Inspection on 26/10/08 for Worcester Lodge

This inspection was carried out on 26th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Worcester Lodge 06/02/07

Worcester Lodge 29/03/06

Worcester Lodge 25/07/05

Worcester Lodge 26/01/05

Worcester Lodge 12/07/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

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 17/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Worcester Lodge 32 Castle Road Walton St Mary Clevedon North Somerset BS21 7DE     The quality rating for this care home is:   two star good 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: Melanie Edwards     Date: 2 6 1 0 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 26 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 26 Information about the care home Name of care home: Address: Worcester Lodge 32 Castle Road Walton St Mary Clevedon North Somerset BS21 7DE 01275874031 01275872717 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Worcester Garden (No.1) Limited Type of registration: Number of places registered: care home 39 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 39. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Worcester Lodge is registered to provide personal care to up to 39 elderly residents, and this can also be be for 39 people who 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. A passanger lift provides access to most areas in the Care Homes for Older People Page 4 of 26 Over 65 0 39 39 0 Brief description of the care home old wing. There is a 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. The current fee levels range between £447 and £545. Residents are expected to pay for their own newspapers, hairdressing, chiropody and activities. The home provides an escort to hospital in emergencies free of charge, but a fee is payable for escort duties provided to routine appointments. Care Homes for Older People Page 5 of 26 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: two star good 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: We met seventeen of the residents living at the home. We met the deputy manager, the assistant deputy manager three care assistants and the cook. We talked with them about their roles, responsibilities, training needs, and how they assist residents. We saw staff assisting residents with their needs on each day of the inspection. We saw the lunchtime meal being served. We looked at a selection of records relating to the running and management of the Care Homes for Older People Page 6 of 26 Home were looked at. Four residents care plans were checked. We saw the majority of the environment and the only areas that were not checked were a small number of bedrooms. An AQAA (an annual quality assessment document that all Homes are required to use) was completed by the acting manager. The Home was operating within the required conditions of registration set down by the Commission. The conditions of registration detail the type of care and the needs of residents, and the numbers of residents who may stay at the Home. What the care home does well: What has improved since the last inspection? 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 8 of 26 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 9 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are only adequately assessed however their needs are well met in the home. Prospective residents and their representatives have the information they need to make an informed choice about living at the home. The statement of purpose is not up to date, in reference to the dementia unit and the use of the secure keypad system. Residents are not provided with intermediate care at the home. Evidence: To find out how prospective residents and their representatives are helped to find out about the home we looked at copy of the service users guide and statement of purpose. The statement of purpose and the service users guide both have in them a good range of information about the service provided, the qualifications of the staff Care Homes for Older People Page 10 of 26 Evidence: employed, and the accommodation. We also saw information about the philosophy of care and how the service aim to meet residents needs. The complaints procedure is in the service users guide so residents know how to complain about the service. However the statement of purpose does not explain the reasons for the use of keypad entry systems . This information is needed to demonstrate the reasons why residents who have dementia and live on the separate unit need this protection. There should also be a procedure in place for residents who do have mental capacity to be able to exit and enter the unit if they so wish. There is a co lour brochure with photographs of the home and other useful information. We read three assessment records to check how effectively their needs are being assessed. There was a moving and handling assessment for each person setting out how best to help them with their mobility. The assessment records we read were basic in the detail they contained. Although they did show some evidence that residents had been asked about their range of physical, mental and social needs. We observed the staff supporting residents with their needs doing the inspection. The staff we saw were patient and very helpful to residents. There were many comments of satisfaction expressed by residents and relatives about the care they receive and how they feel their needs are being met Examples of comments made included, I dont think you could wish for a better place, they dont stand on ceremony and mums looked after really well. These comments were reflective of all the comments made and they tell us residents relatives and significant others, are satisfied with the service. The home does not provide intermediate care to residents Care Homes for Older People Page 11 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are receiving really good care from the staff. However care plans do not reflect fully how residents needs are met. There are safe systems in