mr Jonathan Arthur Hunt Care Home 33 Category(ies) of Dementia (6), Old age, not falling within any registration, with number other category (27) of places The Dene Lodge DS0000016025.V341931.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) The maximum number of service users who can be accommodated is 33 including a maximum of 6 service users with a dementia care need. 5th July 2006 2. Date of last inspection Brief Description of the Service: The Dene Lodge is a care home proving care and support for up to 33 people over the age of 65 years, with a wide range of support needs. There is a selfcontained unit for six people with a primary diagnosis of dementia. The home is located in Alcombe on the outskirts of Minehead. It is close to local shops and services and public transport links. The service users accommodation is arranged on three floors with the communal areas located on the ground floor. The home has a through floor passenger lift and a range of adaptations have been made to the home to ensure it is accessible for those who live there. The home is set back from the road and has attractive garden areas. Johnathan Hunt is the manager supported by a small staff team. The current fee range is £361 to £473 per week. The Dene Lodge DS0000016025.V341931.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. Over the past year the home has undergone substantial building work. The new extension has provided fourteen new bedrooms over three floors. Twelve have en-suite shower rooms. Two bedrooms are large and have been registered for two people in the event that a couple may wish to share a room. On the second floor six bedrooms have been registered to provide care for people needing dementia care. Extensive building on the ground floor has provided very spacious communal areas and a new very well equipped bathroom. There has been consideration of peoples’ comfort and needs during the building programme with at times just ten people in the home. The manager talked about the importance of ensuring that the building work did not disrupt peoples’ care. At the time of the inspection there were 15 people in the home. There have been no admissions to the dementia care bedrooms. Prior to the inspection the manager had completed an Annual Quality Assessment Audit (AQAA) that provided information about the service. Comment cards were sent to people in the home, some relative s and staff. A comment was also sent to the doctors surgery. 10 comment cards were returned from people. The cards confirmed that people received the care and support they needed. Medical support is always available and there are a arrange of activities that people can always (4) or usually (3) take part in. People spoken to during the inspection were very satisfied with the care at the Dene Lodge. “We are well looked after..very happy.” What the service does well: People at the Dene Lodge are well cared for. Most people are happy in the home. “It is beautiful here….A home from home.” Staff are kind and attentive. “The staff are marvellous…” People have confidence that they can talk to the manager and staff and things will be “soon sorted out.” There is a flexible activities provision based on the interests of people in the home. The Dene Lodge DS0000016025.V341931.R01.S.doc Version 5.2 Page 6 The home environment now provides a very pleasant combination of an attractive older building with a new extension fitted and furnished to a high standard. The home is very clean and well maintained. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Dene Lodge DS0000016025.V341931.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 The Dene Lodge DS0000016025.V341931.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. JUDGEMENT – we looked at outcomes for the following standard(s): 36 Quality in this outcome area is good. All people are assessed prior to admission. There is a range of information available for service users and their representatives. Intermediate care is not provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care plans were reviewed that showed evidence of thorough assessment. The manager or deputy visit people whenever possible and use information from SAP assessments or hospital discharge documents. There was discussion with the manager regarding assessment of people coming to the dementia care unit and the need to be confident in meeting peoples needs. The Dene Lodge DS0000016025.V341931.R01.S.doc Version 5.2 Page 9 Comment cards confirmed that people received enough information about the home before they moved in. The inspector spoke to someone who came for respite care and chose to return as a permanent resident. The Dene Lodge DS0000016025.V341931.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is good . People in the home have their health and social care needs met but attention is needed to the care plan documentation. People are treated with respect and kindness. Medication is generally safe and well administered. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care plans were observed. They showed that people received good care but that there were some omissions in recording. There were some clear initial instructions for the care people needed. There was evidence that people had visits from the GP or district nurses when needed. This was confirmed through comment cards and talking to people. There are links with the Community Psychiatric Nurses for those who need them. The Chiropodist visits regularly. The manager discussed the need to review the system of care plan documentation and this will be done in the next six months. In the mean time there should be evidence that care plans are reviewed monthly and that people The Dene Lodge DS0000016025.V341931.R01.S.doc Version 5.2 Page 11 are involved in the production of the initial care plan. There should be a system of showing that short term healthcare needs have been addressed for example when a urine infection has been identified and dealt with or when a wound has developed or been healed this can only be seen by reading the daily records. It was not clear from the records that people had been weighed monthly. The medication records were generally of a good standard with a need for attention to detail. The manager is accessing a training programme from the pharmacist to up-date staff involved. The Dene Lodge DS0000016025.V341931.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is good. People are able to make choices about their day-to-day lives. Visitors are always made welcome in the home. People enjoy the food provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People were observed during the inspection spending their time in different ways. Several people were reading newspapers in their rooms. Another person was doing word puzzles. Others were in the sitting room where the film Casablanca was being shown. The activities co-ordinator was talking to people. It is suggested that a published programme for key activities is helpful as it enables people to make choices and plan. The current system of consulting people and offering activities requested at the time is also valuable. This does not Visitors are welcome in the home at any time and there is a quiet space for people to meet if they wish. One person spoke of the peace and quiet in the home. Food was enjoyed by all people who talked to the inspector. A choice is available and food is home cooked. On the day of the inspection lunch was roast chicken with stuffing and fresh vegetables. The appearance of lunch was The Dene Lodge DS0000016025.V341931.R01.S.doc Version 5.2 Page 13 a result of good teamwork in the home. As the cook was on holiday the manager was acting as the cook. When the inspector arrived the role of cook was taken over by another member of staff. One person spoken to would like an occasional cooked breakfast of bacon and egg and the manager agreed to try and find a way to do this. The Dene Lodge DS0000016025.V341931.