Care Home: Dunraven Lodge

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What the care home does well People who had moved into the home relatively recently considered they had been given good information to help them in their choice of home. The assessments of prospective residents were detailed and objective, enabling the home to make a judgement about people`s levels of need and the home`s ability to provide for them Several residents told us how happy they were living in Dunraven Lodge. One person said: "I`ve been here for a few years now, and have been happy from the start. Another resident said that staff were: "Always cheerful and willing to help", and yet another said: "Staff are wonderful from the cleaners to the manager". One family member said: "We particularly appreciate the emphasis on good, home cooking", and another said: "Dunraven is a home in the full sense of the word. It is a good place to be and a welcome sanctuary from the rest of the world". Care plans and risk assessments were clear and concise. Risk assessments were obviously linked to care plans, and were in place for a number of issues including anxiety and showing physical aggression, as well as potential medication problems. In discussion with the staff, it was clear that they were aware of the ways in which residents could be at risk, and were taking measures to avoid these. When we asked one healthcare professional what the home did well, she said: "It`s well organised, and provides a comfortable home for individuals". One staff member said: "For the most part, the service keeps the residents as well as they can be, in a happy environment". The staff training offered by Dunraven Lodge is of a high standard. Basic induction training is provided to new staff to ensure that they are equipped with the skills and knowledge to deal with care needs. This has been developed using written workbooks.The trainer meets with them to discuss any need for support, checks that the home`s procedures have been understood, and that all documentation has been completed. Workshops and one to one discussions help induction training. One new member of staff said: "This entire training has been the best I`ve ever had anywhere". She went on to say: "I felt able to ask questions without seeming silly". What has improved since the last inspection? At our last visit we asked the manager to make attempts to obtain a police check and a reference from the last employer of staff who were from another country, as well as the checks they did in this country. They have now done so. What the care home could do better: There were good medication procedures in place, although staff had made some basic errors. One medication which was not in use had not been returned and there was occasionally no record of when a medication had been started. This made it difficult to check the stock. The manager has been asked to rectify these errors. When we asked residents what the home could do better, one person said: Short of giving me back my health, I cannot think of anything that could be done better". Inspecting for better lives Key inspection report Care homes for older people Name: Address: Dunraven Lodge 8 - 10 Bourne Avenue Salisbury Wiltshire SP1 1LP     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: Alyson Fairweather     Date: 2 3 1 0 2 0 0 9 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. 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. 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 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Dunraven Lodge 8 - 10 Bourne Avenue Salisbury Wiltshire SP1 1LP 01722321055 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) : eoconnormarsh@aol.com Mrs Eileen O`Connor-Marsh,Mrs Brigid O`Connor care home 20 Number of places (if applicable): Under 65 Over 65 0 4 dementia mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home 2 20 Dunraven Lodge is a privately owned care home which offers accommodation and personal care to a maximum of twenty service users. These are primarily younger adults with a mental disorder. It is one of four registered care homes operated by Mrs OConnor and Mrs OConnor-Marsh in the Salisbury area which have been in operation since the 1980s. Dunraven Lodge is a large detached Victorian house, which is located next door to one of its sister homes, Dunraven House. The location of the home is convenient for residents who make use of the facilities and amenities of Salisbury. The administration of all the homes is centred at Dunraven House and staffing is also organised centrally for all three homes. The premises provide ten single and five shared bedrooms for residents use. Two of Care Homes for Older People Page 4 of 28 Brief description of the care home the single bedrooms are provided with en-suite facilities. Most of the residents bedrooms are located on upper floors, which are accessed by use of a staircase. There are plans for an extension to be built which would mean that all residents would have their own single room. The home s fees charged to residents for the care and accommodation range from £425 to £650 per week. The registered provider/manager is Mrs OConnor.Marsh. Information about the care and services provided is available from the home, in written form, by way of its service users guide. Care Homes for Older People Page 5 of 28 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: This unannounced inspection took place in October 2009. We spoke to residents and their relatives, and we met with various staff members, including care staff, senior carers, office staff, and other senior members of staff, as well as the registered manager. We received an Annual Quality Assurance Assessment (known as the AQAA) from the home. This was their own assessment of how they are performing. It also gave us information about what has happened during the last year. We looked at the AQAA and reviewed all the other information that we have received about the home since the last inspection. This helped us to decide what we should focus on during our visit. We received written feedback from several service users, their relatives, staff members Care Homes for Older People Page 6 of 28 and one healthcare professional. We also looked at various files and documents, including care plans, risk assessments, medication procedures, health and safety procedures, staff training files, and the staff recruitment procedures. 