Inspection on 06/11/08 for The Lodge, Exeter

This inspection was carried out on 6th November 2008.

CSCI found this care home to be providing an Excellent service.

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 10/11/06

The Lodge, Exeter 29/12/05

The Lodge, Exeter 26/07/05

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 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Lodge, Exeter The Lodge 22 Spicer Road Exeter Devon EX1 1SY     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Michelle Oliver     Date: 0 6 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: The Lodge, Exeter 22 Spicer Road The Lodge Exeter Devon EX1 1SY 01392271663 01392431545 thelodge@efhl.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Deborah Skinner Type of registration: Number of places registered: Elizabeth Finn Homes Ltd care home 46 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 46. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home The Lodge, close to the centre of Exeter, retains features of what is one of the citys grander houses. It has been extended in the past to provide facilities for those requiring nursing care. Some people living there are receiving residential care only and are more able. There are various garden areas, patios, an orchard area and a large courtyard directly accessible from some bedrooms and wheelchair accessible. A major re-building and refurbishment programme has been completed to provide Care Homes for Older People Page 4 of 32 Over 65 46 0 Brief description of the care home accommodation for up to 46 people. A new 22 bedded wing has been built and occupied, and extensive landscaping and re-furbishment to the original building. There is a car parking area at the rear for visitors and staff. The Home is owned by the Elizabeth Finn Homes Ltd, which offers accommodation to people from a professional background on application. The average cost of care is £785-980 per week at the time of inspection. Additional costs, not covered in the fees, include hairdressing and personal items such as toiletries, newspapers and magazines and private chiropody and taxis. Current information about the service, including CSCI reports, which are accessible at the Home, is given to prospective residents/their representatives. The Service Users Guide and Statement of Purpose are available on request and a copy given to all people on admission. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: As part of this key inspection the manager completed an Annual Quality Assurance Assessment [AQAA], which contained general information about the home and the people living and working there. With the information provided, CSCI surveys were sent to people living at the home, their relatives, staff and outside professionals, in order to hear their confidential views of the service prior to our unannounced site visit. Completed surveys were received from 9 people living at the home, 8 staff and 3 health and social care professionals expressing their views about the service provided at the home. Their comments and views have been included in this report and helped us to make a judgment about the service provided. Care Homes for Older People Page 6 of 32 We spent 7 hours at the home, speaking with people living there, their relatives and staff. We also spent time observing the care and attention given to people by staff. To help us understand the experiences of people living at this home, we looked closely at the care planned and delivered to three people. Most people living at the home were seen or spoken with during the course of our visit and four people were spoken with in depth to hear about their experience of living at the home. During our visit we spoke with 8 staff, including the General Manager,Clinical Care Manager and ancillary staff, individually or in a small group. A tour of the premises was made and we inspected a number of records including assessments and care plans and records relating to medication, recruitment and health and safety. Finally the outcome of the inspection was discussed with the General Manager and the Clinical Care Manager. What the care home does well: What has improved since the last inspection? No requirements were made during the last inspection. A recommendation was made that staff ensure that people actually take their Care Homes for Older People Page 8 of 32 medication before staff sign the medication administration record confirming that it has been administered. This was to ensure that people were not keeping medication to take at a later time than that prescribed. This recommendation has been complied with. What they could do better: 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good information, about the services offered here, is available to people to help make a decision about whether the home will suit their needs. A good assessment and admission process ensures that the home can meet peoples needs. The home does not admit people who require intermediate care. Evidence: Prior to this inspection we sent questionnaires to 10 people living at The Lodge. Nine of the ten people who responded confirmed they had received enough information about the home before deciding to move in. One person wrote My daughter and son-in-in law visited the Lodge on my behalf and then they took me with them for a second visit. The manager also visited me in my previous home. She was very generous with Care Homes for Older People Page 11 of 32 Evidence: her time on all occasions. The person who had received no information said that their admission had been arranged for them and I know it is the right place for me. Some people spoken to told us their admission to the home had been arranged by relatives as either they were not living in the local area at the time or were not well enough to cope with organizing the move. A guide to the home, the Statement of Purpose, has been produced, which gives people an idea of what to expect of the home. A copy of this and the most recent inspection report is available to people in the entrance hall. Several people told us they knew where it was but hadnt actually read through it. One person told us I only have to ask the staff if I am unsure about anything. Nine of those who responded to questionnaires confirmed they have received a contract , which helps to make sure people are clear about the terms of their stay, their rights and responsibilities.