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Principles of Good Practice

Introduction

Underlying all the statements set out on this site is a conviction that those residents who live at Hankham Lodge do so with dignity and respect from those who support them. They live with no reduction of their rights as citizens and are entitled to live as full and active a life as their physical and mental condition will allow.

Whatever their age, whether sound in mind and body or experiencing disability, residents have a fundamental right to self-determination and individuality. Equally, they are given the right to live in a manner and in circumstances which correspond as far as possible with what is normal for those who remain in their own homes. Hankham Lodge strives to enable residents to achieve their full capacity physical, intellectual, spiritual, emotional and social even when they have a progressive disease such as dementia. We aim to achieve this by sensitive recognition and nurturing of that potential in each individual and by an understanding that it may change over time.

Residents and their well-being are the central focus at Hankham Lodge. It is the interests of residents, individually and collectively, that assumes priority over the home, its management and staff. This means that residents are accorded a standard of care and attention which respects individuals' privacy and dignity, recognises their diversity and individuality, fosters their independence, offers them choice and enables them to control their own lives wherever possible.
The principles underlying daily life at Hankham Lodge
Some basic principles underlie the rights which are accorded to all who find themselves in the care of Hankham Lodge.
Respect for privacy and dignity
The importance of preserving the privacy and dignity of residents is paramount. This means that they have their own individual private space and the opportunity to choose how they dress, what they eat, when they go to bed and get up and how they spend their day. Dependence on staff for help with personal care doesn't mean that their dignity is compromised or that their privacy is not respected. Residents are treated as adults, never as children. Staff always avoid adopting patronising attitudes and behaviour towards residents. Residents determine how they want to be addressed by staff, other residents and visitors to the home.
Maintenance of self-esteem
The preservation of self-esteem amongst the residents who depend on our support hinges upon the status they are accorded. Staff and management do not make the mistake of seeing residents only as frail old people who simply need help. We value the contribution which individuals with their personal qualities, talents and rich experience of life make to the life at Hankham Lodge. Residents' self-esteem is enhanced if they feel valued and in this way their morale is maintained. Staff treat residents courteously and respect their privacy and their right to hold and express opinions or to keep them private.
Fostering of independence
We assume that residents can look after themselves and handle their own affairs until it has been shown otherwise. They may need time to do things themselves but our staff and relatives resist the temptation to 'take over' unless absolutely necessary; otherwise they make residents unnecessarily dependent.
Choice and control
Wherever possible, residents are able to make for themselves the major decisions affecting their lives. They are also able to choose how they spend their time from day to day. For example, this means that individuals are free to decide how far they participate in the common life of the home and how far they maintain relationships with family, friends and the local community. This exercising of choice is a right which often requires a partnership between resident, relatives and ourselves in which choices can be negotiated. Some residents particularly those who are very frail and vulnerable may need help to express their wishes and preferences. All residents have access to external advice, representation and advocacy.. Residents also have opportunities for emotional and sexual expression and for intimate and personal relationships within and outside the home.
Recognition of diversity and individuality
Even though residents are living at Hankham Lodge with other people, they remain individuals with their own likes and dislikes. Staff are responsive to the requirements of individual residents. Ethnic, cultural, social and religious diversity is recognised as an integral part of home life. Residents feel that their needs are responded to willingly by staff who understand the value of maintaining a sense of continuity and identity based on past traditions and practices. For their part, living in a community with others requires that residents recognise and respond to the rhythms and needs of other people. It is helpful for residents to have some knowledge of the life experiences of staff to act as a bridge between them. This emphasises personal connections outside the home and their relevance to those within.
Expression of beliefs
Opportunities are made available for religious and political beliefs to be expressed and pursued. This involves observing particular dietary and dress requirements and facilitating practices such as prayer and contemplation which requires privacy and quiet or enabling residents to attend places of worship.
Safety
Residents are kept safe and feel safe. Wherever possible, fears and anxieties are acknowledged and relieved while recognising at the same time that over-protectiveness and undue concern for safety may lead to infringements of personal rights.
Responsible risk-taking
Responsible risk-taking is regarded as normal and important in maintaining autonomy and independence. Residents are not discouraged from undertaking certain activities solely on the grounds that there is an element of risk. The balance between risk and safety is carefully maintained. Anxieties raised by staff and relatives are discussed, where possible, with the individual resident concerned and agreement reached which balances the risks against the individual's rights.
Citizens' rights
Each resident has a formal agreement (provided by Hankham Lodge or Social Services) setting out the care to be received in the home, the conditions of residence and the fees payable.
Sustaining relationships with relatives and friends
Hankham Lodge values the role which relatives and friends continue to play in the lives of residents. Their participation is encouraged wherever residents wish it and their contribution recognised as an important part of the residents' care.
Opportunities for leisure activities
Provision for leisure activities both in and, outside the home we feel is essential. This is sensitive to individual tastes. Resources existing in the neighbourhood are engaged to help meet the needs of residents. The quality of life at Hankham Lodge is enhanced by inclusion of the widest possible range of normal activities, particularly those with which residents have been familiar in the past. This includes opportunities to go on outings, to go shopping, and attend places of worship if it is within the individual's capacity to do so. However Hankham Lodge is a quiet home and no one is pressured into doing anything they don't want to.
High standards of care
Individuals receive the level of care which their own situation requires. Our care meets high standards and satisfies the full range of physical, clinical, personal, social, spiritual and emotional needs of the individual.
Necessary care
Care and treatment is provided only if it will be positively beneficial. Care does not mean unnecessary restraint. Treatment (the administration of certain drugs, for example) are never given for the convenience of the home. Residents have ready access to the appropriate care given by an appropriate person from within or outside the home. It is always provided with respect for the individual's privacy and dignity and with mutual agreement between the resident, the doctor the family and the home .
Continuity of care
Wherever possible, and whatever the resident's declining state of health or financial position, continuity of care is always assured. Residents do not have to move out of the home to receive additional care (unless dictated by their medical needs). If possible, this is brought into the home by external services. If we cannot provide all necessary care, transitions between the home and the person's own home, or the home and a hospice or hospital is made as smooth as possible.
Care which is open to scrutiny
Residents (and their relatives or advocates) are able to complain about the care they receive if not happy, without fear of being victimised or being asked to leave. However if it is the choice of the resident or family to leave, we will provide all the help and support required.
Entering Hankham lodge
Introduction
People move into residential care for a variety of reasons but for each person it is a major life event. Wherever possible, it should be the result of an individual's own informed decision but this may not always be the case. Some come direct from hospital because a decision to discharge the patient into a supported environment where care is available has been made on the basis of assessment. Some may come in as the result of decisions made by their relatives or as a result of a crisis. The clinical and other care needs of individuals will vary substantially. In many cases, residents will have been assessed by their local authority social services in consultation with medical and nursing colleagues as requiring residential home care and some of them will be paid for in part by the local authority under the NHS and Community Care Act 1990. Others will be paying for themselves.
A prospective resident is likely to be anxious that the decision is the correct one, however it was arrived at. Coming into Hankham Lodge may mean a move away from a familiar area, away from neighbours and friends. It almost certainly means a move into smaller accommodation and the giving up of many personal possessions. Moving into residential care may be occurring at a time of other significant change in the person's life of crisis or emergency. That change may be due to the loss of a partner or carer with all the accompanying grief which that will entail. To be moving into care can itself sometimes feel like a bereavement.
Choice
Individuals should make their own informed decision to come into Hankham Lodge. Other non-residential options should have been considered for example, packages of care organised after local authority assessment by a care manager which enable both health and social care services to be delivered in the individual's own home.

