Inspection on 01/10/08 for Yercombe Lodge

This inspection was carried out on 1st October 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Yercombe Lodge 04/10/06

Yercombe Lodge 08/03/06

Yercombe Lodge 06/06/05

Yercombe Lodge 12/01/05

Yercombe Lodge 29/07/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

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: Yercombe Lodge Yercombe Lodge Stinchcombe Dursley Glos GL11 6AS     The quality rating for this care home is:   three star excellent 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: Adam Parker     Date: 0 1 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 25 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 25 Information about the care home Name of care home: Address: Yercombe Lodge Yercombe Lodge Stinchcombe Dursley Glos GL11 6AS 01453542513 Telephone number: Fax number: Email address: Provider web address: yercombe@btopenworld.com Name of registered provider(s): Name of registered manager (if applicable) Mrs Angela Kathleen Turner Type of registration: Number of places registered: Yercombe (Gloucestershire) Trust care home 11 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Yercombe Lodge is an Edwardian property that has been sympathetically adapted and extended to provide accommodation for long-term and respite care for older people over 65 years and for anyone over the age of 18 with a physical disability. Comfortable and spacious communal areas are located on the ground floor, all of which have the benefit of extensive and attractive views over the surrounding countryside. The fees for this home range form 525 to 555 pounds per week. Additional charges not included in the fees are for hairdressing, chiropody, toiletries and newspapers. 0 11 Over 65 11 11 Care Homes for Older People Page 4 of 25 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: three star excellent 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: The inspection visit was carried out by one inspector on one day in October 2008. The registered manager of the home was present for the inspection visit that consisted of a tour of the premises and examination of residents’ care files. In addition staff recruitment and training was looked at as well as documents relating to the management and safe running of the home. A sample of residents were selected for inspection against a number of outcome areas as a ‘case tracking’ exercise. Survey forms were received from residents, their relatives and a General Practitioner (GP) . Three residents were spoken to during the inspection visit as well as two members of staff. We requested an Annual Quality Assurance Assessment (AQAA) from the home and this was provided, it gave us the information we asked for. Care Homes for Older People Page 5 of 25 The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. 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 7 of 25 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 8 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes admission procedure ensures that all residents are admitted on the basis of a full assessment of their needs, so that they can receive the care that they require while still maintaining a degree of independence. Evidence: The assessment documentation for a number of residents recently admitted to the home was looked at. These had been completed following an assessment of the persons needs recorded on a comprehensive pre-admission assessment document that took the form of an application. As well as information relating to the residents needs the application recorded information about established routines and other important information such as if the resident had a history of falls. Where a resident was funded by a local authority, the home had obtained a copy of the relevant care plan. Care Homes for Older People Page 9 of 25 Evidence: The home does not provide intermediate care and so Standard 6 does not apply. Care Homes for Older People Page 10 of 25 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. The home works well to meet residents personal and health care needs whilst upholding their privacy,dignity and independence. Evidence: The home was using a system of printed care plans covering a number of areas of need including personal care and mobility. There were more specific care plans written for some residents for specific conditions. Care plans had been reviewed on a monthly basis and a daily record had been maintained for each resident that included information about personal care such as when a bath had been taken. Risk assessments had been completed for moving and handling and falls. Where respite care was being given, risk assessments had been reviewed on each admission with the assessments being signed by the residents. Medical information for residents had been recorded along with their consent to share the information. The arrangements for medication storage and administration were looked at. As well Care Homes for Older People Page 11 of 25 Evidence: as a metal cupboard, medication was stored in a locked trolley in an office where there was also a medication refrigerator. Although the refrigerator storage temperatures had been checked daily there was no evidence of any monitoring of the temperatures for the room in which the trolley was kept. This should be done to ensure that residents medication is kept at the correct temperature. There were no items of controlled medication stored in the home at the time of the inspection visit, however the arrangements for storing controlled medication were not in line with current legal guidelines. The home should make the necessary improvements so that any controlled medication brought into the home in the future can be stored correctly. The recording of the administration of controlled medication in the past was in order. Residents had care plans and risk assessments for medication administration and examples looked at had been signed by the resident and the manager. Medication Administration Records (MAR) had been completed with no gaps in the recording of administration. Where handwritten directions had been made on the MAR these had generally been signed by two members of staff. The MAR also allowed for a signature against the entry Administration directions are copied from labels and packaging supplied. Although this was not signed for a number of residents if this is applicable it would be good practice to sign this in the interests of checking that that the correct directions are being followed. With the home offering respite care there was a risk