CARE HOMES FOR OLDER PEOPLE
The Lodge, Exeter The Lodge 22 Spicer Road Exeter Devon EX1 1SY Lead Inspector
Rachel Doyle Unannounced Inspection 29th December 2005 14:50 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 Lodge, Exeter DS0000064453.V268494.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Lodge, Exeter DS0000064453.V268494.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Lodge, Exeter Address The Lodge 22 Spicer Road Exeter Devon EX1 1SY 01392 271663 01392 431545 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) Elizabeth Finn Homes Ltd Mrs Christine Roberts Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places The Lodge, Exeter DS0000064453.V268494.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 26th July 2005 Brief Description of the Service: The Lodge, close to the centre of Exeter, retains features of what was once one of the citys grander houses. It has been extended in the past to provide facilities for those requiring nursing care. Three residents are receiving residential care only. 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 to provide accommodation for up to 42 service users. 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 summer 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 on application. The Lodge, Exeter DS0000064453.V268494.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on Thursday 29th December 2005 from 14.50-17.00. The inspector was welcomed as always by the manager, administrator and staff team. There were 18 residents living at the Home at the time of the inspection. Many were relaxing in their rooms as hot drinks were being provided and 5 others were playing a quiz game with the activities co-ordinator, which the inspector joined in with during the afternoon. The Home had a cosy and relaxed atmosphere with all 8 residents spoken to in depth highly praising the Home and care which they received commenting that they ‘could not do better’ and that they were ‘very lucky to have such lovely staff and that it was like home’. The manager said how the staff had recently been praised for their excellent individualised care during a resident’s terminal illness. The inspector focussed on the National Minimum Standards which were not looked at during the last inspection and any previous recommendations. The manager said that the re-furbishment programme is going well, if slightly behind schedule. Residents did not feel that their quality of life had been adversely affected by the changes. Some wish to remain in their new rooms and all residents will eventually be offered a tour of the new units and be able to make an informed decision as to where they would like to have their rooms bearing in mind risk assessments and needs. Phase 2 is nearly complete and this unit will now be used as storage area whilst Phase 3, the main lodge, is refurbished. The new kitchen is almost ready to be used and this will be the first area to move into the re-furbished building. What the service does well:
All residents spoken with praised the care they received from the staff and said that they were very happy living at the Home. The manager and staff are keen to ensure the well-being and comfort of residents and were seen to treat them with great respect and kindness. Many staff have worked at the Home for some time and provide continuity of care. The environment is purpose built and very homely. Each resident has a doorknocker on their rooms to give them a feel of being in their own homes, with their possessions arranged, as they like around them. Privacy and dignity is well maintained and residents confirmed that they were treated with respect at all times, commenting that they could live as they wished at the Home. Although the standard on meals and mealtimes was not inspected it is worth noting that the Hotel Services Manager had recently reached the final of the Care Awards for Meals, which involved cooking a meal as part of the competition.
