key inspection report · so30 3rs the quality rating for this care home is: two star good service a...

Key inspection report

Care homes for older people

Name: Dawson Lodge

Address: Botley Road West EndSouthamptonHampshireSO30 3RS

The quality rating for this care home is: two star good service

A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection.

Lead inspector: Date:

Ian Craig 1 5 0 4 2 0 1 0

Care Homes for Older People of 27

This is a review of quality of outcomes that people experience in this care home. We believe high quality care should

• Be safe• Have the right outcomes, including clinical outcomes• Be a good experience for the people that use it• Help prevent illness, and promote healthy, independent living• Be available to those who need it when they need it.

The first part of the review gives the overall quality rating for the care home:

• 3 stars - excellent• 2 stars - good• 1 star - adequate• 0 star - poor

There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people.

There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service.

After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.

Outcome area (for example Choice of home)

These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them:

This box tells you the outcomes that we will always inspect against when we do a key inspection.

This box tells you any additional outcomes that we may inspect against when we do a key inspection.

This is what people staying in this care home experience:

Judgement:

This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor.

Evidence:

This box describes the information we used to come to our judgement.


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.

Reader Information

Document Purpose Inspection report

Author Care Quality Commission

Audience General public

Further copies from 0870 240 7535 (telephone order line)

Copyright © Care Quality Commission 2010This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010.

Internet address www.cqc.org.uk

http://www.tso.co.uk/bookshop


Information about the care home

Name of care home: Dawson Lodge

Address: Botley Road West EndSouthamptonHampshireSO30 3RS

Telephone number: 02380465707

Fax number: 02380471581

Email address: [email protected]

Provider web address: www.anchor.org.uk

Name of registered provider(s): Anchor Trust

Name of registered manager (if applicable)

Mrs Jacqueline Ann Sheppard

Type of registration: care home

Number of places registered: 43

Conditions of registration:

Category(ies) : Number of places (if applicable):

Under 65 Over 65

dementia 43 0

mental disorder, excluding learning disability or dementia

43 0

old age, not falling within any other category

0 43

physical disability 43 0

Additional conditions:

The maximum number of service users to be accommodated is 43.

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: Old age, not falling within any other category (OP) Dementia (DE) Physical disability (PD) Mental disorder (MD)

Date of last inspection


Brief description of the care home

Dawson Lodge is a care home providing personal care and accommodation for 43 older people with an age related mental health problem and/or a physical disability. Anchor Trust owns the service: a charitable organisation, providing services throughout the country. The home is located on the outskirts of the small village of West End near Southampton. The home is situated close to shops; pubs, post office, the Hampshire cricket ground (The Rose Bowl) and a large trading estate, which is home to several well-known retail outlets. The home also looks out on to small fields, which is home to a variety of domestic animals and wildlife such as ponies, deer and rabbits. The accommodation is provided in single rooms, each with a front door with individual locks and letterboxes, the room includes a kitchenette, with a small refrigerator, sink and facilities for making hot drinks, and an en-suite assisted shower room and toilet. There are several large communal areas and communal kitchen. The home has extensive gardens that are well maintained and enable service users to move freely around and seating is provided.


SummaryThis is an overview of what we found during the inspection.

The quality rating for this care home is: two star good service

Our judgement for each outcome:

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:

The inspection consisted of a site visit of approximately 6.5 hours. During this time records, documents and polices and procedures were looked at. This included the care records for 5 residents. 2 staff were spoken to during the visit as well as a member of the management team and the registered manager. The views of residents and their representatives were sought by interviews with 2 residents and 2 residents' representatives. Surveys were sent to residents and staff asking for their views on the service provided by the home. These were returned by 5 residents and 6 staff. Some of the residents were helped by a relative to complete the survey. A health and social care professional was also spoken to during the visit.


Staff were observed working with the residents. Care services are required to complete an Annual Quality Assurance Assessment (AQAA). This was completed by the home and returned to the Commission. Information contained in the AQAA has been used for this report.


What the care home does well:

Comprehensive assessments of need are carried and recorded on those considering a move into the home. This helps ensure that the home accommodates only those whose needs it can meet. The home's environment is purpose built and is of a good standard. Each person has his or her own room with a kitchenette area and an en suite bathroom. There are a number of communal areas, including an activities room and a well maintained garden.

What has improved since the last inspection?