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 Care Homes for Older People Page 8 of 28 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.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 Older People Page 9 of 28 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 10 of 28 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. Prospective clients and families are given information leaflets so that they can choose whether or not they wish to use the service. All residents have their individual needs assessed before they arrive, so that staff know how best to support them. Evidence: The home has a comprehensive Statement of Purpose and Service User Guide which give an overview of the service which will be provided. This has recently been updated, and a copy is given to every potential resident. It gives details of the organisations complaints procedure. Of the residents who wrote to us all said they had been asked if they wanted to move to the home and that they had received enough information before they moved in. One person said: From the very first day of moving in I have enjoyed living at Dunraven Lodge, and I am very happy here. Another said: I have been kept informed about the home both before and since moving in. Care Homes for Older People Page 11 of 28 Evidence: Most residents have been at Dunraven Lodge for some time, although there were some new ones. Each new resident is offered a series of trial visits, in order to give them time to get to know the home, the other residents, and the staff. Staff try to find out what they would like to do with their daily routine before they move in. We looked at some of the assessment information and saw that the referral agency, the Community Mental Health Team (CMHT) had completed an extensive application form, with previous risk assessments attached. They had also provided a copy of the most recent Care Programme Approach care plan (CPA), which gives details of how the potential resident can best be supported with their mental health needs. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have all their health, personal and social care needs set out in care plans. Their health needs are fully met. Residents are protected by the homes medication procedures, although there are some areas which need improved. People feel they are treated with dignity and respect. Evidence: Care plans were in place for all residents and showed evidence of regular review. Care staff were seen to use the care plans as working documents, seeking information from them and adding entries as necessary. Some people have written in their own daily notes, so they feel part of the care planning process. Whilst talking to staff, it was clear that they were aware of individuals needs, and daily records reflected this. All residents are provided with a long term assessment and care plan which identifies their strengths, needs, preferences and aims and objectives. They are initially reviewed within the first month of admission, and this provides the basis for the future development of the care plans. Short-term plans have also been established which Care Homes for Older People Page 13 of 28 Evidence: identifies specific goals that the home and resident are working towards. There were risk assessments in place for most residents, all of which had recently been reviewed. Risk assessments were kept alongside the medication records, and were on the residents file. The ones on file were clearly linked to the residents care plans, and these included ones for support during bathing, smoking, anxiety and showing physical aggression to staff as well as potential medication problems. In discussion with the staff, it was clear that they were aware of the ways in which residents could be at risk, and were taking measures to avoid these. Care plans were also in place for people who were on a Community Treatment Order. People all have their own GP and see healthcare professionals as and when needed. There was evidence of optician and dentist visits, as well as district nurses services being used. Residents receive a psychiatric review every six months, and there is a regular clinic for people who need injections. Information on care plans related to sleep routines, eating, communication, mobility, personal care, emotional well being, a medical report, and socialisation likes and dislikes. Peoples weight is also recorded regularly. Records showed that emergency services are sent for quickly if needed. One community nurse who visits the home said that if she gave any specialist advice, it was incorporated in the care plan, and that she was satisfied with the overall care provided to residents in the home. The Standex system of care planning is used in the home. Whilst this gives full details of peoples needs and their goals, both short term and