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Care Home: The White Lodge

  • The White Lodge Braydon Swindon Wiltshire SN5 0AD
  • Tel: 01666860381
  • Fax: 01666862152
  • Planned feature Advertise here!

  • Latitude: 51.603000640869
    Longitude: -1.9210000038147
  • Manager: Mr Stephen John Cousins
  • Price p/w: -
  • UK
  • Total Capacity: 80
  • Type: Care home with nursing
  • Provider: Barchester Healthcare Homes Ltd
  • Ownership: Private
  • Care Home ID: 16682
Residents Needs:
Old age, not falling within any other category, Dementia, Physical disability

Latest Inspection

This is the latest available inspection report for this service, carried out on 9th September 2009. CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.

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

For extracts, read the latest CQC inspection for The White Lodge.

What the care home does well The home continues to provide a very good service to its residents who are well cared for and complimentary about the staff and the support they provide. Their health needs are being met and as far as possible, they are supported to live life in the home as they would wish. Frail residents and those with dementia are safe and well looked after. Several residents told us how happy they were living in White Lodge. One person said: "The staff are very caring and helpful". All the residents and relatives we spoke to said that they always get the medical care they need. One relative said: "You can`t fault the standard of care", and another said: Staff are always cheerful and willing to help". Another said: "Staff are wonderful from the cleaners to the gardener". The home stresses the importance of maintaining an individual`s independence and autonomy wherever possible. Staff induction training makes it clear that the home`s expectation is that residents will be treated with dignity, and that The White Lodge DS0000069228.V377598.R01.S.doc Version 5.2 their independence and self esteem must be encouraged. All relatives we spoke to said that they could visit their relative in private. One person said: "My needs, wishes, privacy and dignity, choices and beliefs are always respected by all staff". One relative said: Visitors are treated as friendly guests - not intruders". The staff training offered by White 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 workbooks for new staff. 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 loved the training in person- centred care, and I felt able to ask questions without seeming silly". What has improved since the last inspection? At the last inspection, we had told the previous manager that there needed to be an improvement in the quality and consistency of care plans and assessment procedures to ensure that they accurately reflect residents` needs. Care plans had greatly improved, and were being done using person-centred methods. They 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. Whilst talking to staff, it was clear that they were aware of individual`s needs, and daily records reflected this. Care plans were laid out in sections, and information was available related to sleep routines, eating, communication, mobility, personal care, emotional well being, a medical report, and socialisation likes and dislikes. There was evidence that pressure care was monitored and hydration charts and movement charts were kept. Not all relatives were aware of the complaints procedure and not all staff were aware of local abuse reporting guidelines when we last visited the home. Since then, matters have improved, and the complaints procedure has been widely disseminated. All the people we spoke to and who wrote to us said they knew who to speak to if they had any concerns about the way the home was being run. All staff had done Safeguarding Vulnerable Adults training, and this had been introduced at induction for new staff. Health and safety arrangements were good but we thought that some further safety checks relating to hot water control would enhance current measures to further safeguard residents. This has now been done, and detailed records are kept of all the checks undertaken. The White Lodge DS0000069228.V377598.R01.S.doc Version 5.2 We asked the previous manager to continue to make efforts to eliminate and control the odour on one of the home`s units. Since then, a new head housekeeper has been appointed and has succeeded in developing her team to provide an improved service. Sufficient cleaning staff are employed and the home was very clean and odour free. The kitchen and laundry areas were clean and good infection control procedures were evident in all areas. All cleaners have had infection control training as well as safeguarding adults and Control of Substances Hazardous to Health (COSHH) What the care home could do better: There were a few areas which needed some attention. Risk assessments were in place relating to falls, smoking, pressure care, and the use of bed rails. These were seen to be regularly reviewed. One person had a care plan which outlined the reasons for only having one side of the bed rails up at night. However, there was no risk assessment in place for this. Another person had their falls risk assessment reviewed, but the person had recently been prescribed more medication and this had not been added to the risk assessment. We have asked the manager to make sure that all risk assessments are updated whenever there is a change in the person`s circumstances. One person was having their oxygen levels checked, although on one occasion we saw that this had not been done. We have asked the manager to ensure that this is done consistently when needed. We also saw some medication which was not needed, but had not been returned to the pharmacy. We have asked the manager to make sure that this is done every time medication is not needed. One staff member told us that they thought the home could improve by changing from a hotel style to a more homely style. When we asked residents what the home could do better, one person said: "Short of giving me back my health and own home, I cannot think of anything that could be done better". Key inspection report CARE HOMES FOR OLDER PEOPLE The White Lodge Braydon Swindon Wiltshire SN5 0AD Lead Inspector Alyson Fairweather Key Unannounced Inspection 09:30 9 and 10 September 2009 th th DS0000069228.V377598.