Making the decision
People contemplating entering Hankham Lodge should have the opportunity to explore the advantages and disadvantages. A sympathetic and knowledgeable person such as an advocate, social worker or health visitor may be appropriate especially if they have no relative or friend to offer advice. Relevant questions to ask will be:

· Why is life difficult?

· Why is care needed?

· Are there any particular worries and anxieties ?

· Are these to do with housing, health, disability or other crises ?

· What are the preferred options?

· Have any been tried?

· What other circumstances are affecting the situation (for example, are relatives involved and if so are they trying to influence the individual) ?

All people have the right to fund their own stay or seek an assessment of their needs by the local authority social services and this should form part of the decision-making process. Under the Carers (Recognition and Services) Act 1995, their carers also have the right to be assessed by the local authority.
Reasons for moving into Hankham Lodge
The reasons for deciding to move into care may be varied. Some people may feel they have no other option because of their current circumstances. Some may be faced with the decision suddenly; others may have planned the move for some time. It may be a combination of several of the following:

· deteriorating mental or physical health;

· general frailty or increasing disability;

· a specific incident such as a fall or illness and hospital admission;

· inability, or fear of being unable, to cope with living at home;

· wanting to be looked after;

· feelings of isolation and loneliness;

· fear of crime;

· fear of falling and not being found;

· bereavement;

· desire for companionship;

· enjoyment of living in a group;

· wish for more convenient accommodation;

· wanting membership of a group or organisation;

· poor housing;

· inability to manage a large house and garden.

The reasons why people come into Hankham Lodge have changed in recent years. More are coming in because of failing health and increased dependency than for social reasons. This has consequences for the levels of care required in homes. Managers and staff understand the varying reasons why, and in what circumstances, residents have come into care. Some individuals may need more support than others in coming to terms with the major change in their lives and the home is sensitive to this. In all circumstances, however, new residents are made welcome and supported through the period of adjustment which all will experience as newcomers.
Assessment prior to care
Increasingly people moving into Hankham Lodge come via the route of a social services-led assessment under the NHS and Community Care Act 1990. They may have been the subject of a joint assessment between social services and the health service prior to hospital discharge. The social services may also have instituted an assessment of their needs while they were still living in their own homes. There may have also been an assessment of their financial means.
The assessment of needs covers a wide range of topics, once the person has moved in, a comprehensive care plan drawn up. Topics covered in the assessment include:

· the wishes of the older person;

· problems and difficulties as seen by the older person;

· general and specific health problems and any current medication;

· mental health problems;

· social concerns;

· living situation and any housing problems;

· any financial worries;

· pattern of daily life and activities;

· mobility and sensory functioning;

· difficulties in carrying out activities of daily living for example, dressing, cooking;

· eating, going to the toilet; bathing and personal hygiene.