the home for the handling and administering of residents medications. Residents are treated with respect and their dignity is upheld. Evidence: We looked at three residents care plans so that we could see how well residents are supported to meet their needs. The care plans were very basic in the detail they had in them. Care plans stated some very basic actions staff could do to assist the resident to meet their needs.We were also told that one resident has their medication covertly. We were told that there had been written confirmation from the GP. that this practise was necessary. We advised there should also be up to date information in the care plan then what was currently written, to set out the reason for this practise. We Care Homes for Older People Page 12 of 26 Evidence: discussed this with the deputy manger and the assistant deputy manager who were on duty.They said they were working closely with the manager and were in the process of re writing all the care plans so that they are far more informative and are written in a person centered way. We saw a fourth care plan that had been written by the deputy manager. This care plan was detailed,informative, up to date and very clear. It had been written in a person centered way and set out how best to meet the residents needs. The residents and relatives that we met told us how staff are very helpful, kind and caring, when they assist them with their needs. There were many comments made about the staff including they dont stand on ceremony and nothing is too much trouble for them. We checked the practices and procedures for administration, storage and disposal of residents medication. We looked at six residents medication administration charts in detail. We found medication stock was generally satisfactorily organised. There was a satisfactory system for ordering and receiving medication, and the records were up to date. Medication stock is stored in a cupboard and in a movable metal drugs trolley, which is kept in a locked room. We saw the assistant deputy manager give out residents medication at lunchtime. The deputy manager was patient and took time with each resident to make sure they had their medication. We saw written information in the care plans that demonstrated residents are well supported with their physical health care needs by the GP, the dentist, and the chiropodist. We were also told that community nurses support residents with their health needs when needed Care Homes for Older People Page 13 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can take part in a range of social and therapeutic activities. Residents are able to exercise choices in their daily lives. Residents are supported to receive visits from family, friends and significant others. Residents can enjoy a nutritious and well-cooked diet. Evidence: Residents can take part in some low key social and therapeutic activities suitable for their needs. The sort of activities that happen include visits from different musicians and singers, bingo, film evenings and quizzes. We were told by the manager that two new activities organizers are going to start working in the home this week to put on a range of activities for the residents. There is a cat that seems to be really well liked by the residents.The home also has a budgie who lives in a cage in the conservatory.We noticed residents seemed to gain pleasure from the budgie. Care Homes for Older People Page 14 of 26 Evidence: A hairdresser comes to the home on a regular basis. This is so that residents can have their hair done. We were told by the deputy manager the home has a relaxed and flexible visitors policy. This helps residents as they can keep in contact with family and friends. We saw residents have visits from family and friends. Visitors said to us that the staff are very welcoming and friendly. We checked the residents menu to see what sort of meal options there are for residents. We found the menu choices were well balanced and varied. The residents who were consulted commented generally positively about the quality of meals that are offered. We ate a portion of the lunchtime meal with a small group of residents. This was roast lamb with potatoes and cooked vegetables followed by homemade deserts. The meal was satisfactorily tasty. Care Homes for Older People Page 15 of 26 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. Residents complaints are responded to, taken seriously and will be acted upon. There are systems in place and practises and procedures to make sure residents are well protected from abuse. Evidence: We looked at the complaints record and we saw there has been one complaint made since the last inspection. The record showed the complaint had been addressed promptly and thoroughly. We discussed with the staff how they deal with residents concerns and potential complaints. Staff demonstrated to us a good understanding that part of their role is to represent residents views if they cannot directly make their complaints known. This is a good way of demonstrating how seriously residents concerns will be dealt with. We were told that the residents and significant others get their own copy of the complaints procedure when residents are first admitted to the home. This means resident have up to date information they need to make a complaint. The complaints procedure includes the contact information for us if a person wants to contact us directly. The staff have done one day training courses in understanding the principle of the Care Homes for Older People Page 16 of 26 Evidence: protection of vulnerable adults from abuse. The staff we met had an understanding about the subject of abuse and how they protect residents in the home. Care Homes for Older People Page 17 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a safe, satisfactorily maintained and suitable home . Evidence: Worcester Lodge is an older residential style home. It is situated among private houses and a short drive or walk from the town center of Clevedon. This helps residents to be a part of the local