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. The White Lodge DS0000069228.V377598.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address The White Lodge DS0000069228.V377598.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The White Lodge Address Braydon Swindon Wiltshire SN5 0AD 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) 01666 860381 01666 862152 www.barchester.com Barchester Healthcare Homes Ltd Mr Stephen John Cousins Care Home 80 Category(ies) of Dementia (54), Old age, not falling within any registration, with number other category (26), Physical disability (10) of places The White Lodge DS0000069228.V377598.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia (Code DE) - maximum of 54 places Old age, not falling within any other category (Code OP) - maximum of 26 places Physical disability (Code PD) - maximum of 10 places The maximum number of service users who can be accommodated is 80. October/November 2006 2. Date of last inspection The home is situated in a rural position near the village of Braydon in Wiltshire, the nearest large town being Swindon. The White Lodge is a purpose built nursing home and is part of the Barchester Healthcare group. The home is registered with the Care Quality Commission (CQC) to accommodate older people who require nursing and personal care, people who have dementia and people with physical disabilities, all within separate parts of the home. The two ground floor units accommodate older people and those with physical disabilities, the first floor those with dementia and the top floor is for older people. The range of fees is currently between £865 and £1,300. The accommodation is of a very high standard and there are pleasant, accessible gardens and grounds. Registered nurses are on duty at all times, supported by care workers. Catering, laundry and domestic services are all on site and hairdressing and chiropody services are available. Activity staff are employed and the home has its own vehicles to provide transport for residents. The White Lodge DS0000069228.V377598.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 3 star. This means the people who use this service experience “Excellent” quality outcomes. This unannounced inspection took place over two days in September, with one inspector visiting on the first day and two inspectors on the second day. We spoke to residents and their relatives, and we met with various staff members, including nurses, the in-house trainer, care staff, cleaners, caterers, 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, and staff members. We also looked at various files and documents, including care plans, risk assessments, medication 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 service does well: The home continues to provide a very good service to its residents who are well cared for and complimentary about the staff and the support they provide. Their health needs are being met and as far as possible, they are supported to live life in the home as they would wish. Frail residents and those with dementia are safe and well looked after. Several residents told us how happy they were living in White Lodge. One person said: The staff are very caring and helpful. All the residents and relatives we spoke to said that they always get the medical care they need. One relative said: “You can’t fault the standard of care”, and another said: Staff are always cheerful and willing to help. Another said: Staff are wonderful from the cleaners to the gardener”. The home stresses the importance of maintaining an individuals independence and autonomy wherever possible. Staff induction training makes it clear that the homes expectation is that residents will be treated with dignity, and that The White Lodge DS0000069228.V377598.R01.S.doc Version 5.2 Page 6 their independence and self esteem must be encouraged. All relatives we spoke to said that they could visit their relative in private. One person said: My needs, wishes, privacy and dignity, choices and beliefs are always respected by all staff. One relative said: Visitors are treated as friendly guests - not intruders. The staff training offered by White 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 workbooks for new staff. 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 loved the training in person- centred care, and I felt able to ask questions without seeming silly”. What has improved since the last inspection? At the last inspection, we had told the previous manager that there needed to be an improvement in the quality and consistency of care plans and assessment procedures to ensure that they accurately reflect residents’ needs. Care plans had greatly improved, and were being done using person-centred methods. They 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. Whilst talking to staff, it was clear that they were aware of individuals needs, and daily records reflected this. Care plans were laid out in sections, and information was available related to sleep routines, eating, communication, mobility, personal care, emotional well being, a medical report, and socialisation likes and dislikes. There was evidence that pressure care was monitored and hydration charts and movement charts were kept. Not all relatives were aware of the complaints procedure and not all staff were aware of local abuse