· position of carers and relatives;

· medical assessment;

· nursing assessment;

Copies of the assessment are given to Hankham Lodge as part of the admission process and form the first stage of care planning. Wherever possible, this begins before the person moves into the home. Planning starts as early as possible.
Preparation
People planning to enter Hankham Lodge are able to visit the home Similarly, it is desirable if so wished that the manager of the home should visit potential residents to establish a personal relationship, gain information about their way of life and advise them about what possessions can be taken with them into the home.
Sources of advice
There are a number of organisations which can offer advice to people thinking of entering care. Information about them should be made available by social services/work departments, at GP surgeries, clinics, citizens advice bureau, community health councils (England and Wales), local health councils and councils of social service (Scotland), health and social services councils (Northern Ireland) and other advice agencies.
Terms and conditions
A clear statement of the terms and conditions of residence is given in writing to the resident before moving in. these are included in the 'Welcome' pack. These include:
· The level of fees, time and method of payment;

· The services covered by the fees;

· Extra services which are charged for separately .

· Procedure for increasing fees;

· The personal items which the resident will be expected or is able to provide for himself or herself;

· The terms under which a resident can vacate the accommodation temporarily;

· The circumstances in which a resident might be asked to leave;

· The procedure under which the resident might be asked to leave;

· The procedure on either side for terminating the agreement or giving notice of changes;

· A statement of insurance cover of the home and where responsibility lies for insuring personal valuables (amounts of cover are made clear and details of insurers given);

· A statement to the effect that the home is registered as a residential care home by the local authority which are responsible for seeing that standards are maintained;

· The procedure for making complaints to the owner and information on how to contact the registration authority in the case of unresolved complaints which fall within the scope of the Registered Homes Act 1984;

· Procedure on the death of a resident;

· Information regarding the home's policy on pets.
Appropriateness
The first six weeks is a trial period to allow time to see how well the new resident settles in. Many people will come into care as the result of a crisis or direct from a period in hospital. Relatives or others concerned with their welfare should be made aware of the nature of the trial period. Residents coming from their own homes should be careful to delay selling their houses or terminating their tenancies until they are certain they want to remain in Hankham Lodge.
Reviews
During the trial period, the suitability of the arrangements are discussed fully with the resident and whoever is the individual's key supporter (relative, friend, social worker). The possibility of transfer if the arrangement is turning out to be unsuitable may be considered. Review decisions are recorded and implemented.
Once the individual has become an established resident, a programme of regular reviews to monitor progress and to ensure the resident is satisfied with the home are agreed and their purpose explained. These reviews will become part of the care plan.
Short-term stays
A short stay may be planned for convalescence, rehabilitation or respite. In some cases, some people's health may improve so that they are able to return home. The aim of convalescence rehabilitation or respite (which is available to all residents) is to retrieve a person's functioning and to maintain it at its highest level.
Funding for individuals coming into Hankham Lodge
By the social services department
Older people who qualify for statutory funding retain the right to choose which home they would like to live in even though the social services department is partly funding their care. The department will put an upper limit on the level of fees it is prepared to pay, If the resident wishes to come in to Hankham Lodge which has a higher fee level this is still possible provided that the difference is guaranteed (usually by a relative or another organisation). This difference is referred to as (top up) or 'third party' contribution.
Support for residents paying their own fees

Where residents are paying full fees themselves and are likely to continue to do so for a minimum period of two years it is not necessary for the statutory services to be involved. However, if a resident becomes in need of financial assistance after the minimum period of two years social services should be approached This may also be available through independent organisations which specialise in helping people find suitable residential care, through welfare organisations or advice agencies. Prospective residents should also make clear their own financial position.
Good practice

As a matter of good practice Hankham Lodge states that entering care should:

· Be the preferred option after considering alternatives (especially additional help at home);

· Be sensitively carried out and be unhurried;

· Take account of the person's wishes and lifestyle.

Hankham Lodge Manager or Deputy

· Confirms that the home is able to provide the care needed by the person;

· Provides full details of conditions, fees, and services provided;

· Assess the residents needs.

· Records sufficient information to enable the home to carry out its responsibilities in caring for the resident;

· Develops a care plan detailing the care required to be provided;

· Has clear arrangements about the roles family and friends have in the care and life of the resident.

Prospective residents are

· Helped to find the best place to live;

· Not forced into care against their will;

· Not deceived or misled into entering care.