assessment in place for residents to administer their medication themselves as they would have done at home. A locked storage facility was also available in each room. A survey form received from a General Practitioner indicated that residents medication was appropriately managed in the home. Residents confirmed that staff knocked on doors before entering and were polite to them. Staff had recently attended training in privacy and dignity. Care Homes for Older People Page 12 of 25 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 benefit from a contact with the adjoining day centre which can provide a range of activities and a good degree of social contact. In addition the choice and variety of meals ensures residents receive a nutritious and balanced diet. Evidence: In addition to a number of activities organised in the care home, residents have the choice of attending the day centre adjoining the home. As well as activities this provides a degree of social contact. Residents are given the choice on a daily basis if they wish to attend. At weekends the day centre could be accessed for activities or materials brought into the home. One resident was involved with knitting clothes for refugees abroad. As part of the quality checks in place a record was being kept of residents comments about activities provided. Christian services had been held in the home in the past although these had stopped due to lack of demand from residents. A computer was available and the registered manager described how one resident had made use of this. The day centre and the care home had developed closer ties with recent changes in the management structure. Outside entertainers who had previously visited the care home now came to the day Care Homes for Older People Page 13 of 25 Evidence: centre where residents could view their performances. In the past the home had been visited at Christmas by children from local schools to perform carols. At the time of the inspection visit the day centre was preparing a harvest festival celebration which the care home residents would be invited to. There were no restrictions placed on times for visiting residents. It was evident that the approach of the home to respite admissions was one of promoting the independence of the resident through an assessment of established routines. There were arrangements in place to continue independent tasks such as self medication. There was information available about advocacy services although there had been no need for residents to make use of these. Long stay residents had brought their own personal possessions including furniture into the home. The serving of lunch was observed, this was served to tables in a variety of covered dishes allowing residents to serve themselves at the tables. However where help was needed this was provided by staff. Jugs of drinks were also provided on the tables.Two residents spoken to described the meals as Excellent and another confirmed the choice on offer which also included a choice of sandwich filings for afternoon tea. On the day of the inspection visit there was salad for lunch and later one resident spoken to confirmed how she had enjoyed this. It was reported that menus were under review with the previous five week menu changing over to seasonal menus. An alternative main dish is available each day for lunch. At the time of the inspection visit the home was catering for diabetic and soft diets and could provide vegetarian meals if requested. Supper was a choice of a cooked snack of sandwiches. On a survey form received in June 2008 one resident commented The meals are always prepared appropriately for my needs. they are varied and suitable for my age group. another resident indicated that they Always liked the meals at the home. Care Homes for Older People Page 14 of 25 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. Information is available if any resident or their representative should wish to make a complaint and the homes approach to staff training should ensure that residents are protected from abuse. Evidence: The homes complaints procedure was displayed on a notice board under the title of Comments, Compliments and Complaints. The AQAA document indicated that the home had not received any complaints in the twelve months prior to August 2008. Three survey forms were received from residents and all indicated that they knew how to make a complaint. One resident stated Any slight problem I have had has always been speedily addressed. The home has a policy for protecting residents from abuse as well as a whistle blowing policy that includes information on referrals to the Commission, the police and the local authority. The majority of staff had received training in protecting residents from abuse. There had been no reported incidents of abuse in the home. Care Homes for Older People Page 15 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have the benefit of living in a well-maintained and clean, environment which provides a number of communal rooms. Evidence: A tour of the premises was undertaken. All areas of the home inspected were found to be clean, well maintained and decorated and smelt fresh throughout. There were a number of communal rooms including a large lounge and dining area. The accommodation is arranged so that long-stay residents have their rooms on the first floor and those staying for respite are on the ground floor. Individual rooms on the ground floor have their own access to the grounds which have been landscaped. There is also a recently constructed decking area for use in the fine weather. One resident spoken to described how when a light bulb had failed in her room it had been replaced on the same day. Another resident described how alterations had been made to a wardrobe in her room at her request to allow her to make use of this independently. The laundry had washable floor surfaces and hand washing facilities were provided. However the wall surfaces although in generally good order were showing some signs of deterioration in one corner and would need some attention to provide a completely washable surface. Three survey forms were received from residents and on all of these they indicated Care Homes for Older People Page 16 of 25 Evidence: that the home was always fresh and clean with one stating Always maintained to an excellent standard. a resident spoken to at the inspection visit stated cleanliness is very good. Care Homes for Older People Page 17 of 25 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. Sufficient staff are deployed and training is undertaken