reporting guidelines when we last visited the home. Since then, matters have improved, and the complaints procedure has been widely disseminated. All the people we spoke to and who wrote to us said they knew who to speak to if they had any concerns about the way the home was being run. All staff had done Safeguarding Vulnerable Adults training, and this had been introduced at induction for new staff. Health and safety arrangements were good but we thought that some further safety checks relating to hot water control would enhance current measures to further safeguard residents. This has now been done, and detailed records are kept of all the checks undertaken. The White Lodge DS0000069228.V377598.R01.S.doc Version 5.2 Page 7 We asked the previous manager to continue to make efforts to eliminate and control the odour on one of the home’s units. Since then, a new head housekeeper has been appointed and has succeeded in developing her team to provide an improved service. Sufficient cleaning staff are employed and the home was very clean and odour free. The kitchen and laundry areas were clean and good infection control procedures were evident in all areas. All cleaners have had infection control training as well as safeguarding adults and Control of Substances Hazardous to Health (COSHH) What they could do better: If you want to know what action the person responsible for this care home is The White Lodge DS0000069228.V377598.R01.S.doc Version 5.2 Page 8 taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. The White Lodge DS0000069228.V377598.R01.S.doc Version 5.3 Page 9 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 The White Lodge DS0000069228.V377598.R01.S.doc Version 5.3 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4. Standard 6 does not apply to this home. Prospective residents are informed about the services offered by the home, in order to help them decide if they want to move there. All residents admitted for long-term care had a contract in place. Everyone had an assessment of their needs prior to admission and the home was able to demonstrate that it could meet the needs of its residents. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The White Lodge has a statement of purpose and service users guide, which describe the services offered. This is given to either the resident or their family member when a referral is made to the home. All of the people we spoke to said that they had had enough information on the home prior to admission. All of them said they had received a contract from the home. The White Lodge DS0000069228.V377598.R01.S.doc Version 5.3 Page 11 Records reviewed contained pre admission assessments that had been carried out by registered nurses. Some contained other supporting documents such as assessments from care managers and hospital discharge summaries. The information is used to aid completion of individual care plans and information had been supplied by relatives where required. Staff reported that thought is given to where best to accommodate the resident within the home, particularly those with a mild degree of dementia, in order to try and reduce the stress associated with moving into a new environment. A detailed range of information is obtained, including information on mobility, communication, specific health needs and family circumstances. Details of any medication support needed is written down and agreed with the resident or a relative. A member of the senior management team meets with any prospective resident and family as part of the assessment process. Following admission, the home then develops an initial care plan based on the assessment, in order to ensure the needs of service users are being safely met. Staff help new residents settle in by giving them a cup of tea, helping them unpack, showing them round and sitting with them and talking over the first few days to help them get used to their new environment. We spoke to several relatives during our visit, and all of them said they were happy with the service offered to them and their family members. One family member told us that they have looked at lots of homes for their relative. They “happened” to come across White Lodge, and said: “Nowhere else came even close”. Another relative said: “Steve (the registered manager) has bent over backwards to help us sort out the funding”. There were no intermediate care beds in the White Lodge. The White Lodge DS0000069228.V377598.R01.S.doc Version 5.3 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 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, and people feel they are treated with dignity and respect. People using the service experience Good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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. Whilst talking to staff, it was clear that they were aware of individuals needs, and daily records reflected this. Care plans were laid out in sections, and information was available related to sleep routines, eating, communication, mobility, personal care, emotional well being, a medical report, and socialisation likes The White Lodge DS0000069228.V377598.R01.S.doc Version 5.3 Page 13 and dislikes. There was evidence that pressure care was monitored and hydration charts and movement charts were kept. We saw that care plans were being reviewed monthly. One resident had previously been admitted with serious pressure ulcers, and the care given by the staff at White Lodge has meant a big improvement. The care plan had clear documentation about the way to look after the skin by staying in bed and gradually increasing the time spent up in a chair. This is the current good practice guidelines from the National Institute for Clinical Excellence (NICE). The care plan says that the person must be turned/moved frequently, but it is recommended that records show precisely how often a