( One person did not answer this question) The home has an excellent pre admission format , which provides staff with a good model for assessing peoples individual needs. Pre admission assessments identified care needs in sufficient detail for a plan of care to be written. We were told that the manager or clinical nurse manager visits people at their home, or in hospital, before they move to the home to talk about and assess their needs and ensure that the home is able to meet their needs. One pre admission assessment we looked at highlighted the need for additional staff training to enable staff to fully meet the persons needs. We saw evidence of this training taking place before the person was admitted. A member of staff who responded to a questionnaire wrote Pre admission assessments ensure we do not take clients we cannot deliver the care to or we are trained first before they arrive. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health care needs are well met and the home ensures people have access to the care they need. People can be assured that caring staff will respect their privacy and dignity and enable them to make choices within their daily lives. Evidence: All people living at the home, who responded to questionnaires, felt confident that the home always met their needs. One person wrote staff are always sensitive to my needs and make me feel a valued member of the community. My daughter has recently written to the manager to praise the residential care team, and another care of the highest level provided at all times. All staff who responded to questionnaires confirmed they are always given up to date information about the needs of people they support or care for. They also confirmed they had not been asked to care for people outside of their area of expertise, Care Homes for Older People Page 13 of 32 Evidence: suggesting the home admits people appropriately. All people living at the Lodge have individual plans of care, which are regularly reviewed or updated when changes take place. The home operates a computerised care planning system with paper copies also being available to individuals who choose to keep their individual plan in the privacy of their own room or have access to it whenever they wish. We looked at the care plans for 5 people during this inspection, both on the computer and in paper copies. Care plans were excellent. Individual needs had been assessed including both short term and long term goals and action required to achieve the goals. Plans included detailed records of medical tests that had been undertaken, individual preferences, changes and reasons for increased needs and general health care and risk assessments. Care plans looked at all included important information about peoples past life and occupation, providing staff with an understanding of the individual. There was some good detail about peoples likes and dislikes, for example, the time they preferred to get up or go to bed. Care plans consider the needs of people with diabetes, and records show their condition is monitored. However, there are no clear guidelines to ensure an agreed range of acceptable results for blood sugar levels to ensure all staff know what to do should levels fall outside the range. Risk assessments were in place and generally reflected behavior or situations that may cause harm to people, for example poor mobility, falls and the use of equipment such as bed rails. Moving and handling assessments and plans, skin care and tissue viability and continence assessments were in place and provided staff with the necessary guidance to deliver person centred care. Peoples nutritional needs are assessed and records of peoples weights show that they either gain or maintain weight after moving into the home. We noted some areas of communication that would benefit from improved record keeping. For example, care plans, both paper and computerised, indicated clearly that a person should not be using their wheelchair as it was faulty and a replacement had been ordered. This indicates good , safe practice. Although records indicated when a replacement wheelchair was due to be delivered no record had been made indicating that it had actually been delivered. Staff told us that the wheelchair had been delivered and we saw staff using a wheelchair to take this person from their room to Care Homes for Older People Page 14 of 32 Evidence: another area of the home. It was generally agreed that the replacement chair had been delivered but care plans continued to instruct staff not to use the wheelchair in the persons room. This lack of up to date recorded information potentially puts people at risk of not receiving appropriate care and also staff not being kept informed of current information. Another care plan we looked at included general information indicating that the person was married. Some good detail had been recorded on a pre admission assessment including how the person was likely to react in relation to missing/ worrying about their spouse when they moved into The Lodge. However,included in a daily report, some time after the person had been admitted to the home, staff had written that the person was still grieving following the death of their spouse. Although staff spoken to were aware of the bereavement there was nothing included in the care plan as to how this was to be managed. One member of staff told us the person had short term memory loss and relived the bereavement daily. Not having a plan of how peoples needs will be met by all staff puts individuals at risk of not receiving the care appropriate for their individual needs. We discussed this with staff and managers and all were enthusiastic about further improving care planning to further ensure that people continue to be cared for in a person centred way by all staff at The Lodge. Although relevant information was not consistently recorded in care plans all staff were aware of peoples needs and how best they were met. Improvement is needed to ensure that relevant information is recorded, both on computerised and hand