long term, there is little room for information relating to the individuals strengths and what they are like as a person. The providers should consider having a pen portrait style of narrative alongside the care plans in order to show a more holistic approach. Medication is stored securely in the home, and staff do not administer medicines until they have received appropriate training. They have upgraded their medication storage with a new Medication Trolley. Information about various medicines is available in the home and we saw staff manage a medication round well. All the medication administration records checked were clear. They have good systems in place to store and record any controlled drugs. There was no date marked on some of the boxes or bottles, and although old stock was said to be returned monthly, there was one occasions where this had not been done. We recommend that the date when a box or bottle is opened is clearly recorded. We also found that one medication was no longer being used by the resident. We have asked the manager to make sure that all unused medication is returned to the Care Homes for Older People Page 14 of 28 Evidence: pharmacy. All residents spoken with confirmed satisfaction with staff members and expressed that his or her privacy and dignity were respected at all times. Staff were observed knocking on doors and residents were spoken to with their preferred form of address. Residents confirmed that all personal care was given appropriately and staff respected their wishes when they wanted to spend time in their room. There are a few shared rooms, but each of these has a screening facility. There are building plans in progress which will mean that all residents will have single rooms in future. Staff induction training makes it clear that the homes expectation is that residents will be treated with dignity, and that their independence and self esteem must be encouraged. All relatives we spoke to said that they could visit their relative in private. The community nurse who wrote to us said: Staff are always doing their best to maintain dignity and individualisation of people all the time. Care Homes for Older People Page 15 of 28 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. The home seeks to identify and meet peoples social, religious and recreational needs. There are no barriers to contact with family and friends, and people are able to make some decisions about every day life. People are offered a choice of good quality meals, which take account of dietary needs and preferences and are served in a pleasant environment. Evidence: All residents spoken to reported that they are able to follow their preferred routines and choose how they spend their day. Residents are therefore able to get up and go to bed at preferred times, although people are expected to get up for breakfast. They can spend time in their room as required. However, most people had an active life outside the home, and were involved in things such as swimming, bowling, snooker and riding for the disabled. Some people attend the drop in centre and access the various activities and social events on offer, while others attend college. There is a large allotment adjacent to the house, and some people grow their own vegetables. Residents have the opportunity to pursue their own hobbies and interests and are encouraged to do so. Some people also attend the church of their preference. Staff duties cover attending and supporting residents in activities and appointments. Care Homes for Older People Page 16 of 28 Evidence: Residents can entertain family or friends either in the privacy of their own bedrooms or in the communal areas available. Staff encourage and support links between residents and their families, although the frequency of contact varies depending on individual circumstances. Some family members keep in touch with regular phone calls and others visit whenever they can. Residents can bring some of their own possessions to the home when they move in, and many of the rooms contained personal items, including TVs and stereos. It is the policy of the home not to become involved in residents finances. These are normally managed themselves or by their representative. Any expenditure necessary is usually invoiced to the residents families or their appointee.Smoking is restricted to the rear garden and Chalet, which is located at the bottom of the garden. Residents incoming mail is given directly to them unopened, although staff would assist people to understand the contents of their mail, if required. A phone is available within the home for residents to receive any calls, although a number of residents have their own mobile phones to make outgoing calls. Care plans showed that peoples preferences about food were gathered at assessment and passed to the cook on admission. The main meal of the day was lunch, for which there were two choices of alternative main courses. There was a choice of sweets, and of breakfasts. People told us they enjoyed their meals and our observation was that they did so. The cook was aware of and able to manage varied dietary needs, including a diabetic diet. She was enthusiastic and saw it as part of her job to have plentiful interaction with the residents, in order to maintain direct feedback from them. Menu planning was geared to the preferences of the resident group and to the season. Daily records are kept about how what people eat, so that any lack of appetite will be spotted early. There are various dining areas within the home and there is an expectation that residents will eat their meals within these. Drinks are also available for residents at other set times of the day and staff would facilitate this. All the residents we spoke to said they really enjoyed the food. One said: You get great grub here! Another said: There is always a nice selection of meals to choose from. If I want something other than what is offered, they will always oblige. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. The policies and procedures which the home has in place ensure that residents are protected from abuse. Evidence: The home has a complaints procedure in place, and this is given to residents and their families. There have been no complaints made to CQC about the home. Staff spoken to were clear that they wished the service to be run in the interests of the residents. All the people who wrote to us said they knew who to speak to if they were not happy and knew how to make a complaint. Several compliments had been received from relatives of people living in the home.. The home has copies of the local No Secrets document, as well as their organisational policy and procedure on responding to allegations of abuse. All staff members are encouraged to report any incidences of poor practice, and a Whistle Blowing procedure is also available. Staff are encouraged to go to the management if they have any concerns. Some of the staff we spoke to confirmed that they have received training in this area, and the issue of abuse is also covered during the induction of new staff. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a safe, well maintained, comfortable and hygienic environment. Evidence: The location of the home is convenient for residents who make use of the facilities and amenities of Salisbury. The property is in keeping with its surroundings and the residential neighbourhood. Furnishings, fittings and decoration are maintained to a good standard. Some people have recently had their bedrooms decorated, and there is a rolling programme of re-decoration. The premises provide ten single and five shared bedrooms for residents use. Two of the single bedrooms are provided with en-suite facilities, although it is planned to have six more en-suite single bedrooms built. Most of the residents bedrooms are located on upper floors, which are accessed by use of a staircase, although the fact that there is no lift means that the layout of the home is not suitable for wheelchair users. Bedrooms are well furnished and people can bring limited items of furniture and personal possessions to make their bedrooms more homely. Residents are provided with a lockable storage space within their bedrooms, although their bedroom doors are not provided with locks. The manager told us that locks could be fitted if anybody wanted this, and that the subject is often discussed at residents meeting. Care Homes for Older People Page 19 of 28 Evidence: One resident said: I like my room; its really big and nice. Another said: I have a lovely room. The communal space consists of two lounges, two dining rooms and a dining area within the kitchen. These facilities are comfortable and suitably decorated and furnished. A chalet is located at the rear of a well-maintained garden, which has been designated as the smoking area for the home thus providing a smoke free zone to all other parts of the environment. Several residents commented on the clean, fresh rooms, and one relative told us: Its always spotless. One resident said the home was: Cleaned daily and extra if there is a mess. The equipment and practices for handling laundry are suitable for reducing the risks from any items which may be soiled or infected. The kitchen and food storage areas were seen to be clean and hygienic. The homes infection control policy is discussed with new members of staff at induction, and all other staff have had infection control training. Toilets and bathrooms were seen to have single use soap and paper towel dispensers. Care Homes for Older People Page 20 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has the number and skill mix of staff to meet residents care needs. A safe system for recruitment and selection of staff is in place, and residents are supported by staff who have an extensive training programme. Evidence: Dunraven Lodge has three members of care staff on duty throughout the waking day with two care staff sleeping in each night. There are three cleaners employed who work throughout all the homes, providing a full clean in each home once a week with additional cleaning undertaken daily by the care staff. There are also staff to deal with administration, maintenance and gardening. Many of the care staff have NVQ Level 2 with some also having NVQ Level 3. One of the added benefits of the organisation that each of the four care homes has a care manager, and all of these people have achieved an NVQ Level 4 and the Registered Managers Award (RMA). Dunraven Houses employment checks include Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks, two written references and a medical declaration. All potential staff complete an application form, and this is kept by the home, as well as photographic ID. All the files we checked contained the appropriate checks. Care Homes for Older People Page 21 of 28 Evidence: One resident told us: Staff are always available, and another said: The staff are always very kind and friendly. Another resident said: Staff are very friendly and helpful at all times. There was evidence that new staff have induction training when they start to work at Dunraven Lodge. Two new staff members we spoke to confirmed that they had had induction training, and we saw some induction workbooks. Other staff