Inspection on 06/10/09 for The Dene Lodge

This inspection was carried out on 6th October 2009.

CQC found this care home to be providing an Adequate service.

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 08/04/09

The Dene Lodge 17/08/07

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 26/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE The Dene Lodge Bircham Road Alcombe Minehead Somerset TA24 6BQ Lead Inspector Jane Poole Key Additional Inspection 6th October 2009 09:45 DS0000016025.V377912.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. The Dene Lodge DS0000016025.V377912.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address The Dene Lodge DS0000016025.V377912.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 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.V377912.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. 8th April 2009 2. Date of last key 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. Accommodation is arranged on three floors with the communal areas located on the ground floor. The home has two through floor passenger lifts 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. The home is owned by Hazelgate Ltd and there is currently no registered manager in post. The Dene Lodge DS0000016025.V377912.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of this inspection visit was to inspect relevant key standards under the Commissions Inspecting for Better Lives 2 framework. This focuses on outcomes for people and measures the quality of the service under four general headings. These are:- excellent, good, adequate and poor. Since the last key inspection We, The Commission, have carried out 3 random inspections and met with the provider. Some evidence from random inspections has been included in this report. This inspection was carried out by two inspectors over a one day period. 12 people were living at the home at the time of this key inspection. During the inspection we were able to speak with people living and working at the home, tour the building, view records and observe care practices. 5 visitors, including one healthcare professional, were spoken with during the day. 3 relatives completed questionnaires on behalf of people living at the home prior to the inspection. Some of their comments have been included in this report. We were given unrestricted access to all areas of the home and all records requested were made available. Since the last inspection the registered manager has left the home and a general manager has been appointed. The general manager is responsible for all systems and procedures and has substantial experience of care home environments. They are not qualified to plan and implement care and therefore an acting care manager has been appointed to oversee day to day care. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the service does well: The Dene Lodge provides a comfortable and clean environment for the people who live there. There are shops nearby and access to public transport. The Dene Lodge DS0000016025.V377912.R01.S.doc Version 5.2 Page 6 Communal areas of the home include a spacious dining room and conservatory that overlook the garden. Bedrooms are well presented and people are able to personalise them to their own tastes and needs. People have unrestricted access to their rooms and communal rooms in their part of the home. Visitors are always made welcome and people are able to see personal and professional visitors in the privacy of their rooms. Throughout the day it was observed that staff interacted with people in a friendly and respectful manner. People were assisted in a manner which promoted their dignity. A hairdresser visits the home regularly and everyone seen was well presented. What has improved since the last inspection? The general manager has bought leadership and direction to the home which has resulted in many improvements to the service. They demonstrate a commitment to ongoing improvement and further development of the service and care offered. People living at the home are now within the category of registration and staff felt that they had the skills and experience to care for everyone currently living there. Daily records seen gave evidence that the healthcare needs of people are being monitored and appointments made with appropriate healthcare professionals in a timely manner. Since the last inspection staff training has improved. The home has made contact with training advisors and staff are undertaking certificated distance learning courses. Each member of staff now has a personal development plan which sets out the training that they are expected to undertake with timescales. A training matrix has been created to clearly show which staff have received which training. Since the last inspection all staff have received training in fire safety and moving and handling. Senior staff and night staff have up to date certificates in first aid. The majority of staff have completed or commenced training in the care of people who have a dementia. At the time of the last key inspection night staff were based in the main part of the home leaving the Exmoor unit without staff for periods of time. This was particularly concerning as the majority of people were unable to use their call bells to summon help and could not leave the unit as it is locked by an electronic key pad. This practice has now changed and there is a member of night staff in each part of the building. The Dene Lodge DS0000016025.V377912.R01.S.doc Version 5.2 Page 7 An activities worker has been employed and this has improved social stimulation for people living at the home. The main dining room has been improved by the addition of tablecloths, table decorations and other homely touches. Staff are now available during mealtimes to offer support and monitor the food eaten by people. There are now facilities for tea and coffee making in the Exmoor unit to ensure that people are able to have drinks at anytime of the day or night. There have been some improvements to medication administration practices but further improvements are required to ensure safe practice and make sure everyone receives their medication in line with their prescription. What they could do better: There are 3 outstanding requirements and a further 4 have been made as a result of this inspection. 