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Inspection on 20/04/10 for High View Lodge

Also see our care home review for High View Lodge for more information

This is the latest available inspection report for this service, carried out on 20th April 2010.

CQC found this care home to be providing an Good service.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People living at High View Lodge told us `the carers are good`, ` I like it here very much`. The manager has put an action plan in place to review all care plans and ensure they are updated and person centred. To ensure staff are appropriately informed training in Mental Capacity Act and the Deprivation of Liberty is part of the on going training programme. The manager has put a plan in place to improve the staff room and make it a more pleasant environment where staff can enjoy their break time. Staff told us there is an open door policy and that they are able to approach the management team and discuss any ideas or concerns they have which will improve the lives of the residents. Equality and diversity issues are understood by staff and they are addressed within the care plans, which appropriately describes how a residents needs are to be met.

What has improved since the last inspection?

Although the activity co-ordinator oversees the activity programme all staff are responsible for supporting the residents to attend and take part. There are a variety of activities on offer and residents confirmed they are able to choose to join in or not. The manager has a training matrix in place and this provides an overview of the training staff have completed and what is needed to ensure they have the appropriate skills to do their job. Our random inspection showed that they had met the requirement that was made at the last key inspection in May 2009. This has ensured that staff are meeting the hygiene requirements and have access to soap and disposable towels in the laundry areas. The flooring in Colne path unit kitchen has been replaced and has improved the overall safety for the residents and staff.

What the care home could do better:

Staff need to ensure that when other health professionals visit the residents, they cross reference the information in the daily record. This would help to show that a visit has taken place and the care a person has received. It would also support the monthly review process and provide a good audit trail. We saw that some risk assessment had not been completed and we were assured that these would be dealt with as a matter of urgency to ensure the safety of the residents is at all times is managed appropriately.