The Lodge, Exeter DS0000064453.V268494.R01.S.doc Version 5.0 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 Lodge, Exeter DS0000064453.V268494.R01.S.doc Version 5.0 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 Lodge, Exeter DS0000064453.V268494.R01.S.doc Version 5.0 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): Not judged on this occasion. EVIDENCE: Please see information contained in previous inspection report. The Lodge, Exeter DS0000064453.V268494.R01.S.doc Version 5.0 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 Residents’ health needs are well met and evidenced with evidence of good multidisciplinary working taking place on a regular basis. EVIDENCE: Three care plans were looked at on the computer and their corresponding hard copies. Care plans were excellent and short-term goals and actions were clear. One resident had very detailed records as to how they had been assisted through a period of anxiety. There were detailed records about any medical tests, changes and reasons for increased needs and general health care and risk assessments. All care plans were well reviewed on a monthly basis and involved the resident and/or representative. The GP was busy doing their weekly rounds at the Home and there were excellent records about health care professional visits to the Home and follow up. The Lodge, Exeter DS0000064453.V268494.R01.S.doc Version 5.0 Page 10 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): Not judged on this occasion. EVIDENCE: Please see information contained in the previous inspection report. The Lodge, Exeter DS0000064453.V268494.R01.S.doc Version 5.0 Page 11 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): Not judged on this occasion. EVIDENCE: Please see information contained in the previous inspection reports. The Lodge, Exeter DS0000064453.V268494.R01.S.doc Version 5.0 Page 12 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): 24, 26 Residents are provided with safe, comfortable and clean surroundings decorated to a high standard. EVIDENCE: The Home was beautifully decorated for Christmas with lovely place settings in red and green in the temporary dining room and decorations and Christmas trees throughout the Home. Residents had all their Christmas cards displayed in their rooms and there was a jovial atmosphere. Five resident all said that ‘the girls did their best to give us a good Christmas’. The Home was very clean and tidy throughout, the manager said how each room is deep cleaned when they become vacant and paint refreshed, especially if there is a case of infections. One resident said ‘you won’t see any infection here’. Residents also sign a disclaimer if they wish to eat any food that has been brought in. The Lodge, Exeter DS0000064453.V268494.R01.S.doc Version 5.0 Page 13 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): 28, 29 Residents benefit from having skilled experienced and friendly staff that have a good understanding of their needs. EVIDENCE: The Home has recently employed a new maintenance man who is currently undergoing an induction programme. There was the manager, administrator, activities co-ordinator, kitchen staff, laundry, an RGN and a carer on each floor on duty at the time of the inspection. Call bells were answered promptly and residents confirmed that this was always the case. The Home has a paging system, which means that staff can focus on the individual more easily. Residents commented that ‘the staff are wonderful, so kind, marvellous and always cheerful’ during the inspection. The Home has 13 carers who have achieved NVQ 3 qualifications including some bank staff. The manager is encouraging 2 carers on night duty to consider NVQ. Recently 5 carers have passed their NVQ 2, which is commendable. The Lodge, Exeter DS0000064453.V268494.R01.S.doc Version 5.0 Page 14 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): 35, 36, 38 There are reliable systems in place to ensure the good health and welfare of residents. EVIDENCE: For information on the manager, see previous reports. Three residents’ financial records were looked at and found to be correct. These are checked monthly and any entries are signed by two staff. Only the manager or administrator has access to the safe. The Home is not an appointee for anyone and relatives or representatives manage these for residents. Residents may manage their own finances if they wish but currently no resident wants to do this and all residents’ financial skills and wishes are recorded in their care plans. The care plans encourage independence. Monies are kept in named individual pockets in the safe with any receipts. Records are clear and itemised. Residents are advised to keep up to £100 only at the Home. This is covered under general Home insurance. There is lockable storage available in all bedrooms. Staff receive two monthly supervision sessions and records were
The Lodge, Exeter DS0000064453.V268494.R01.S.doc Version 5.0 Page 15 seen. These include observations, competency checks and mandatory training checks. Three recruitment files were seen and all contained the correct information prior to the staff member commencing work. The COSHH substance cupboards are now locked and secure so that they are not potentially accessible to residents. The lounge doors, which were previously heavy are now fitted with fire door units which allow for easy access on a light swing and residents and staff were seen able to access these rooms safely. All fire equipment was checked. The Lodge, Exeter DS0000064453.V268494.R01.S.doc Version 5.0 Page 16 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X x X X X X 3 X 3 STAFFING Standard No Score 27 X 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 3 X 3 The Lodge, Exeter DS0000064453.V268494.R01.S.doc Version 5.0 Page 17 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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. Refer to Standard Good Practice Recommendations The Lodge, Exeter DS0000064453.V268494.R01.S.doc Version 5.0 Page 18 Commission for Social Care Inspection Exeter 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
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