written records that provide all staff with up to date information to ensure that care is provided in a monitored consistent way. We saw evidence of people being involved in the drawing up and regular reviews of their care plans. This means that people have a say in how they live their lives at the home. Care files showed that people have access to outside professionals such as chiropodists, dentists, G.P, specialist consultants, and optician to ensure their health care needs are met. Peoples personal care is well attended to. People were well dressed and groomed and attention to their personal care was good. Many of the female residents were wearing makeup and jewelery and one told us I like to have my hair done regularly, makes me feel so much better. The male residents were smartly dressed, well shaved and groomed. Staff spoken with and observed showed a good understanding of peoples needs and preferences. Care Homes for Older People Page 15 of 32 Evidence: Medication is well managed at the home. Storage of medication, including controlled medicines was satisfactory. Suitable arrangements are in place for the disposal of unwanted medication. Medication Administration Records (MAR) were looked at; where hand written entries had been made, two signatures had been obtained to ensure accuracy, this is good practice.Where variable doses of medication are needed, accurate records were available with the actual dose given recorded. Staff confirmed that MARs were not signed unless medications had actually been taken, following a recommendation made at the last inspection. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Routines are flexible and people are supported to exercise control over their daily lives. Social activities generally meet peoples expectations and preferences and people enjoy a balanced diet, which takes into account the likes and dislikes of individuals. People benefit from contact with their family and friends, which is encouraged and supported by the home. Evidence: People spoken with told us staff respect their private and dignity. A health care professional confirmed this in response to a questionnaire, writing Resident is addressed in the manner they wish and are spoken to courteously, politely and at a pace of speech that they can follow and clearly understand. Admission to individual rooms are always preceded by politely knocking on the door before entry. During all care interventions the door remains closed and an engaged sign is hung on the door handle to let others know what is happening within the room. During this inspection we saw staff knocking on peoples bedroom doors and addressing them in a respectful way. It was evident that staff had established a good rapport with people living at The Care Homes for Older People Page 17 of 32 Evidence: Lodge. People told us there were no routines at the home. One person told us we can all do as we wish, this is our home. We are offered the choice of when we get up, go to bed, go out, have our meals, we are consulted on just about everything that is important. Another person told us there are no rules here, this is our home. Five people returning questionnaires told us that there were alwaysactivities at the home they could take part in and four people felt this was usually or sometimes the case. An activities person is employed at The Lodge on a full time basis. She is energetic and enthusiastic about the variety of activities offered at the home and encouraging and supporting people to take part. Regular activities include, keep fit session, arts and crafts, flower arranging, quizzes, pampers sessions and musical events. One person wrote, There are activities every day,however, I enjoy the musical events best. A weekly activities sheet is produced at the home and all people living there are given a copy, this is also posted on a prominent notice board for all to see. People are able to choose whether to take part in activities or not, one person wrote I join in about twice a week but I am always kept well informed by the events organiser. During this inspection several people took part in an exercise session in the light and airy conservatory. The atmosphere was comfortable with people chatting whilst waiting for all those who wished to take part to join them. Everyone enjoyed the session greatly. We were told that trips are arranged weekly, depending on the weather.People spoke about going out for drives, going to Dartmoor, enjoying cream teas and attending the Sidmouth Folk Festival during the summer. Some people living at the home do not wish to take part in organised activities. When asked how staff prevented these people from the potential of being socially isolated staff told us that they spend time with people on a 1:1 basis to chat or be involved in personal interests or hobbies. Comments made by a visiting health care professional included the activities staff have a range of resources open to them. They are diligent in ensuring that activities are within the means and capabilities of all residents physical and psychological capabilities, ensuring that all who wish to participate in social interactions do so in a Care Homes for Older People Page 18 of 32 Evidence: comfortable way. There is no restriction on visiting times and throughout the day visitors came to the home and were made to feel welcome. Relatives told us that they could visit at any time and that they felt welcome at the home, one wrote, I am encouraged to visit anytime that suits me. Relatives said the home kept in touch with them and informed them of any changes or events affecting their relative, another relative wrote, All staff are very approachable and keep us informed about anything thats happening. One relative told us, The staff are prepared to listen and another said, I have been involved in decisions, they do consult with us. Eight people living at The Lodge who responded to questionnaires felt that staff listened and acted on what they said, two said this was mostly the case. People were given choice throughout the day, for example what they wanted to eat and drink,where they sat, what clothes they wore and people said that they were able to choose when they got up or went to bed. Surveys showed that