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome area is good. There is a complaints policy that is clearly written and is accessible to service users and visitors. Managers of the home are aware of the appropriate procedures to be taken to protect service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All people who spoke to the inspector knew who they could talk to if they were worried or had a complaint. There have been no complaints since the last inspection. The manager said it was important to address any issues promptly so that they did not become an issue. Staff have received Protection of Vulnerable Adults training. All staff have POVA and CRB checks prior to commencing work. The Dene Lodge DS0000016025.V341931.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 22 23 24 25 26 Quality in this outcome area is good. People live in a home that is clean and comfortable and meets their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector was able to see most of the bedrooms and all communal areas. The building work is completed and the finish and furnishings in new rooms is of a high standard. A tour of the building showed that the housekeeping staff work had to maintain an excellent standard of cleanliness. People enjoyed the environment. Two people had furnished a large shared room with treasured possessions from home. “It made all the difference having our own things here.” People talked of going into the gardens or new conservatory. Another person who lived in the country all his life enjoyed having a sky light above his bed so he could see the stars. The Dene Lodge DS0000016025.V341931.R01.S.doc Version 5.2 Page 16 At the time of the inspection the courtyard that is to provide a secure outside space for people with dementia has not been provided with furniture or plants. It is important that this facility is completed before people are admitted. New bathrooms and en-suite facilities are well equipped. There is appropriate signage in the new areas and useful adaptations such as lights that come on automatically in toilets. The Dene Lodge DS0000016025.V341931.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is adequate. Staffing levels in the home are good. Staff are competent to provide care to people in the home at this time of inspection. Recruitment practices must be reviewed to ensure people are always protected. The induction programme should be developed further. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were sufficient staff on duty. There is an established staff team. Training has been provided in Manual Handling, Protection of Vulnerable Adults, First Aid and Fire safety. The home has a young person on a Modern Apprenticeship scheme. There have been few new staff in the past year and recruitment to provide for the increase in people expected in the home is to commence. One recruitment file was reviewed. There had been appropriate CRB checks but only one reference had been received. It is recommended that the manager uses a checklist in all recruitment files to ensure all appropriate documents are received prior to the commencement of employment. there was evidence of an induction program but this should be developed in line with the Skills for Care guidance. There is evidence that people receive manual handling training. The training of an “in-house” manual handling trainer was discussed in order to provide induction training for new staff in the home. The Dene Lodge DS0000016025.V341931.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31 32 33 35 36 37 38 Quality in this outcome area is good. The home is well run in the interests of the people in the home. The home is safe and well maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Johnathan Hunt has been in post as manager for twelve months and registered with CSCI since May. He has a variety of care experience and is completing the Registered Manager Award this year. On the day of the inspection the home appeared well managed. As the numbers of people in the home increase it will be important to identify the roles that key staff will undertake in order to ensure all areas of management are covered. Key areas such as training plans, appraisal of staff, recruitment records and induction of new staff will be very demanding in the The Dene Lodge DS0000016025.V341931.R01.S.doc Version 5.2 Page 19 next year. There are experienced staff available and a team approach will enable the home to develop in a successful manner. A review of the system for managing peoples’ money showed clear records. The home finances are managed by the Responsible Individual Julian SykesBrown who visits the home regularly. The inspector observed the results of the annual quality survey. The reviews showed that people were satisfied with the care in the home. It is usual for the results of the survey to be summarised and any action to be taken noted in order for the surveys to form part of a quality assurance system. There was evidence of appraisal and observation of staff in three staff files. . This should be further developed in line with NMS guidance. Three comment cards returned by staff confirmed that they felt they received adequate supervision and that there was always a senior member of staff to confer with. Maintenance records were well organised and indicated key areas are contracted. For example hoists and lifts had been serviced according to LOLER regulations. Fire prevention records were clear and up-to-date. There was evidence that the new building had been completed safely according to regulations. The Dene Lodge DS0000016025.V341931.R01.S.doc Version 5.2 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 2 3 3 The Dene Lodge DS0000016025.V341931.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No 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 OP4 Regulation 18 (1) a Requirement There must be a comprehensive training programme for staff who are to work in the dementia care area. This training should include care planning and practical care of people with dementia. The manager must ensure that key staff are trained prior to the admission of people. Timescale for action 01/10/07 2. OP29 19 £. OP7 15 There must be a recruitment 01/09/07 system in place that ensures two references are received prior to commencement of work with people. Care plans must be audited to 01/10/07 ensure they are regularly reviewed and contain evidence of peoples’ involvement. It must be clear from the plans how short term health needs have been addressed. The Dene Lodge DS0000016025.V341931.R01.S.doc Version 5.2 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 OP7 Good Practice Recommendations The home should develop a training overview so that it is clearly evident when staff have completed training. The manager should review the care plan system to ensure it is suitable for the care of people with dementia. The Dene Lodge DS0000016025.V341931.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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