Life at Hankham Lodge
Putting principles into practice
The principles that govern life within Hankham Lodge focus on the importance of promoting residents' independence through enabling them to make their own decisions, fostering their individuality, sustaining family and community contacts and ensuring that they are satisfied with the quality of life and care in the home.
Control and independence
Quality of life for individuals is enhanced because they are able to have control over what happens to them. We realise there is a danger that living in a group means people may lose control over their own lives.. It is obvious that in some cases the degree of dependency experienced by many of the residents will preclude any possibility of extensive independence. However, the spirit of the principles of control and independence govern the care provided to all residents.
Rules and routines
So the imposition of rules and routines do not lead to an erosion of residents' independence, we keep them to a minimum, and employed only to promote rehabilitation (with the agreement of the resident). We fulfil statutory requirements, prevent undue disturbance to other residents and ensure acceptable standards of safety and hygiene.
Risk-taking
At Hankham Lodge responsible risk-taking is regarded as part of the normal expression of people's independence. After appropriate assessment of risk, residents are not discouraged or unduly restrained from undertaking certain activities solely for fear of the consequences, for example that they may hurt themselves. We feel excessive paternalism and concern for safety may lead to infringement of personal rights. Those who are competent to judge the risk themselves are free to make their own decisions so long as they do not threaten the safety and lifestyle of others. The Management and Senior Staff distinguishes between behaviour which endangers or seriously inconveniences others and that which involves only the individual concerned. The latter, such as going out unaccompanied, is restricted only if the resident is not capable of making an informed decision for which he or she can be responsible or if it runs counter to an existing agreed therapy or treatment programme. The Management and Senior Staff recognises the demands that this policy places on junior staff and provides support and training to assist them.
Individuality
Hankham Lodge's staff recognise the individuality of each of its residents and this we feel goes to make a good home. From this recognition flows a style of management which enables our residents to make decisions for themselves, choose the way in which they spend their time, build friendships with whom they wish, and find satisfaction in living in the home environment.
Ways of maintaining individuality
We ensure that residents have their own private space, with plenty of reminders about their identity for them to maintain their individuality. Their rooms are places to withdraw to from busy, active communal areas, and choice over when they get up and go to bed all contribute to the process.
A resident's earlier life
We try at Hankham Lodge not to underestimate or undervalue the qualities, experiences and talents of people in our care. Residents' willingness to share their past experiences, interests and life histories with their companions help create their individual identity for fellow residents and staff. To reinforce the esteem in which residents are held we encourage family and friends (with the residents' agreement) to be involved with the continued care of the resident.
Culture, background and ethnicity
Hankham Lodge's principles and values determine that anyone, from any background, is treated as an individual. As people grow older, their earlier associations and allegiances remain important (and often become more so). Hankham Lodge tries to reflect a residents particular ethnic, religious, educational, occupational and social background. Wherever possible, the staff complement reflects the cultural and ethnic mix of residents in the home.
Satisfaction with the quality of daily life
A key measure of the quality of life at Hankham Lodge is the degree to which residents are satisfied with their daily lives. This relates to:
· the activities of daily life;
· the quality of food and the way in which it is served;
· opportunities, for those who wish, to engage in social and leisure activities;
· quality of care;
· choice in daily routines;
· the skills and attitudes of staff, managers and volunteers.
Residents are able to look forward positively to the day, and days, ahead. The regular monitoring of residents' views about the quality of the service they receive is part of the management process. This is achieved by way of the residents Care Planning which includes a system to monitor and review residents activities and interests . Also every twelve months we carry out an extensive Quality Assurance programme, this is evaluated and acted upon. For people who may not communicate their feelings well this is done by using techniques such as 'care mapping' which involves careful observation of individuals over a specific period of time and assessment of their interaction and reactions, this is recorded in the care plan. Hankham Lodge is receptive to any ideas and suggestions that residents, their family, friends and advocates might make to improve the general quality of life at Hankham Lodge. It is recognised that relatives and friends are sometimes fearful of appearing critical . They are also often very grateful for the care given and feel guilty they can no longer provide this at home, so they do not want to criticise. Therefore Hankham Lodge tries to generate a positive and easy welcome for ideas. Openness and receptivity is seen as a mark of good management and procedures are established for enabling this.

