Care Home: Madeira Lodge

What the care home does well We received comments from three relatives of people living in the home and one resident who was helped to complete the survey by her daughter, prior to the annual service review in February, and they are included here. All continue to be very satisfied with the quality of the care. Comments included "We have found that the management & carers at Madeira lodge are always supportive not only to the residents but also to the families", "We are very pleased with the group stimulation activities which take place regularly", "The meals we have seen look really good & plentiful. We have tasted the food prepared at buffets for birthdays, Christmas party etc and this is excellent & the choice is fantastic", "We have found it to be a very caring place not only for the guests but also us as a family", "They have been really supportive", "Staff always present with the residents sitting with them and responding to their needs", "They try to maintain the dignity of the residents", "all the staff are very caring and very kind to the residents" and "I personally feel that there is good communication between carers and relatives. Residents` relatives, visiting on the day of this inspection confirmed that they were very satisfied with the care provided; they were kept informed about their relatives well being and they were always made welcome by staff. What has improved since the last inspection? There were no requirements from the previous inspection. Within the AQAA, the manager identified that the following had been improved:- hoists have been updated; improvements made in care plan documentation; working relationships with health care professionals have been strengthened; day care services operated by the same company have been accessed; ongoing refurbishment and redecoration of the home has taken place and staffing levels have increased. CARE HOMES FOR OLDER PEOPLE Madeira Lodge Madeira Road Littlestone New Romney Kent TN28 8QT Lead Inspector Christine Lawrence Unannounced Inspection 13 June 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Madeira Lodge DS0000023467.V365437.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Madeira Lodge DS0000023467.V365437.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Madeira Lodge Address Madeira Road Littlestone New Romney Kent TN28 8QT 01797 363242 01797 367216 info@belmontsandbanks.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Belmont Sandbanks Ltd Mrs Rachel Daykin Care Home 28 Category(ies) of Dementia - over 65 years of age (0) registration, with number of places Madeira Lodge DS0000023467.V365437.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies 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 categories: 2. Dementia (DE(E)). The maximum number of service users to be accommodated is 28. 13 July 2006 Annual Service Review 7 February 2008 Date of last inspection Brief Description of the Service: Madeira Lodge is a residential home providing care for up to twenty eight older people with dementia. Belmont Sandbanks Limited is the registered provider and Mrs Rachel Daykin is the manager of the home. The home is situated close to the seafront at Littlestone. It is about a mile from the small town of New Romney. Accommodation is provided on two floors with a shaft lift connecting the two floors. There are twenty eight single rooms, three of which have en suite facilities. There is a choice of sitting areas on the ground floor and residents have access to a well-established garden with seating to the rear of the premises. The fees for this home range between £380 and £480 per week. Information about the home, including a copy of the last inspection report, will be made available by the manager, on request. Madeira Lodge DS0000023467.V365437.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The inspection visit was unannounced and started at 10.00 and finished at 15.00. We, that is the commission for social care inspection (CSCI) looked at various records in the home and also used information sent to us by the manager through her completion of the Annual Quality Assurance Assessment (AQAA). We received surveys from relatives and information from these surveys is included in this report. Information from the previous inspection and the annual service review was also referred to. A tour of parts of the building was undertaken in the company of the manager. We observed staff interacting with residents and we spoke to staff on duty as well as the manager. We chatted to some residents and made observations of how they responded to staff. We spoke to some visiting relatives. What the service does well: We received comments from three relatives of people living in the home and one resident who was helped to complete the survey by her daughter, prior to the annual service review in February, and they are included here. All continue to be very satisfied with the quality of the care. Comments included “We have found that the management & carers at Madeira lodge are always supportive not only to the residents but also to the families”, “We are very pleased with the group stimulation activities which take place regularly”, “The meals we have seen look really good & plentiful. We have tasted the food prepared at buffets for birthdays, Christmas party etc and this is excellent & the choice is fantastic”, “We have found it to be a very caring place not only for the guests but also us as a family”, “They have been really supportive”, “Staff always present with the residents sitting with them and responding to their needs”, “They try to maintain the dignity of the residents”, “all the staff are very caring and very kind to the residents” and “I personally feel that there is good communication between carers and relatives. Residents’ relatives, visiting on the day of this inspection confirmed that they were very satisfied with the care provided; they were kept informed about their relatives well being and they were always made welcome by staff. Madeira Lodge DS0000023467.V365437.