Day Care, Respite Careand Permanent Residential Care

Record-keeping in relation to residents

Records

Certain records, detailed in the National Minimum Care Standards Act 2000 Act are open to inspection by the CQC on request. Personal details in these records are kept in a secure place and access is limited to those with overall responsibility for the day-to-day care of the residents. Anyone who has access to records is instructed in the proper handling of confidential information. Managers and staff have been adequately briefed on issues relating to confidentiality and access to case files.

As well as those records required to be kept by law, such as personal details and next of kin, the home also keeps other records:

A care plan which is agreed with the resident and relevant care staff;

A resident’s life information (particularly important for maintaining and restoring a person’s sense of identity and as a source of information for staff);
financial records, detailing payments made to the home;
agreements entered into for accommodation;
Agreements for particular services and care not included in the overall agreement.

Residents’ access to personal records

The staff share information with residents in the context of an open, professional relationship. Residents who wish to have access to their health records have a right in law to do so In some instances, counselling can be offered where sensitive information is disclosed.

Information about a third party is not disclosed without the consent of that party;
Information derived from a third party is not disclosed without the consent of that party.

Management and administrative records

Hankham Lodge has produced an ‘aims and objectives’ document underpinning the day-to-day work of the home which is regularly reviewed and updatedHankham Lodge’s certificate of registration is displayed in the front lobby and can be seen on entering the home to assure prospective residents and their families and friends of the registered status of the home. There are records kept which set out details about the home and which are available for inspection by the CQC.

These include:

Details of the home’s registration;
A list of all those in residence and their case records;
A list of staff, their qualifications and their references;
Records relating to medication;
Records of complaints.

Following guide lines Hankham Lodge keeps records of residents for three years from the last entry.

Other records that are kept will relate to safety:

Maintenance records of specified equipment;
Records for health and safety purposes;
Records in line with fire regulations: precautions and practices undertaken and a list of those who will need help in the case of evacuation in a fire;
Records to meet food and hygiene regulations;
Records detailing accidents and other incidents.

Other documentation includes:

The policies and procedures of the home; the residents’ handbook (detailed information about life in the home and its fees and charges for various additional services); i.e. This Document
The staff handbook (which sets out terms and conditions of employment not included in individuals’ statement of terms and conditions, general procedures at work and health and safety as it applies to staff members);
Staff rotas;
Staff records and employment procedures.

Financial systems are also in place which record:

The collection of fees;
Salary and wages payments;
Tax payments.

Fees

Fee levels
Details are clearly set out in agreements entered into at the time of moving into the home. They specify in detail what is included in the fee and what services or elements of care are costed and charged for separately.

Increases in fees

There is one month’s notice of the annual increase in fees this allows time for a consultation process. This is important both for individuals funding themselves and for residents who are funded by other sources. Local authorities are closely involved in any changes in existing fee levels, particularly in relation to their contractual arrangements and service specifications with the home.

Residents’ money

Owner/Managers Deputies or staff never, under any circumstances, control residents’ money. To do so may lay us open to suspicion of malpractice. Control of one’s own finances is an important way of being able to be in control of one’s life. In line with this, residents handle their own money as far as they are able. They need to make their own arrangements for collecting their pensions. Residents are made aware that they are responsible for the safekeeping of their own money, documents such as pension books and other valuable possessions, by means of the safe (strong Box) located in every room, unless they are unable to do so because of mental or physical impairment.

Legal issues

Appointments of agents, appointees, attorneys and trustees by residents

Agents and appointees

A resident may nominate a relative, friend or someone in the community over the age of eighteen to act as his or her agent in drawing and making payments. There is a well-established procedure for doing this for social security payments. If the resident wants a third party to operate his or her bank account then he or she can instruct a bank accordingly. When there is no relative or friend available whom the resident trusts, the Department of Social Security (DSS) is asked to recommend someone to act as agent. Hankham Lodge, manager or staff members DO NOT take on this role

In some circumstances, a relative, friend, or someone in the community such as an advocate, may become an appointee, able to make claims for and receive and deal with state benefits on behalf of the resident. In order to do so, an application needs to be made to the local DSS office. Social security regulations state that the claimant must be ‘unable for the time being to act’. This usually means that the person does not have the mental capacity to look after his or her financial affairs, because of memory loss, disease, or some sort of disability. Occasionally, the problem might be temporary, for example because of a serious accident.

The person to be appointed must demonstrate to the DSS that he or she would make the most suitable appointee and show an active interest in the welfare of the individual. Once accepted, an appointee has a duty to ensure that the resident will get the full benefit of the payment made and that any changes in the circumstances of the resident which may affect his or her benefits are promptly reported.