Daily life at Hankham Lodge
Domestic routines are necessary for the smooth running the home and are part of the normal rhythm of most people's day. We take account of individual needs and preferences. As far as possible, routines are agreed with residents and carried out in a friendly and flexible way.
Examples of flexibility:
· changing the time of a regular events eg. baths, hairdresser etc. so that the care assistant can take the resident for a stroll or in to the summerhouse;
· a resident having a meal at a later time in the afternoon (instead of the meal at lunchtime) so that he or she can go out with family in the morning;
Getting up and going to bed
One example of the flexible approach to daily life is the extent to which residents are able to choose when they get up and when they go to bed. It is always their choice and never fixed to fit into a routine dictated by staff rotas. Some people can lose their sense of night and day. In these cases, assistance includes reviewing medication, the provision of highly visible clocks and orientation to daylight and darkness.
Mealtimes and food
Food and mealtimes are of great social importance in the lives of our residents. The degree to which residents aredirectly involved in choice, preparation and serving of meals and participating fully in mealtimes depends on their abilities but where possible the emphasis is on willing participation
The following points observed:
· residents, according to their capacities, have the opportunity to be involved in menu planning, laying tables, clearing away and washing up. Staff make great efforts to find out individual preferences for types of food and style of preparation, particularly where residents are less able to do things for themselves;
· residents have regular opportunities to talk to the cook(s) about the sort of food they like and to comment on the meals they are given;
· assistance with eating food is given individually and discreetly and with care and sensitivity. Staff sit with the person they are assisting. Residents always have a choice of food so that they can avoid the type of food which they find difficult to handle (for example, peas). If people wish to eat in private in their own rooms they are able to do so. Care is taken by staff to enable residents to make their views known if another resident's messy eating habits cause distress to others;
· food preferences based on ethnic, religious and ethical observances are respected. Storage and preparation facilities are provided, and staff are trained in how to prepare different sorts of food and to find out what residents want.
· food is nutritious, well-balanced and appealing. Great efforts are made to ensure that food is offered which residents take pleasure in eating;
· the serving of food is seen as part of the social life of Hankham Lodge. Quality matching crockery and tableware is very important to us. Care is taken to ensure that food offered to an individual resident is attractive even though it has to be appropriately prepared to meet the physical capacity of the individual. Food is only liquidised if absolutely necessary and care is taken to present it attractively (for example, by keeping different types and colours of food separate);
· Hankham Lodge's dining room does not have the appearance of an institutional canteen. Furniture and furnishings are domestic in style and match the cottage atmosphere. Chairs are of a comfortable height with cushions (which can be pulled right up to the table) to assist those who have difficulty in getting up from sitting. Residents are able to choose how mealtimes are organised and how dining tables are arranged. Some residents enjoy setting the tables.
· Hankham Lodge's dining room is non-smoking in line with the home's overall smoking policy;
· expert advice from dieticians is sought and followed with regard to nutritional requirements. Special diets specified on medical grounds are adhered to;
· the handling, storage, preparation and serving of food complies H.A.C.C.P, and all official requirements
Activities
The therapeutic benefits derived from being physically and mentally active are well known and Hankham Lodge provides stimulation of this sort for our residents. The range of opportunities available in the home for people to pursue leisure and intellectual activities reflect the diversity of the residents and their social and cultural interests and intellectual and physical capacities. Hankham Lodge staff remember that just because people have become infirm and just because they have reached old age, it does not mean that they all have the same likes and dislikes. Not everyone wants to sit and watch television (or the same programme on television); not everyone likes playing bingo or having singsongs. Scope for choice and variety is made available. Residents confined to bed as far as possible also have the opportunity for social interaction and intellectual stimulation.
· the involvement with the local community provides welcome social activity for residents. Children from schools sometimes visit and in some cases entertain residents. Carol singing at Christmas is a good example although this is not restricted to festival times. Local voluntary organisations have established a continuing relationship with the home which residents welcome. Residents are always consulted before any arrangements with outside organisations are established;
· some residents maintain their religious links coming into Hankham Lodge. We positively foster such links with religious and spiritual bodies of all faiths and denominations as appropriate. These are sometimes a source of comfort and reassurance to residents. The wishes of individual residents, not to have links of any sort with religious bodies is also respected. Religious belief are not be assumed;
· staff are sensitive to the changing needs of residents. Over time, some people may wish to withdraw from activities that previously they were closely involved in. These changing attitudes are picked up and acted upon via care plan reviews.
General examples of daily activities:
· gatherings in the home, coffee and tea groups;
· exercise classes, movement to music, dancing;
· books, newspapers (including large-print and audiotape);
· indoor and outdoor gardening (with modifications for disabled people);
· craft activities;
· intellectual activity education classes, quizzes, life history and reminiscence work;
· walking
· active games (carpet bowls);
· religious worship;
· shopping trips, outings;
· social events, local community activities.
· Trips out with relatives and friends.
For some residents, the ability to participate is limited by restricted movement, deafness, visual impairment or memory loss. When individual residents have a clear wish to participate in certain activities, every effort is made to help them overcome or compensate for these restrictions by providing personal assistance or aids and adaptations.
In everyday life, many families and friends enjoy doing things together and additional pleasure can be generated for residents and their visitors to socialise in the summerhouse. Visiting often increases when people feel that they are coming in to join in an activity or to assist residents.
Special occasions
Special occasions are important for both the communal life of Hankham Lodge and for the individual. Residents' birthdays are celebrated; the opportunity to have a party is given to every resident
Clothes
A person's sense of identity is partly linked to his or her appearance. Clothes are an important part of this. All residents are encouraged to wear their own identifiable clothes and the staff take great care to ensure that clothes do not go astray or get damaged by careless handling. Residents (and family and friends) are advised about the suitability of fabrics for laundering when planning to purchase new clothes. Staff are ready to assist in making arrangements to purchase new clothes. The following points are to be observed:
· all personal belongings of residents are treated with care;
· clothes are labelled discreetly with name tags to ensure they do not get lost during laundering. Families are asked to leave any cloths they bring in at the office so they can be named and recorded.
· opportunities for hand-washing and ironing are available and staff check regularly whether clothes need mending. Clothes may be taken for dry-cleaning if necessary. However residents and families must realise we have no professional expertise in specialised laundry.
· where residents have difficulty in dressing, for example because of arthritis or rheumatism, clothes are chosen which are easy to put on or have simple fastenings. Clothes which are easy to remove sometimes help people who suffer from incontinence. Occupational therapists offer us advice on this.
Personal care
It may be that some residents at Hankham Lodge need assistance with personal care washing, dressing, eating, going to the toilet and getting about (either walking or in a wheelchair) in order to be able to participate in the social life of the home. Any tasks associated with providing care of this sort is undertaken with due regard to the privacy and dignity of the individual.
In particular:
· attention is paid to ensuring such things like catheters and colostomy bags are not exposed;
· special care is taken of dentures, spectacles and hearing aids;
· residents choose when they are washed or bathed and they are assisted in doing as much for themselves as they wish. While encouragement to bath regularly is given, rigid bath routines are avoided.

