CARE HOMES FOR OLDER PEOPLE
Worcester Lodge 32 Castle Road Walton St Mary Clevedon North Somerset BS21 7DE Lead Inspector
Catherine Hill Announced Inspection 29th March 2006 09:30 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 Worcester Lodge DS0000038262.V274933.R01.S.doc Version 5.1 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. Worcester Lodge DS0000038262.V274933.R01.S.doc Version 5.1 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 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) Worcester Garden (No.1) Limited Mr John Allsopp Care Home 39 Category(ies) of Dementia - over 65 years of age (11), Old age, registration, with number not falling within any other category (39) of places Worcester Lodge DS0000038262.V274933.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 25th July 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 DS0000038262.V274933.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection was conducted over the course of one-day and focused on the range of services provided, residents care, staffing issues, and medications administration. Ten people returned CSCI comment cards prior to this inspection, including a professional who visits the home. The others were all returned by relatives or visitors. Many people made additional comments about the quality of service, referring to the wholehearted backing of staff, staff giving their time and making people feel valued, staff being very helpful and friendly, staff being supportive and caring, and keeping relatives well-informed. One respondent said they couldnt wish for a better place. During the inspection itself, the inspector spoke with six of the residents in depth, and also spend time with groups of residents in the communal areas of the home. She also spoke with four of the staff, the homes manager, the Responsible Individual from Worcester Garden Ltd, a visiting contractor, a social work student on placement at the home, and a visiting GP. The impression built up from all these conversations was entirely positive. Records sampled included: • residents care plans, risk assessments and daily notes • medications administration records • staff recruitment, training and supervision records • staff rotas What the service does well:
The home provides good care with kind cheerfulness. One resident commented about the staff they take things in their stride - theyre calm, and another said its a very good place here actually. Residents felt that the meals are interesting and tasty: one person said the food is absolutely gorgeous. Visitors described an unfailingly pleasant approach from the staff, clear but flexible routines, and effective care practices. Worcester Lodge DS0000038262.V274933.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? 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 DS0000038262.V274933.R01.S.doc Version 5.1 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 Worcester Lodge DS0000038262.V274933.R01.S.doc Version 5.1 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 the following standard(s): 1, 3, 4 Prospective residents can be reasonably sure their needs will be met, but would be better informed if the Statement of Purpose were updated. EVIDENCE: The Statement of Purpose should be reviewed in the light of the numbers of residents who are developing significant confusion. The staff team is in a good position to offer an effective service to very confused people, but the Statement of Purpose ought to reflect current practice developments. The three rooms at the end of the old wing are being fitted out as a more independent living area, and this could also be reflected in the homes Statement of Purpose. Worcester Lodge DS0000038262.V274933.R01.S.doc Version 5.1 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 the following standard(s): 7, 8, 9, 10, 11 Residents receive good care, given sensitively and with flexibility. EVIDENCE: The resident who was receiving bed care looked comfortable and well kempt. Call bells had been placed within easy reach, and staff looked in on people frequently. Care plans, including one for a person having respite care, were clear and informative, and incorporated the residents viewpoint. Staff were well-informed about the content of care plans, and were familiar with individual peoples preferences. Daily notes gave a good level of detail about the persons mood, physical health, any necessary changes to their routines, visitors, and appetite. They also showed that people are able to refuse care at the time it is offered and staff will simply negotiate a different time with the person. However, there were very few references to activities in these notes.
Worcester Lodge DS0000038262.V274933.R01.S.doc Version 5.1 Page 10 Medications records were clear and up-to-date. The medications record file contained written instructions to staff on good practice. Residents felt that they are treated with respect by staff. There were a couple of complaints earlier in the year about the attitude of two separate staff members, and the way these were dealt with by the manager helped people to feel valued. Worcester Lodge DS0000038262.V274933.R01.S.doc Version 5.1 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 the following standard(s): 12, 13, 15 Most aspects of the service suit individual residents needs very well, that the area of activities needs more research. EVIDENCE: One of the cooks does activities several afternoons a week, and organizes at least one outing every week. The schedule of activities is posted on the noticeboard in the main wing, and shows that there is some sort of organised activity or outing several times a week. There are also daily low-key activities in the garden wing. Some residents were not aware of the activities available, and felt that there is not enough to do. This may not be due to any shortcoming on the homes behalf, but it would be useful for the activities coordinator to canvass residents and their relatives about what sort of activities they might enjoy, and to ensure that the schedule of activities contains something for all tastes and abilities. Visitors are made welcome, and residents felt that they are able to maintain the sort of relationships they had with their families before they came into the home. Everybody who spoke to the inspector about meals said how nice they are.
