Care Home: Dean Lodge

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Dean Lodge Dean Lodge Dean Road Ferryhill Co. Durham DL17 8ET three star excellent service The quality rating for this care home is: 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: Stephen Ellis Date: 0 3 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. They reflect the things that people have said are important to them: 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 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 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. 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. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Dean Lodge Dean Lodge Dean Road Ferryhill Co. Durham DL17 8ET 01740 652059 P/F Anne.appleton@durham.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Durham County Council care home 7 Number of places (if applicable): Under 65 Over 65 7 0 learning disability Additional conditions: The registered person may provide personal care (excluding nursing) and accommodation to service users of both sexes whose primary care needs on admission to the home are within the following category: Learning Disability (Code LD) The maximum number of service users who may be accommodated is 7. Date of last inspection 0 6 1 0 2 0 0 6 A bit about the care home Dean Lodge is a purpose built home that provides a short break service for 7 people with learning disabilities. The home is a bungalow situated in a residential area close to the town of Ferryhill. At any one time the home can take up to 3 people who have multiple disabilities; the home has aids and equipment for this purpose. All people who use the short break service are provided with a single bedroom (all of which exceed the National Minimum Standards) and have free access to lounge, conservatory, and dining room. There is a domestic style kitchen that people can use with supervision. All accommodation is on ground floor level with good access. The home has easily accessible rear gardens and sitting areas. There is parking for visitors to the front of the home. 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home The last inspection on this service was completed on 6th October 2006. The present key inspection was carried out on 3rd October 2008. It included a site visit, tour of the building, examination of key documents and comments from people who use the service, relatives and staff. Pre-inspection material was considered and this included the homes own self assessment of quality (Annual Quality Assurance Assessment) plus returned surveys from 4 people who use the service, 2 relatives and 7 staff. The weekly cost of this service is 1761 pounds, but the actual amount paid by people who use the service is more likely to be about 80 pounds, depending on individual circumstances. What the care home does well This is an excellent short break service and it does very well across the board. People who use the service and relatives rate it very highly and it scores well against National Minimum Standards. It achieves a 92 occupancy rate, with over 700 admissions per year. Typical comments included: “There is excellent communication; staff keep you fully informed and welcome your involvement.” “I just think it’s an excellent service.” “I love coming here” “All the staff are very approachable and I have great confidence in the service.” What has got better from the last inspection What the care home could do better The service is considering appointing an activities coordinator and this could have a further positive impact on opportunities for people to enjoy social and recreational activities. It is also looking at the possibility of developing an amenities fund to support activities. The service should review its minibus provision to see whether it is suitable to transport people with a wide range of disabilities in sufficient numbers, or whether alternative forms of transport should be considered. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Stephen Ellis CSCI St Nicholas Building St Nicholas Street Newcastle upon Tyne NE1 1NB Tel. 0191 233 3300 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 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 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . A person centred approach is taken by the home so that people who are thinking about using the service can make fully informed choices about services and facilities on offer. Evidence: Thorough assessments of need, wishes and preferences have been completed before admission for a short break service, as found documented in the plans of care of four people who use the service. These are based on the documented profiles of people who use the service and the written feedback from them or their representatives after the short break has ended. Comprehensive preadmission information is supplied, including up to date, accurate details of any medicines required. People who use the service and their relatives said that they had excellent knowledge of the service prior to admission because of previous contacts and very good information in the service user’s guide and welcome pack supplied by the home. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The service is based on respect for individual needs and choices, with the person who uses the service at the centre of all activity, supporting independence and responsible risk taking. Evidence: People who use the service and their relatives said that they felt empowered by the service provided by Dean Lodge because it treated each person as a unique individual and valued their needs, wishes and feelings in all things. This person centred approach was evident in the four plans of care for people who use the service that were examined on the day of the inspection. These also showed that responsible risk taking was encouraged and supported by thorough assessments of risk carried out by the home. Activity logs record individuals daily, personally chosen activities. Weekly meetings with people who use the service provide additional opportunities for consultation and feedback, as do the exit questionnaires completed by people who use the service after their short break has ended. Pictorial information, such as complaints procedures and menu provision, help meet individual needs and choices, and was of a very good standard. Typical comments received from people who use the service or their relatives included: “There is excellent communication; staff keep you fully informed and welcome your involvement.” 