Terms of address
At Hankham Lodge we take account of individual preferences in the way in which people are addressed. A person is entitled to be called whatever he or she wishes whether it be, for example, Mrs Smith, May Smith or May. Names and special names are not only labels of identity, they are personal possessions and are handled in the manner their owners choose. It is reasonable to wish to be addressed in different ways by different people. Even when people invite fellow residents to use their first or special names, they may still prefer strangers or members of staff to use a more formal mode of address.
Staff never use terms of address which patronise residents or make them seem like children. They never discuss residents' persona! matters in the hearing of other residents. They also never talk to each other over the head of a resident as if he or she were an inanimate object.
Personal relationships
Residents have opportunities for emotional, physical and sexual expression and for intimate and personal relationships within and outside Hankham Lodge as they wish. Sensitivity is always shown to prevent possible exploitation of vulnerable individuals. The ability to manage relationships and to assume personal responsibility may fluctuate over time. Nevertheless residents continue to have the same needs as other people for expressive behaviour and physical human contact and these needs are respected.
Pets
Many older people value contact with pets and have had pets living with them until the time of moving into the home. The following points are taken into account:
· Hankham Lodge makes it clear in the information and brochure that only small pets can be brought in to the home by residents.
· We also took account of the therapeutic benefit of pets (for some people) in deciding that it is quite acceptable for friends and relatives to bring pets to visit
Transport
Having access to transport improves the quality of many residents' lives. Hankham Lodge has it's own minibus with wheelchair access. The trips out include community activities, shopping, afternoon tea and local events.
The bus and cars that we use have the necessary formal requirements of insurance, minibus regulations, driver training and certification, seatbelts, wheelchair clamps).
The role of staff, relatives, friends and visitors
The way in which staff, relatives and friends are involved with residents on a day-to-day basis affects residents' well-being and sense of satisfaction.
Staff
Hankham Lodge staff have a responsibility to be alert to the needs of residents. They are ready to talk and listen to them during the course of the day and especially at night. Some residents may find it hard to express their true feelings about how they are and what they want to do. Care assistants are the best placed to discover some of these things while going about their general duties. They are also sympathetic and sensitive to the residents enabling them to express their feelings.
A normal and natural part of daily conversation for staff is to talk about what residents would like to do or have, about ideas for doing different things, or changes they would like made.
The Deputies ensures that opportunities are built into the staff routine so that time can be devoted to doing things with individual residents or to talking to them (especially about things which might be worrying them). The trust and friendship staff members is particularly important. The residents care plan is very important it notes that each resident has been spoken to each day. This record gives the opportunity for residents to talk about anything they wish.
Relatives and friends
Relatives and friends have an important role to play at Hankham Lodge. They are encouraged to participate in the daily life of the home as long as the resident wants them to. This might involve doing shopping, reading and other social activities. While the benefits of involving relatives and friends are usually clear, we recognised that relationships between them and the resident may not always be harmonious. Staff are careful not to make unwarranted value judgements but are always ready to support the resident in whatever way is appropriate should the resident so wish.
The role of visitors
It may be that some people living at Hankham Lodge have no relatives or friends to take an interest in them or provide advice and support in matters affecting their daily lives. Visitors that have been coming to Hankham Lodge to see a relative or friend who has subsequently died often continue to visit. This is encouraged both by staff and residents.

Communication at Hankham Lodge
Residents are kept informed about what is happening in the home so they are to be able to participate fully. Staff ensure that they keep residents informed directly. Reliance on non-personal means of communication (notice boards & Newsletters) is not substituted for direct communication between staff and residents as part of a normal social interaction.
Residents Input
Our residents have an opportunity to have a say in how the home is organised and run. Informal, natural, day-to-day conversations, for example over meals, at coffee time or on social occasions, are very productive. A more formal communication is available through the regular Quality Assurance programme.

Care
Introduction
Moving into care is often accompanied by negative feelings and a sense of loss of status. This is understood and taken into account by the staff at Hankham Lodge, to minimise as far as possible the loss of self-confidence and the failing sense of self-worth. Receiving intimate care in a new setting, often away from loved ones, especially at a time of adjusting to the 'home' as home, may be particularly difficult. Some people may resent their increased dependency, the need to receive care in a new and different environment and their reliance on staff. Their sense of loss may be similar to a feeling of bereavement. Staff are sensitive to these feelings and assist in helping enable residents to come to terms with their changing needs. For people with impaired memory and reasoning, the transition may be bewildering.
Living in a home in no way diminishes residents' rights of access to health and rehabilitative services available in the community. This includes the right to choose his or her own GP and to see him or her in private. Managers & Deputies seek the consent of the resident, to be kept informed of any necessary changes in the resident's care. In the case of Hankham Lodge, the rights of residents to have access to community nursing services are not diminished in any way. Hankham Lodge has a right of access to available community resources and advice in the interests of their residents.