Worcester Lodge DS0000038262.V274933.R01.S.doc Version 5.1 Page 12 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 the following standard(s): 16, 18 Concerns are taken seriously, and residents well-being is well protected. EVIDENCE: The home has logged several complaints over the past year, some regarding the behaviour of residents or visitors, and two regarding the attitude of a member of staff. In all cases, the log shows that management staff have taken the complaints seriously, and acted promptly and appropriately. No complaints have been received by CSCI. Worcester Lodge DS0000038262.V274933.R01.S.doc Version 5.1 Page 13 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 the following standard(s): 21 & 22 Many aspects of the environment are well-suited to residents needs, but some additional signage for people with dementia might help them find their way around the home. EVIDENCE: The Garden Wing has been greatly improved over the past year and is now a very pleasant environment for its residents. However, residents might benefit from some more signage to help them orient themselves around the home. There are large written signs on toilet and bathroom doors but a picture sign might be useful for those people who now have difficulty reading words. The doors are all white, and some colour coding might also help people find the right room. Residents’ names are on small nameplates on their bedroom doors but these might be hard for some people to read. Larger nameplates and/or symbols or pictures that have some significance to the individual may help people identify their own bedroom. This may reduce the number of times residents go into other people’s bedrooms, and the problems this can cause.
Worcester Lodge DS0000038262.V274933.R01.S.doc Version 5.1 Page 14 Ways of supporting some people to use their own door keys could also be explored. The Responsible Individual and the Manager had been on a dementia course the week prior to this inspection and have already been discussing these ideas for improving the environment for its users. The lock on the bathroom by room 20 was not working. All other locks tested by the inspector were in good order. The handyman tried to fix this lock during this inspection but has had to order a replacement lock. Worcester Lodge DS0000038262.V274933.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 - 30 Residents are well protected by the staffing practices, but the current recording systems are insufficient. 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. An additional member of staff covers any necessary extra work between the two wings during the daytime. 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. In addition to these staff, there are cooks, domestic staff, a handyperson, and an administrator. Staff recruitment checks are done thoroughly, and there is a very clear system for recording all checks and ensuring that the necessary information is received in the home before the person starts work. One of the staff files sampled showed that references have been requested and received, but the references themselves were not on file. The manager explained that he had given these to the member of staff when she left, as she had requested them to take to her next job. The Care Standards Act 2000 requires that these records are kept by the home for a minimum of three years. Worcester Lodge DS0000038262.V274933.R01.S.doc Version 5.1 Page 16 There have been some glitches with the staff training schedule over the past year, the home having had problems with getting its NVQ work assessed and having a vacancy in the deputy managers position who would normally have delegated responsibility for staff training. However, the manager has been reviewing staff training, updating the records, and planning a schedule of new training. Several staff are restarting their NVQs, some staff did a distance learning course on dementia last year, and some did manual handling training. Eleven staff recently did refresher first aid training. At present, all staff are working through the detailed questionnaires about fire safety. Once the manager has assessed whether gaps in knowledge are, he will plan training sessions accordingly. The requirement for each member of staff to have a minimum of three days training per year is not being fully met at present, but the home is likely to be meeting it in the near future. Worcester Lodge DS0000038262.V274933.R01.S.doc Version 5.1 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 36, 37 Residents benefit from a well-run home. EVIDENCE: The manager has many years experience in care settings and of running care homes. The Responsible Individual completed her NVQ 4 last autumn, and the deputy manager is about to start her NVQ 4 State document. Staff were clear about their roles and feel well supported to provide a high standard of care. Staff described a really happy working environment, and feel encouraged to be creative. Many residents, visitors and staff commented how approachable and friendly the group of senior staff is. A system has been set up for a formal staff supervision, and there is a useful format for keeping a record of each session. Worcester Lodge DS0000038262.V274933.R01.S.doc Version 5.1 Page 18 The homes policies and procedures have all been reviewed over the past few months. Worcester Lodge DS0000038262.V274933.R01.S.doc Version 5.1 Page 19 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 X 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X 3 3 X X X X 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 X X X 3 3 X Worcester Lodge DS0000038262.V274933.R01.S.doc Version 5.1 Page 20 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. Standard Regulation Requirement Timescale for action 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. Refer to Standard OP1 OP12 Good Practice Recommendations The Statement of Purpose should be reviewed in the light of the numbers of residents who are developing significant confusion. Residents and their relatives should be consulted about what sort of activities they might enjoy, and the schedule of activities should be tailored accordingly. Worcester Lodge DS0000038262.V274933.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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