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The lifestyles of people who use the service are enhanced wherever possible, building on their known preferences and requirements, providing opportunities for personal development and fulfilment. Evidence: People who use the service are supported to follow a lifestyle of their choice, reflecting their preferences wherever possible. For example, they can continue to pursue their usual programme of activities or choose to participate in a range of indoor and outdoor activities on offer, including outings to places of interest. Typical comments received from people who use the service or their relatives included: “I love coming here”. Also, relatives trusted the service and regarded it as operating in the best interests of the people who use it. Menus were observed to be varied and appetising, with alternatives readily available. Menus were well presented, using pictures to illustrate meals on offer. Some staff commented that the homes minibus was not always suitable for transporting some people with special mobility needs and this would benefit from being examined further. The home is hoping to appoint an activities coordinator in the near future and this would help to develop the opportunities for people who use the service to engage in rewarding activities relevant to their needs and interests. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Personal and health care support is provided in a person centred, holistic way, which values each individual and seeks to promote excellent outcomes for them, fulfilling their health and personal care needs. Evidence: People who use the service and relatives expressed high levels of satisfaction with the quality of personal care and health care support. Typical comments included: “I just think it’s an excellent service.” “I love coming here” “All the staff are very approachable and I have great confidence in the service.” The case files examined were impressive in their detailed, up to date information about the care, health and support needs of the individual person who used the service. These were based on the personal profiles of people who used the service, taking into account assessments of need from Local Authority commissioning teams, plus inputs where appropriate from Occupational Therapists, General Practitioners, Community Nurses and Speech and Language Therapists. Good arrangements were observed with regard to medicines, including their storage, administration and return or disposal. All staff members responsible for administering medicines have completed Safe Handling of Medicines accredited training and undergo competency assessment. There are very good links with community health services, including GPs and specialist nurses. A very high percentage of care staff members have completed National Vocational Qualifications (NVQ) in health and social care, plus the Learning Disability Initial Award or equivalent, which reinforce good social care values and principles, such as respecting and valuing the individual person, promoting their dignity, rights, privacy, independence, choice and fulfilment, wherever possible. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who use the service can be confident that there are very good systems in place to protect them, inviting comments, complaints and compliments. All members of the staff team take such matters very seriously. Evidence: There are robust systems for inviting and dealing with comments, complaints and compliments (CCC) from people who use the service and their representatives. These include weekly, minuted meetings between members of staff and people who use the service, exit surveys completed by people who use the service or their representative after each short stay break, informal consultations with relatives and people who use the service, monthly minuted staff meetings at which CCC is a standing item, plus monthly visits from the registered providers representative who makes a report. The home’s steering group of representatives of people who use the service meets bimonthly, providing another important forum for monitoring CCC. Complaints procedures and the home’s charter of rights for people who use the service are very well displayed and accessible, using pictures wherever appropriate. The provider also has an excellent representations procedure for dealing with any complaints against members of staff. Staff recruitment procedures are high quality, including criminal records checks at an enhanced level, protection of vulnerable adults checks, the taking up of 2 references, and a probationary period for up to 6 months. The views of people who use the service are taken into account concerning the suitability of staff, including 2 direct observations of staff practice by supervisors each year. Staff induction and training is excellent in addressing safeguarding and ‘whistle blowing’ issues to protect people who use the service. People who use the service and their relatives said they would not hesitate to approach staff with any concern or complaint and described all staff as friendly, helpful and approachable. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . An excellent, well-equipped and homely environment has been created to support and enhance the quality of life of people who use the service. Evidence: Very positive comments were received from people who use the service and their relatives about the quality of the premises and their cleanliness. Typical comments included: “The home is always fresh and clean.” This purpose built bungalow is very well maintained and very well equipped, including aids and adaptations for people with physical disabilities. Each bedroom is a spacious single with access to high quality en suite bathing and toilet facilities. A tour of the premises confirmed that the home provides spacious, clean and homely accommodation. New, high quality non-slip floor covering has been installed in bathrooms and each bedroom has its own TV. New bedroom furniture and kitchen are on order. Alcohol gel is supplied throughout the home to minimise the risk of cross-infection and all staff members have completed accredited training in infection control. A new shed is on order and improved exterior lighting has been installed. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Excellent staffing levels, recruitment procedures, training, qualifications, supervision and skill mix are provided to ensure high quality support and care for people who use the service, at all times. Evidence: People who use the service and relatives spoke very highly of the care and support provided by all members of the staff team. Typical comments included: “Excellent caring staff. We have every confidence in them. X couldn’t be treated any better.” Staff members are well qualified and trained. Over 90 of staff members have achieved National Vocational Qualifications (NVQ) in health and social care, or promoting independence, at level 2 or above. Very good recruitment and appointment procedures are in place, including enhanced criminal records check, protection of vulnerable adults checks, the taking up of 2 references and a 6 months probationary period. Criminal record checks are repeated every 3 years. All staff members have an occupational health medical check before being confirmed in post. All members of staff do Learning Disability Initial training to ensure their training is focused on the needs of people who use the service. Staff said that their training was very good. Staff records confirmed all mandatory staff training had been completed and that specialist training was carried out to equip staff with the appropriate knowledge and skills to support all people who use the service. Very good arrangements for staff supervision and support are in place, including evidence based supervision and appraisal that require staff practice to be observed on at least 2 occasions each year. Staff meetings are held monthly and minuted. Staffing levels were observed to be very good, in keeping with the assessed needs of people who use the service. At the time of inspection, 2 people who use the service were each receiving 1 to 1 care inputs during the day, with another 3 staff on duty. At night, there were 2 awake members of staff and one on call on the premises. Normally, there is one awake member of staff and one on call on the premises, but this minimum number would increase if the needs of people who use the service were to increase. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The conduct and management of the service is in the best interests of people who use the service and achieves a consistently high standard. Evidence: People who use the service and relatives spoke highly of the conduct and management of the service. They said they had great confidence in all aspects of the provision. They found the booking system for short breaks to be fair and flexible, with sensitivity and integrity in equal measure. Communication and understanding was described as being very good. The home has a well-qualified and experienced manager in post, including the Registered Manager’s Award at National Vocational Qualification (NVQ) level 4 and Registered Nurse Award in Learning Disability, with over 32 years experience of working in health and social care with people with learning disability. The deputy manager is also well qualified, including a level 3 Award by the Institute of Leadership and Management (ILM) in first line management. The home has very good quality assurance systems operating, including weekly consultations with people who use the service and exit surveys to be completed after each short break. Relatives and people who use the service are invited to contribute comments, complaints or compliments. These are recorded and taken seriously. The home has a steering group of representatives of people who use the service that meets bi-monthly and relatives and other stakeholders, such as Social Services Commissioning Social Workers, are invited to 4 coffee mornings each year. These meetings provide opportunities for people to discuss the quality and direction of the service. The service has achieved the Investor in People and Charter Mark Awards, both important indicators of quality assurance and public service. There are very good support and supervision systems for staff, including monthly team meetings, which are minuted, plus four I to 1 supervision sessions per year for each member of care staff, including Evidence: two direct observations of practice. Health and safety matters are thoroughly addressed and there is very good training provided, including Fire Safety, Safe Handling of Medicines, Safeguarding Adults, Mental Capacity Act, First Aid, Food Safety and Infection Control. Are there any outstanding requirements from the last inspection? Yes  No  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 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 Description 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 Description 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 14 The suitability of the current minibus would benefit from review. 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. - 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!