Principles of care

The care provided a Hankham Lodge is tailored to meet the needs (social, personal, nursing or medical) of each individual. It is provided on the basis of an assessment that is both timely and comprehensive. At all times care is provided with respect and in a manner that is sensitive, maintaining the dignity of whoever is receiving care. The privacy of individuals, particularly in all matters dealing with intimate care-giving, is ensured at all times and their cultural and gender needs and sensitivities are always be recognised.
Care is given by, or supervised by, skilled and trained people; training opportunities are provided for staff at all levels and are encouraged to take them up. The importance of early recognition of symptoms particularly mental health problems (for example, depression and dementia) cannot be over-emphasised. The first essential is to ensure that the causes of any symptoms are diagnosed and any necessary treatment given. Many kinds of physical illness can give rise to an acute confused state, as can over-sedation or other inappropriate medication. Dementia is the condition that generally gives cause for most concern but depressive illness is very common in old age and can be mistaken for dementia. Delusional symptoms can develop in an otherwise intact personality. All these conditions can be cured or at least alleviated and the managers and senior staff a Hankham Lodge take responsibility for seeing that no such illness is ignored. Junior staff are trained to recognise symptoms as they appear. The GP is always contacted at the first signs of any problems. Hankham Lodge can not admit anyone who has been diagnosed as suffering with dementia.
Care giving is never coercive, and we always guard against risk of abuse and restraint. Nothing is done which makes individuals lose their self-esteem. Even at their most frail and vulnerable, individuals are helped to make choices about the care they receive.
The continuum of care
In April 2002 the National Care Standards Commission replaced the Registered Homes Act 1984 which made a distinction between residential care homes (in Part I) and nursing homes (in Part II). Under the Act, residential care homes provided accommodation and personal care while nursing homes provided care which required the skills of, or supervision by, a registered nurse. This in essence is still the case however now the distinction is solely in registration classification. In practice the differences are sometimes hard to define, particularly because of the changing needs that an individual may experience while remaining in the same setting. Some flexibility is given when taking into account fluctuations in residents' health. CQC will review the position periodically to determine whether changes in registration are required. Under this new Umbrella of "Care Home", Hankham Lodge ensures that any nursing care provided is under the control of a community nurse with an agreed protocol relating to named individuals within the home.
Types of care
Care at Hankham Lodge is provided holistically that is, looking at the whole needs of residents as individuals and not isolating different elements of care into separate unrelated tasks. However, for the purposes of this guide it is useful to identify different elements to help clarify roles and responsibilities.
Social support
Social support within Hankham Lodge is the support which is provided to older people to enable them to function as social beings. It includes social activities designed to enhance residents' sense of well-being, moral support, care and attention paid to ensure individuals can maintain contact with family and friends in the community, and making advice and advocacy available to help individuals deal with their personal, financial and legal affairs if desired. Attention to the spiritual needs of individuals is also important and care is taken to identify what those needs may be for particular individuals.
The provision of social support is an integral part of many of the daily activities at Hankham Lodge It forms an element in getting up, eating and drinking, being involved in social activities within the home, having spiritual needs attended to, getting around the building and garden, and going to bed. Other sections in this guide deal with these aspects in more detail. Staff are alert to the needs of residents and spend time listening to their views on what sort of activities they may wish to become involved in or stay away from.

Personal care
Personal care is the intimate tending of physical needs, which the individual finds difficult or impossible to do alone. Some sorts of personal care is given during the normal pattern of daily life helping a resident to get around, helping at mealtimes. Other aspects require privacy and sensitivity washing and bathing, going to the toilet. The individual are always able to choose where and when these activities are performed and are not subject to rigid routines. All equipment used is personal to the individual (flannels, soap, etc).
Nursing care.
Many of the functions categorised as nursing care are carried out under the supervision of a community nurse or the resident's GP (as would be the case if the resident were still living in his or her own home).
The holistic approach that Hankham Lodge uses looks to the needs of the whole individual. Following assessment of care needs, staff may work closely with individual residents, or seek advice on care delivered by others. Nursing involvement in the form of consultation with both community nurse and GP is essential for the overall assessment, monitoring and coordination of health care.
The care component at Hankham Lodge is structured to include all following and is undertaken by the Manager, or by a care worker under the supervision, where appropriate, of a community nurse:
· assessment;
· formulation of a care plan;
· monitoring and observing;
· coordination of care by others;
· health and illness recognition;
· prevention of complications;
· physical and emotional comfort;
· pain control;
· liaison with doctors, specialist nurses and professions allied to medicine outside the home;
· rehabilitation, including maintenance rehabilitation;
· intimate personal care;
· recognition of social needs;
· mobility;
· disease management;
· supervision of medication;
· prevention and management of pressure sores;
· wound assessment and care;
· continence assessment and management;
· maintenance of catheters;
· auditing of standards of care.
On occasions nurses who have specialist expertise and experience will be required to attend residents who, for example, have cancer, diabetes, a psychiatric illness, challenging behaviour or who are dying. Agreements and protocols with local trusts ensure the availability of nurses in these situations.
Medical care
Medical care may be required on a regular or intermittent basis, either from a GP or specialist consultant after referral by a GP, depending on specific medical needs. Our close links with GPs are invaluable. Residents retain their own GPs if they wish, and they are willing, without feeling pressure to register with the local Health centre which acts as an overall health resource for the home.. However, in some cases, where the person's GP does not want to continue looking after the patient after entry into a home, this may be the only option. GPs involved in providing medical care and advice to residents in Hankham Lodge have experience and proven interest in the care of older people.
Relationships with outside health services
Protocols have been established with GPs and local hospital consultants for dealing with discharges from and admissions to hospital, clarifying the roles and responsibilities of all parties and for visiting residents at Hankham Lodge . Staff from the local psychogeriatric service such as the consultant psychiatrist, the psychologist and the community psychiatric nurse (CPN) are very helpful in planning and reviewing the care and treatment of people with who may be developing dementia and depression. Health promotion advisors from the local health authority are involved in developing activity programmes for residents.
Community nursing and specialist nursing care
Hankham Lodge does not have qualified nursing staff so protocols have been agreed setting out arrangements for local community nursing services to be available for residents when they need nursing care. Clear lines of communication have been established which are known to all staff about when and how to call in community nursing services. Similar arrangements have been established with specialist nursing services (Incontinence, CPNs, or specialist nurses from the community nursing service for diabetes, for example) are also available to Hankham Lodge .