4 recommendations for good practice have also been made. There was no evidence that the most recent resident had had their needs assessed before being offered a place at the home. There was therefore no way of telling how the decision that the home was able to meet their needs and expectations had been made. Care plans at the home are based on an assessment model and do not give clear guidelines for staff to support people with their needs. This means that in many instances interventions to promote healthcare are not being monitored and evaluated. Risk assessments relating to falls and nutrition have been completed but where a risk is identified no plan of action has been put in place. There are no care plans in place regarding the night care needs of people and no recorded information about peoples preferred routines or wishes. An informal audit of care plans has begun but as yet no robust care plans have been put in place. An accident audit form has been created but again this has not been put into practice. The home must formalise their quality assurance systems in respect of day to day care and care documentation. This is to ensure that any shortfalls in this area are identified and action taken to promote good health and independence. The medication administration and recording has improved but there is room for further improvement. One person, who is prescribed a pain relief patch weekly, had not had this administered at the correct time. This places the person at risk of unnecessary pain and discomfort. Staff have completed some training courses since the last inspection and a development plan for each person has been completed. To ensure that staff have appropriate, up to date, skills this training needs to be ongoing. The The Dene Lodge DS0000016025.V377912.R01.S.doc Version 5.2 Page 8 home offers care to some people who require care because of a dementia and staff need to have up to date, ongoing training in this area to enable them to deliver this specialist service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. The Dene Lodge DS0000016025.V377912.R01.S.doc Version 5.3 Page 9 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.V377912.R01.S.doc Version 5.3 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is adequate information available for people wishing to move to The Dene Lodge. The management team gave assurances that no one moves into the home without having their needs assessed but there was no evidence that an assessment had been carried out with the newest resident. EVIDENCE: The home has an up to date statement of purpose and service user guide. Three questionnaires, completed by relatives on behalf of people living at the home, stated that they had received enough information about the home. The Dene Lodge DS0000016025.V377912.R01.S.doc Version 5.3 Page 11 Since the last inspection one permanent resident has moved in. The person had been living at the home for approximately six weeks. We looked at the documentation for this person. Their personal file contained no evidence that a pre-admission assessment had been carried out and therefore it was difficult to tell how information about their needs had been obtained. There was no photograph or description of the person and no inventory of personal possessions bought to the home. A falls risk assessment indicated that the person was at high risk of falls but there was no care plan in place to minimise or monitor falls. A nutritional assessment stated that the person was average weight and had a usual appetite. The new person was seen and spoken with, they were very slightly built and frail. Although the personal file contained some information about the person there was no clear guidance for staff about how the person should be assisted or their preferred daily routines. The management team gave assurances that there is a pre admission process and the person would have had their needs assessed before moving to the home. Since the last key inspection a number of people have had their needs reassessed and have moved to alternative accommodation more suitable to meet their needs. Staff spoken with felt that they had the skills and experience to care for the people now living at the home. The Dene Lodge DS0000016025.V377912.R01.S.doc Version 5.3 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans do not give sufficient information to ensure that people receive care according to their personal needs and preferences. People have access to healthcare professionals from outside the home. Medication administration practices have improved but further improvements are needed to make sure that people always receive medication as prescribed. EVIDENCE: At this inspection 3 personal files were looked at in detail. Others were sampled and seen at previous random inspections. There has been little improvement in the care plans since the last inspection. Care plans are based on an assessment model and do not give clear guidance for staff to support people with their needs. People who’s assessments indicated that they were at The Dene Lodge DS0000016025.V377912.R01.S.doc Version 5.3 Page 13 high risk of falls or required nutritional support did not have care plans in place to show what actions the home would take in response to these risks. One personal file had incorrect information relating to the persons doctor. The care plan entry relating to nutrition said “needs to be encouraged to eat.” There was no information about how this person should be encouraged or their food likes and dislikes. It was noted that the persons’ food intake was being recorded but there was no care plan to say why this was being done or how it would be evaluated. Another person had osteoporosis but there was no care plan in place for the management of this or possible associated pain. In some instances there were just observations which did not form a care plan. In one persons