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Inspection on 25/07/05 for Worcester Lodge

Also see our care home review for Worcester Lodge for more information

This inspection was carried out on 25th 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

Residents said they feel safe in the home, that staff are very pleasant, and that the meals are good. Residents also felt that staff genuinely want to hear their comments. One person said, when asked if she would feel comfortable making a complaint, "Oh, they like to say what you think - they ask for comments". Staff described a relaxed working atmosphere with good support from management staff and other team members. In general, recording and administration systems are thorough and provide a good framework to the home`s care practice.

What has improved since the last inspection?

One requirement was made at the last inspection, and this concerned medications. This had been partly met. Medications and toiletries are now only used for the person for whom they were prescribed or bought. Toiletries are now kept in individual small baskets in the bathrooms if people are unable to safely keep them in their own bedrooms, and these baskets are named so that staff helping the person with intimate care know which toiletries are theirs. However, home remedies records are still not being kept to the same standard as those of prescribed medications. The new supplying pharmacist will be giving the home its own recording formats at the end of next month, and these will prompt staff to enter all the necessary information on the record, so the requirement should be fully met at that point.

What the care home could do better:

No requirements or recommendations were made at this inspection. Some of the residents commented that they are unsure about what activities are on offer, and other people felt that there is not enough to do. The home has had difficulty in appointing and retaining an activities coordinator, but has fairly recently appointed a member of staff to this role. This person has started a schedule of activities based on residents` comments and known interests. A new noticeboard has been installed in the main hall especially for activities notices. Staff in the garden wing keep a note of activities in the diary, and a weekly record is now being printed out of general activities by the home`s administrator. There have been a few outings over the summer to local garden centres, but the activities schedule is only really starting to get off the ground over the past week or so. Hopefully, residents will soon start to benefit from a more regular and varied schedule of activities, and this will be discussed with them at the next inspection.

