Inspection on 21/07/05 for Totham Lodge

This inspection was carried out on 21st 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

Totham Lodge 21/06/07

Totham Lodge 27/07/06

Totham Lodge 08/12/05

Totham Lodge 03/03/05

Totham Lodge 22/10/04

Totham Lodge 30/03/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Totham Lodge Broad Street Green Road Great Totham Maldon, Essex CM9 8NU Lead Inspector Alan Thompson Final Report Unannounced 21 July 2005 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. Totham Lodge I56 105 S17982 Totham Lodge V240424 21.07.05 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Totham Lodge Address Broad Street Green Road Great Totham Maldon Essex CM9 8NU 01621 891209 01621 893582 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) Mrs M Page Mrs M Page Care Home 28 Category(ies) of Dementia - over 65 years of age (14), Old age, registration, with number not falling within any other category (28) of places Totham Lodge I56 105 S17982 Totham Lodge V240424 21.07.05 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 28 persons) Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 14 persons) The total number of service users accommodated in the home must not exceed 28 persons. Date of last inspection 3rd & 8th March 2005 Brief Description of the Service: Totham Lodge is a large fully detached grade 2 listed property. The home was built in 1830 and was originally used as a hunting lodge. It is situated in a rural location accessed by a long private gated driveway. Accommodation is provided on two floors, in nineteen single and four shared rooms. All but two bedrooms have private en-suite wc’s. Communal areas comprise of the large inner hallway sitting area, an inner conservatory, a large lounge/dining room and a small dining/sitting room, all on the ground floor. Access between floors is provided by a passenger shaft lift. Totham Lodge is set in approximately seven and a half acres of grounds, all enclosed. Many rooms in the home benefit from fine views of the grounds and surrounding countryside. Ample visitor car parking is available to the front of the property. Totham Lodge I56 105 S17982 Totham Lodge V240424 21.07.05 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection began at 1045 hours and ended at 1530 hours on Thursday 21st July 2005. This was the first inspection of this home in the inspection year 2005/6. The content of this report reflects the inspector’s findings on the day of the inspection, and from taking account of the findings from previous inspections of the home. Practice and procedures occurring after this inspection will be reported on in future inspection reports. Seven residents and three staff were spoken with. Random samples of records, policies and procedures were inspected and a tour of parts of the premises and grounds took place. All residents spoken to who were able to express an opinion confirmed that they were satisfied with the care they received and with the accommodation and food offered. Staff confirmed they had been offered NVQ award level 2 training. What the service does well: What has improved since the last inspection? What they could do better: Residents meetings should be offered more frequently. The quality assurance process should include a written summary of any actions taken. Totham Lodge I56 105 S17982 Totham Lodge V240424 21.07.05 Stage 4.doc Version 1.40 Page 6 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. Totham Lodge I56 105 S17982 Totham Lodge V240424 21.07.05 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Totham Lodge I56 105 S17982 Totham Lodge V240424 21.07.05 Stage 4.doc Version 1.40 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 standard(s) 3 & 5 The home’s assessment format and process was adequate for ensuring that initial perceived needs were identified upon admission of new residents. EVIDENCE: The home’s pre-admission needs assessment format was seen. This included assessment headings of: mobility, toilet needs, continence, dressing, eating/feeding, washing, bathing, speech, sight, hearing, memory, orientation, awareness, behaviour, social needs, breathing, travel needs, sleep, oral health, diet, weight, dying, personal safety, hobbies. The assessment is compiled by the manager/proprietor and the deputy manager at or immediately following the pre-admission assessment visit. The contract/ terms & conditions of residency states that new admissions are on a four week trial basis. The registered provider confirmed that prospective new residents and their relatives are invited to visit the home prior to deciding on moving in, to see rooms and to meet with existing residents and staff. The registered manager and/or the registered provider always visit (unless long distances involved) prospective new residents at home or in hospital to Totham Lodge I56 105 S17982 Totham Lodge V240424 21.07.05 Stage 4.doc Version 1.40 Page 9 undertake a pre-admission assessment of need, and to leave information on services and facilities provided. Emergency admissions do not generally take place as the home has a waiting list. Totham Lodge I56 105 S17982 Totham Lodge V240424 21.07.05 Stage 4.doc Version 1.40 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 & 10 Care plans in place set out the residents daily needs to provide staff with the actions required to meet these. Staff pay attention to ensuring that residents privacy and dignity is respected. EVIDENCE: The care plan format was unchanged since the last inspection. Needs were based on the home’s pre-admission assessment format, with actions identified as required from staff, including specific daily