Administration of medication
Safety
Staff at Hankham Lodge take meticulous care over the administration of drugs. Only nominated and trained staff are involved in giving medication to residents. Procedures are in place to ensure the wrong drug is never administered. Some conditions, for example diabetes or Parkinson's Disease, require a strict drug routine which may not fit into the daily meal pattern. These routines are observed with care.
Medicines are kept safely and locked away, with full records of their receipt, administration and disposal. Medicines are administered directly to the resident and a record is taken they are not transferred to open unnamed containers for distribution. If the medicine is not taken it is disposed of and accounted for in line with the CQC disposal of drugs policy.
The dangers of polypharmacy
A common problem amongst residents is the large number of drugs (polypharmacy) which they are taking, often over a period of years without any proper review. Sometimes this leads to unwanted effects or unnecessary confusion. The use of sedatives and sleeping pills is sometimes prescribed as a matter of course. Drugs' being prescribed from hospital without any proper feedback to the resident's GP and vice versa may cause a problem. We try to eliminate this by the GP reviewing the medication on admission to the home and review it regularly thereafter every two or three months.
Non-prescribed remedies
Non-prescribed remedies are purchased separately by each resident for his or her own use (or someone else should do it on his or her behalf).
Wherever possible, and depending on their capabilities, residents are responsibility for their own medicines. A monitored dosage system, in which a month's supply is divided up into separate, sealed compartments (Compliapack), is used at Hankham Lodge . A positive decision is taken on admission to who (resident or home) is responsible so that no false presumptions are made. Hankham Lodge's policy is to provide a system of drug administration for all who want or require it. GPs are informed of any residents' self administration. A photo of the resident accompanies all medication records
Care plans
Care plans for individual residents at Hankham Lodge are to ensure that each resident receives the individual care he or she requires. They are a necessary part of the record-keeping of the home and facilitate good communication between residents and internal and external staff. Residents (and their relatives where appropriate) are encouraged to take a lead in saying how they would like to be looked after. Care plans are the basis for daily care and they are referred to regularly and updated as appropriate. They are available to relevant staff at all times. Consistency in their implementation is one of our most important concerns. Residents have direct access to them, at any time. Their permission is sought before people other than the responsible care staff can see them and use the information they contain. With the individual resident's permission, the care plan is used by inspectors as one means of checking on the quality of care provided at Hankham Lodge .
Drawing up care plans
Care plans at Hankham Lodge have been developed specifically for our residents and environment. The following areas are what have been taken into consideration.
· assessments covering the major areas of care. If assessments have been made before coming into care, they form the starting point;
· specific assessments if not already completed are undertaken and included in the plan.
· deciding with the resident the best way to provide the care. This includes any contributions that relatives are able to make;
· the plan is monitored and reviewed at prescribed intervals, usually every three to six months. The reviews focus on the resident's experience and opinion on what should happen in the future;
· the care is revised in the light of care plan reviews;
· the plan is confidential and remains the property of the resident. We endeavour to make the Hankham Lodge Care plans factual and jargon-free.
Content of care plans
The following areas are considered when writing up the care plans.
· basic personal details, date of birth, relatives, next of kin;
· social information (if given by the resident), previous places lived, work, family, interests;
· preferences about daily life;
· food preferences and any dietary requirements (both medical and cultural);
· general health record (including past medical history which affects present functioning);
· risk assessments for safety;
· the extent of confusion or challenging behaviour;
· risk assessments for manual handling;
· medications and treatment (and whether the resident is able to look after this personally);
· any nursing care required by the community nurse;
· ability of resident to care for self;
· any help required and preferences as to how this should be given;
· any preferences about future care options;
· religious, spiritual and cultural background;
· expressed wishes in relation to death and dying.
Wherever possible, clear and attainable goals are set out in the care plan which the resident and care staff can follow on a planned basis, with a time-scale (which is not too far in the future) for achievement. In this way progress is monitored and incentives given to both resident and staff.
Key workers
Hankham Lodge operates a keyworker scheme whereby a 'Key' member of staff is assigned to each of our residents and should be the first point of contact for special requests or complaints etc.
Hankham Lodge is a small Residential Care Home for the elderly, situated in a country setting near Eastbourne, Sussex on the South coast