community. The home is set in its own grounds and the garden looked satisfactorily maintained. There are seats and an area where residents can sit and walk safely. We found that the environment looked to be satisfactorily maintained in all parts that we saw.The fixtures and fittings throughout the home are domestic and homely in their design. There are three spacious lounges, a conservatory area and two good sized dining rooms. We saw that residents looked relaxed and comfortable in all the communal rooms. Bedrooms are single sized and a number of the bedrooms have en suite facilities and Care Homes for Older People Page 18 of 26 Evidence: the other rooms are near to bathrooms and toilets. We saw that the bedrooms looked personalised to reflect the tastes of residents. We saw photographs, mementos and small items of furniture in residents bedrooms. We saw staff working hard cleaning the home. We found that the home was clean and tidy in all of the areas that we saw. Care Homes for Older People Page 19 of 26 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. Residents are cared for by a sufficient number of competent staff.However residents with dementia would benefit if staff did training on the subject of the Mental Capacity Act. Residents are protected by the Homes recruitment procedures. Evidence: We checked the number of care staff to see if there is enough staff on duty to support residents. As well as senior staff who are on duty every day and the manager, the deputy manager and the assistant manager .There is a minimum of five care assistants in the morning, with four care assistants on in the afternoon. At night there are three care assistants on duty. All of the staff we saw were really warm and sensitive in manner when supporting the residents. We noticed that residents were supported with their personal care needs in a thoughtful and patient way. There are full time catering, and domestic staff also employed although the number of these staff was not reviewed. Care Homes for Older People Page 20 of 26 Evidence: The staff have done training courses in understanding dementia. This should help the staff on a range of good practices and principals when supporting people who have dementia. However currently most of the staff team who work with the residents with dementia have not done any training on the Mental Capacity Act. We advised that this would be really useful as it would help the staff to be able to uphold residents legal rights . When we talked to the staff about dementia, they demonstrated a good understanding of how it impacts on the lives of the residents. We checked the training records of three care assistants were to see if staff are up to date in their knowledge and practice. We saw evidence that demonstrated staff had done training sessions and updating over the last twelve months. The records also demonstrated staff had attended training sessions over the last six months. There is now a reasonable number of care staff in the Home who have National Vocational Qualifications. We checked the staff employment files of three care staff. We saw written professional references taken up for all new staff prior to offering work at the Home. In addition, all staff complete a Criminal Records Bureau check before commencing employment. These checks are a further safeguard for vulnerable residents. Care Homes for Older People Page 21 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home run in their interests. Staff are getting supervision in their work and this helps them to better support residents. The health and safety of the residents and the staff is protected. Evidence: Ms Holbrow is the manager of the home. She has been working at the home for six months. She has put in an application to us to be registered as manager. Before Ms Holbrow worked at the home she was a team leader in another care home in Avon. She has also worked in a senior position in a care home run by Bristol City Council . The home has a quality assurance system in place to check on the quality of the care and the service residents receive. Residents families are encouraged to complete Care Homes for Older People Page 22 of 26 Evidence: regular surveys about the home. The staff told us senior staff support them with regular one to one supervision sessions. The supervision records that we looked at demonstrated staff are being well supervised and supported. However supervision sessions had not been kept up to date for all staff. There were at leat two staff who had not had formal supervision for over six months. We saw the homes system for monitoring the quality of the care and the overall service. We looked at the residents survey forms that are one method used to audit the care and service in the home. We found residents records to be satisfactorily maintained up to date legible and in order. The records relating to the management of the home were also satisfactorily maintained and in order. Individual records and the home management records are kept secure. We have referred to other records elsewhere in the report. Care Homes for Older People Page 23 of 26 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 24 of 26 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 1 1 4 The statement of purpose needs to set out the reason for the use of keypad entry systems on the Dementia unit . This is to demonstrate the reason why residents who have Dementia, need this protection. Legal rights of the residents 27/11/2008 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 1 7 15 Care plans must show in sufficient detail how residents needs are met for the care and well being of the residents 26/11/2008 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 2 30 36 Staff should do training in understanding the Mental Capacity Act. Staff should be regularly supervised in their work. Care Homes for Older People Page 25 of 26 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 26 of 26 - 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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