person is to be turned and their position changed when up in the chair. Risk assessments were in place relating to falls, smoking, pressure care, and the use of bed rails. These were seen to be regularly reviewed. One person had a care plan which outlined the reasons for only having one side of the bed rails up at night. However, there was no risk assessment in place for this. Another person had their falls risk assessment reviewed, but the person had recently been prescribed more medication and this had not been added to the risk assessment. We have asked the manager to make sure that all risk assessments are updated whenever there is a change in the person’s circumstances. Some risk assessment forms had been completed in a different way on different units. Some staff reported that they were unsure about how to fully complete the forms. There was no guidance about how often these should be reviewed, although some staff reported that they did so every time the care plan was reviewed. Some of the scoring had not been completed. We have recommended that guidance is given to staff about the frequency of reviews and the expected content on the form. By the time we left on the second day, plans had been made to introduce risk assessment training. All the care staff who wrote to us said that they were given up-to-date information about the needs of the people they support in the care plans. A General Practitioner (GP) visits the home weekly and records showed that staff take prompt action when there is a health care need. There is input from other health professionals, such as dentists and opticians as required, with appointments being recorded in the care plan. The home also employs an osteopath. Nursing staff had recorded that they had sought advice from a specialist diabetic nurse and the GP for one person with unstable diabetes. They had agreed a plan to improve stability and this had helped improve their health considerably. 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 White Lodge DS0000069228.V377598.R01.S.doc Version 5.3 Page 14 Weight checks are done for residents monthly, and each person has a nutritional profile. Some people have to have their drinks thickened, and nurses have shown care staff on each unit how to do this for individuals. They did not use standard phrases to describe consistency, such as syrup, custard, or jelly to advise care assistants on how thick fluids need to be, and we have recommended that they do so. One person was having their oxygen levels checked daily, but we saw one occasion where this had not been done. We have asked the manager to make sure that where healthcare needs indicate the need for oxygen levels to be checked this must be consistently done. All the residents and relatives we spoke to said that they always get the medical care they need. One relative said: “You can’t fault the standard of care”. Medication is stored securely in each of the units, and staff do not administer medicines until they have received appropriate training. Nurses having drugs competency training on a regular basis with both written and practical work supervised. Information about various medicines is available in the home and we saw staff manage a medication round well. All the medication administration records (MAR) checked were clear, the nurse consistently locked the medication trolley when not with it, and always signed the MAR after giving drugs. We saw several examples of good practice, where the nurse to dispense tablets for a resident into a pot, go over to them, get a chair, sit down next to them, and then explain to them that they needed to take their tablets, checked the person understood and then slowly and carefully gave them their tablets, with no feeling of rush or hurry, and lots of eye contact and support. We saw that the medication cupboard was slightly small, and although the nurse knew how to fit all the boxes in, and she is used to doing it, it was still a tight fit. It is recommended that the manager considers the size of each medication cupboard, and whether they are able to contain all the medications needed in the units. They should be replaced with larger ones where necessary. The medication stock in one unit had eye drops for a resident which were not needed, but had not been returned to the pharmacy. The manager has been asked to make sure that all medication is disposed of when no longer needed. We also spoke to nurses about how they give injections to residents. They were aware about the need to rotate the site of regular injections, and not to use people’s arms unless they have to. However, we recommend that they develop a chart to document the rotation of sites. The White Lodge DS0000069228.V377598.R01.S.doc Version 5.3 Page 15 All residents spoken with confirmed satisfaction with staff members and expressed that his or her privacy and dignity were respected at all times. Personal care was given behind closed doors and staff knocked on doors before entering a room. For those with dementia, efforts were made to ensure that they were appropriately dressed and their personal hygiene needs were met. Residents receive any daily mail direct to their room and it is documented if they need assistance with this and by whom. 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. One person said: My needs, wishes, privacy and dignity, choices and beliefs are always respected by all staff. The White Lodge DS0000069228.V377598.R01.S.doc Version 5.3 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 A variety of social activity is provided and residents are able to maintain contact with family and friends. Residents are encouraged to live their own lifestyle as far as possible with the support of the staff if necessary. Nutritious, balanced meals are available in comfortable surroundings. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There are three staff members employed to assist with social activities in the home. Each person wears a uniform so that they might be easily identified. A range of in house and external activities were provided, which were either held in groups or with individual residents. A monthly activity programme is produced and most residents spoken to appeared to be aware of the activities provided. Care plans relating to activities are in place and these are reviewed regularly. One resident told us: Small groups or individuals are taken out on visits, eg to the local garden centres, or on shopping trips. Local entertainers The White Lodge DS0000069228.V377598.R01.S.doc Version 5.3 Page 17 appear occasionally or on a regular basis. This all tends to remove any feeling of exclusion. There is a large piano in one of the home’s lounges, and a music therapist visits weekly, often spending time with residents on their own as well as in groups. The home says it tries to centre on individuals’ interests and focus on maintaining their life long preferences. They provide a variety of activities based on people’s life skills, and hope to promote self worth and a sense of purpose. We saw a group of people in one of the lounges discussing holidays and foreign travel. In one of the units, Memory Lane, residents can come and sit with staff in the nurses’ station if they want to, and we saw three different residents doing this at various times. We saw various members of staff including residents in conversation, including a cleaner who spoke to someone who was wandering the corridor, offering a cup of tea. We overheard a conversation in one of the units, where a male resident said: “I’d like a beer” to no-one in particular. The activities person heard, called a member of staff who was passing and asked them to check in the fridge to see if there was a cool beer for the resident, as they were with someone at the time. A member of the activity staff attends the residents and relatives meetings and there is transport available in order to access social events in the local community. All the residents we spoke to as well as their families said that the home arranged activities that they could take part in if they wanted to. One relative said: It makes the home feel part of the ‘outside’ world. That is, national celebrations are reflected fully in the home. Appropriate decorations appear in the dining rooms and lounges”. 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 frequently. One relative told us: Visitors are treated as friendly guests - not intruders, and another said: “They welcome you by day or night” As far as possible, residents were being supported to exercise choice and control. Some residents were seen enjoying a late breakfast in their rooms and others were left undisturbed to sleep. Residents can bring some of their own possessions to the home when they move in, and many of the rooms contained personal items. People have their own telephones in their room if they want to. There is a hairdressing room in the home where people can have their hair done. There were two couples living in White Lodge when we visited and both had been given a suite of two rooms. One room was used as a bedroom and one used as a sitting room. The White Lodge DS0000069228.V377598.R01.S.doc Version 5.3 Page 18 There was a good standard of food in extremely pleasant dining rooms. Menus are available and people are asked their choice, or alternative dishes can be cooked. Hostesses are employed to serve meals and to supply drinks and snacks throughout the day. The chef communicates with residents and care staff in regard to peoples’ likes and dislikes and their assessed nutritional needs. Staff try to make lunch times a social occasion, tables are set to restaurant standards, and wine is available. Service was friendly and unobtrusive. Where a person needed assistance to eat, this was provided with a sensitive approach. The care assistant was seen to cut up the resident’s meal carefully, so it continued to look attractive. The staff helped to create a good atmosphere in the dining room. The qualified nurses told us that they always made a point of going into the dining room to help with meals, particularly to support anyone with poor swallowing reflexes. Meals were portioned to match peoples appetites and tastes. One resident, who said they had a very poor appetite, said: “The food’s not too bad. You can always ask for something different”. One relative told us that the home always offered them a drink and gave them lunch too if they wanted. Another person said how much they appreciated being able to have Sunday lunch with their relative. The White Lodge DS0000069228.V377598.R01.S.doc Version 5.3 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 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, and all staff have training in safeguarding adults. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has a complaints procedure on display, which is also contained in the service users guide, and there is a commitment by the management of the home to deal with complaints immediately they are made. Barchester Healthcare conduct regular audits of any complaints received. The home told us in their AQAA that they encourage residents and their families to feel free to raise any concerns about the service to any member of staff or management. They investigate any issues raised as quickly as possible and work together with the person concerned to try to resolve the issues. Staff are given feedback about any concerns promptly. For example, they had some concerns raised about how quickly staff respond to call bells and have made improvements in response times. They are continuing to monitor this. The White Lodge DS0000069228.V377598.R01.S.doc Version 5.3 Page 20 We had been made aware of several complaints over the period of about one month earlier in the year. We had asked the manager to deal with them, and we were satisfied that he had done so thoroughly and efficiently, with clear documentation in place regarding all the actions taken. When we asked people if they knew who to speak to informally if there was a problem, they all said they did. One person said: I would tell sister if I had a problem.”