Redecoration and refurbishment has taken place in a number of areas. This includes the use of specialist colour schemes to help orientate those with dementia. An area of the lounge has been converted into an 'internet cafe' for the residents to use. The care planning system has been developed to include details of residents' life history A new activities programme has been introduced and the home now has staff with responsibility for planning and co ordinating activities. Staffing hours have been increased.

What they could do better:

Greater attention is needed regarding the safe handling of medicines. Individual care plans need to be reviewed and developed so that identified areas of risk are assessed and plans devised to minimise those risks.

If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4.

The report of this inspection is available from our website www.cqc.org.uk.

You can get printed copies from [email protected] or by telephoning our

order line 0870 240 7535.


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


Choice of home


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.


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 residents are able to make an informed choice about whether or not to move in to the home. The home's assessment procedures help ensure that the home accommodates only those whose needs it can meet.

Evidence:

The home has 2 documents which are supplied to residents and those that are considering a move into the home. These are called 'Statement of Purpose' and 'Service Users' Guide.' Both give details of the service, the staff structure, the facilities, the care planning and the complaints procedure. Copies of the documents are available in the front entrance hall. Each resident who returned a survey states that he or she received enough information to help them decide if it was the right place for them to move into.


Evidence:

Residents said that they and their relative had an opportunity to look round the home before making a decision about whether or not to move in. The home completes an assessment of need before the person is admitted. This was found to be comprehensive with assessment details for each of the following headings: religion, preferred form of address for name, past medical history, past mental health history, events leading to admission, medication, main aims of the placement, service users' views, activities of daily living, breathing, eating/drinking, personal hygiene and dressing, mobility, continence, maintaining a safe environment, maintaining a body temperature, leisure and activities, expressing sexuality, sleeping/routines, end of life care, description of care and support, any nursing needs, specialist services, staff involvement and relatives.


Health and personal care


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.


Judgement:


Residents' health and personal care needs are generally met with the exception that medication procedures need to be improved so that medication is securely stored and safely administered.

Evidence:

The home has a procedure in the form of a 'flow chart' for assessing and recording care plans. Following admission to the home, a further assessment of need is completed covering mobility, lifestyle choices, support and daily care, physical health, diet, communication, pressure area risk assessment and falls risk assessment. Care records included the following: personal details, life history, end of life decisions, agreement to medication procedures and agreement to night time checks. Care plans included personal care, medication, daily living and activity, mobility, care at night time, and arrangements for laundry. Care plans include reference to individual


Evidence:

needs and preferences. Records show that care plans are reviewed and updated. This includes using a 'pre review' questionnaire for staff to complete. Care plan progress and evaluations are carried and recorded as well as monthly reviews. Care records show that dietary needs are assessed and resident's weight monitored and recorded. A record of any accidents for individuals is recorded. Records show that assessments are carried out where risk is identified along with plans for reducing those risks. The Complaints and Protection section of this report refers to examples of where this needs to be more fully addressed. Charts are used to monitor behaviour needs. Records of community health service involvement is recorded. Residents' surveys state that arrangements are made so that residents get the medical care they need. 2 residents spoken to described the staff as kind and helpful. Comment was made that staff respond promptly if they call for assistance using the call point in their rooms. A relative also described the staff as helpful and understanding, adding that personal care needs are met although there had been occasions when items of clothing had been mislaid in the laundry. Comment was made that a resident had been dressed in another person's clothes. Two people described how their morning routine is respected and that they have breakfast in their room at the time they wish. Comment was made in the surveys that residents get the care and support they need. A relative commented, 'We have been very satisfied with the care and the friendly but professional atmosphere.' Another relative said, 'The home looks after our relative and other residents with the care and compassion they all deserve.' A resident said, 'They take good care of me.' A health and social care professional said that the standard of personal care is good and the home's staff are skilled at working with people with dementia. The home is said to seek advice from health service professionals. Staff receive training in dementia care. A relative aslo commented that staff provide appropriate care to those with dementia. Staff were observed to interact with residents with kindness and respect. Residents' bedrooms contain items of a personal nature including furniture, ornaments, family photograph displays and other belongings.