Appointment under the social security regulations comes to an end: if it is revoked by the DSS; if the appointee resigns after giving one month’s notice; or if the DSS is told that a receiver has been appointed by the Court of Protection for England The DSS must also be notified if either the claimant or the appointee dies.

Power of attorney

A power of attorney is an arrangement by which one individual (the donor) gives authority to another or others to act on his or her behalf. The attorney is required to act as if he or she were the donor. Appointing an attorney might be a good idea if a resident has difficulty getting out to the bank or building society, or has difficulty signing cheques or documents. However, power of attorney (like agency) cannot be used where the person does not have the mental capacity to give authorisation to the attorney.

The power can be used in specific or general areas of managing income and capital. Copies can be shown to banks, building societies, pension funds or insurance and pensions companies when required. At any time the donor can cancel the power of attorney. The attorney must demonstrate that he or she is taking proper care of the donor’s affairs and may be sued for any loss due to insufficient care.

It is very important to realise that in England, Wales and Northern Ireland a power of attorney is automatically cancelled by operation of law when the individual loses mental capacity to manage his or her own affairs. An attorney who then continues to act is doing so without authority and is liable to be sued. Instead, the attorney should stop acting. The person’s affairs may then have to be handled by the Court of Protection in England and Wales or the High Court and the Office of Care and Protection in Northern Ireland.

Enduring power of attorney

Unlike an ordinary power of attorney, in England, Wales and Northern Ireland an enduring power of attorney (EPA) can continue in force even if the individual loses mental capacity. EPAs are often made by older people who are aware of failing mental faculties, but still have capacity to understand what is involved in creating an EPA. The EPA can give the attorney general power to act in relation to the donor’s property and affairs, or can relate to specific items. An EPA must be made in a prescribed form laid down by law, and the person may wish to consult a solicitor or legal advisor and may appoint a solicitor or social services department to act as an attorney under an EPA. More often, the attorney chosen will be a son or daughter, spouse or other close relative.

An attorney under an EPA must take proper care of the donor’s affairs and also takes on certain special duties. As soon as the attorney believes that the donor is or is becoming mentally incapable then the attorney must stop acting until the EPA has been registered by the Court of Protection in England and Wales or by the High Court in Northern Ireland. Again, this must be done in the correct prescribed form, with certain relatives of the donor (laid down by law) being informed. Once the EPA is registered, the attorney can safely start acting again. An EPA may, alternatively, stipulate that it should take effect only if mental incapacity should occur, in which case it would first need to be registered as above.

Trusts

Alternatively a resident may decide to set up a trust to manage his or her affairs. This is normally worth doing only if there are substantial assets but it has the great advantage of continuing to be valid even if the resident should cease to be mentally competent.

Hankham Lodges managers’ responsibilities

Hankham Lodge has no legal obligation to defend the interests of residents who are no longer capable of looking after their financial affairs. However, we do have a duty to safeguard and promote the welfare of our residents Under no circumstances will anyone connected with the home take on a role of financial responsibility

As noted Hankham Lodge has no obligation to see that the law is complied with where residents’ financial affairs are concerned However, if we feel that something (not necessarily of a legal nature) is going wrong, and the resident is unable to deal with it, we will draw their fears to the attention of relatives or the CQC, whichever is more appropriate.

This duty in no way contradicts the essential principle that all those connected with Hankham Lodge will not become involved in the handling and management of a resident’s financial affairs. Homeowners and managers are potentially vulnerable to accusations of misconduct. Suggestions of impropriety may be hard to dispel even if they are without foundation.

Advance statements about health care

A resident with a progressive illness which could lead to loss of decision-making capacity in the future may wish to record his or her views about health care options. This might cover issues concerning refusal of treatment, requests for treatment and purposes of treatment. If the person then loses capacity and cannot participate in health care decisions, those involved in treatment and care are able to take the previously expressed views into account. These views are written down then the document is put in their “Care plan” and called an ‘advance directive’

Improving quality: procedures for making suggestions

Hankham Lodge welcomes suggestions for improving or adding to the life of the home. An open and friendly style of management encourages this and prevents residents and their families and friends from feeling inhibited about raising issues, making comments or putting forward suggestions. Clear information about how to make suggestions is provided. This is through the provision of a suggestions box. Staff are always ready to listen to ideas that residents express and pass them on to the managers. Also regular Quality Assurance programme gives the opportunity for input.