CARE HOMES FOR OLDER PEOPLE Worcester Lodge 32 Castle Road Walton St Mary Clevedon, BS21 7DE Lead Inspector Catherine Hill Unannounced 25 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. Worcester Lodge D53-D02 S38262 Worcester Lodge V225216 25.07.05 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Worcester Lodge Address 32 Castle Road Walton St Mary Clevedon North Somerset BS21 7DE 01275 874031 01275 872717 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) Worcester Garden (No 1) Limited Mr John Allsopp Care Home - Personal Care Only 39 Category(ies) of Dementia - over 65 - (11) registration, with number Old Age - (39) of places Worcester Lodge D53-D02 S38262 Worcester Lodge V225216 25.07.05 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26 January 2005 Brief Description of the Service: Worcester Lodge is registered to provide personal care to up to 39 elderly residents, 11 of whom may have dementia and are accommodated in a separate garden wing. The main part of the building is Victorian and on two storeys; the accommodation for people with dementia has been built more recently and is all at ground floor level. Stairlifts provide access to most areas in the old wing. There is no passenger lift. Each wing is allocated its own staffing levels and has its own communal and garden areas. Meals are provided to both wings from the main kitchen. The building has many original features and pleasant gardens. The reception area is staffed during office hours. The home is in the Lady Bay area of Clevedon. Local amenities are a short distance away by car. Worcester Lodge D53-D02 S38262 Worcester Lodge V225216 25.07.05 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted during the morning and lunchtime. The inspection focused on talking to residents and staff, and observing practice. Some records were sampled, including medications records and personal care records. The inspector spoke with 10 of the residents in depth, with two visitors, and with six of the staff on duty, including the manager. What the service does well: What has improved since the last inspection? One requirement was made at the last inspection, and this concerned medications. This had been partly met. Medications and toiletries are now only used for the person for whom they were prescribed or bought. Toiletries are now kept in individual small baskets in the bathrooms if people are unable to safely keep them in their own bedrooms, and these baskets are named so that staff helping the person with intimate care know which toiletries are theirs. However, home remedies records are still not being kept to the same standard as those of prescribed medications. The new supplying pharmacist will be giving the home its own recording formats at the end of next month, and these will prompt staff to enter all the necessary information on the record, so the requirement should be fully met at that point. Worcester Lodge D53-D02 S38262 Worcester Lodge V225216 25.07.05 stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Worcester Lodge D53-D02 S38262 Worcester Lodge V225216 25.07.05 stage 4.doc Version 1.30 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 Worcester Lodge D53-D02 S38262 Worcester Lodge V225216 25.07.05 stage 4.doc Version 1.30 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) EVIDENCE: These standards were not assessed today, but the inspector suggested that the Statement of Purpose is reviewed in the light of the changing emphasis of the service, to ensure that it reflects an accurate picture of the homes aims. Worcester Lodge D53-D02 S38262 Worcester Lodge V225216 25.07.05 stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 9 & 10 Residents comments indicated that they feel respected. Medications practice is good but will be improved by the introduction of the new record format at the end of this month. EVIDENCE: Staff paused in their work to chat with residents, and residents responses indicated that they are used to being given time and kindness by the staff. Residents said the night care staff also take time to sit and chat with them. Staff were particularly gentle and supportive in their approach to confused residents, and managed to do this in an adult-to-adult manner. Staff asked the residents if they would like music or television on, or other changes to their environment, without simply assuming that music should be switched on or windows shut. The inspector noted that one member of staff did not knock and await an invitation to enter the residents room. From observations during this inspection and residents comments, this is not the usual practice. The manager undertook to remind the staff member that this is an important way of preserving residents privacy and dignity. Worcester Lodge D53-D02 S38262 Worcester Lodge V225216 25.07.05 stage 4.doc Version 1.30 Page 10 Residents said that staff come quickly and respond very pleasantly if they ever use the emergency call bell. All the residents looked well groomed and nicely dressed. Staff gave medications out to one person at a time, having thoroughly checked them against the record first. The record was signed after each dose was given out. These practices help to avoid the chance of error. The requirement about medications records that was made at the last inspection should be fully met once the new recording format has been introduced at the end of this month. Worcester Lodge D53-D02 S38262 Worcester Lodge V225216 25.07.05 stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12-15 Residents are able to follow their own preferred lifestyles to a reasonable degree, and will hopefully begin to benefit soon from the newly introduced activities schedule. EVIDENCE: Some residents were either unsure what activities are available or felt that there is not enough to do. The home has had difficulty attracting and retaining people to the post of activities coordinator, but has fairly recently reappointed and the activities schedule is now starting to get underway again. In the garden wing, staff engage in activities on a daily basis with the residents with dementia. These tend to be low-key, fairly unstructured activities, so that they do not demand too much of the residents. Several people enjoy having their hands or feet massaged, and a few of the more mobile residents enjoy dancing to music. Several of the residents can chat with staff about former times, and some of the other residents appear to enjoy this even if they cant actually join in. The people with dementia were very calm but looked engaged with their environment. One lady smiled a welcome at the inspector, and several others willingly chatted with her. Several residents initiated contact with the staff or with each other during the time the inspector was sat in their lounge. Their behaviour indicated that they feel socially poised and confident, which in turn Worcester Lodge D53-D02 S38262 Worcester Lodge V225216 25.07.05 stage 4.doc Version 1.30 Page 12 indicates that staff give them a lot of positive reinforcement. Visitors said that they are always made welcome, and are very satisfied with what they see of the care and attitude of staff. One visitor commented that staff know what is going on and are able to give up-to-date and accurate information, and that the team is very flexible about trying to accommodate residents wishes. Residents said that the meals are very good. The pantry has been reorganised so that staff no longer have to use the outside store. The Cook showed the inspector the new layout of the pantry and the food stores, and talked her through the menus. There is a good supply of protein-based foods for the vegetarians. One of the first questions new residents are asked is about their meal time preferences. There is only one choice listed on the main lunch menu, but an alternative is offered to those people who wish. Tea-time menus include choices, and staff see each resident individually about these on a daily basis. Worcester Lodge D53-D02 S38262 Worcester Lodge V225216 25.07.05 stage 4.doc Version 1.30 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) EVIDENCE: These standards were not assessed at todays inspection. Worcester Lodge D53-D02 S38262 Worcester Lodge V225216 25.07.05 stage 4.doc Version 1.30 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) 19-26 The environment is comfortable, pleasant and well-suited to residents needs. EVIDENCE: There is a large lounge-diner in the Garden Wing, and two spacious lounges in the old wing. The large dining room in the old wing is divided into two separate areas. A large conservatory provides additional lounge space. There are 6 communal toilets and 5 bathrooms. The housekeeper is evidently highly committed to keeping the environment safe, pleasant and homely for everyone in it. She not only supervises the cleaning staff and cleaning schedules, but is also responsible for ensuring that soft furnishings are kept at a good standard. She has been working hard over the past year to replace or repair curtains, and has made matching bedspreads and cushion covers for many rooms. Residents were really delighted with what she has achieved. Since the last inspection, the Garden Wing lounge has been recarpeted and all Worcester Lodge D53-D02 S38262 Worcester Lodge V225216 25.07.05 stage 4.doc Version 1.30 Page 15 the old furniture replaced. Residents commented that the room looks really smart now. Unfortunately, the corridor carpet in this wing that was new earlier this year has already become badly stained. The manager has asked the supplier to visit and suggest solutions. Worcester Lodge D53-D02 S38262 Worcester Lodge V225216 25.07.05 stage 4.doc Version 1.30 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 Residents needs are met by satisfactory staffing levels. EVIDENCE: Two staff are on duty at all times of day in the Garden Wing. On the old wing, two staff and a senior are on duty in the mornings; one staff and a senior are on in the afternoons. Three waking staff are on duty at night, one of whom is a senior covering both wings. The manager is also on duty during office hours, supported part-time by the Administrator. One of the new overseas staff members employment records were checked. These included a suitable work permit. Worcester Lodge D53-D02 S38262 Worcester Lodge V225216 25.07.05 stage 4.doc Version 1.30 Page 17 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) EVIDENCE: These standards were not assessed todays inspection. Worcester Lodge D53-D02 S38262 Worcester Lodge V225216 25.07.05 stage 4.doc Version 1.30 Page 18 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x x Worcester Lodge D53-D02 S38262 Worcester Lodge V225216 25.07.05 stage 4.doc Version 1.30 Page 19 Yes 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 7 Regulation 17 Requirement Home remedies must be recorded to the same standard as prescribed medications. Timescale for action 1/8/05 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. Refer to Standard Good Practice Recommendations Worcester Lodge D53-D02 S38262 Worcester Lodge V225216 25.07.05 stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL 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 Worcester Lodge D53-D02 S38262 Worcester Lodge V225216 25.07.05 stage 4.doc Version 1.30 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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