. Another one said: “I have never needed to complain”. All the staff we spoke to and those who wrote to us said they knew what to do if someone had a concern about the home. The White Lodge has copies of the local No Secrets document, as well as the organisational policy and procedure on responding to allegations of abuse. Referrals to the local safeguarding team have been made appropriately, and notifications sent to us. All staff members are encouraged to report any incidences of poor practice, and a Whistle Blowing procedure is also available, with staff encouraged to go to the management if they have any concerns. This was verified by one member of staff who told us that she had gone to speak to the management when she saw something she was unsure about. She reported that it had been dealt with quickly by them, and she was happy with the outcome. Safeguarding Vulnerable Adults training is done by all new staff at their induction and this training is on-going for all staff. Barchester Healthcare asks for a Criminal Records Bureau (CRB) check when new staff start work, and this is renewed every three years. New staff members are supervised and do no lone working at first. The White Lodge DS0000069228.V377598.R01.S.doc Version 5.3 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 24 and 26 The home meets, and in some areas, exceeds the standards, providing a clean, comfortable, well-equipped and safe environment for residents, which meets their needs. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: White Lodge is purpose built, furnished and equipped to a very high standard. The building is air-conditioned. There are ample communal areas and good access to the surrounding grounds. There is an enclosed garden, which provides a safe environment for those with dementia. All rooms have full en suite facilities and there are also assisted bathrooms and other toilets close to The White Lodge DS0000069228.V377598.R01.S.doc Version 5.3 Page 22 communal areas. A maintenance manager is employed, and records indicate that the home is well maintained. Residents spoken to were happy with their accommodation; bedrooms were spacious, well decorated and fittings were of a high standard. All beds are height adjustable, profiling and have pressure relief mattresses and there are comfortable reclining chairs for frail residents. A new head housekeeper has been appointed and has succeeded in developing her team to provide an improved service. Sufficient cleaning staff are employed and the home was very clean and odour free. The kitchen and laundry areas were clean and good infection control procedures were evident in all areas. All cleaners have had infection control training as well as safeguarding adults and Control of Substances Hazardous to Health (COSHH) A standard system for the management of laundry was in place. All linen was separated at source, and all infected laundry managed appropriately. The laundry operates a separate entrance for dirty washing and an exit for clean washing. Laundry staff had been trained in the tasks of the role, as well as infection control, safeguarding adults and COSHH. Gloves and aprons are worn at all times by laundry staff. All hoist slings are individual to residents, and there is no communal use. We saw that commodes were all clean including under surfaces. Sluice rooms were large enough to work in and very clean. Lights in bathrooms and sluices are movement sensitive, so no-one need enter a dark room. One staff member who wrote to us said: “We have really good housekeeping, inside and out”. The White Lodge DS0000069228.V377598.R01.S.doc Version 5.3 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 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 are well trained and competent. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home accommodates up to 80 residents and is divided into four distinct areas, each with its own minimum staffing notice. There were 76 residents in the home at the time we visited. The employment of hostesses to help with food and drink, and activity coordinators to help support residents with their interests and hobbies, means that care staff are free to meet the needs of residents as they arise. Staff were seen to be very much in evidence, promptly noticing matters which needed attention. One resident told us: “When I ring the bell, staff come quickly; sometimes very quickly”. The White Lodge DS0000069228.V377598.R01.S.doc Version 5.3 Page 24 When we visited the sitting rooms in all the different units, there was always a staff member with residents and fully engaged with them. One relative described staff as: “All trained and experienced, unlike in some other homes. It’s really good that they don’t need to use agency staff”. One nurse told us that they really enjoyed working in the home, saying: “It’s a lovely place to work”. One resident told us: Staff are always available, and another said: The staff are always very kind and friendly. Another relative said: Staff are very helpful at all times. White Lodge’s 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. All other documentation required was in place. The senior management team at White Lodge are committed to the ongoing training and development of staff. Staff are fully supported to attend training; they are paid for the training that they attend and any course fees are fully funded. A training budget is also available to access external resources. Training is available for nursing, care and support