file under ‘psychological problems’ it stated that due to dementia the person repeatedly asked to go to bed and that the home try to distract her. This is a statement and not a care plan that gives guidance for staff. Food and fluid charts seen had not been evaluated to show the daily intake of the person. There was no guidance to state what was considered an adequate intake or what steps to take if this was not met. There were no care plans for the support that people required at night and no clear information about peoples preferred routines or preferences. The acting care manager gave evidence that they have begun to audit the personal files but as yet no robust care plans have been put in place for anyone. Daily records written by care staff demonstrated that health was being monitored and appropriate professionals were involved. Recordings were not always consistent. For example one person was taken to casualty, after an accident, where it was requested that the person be closely observed. There was no entry in the running records to suggest any observations had been undertaken and no further mention of the accident. A new format to monitor accidents and ensure that after care is provided has been devised but not yet put into practice. All appointments with medical professionals are recorded and these showed that people had access to GPs and community nurses according to their individual need. We spoke to one visiting professional who stated that they were satisfied with the overall care that their client received and felt that there had been improvements. It was observed that people were able to see personal and professional visitors in the privacy of their rooms. Staff interacted with people in a kind and respectful manner. The Dene Lodge DS0000016025.V377912.R01.S.doc Version 5.3 Page 14 A random inspection was carried out by the pharmacy inspector from the Commission in May this year. A number of requirements were made to improve practice and ensure that people received their medication as prescribed. Medication and Medication Administration Records were viewed again at this inspection and improvements were noted although there were still some gaps in the signing of records. Controlled drugs were viewed and these shown that one person who had a pain relieving patch applied weekly had not received this medication. This places the person at risk of unnecessary pain and discomfort. The home has suitable storage facilities for all medication including medication that requires refrigeration. The temperature of the fridge should be between 2 and 8 degrees centigrade and although the temperature is taken daily staff are consistently recording temperatures outside this range without making adjustments to the fridge. The Dene Lodge DS0000016025.V377912.R01.S.doc Version 5.3 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There have been great improvements in the lunch time experience, the dining room is more inviting and staff are on hand to offer support and encouragement. The employment of an activity worker means there is now greater social stimulation for people who live at the home. Visitors are welcome at all times. EVIDENCE: Since the last inspection an activity worker has been employed on a part time basis. The worker is enthusiastic about their role and is tailoring activities towards individual interests. There are some group activities and some one to one sessions for those who do not wish to join in. For example some people have been taken out to town, one person has been painting, another has The Dene Lodge DS0000016025.V377912.R01.S.doc Version 5.3 Page 16 enjoyed cleaning brass and others have joined in organised activities such as quizzes and bingo. People living at the home, and relatives spoken with, were positive about the increased activity and social stimulation now available in the home. There is room for further improvements in the provision of social activities. Care staff should understand that part of their role is to encourage and support people with social activities and personal interests. Visitors said that they were always made welcome and there were no restrictions on visiting times. Some people continue to enjoy going out with friends and family. It was observed that people were able to make choices about how they spent their time. Some people use the communal areas and others prefer to spend time in the privacy of their rooms. People have unrestricted access to their personal rooms and communal areas in their part of the home. One person said that they liked to spend the morning quietly in their room and then join other people at lunch-time. Care staff working in the main part of the home work in a task centred way and there is limited social interaction when tasks are not being performed. It was observed in the Exmoor unit that there is constant interaction between the staff member and the people who live there. The main dining room is on the ground floor with a lounge/diner in the Exmoor unit. The main dining room has been improved with the addition of table cloths and table decorations, which gives it a much more welcoming feel. There is a 4 week menu which offers a choice at each meal. The days’ menu is displayed in the main dining room but not in the Exmoor unit. The lunch time experience was observed and great improvements have been made since the last key inspection. At this inspection staff sat with people living at the home to encourage and prompt them with their meal. There were drinks on tables to enable people to help themselves. Meals are still served plated and it was difficult to tell how people made choices about vegetables or portion sizes. It was observed that one person chose not to eat with others and their meal was bought to them in the lounge. The Dene Lodge DS0000016025.V377912.R01.S.doc Version 5.3 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has suitable policies and procedures in place to minimise the risks of abuse to people living at the home. EVIDENCE: The home has policies and procedures in respect of making a complaint, recognising and reporting abuse and whistle