Key inspection report Care homes for older people Name: Address: High View Lodge Cherry Orchard Gadebridge Hemel Hempstead Hertfordshire HP1 3SD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Alison Butler     Date: 2 0 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 22 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 22 Information about the care home Name of care home: Address: High View Lodge Cherry Orchard Gadebridge Hemel Hempstead Hertfordshire HP1 3SD 01442239733 01442239154 manager.highview@runwoodhomes.co.uk www.runwoodhomecare.com Runwood Homes Plc Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: care home 77 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 77. The registered person may provide the following category of service only: Care Home Only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia over 65 - Code DE(E) Physical disability - Code PD Date of last inspection Brief description of the care home High View Lodge is a purpose built residential care home, which can accommodate up to 77 service users. The home is divided into four units, one of which is a specialist Care Homes for Older People Page 4 of 22 Over 65 77 77 0 0 0 77 1 4 1 2 2 0 0 9 Brief description of the care home dementia care unit. There is also an additional respite unit. Each unit has a lounge and dining area and there is a large communal lounge at the front of the home. Bedrooms are single occupancy however couples can be accommodated if necessary. All bedrooms have en-suite facilities. The home is situated in a residential area of Hemel Hempstead and is accessible by public transport. The homes Statement of Purpose, Service Users Guide and a copy of the latest Inspection Report, which provide information about the service, are kept on display in the entrance area and available on request from the manager. For information on up to date fees contact should be made with the manager. Care Homes for Older People Page 5 of 22 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection took place on 11 May 2009 followed by a random inspection 14 December 2009 which was conducted to look at progress on the requirements we made and any progress that had been made for the benefit of the residents. This unannounced inspection was carried out by one inspector representing the Care Quality Commission. However, for the purposes of this report this will be shown as we. The inspection started early morning and provided us with the opportunity to observe staff interacting with residents and the daily routines. We conducted a tour of the home, examined personnel and care records. Comments we have received either through the responses to our surveys we sent out prior to the inspection, or during the inspection have been included throughout this report. Information received by us was reviewed and this included the Annual Quality Assessment (AQAA). This is a self assessment document and focuses on how the home meets the outcomes for the residents and also provides some statistical data. Care Homes for Older People Page 6 of 22 Care Homes for Older People Page 7 of 22 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 22 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 22 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at High View Lodge can be assured that they have their needs fully assessed prior to admission and are given the information to make an informed choice. Evidence: The manager provides prospective residents with a copy of the statement of purpose and service user guide to provide them with the appropriate information to make an informed choice. We spoke to residents about coming to live at the home whilst not all of them had personally visited the home but their families had done so on their behalf and they were happy living at High View Lodge. We found from the files we examined of newly admitted residents that they contained appropriate and detailed information to evidence that they are able to meet the needs of the person. Positive comments we received included the carers are good, I like it very much, and nice to have people around me. Care Homes for Older People Page 10 of 22 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at High View Lodge can be assured that their health and personal care needs are met and they can expect to be treated with dignity and respect. Evidence: The residents informed us that they are happy that their care needs are being met appropriately. A GP visits the home twice a week and staff provide a list of those residents that have requested a visit or who requires care input from the GP for example a medication review. Although some care plans contained detailed information and were person centred, some contained details of what care the staff needed to do in order to provide the care. Not all information had been signed and dated in order to provide an audit trail of any changes. Since the manager appointment in February 2010 she has been in the process of reviewing the care plans. The manager has an action plan in place to ensure all care plans contain appropriate detail on what the residents is able to do for them selves and then what support staff need to carry out in order for all their health and care needs to be fully met. Most plans we looked at relevant health visits were recorded also providing information on any follow up treatment or appointments Care Homes for Older People Page 11 of 22 Evidence: where necessary. On those that did not record health professional visits staff should remember to ensure that information is cross referenced to show that a visit has taken place to show continuing information on the care the person has received and would support the monthly review process. Observation of staff showed us that they were kind, patient and encouraging to ensure residents are kept as independent as possible. Comments we received included the staff are always happy to help us, they are always happy and they cant do enough. The medication and storage were found to be well managed and we saw all records were well kept with the exception of a risk assessment for the person who goes on social leave with family. This we were assured would be addressed as a matter of urgency to ensure the residents is kept safe in regard to their medication. There is a robust audit procedure in place for dealing with any medication errors to ensure residents are kept as safe as possible. Care Homes for Older People Page 12 of 22 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at High View Lodge can be assured that they are offered various activities and recreational interests of their choice, and are encouraged to maintain links with families and the local community. Residents are provided with a balanced and wholesome diet. Evidence: On the day of the inspection various activities were taking place, a group of men were in the garden planting up some pots with seeds, one of the men was a very keen gardener and was instructing others of how to do the planting. All of the them were enjoying this activity and looked forward to watching them grow. Another group of residents were taking part in a quiz and they told us they were very much enjoying this. A group of ladies were arranging some fresh flowers. The activity co-ordinator told us that trips to a local coffee shop had been arranged and this proved to be a successful and enjoyed by those who went. Further trips out are being planned in the coming months. Whilst the activity co-ordinator oversees the programme all staff are responsible for supporting the residents to attend and take part. Residents told us they enjoyed the activities on offer and they were asked if they wished to join in and could choose to join in or not as it would depend how they felt about the activity on offer. Care Homes for Older People Page 13 of 22 Evidence: We observed breakfast on various units and saw that it was very relaxed and unhurried. Residents were served fairly quickly with a choice being offered. Comments about the food were generally good I get plenty to eat, we have a choice, could be better. We saw drinks being offered at various times as well as at set times. Residents confirmed that they can ask for snacks and drinks throughout the day. Care Homes for Older People Page 14 of 22 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at High View Lodge can be assured that their views and any concerns they may have will be listened to and acted upon. Robust policies and procedures are in place to protect the residents from abuse. Evidence: There is a clear procedure in place for reporting complaints. The compliments, complaints and concerns folder was examined which showed a record of any action taken and the outcome. Complaints are fed into the quality assurance process to look at any improvements that can be made to the service to the benefit of the residents lives. Residents spoken to were clear and felt confident that they were able to speak up if they were unhappy and they would be listened to and any action needed would be taken. There are appropriate procedures in place for safeguarding vulnerable people. Staff spoken to were clear about the safeguarding procedures and their responsibility to report appropriately. Training in Mental Capacity Act and the Deprivation of Liberty is part of the on going training programme, all staff will have completed this over the coming year. Care Homes for Older People Page 15 of 22 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at High View Lodge can be assured that they live in a welcoming, warm, clean and well maintained environment that meets their needs. Evidence: A tour of the home was conducted and we saw cleaning staff working throughout the home. We found all area to be clean and free from any mal odours. There is an on going re-decoration and maintenance programme in place to maintain a safe and pleasant environment. Since our visit December 2009 the flooring in Colne path unit kitchen has been replaced and has improved the overall safety for the residents and staff. Policies and procedures are in place for the control of infection which includes the Department of Health essential steps guidance and audit process. The manager told us they have plans in place to improve the staff room and make it a more pleasant environment where staff can enjoy their break time. Care Homes for Older People Page 16 of 22 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at High View Lodge can be assured that a robust recruitment procedure is in place to keep them safe and there are sufficient competent staff on duty to meet their needs. Evidence: An examination of two newly recruited staff files showed us that all the required information and checks had been carried out prior to them commencing employment at the home. All staff receive an induction and there is an ongoing training programme in place, this includes staff working towards an NVQ qualification. Staffing levels on the day of the inspection were adequate to ensure that the residents personal and care needs could be met at all times. We spoke with the GP who was at the home during our inspection and he told us that the staff were very knowledgeable about the care of the residents and were able to follow any instructions they had been given. Staff felt that they were well supported to ensure they provide the residents with the best care possible. Care Homes for Older People Page 17 of 22 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at High View Lodge can be assured that the home is run in their best interests and that their health, safety and welfare is protected through a series of checks. Evidence: Since our last visit to the service a new manager has been appointed and has been in post since February 2010. She has told us that she is completing the application form to apply to become the registered manager and hopes this will be sent to us by the end of the month. Staff confirmed there is an open door policy and that they are able to approach the management team at any time if they have any concerns or ideas for improving the lives of the residents who live at the home. There are comprehensive policies and procedures in place to ensure staff are working and supporting residents safely. A quality assurance system is in place and monthly unannounced visit takes place. A report is completed and sent to the home, this was available for inspection. Equality and diversity issues are understood by staff and they are addressed within Care Homes for Older People Page 18 of 22 Evidence: care plans, which appropriately describe how a residents needs are to be met. Fire safety records were checked and were well maintained with the exception of the fire risk assessment which needs to be reviewed and updated appropriately. Signs were in place on the rooms where oxygen is stored but this information should be available on the fire plans to ensure the safety of everyone and provide information to the fire service in the event of an incident. This we were assured would be addressed as a matter of urgency. Runwood have a regular finance audit which takes place and includes the small amounts of money that is held on behalf of residents and the homes petty cash to ensure it is being managed appropriately in line with the companies procedures. The previous manager had completed the AQAA within the given timescales and it gave us the information required and they continue to inform us of anything that effects the welfare of the residents under regulation 37. Care Homes for Older People Page 19 of 22 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 20 of 22 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 21 of 22 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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