Complaints procedures

Hankham Lodge has a clearly established complaints procedure which is described in the following section and about which residents, their relatives and friends are told when the resident first moves in. Managers and staff do not assume that an absence of complaints means that everything is running smoothly. We are particularly alert to the general hesitancy of residents and relatives to complain for fear (however unjustified) of recrimination. It is understood that residents and relatives may even be reluctant to make suggestions because they fear this may be seen as implied criticism. Residents may feel fearful and vulnerable and therefore unwilling to speak out because they are dependent on staff and managers for their care and assistance. More generally, it is remembered that many older people tend to ‘go along with things’ in response to questions and that a comment to the effect that something is satisfactory could in fact indicate that improvements could be made. Advocates have a useful role in supporting residents in making a complaint and Hankham Lodge welcomes their involvement in the life of the home.

The information given to residents and relatives stresses that ideas, suggestions and complaints are welcome and expected.

Our complaints procedure has the following features:
It is set out clearly to whom the complaint in the first instance should be made and indicate to whom the resident can complain if he or she remains dissatisfied;
It makes an explicit commitment which states that matters will be taken seriously and prompt action will result if the complaint is justified;
It contains assurances that residents will not be victimised as a result of making a complaint;
It assures fairness and impartiality and offers access to an impartial third party if the resident so wishes;
It provides clear and concise written responses if the resident wishes;
It guarantees that action will be taken to ensure no repetition if the complaint is shown to be valid;
It offers an apology if the complaint is valid;

Staffing

Introduction
The quality of life which residents experience depends to a great extent on the calibre of the staff caring for them. Our trained and experienced staff team, which is well managed and adequately paid, provides high quality care in a responsive and understanding atmosphere. People living at Hankham Lodge are often vulnerable, both physically and emotionally. Staff carry out personal and potentially embarrassing intimate services for residents and need special qualities to do this sensitively and tactfully. Such qualities include personal warmth, patience and responsiveness to and respect for the individual. They can provide competent and tactful care whilst supporting residents in maintaining and extending skills and self-care abilities.

The staff team

At Hankham Lodge staff see themselves as a team which is consistent in its shared aims, with members fulfilling complementary roles. this ensures residents receive a satisfactory standard of care, The balance of staff can therefore match the residents’ needs.

There are four main groups of staff at Hankham Lodge
· Owner/Managers- Peter & Svetlana Sims
· Deputy Manager
· Day care staff and night care staff
· Ancillary staff (which includes the cook, housekeepers, building maintenance staff, gardeners).

In addition, the role to be played by peripatetic staff such as occupational therapists and chiropodists is considered carefully.

Current law requires Hankham Lodge runs with an adequate number of staff who have the right balance of skills and experience to meet the needs of residents. Each year Hankham Lodge draws up a staffing schedule to show how the staff team meets the residents’ requirements. The schedule is subject to inspection and approval by the inspection and registration authority Hankham Lodge provides sufficient evidence that the right level of staffing with appropriate competence and training is provided. Hankham Lodge never leaves the home in the control of a person with insufficient training and experience. The staffing establishment and rota system therefore are arranged so that there are enough senior staff and they are suitably deployed to give the cover required to meet the home’s stated aims.

Staff recruitment and selection

Recruitment
The recruitment of good staff is critical to the running of Hankham Lodge and is undertaken carefully. Staff at all levels demonstrate the right degree of knowledge, skills, experience and attitudes relevant to their jobs. Managerial and supervisory staff have qualifications as appropriate.

The following stages are involved:

  • advertisements are clear about the sort of person wanted and the work they will do.
  • comprehensive information is be available for potential applicants.
  • a person specification and job description is drawn up.
  • application forms are completed by all people applying for jobs.
  • the interviewing process is conducted fairly by senior staff with the appropriate skills. It includes candidates talking to residents and existing staff; references are taken up from two people, one at least from a previous employer or from someone who, for example, has supervised the applicant in a volunteer capacity (rather than a character reference from a friend).
  • references are written and sent directly by the referee, and where necessary followed up with a telephone call to check statements.
  • employment histories are checked for any gaps or evidence of misconduct.
  • prospective employees must disclose all previous criminal convictions including those which are ‘otherwise spent’. The Rehabilitation and Offenders Act 1974 (Exemptions) Order 1975 requires residential and nursing home care staff to disclose previous convictions.
  • the authenticity of qualifications are checked; a health declaration is requested before appointment.
  • proper records of the recruitment process are kept.

Equal opportunities

It is sometimes difficult to balance equal opportunities procedures with the needs and rights of residents. The recruitment procedures and the composition of the staff team does as far as possible match the mix of cultural and language backgrounds of residents and local area.

Job descriptions

Job descriptions describe the roles and tasks which staff have to undertake. They outline the management structure and lines of accountability and the support and supervision available. They also set out the overall purpose of the job, linking the importance of the tasks described to the aims of the home as a whole.