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Madeira Lodge DS0000023467.V365437.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Madeira Lodge DS0000023467.V365437.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents can be confident that the home judges that it can meet their needs because it assesses their needs before they move in. EVIDENCE: We looked at the individual records for three people living in the home, including one person who had recently moved in. The records showed that the manager, Rachel Daykin, carries out a pre-admission assessment which covers a range of needs and information. Examples were also seen of joint assessments carried out by social services staff and health care professionals. Relatives or representatives are included in this process wherever appropriate and possible. The information from the assessment is used to compile a care plan. The home offers respite care and the manager confirmed that the assessment process is still undertaken even for short stays. Madeira Lodge DS0000023467.V365437.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from having an individual plan of care which identifies how their health and care needs are to be met. They are protected by the home’s procedures for dealing with medication and they can be confident that they will be treated with respect. EVIDENCE: As previously noted, three individual records/care plans were examined for this inspection. The care plan format has been recently re-structured by the manager. A member of staff said that the information was much more succinct and the format was much more focussed on the resident and this has helped staff to see people as individuals. She said that staff used them each day and the daily records are also part of the care plan. The daily records seen by us were informative and used respectful language. The care plans contained clear guidance to staff about how to help residents with personal care and support them in their daily routines. The assessment and the care plan make reference to any history of falls, as well as other areas of risk which Madeira Lodge DS0000023467.V365437.R01.S.doc Version 5.2 Page 10 are specific to individuals. The care plans are reviewed regularly and any changes are noted. Where family members are involved, the home seeks to make sure that their views are known so they feel a part of what’s going on. The health care needs of residents are also clearly identified and guidelines given to staff about how to respond. Each individual has a record of visits to/from health care professionals such as general practitioners, community nurses, chiropodists, out patient appointments etc. Risk assessments are in place regarding nutrition, skin integrity and falling. The home uses a monitored dosage system for residents’ medication. At the time of this visit the supplying pharmacist was carrying out a review of storage and administration with the manager. The medication administration sheets were appropriately completed and there is also a relevant policy in place. Staff who give out medication have received training. Specialist training has also been provided for some staff with regard to insulin. The manager is planning for some refresher training to take place. Madeira Lodge DS0000023467.V365437.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents can be confident that their preferences will be identified and responded to and that they will be enabled to maintain contact with friends and family. Residents will be enabled to make choices and they will benefit from healthy, well-presented food at a time and place to suit them. EVIDENCE: Social activities are noted separately and staff said this was easier then to check that people were not becoming isolated or withdrawn. There is an activities person employed at the home, with more structured things at least three days a week and staff also see stimulating and engaging with residents as part of their role. There are also opportunities for residents to go out and about and recent trips included Hastings, Leas Cliff Hall for an ABBA tribute performance, walking along the seafront, going to the local Sainsbury’s. Staff will chat with residents and spend time doing things such as read newspapers with people, play dominoes etc. On the day of this inspection one resident was enjoying a ‘manicure’. Staff said that they are encouraged to interact with residents. There are sometimes reminiscence sessions and music and video/DVD sessions. Some of the residents visit the company’s day centre Madeira Lodge DS0000023467.V365437.R01.S.doc Version 5.2 Page 12 which is next door. There is a shared garden also and residents have opportunities to potter there or simply sit and enjoy the surroundings. There is a pond and bird feeders. The care plans include life stories as much as possible although this is sometimes dependant on the involvement of families. Other activities are based on visitors to the home such as an interactive theatre group (usually for special occasions or celebrations) and a ‘music for health’ session. Throughout this inspection staff were observed to chat to residents as they passed them, taking time to say just a few words if they weren’t able to spend more time. We spoke with people visiting residents and they confirmed that they are made welcome when they visit. There are facilities to visit in private if required. We noted examples of residents being helped to make choices in such things as where and what to eat, to be with others or to be alone, to walk freely around the building or in the garden. Some people were wearing slippers and others preferred outdoor shoes. Staff spoken to said that it was important to keep people safe as far as possible but they had to be allowed to make decisions for themselves. We observed a mealtime. Staff were knowledgeable about residents’ preferences and they were observant and responsive to individual’s needs. The cook also confirmed that she is aware of any special needs regarding diets. The manager explained that they plan to review menu planning to encourage residents to experience new things. Madeira Lodge DS0000023467.V365437.