training has included health and safety, food hygiene, care and administration of medicines, diabetes and safeguarding vulnerable adults. A tutor has been arranged to visit the home weekly and to support several staff to complete a variety of work books leading to an ASET qualification. These workbook courses include: Infection Control, Dementia, Medication Administration, Nutrition and Palliative Care. Manual Handling training is now offered on site regularly by one of two qualified trainers who have completed and achieved the Train the Trainer Award. Training is also planned in the Mental Capacity Act and Deprivation of Liberty. Care Homes for Older People Page 22 of 28 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 run and managed by a person who is appropriately qualified and has considerable experience within the care setting. The home creates an atmosphere where residents and staff can express their views and contribute to the running of the home. The health, safety and welfare of the residents and staff are promoted and protected. Evidence: Mrs OConnor-Marsh has primary management responsibility for this home and is qualified as a State Enrolled Nurse, has obtained the Certificate in Social Services which includes a Management component and has achieved the Registered Managers Award (RMA). She has considerable experience in the care profession, and is supported by a deputy manager who has day to day responsibility for the care provided to the residents and has also achieved the RMA. They have organised the staffing structure to enable a Deputy Manager to be available on every day shift at Care Homes for Older People Page 23 of 28 Evidence: Dunraven Lodge, surplus to the allocated carers. Managers meetings are held on a regular basis. Discussions with staff and residents indicated that there is an open, positive and inclusive atmosphere within the home where the proprietor manager communicates with a clear sense of direction and leadership. Staff feel able to contribute ideas and suggestions pertaining to the running of the home. Regular staff meetings and daily hand over meetings have been established which ensure that staff are kept fully up to date. Staff commented that management are very approachable and they are happy with the level of support provided. Similarly, residents feel able to discuss any issues or concerns with the management and/or staff and feel these would be suitably dealt with. Residents meetings are held every two months and this provides them with a forum to discuss any issues about the running of the home. Residents also have the opportunity to discuss individual issues through the key worker system. We looked at the results of the some of the questionnaires which are given to relatives and outside professionals. One family member said: Our family members care needs are fully met, and he feels at home. There are a range of mechanisms in place for the proprietors to receive feedback from staff in order to monitor the standard of care and services provided to the residents. These include regular staff meetings, daily handover meetings and both formal and informal staff supervision. Staff told us that they receive formal supervision and they are happy with the level of support available. We confirmed this when we looked at the files. Annual appraisals were also in place. The quality of peoples supervisions was sometimes variable. Currently the senior staff who run supervision sessions have had had some training in how to conduct them, and a standard format is used. The manager told us in the homes Annual Quality Assurance Assessment (AQAA) that they would like to provide training courses for supervisors so that they will be enabled to have quality supervisions sessions which all staff view as a pleasant experience. We recommend that all senior staff who conduct supervision with staff should have training in how best to do this. There were good health and safety records in place. Records show that staff have been trained in areas relating to health and safety, such as manual handling and health and safety. All staff had done fire training, and there were various health and safety checks done daily, weekly, monthly and annually. The homes fire drills are done on a quarterly basis, and fire extinguishers were checked in June 2009. there is a fire risk assessment in place. In discussion with the manager, she was clear that all the residents in Dunraven Lodge were mobile and were able to be evacuated in the event of a fire. Care Homes for Older People Page 24 of 28 Evidence: The Environmental Health Officer visited the home and they were awarded five stars an Excellent Score on the Door. There were no outstanding requirements or recommendations. Care Homes for Older People Page 25 of 28 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 26 of 28 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 9 13 All medication no longer in use must be returned to the pharmacy. So that nobody receives medication they should not. 20/11/2009 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 7 The providers should consider having a pen portrait style of narrative alongside the care plans in order to show a more holistic approach. The date when a box or bottle of medication is opened should be clearly recorded. All senior staff who conduct supervision with staff should receive training in how best to do this. 2 3 9 36 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or 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) 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. 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