staff and individual training records were kept. A training provider is employed by Barchester Healthcare, and uses a computer aided system of recording staff training in the home. This system keeps clear records of who has done training and flags up when training refreshers are due. The trainer was complimentary about the systems used by Barchester Healthcare, and was enthusiastic about the fact that they have their own NVQ Academy, where care staff can work towards their NVQ qualifications. Whilst we were visiting, she introduced a new risk assessment training programme for staff. We met with one new member of staff who discussed her induction training. She showed us the induction workbook she has to complete, and said she had also done infection control, food hygiene, safeguarding vulnerable adults and shadowing people on shifts. She said she spent time observing ad being observed. She had previously worked in care and said: “This entire training has been the best I’ve ever had anywhere”. She went on to say: “I loved the training in person- centred care, and I felt able to ask questions without seeming silly”. Training records indicate that as well as mandatory and legislative training, there has also been a management development programme for staff in leadership roles. In addition, further clinical/professional training has been provided and staff members have successfully completed NVQs in assessment and health and social care. The White Lodge DS0000069228.V377598.R01.S.doc Version 5.3 Page 25 The Alzheimer Society course ‘Yesterday, Today and Tomorrow’ (YTT) is also facilitated at White lodge by a senior registered nurse on the dementia unit. Fourteen staff have successfully passed the exam in the last 18 months. In addition, there have been dementia care trainings sessions for all staff groups. Four staff have recently completed the A1 Assessor qualification and have supported care staff to complete a Level 3 NVQ in Health and Social Care. Two staff have commenced an apprenticeship and six additional staff have applied to complete further National Vocational Qualifications in support services and health and social care. All the staff we spoke to were positive about the quality of the training they had received, which included food hygiene, catheter and stoma care, safeguarding, emergency first aid, management of medication, manual handling, infection control, tissue viability and palliative care. Staff have had specific training in how to communicate with people with dementia and have had a speaker on CJD. There are two manual handling trainers on site, so that new staff can be quickly shown how to use a hoist if needed. The maintenance manager does all the training in fire procedures for staff. All the staff who wrote to us said the were being given training which is relevant to their role, helps them understand and meet the needs of service users and keeps them up to date with new ways of working. The home told us in their AQAA that they hope to recruit an additional moving and handling trainer, as well as an additional trainer for the YTT course. There are also plans to appoint at least two senior care staff to formal ‘buddy-like’ roles to support new starters. They will be provided with training to develop their mentoring/coaching skills and will support Unit Managers by overseeing the completion of the induction programme. The White Lodge DS0000069228.V377598.R01.S.doc Version 5.3 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 The home is very well managed in the best interests of the residents. Quality assurance systems are in place and residents financial interests are safeguarded. The health safety and welfare of the residents and staff are promoted and protected. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has a management system in place with a general manager, clinical nurse manager (deputy), unit managers and heads of department for non care services, all based in the home. The general manager, Mr Cousins, is line The White Lodge DS0000069228.V377598.R01.S.doc Version 5.3 Page 27 managed by a regional operations manager who is a senior manager in Barchester Healthcare. He is a registered nurse and has 11 years experience in care home management and care home regulation and the deputy manager is a registered mental nurse who has 14 years experience working and managing in care homes. One relative told us she was “extremely impressed” to see the manager pushing a resident out in the garden, commenting that she had not often seen that before, saying: “You don’t see the manager on the tills at Boots, do you”? There are several systems for auditing quality in the home. People are able to talk with the manager or deputy at any time and there are regular meetings with the people who live in the home, their relatives and with staff groups providing opportunities for good communication, updates and feed back on our services. Barchester Healthcare undertake annual satisfaction surveys whereby people who live in the home (and/or their relatives) are asked to complete questionnaires about the service. The results are sent to the general manager, along with an action plan. The results of the survey are communicated to residents, relatives and staff groups. We met with the clinical nurse manager, who conducts a series of monthly audits covering all key aspects of care and associated services including medication, infection control, nutrition, pressure care, activities, care planning and resident care. Where required, action plans are completed and findings shared with the appropriate staff group. A regional clinical development nurse undertakes an annual audit of the home which focusses on clinical issues and a report and action plan are generated. A property audit is also done annually. In addition to the above audit system, either the manager or the deputy manager does a morning round each week day, seeing residents and staff. There are random weekly checks on medications and care profiles. The home told us in their AQAA that the last resident and relatives satisfaction survey for 2008 completed by 32 respondants indicated that 97 felt that the home treated residents with dignity and respect and that their privacy was respected. 