people always or usually enjoyed the food served at the home. People we spoke with all said how good the food was. They described the choices available and were full of praise for the chefs, who are experienced and knowledgeable about peoples dietary needs and preferences. All relatives contacted commented on the high quality of food provided, one said, Beautiful meals provided, and another said, Food is of a very good standard. People can choose where to have their meals and many people choose to eat in the dining room. The atmosphere in the dining room at lunchtime was convivial; tables were nicely laid with menus, napkins, flowers and condiments. Staff were available to assist people in a discreet manner where needed. The lunchtime meal was very nicely presented and appeared to be well balanced and nutritious. Staff offer a waitress service assisting with dishing up vegetables, which are placed on every table for people to help themselves and offering seconds. People living at the Lodge may entertain their family or friends, who can have a meal for a nominal fee, in a smaller more private room. We were told that several people have used this facility to hold parties and entertain. Individual tastes are catered for by the hotel service at the home , which also provides an excellent varied menu and delivery to a very high standard. Coffee and tea services are also undertaken by hotel service staff morning and afternoon so that care staff are free to attend to people living at the home. A new Head Chef has also added to the high standards by introducing a more exciting menu and wider variations on menus Care Homes for Older People Page 19 of 32 Evidence: already in place. People living at the home are consulted by kitchen staff about their views and suggestions for menus on a monthly basis as well as within the annual quality questionnaire. One person told us there were certain foods they were unable to eat but substitutes are usually available. The kitchen is newly refurbished and well organised and hygienic. Care Homes for Older People Page 20 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home can be confident that any issues raised will be taken seriously and that they, and staff, are protected from abuse by robust policies and procedures. Evidence: Staff are aware of the procedure to follow to protect people from abuse or harm. People living at the home know who to speak with should they have any concerns or complaints and most were aware of the complaints procedure.One person told us, I have nothing to complain about but would soon tell them, another said, I could talk to any one about concerns. The home has not received any complaints/concerns since the last inspection and no complaints have been received by the Commission in respect of this service. All staff responding with surveys said they were aware of the adult protection procedure in place to protect people living at the home. Staff spoken with said they had received training to help them recognise any poor practice or evidence of abuse and all were aware of their responsibility to report any concerns. People living here felt well cared for and described staff as kind, caring, polite and friendly. Care Homes for Older People Page 21 of 32 Evidence: Care Homes for Older People Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Lodge provides people with safe, comfortable and clean surroundings decorated to a very high standard. Evidence: The Lodge provides accommodation in a purpose built 22 bedded wing [Spicer] two refurbished wings [Robeson and Rainbow] and the Old House all retaining original features of the Victorian building. Communal areas include a large airy dining room, various small sitting rooms, a conservatory, and a large lounge and reception area with security measures and beautifully landscaped gardens with a large patio area. All areas are wheelchair friendly, including a wheelchair entrance and passenger lifts are provided throughout the buildings. All areas have been well designed to cater for peoples needs. Excellent quality furniture, fittings and soft furnishings make the Lodge a very comfortable place to live. The home employs a team of domestics led by the Team Leader for domestic services. All areas of The Lodge were exceptionally clean and fresh during our visit whilst maintaining a homely atmosphere. Comments made in questionnaires included My room is always beautifully clean and the cleaning staff are very willing and attentive. My visitors always comment on the high standard of cleanliness. Care Homes for Older People Page 23 of 32 Evidence: Good infection control is maintained through staff training and practice. Staff have the necessary protective equipment, such as gloves and aprons. Liquid soap and disposable towels are provided in toilets and bathrooms to promote good standards of cleanliness. The laundry is well equipped and managed and we were told that great care is taken with peoples personal items of clothing. People spoken with said they were very satisfied with the laundry service provided and that their clothes were taken care of and always nicely pressed and returned in good condition. The top floor of the Old House has been designated for staff use only where changing rooms, shower facilities, training room and a kitchenette have been provided. There are plenty of sluices in each area and substances,such as cleaning products, which could be harmful to health, were stored safely. Care Homes for Older People Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at The Lodge benefit from having skilled experienced and friendly staff that have a good understanding of their needs. The procedures for the recruitment of staff are robust and consistently protect residents. Evidence: The Lodge aims to have a clinical manager, two Registered General Nurses and four carers on duty on the nursing wing from 7.30am to 8pm to care for 23 people plus a team leader, a senior carer and 4 carers on the residential wing to care for 23 people. In addition the registered manager, an administrator, a receptionist, an activities person, a maintenance person, hotel service staff and domestic staff are also employed at the home throughout the day to ensure that standards relating