Terms and conditions of employment

It is mandatory for certain terms and conditions of employment to be clearly stated in writing and given to each employee as part of the contract of employment. This is done by means of the SMT (Statement of Main Terms and conditions) which makes reference to the staff hand book which is available to all staff on duty At Hankham Lodge

Staff handbook

A detailed handbook is readily available for each member of staff, setting out terms and conditions of employment as above and also covering procedures to be observed during working hours. It is an integral part of the contract of employment. It includes:

  •  terms and conditions of employment
  •  health and safety at work policies
  •  procedures in specific circumstances, for example fire and other emergencies
  •  policies and procedures relating to sickness and absences
  •  instructions on maintaining confidentiality
  •  instructions on receiving gifts or gratuities and not being involved in the drawing up of wills

 

Induction

New members of staff are given a job induction during which they are introduced to residents and other members of staff and the nature of their job described. The aims and objectives of the home and its routines and procedures (especially fire and safety) are set out for them, along with the standards of care which all members of staff are expected to achieve. This induction is inline with the standards laid down by Skills For Care and is completed by all care staff within six weeks of their start date.

Probationary period

At Hankham Lodge all staff to undergo a formal probationary period at the discretion of the managers to ensure that they are suitable for the job and the home. They are supported during this time with a review undertaken at the end of the period. In some cases this probationary period can be extended. Care is taken to ensure that new staff are not placed on duty together and unsupported. At Hankham Lodge we place a new member of staff alongside a more experienced person who can act as mentor.

Working conditions

Hours of duty
Duty rotas are based on a two-week rotation. Staff are not expected to work additional hours regularly or to work more than five days continuously without taking a break. Rotas therefore pay attention to both shift patterns and time off duty. Care is taken to ensure that enough time and attention is given to handover procedures between shifts so that staff coming on duty are fully informed about any developments or changes in residents’ circumstances. Detailed records of all information handed over are kept.

Dress

Clothing worn by staff is suitable for the tasks that they have to carry out. There are arguments for and against uniforms. They tend to give an institutional feel to an establishment but the majority of our residents express a preference for staff to wear them so we consider them appropriate. We are careful not create a misleading impression that staff are nurses (they are not) or that staff are medically qualified if they are not.

Hankham Lodge has a corporate colour and style of clothing. Name badges we find helpful, particularly if residents find it difficult to remember names. They are also helpful for visitors.. Jewellery such as brooches, chains and rings are either covered or not worn if they might scratch or harm residents.

Attention is always given to matters of infection control, either from resident to resident, resident to staff or staff to resident, and so practical protective clothing is available for staff when needed.

Care staff wear Blue tunics and Black trousers.

Support for staff

Peter & Svetlana Sims, together with the Deputy Manager, ensure that managerial structures, communications systems and staff supervision are sufficient to enable staff to undertake their duties effectively.

Staff induction, manuals of guidance, inhouse training, staff meetings and individual supervision were considered carefully and laid out in detail. Hankham Lodge takes on board that in the event of a crisis or an enquiry, management may have to demonstrate that the support structures which we had in place were sufficient. Hankham Lodge staff are included in discussions about the running of the home.

Staff meetings

Staff meetings take place regularly and involve all staff.

Newsletter

An important part of the line of communication is the newsletters which are produced every three months

Staff supervision

There are one-to-one supervision sessions for all staff on a regular basis although they may be required more frequently for care staff than other staff categories. The sessions enable managers to ensure that staff are performing satisfactorily and provide opportunities for constructive criticism and understanding support. Personal and career development is discussed.

Stress

Working at Hankham Lodge can be stressful. Staff learn to cope with death, serious illness and the difficult behaviour of some residents. For the home to be able to deal with such things as high levels of incontinence and aggressive and violent behaviour, we have policies and procedures in place which ensure enough support and training opportunities for staff and adequate staffing levels.

Establishing staffing levels

Hankham Lodge has considered the residents’ needs in relation to all types of staff in drawing up our staffing arrangements. We have set out the number of staff, their duties, salaries and the types of qualifications, experience and training which is expected for each post. We tend to employ part-time care assistants, which allows for more flexible deployment while our full-time posts tend to improve consistency and continuity of care At Hankham Lodge staff carry out a wide variety of responsibilities, including resident care, cleaning, cooking and so on. In all cases, however, the duties required of staff are made clear at the time of appointment and any changes of duty or role, are recorded in writing.

Hankham Lodge : managerial and care staff
Minimum cover
Hankham Lodge ‘s management and care staffing arrangements, consider two main factors. The first is the provision of minimum cover. There is a ‘responsible person’ designated on duty at all times during the twenty-four hour day. This means that there is someone present who can make decisions in an emergency, who is familiar with the home’s procedures and practices and has the necessary skills and training to manage the service provided.

