Inspection on 05/07/06 for The Dene Lodge

This inspection was carried out on 5th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

The Dene Lodge 06/10/09

The Dene Lodge 08/04/09

The Dene Lodge 17/08/07

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 Alison Philpott Unannounced Inspection 5th July 2006 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.V301635.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.V301635.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 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 MRS PATRICIA ELIZABETH PALMER Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places The Dene Lodge DS0000016025.V301635.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 02/12/05 Brief Description of the Service: The Dene Lodge is a care home proving care and support for up to 18 people over the age of 65 years, with a wide range of support needs. The home is located at 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. Pat Palmer who is supported by a small staff team manages the home. The current fee range is £361 to £473 per week. The Dene Lodge DS0000016025.V301635.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The previous inspection took place on 2 December 2005. This unannounced key inspection took place over 7.5 hours on 5 July 2006. Mrs Pat Haden, Deputy Manager was available throughout the inspection. There were twelve residents living in the home. During the inspection, seven residents and three members of staff were spoken with. The Inspector viewed the home. There was a comfortable and homely atmosphere. Staff were friendly and were observed being kind and caring toward residents. The home is currently extending its facilities to provide further bedrooms and communal space. Building works were taking place during the inspection. Staff were committed to ensuring that residents were comfortable and that any disturbance was minimised. Records viewed included care plans; health and safety; accidents; medication; staff recruitment & training; and quality assurance. The Inspector would like to thank the residents and staff for their involvement and participation in the inspection process. As a result of this inspection the home has 4 requirements and 3 recommendations. What the service does well: Residents living in the home are happy with the care and support that they receive. Care plans are comprehensive and detailed. They generally provide clear information for staff to follow in order to meet resident’s needs appropriately. Residents enjoy their meals. The food is home cooked and plentiful. Staff are kind and caring. Staff respect resident’s privacy and were observed offering support and choices to residents. The home was clean and provides a homely environment with comfortable furnishings. There was a pleasant and relaxed atmosphere and staff were observed chatting with residents. The Dene Lodge DS0000016025.V301635.R01.S.doc Version 5.2 Page 6 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 Dene Lodge DS0000016025.V301635.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.V301635.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, 6. The quality in this outcome area is good. The home ensures that the needs of prospective residents can be met appropriately. EVIDENCE: The inspector viewed a pre-admission assessment for a new resident. This was comprehensive and detailed. When prospective residents are referred through Social Services, a copy of the care plan is obtained. The home encourages prospective residents to visit the home for the day prior to admission and move in on a four week trial. If a prospective resident is in hospital, the manager will visit them and undertake an assessment. The manager ensures that prospective resident’s needs can be met appropriately. The home has not introduced intermediate care since the last inspection. The Dene Lodge DS0000016025.V301635.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. The quality in this outcome area is adequate. Care plans are comprehensive and detailed. Medication is stored securely. The medication administration record sheets currently in use do not protect residents. Staff respect resident’s privacy and dignity. EVIDENCE: The Inspector viewed three care plans. These contained clear and detailed information for staff to follow in order to meet resident’s healthcare & social needs. Individual care plans are reviewed monthly and updated where necessary. One care plan viewed was for a new resident. This was still being generated from the pre-admission assessment. A risk of falls had been identified. The deputy manager was advised that a detailed risk assessment relating to falls would need to be completed, to minimise the risk of harm to The Dene Lodge DS0000016025.V301635.R01.S.doc Version 5.2 Page 10 the resident. Some areas of assistance with personal care were yet to be completed. These should provide detailed guidance for staff to follow. Residents have access to a range of professionals including GP, District Nurse, Dentist, Social Worker, Optician and Chiropodist. The home has a designated member of staff who supervises medication procedures. Medication is stored securely. Resident’s photographs were included with each Medication Administration Record (MAR) Sheet. The MAR sheets were fully completed. The MAR sheets had been hole punched so that they could be filed. However, due to the layout of the sheet on many occasions the hole was taking out the name of the medication and the directions. The home must ensure that all of the information is legible. The deputy manager advised that she would be contacting the pharmacist. Hand transcribed MAR Sheets contained two signatures and were dated. On one occasion, the maximum dose for Paracetamol had not been stated. The home should ensure that this is written onto the MAR sheet. The home had recorded variable doses of medication, on some occasions. The inspector advised that the home should record variable doses on a separate sheet so that staff can clearly see the quantity that has been administered. The home has produced a list of the medicines that each resident takes. The home has a staff signature list to identify the staff who administer medication. Staff identified on the list have all completed medication training. Staff spoken with demonstrated a good awareness of how to respect resident’s privacy and dignity. Residents confirmed that they are treated with respect. Some residents have chosen to have a private telephone line in their bedroom. The Dene Lodge DS0000016025.V301635.