Evidence:

The home's medication procedures were looked at. The home uses a monitored dosage system where medication is dispensed from blister packs at the prescribed time and given to residents. Examination of the blister packs and the records signed by staff showed that residents' medication was being administered at the prescribed times. It was noted that 2 morning medications for 2 people had not been given as the residents were still in bed. A staff member had dispensed this medication into 2 pots with a paper label indicating which medication belonged to which resident. This was left on the top of the medication trolley. It was also noted that 19 cassettes of medication, that is taken on an occasional basis, was left in the lounge on top of a table. This was removed and placed in a secure place when raised with the staff member responsible for medication. This was said to be an oversight. Staff were present in the lounge area and were monitoring residents. Controlled medication procedures were looked at. These showed that the stocks of medication tallied with the records held with the exception where 1 tablet was missing. This was found at a later time on the top shelf of the medication cupboard. Monthly medication audits are carried out. Staff receive training in medication procedures consisting of a 1 day course from the supplying pharmacist plus additional refresher courses. Records of this training were seen.


Daily life and social activities


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.


Judgement:


Residents benefit from a range of activities and stimulation. There is a choice of food and nutritious meals are provided.

Evidence:

The home has recently appointed 2 staff for co ordinating activities for a total of 55 hours per week. An activities programme was seen showing 34 activities for the month of April 2010 including the following: bingo, quizzes, board games, exercise classes, musical entertainment from visiting musicians, flower arranging, arts and crafts and film sessions with refreshments. A copy of the activities programme was seen in residents' bedrooms. There was a mixture of views expressed about the home's activity provision. 1 person said that suitable activities are 'always' provided. Another person said that he/she enjoys taking part in gardening activities and that he/she has frequent visitors. Comment was made by 1 person that some of the planned activities do not take place and 2 other people said that the activities could be improved. One person said that residents can suggest activities that they would like. Residents' surveys state that activities are arranged.


Evidence:

A staff member said that the recently appointed activities staff will be able to develop the activities programme. 3 staff commented in the surveys that activities, stimulation and entertainment for the residents could be improved. The home intends to recruit volunteers for providing activities in the future. The home has turned an area of the lounge into an 'internet cafe' where residents can access computers, which have a webcam facility for communicating with relatives. The home also has 2 laptops for residents to use in their rooms. There is an activities room with a wide screen television, which also facilities for interactive computer games. A mobile library visits the home each month. Residents were observed reading daily newspapers. Hairdressing facilities are available. Religious services are arranged. Residents are able to bring their pets to the home. One person has his/her cat at the home. The home has its own chickens. Residents are able to make suggestions about activities and to express their views at the monthly residents' meetings. Minutes of these meetings were displayed in the home. Meal times are flexible to suit the preferences of individual residents. Breakfast is between 0730am and 1030am. Residents said, 'You can have what you want to eat and the time you want.' Residents and relatives confirmed that choice is available at each meal time. A noticeboard in the dining room gives details of the choices available for the midday meal and the week's menu plan is displayed in the hall. Residents said that they like the food. The serving of the midday was observed. Meals were taken to residents at the dining tables. Residents were gently encouraged to eat and were given help by staff where needed. It was noted that staff communicated with residents whilst helping them to eat.


Complaints and protection


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.


Judgement:


The home has an effective complaints procedure and acts on matters raised by residents and their representatives. Recorded guidelines do not give enough information so that staff know what to do to minimise risks to residents.

Evidence:

The home's complaint procedure is available to residents and visitors in the front entrance hall. The complaints procedure is contained in the 'Statement of Purpose' and 'Service Users' Guide.' A relative said that the home acts if any concerns are raised. Residents and relatives state that there is someone available to speak to informally if they are not happy and that they know about the complaints procedure. The AQAA states that there have been 17 complaints in the last 12 months, 15 of which were resolved within 28 days. 7 of the complaints were upheld. The home has a system for recording each complaint along with details of how it was investigated as well as the outcome. The AQAA states that there have been 3 referrals to the local authority in the last 12 months under the safeguarding procedures. The home has records of these, which have been resolved.


Evidence:

Staff receive training in how to deal with any suspected abuse. This was confirmed from training records and from staff themselves. Care records varied in how staff should deal with behaviour where there is a risk such as challenging behaviour or leaving the building. Clear guidelines were recorded for 1 person regarding disorientation and wandering. There was a lack of detail regarding behaviour for 1 person following an incident and the care plan did not have guidance on how staff should deal with any reoccurence. It was also noted that a risk assessment and care plan was needed regarding another person's behaviour, although the home had made a referral to the appropriate mental health services. Comment was made by a health and social care professional that staff do not always deal with behaviour in the best way, but that the home will seek advice on how to deal with these situations.


Environment


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.


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.

Residents benefit from a purpose built and well maintained home with excellent facilities.