Hankham Lodge ‘s cover is designed to cope with the general running of the home. But there are peaks and troughs in the residents’ demand for staff support and help. Peaks include getting up, mealtimes, activities and going to bed; troughs include times when residents are out of the building and rest periods. Hankham Lodge, therefore doesn’t only provide minimum cover but also deploys staff to offer additional support at peak periods. The employment of part-time staff enables such deployment to be flexible without causing problems such as split shifts for other staff.

Total staff required

The second main factor in the calculation of day care staffing is the degree of need presented by the residents and the consequent amount of staff time required. Total requirements are arrived at by estimating the number of care hours required according to residents’ needs per week and then totalled per resident per annum, and then totalled for Hankham Lodge as a whole. Thus the number of staff needed is worked out once allowance is made for holidays, illness and other absences. This approach gives the total staffing required for all managerial and care staff on day duties, inclusive of the minimum cover.

Night staffing

At Hankham Lodge night staffing requirements depend upon the mobility and lucidity of residents on the one hand, and the type of handling problems anticipated on the other. Where residents require moving, for example, two members of staff are needed Mr & Mrs Sims are on call every night.

Ancillary staff

Ancillary staffing includes staff not primarily engaged to undertake managerial or care roles, but the value of their contact with residents or their therapeutic role is not underestimated. While only basic guidelines are offered for the numbers of such staff, Hankham Lodge considers the tasks listed below.

Cooking

Our cooking is one of our great strengths. We have two excellent cooks who produce wonderful lunchtime meals to the satisfaction of all the residents (and staff)
At Hankham Lodge, care staff do the teatime cooking to help create a homely atmosphere, This approach was determined by the overall aim of the home, and appropriate training made available to ensure that residents obtain a varied, balanced diet that also reflects their individual wishes.

Gardening and maintenance

This work is undertaken by outside contractors. In some circumstances, since good maintenance is important for the comfort of residents, especially when they are dependent on the efficient functioning of heating systems, hot water supplies, other household systems and aids with which the home is equipped.

Training and staff development

Hankham Lodge enables and encourage staff to undertake training. As part of staff appraisal and supervision, an individual training and development plan has been drawn up for all staff. Staff are encouraged to undertake training courses to acquire skills and, where appropriate, qualifications. The benefits to be derived from having a trained staff are many:

  •  residents receive better care
  •  staff feel more confident that they are doing the work as it should be done and that they can tackle problems that arise
  •  staff feel valued by management when the training programme has the management’s backing
  •  the ethos of the home is improved
  •  a pool of staff is available for promotion and career progression

Hankham Lodge provides training in-house as well as arranging for staff to spend time away on courses. In-house training of this kind is seen as an integral part of the running of Hankham Lodge and emphasis is given to the timing and arrangement of staffing rotas to ensure relief cover is provided to enable staff to receive training. Night staff are included in all training opportunities. Training costs money and this is incorporated into the fees charged to residents. There are a range of courses and types of training available at Hankham Lodge :

  •  in-house training provided by colleagues who themselves are skilled
  •  peer group training
  •  distance learning (for example via the Open University, the Royal Institute of Public Health and Hygiene)
  •  courses provided by local colleges, university departments, hospital teaching departments
  •  courses organised by care homes associations

Hankham Lodge also offers National Vocational Qualifications (NVQs) Five levels of qualifications are set out within the NVQ framework. At level 2 (which is the level most often worked towards by Hankham Lodge staff), competence is expected in a variety of work activities, some complex and non-routine, along with the ability to work both alone and in collaboration with others in different situations.

Hankham Lodge staff find the combined support and direct care awards particularly relevant.

The NVQ system of training covers staff at all levels, including managerial training, Hankham Lodge will be linking career progression to the achievement of specific NVQ levels.
Hankham Lodge is committed to the training for all staff, particularly those who have direct contact with residents, training cannot be overemphasised. In particular, staff (both care staff and ancillary staff) benefit from training in guarding against abuse, promoting continence, and caring for those who are dying. In the case of residents who may show signs of developing dementia, it is important that those who have most contact with them understand their symptoms and know how best to handle those symptoms. This has a bearing on many aspects of residents’ daily lives getting dressed, activities, mealtimes, going out, going to bed. We also provide training on health and safety issues, particularly, for example, in relation to food safety, manual handling and the use of hoists.

Buildings

Principles
Hankham Lodge’s design is an important influence on the residents’ qualify of life. The design has been geared to satisfying the needs of residents and staff providing care within the home while keeping the charm of a rural country house.