needs. Individual care plan files included general risk assessment, falls and pressure sore risk assessment, records of visits by GPs district nurses etc and full background details. Care plans seen had been reviewed by staff. Residents spoken with confirmed that staff show respect and consideration towards their privacy and dignity when providing personal care support. Treatments and consultations are provided in private or behind privacy screens. Residents also said they wear their own clothes and that staff refer to them by their preferred term of address. Totham Lodge I56 105 S17982 Totham Lodge V240424 21.07.05 Stage 4.doc Version 1.40 Page 11 Staff spoken with confirmed that at induction, when commencing employment, they were made aware of the expectation to treat residents with respect at all times. Screens were provided for use in shared rooms. The home’s ‘privacy & dignity’ policy provided clear written expectations to staff on the headings under this standard. There was a payphone telephone in the entrance lobby and some residents had private telephone lines in their rooms. The office portable phone was also available for incoming calls. The home’s medication procedure had been updated to included clear instructions to staff on the receipt of medication. This met the recommendation made in the last report. Totham Lodge I56 105 S17982 Totham Lodge V240424 21.07.05 Stage 4.doc Version 1.40 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) 13 & 14 The home appeared to have maintained good contact with, and encouraged involvement from relatives. Residents were enabled to exercise choice on a day to day basis, however residents’ group meetings had not taken place. EVIDENCE: The home’s policy towards visitors confirmed that visitors are welcome at all reasonable times and contact is encouraged. Staff support residents right to refuse visitors. Residents spoken with confirmed that staff always make visitors feel welcome. Two residents continued to maintain control of their own finances. The remainder were supported by relatives. Evidence was seen to confirm that new residents are able to bring personal items of possessions into the home. Information regarding access to independent advocacy support was displayed in the hallway. This met the recommendation made in the last report. No recorded residents meetings had taken place and the recommendation made in the last inspection report therefore remains in place until met. Totham Lodge I56 105 S17982 Totham Lodge V240424 21.07.05 Stage 4.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The home’s complaints procedure allowed for residents and relatives to formally raise any concerns or areas of dissatisfaction with the service. EVIDENCE: The home’s complaints policy/procedure was seen. The policy included information on how to make a complaint and the expected timescales for response from the home. Details were also included on how to contact the registration authority and the local Social Services office. Totham Lodge I56 105 S17982 Totham Lodge V240424 21.07.05 Stage 4.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23, 24,25,26 Furnishings in the home looked comfortable and areas of the premises seen were generally well maintained, however until all radiators are guarded there is a potential risk to residents. Private accommodation was comfortable and suited to needs and preferences. The premises were accessible, and had sufficient (according to these standards) numbers of toilets and bathrooms. The home looked clean and was considered to be hygienic. EVIDENCE: Private and communal accommodation was regarded to be comfortable and homely. Many communal and private rooms benefit from views over the grounds and surrounding countryside. Totham Lodge I56 105 S17982 Totham Lodge V240424 21.07.05 Stage 4.doc Version 1.40 Page 15 Residents have access to the grounds, usually with full staff support. An area of garden to the immediate side and front of the home has been enclosed with a fence and gate. The area around the raised garden had been cleared. The local fire service and environmental health department continue to visit the home at periodic intervals, records of visits were available for inspection. General day to day maintenance is undertaken by the home’s maintenance person Communal space comprises a large inner hallway sitting area, one large lounge dining room, one small dining/sitting room and an inner conservatory. Twenty one bedrooms benefit from private ensuite facilities. There are three bathrooms and one shower, all providing assisted bathing facilities. One bath also has a Jacuzzi facility. All rooms were fitted with curtains or blinds, a mirror and appropriate bedside lighting was available. Furnishings are provided to individual wishes and choices. Door locks and keys are fitted/available for residents. All but three bedrooms met recommended size standards. Rooms inspected were individually and naturally ventilated with windows. All rooms were centrally heated and radiators were fitted with thermostatic control valves. Radiator guards have been fitted to most bedroom radiators however not all radiators in the home, including those in communal areas, were guarded and there is a recommendation on this issue in this report. Regulator valves had been fitted to all baths and wash hand basins, testing had taken place of delivery temperatures. Lighting in the home was considered to be domestic in character. Emergency lighting is fitted throughout. Laundry facilities were appropriate for the size of the home. A new industrial type washing machine had been installed since the last inspection. Totham Lodge