blowing. The complaints procedure is displayed in the home. People who completed questionnaires stated that they knew who to speak to informally and how to make a formal complaint if they were unhappy about the care provided. No complaints have been made since the last inspection. People living at the home stated that they would be comfortable to raise any concerns with a member of staff and relatives said that the home’s management was approachable and listened to any concerns raised. Since the last inspection a training and development plan has been put in place for all staff to ensure that everyone receives training in the protection of vulnerable adults with the next two months. The Dene Lodge DS0000016025.V377912.R01.S.doc Version 5.3 Page 18 We saw evidence that staff supervision is used to address issues of staff attitude and practice which may be detrimental to people living at the home. As a result of the poor rating awarded at the last key inspection the home has been subject to the Local Authorities safeguarding procedures. The home has co-operated in this process and actioned recommendations made. The Dene Lodge DS0000016025.V377912.R01.S.doc Version 5.3 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable and clean environment for the people who live there. EVIDENCE: The Dene Lodge is a large older style building which has been extended to provide accommodation on three floors. The home is divided into two parts, the main part of the home is able to provide accommodation for up to 27 people and there is a smaller unit, The Exmoor unit, which provides accommodation to up to 6 people who require care due to a dementia. The Exmoor unit is located on the first floor and locked by an electric keypad meaning that people who live in this area do not have unrestricted access to the garden. Staff spoken with stated that they ensure that people are offered The Dene Lodge DS0000016025.V377912.R01.S.doc Version 5.3 Page 20 opportunities to use the garden with staff support. The Exmoor unit does not have kitchen facilities and at the last random inspection a requirement was made to ensure that people have access to drinks at all times. In response to this they have installed tea and coffee making facilities in an unoccupied room until a more permanent solution can be found. The home is within walking distance of some local shops and public transport. All areas are fitted with a fire detection and call bell system. There are no personal risk assessments in place to ensure the safety of people who are unable to summon assistance using the call bell. Since the last inspection the home has redecorated and added additional lighting to some hallways and landings, making them brighter. Some bedrooms have also been redecorated. All bedrooms are currently used for single occupancy but the home is able to accommodate people who wish to share. Bedrooms seen had been personalised to reflect the tastes of the individual residents. The home has a modern laundry which is appropriate to meet the needs of the home. Protective clothing and hand washing facilities are available for staff. On the day of the inspection all areas seen were clean and fresh. The Dene Lodge DS0000016025.V377912.R01.S.doc Version 5.3 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff training in the home is now more organised and all staff are undertaking training to ensure that they have the skills to appropriately support people. Recruitment procedures are safe and minimise the risks of abuse to people who live at the home. EVIDENCE: The home employs 16 care staff, 7 have a National Vocational Qualification (NVQ) in care at level 2 or above. In addition to this 5 ancillary staff are employed. 4 members of the care staff team are senior staff and the home has recently employed an acting care manager to oversee standards of care in the home. At the time of the inspection there were 12 people living at the home. There were 3 care staff on duty and 4 ancillary staff. The general manager, acting care manager and registered provider were also at the home. Staff spoken with stated that there were adequate staff on duty at all times to support the people currently living at the home. The Dene Lodge DS0000016025.V377912.R01.S.doc Version 5.3 Page 22 At the time of the last key inspection night staff were based in the main part of the home leaving the Exmoor unit without staff support for periods of time. This was particularly concerning as the majority of people living there were unable to use their call bells to summon assistance. On the 14th May a random inspection was carried out during the evening and this practice had ceased. There is now one member of staff based in each area of the home throughout the night. Interactions between staff and people living at the home were observed to be kind and polite and requests for assistance were responded to. In the Exmoor unit there was constant interaction between the staff member and people living there and this was very friendly and person centred. In the main part of the home interactions were more task focussed with limited social interaction. For example, in the afternoon 3 people were sat in the lounge with the TV on but there was no interaction from staff until drinks were offered. Since the last inspection staff training has improved. The home has made contact with training advisors and staff are undertaking certificated distance learning courses. Each member of staff now has a personal development plan which sets out the training that they are expected to undertake with timescales. A training matrix has been created to clearly show which staff have received which training. Since the last inspection all staff have received training in fire safety and moving and handling. Senior staff and night staff have up to date certificates in first aid. The majority of staff have completed or commenced training in the care of people who have a dementia. If the home is offering a specialist service to people with dementia care needs this training needs to be ongoing. Staff spoken with during the inspection felt that there was now more