Hankham Lodge:

  •  Provides a safe and secure environment for residents
  •  Ensures their privacy and provides their own personal space under their own control
  •  Protects their dignity
  •  Offers them a stimulating setting for daily activities
  •  Enables them to have easy access around the home
  •  Provides a work setting which enables staff to deliver high quality care
  •  Meets the standards relating to the design and fabric of residential care home required by law, regulations and directives

Over time, expectations have risen and standards are continually improving.Hankham Lodge is committed in providing many of the features outlined here.

Location and setting

Hankham Lodge is set in a wonderful rural setting. And is accessible to public transport, local shops and other community facilities such as pubs and libraries,

Access to the local community

Hankham Lodge maintains good community links. In some cases residents may be frail and unable to get out and about but they still value links with the local community, schools, community organisations and places of worship.

Transport

If residents cannot get about by themselves, we have our own transport for outings and trips to shops and places of worship, and arrange for friends, relatives and volunteers to accompany them. Such help can also be arranged for relatives and friends who have no transport of their own and who cannot use public transport. Car parking for visitors (and residents in some cases) is also available.

Views and aspect

First impressions of Hankham Lodge are its setting and the building itself. Open views on to gardens and the surrounding countryside are important. .Hankham Lodge has well designed gardens and great pride is taken in all the grounds.

Building design

Hankham Lodge is a converted country house and cottage which is very unusual for a care home but it’s this that makes .Hankham Lodge totally individual and unique It is for this reason that at times it has been hard for .Hankham Lodge to comply with regulations to do with the building. However this is not taken as a reason to avoid meeting certain standards These are the standards which guarantee the privacy and dignity of residents, promote their independence and enable them to live their lives in the way that suits them best. Some standards are ruled by legislation, regulations and guidance; others are set by national associations (of the professions, homeowners and others) or are the outcome of agreement between .Hankham Lodge and inspection and registration units.

Improvements

Hankham Lodge has constantly strived to improve its accommodation as and when possible, either as part of the development programme or, for example, redecorating between residencies.

Such improvements have included:

  •  A programme of phasing out all shared rooms
  •  Using former double rooms for single rooms with en suite facilities or for activity rooms
  •  Where practicable, adding en suite facilities to rooms
  •  Adopting a policy of redecoration between residencies, ideally with the new resident taking responsibility for deciding what should be done
  •  Building a summer house
  •  Improving access to the garden and incorporating new features

Size of home and living units

The size of home is governed by the fact that Hankham Lodge is in Greenbelt land (unusual for a care home): The central aim is to support and enhance the quality of life for residents, the fostering of individuality and the maintenance of privacy and dignity

Unit or group living

Our aim is, regardless of the overall size of the home, for life to be on a domestic scale for every resident. Residentsare able to identify with a group of other residents within the home.

Domestic style

Every effort has been made to prevent the home from having an institutional feel. The setting, design and decoration of the building all contribute to this (along with the way in which staff and management operate). The chart on the following page sets out some of the differences:

A supportive environment

We recognise that older people may have restricted mobility or sensory impairments. Some may show signs of the onset of dementia. Supportive features are incorporated so as to minimise and compensate for all these difficulties. The following design characteristics have been important:

  • It is easy for residents to find their way around the building. Each resident can easily locate their own private space, identify how to get to a toilet wherever they are in the building, know where and how to find help and assistance, and know how to get to sitting areas;
  • There are simple, obvious routes around the building, with points of interest as ‘landmarks’ (for example, plants or pieces of furniture) so that the individuals know where they are..
  • There is easy movement between all parts of the building with doors which can be opened easily and used by people with walking frames or sticks;
  • There is a 4-person stair lift to upper floors.
  • Easy-to-climb stairs with handrails both sides
  • Good levels of lighting , no changes of floor levels. Good lighting is important in helping to reduce confusion. Lighting which casts shadows on to floors has been avoided because these shadows might give the impression that there is something to step over;
  • All specially designed fixtures and fittings, for example in toilets and bathrooms, are as much as possible in as domestic style.
  • The use of technology is sensitive, for example nurse call systems which are non-intrusive;
  • Residents rooms are personalised with their own fittings and furniture (where possible) and other bits and pieces which have meaning for the individual;
  • A smaller lounge, conservatory and the summerhouse as well as the larger lounge help people to mix with each other.
  • Hankham Lodge provides a safe environment which provides a balance between overprotection and risk with unobtrusive fire and security precautions;
  • There is access to a safe and interesting garden with ‘wandering’ paths that is, a route which leads a person through the garden and back into the building unobtrusively.

