Inspection on 26/07/05 for The Lodge, Exeter

This inspection was carried out on 26th July 2005.

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 Lodge, Exeter 06/11/08

The Lodge, Exeter 10/11/06

The Lodge, Exeter 29/12/05

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

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 Lodge 22 Spicer Road Exeter Devon EX1 1SY Lead Inspector Rachel Doyle Announced 26 July 2005 th 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 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 Lodge D54-D06 S64453 The Lodge V231696 260705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Lodge Address 22 Spicer Road, Exeter, Devon EX1 1SY 01392 271663 01392 431545 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Elizabeth Finn Homes Ltd Mrs Christine Roberts Care Home 42 Category(ies) of OP - Old Age (42) registration, with number of places The Lodge D54-D06 S64453 The Lodge V231696 260705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 13/01/2005 Brief Description of the Service: The Lodge, close to the centre of Exeter, retains features of what was once one of the city’s grander houses. It has been extended in the past to provide facilities for those requiring nursing care. Three residents are receiving residential care. There are various garden areas, patios and a large courtyard directly accessible from some bedrooms.A major re-building and refurbishment programme is in progress. A new 22 bedded wing has been built and occupied, extensive landscaping and re-furbishment to the original building is now ongoing and there will be up to 18 residents living at the Home in the new wing until the refurbishment is completed in 2006. There will be limited car parking whilst this is in progress.The Home is owned by the Elizabeth Finn Trust, which offers accommodation to people from a professional background. The Lodge D54-D06 S64453 The Lodge V231696 260705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector arrived for the announced inspection at 10.00 and was greeted by the Home Manager who kindly gave the inspector a guided tour of the newly occupied 22-bedded wing. The inspector was able to have access to all relevant documents and was able to also wander freely around the Home. Staff were very helpful and the inspector also took lunch in the dining room along with the majority of the service users in residence, sitting with 3 service users in particular. CSCI received 7 service users comment cards and 8 relatives/representatives comment cards, which were generally positive. There were 17 service users over the age of 83 in residence at the time of the inspection and 1 vacancy. Other rooms are currently being used as office and kitchen space. The inspector spoke to 8 residents in depth, took lunch with the some of the residents in one of the two temporary dining rooms, spoke to 1 relative, the new activity co-ordinator, the manager, 3 staff members and the hotel services manager. It is noted that the move of all facilities, residents and staff to the new wing has been a stressful time. One relative commented that ‘the staff have all been wonderful about the move’ and the manager and all staff have worked very hard. Unfortunately two issues were raised by many residents and relatives, which had affected resident’s ability to settle in well. The previous activity coordinator had unavoidably left just prior to the move and the Home had been fortunate in appointing the new activity co-ordinator who had been in post for the last two weeks. They were now developing an excellent activity programme in conjunction with residents’ ideas. Unavoidably, the period of recruiting had meant that residents had had little organised activity input during the first few weeks of their time in the new wing. Additional to this there had been a problem with connecting residents’ private telephones in their rooms for some weeks resulting in a negative effect on residents’ quality of life and ability to remain in contact with their family and friends. This was the main cause of concern for the majority of residents and relatives. The problem with the phone connection was discussed in depth with the manager who also discussed this with the Project Manager, who offered to supply detailed information as to how the home had tried to rectify the problem. It was clear that the problem was solely caused by agencies outside the Home and that the Home had done everything they could to impress on these agencies the importance of resolving the phone connection problem as soon as possible. The Home had dealt with the ensuing residents’ and relatives’ complaints and enquiries sensitively and efficiently during a busy and unsettling time for all concerned. Therefore it was felt that no requirements relating to these matters were appropriate. The Lodge D54-D06 S64453 The Lodge V231696 260705 Stage 4.doc Version 1.30 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The Home has no requirements. Care planning is excellent in general although some short-term problems and wound care actions could be made clearer. Almost all fire doors in the new wing are able to be safely left open except the lounge doors which are difficult for staff and residents to easily use independently. The Lodge D54-D06 S64453 The Lodge V231696 260705 Stage 4.doc Version 1.30 Page 7 Access to COSHH itmes should be formally risk assessed. Priority should be given to making residents’ rooms as homely as possible following the move. 