Care Home: Davigdor Lodge Rest Home

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What the care home does well The relaxed atmosphere has evolved over many years and reflects the commitment of the proprietors and the close professional relationships that have developed between residents and the dedicated staff team. Information is made available for prospective residents and their representatives regarding the facilities and services provided, enabling them to make an informed decision as to whether the home can meet their assessed care and support needs. Residents are able to choose their own routines and were observed to move freely within and outside of the home environment throughout the site visit. Visitors are welcomed at the home. Levels of cleanliness were found to be satisfactory throughout and residents` rooms generally clean, comfortable and personalised to reflect individual taste, preference and personality. What has improved since the last inspection? It is evident that since the previous inspection a lot of time and effort has been put into improving documentation, particularly care plans, to help ensure that individual support is provided in a more structured and consistent manner. Robust medication policies and procedures have been developed and implemented, regarding the safe control, storage, administration, recording and disposal of medicines received into the care home, safeguarding residents and staff. Recruitment procedures have been reviewed and improved to ensure residents are safeguarded. The acting manager has recently undertaken appropriate training relating to Safeguarding Adults. What the care home could do better: Following discussion with the acting manager, risk management strategies should be reviewed and personal and environmental risk assessments developed in consultation with the individual resident. The lifestyle of residents could be enhanced by more opportunities being provided for local, social and community activities. It is also important that the leisure and recreational interests of residents are recorded in their individual care plans. Staff, including key workers, should spend more time with individual residents to ensure that their assessed personal support needs are met. Residents must be safeguarded from all forms of potential abuse by all staff undertaking appropriate training and relevant and up to date policies and procedures being developed and implemented.As discussed, some serious thought and effort should be put into refurbishing and significantly improving the current unsatisfactory dining room, The area could be made a far more conducive environment in which residents eat their meals. Lighting in some areas of the home could also be improved. Staffing levels must be maintained and regularly reviewed to reflect the current and changing support needs of the residents. It is also important that the currently negative impact, on residents and staff, of having no recognised chef at the home be addressed. Following an unsettled period of management restructuring, it is essential that the person running the home has a clear sense of direction and leadership, as well as the necessary managerial qualifications, skills and experience for the post. Key inspection report Care homes for adults (18-65 years) Name: Address: Davigdor Lodge Rest Home 56-58 Tisbury Road Hove East Sussex BN3 3BB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Nigel Thompson     Date: 0 9 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Davigdor Lodge Rest Home 56-58 Tisbury Road Hove East Sussex BN3 3BB 01273726868 01273726868 e.hyslop1955@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr G Rawat,Mrs B Rawat Name of registered manager (if applicable) Type of registration: Number of places registered: care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 25 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Mental disorder, excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home Davigdor Lodge is a privately owned residential care home for up to 25 people who have a past or present mental health illness. The registered provider has owned Davigdor Lodge since 1992. Davigdor Lodge comprises of two homes that have been joined together and converted for its current use. The home is located in a residential area of Hove and is situated within walking distance of local amenities, sea front and bus routes into Brighton. Accommodation is presented across four levels, lower Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 25 0 2 1 2 2 0 0 8 Brief description of the care home ground, ground, first and second floors. Residents accommodation consists of twentyfive single bedrooms, of which four are provided with toilet and handbasin en suite facilities. There are seven bathrooms with toilet and bath facilities located throughout the home and a shower room. Residents must be able to mobilise independently to access areas not at ground level. The home is not suitable for wheelchairs. The dining area is located on the lower ground floor. There are two lounge rooms for residents to use and a conservatory is the designated smoking area. There is a garden at the rear of the home that residents have access to. As of 9 December 2009, fees range from £350 to £650 per week. There are additional costs for chiropody, personal toiletries, newspapers/magazines and any cost incurred by the individual when they go out. Care Homes for Adults (18-65 years) Page 5 of 32 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The last inspection on this service was completed on 2 December 2008. It should be noted that the home uses the term residents for people living at Davigdor. Therefore, for the purpose of this report, people who use the service will be referred to as residents. This key unannounced inspection took place over six hours, commencing at 09:30 on 9 December 2009. It found that many of the National Minimum Standards that were assessed had been met or partially met and the overall quality of care provided was evidently improved since the previous inspection. The purpose of this inspection was to assess compliance with the requirements of the Care Homes for Adults (18-65 years) Page 6 of 32 previous inspection and to generally monitor care practices at the home. On the days of the inspection there were twenty five residents living at the home. The inspection process involved a tour of the premises, observation of working practices, examination of the homes records and discussion with five residents, two relatives, three members of staff, the acting manager and the two proprietors. The self assessment document, the Annual Quality Assurance Assessment (AQAA) had been returned by the acting manager, as required, prior to the inspection. It had been completed fully and contained much of the information requested. The focus of the inspection was on the quality of life for people who live at the home. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Following discussion with the acting manager, risk management strategies should be reviewed and personal and environmental risk assessments developed in consultation with the individual resident. The lifestyle of residents could be enhanced by more opportunities being provided for local, social and community activities. It is also important that the leisure and recreational interests of residents are recorded in their individual care plans. Staff, including key workers, should spend more time with individual residents to ensure that their assessed personal support needs are met. Residents must be safeguarded from all forms of potential abuse by all staff undertaking appropriate training and relevant and up to date policies and procedures being developed and implemented. Care Homes for Adults (18-65 years) Page 8 of 32 As discussed, some serious thought and effort should be put into refurbishing and significantly improving the current unsatisfactory dining room, The area could be made a far more conducive environment in which residents eat their meals. Lighting in some areas of the home could also be improved. Staffing levels must be maintained and regularly reviewed to reflect the current and changing support needs of the residents. It is also important that the currently negative impact, on residents and staff, of having no recognised chef at the home be addressed. Following an unsettled period of management restructuring, it is essential that the person running the home has a clear sense of direction and leadership, as well as the necessary managerial qualifications, skills and experience for the post. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. Residents are admitted only on the basis of a thorough needs assessment, undertaken by people competent to do so. Comprehensive and detailed information regarding the home ensures that prospective residents know that the service is able to meet their individual care and support needs. Evidence: Comprehensive information regarding the home, including the Statement of Purpose and Service User Guide has been produced and is made available to all prospective residents. The Statement of Purpose provides an introduction and overview of the service, including the Philoophy of Care, aims and objectives and details of the organisational, management and staffing structure. Within the Service Users Charter are details of residents rights and responsibilities. It also includes information regarding the homes admission criteria, complaints procedure, facilities and activities available. There is a clear admissions criteria in accordance with the homes aims and objectives. As well as being invited to visit the home to look around and meet with existing Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: residents and staff, prospective residents have the opportunity to stop overnight or occasionally for a weekend stay before moving in. In addition to establishing whether the individuals care and support needs can be met within the home, the acting manager also stressed the importance of ensuring compatibility with existing residents. Documentation relating to the assessment and admission of two residents, admitted since the previous inspection, was examined and found to be generally satisfactory. Although several gaps were noted in the pre admission assessment, it was evident that the missing details were recorded in a separate and comprehensive social care assessment, provided by the individuals care manager. The acting manager confirmed that new residents undergo a flexible trial period at the home, followed by a thorough placement review, during which time their suitability and compatibility are fully assessed and it is established whether their identified care and support needs are able to be met. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. Improved and comprehensive care plans enable staff to meet the assessed support needs of residents in a structured and consistent manner. Systems for consultation and participation are effective. Residents are treated with respect and encouraged and enabled to make decisions about their day to day living. Evidence: Much improved care plans are in place for each resident. Individual plans include basic details and health and support needs, individual goals and associated targets. The revised plans represent good practice and are divided into three main sections: physical, social and psychological. Each section is further subdivided into Objective assessment, signed and dated by a member of staff and a Subjective assessment which is signed by the resident. The third column details the Combined goals. The acting manager confirmed that residents and, where appropriate, a relative or representative continue to be directly involved in annual care plan reviews. It was Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: evident from plans that were examined that reviews are appropriately recorded and plans, including risk assessments, are amended appropriately to reflect changing needs or circumstances. Information recorded includes who was present at the review and details of issues discussed and agreed goals. There was documentary evidence of risk assessments and management plans to enable residents to undertake a range of activities, both within the home and in the wider community. All of those seen had been recently reviewed and updated as necessary, however it was noted that the information recorded in these assessments and the overall quality varied significantly. Individuals are clearly enabled and supported to make decisions about many aspects of their life and are made aware of and understand the reasons for specific action being taken. Independence and individuality continue to be encouraged and promoted within the home and are clearly reflected in the personalising of residents rooms and individual preferences for menus and activities. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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. The ethos of the homes promotes the right of residents to make choices in many aspects of their lives. Although opportunities are limited, residents are supported and enabled to take part in appropriate activities, reflecting their needs and interests. In accordance with their wishes, residents are supported to maintain positive relationships with family and friends. Evidence: Although many residents at Davigdor have lived there for many years, the acting manager confirmed that, where appropriate, residents family links continue to be supported, however this is variable and not all residents have regular family contact. Visiting to the home continues to be unrestricted and residents relatives and friends are made welcome at any reasonable time. Residents were observed throughout the day to be able to leave the house independently when they chose to. As part of the Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: inspection process, two residents relatives were spoken to and both expressed general satisfaction with the home and the care and support provided. Community participation is also variable, however the acting manager confirmed that, in accordance with their wishes, residents continue to be encouraged and supported, where appropriate, to visit local restaurants, cinemas, theatres, shops and other amenities. They are also evidently supported to access local day centres and activities and facilities, including bowling and swimming, reflecting their individual needs, preferences and abilities. Following discussion with the acting manager, it is recommended that the current in house activities be reviewed and the recreational and leisure interests of residents be identified and recorded in their individual care plan. Several residents regualrly visit a holiday camp on Hayling Island. From their enthusiastic comments and the many photographs taken they obviously enjoy the experience. By the very nature of the service and the people who live there routines evidently need to be flexible. From dsicussions and direct observation throughout the inspection it is evident that many residents prefer their own company and consequently group activities are not necessarily appropriate in this setting. In the self assessment form (AQAA) completed by the acting manager,he stated that In some cases the nature of their illness and long term institutionalisation interferes with certain aspects of their lives. The catering situation within the home has evidently not improved since the previous inspection and there is currently no qualified chef at Davigdor. The post had been advertised and on the day of the inspection the proprietor was visiting the local job centre in an effort to fill the vacancy. In the meantime, care staff are currently undertaking the cooking in the home as well as other kitchen duties, which clearly has an impact on residents and the level of support that they receive. Staff indicated that food and menus are discussed at residents meetings and residents spoken with during the inspection confirmed that they are consulted with and are offerd an alternative to the main meal. However there is clearly some dissatsfaction with the food provided: Its alright but we dont get much. Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: Its like a cafe here - only not as good! Some residents continue to be involved in various aspects of meal preparation, including laying the tables, washing up and drying and preparing packed lunches. Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. Staff have developed close and positive relationships with residents and demonstrate an awareness and understanding of their individual care and support needs. Residents are protected by improved policies and procedures in place for the control and safe administration of medication. Evidence: The acting manager confirmed that close and effective working relationships between residents and their key worker ensures that any change in an individuals mood or behaviour can be identified and addressed at an early stage. All residents are registered with local GPs and have access via the CLDT to other health care professionals, including community phsychiatric nurses, psychologists and psychiatrists, as required. It was noted, in care plans that were examined, that all appointments with, or visits by, health care professionals are recorded. Recently revised policies and procedures relating to the control, storage, administration and recording of medication are in place. Medicines are stored and recorded appropriately. It was noted that at a recent staff meeting the signing of Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: Medication Administration Records (MAR sheets) was discussed and is evidently now being closely monitored. The Team Leader confirmed that all staff responsible for administering medication have received appropriate training and are individually assessed and authorised to do so. This was confirmed through discussions with staff and supported by training records examined. There is a key worker system in place, however some residents thought that they did not get enough time with their dedicated key worker. One resident who had some help with personal care felt they were being hurried. Guidance and support is provided, where needed, regarding individuals personal hygiene. Short term goals have been implemented about some issues of personal hygiene for individuals. On observation, residents continue to choose their own clothes, hairstyle, makeup and their appearance evidently reflects their personalities. Care Homes for Adults (18-65 years) Page 19 of 32 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. The open and inclusive atmosphere within the home enables residents, staff and visitors to feel able to express any concerns, confident that they will be listened to