Pleasant environment

In addition to being functional, the building is a pleasant and secure environment in which to live. Attention has been paid to the aesthetic qualities of a building. For example:

  •  Lighting, especially the maximum use of natural daylight
  •  The imaginative ornaments and decorations
  •  Having points of interest which may provide stimulation and conversation
  •  A variety of usable spaces both inside and outside the building, some of which are semi-protected for example, porches, and summerhouse.

Gardens

The gardens at Hankham Lodge are an important part of the premises. They are safe for people to walk in, without steps and accessible for wheelchairs. Security measures are unobtrusive but reliable. Seats at strategic points with sheltered and shaded areas enable residents to spend time outside. People who are visually impaired value scented gardens. Birds and other wildlife are encouraged.

Common facilities

Facilities and space that are shared by residents have been provided in domestic-style and are interesting and varied.

Communal rooms

Both communal space and personal accommodation is very important at Hankham Lodge. The rooms are well decorated and accessible for everyone. Efforts have been made to ensure that common space is welcoming. For example, minimising noise so not disorientating people.

Within the rooms:

  •  Chairs and furniture are of different styles and heights
  •  Easy chairs are domestic in appearance for example not being covered in plastic
  •  Side tables are available (waist-height for drinks, papers, paraphernalia)
  •  Chairs are not just arranged around walls (unless for a special occasion or because residents prefer this) because small groupings are more homely and intimate
  •  Furniture is arranged for easy access, both to allow use of walking frames and to provide support for those who have difficulty walking
  •  Fabric and furnishings are all fire-retardant.
  • Activity rooms

Rooms are available for a variety of activities. Options include:

  •  A quiet room and for reading
  •  2 acres of land to participate in any activity
  •  Use of the dining room or conservatory by residents, for large meetings with families and friends etc

Connecting spaces

All corridors and entrance lobbies:

  • Have level access and meet all the mobility criteria
  • Have just sufficient width and space for wheelchairs and walking frames
  • Minimise the distance between private and communal space
  • Provide a variety of spaces for sitting and looking out of a window

Toilets, bathrooms in common areas

Access to toilets in common areas is aided by having them situated close to the lounges and activity rooms’ privacy in using the toilets is an essential consideration. Hankham Lodge provides facilities in the following ratios:

  •  Toilets/residents, 1:4
  •  Bathrooms/residents, 1:6

Toilets have been designed with mobility and disability in mind without having a clinical appearance. Bathing equipment is as domestic in style as possible. Staff endeavour to minimise fear when using the bath lift

Storage space

There is ample space in the garage to store luggage, spare equipment including hoists, furniture and other bulky items that are infrequently used. Proper tied storage is also provided for wheelchairs and walking frames.

Residents’ own accommodation

The single most important aspect of living in residential care is the living accommodation provided for the individual resident. All research shows that most residents prefer a single room. However some people do prefer to share a room they feel less alone and less vulnerable.

Single occupancy

People moving into Hankham Lodge can choose to have their own single room accommodation (unless they prefer otherwise). We strongly recommended that shared rooms are available for couples; relatives or close friends are able to live together if they so wish.

Shared occupancy

Two people only live in the same accommodation if they have chosen to do so. The accommodation is specifically designed for two people (in terms of size and facilities), paying due account to privacy.

En suite toilet and washing facilities

Careful design has reduced the amount of space taken from the living area of the accommodation although it must be recognised that installing en suite facilities into existing accommodation eats into available space and can therefore has only be done where practicable. There is a vanity unit and storage space for toiletries. Toilets are a comfortable height with built-in support. Taps designed for people with weak or arthritic hands have been fitted.

Suitability of accommodation

There are a number of factors we have considered when designing the accommodation most were checked prior to registration and the following is what we took in to account. Some of which makes up the improvement programme.

Size of room

The total area of a room is one of the key input measures that were checked by inspection and registration units before registration. The generally accepted minimum size is ten square metres for single accommodation. We aim to ensure that over time our provision will enable residents to have their own private rooms large enough to hold a reasonable amount of their own furniture and to accommodate all the activities of daily living that a resident can expect to carry out. There is room for an armchair, a television and other leisure activity paraphernalia. There is space for manoeuvring a walking frame and for staff to provide assistance. It is also be possible to move the bed into alternative positions.

Other factors

Other factors we considered include:

  • The proportion of a room (in keeping with a cottage atmosphere);
  • There is adequate soundproofing to ensure residents are not unnecessarily disturbed by outside noise. But care was taken so not to make the residents feel isolated and cut off from the normal bustle of daily activity;
  • Where a room doesn’t have as good a view as some rooms effort has been made to counteract this by, for example, planting a shrub or growing climbing plants;
  • Window(s) are of an adequate size are of good proportion in relation to size of room. all the window-sills are low enough for the resident to look out without obstructed vision when seated or when lying in bed.