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 Lodge D54-D06 S64453 The Lodge V231696 260705 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Lodge D54-D06 S64453 The Lodge V231696 260705 Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4, 5, 6 Residents benefit from good admission and assessment practice which ensures that the Home can meet their needs. EVIDENCE: The Home brochure and Statement of Purpose both re-iterate that the Home encourages service users to retain as much independence and mobility as possible. Staff spoken to and practice observed during the inspection confirmed this ethos. Service users spoken to felt that staff were able to meet their needs. Staff spoken to were knowledgeable about service users needs, including one kitchen staff and there was evidence that healthcare professionals were accessed appropriately. Records were meticulously kept both on paper and using the computer system. Admission is by application to the Trust and Home committee. The manager conducts a thorough home or hospital assessment and makes a final decision ensuring that the Home can meet the person’s needs in line with existing residents. The Home does not provide intermediate care. The Lodge D54-D06 S64453 The Lodge V231696 260705 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10, 11 Residents’ health needs are well met with evidence of good multidisciplinary working taking place on a regular basis. Staff offer care in a way that maintains and promotes residents’ privacy, dignity and independence. EVIDENCE: Care planning is excellent in general although some short term problems such as communication issues and individual wound care actions could be made clearer. Some daily notes did not relate to care plans. Three hard copy care files were looked and one on the computer. There were excellent resident/relative involvement forms and carers said that they assist the seniors in planning care. Staff were very aware of residents’ needs in detail. There were good summaries of the identified problems with clear actions cross referenced to risk assessments. Staff sign the diary to say that they have received up to date information such as residents’ health care appointments including GP and audiology. The Home uses the MUST nutrition tool and Waterlow score in conjunction with pressure area care. All staff treat residents with care and respect maintaining privacy. Residents confirmed this. Medication administration and record keeping is excellent including individalised homely remedy records and self medication reviews. Storage is purpose built and the Home have arranged a new disposal system. The Lodge D54-D06 S64453 The Lodge V231696 260705 Stage 4.doc Version 1.30 Page 11 Records relating to spiritual wishes and care of the dying are excellent with information of where more detailed wishes are recorded and contacts. The Lodge D54-D06 S64453 The Lodge V231696 260705 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 Social activities are well managed, creative and provide choice and interest for those living at the Home and residents are able to exercise choice and control over their lives. Residents’ contact with friends and relatives is encouraged and faccilitated by staff to the best of their ability. (see summary). The Hotel Service at the Home caters for individual tastes and provides an excellent varied menu and delivery to a very high standard. EVIDENCE: The new activity organiser is very enthusiatic and is consulting all the residents about what activities they would like and offering suggestions. There are detailed individualised records and the July programme includes games afternoons, quizzes, pamper sessions, craft and current affairs. External trips will resume weekly when the driver returns from holiday. Records relating to relatives phone calls were clearly listed and issues relating to visits. Visiting times are open. Resident choices are respected such as choices relating to routines and personal care and access to the grounds in relation to risk assessments. All residents felt that they could live as they wished at the Home. The standard of meal provison continues to be high from the temporary kitchen, which is commendable. All residents commented on the good food and choice. Staff were attentive during the meals and assisted with sensitivity. The Lodge D54-D06 S64453 The Lodge V231696 260705 Stage 4.doc Version 1.30 Page 13 The Lodge D54-D06 S64453 The Lodge V231696 260705 Stage 4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 Complaints are handled well and recorded thoroughly giving residents confidence that any issues raised will be taken seriously. Residents and staff are protected from abuse by sound policies and procedures. EVIDENCE: The complaint book was seen and any issues raised by relatives or residents were seen to be logged and actioned appropriately. One complaint related to health and safety and this was dealt with effectively with the residents’ needs being the focus. There is a comprehensive complaints procedure which is acceible to residents. All residents felt that they were listened to by staff. All staff are booked to attend a training programme for Protection of Vulnerable Adults. The Alerters’ Guide was at the nurses’ stations and No Secrets. There were clear records relating to Abuse to Staff issues and appropriate multidisciplinary involvement. 