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Inspection on 15/11/06 for Warren Lodge Care Centre

Also see our care home review for Warren Lodge Care Centre for more information

This inspection was carried out on 15th November 2006.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Warren Lodge offers Service Users care in a comfortable environment where the rooms are individual and light in a very attractive rural setting. There is a good staff team working in the home; the atmosphere was welcoming and hospitable. Service Users reported that staff give good care and this was observed to be the case during the inspection visit. The service has undergone major changes during the year and staff on duty reported that the home is now a better place in which to work.

What has improved since the last inspection?

Under the new ownership of the Service the exterior of the house has been redecorated and inside redecoration has commenced with the public areas of the house. The hall and stairs have been attractively carpeted. Less agency staff are employed and more employees are coming from the local area. All staff are given better training opportunities. The requirements of the last inspection have been met.

CARE HOMES FOR OLDER PEOPLE Warren Lodge Warren Lane Finchampstead Wokingham Berkshire RG40 4HR Lead Inspector Sandra Grainge Unannounced Inspection 15th November 2006 10:15a 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 Warren Lodge DS0000011404.V318263.R01.S.doc Version 5.2 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. Warren Lodge DS0000011404.V318263.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Warren Lodge Address Warren Lane Finchampstead Wokingham Berkshire RG40 4HR 0118 973 4576 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) Phoenix Healthcare Limited Mrs Sharon Leslie Williams Care Home 41 Category(ies) of Dementia - over 65 years of age (11), Old age, registration, with number not falling within any other category (30) of places Warren Lodge DS0000011404.V318263.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th January 2006 Brief Description of the Service: Warren Lodge is a privately owned large country house that is registered to provide residential care for older people; it has an additional ground floor wing registered to provide personal care and support for older people who have dementia but do not need nursing care. The rooms are large and individual. Bedrooms are located over three floors; there is a shaft lift for disabled access. Some double rooms are available but most are single and have en suite facilities. The property is situated near to Finchampstead in an attractive secluded area with views over the countryside at the rear. There is large well-maintained garden with a small aviary. Ample car parking spaces are available and public transport is nearby. Local amenities include shops and a doctor’s surgery. Warren Lodge DS0000011404.V318263.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key report contains information collected during an unannounced site visit to Warren House made during a weekday by a locum inspector. Information held in the Service file pre- informed the inspection together with data provided by the Registered Manager. In addition, prior to the visit, Service User views had been sought in a survey “Have your say about”. Thirteen forms were returned to CSCI; the comments were favourable and are included in the appropriate sections of this report. A tour was made of the premises and during the visit care practice was observed. Records were inspected and the Inspector spoke to Service Users and members of staff. Service Users were pleased to praise the service and the staff. Relatives who spoke to the inspector endorsed the praise for staff and are pleased with the service that is given. Requirements of the previous inspection had been met. Scale of charges as supplied on 29.09.06: - from £370- £ 650 per week. What the service does well: What has improved since the last inspection? What they could do better: The service currently offers both care to older people and to those who have dementia. Although the boundaries of these categories can overlap there needs to be a clearer provision of service and management to allow Service Users the Warren Lodge DS0000011404.V318263.R01.S.doc Version 5.2 Page 6 choice to mix or not. The provision of care for those with dementia needs to be developed in accordance with professional advice and best practice. Bathrooms on the second and ground floors are in need of urgent refurbishment and the remainder of the bath and toilet facilities need upgrading. The home does not have its own transport vehicle and this could be considered to enhance the facilities offered to Service Users. Development of the Service is being planned and it would be good practice to include the Registered Manager in the development of these plans and in budget planning. 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 summary of this inspection report can be made available in other formats on request. Warren Lodge DS0000011404.V318263.R01.S.doc Version 5.2 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 Warren Lodge DS0000011404.V318263.