to food, cleanliness and the general environment are met. During our visit staff were seen to attend to people in a timely way and people living at the home confirmed that this was always the case. Bells were answered promptly and although busy during the morning, a calm and orderly atmosphere was maintained. The Home has a paging system, which means that staff can focus on individuals more easily. Care Homes for Older People Page 25 of 32 Evidence: Potential staff are screened rigorously this includes obtaining at least 2 references and a criminal records bureau check prior to induction training when employed at the home. The interview process is based on set criteria ensuring that it is fair and equable for each candidate. During this inspection we looked at the employment records for 3 recently recruited staff. All records were well maintained, accurate, up to date and included all documentation. This procedure ensures that peopel living at the home are protected from having unsuitable staff employed at the home. All newly employed staff,including catering and housekeeping,undertakes a 2 day initial induction programme,which includes all mandatory training,including Safeguarding Vulnerable Adults.This is followed by 2 weeks working with an appropriate NVQ 3 trained carer who will carry out support and training for new care staff. All staff participates in a comprehensive 12 week induction programme to comply with legislation.During this inspection we looked at documentation relating to 2 staff induction training programmes. We were told the home has a generous budget to ensure all staff training needs can be met. The home maintains a record of all training staff have undertaken and has a system for identifying who and when refreshers are due to be completed. Staff meetings are held regularly for day and night staff ensuring that all staff are kept up to date with, and included in future developments at the home. The Lodge employs a Clinical Care Manager and an Administrator,which we were told, has improved the day to day running of The Lodge by ensuring that people living at the home, their relatives and visitors are able to keep in touch with the management of the home 7 days a week. People we spoke to confirmed this during the inspection. One person said, I always know that there is someone I can speak to if I have any problems. Everyone is so professional and caring. Staff who responded to questionnaires, and those spoken to during this inspection, confirmed that high staffing levels are maintained at the Home, there is good teamwork, open honest communication channels, positive customer service, excellent presentation of both home and staff and Hotel Services and that they receive support and encouragement to undertake training and to deliver high standards of care. Care Homes for Older People Page 26 of 32 Care Homes for Older People Page 27 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Lodge has reliable systems in place to ensure the good health and welfare of those living and working there. Evidence: The current General Manager is a level 1 nurse with an Honours Science Degree and has attained a Registered Managers Award. The Home has a corporate quality assurance policy that is undertaken 6 monthly. People living at the home may wish to remain anonymous if they wish when completing the questionnaires. Residents meetings and staff meetings are held regularly at the Lodge and minutes of these meetings are kept. This means that people living at the Home are given a voice and have a say in the running of their home. The Home Committee also meets regularly to discuss issues that may affect those living at The Lodge. Care Homes for Older People Page 28 of 32 Evidence: Staff spoken to confirmed that they felt well supported by the current management at the Home. Regular staff meetings are held and the manager operates an open door policy that enables people to approach her with any problems as and when they may occur. The Home has a computerised communication system for staff and any issues, new policies or procedures are posted to ensure that staff are kept well informed. There is a very low staff turnover and staff are obviously very happy working at the Lodge. A member of staff stated I remain proud to be working at The Lodge. 99.5 of the time we get it right and give excellent care, the challenge is to achieve 100 constantly. All records were up to date and there was strong evidence that people living and working at the Lodge are listened to, and valued. The ethos of the home is to encourage and support independence for as long as individuals wish or are able to maintain. People living at the Lodge may manage their own finances if they wish and some do. There is lockable storage available in all bedrooms so that people can keep money readily available to them at all times. Peoples financial skills and wishes are recorded in their individual plans of care. However, some people choose for the home to look after their personal allowances. The financial records of two people who have made this choice were looked at and found to be correct. Only the manager or administrator has access to the safe where monies are stored. All personal allowances are checked monthly and two staff sign entries when made. This ensures that finances are protected and safe with clear systems of accountability. Information received from the general Manager prior to this inspection indicates that all policies and procedure required are in place at The Lodge and these are updated regularly. Information also confirms that all equipment, fire, gas, electrical and lifts are maintained and serviced as required to meet safety standards. This means that the Lodge promotes health and safety for those living, working and visiting the Home. Care Homes for Older People Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Individual care plans should include up to date information that provides staff with the relevant information to meet changing needs. This relates to changes not being included between monthly reviews and the some lack of monitoring of individuals changing needs. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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