1 carer told the inspector that they had studied abuse issues withint their NVQ and other staff were also aware of the procedures. The Lodge D54-D06 S64453 The Lodge V231696 260705 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 26 Residents are provided with safe, comfortable and clean surroundings decorated to a high standard. Some residents do not have their possessions displayed as they would like since the move. EVIDENCE: The new purpose built wing currently accomodates up to 18 residents over two floors. It is bright and airy with a well equipped communal lounge on each floor, which are also used for activities. The two temporary dining rooms in the main house have been made comfortable and attractive. There is a temporary entrance at the rear of the new wing whilst building work continues. A beautiful landscaped garden and central courtyard are now accessible. Rooms have begun to be personalised by residents since the move but some felt that their possessions such as precious sentimental items should be able to be displayed to help them settle in. The Home has shelves and picture hanging on their ‘jobs’ list. There are a wide range of appropriate adaptations and décor is to an excellent standard throughout, some of which was able to be chosen by residents. The Home was full of fresh flowers and was clean and hygenic. The Lodge D54-D06 S64453 The Lodge V231696 260705 Stage 4.doc Version 1.30 Page 16 The Lodge D54-D06 S64453 The Lodge V231696 260705 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 30 Residents benefit from having skilled experienced and friendly staff who have a good understanding of their needs. EVIDENCE: The Home has a staff complement in excess of CSCI guidelines and intends to keep these numbers throughout the re-furbishment programme.Residents felt that their needs were well met (see summary). The staff team is stable and there is a low turnover. Staff were easily found around the Home and there is a well equipped nurses’ station on each floor. Call bells were seen to be answered promptly and staff carry pagers. Staff attend a wide variety of relevant study days. All staff felt that there was excellent training and support from the management. Issues raised by staff are addressed and appropriate training sought. One staff member praised the in-house assessor. All residents praised the staff for their good work. The Lodge D54-D06 S64453 The Lodge V231696 260705 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 37, 38 There are generally reliable systems in place to ensure the good health and welfare of residents. EVIDENCE: Mandatory training is all up to date. Fire equipment, electrics and other adaptations are new and recently checked. Records were all clear and regularly updated and stored appropriately. Accident forms were completed with clear details of actions taken. The quality assurance audit system is now in place and questionnaires have been sent out although these are not easily able to be returned anonymously. All residents are able to participate in some way and letters are also sent to relatives. All water outlets are thermostatically regulated and all radiators are covered. Most fire doors are able to be left open safely except the lounge doors which are heavy.Standard 26 will be inspected at the next inspection. COSHH items are kept in a cupboard where the key is accessible. The Lodge D54-D06 S64453 The Lodge V231696 260705 Stage 4.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 3 15 4 COMPLAINTS AND PROTECTION 3 3 3 3 3 2 3 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x 3 x x x 3 2 The Lodge D54-D06 S64453 The Lodge V231696 260705 Stage 4.doc Version 1.30 Page 20 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 7 Good Practice Recommendations It is recommended that all issues requiring action including short term issues such as wounds and communication problems are clearly identified within care plans and that daily notes relate to care plans. It is recommended that priority following the move is given to ensuring that residents rooms are personalised as residents wish such as shelving and picture hanging. It is recommended that the lounge fire doors are able to be left open safely to facilitate residents mobility. It is recommended that the accessibility of COSHH storage keys is risk assessed formally. 2. 3. 4. 24 38 38 The Lodge D54-D06 S64453 The Lodge V231696 260705 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Exeter Office, Suites 1 & 7 Renslade House Bonhay Road EXETER, EX4 3AY 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 Lodge D54-D06 S64453 The Lodge V231696 260705 Stage 4.doc Version 1.30 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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