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 and 6 Quality in this outcome area is good. A new Statement of Purpose has been produced to define the service that can be offered. Service Users and their representatives have the information necessary to assist them to choose a home that is able to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Warren Lodge offers care for older people including some who have dementia but do not require nursing care. The Manager has produced a new Statement of Purpose that clearly sets out the service that is offered. This is in accordance with a requirement of the previous inspection. There was evidence that all prospective Service Users and their relatives are provided with a copy of the Statement of Purpose. The surveys “Have your say” completed by the Service Users and their relatives were all positive that they received enough information and support to make a decision about entry to Warren Lodge. Senior staff from the home assesses the needs of prospective Service Users prior to admission. Warren Lodge DS0000011404.V318263.R01.S.doc Version 5.2 Page 9 Trail visits are arranged when appropriate and each person has a contract of terms and conditions with the Service. There was a planning application displayed at the entrance to the property; the Registered Manager is aware that the Registered Individual is considering extension of the ground floor wing. If additional dementia care is to be provided it will be necessary for the registered individual to demonstrate that Warren Lodge has the capacity to meet the assessed needs of those who are to be admitted to the home. The home does not offer intermediate respite care. Warren Lodge DS0000011404.V318263.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10 Quality in this outcome area is good. Each Service User has a plan of care that includes their health, personal and social care needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Work has been carried out during this last year to improve the care plans that are generated from the assessed needs of Service Users. All care staff have yet to be included in the care planning and recording process and the development is not yet complete. The Registered Manager has been developing links with local medical practitioners and specialist nursing staff to ensure good communication for referral of Service Users to access health care services. Routine risk assessment and nutritional screening are carried out and care plans are reviewed regularly. Four Service Users are able to be responsible for the administration of their own medication and arrangements are in place for this to be carried out safely. Staff receive training in medication administration and new arrangements have been made for the supply, storage and administration of medication using the nomad system. A supplying pharmacist inspects the system; records were found to be in order on the day of the site visit. Warren Lodge DS0000011404.V318263.R01.S.doc Version 5.2 Page 11 Service Users told the inspector that they feel the staff treat them with respect and courtesy. This was observed to be so during the site visit and the views of Service Users in the surveys all stated that they received the care that they needed from staff who are available and listen to what they say. There was no opportunity during this site visit to review the care given to those who are very ill and approaching death. Warren Lodge DS0000011404.V318263.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15 Quality in this outcome area is good. Service Users enjoy the lifestyle available to them in Warren Lodge and the routines are flexible to allow them to make choices about their leisure. There is some incompatibility between the two groups within the service and the provision made for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans indicated that Service Users’ spiritual needs are noted and observed. There was evidence that the manager had made considerable effort to make arrangements to meet the known spiritual needs of a new Service User; her bedroom had been set up to contain a cross and symbols of her belief that she had used all her life. There are two groups of Service Users within Warren Lodge; those who have dementia are accommodated in the ground floor separate wing but their families like them to be integrated into the main group of occupants of the home. This can cause tension between those who have developing dementia and those who do not. The staff are aware of this incompatibility, however, it is a source of conflict. It was illustrated during lunch when a Service User from the dementia unit informed the inspector that the others were watching her and she felt uncomfortable; equally, the other two Service Users were concerned about her behaviour at the lunch table. Staff were aware of the Warren Lodge DS0000011404.V318263.R01.S.doc Version 5.2 Page 13 problems and were at hand to keep the peace. This should not occur and mixing of the two groups in the home should be planned and monitored with care. The Registered Manager has considered the provision of an activities coordinator trained to organise and monitor an activity program particularly for residents with a diagnosis of dementia. Some staff have received dementia training but this work is still not complete. Those with dementia are accommodated where there is one large room used both as a dining and lounge area within the wing. . The Inspector spoke to several Service Users in the main house who feel that they are given the support and assistance to have a good quality of life within the home. There was clearly an involvement with family and friends and the local community. Those who occupy the dementia unit were unable to express their views in the same way. The Inspector did observe that they responded well to care and support given by the two staff who were with them in the dining room. Nutritional assessments are carried out; staff were observed to give assistance skilfully to those who are unable to feed themselves and to prompt others who need support. Two Service User survey comments indicated that the Service Users were only sometimes satisfied with the meals offered in the home. The inspector was able to speak to one of these Service Users who reported that things had improved since the employment of another cook. Warren Lodge DS0000011404.V318263.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18 Quality in this outcome area is good. Residents have access to a complaints procedure and are protected from abuse. Staff are trained to be aware of abuse issues. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One complaint had been received by CSCI; this had been passed to the manager for action. The issue was resolved appropriately. The Manager had recorded a high number of complaints n the home. When they were examined it was evident that all incidents, however small, had been included. There were no founded complaints and all had been recorded and managed rapidly to the satisfaction of the complainant. There is a policy and procedure in place for the protection of Service Users from abuse. No allegations had been made. Staff in the home had received training in the awareness of abuse. Warren Lodge DS0000011404.V318263.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, and 26 Quality in this outcome area is good. Service Users live in an attractive, safe, well-maintained and comfortable environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Warren Lodge is located in an attractive setting that allows Service Users to appreciate the views and countryside. It is very suitable to meet the needs of older people. The ground floor dementia unit is a newer development and it has not been designed to meet the needs of those with dementia. One room is available for use as both a lounge and dining room, although there is a small sunroom with access to a secluded garden. The Manager was not aware that specialist advice had been sought concerning the design of the layout of rooms or inclusion of the use of strategies such as colour coding to assist Service Users. Expert advice and the use of good practice guidance would enhance future development of the service. The building complies with fire regulations and those of the local environmental health department are being met. Warren Lodge DS0000011404.V318263.R01.S.doc Version 5.2 Page 16 The home is attractive; some parts are newly decorated and carpeted and the whole building is clean and tidy. The ground floor bathroom is due for refurbishment; a bath is damaged and tiles are chipped. The second floor bathroom also needs to be upgraded. Warren Lodge DS0000011404.V318263.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. Service Users’ changing needs are met by staff who have been trained and have the skills to provide care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service Users consider that there are sufficient numbers of staff employed to meet their needs. The staff were able to demonstrate that they have the skill to meet the assessed needs of the Service Users. Fifty eight of staff have now achieved NVQ level 2 or above. Many of the staff have worked in the home for a long time and are able to give continuity of care to Service Users. This has been assisted by the employment of more permanent staff from the local area and less use of agency staff. There was evidence that the correct procedures for recruitment of new staff were followed. Warren Lodge DS0000011404.V318263.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37 and 38 Quality in this outcome area is good. Service Users live in a well run and managed home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The management of the home is open and transparent. The Registered Manager has enrolled and commenced the Registered Manager’s award as required following the last inspection. The Manager is a registered nurse and is familiar with the conditions and diseases of old age. The displayed Insurance certificate was just out of date; another was expected from the Registered Individual. The Manager does not hold a budget for the home and is not involved in the business and financial planning. It is recommended that she is included in these aspects of the business. Warren Lodge DS0000011404.V318263.R01.S.doc Version 5.2 Page 19 There are systems in place for the safe management of Service Users’ personal finances. A system of supervision for staff is in place, however, the Manager would benefit from formal training in this from an outside provider. Records for the protection of Service Users are kept and up to date. There are systems and records in place relating to the management of health and safety that include Manual handling regulations and accident recording; Fire prevention records and drills; service and maintenance of gas, electricity and water supplies and equipment maintenance; There are also systems for risk assessment for safe working practise; COSHH; and environmental health. Warren Lodge DS0000011404.V318263.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 2 3 3 3 3 Warren Lodge DS0000011404.V318263.R01.S.doc Version 5.2 Page 21 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. 1. OP12 2. OP22 13 (1)( b) 12 (1)(a) ( 3) 16 (2) (m)(n) 23 (9)(2)(j) Standard Regulation 16 Requirement The Registered Individual must consider the mix of categories of care within the home and make plans to allow Service Users to remain separate if they wish. The Registered Individual must provide a plan to show the development of dementia care in accordance with professional advice and good practice in the field. The Registered Individual is required to supply a schedule for refurbishment of the ground and first floor bathrooms. Timescale for action 15/01/07 15/01/07 3. OP21 15/01/07 Warren Lodge DS0000011404.V318263.R01.S.doc Version 5.2 Page 22 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. OP34 2. OP36 Refer to Standard Good Practice Recommendations The Registered individual is recommended to include the Registered Manager in budget planning for the home. The Registered Manager is recommended to attend a training course on supervision of staff. Warren Lodge DS0000011404.V318263.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: 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 © 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 Warren Lodge DS0000011404.V318263.R01.S.doc Version 5.2 Page 24 - 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!