Evidence:

Residents' bedrooms are referred to as flats as they contain a kitchenette area, are spacious and each has its own en suite bathroom. Residents said how much they like their bedrooms and the views of the garden and fields. The home has several communal sitting areas, which residents were observed using. These include sitting areas in halls, a dining room, an activities room and an area with computers for the residents to use. The home has toilet and bathrooms which are adapted for those who may have mobility needs. There are 2 passenger lifts. The home was found to be clean and free from any odours. Residents and relatives commented that the home is clean, although 1 person commented that their bedroom was not always cleaned to a satisfactory standard.


Staffing


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.


Judgement:


Residents benefit from a well trained staff team supplied in sufficient numbers to meet their needs. Staff recruitment procedures protect the residents.

Evidence:

The home's staffing levels were looked at. This was done by discussion with the home's management, looking at the staff duty roster, observations on the day of the visit and feedback from staff and residents. The home aims to provide the following staff: 8am to 3pm 6 care staff plus 2 team leaders, 3pm to 10 pm 5 care staff plus 2 team leaders, and, 3 'waking' night staff plus 1 team leader at night. The staff rota showed that these hours were being maintained. In addition to the above, the home has the following ancillary staff: 2 cooks 7 days a week, 12 hours of housekeeping staff per day, 55 hours activity staff, a laundry assistant, 2 receptionists, an administrator, the deputy manager and the registered manager. Residents said that there are sufficient staff who respond when they need help. A


Evidence:

relative said that the home has enough staff. 2 people commented in the surveys that the home would benefit from additional staff. Comment was also made in 2 staff surveys that staffing levels could be better. The home has 44 care staff. 21 care staff have National Vocational Qualification (NVQ) level 2 and 14 NVQ level 3. A training matrix is maintained so that that the home's management can monitor staff training. Records of staff training were looked at in detail for 4 staff. These show a variety of training courses attended including the following: health and safety, first aid, risk assessment, fire safety, moving and handling, infection control and NVQ in care. Staff confirmed that they have access to a variety of training courses. Newly appointed staff complete an induction which is recorded. Staff also confirmed that they received an induction which prepared them for the job. Supervision and personal development appraisals are provided for staff on a regular basis. This was confirmed from staff, records and the AQAA. Regular staff meetings are held. Staff report that they staff work well as a team. Recruitment records were looked at for 5 staff who have started work at the home since the last key inspection. Each person completes an application form and the required checks are carried out before the person completes work, including obtaining 2 written references as well as a criminal record bureau (CRB) check. Residents and residents' relatives described the staff as helpful, caring and kind. One person said, 'The staff couldn't be better.' A relative commented, 'I have a great deal of respect for many of the staff and the team leaders. They go out of their way to help and readily answer any questions I have.'


Management and administration


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.


Judgement:


The home is effectively managed with systems to audit its own performance and to take account of residents' views.

Evidence:

The home's manager has National Vocational Qualification (NVQ) level 4 in care and is an NVQ assessor. She has completed a number of management courses including NVQ level 3 in Business Administration. Staff described the home's management as supportive and approachable. The home uses a number of methods for auditing its own performance. This includes surveys being given to residents to ask their views on the service they receive. The results of these surveys are summarised. There are regular residents' meetings. There is a comments book and suggestions box in the communal areas. The home completes its own audit against the Care Quality Commission national minimum standards. Monthly visits are made to the home by a member of the organisation's management


Evidence:

team and a report is compiled based on an audit of the home. Copies of these reports were seen. The AQAA states that regular infection control audits have been introduced. The home looks after some residents' valuables. A record is kept of this as well as dates of when it is deposited for safekeeping or returned to the resident. Staff receive training in first aid, moving and handling, food hygiene, fire safety and infection control. The AQAA confirms that the home's appliances are tested and serviced by suitably qualified persons.


Are there any outstanding requirements from the last inspection?

Yes £ No R

Outstanding statutory requirementsThese are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.No. Standard Regulation Requirement Timescale for

action


Requirements and recommendations from this inspection:

Immediate requirements:These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.No. Standard Regulation 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 Medication must be securely stored at all times. Staff must not predispense medication. Accurate records of medication stocks must be maintained. So that medication is secure and safely administered to residents.

20/05/2010

2 18 13 Assessments of risk and corresponding action plans must be devised to minimise the risk of harm from behaviour of individual residents. So that residents are protected from possible harm.

31/05/2010


RecommendationsThese 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


Helpline:

Telephone: 03000 616161

Email: [email protected]

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.

© Care Quality Commission 2010

This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010.

key inspection report · so30 3rs the quality rating for this care home is: two star good service a...

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