in a number of areas to meet residents needs with robust recruitment practices in place. Evidence: Staffing in the home was arranged so that on a typical day there were three carers in the morning and two in the afternoon. At night there is one waking carer and one sleeping in. In addition to care staff the registered manager works in a supernumerary capacity and there are also domestic and kitchen staff. Additional support can also be provided by a team leader who also works in the day centre. Based on information supplied during in the homes AQAA document the home currently has a high level of staff trained to NVQ level two or three with 12 out of 15 having achieved the qualification and a further two working towards an NVQ. Records for recently recruited members of staff were examined. All the required information and documentation had been obtained including an employment history against which any gaps in employment could be explored. Checks against the Protection of Vulnerable Adults list were being made as well as with the Criminal Records Bureau. Care Homes for Older People Page 18 of 25 Evidence: Induction training had been provided to staff in the home although on examination this was not in line with the nationally recognised Common Induction Standards.Staff had received training in a number of other areas relevant to residents needs including care planning,continence and privacy and dignity. One resident spoken to described the staff as Excellent, willing and dedicated. Care Homes for Older People Page 19 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed with a variety of quality assurance audits in operation and safety checks to ensure that the home is run in the best interests of residents. Evidence: The registered manager has been in post for ten years and has achieved the Registered Managers award as well as a qualification in Caring Services. Recently she has undergone training in Safe Handling of Medicines and privacy and dignity. The registered manager was planning further management training in the future. The arrangements for looking after residents money was looked at and satisfactory arrangements were in place with records kept. A check on the money held for one person showed this to be accurate in relation to the records kept. Secure storage is available both centrally and in individual rooms. Quality assurance in the home takes the form of a quality audit which takes place Care Homes for Older People Page 20 of 25 Evidence: monthly apart from some of the summer months. As part of the process the registered manager is audited on her understanding of policies and procedures. On examination the audits were thorough and detailed. Visits had been made and reports compiled by the registered provider as required under the Care Homes Regulations 2001. These reports were of a good standard and included evidence of discussions with residents. A number of other quality checks were in place such as customer comment forms. These are available in various areas of the home for residents and visitors to complete. The homes AQAA document described how comments may be actioned if practical. The registered manager also reported how she had followed up on issues raised in the homes Annual Service Review produced by us. Staff have received training in safe working practices in the areas of fire safety, infection control, food hygiene, moving and handling and first aid. Regular checks are made on hot water temperatures with records kept although the form indicated that room six was the only bedroom checked. The registered manager stated that she was aware that other bedrooms were being checked. The form should be reviewed so that it clearly demonstrates where water temperature checks are made on other bedrooms. Although some work had been carried out with shower heads regarding controlling the risk of legionella, a risk assessment should be completed following Health and Safety Executive (HSE) guidelines to establish the level of risk if any. Central heating boilers had been serviced during 2008. The electrical wiring in the home has been checked as well as portable electrical appliances. The home has completed a fire risk assessment and has had an inspection and recent follow up visit from the fire safety officer. It was reported that he was satisfied with fire safety arrangements in the home. In addition comments to us from a relative about evacuation procedures in the homes Annual Service Review were raised with the fire officer by the registered manager. Cleaning materials were securely stored with no decanting from large to small containers evident. Staff have attended training in handling hazardous substances. Window restrictors are fitted to first floor windows and these are checked by the registered manager during checks on the environment of the home. The registered manager described proposed improvements to the security arrangements of the home.Although there have been no security problems reported with the home it is recommended that a security risk assessment should be completed for the premises. Care Homes for Older People Page 21 of 25 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 22 of 25 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 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 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 9 The statement Administration directions are copied from labels and packaging supplied should be signed where this applies. The temperature in the room that the medication storage trolley is kept should be monitored and recorded to check that residents’ medication is being kept at the correct temperature. Consideration should be given to the future storage arrangements for any controlled medication to ensure these follow legal guidelines. Attention should be given to the wall surface in the laundry to preserve a washable surface throughout. New staff should receive training in line with the nationally recognised Common induction Standards. A risk assessment should be completed regarding the security of the premises. A risk assessment for Legionella should be completed taking into account guidelines from the Health and Safety Executive. The form used to record water temperature checks should be reviewed so that it shows where checks have been made 2 9 3 9 4 5 6 7 26 30 38 38 8 38 Care Homes for Older People Page 23 of 25 on other bedrooms apart from room six. Care Homes for Older People Page 24 of 25 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 25 of 25 - 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!