I56 105 S17982 Totham Lodge V240424 21.07.05 Stage 4.doc Version 1.40 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 & 29 Staffing levels and skills appeared to meet the needs of residents. Staff recruitment procedures aimed at the protection of residents had been followed. EVIDENCE: Staffing levels were advised as: five carers mornings shifts until 1300 hrs, then four carers until 1400 hrs, three carers until 1530 hrs, four carers until 1830 hrs, three carers until 2000 hrs. Night time staffing was two awake carers with one on sleeping-in support and a further two senior staff on standby call close by. The manager hours were advised as supernumery. Additional staff were employed for cooking, cleaning, maintenance and administrative duties. The manager confirmed that staff providing personal support were all at least 18 years of age, with staff left in charge of the home all at least 21 years of age. The management structure of the home includes (in addition to the registered manager) one deputy manager (who works 0900-1700 hours Monday to Friday), two assistant managers and three senior carers. Totham Lodge I56 105 S17982 Totham Lodge V240424 21.07.05 Stage 4.doc Version 1.40 Page 17 Staff recruitment procedures included two written references for new staff, and the manager confirmed that new and existing care staff have Criminal Records Bureau checks. Evidence was provided to confirm that checks had now taken place on ancillary staff. This met the requirement made in the last report. Guidance has been provided by the inspector regarding POVA First checks. The inspector has also confirmed that CRB disclosure checks are no longer valid from previous employment. The manager was now keeping evidence on personal files of documentation provided by new staff to confirm their identity. Totham Lodge I56 105 S17982 Totham Lodge V240424 21.07.05 Stage 4.doc Version 1.40 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) 35,37,38 Financial practices in the home appeared to have been competently managed. Records required by regulation were up to date. The health and safety of residents and staff was generally assured however there is a potential risk until the testing of the gas supply to kitchen equipment is updated. EVIDENCE: The home’s quality assurance (QA) process had been implemented in March 2005. This met part of the recommendation made in the last report, however until there is written evidence of any actions taken from the responses there remains a recommendation on this standard in this report. Totham Lodge I56 105 S17982 Totham Lodge V240424 21.07.05 Stage 4.doc Version 1.40 Page 19 The home did not hold any residents’ monies for safe keeping, relatives provide support. Any expenditure incurred by the home, on behalf of a resident, is invoiced to the resident or designated relative. The inspector was advised that two residents continued to control their own finances, the remaining receiving support from relatives. Written records were kept of furniture brought into the home by new residents. Random samples of records required to be kept were inspected. These included: care plans, assessments, staff rota, visitors record, regulation 37 notices, accidents, fire drills background information and next of kin details, all seen were considered appropriately maintained. The home’s premises risk assessment was available for inspection. Training records presented for inspection evidenced that moving and handling training is provided to staff, along with fire safety, food hygiene, first aid training and occupational health & safety. The home’s policy on infection control was also available. Evidence was available to confirm that the home’s hoists, fire alarms, fire fighting equipment, boilers, portable electrical appliances, emergency lighting and shaft passenger lift had all been tested/serviced by appropriate contractors. The gas supply (propane/butane) to the home’s cooker was due for re-testing and there is requirement on this in this report. The five yearly check to the electrical installation supply in the home was being actioned. The home’s policy and records covering the Control of Substances Hazardous to Health (COSHH) was unchanged and met the standard. Totham Lodge I56 105 S17982 Totham Lodge V240424 21.07.05 Stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 x COMPLAINTS AND PROTECTION 3 3 3 3 3 3 2 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x 2 x 3 x 3 2 Totham Lodge I56 105 S17982 Totham Lodge V240424 21.07.05 Stage 4.doc Version 1.40 Page 21 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 38 Regulation 13(4) Requirement The registered provider must ensure that testing of gas equipment in the home is updated. Timescale for action 30/9/05 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. Refer to Standard 12 25 33 Good Practice Recommendations The registered manager should ensure that residents meetings take place at regular intervals, with written records of issues discussed available for inspection. The registered provider should ensure that all radiators in the home are guarded or have guaranteed low surface temperatures. The registered provider should ensure that the homes quality assurance process includes a wriitten summary of any actions taken resulting from responses received. Totham Lodge I56 105 S17982 Totham Lodge V240424 21.07.05 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Fairfax House Causton Road Colchester Essex, CO1 1RJ 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 Totham Lodge I56 105 S17982 Totham Lodge V240424 21.07.05 Stage 4.doc Version 1.40 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!