97 also reported having confidence and trust in the nurses and carers. Over the past year they have received correspondance from the relatives of six people indicating their satisfaction with the care given during the last days of their life. Most residents are encouraged to manage their own financial affairs including retaining their own money for person spending. No personal money is held and residents or their advocates are sent invoices for any expenditure incurred on The White Lodge DS0000069228.V377598.R01.S.doc Version 5.3 Page 28 their behalf. This might include hairdressing and chiropody bills, or any items bought whilst out shopping. Financial interests of the home and people living here are protected by robust procedures carried out by a full time administrator and the general manager; who are also supported by a regional business manager. An annual financial audit is carried out. A formal staff supervision system is in place, and unit managers have been trained in supervision techniques. Individual records are kept, and annual appraisals were in place. Staff members reported receiving good support from their unit managers, as well as the general and clinical managers. One person said: “It’s a really good chance to discuss my working practice. I quite look forward to it”. There were excellent health and safety records in place. Records show that staff have been trained in areas relating to health and safety, such as manual handling, health and safety, fire safety, food hygiene, infection control and first aid. We saw good practice by care staff when they staff consistently moved residents in wheelchairs using the footplates attached, so that people’s feet were not dragging on the ground. We met with the maintenance manager, who does all the fire training including the use of equipment and the fire extinguishers. He described the training he gives, and said that there are fire marshals on each floor. There is a designated fire marshall and first aider on duty at all times. The maintenance manager ensures that various health and safety checks are done daily, weekly, monthly and annually. All essential equipment is routinely maintained and repaired or replaced as necessary. The water supply is checked regularly for Legionella, and a certificate was in place to say that this had been done and was clear. The maintenance manager demonstrated good practice by regularly flushing water in unused rooms to avoid the build up of any potential infection. There are monthly checks on window restrictors and profiling beds, and oxygen cylinders are stored outside the premises, not in the home. The homes fire drills are done on a quarterly basis, and attendance at all drills is recorded. Fire extinguishers are checked regularly by an outside contractor. There is a clear fire evacuation plan, in the event of a fire. Each resident has their own personal evacuation care plan which includes plans for management of complex behaviours in the event of a fire, and documents constraints of any physical care needs on evacuation. To help with the on-going maintenance of the home, action plans are kept of work to be done. It is recommended that the form is added to so that it is clear that the work has been done, by whom and on what date. The White Lodge DS0000069228.V377598.R01.S.doc Version 5.3 Page 29 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 3 X 3 4 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 4 4 4 4 X 4 4 X 4 STAFFING Standard No Score 27 4 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 4 X 4 The White Lodge DS0000069228.V377598.R01.S.doc Version 5.3 Page 30 Are there any outstanding requirements from the last inspection? No 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 Standard OP7 Regulation 13 Requirement All risk assessments must be updated whenever there is a change in the person’s circumstances. Where healthcare needs indicate the need for oxygen levels to be checked this must be done consistently. All medication must be disposed of when no longer needed. Timescale for action 10/11/09 2 OP8 13 10/11/09 3 OP9 13 10/11/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP7 OP8 OP8 Good Practice Recommendations Guidance should be given to staff about the frequency in which risk assessments should be reviewed and how best to complete them. Records should show precisely how often a person is to be turned and their position changed when in the chair Standard phrases to describe consistency of thickened fluids, such as syrup, custard, or jelly, should be used to advise care assistants on how thick fluids need to be. DS0000069228.V377598.R01.S.doc Version 5.3 Page 31 The White Lodge 4 OP9 5 6 OP9 OP38 The size of each medication cupboard should be reviewed to see whether they are able to contain all the medications needed in the units. They should be replaced with larger ones where necessary. A chart should be introduced so that nurses can document the rotation of injection sites. The action plan which helps to inform the on-going maintenance work should have a section added so that it is clear that the work has been done, by whom and on what date. The White Lodge DS0000069228.V377598.R01.S.doc Version 5.3 Page 32 Care Quality Commission Care Quality Commission Southwest Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. The White Lodge DS0000069228.V377598.R01.S.doc Version 5.3 Page 33 - 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!

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