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. The quality in this outcome area is good. The home has its own activities co-ordinator. Visitors to the home are made to feel welcome. Residents are very happy with the food at the home and the choices available to them. EVIDENCE: The inspector spoke with the home’s activities co-ordinator. The home has an activities programme that is displayed in the lounge. The activities coordinator maintains a file that contains a record of activities. Activities included exercise; music; films; scrap books; group chats; and short trips out. The co-ordinator involves residents by asking what they would like to do. For the residents who choose to spend time in their rooms, the activities coordinator will visit them and provide support with activities or have a chat. Residents are able to attend the local church service. The Inspector observed warm and friendly interaction between staff and residents. One resident commented “the staff are wonderful, smiley and pleasant”. The Dene Lodge DS0000016025.V301635.R01.S.doc Version 5.2 Page 12 All residents spoken to confirmed that their visitors are made to feel welcome at the home. The Inspector observed staff offering resident choices throughout the day. Residents confirmed that they can spend their time as they want to and that they are given choices. Resident’s rooms are homely and personalised with their own possessions. Residents can access their personal records on request in accordance with the Data Protection Act 1998. The home has a four week menu. The tables in the dining room were laid attractively for lunch. All residents spoken with confirmed that the food is very good and there is always a choice of dishes. The food is home baked, nutritious and plentiful. The home purchases quality fresh produce locally. An alternative menu is available for residents who have special dietary requirements. The residents confirmed that they all enjoyed their lunch. The Dene Lodge DS0000016025.V301635.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 The quality in this outcome area is good. The home has a clear complaints procedure. Residents are protected from the risk of harm and abuse. EVIDENCE: The home has a comprehensive complaints procedure that includes a form for logging the complaint details and a letter of acknowledgement for the complainant. The home had not received any complaints since the last inspection. Residents confirmed that they knew who to speak to if they had any concerns. The staff file viewed contained a POVA first check and completed CRB disclosure check. Staff spoken with demonstrated a good awareness of the steps to take if they witnessed or discovered abuse. The Dene Lodge DS0000016025.V301635.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, 21, 25, 26. The quality in this outcome area is adequate. The home provides a homely environment with comfortable furnishings. The home does not provide sufficient bathing facilities for residents. The home was clean. The home has systems in place to control the spread of infection. EVIDENCE: The home is currently being extended to provide further facilities including bedrooms, bathrooms, a laundry room and communal space. There is currently limited access to the front of the home due to the building works. The home has access at the rear of the property. Building works were taking place during the inspection. The inspector observed that staff were committed to ensuring that residents were comfortable and that any disturbance was minimised. The Dene Lodge DS0000016025.V301635.R01.S.doc Version 5.2 Page 15 The Inspector viewed the home. The environment is well maintained and homely with comfortable furnishings. The home has a pleasant lounge and dining area. The garden was well maintained. A carpet on one of the landings had a large unsightly stain. The home has tried to clean the carpet but the stain cannot be removed. The manager advised that the home has a plan to renew the carpeting in the home, as part of the current works. This will be followed up at future inspections. The home currently has one communal bathroom with an assisted bath and a level access shower for all residents. The deputy manager confirmed that once the extension to the home is completed, sufficient bathing facilities will be provided for residents. The baths in en-suites are unsuitable for residents living at the home and have been disabled. The hot water temperatures in resident’s en-suites were in excess of 43 degrees Celsius. The home has placed signs next to the sink to warn residents that the water is very hot. The home has not undertaken risk assessments relating to this. The home must undertake a detailed risk assessment for each resident. The manager advised that the home is currently obtaining quotes for thermostatic mixing valves to regulate the water temperature. The provider will need to submit an improvement plan detailing how the home proposes to manage the hot water temperatures and protect residents from the risk of scalding. The home was clean and smelt fresh throughout. Aprons and gloves were available for staff. Staff were observed wearing aprons. Liquid soap and hand towels were provided. A bottle of alcohol gel was available in the entrance area for visitors to the home. During the inspection, the laundry was being resited to a temporary area due to the building works. The washing machine had been connected and a sink had been installed for hand washing. The Dene Lodge DS0000016025.V301635.R01.S.doc Version 5.2 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, 29, 30. The quality in this area is good. The home appeared to have sufficient staff on duty to meet resident’s needs. Staff recruitment procedures are robust and protect residents. Staff are encouraged to undertake NVQ training. EVIDENCE: The inspector viewed the rotas. There were sufficient staff on duty during the inspection to ensure that resident’s needs were met. The