Furniture

The accommodation at Hankham Lodge is large enough to contain:

  •  A bed (three feet wide)
  •  One comfortable armchair
  •  Storage space for clothes, i.e. a chest of drawers and hanging space
  •  Storage space for other possessions i.e. shelves, cupboards
  •  Lockable strongbox for money and valuables.

Doors to bedrooms

We recognise that Doors represent, both physically and psychologically, the entrance to a resident’s private space therefore, that as far as possible the resident controls who enters, all residents are given a key and staff and visitors always knock and wait for an invitation to enter.

Locks

Doors to resident’s rooms are lockable from both sides with staff holding a master key in case of emergency. As far as possible, residents hold their own keys with no restriction as to when they can lock the door.

Opening doors

Doors are easy to open for people who are frail. Where appropriate, their wishes to keep doors open is respected.

Identification

The outside of doors every residents room has a large number on it so that residents can easily recognise their own door.

Furniture, fittings and decoration

It is normal practice for people to bring some of their own suitable furniture with them when moving in on a permanent basis. They can decorate and furnish their rooms in their own style within reason if the wish. If not, they are freshly decorated by the home, although this may not be reasonable where the length of the previous residence has been very shor.

If residents do not have their own furniture or if they are staying for a short period, then Hankham Lodge provides suitable domestic furniture as described above.

Rooms are equipped to allow residents to continue a familiar life style and include (though individual requirements are likely to vary):

  • Sufficient electric power points, with at least two double-switched outlets
  • Light switches set at convenient points around the room
  • An aerial socket
  • A telephone socket

Emergency Call system

There is a straightforward, easy-to-use call system for both emergency situations and minor calls,. Once activated, the system indicates the origin of the call without disturbing other residents. But the staff constantly monitor the residents throughout the day and night (if agreed by the resident).

Environment within the home

Wherever possible, residents can control the environment in their own rooms.

Temperature

Hankham Lodge’s heating system maintains adequate temperature and complies with all safety regulations, and is controllable in 5 zones and some rooms have their own TRV or thermostat. Water temperatures comply with safety regulations and are checked regularly.

Ventilation

All windows are easy to open with no risk of falling out. There are curtains which residents can operate easily to provide privacy at night time and during the day when necessary.

Lighting

Different forms and type of lighting are available a main room light, bedside light and direct light over chair or table. Account has been taken for a resident’s reduced vision. Trailing flexes have been avoided where possible.

Technology

During the coming decade, technology will become an integral, familiar and natural part of care provision. Hankham Lodge’s attempts to keep up to date with new developments from which their residents and staff can benefit.

Uses

Some the uses we are looking at are:

  •  As a reminder for the resident to do something: for example, that it is a meal time or to take some medication
  •  As a compensation for memory loss: for example, switching off the tap if the bath is overflowing
  •  As stimulation: for example, personal reminiscence videos
  •  For environmental management: for example, to keep the heating at an individually comfortable level
  •  For behaviour management: for example, to adjust aspects of the environment (heat or light) which are causing restlessness and agitation (similar to Feng Shui)
  •  For control: for example, new-style locks on doors
  •  For safety: for example, passive infra-red sensors which will turn on the light when someone gets out of bed
  •  For communication: for example, using video telephones to keep in touch
  •  For coordination: for example, shared use of resident’s records in the resident’s room by all professional staff.

These new technologies will increasingly be controlled by personal computers, which will make it possible to tailor the use of them to fit the individual care plan. It will also be possible to programme their use by prompting regular reviews. While the benefits will be enormous, there may be dangers, which we intend guarding against. The unethical use of technology is an infringement of residents’ civil liberties and is regarded in the same way as restraint and abuse.

How we intend to use technology

The following section is a policy for the development of equipment or technology:

  •  It will only be used for the positive benefit of a resident which results in improvement in quality of life
  •  It will be the least intrusive of equally beneficial actions: that is, simple actions will be used first
  •  Wherever possible it will be used only with the active consent of the resident who recognises the action as beneficial
  •  Any risks or side effects will be fully explained to the resident (or relatives and staff)
  •  Proper protocols will be followed for actions which are controversial, and proper records kept (as below)
  •  Its use and effectiveness will be reviewed at appropriate intervals
  •  It will never be used solely for the convenience of staff.

The records kept will state:

  •  The nature of the problem being addressed
  •  What methods have been used to resolve the problem
  •  Why a particular action or technology has been chosen
  •  How long it is to be used for and a date set for its review.
  •  Who agreed to its use and who will participate in the review