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Complaints would be handled objectively and in keeping with the home’s appropriate procedures and residents/their representatives can be confident that any concerns will be listened to, taken seriously and responded to. Staff are aware of adult protection issues and there are systems in place which create an atmosphere for protecting residents from abuse. EVIDENCE: We noted that the company has a clear policy and procedures for making complaints and visiting relatives confirmed that they knew what these were. There are also procedures and guidance to staff including disclosure of abuse and bad practice (whistle blowing), management of residents’ money and valuables, safeguarding adults and the prevention of abuse and dealing with aggression. Conversations with the staff, as well as the manager showed that people had a real sense of their responsibility to protect residents and maintain their well being. Madeira Lodge DS0000023467.V365437.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a safe, well-maintained home which is homely, clean, comfortable, pleasant and hygienic. EVIDENCE: Maintenance staff are employed by the company and they work both in Madeira Lodge and the other home owned by the company nearby. The rear garden is kept tidy and attractive. The communal areas allow for different things to happen and this includes lounge and dining areas and a seating area within a large corridor which some residents like to use. Residents’ own rooms are personalised wherever possible and this gives a homely feel to Madeira Lodge. The home was clean and fresh at the time of this inspection. The laundry facilities are satisfactory. Staff have not yet received infection control training but there are policies in place. Madeira Lodge DS0000023467.V365437.R01.S.doc Version 5.2 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ needs are met by sufficient staff who are competent and trained and residents would benefit further from all staff having more training. Residents are supported and protected by the home’s recruitment procedures. EVIDENCE: The manager has reviewed the staffing levels over the last twelve months and these have been increased. A rota is used and showed that staffing reflects identified needs. Our observations during this inspection did not identify any shortage of response. There are domestic staff employed including laundry staff, catering and maintenance staff. Ten of the nineteen care staff have national vocational qualifications at level 2 or above, two people are currently undertaking this and two people are planning to undertake level 3. The records for three members of staff were viewed for this inspection. They showed that the recruitment procedures are robust and include application forms, references, criminal record bureau checks and terms and conditions of employment. Madeira Lodge DS0000023467.V365437.R01.S.doc Version 5.2 Page 16 The manager has now introduced the skills for care format for induction (common induction standards). Although some staff have received training in various aspects relating to providing a service at Madeira Lodge this does not yet apply to all staff or all areas of specialist knowledge. The manager has identified that further training opportunities need to be developed. There needs to be a programme in place which identifies how staff will be trained and developed and allows the manager to monitor that staff skills keep pace with residents’ needs. Madeira Lodge DS0000023467.V365437.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, and 38 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from the home being managed by someone who is competent, experienced and knowledgeable. Residents’ financial interests are safeguarded and their views are sought. Staff and residents have their health and safety promoted and protected. EVIDENCE: The manager is experienced and has a background of community psychiatric nursing. She talked knowledgeably about up to date ways of working with and supporting people with dementia, and their carers/family. Staff spoken to said that she regularly has small staff group discussions which focus on areas of concern or interest that staff have. Staff said that she has provided them with Madeira Lodge DS0000023467.V365437.R01.S.doc Version 5.2 Page 18 opportunities to be more involved and to contribute to the care plan process and she has helped them focus on the residents as individuals. There are surveys for visitors and an audit system has been created to monitor the service provided at Madeira Lodge and this will be worked on over the next twelve months. The responsible individual representing the owning company does visit the home regularly each week but there were no reports available in keeping with regulation 26. A spot check on maintenance and service records showed that these are appropriate and up to date. The tour of the building did not identify any health and safety concerns. There are environmental risk assessments in place. The manager will include a review of all training related to health and safety in keeping with the programme for training and development identified under standard 30. Madeira Lodge DS0000023467.V365437.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X X X 3 Madeira Lodge DS0000023467.V365437.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP30 OP33 Regulation 12(1) (a)(b) 26(2)(a) (3)(c) Requirement A programme of planned training and development for staff to be in place Reports of visits to be written and available for inspection Timescale for action 31/08/08 31/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Madeira Lodge DS0000023467.V365437.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Madeira Lodge DS0000023467.V365437.R01.S.doc Version 5.2 Page 22 - 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. 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