leadership in the home and everyone was working as a team to improve standards. The recruitment files of the two most recently appointed members of staff were viewed these gave evidence of a thorough recruitment process which minimises the risks of abuse to people living at the home. Where people had begun work before full Criminal Records Bureau (CRB) checks had been received, Protection Of Vulnerable Adults (POVA) checks had been carried out and risk assessments put in place. The Dene Lodge DS0000016025.V377912.R01.S.doc Version 5.3 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The general manager gives clear leadership and direction to the home. Quality assurance systems need to include the formal monitoring of care practices to ensure that improvements needed are identified and appropriate action taken. EVIDENCE: There is currently no registered manager at the home. A general manager is in post and the home has recently employed an acting care manager. The general manager has bought organisation and leadership to the home which has The Dene Lodge DS0000016025.V377912.R01.S.doc Version 5.3 Page 24 resulted in many improvements. Information, including policies and procedures, has been updated and systems have been put in place. To gauge peoples’ views, and share information, meetings have been held for people living and working at the home. The home has also sent out questionnaires to relatives. Returned forms showed that people were generally happy with the service provided and acknowledged recent improvements. As part of the quality monitoring in the home the registered provider is now recording the findings of visits made. To ensure that all parts of the home are safe and comfortable health and safety audits are carried out and recorded. All fire safety and lifting equipment is regularly tested and serviced. The acting care manager has begun auditing the quality of care and the documentation relating to day to day care. To date these procedures have not been formalised and so there is currently no way to analyse findings to influence changes needed. Accidents are being recorded and again an audit procedure has been developed but not yet put into practice. The home does not act as a power of attorney, or financial appointee, for anyone living there. They do hold small amounts of personal money to ensure people have access to money whilst living at The Dene. Clear records are kept of money held on other peoples’ behalf and these have recently been audited. Certificates of insurance and registration are displayed. The Dene Lodge DS0000016025.V377912.R01.S.doc Version 5.3 Page 25 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 1 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 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 2 3 3 3 x x 3 x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 2 x 3 2 x 3 The Dene Lodge DS0000016025.V377912.R01.S.doc Version 5.3 Page 26 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) Requirement The home must ensure that people receive their medicine as prescribed to protect their wellbeing. Arrangements must be made to ensure that when entries are hand written on the MAR Sheet a safe system is used. This is to ensure that the records of administration are accurate. (Requirement previously made 15/05/09) Timescale for action 10/10/09 2 OP16 22 The registered person must ensure that all complaints are dealt with using the homes complaints policy. This is required to ensure that people are protected from any risks and that the home is proactive in addressing any issues raised. ( This requirement was made at the previous inspection 8/04/09 DS0000016025.V377912.R01.S.doc 08/10/09 The Dene Lodge Version 5.3 Page 27 3 OP31 12 4 OP3 14 (1) and has not been inspected on this occasion) The registered person is required to ensure that care provided at the home is monitored and audited to ensure good practice is maintained. This is required for the health, safety and well being of people using the service. (This requirement was made at the previous key inspection and the timescale of 08/06/09 has not been met) The registered person must ensure that anyone wishing to move to the home has their needs assessed by a suitably qualified person. 31/10/09 31/10/09 5 OP7 15(1) To ensure that the home has the skills and experience to meet the needs and expectations any new residents. The registered person must 30/11/09 ensure that care plans clearly set out the needs of people and the action to be taken by staff to address needs. Care plans must be measurable to ensure that their effectiveness can be monitored. The plans must also record the wishes and preferred routines of people living at the home. This is to ensure that everyone receives appropriate care in their chosen manner. The registered person must ensure that there is an ongoing training programme for all staff. To ensure that staff have up to date knowledge and skills and provide the specialist service as identified in the statement of 6 OP30 18(1) [a] 31/12/09 The Dene Lodge DS0000016025.V377912.R01.S.doc Version 5.3 Page 28 7 OP33 24 (1) purpose. The quality assurance systems must include the formal auditing of care practices and documentation. To ensure that shortfalls are identified and action taken to improve services. 30/11/09 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 3 4 Refer to Standard OP22 OP12 OP15 OP15 Good Practice Recommendations The home should review the call bell system, undertake a risk assessment for each person and provide a suitable means for people to call for assistance, when needed. Care staff should be encouraged to socialise with people to increase the social stimulation when the activity worker is not at the home. The menu should be displayed in the Exmoor unit so that people know what the days’ meals are. The home should consider the use of serving dishes on tables to enable people to make choices about food and portion size. The Dene Lodge DS0000016025.V377912.R01.S.doc Version 5.3 Page 29 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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