and acted upon. Policies and procedures relating to safeguarding adults are in place, however the issue of inconsistent staff training must be addressed. Evidence: A clear and accessible complaints procedure is in place. Residents and members of staff spoken to during the inspection confirmed that, should they have a concern or complaint, they would have no hesitation in speaking to the acting manager and each person was confident that they would be listened to. Records viewed demonstrated that the service takes any concern seriously. Seven complaints had been received by the home since the last inspection. They were generally minor concerns by residents and were not related to care provided within the service. They largely related to the environment, other residents or issues regarding smoking. it was noted that all had been appropriately investigated and resolved to the evident satisfaction of the complainant. Policies and procedures relating to safeguarding adults, including whistle blowing are in place and were found to be up to date and generally well maintained. The acting manager confirmed that staff are made aware of these and other key policies and procedures as part of their induction and foundation training and they are also Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: reinforced during regular supervision and staff meetings. Specific training related to Safeguarding Adults has receently been undertaken by the acting manager. However it was of some concern that two members of staff including a Team Leader, spoken with during the inspection, confirmed that they had not received updated training on Safeguarding Adults. This inconsistency was discussed with the acting manager who has made assurances to address the issue as a matter of priority. Therefore on this occasion no requirement has been made. Care Homes for Adults (18-65 years) Page 21 of 32 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 service is accessible, safe and clean and remains suitable for its stated purpose. With the exception of the stark and functional dining area, residents benefit from accommodation that is generally comfortable, well maintained and decorated to a satisfactory standard. Evidence: Davigdor Lodge comprises two large houses joined together and is located in a residential area in Hove. Residents bedrooms are located over four floors and residents must be able to moblise independently to access areas above and below ground level. During my tour of the premises, including residents accommodation and communal areas, it was evident that the generally well maintained decor and adequate furniture and furnishings continue to provide a reasonably comfortable environment for the residents. The acting manager confirmed that independence and individuality continue to be promoted within the home and this is evident from the personalising of residents individual rooms, which clearly reflects individual tastes, interests and personalities. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: As previously documented, the dining room is fairly small for 25 people and a bit of a passageway to other areas of the home. There is very little natural light coming into the room, as the windows are small and high up. With the stone tiled floor and random tables and chairs, the dining area has a stark and institutionalised feel and appearance. In discussion with the acting manager, he accepted and acknowledged that the dining room does not feel homely or welcoming and some real thought and effort is now needed to improve this important focal point within the home. At the rear of the home there is a conservatory which is the designated smoking area. Since the previous inspection the number of domestic staff has been increased and on the day of the inspection, levels of cleanliness and hygiene throughout the home were found to be generally satisfactory.There is a cleaning checklist on all toilet facilities to ensure these areas are monitored. There were no offensive odours noted throughout the home, however in some areas there is the unmistakeable smell of smoke from residents smoking indoors. This has been an ongoing problem, which was highlighted in the previous inspection report. The management is trying to address this problem with the individuals concerned. Risk assessments are in place for those residents who smoke in their rooms. A welcome development has been the introduction of automatic door closures for many bedrooms, which reduces the incidence of doors being wedged open. Care Homes for Adults (18-65 years) Page 23 of 32 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 protected by the homes robust recruitment policy and procedures and benefit from there generally being sufficient trained, competent and dedicated staff on duty at all times to meet their assessed care and support needs. However the negative impact, on residents and staff, of having no recognised chef at the home should be addressed. Evidence: In addition to the comprehensive induction programme undertaken by all newly appointed staff, the acting manager confirmed that appropriate core skills training is provided, including first aid, food hygiene and fire safety. This was evidenced through discussions with staff and supported by individual training records examined. The acting manager confirmed in the AQAA that currently one member of staff has achieved NVQ Level 4, five have Level 3 and three have obtained NVQ Level 2. Two part-time staff are Registered Mental Nurses and two part-time staff are hoping to start their NVQ training in the near future. A current duty rota was made available for inspection. To address the unpredictable Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: nature of working at Davigdor, the acting manager personally provides all care support staff with formal supervision on a regular basis. The management team evidently operates an open door policy, with staff able to discuss any issues at anytime. This was evidenced by supervision records examined and through discussions with staff, spoken with during the inspection, who acknowledged the benefits of effective supervision and confirmed feeling valued and supported by the acting manager and proprietors: They are all supportive and always have time for you. The acting manager is clearly aware of the need for thorough and robust recruitment procedures, to ensure the protection of residents. It is evident that sice the previous inspection these policies and procedures have been revised and improved. Individual files that were examined, relating to recently appointed members of staff, were found to be well maintained, containing all relevant and necessary information, including two satisfactory references, proof of identity and satisfactory Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) disclosures. The acting manager confirmed that, as previously documented, the home is currently looking to recruit a full time chef. Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 the dedication, experience and close involvement of the proprietors and the commitment and motivation of the acting manager. The views and rights of residents underpin the ethos of the home but quality monitoring systems should be reviewed and expanded. Evidence: The service has clearly gone through a very unsettled period this year with the registered manager leaving in May, after a long illness, and her replacement going off on maternity leave. This has inevitably impacted on residents and staff. The son of the proprietors, a very experieced carer, has been appointed acting manager and is clearly working hard to improve staff morale and address identified shortfalls, many in relation to care planning systems and other documentation, including risk assessments and policies and procedures. In his recently completed AQAA, the acting manager described the current situation regarding the mangement of the home: Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: Davigdor Lodge had faced one of its most challenging times since its inception. The manager had been ill for quite a while, the extent of the deterioration in the paper work and administration of the home had greatly suffered. This had caused quite a strain on the management of the home. Fortunately the existing staff have been loyal and supportive. They have managed to keep the service users safe and functioning despite their own fears and anxieties. The service users were kept safe from the under-current of the upheaval. The maternity leave of the assistant manager just added to the anxiety and confusion. Again the staff have been understanding and supportive. The acting manager has been supported fully by everybody and the care will only get better. Quality monitoring systems are in place, including a satisfaction questionnaire for residents, developed since the last inspection. Following discussion, the format for the questionnaire is to be reviewed and amended to provide opportunity for residents to add any comments or suggestions they may have regarding the standard of service provision. The quality assurance system is also to be extended to seek the views of residents relatives, health care professionals and other visitors to the home. The acting manager confirmed that the health, safety and welfare of residents and staff remains of paramount importance within the home. Staff training is provided in many aspects of safe working practices, including food hygiene; fire safety and first aid. All staff training is recorded. COSHH assessments and guidelines are in place. Regular fire drills are undertaken and recorded and fire safety systems within the home, including alarms and emergency lighting are tested on a regular basis. Temperature regulators are fitted to all hot water outlets, accessible to residents. All accidents, incidents and injuries are recorded and reported, as required. Care Homes for Adults (18-65 years) Page 27 of 32 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 Adults (18-65 years) Page 28 of 32 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 1 13 16 It is required that the lifestyle of residents be enhanced bythe provision of local, social and community activities. Opportunities for social activities and community participation are limited by staffing levels and inadeqaute resources. 31/01/2010 2 14 16 It is required that residents 31/01/2010 have acces to, and choose from, a range of appropriate leisure activities. The recreational and leisure interests of residents are currently not identified in their individual care plan. 3 33 18 It is required that staffing levels are maintained and regularly reviewed to reflect the current and changing support needs of the residents. 31/01/2010 Care Homes for Adults (18-65 years) Page 29 of 32 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 Staff working in other roles, including cook, adversely effects residents and colleagues. 4 37 9 It is required that the person 31/03/2010 managing the home has the necessary qualifications, skills and experience for the post. With registered manager having left and her replacement going off on maternity leave it has inevitably impacted on residents and staff. 5 39 24 It is required that the current quality assurance system be reviewed and extended to seek the views of residents relatives, stakeholders and other visitors to the home. At present only basic satisfaction questionnaires for residents are in place. 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 31/01/2010 1 9 It is recommended that risk management strategies be reviewed and personal and environmental risk assessment be developed in consultation with the individual resident. Care Homes for Adults (18-65 years) Page 30 of 32 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 2 18 It is recommended that staff, including key workers, spend more time with individual residents to ensure that their assessed personal support needs are met. It is recommended that, as discussed, inconsistencies in staff training be addressed as a matter of priority. It is recommended, as discussed, that thought and effort be put into refurbishing and significantly improving the current unsatisfactory dining room. It is recommended that the negative impact, on residents and staff, of having no recognised chef at the home be addressed. 3 4 23 24 5 33 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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 © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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