home employs three care staff in the morning; two care staff in the afternoon and two care staff at night. Residents confirmed that staff are available when assistance is required. New staff had been recruited since the last inspection. One staff file was viewed. This included all of the required documentation listed in Schedule 2 of the Care Homes Regulations 2001. The home’s application form contained a generalised health section. Further to discussions with the deputy manager, the inspector advised the home to implement a more detailed health questionnaire to ensure that new staff are fit to carry out their duties. The Dene Lodge DS0000016025.V301635.R01.S.doc Version 5.2 Page 17 Each member of staff has an individual file containing the staff handbook, induction & training record, contract and certificates. Staff sign to confirm that they have received training. This is good practice. Training areas include medication, dementia care, health and safety, first aid, moving and handling, infection control, food hygiene and fire awareness. The home has also planned training in continence care. The inspector recommended that the home introduces a training matrix that provides a clear overview of training undertaken. 60 of the care staff working at the home hold an NVQ at level 2 or above. The home is currently in the process of enrolling eight members of staff on NVQ 3. The Dene Lodge DS0000016025.V301635.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38. The quality in this outcome area is good. The home is well run. The home has quality assurance systems in place and residents views are welcomed. The inspector was unable to view resident’s monies and financial transaction records on the day of inspection. The home is committed to maintaining and improving health and safety. EVIDENCE: Mrs Palmer is the Registered Manager. She has extensive experience in the care industry and has managed the home for six years. Mrs Palmer has The Dene Lodge DS0000016025.V301635.R01.S.doc Version 5.2 Page 19 completed the Registered Managers Award. The manager is supported by a deputy manager who was the person in charge during the inspection. The home has a quality assurance policy. Quality assurance audit forms include areas such as catering, housekeeping, care and administration. The home had recently carried out a service user and visitor satisfaction survey. The inspector viewed the questionnaires. These generally contained very positive responses. Visitors comments included “I feel the home covers every aspect of care with great thought and kindness for everyone concerned”. The home holds small amounts of cash for some residents. The monies are stored securely. However, the inspector was unable to assess the standard fully as no one in the home had access to the monies. This will be followed up at the next inspection. The home’s health and safety records were viewed. The fire alarm system is tested weekly. The last test was carried out on 26.06.06. The home carries out a visual check of fire equipment on a weekly basis. The home has a fire risk assessment and comprehensive fire plans. The fire alarm system was serviced on 05.05.06. Fire extinguishers were serviced on 16.01.06. There had been four accidents since the last inspection. These were fully documented. The home’s accident book complies with the Data Protection Act 1998. The home’s lift and hoist were serviced on 24.05.06. The bath hoist was serviced on 16.01.06. The gas safety check had not been completed. The manager confirmed that the check is due to take place on 18.07.06. The manager agreed to submit the gas safety certificate to the Commission for Social Care Inspection, once the check is completed. The home’s electrical equipment displayed stickers stating portable appliance testing was carried out in March 2005. This testing must be carried out annually and is now overdue. The kitchen was clean and tidy. Fridge and freezer temperatures are checked and recorded daily. Food is temperature probed before serving and records are maintained. The home had a food hygiene inspection on 29.03.06. Cleaning chemicals were stored securely in locked cupboards. Control of substances hazardous to health (COSHH) sheets were available for the products used within the home. The Dene Lodge DS0000016025.V301635.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 3 8 3 9 2 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 X 1 X X X 1 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X N/A X X 2 The Dene Lodge DS0000016025.V301635.R01.S.doc Version 5.2 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. 1. Standard OP9 Regulation 13(2) Timescale for action The home must ensure that all of 12/07/06 the information on the medication administration record sheet is legible. The manager must review the 05/10/06 bathing and showering facilities, including en-suites, to ensure there are adequate facilities to meet the needs of service users and promote privacy and dignity. (This requirement has been previously unmet). • The provider must submit 05/08/06 an improvement plan in relation to how the home will manage the hot water temperatures in en-suites to protect residents from the risk of scalding. • Risk assessments must be undertaken for individual residents. Portable Appliance Testing must 05/10/06 be carried out. Requirement 2. OP21 23 (2)j 3. OP25 13(4)(c) 4. OP38 13(4) The Dene Lodge DS0000016025.V301635.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. Refer to Standard OP9 Good Practice Recommendations Variable doses for medication should be recorded on a separate sheet so that staff can clearly see the quantity that has been administered. • The maximum dose for Paracetamol should be written on hand transcribed medication administration record sheets. The home should devise a more detailed staff health questionnaire. The home should develop a training overview so that it is clearly evident when staff have completed training. • 2. 3. OP29 OP30 The Dene Lodge DS0000016025.V301635.R01.S.doc Version 5.2 Page 23 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 The Dene Lodge DS0000016025.V301635.R01.S.doc Version 5.2 Page 24 - 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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