Inspection on 20/05/09 for Whitchurch Lodge

This is the latest available inspection report for this service, carried out on 20th May 2009.

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.

Other inspections for this house

Whitchurch Lodge 13/07/07

Whitchurch Lodge 20/04/06

Whitchurch Lodge 21/06/05

Whitchurch Lodge 06/04/05

Whitchurch Lodge 08/12/04

Whitchurch Lodge 15/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 21/07/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Whitchurch Lodge 154-160 Whitchurch Lane Edgeware Middlesex HA8 6QL Lead Inspector Judith Brindle Unannounced Inspection 20th May 2009 08:30 DS0000017565.V375465.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Whitchurch Lodge DS0000017565.V375465.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Whitchurch Lodge DS0000017565.V375465.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Whitchurch Lodge Address 154-160 Whitchurch Lane Edgeware Middlesex HA8 6QL Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8952 5777 020 8866 3288 Finbond Limited Mr Jamnadas Haridas Raithatha, Mr Mahendra Mehta Mrs Beatrice Anne Donlevy Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Whitchurch Lodge DS0000017565.V375465.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home 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: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 32 9th July 2008 Date of last inspection Brief Description of the Service: Whitchurch Lodge is a care home providing personal care, and accommodation for up to 32 older people. The registered provider of services at the home is Finbond Limited, a local organization run mainly by Mr. Raithatha, who is referred to as ‘the owner’ in this report. He visits the home a number of times each week. The home itself has been operating as a care home since 1965. The premises is a two-storey building that was adapted from local houses. It was significantly rebuilt in the mid-1990s. It blends in well with surrounding homes. The home is located within a residential area of Edgware, near Canons Park tube station, within the London Borough of Harrow. It is around five minutes walk from shops and a park, and has a bus stop outside the home for buses on the route between Harrow and Edgware. The home has a driveway that can take about six vehicles. Five of the homes bedrooms are double rooms. All bedrooms are fully furnished. They have either built-in sinks or en-suite toilet facilities. The home has four communal bathrooms including a walk-in shower upstairs, and nine communal toilets. Access to the first floor is by stairs or a lift. The home has a large dining room and a large main lounge that is arranged into two separate areas. The home has a fair-sized and accessible garden, with an extensive patio area. The home has information documentation (service user guide) about the service that it provides. Information about the fees is available from the owner and/or manager. Whitchurch Lodge DS0000017565.V375465.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 Star. This means the people who use this service experience good quality outcomes. The unannounced key inspection of Whitchurch Lodge took place during ten hours within one day in May 2009. Prior to this unannounced key inspection the Commission received a completed Annual Quality Assurance Assessment (AQAA) document from the manager of the care home. The AQAA is pre-inspection paperwork, which is a selfassessment of the service provided by the care home that is carried out by the owner and/or manager. It focuses on the quality of the service, and how well outcomes for people using the service are being met by the care home. It also includes information about plans for improvement, and it gives us some numerical information about the service. This AQAA was completed very comprehensively by the manager and told us what we needed to know about Whitchurch Lodge. A number of feedback surveys were supplied to the care home prior to this inspection. These requested feedback from people using the service, health and social care professionals, and staff. At the time of writing this report, we had received twelve completed surveys from people using the service, two from staff and two from health care professionals. We also spoke to a visitor via the telephone. During the inspection we talked with people using the service, staff (including the manager and the owner) and visitors. Other information received by us since the previous key unannounced inspection about Whitchurch Lodge was also looked at. This included information with regard to incidents that the service has told us about that have happened in the home. These are called notifications, and are a legal requirement. Other documentation we looked at included; care plans of people using the service, risk assessments, staff training, staff personnel records, and some policies and procedures. The inspection also included a tour of the premises. Assessment as to whether the requirements, from the previous inspection had been met, also took place during this inspection. These were judged to have been met. 26 National Minimum Standards for Older Persons, including Key Standards, were inspected during this inspection. Whitchurch Lodge DS0000017565.V375465.R01.S.doc Version 5.2 Page 6 The inspector thanks the people living in the care home, staff, the owner and manager, and all those who spoke with us prior and during the inspection, as well as those who had completed feedback surveys, for all their assistance in the inspection of Whitchurch Lodge. What the service does well: The home is welcoming. A visitor spoke of the home having a very nice ‘atmosphere’. Meals meet the various religious, ethnic and specialist dietary needs of people using the service. Comments included ‘the meals are very good’, and ‘I can choose what I want’. Staff receive appropriate training to ensure that they have the skills to understand, and meet the varied and multiple needs of people using the service. Comments from people using the service include; ‘the care is always very good’, and the ‘staff are helpful and kind’, and ‘the staff are wonderful’. People using the service and visitors spoke very positively about the service provided by Whitchurch Lodge to residents. Comments from residents included ‘I’m happy here’, ‘I get what I want’ and the ‘staff are nice’, and ‘I feel its home’. The manager is experienced and competent and it is evident that she cares about providing a quality service to residents, and is keen to continue to develop and improve the service provided by Whitchurch Lodge to people. What has improved since the last inspection? It is evident that the home has taken appropriate steps to improve the quality of its service. The requirements from the previous key unannounced inspection that took place on the 9th July 2009 have been met. Staff receive one to one supervision regularly to ensure that they are supported with regard to carrying out their roles and responsibilities. When staff start working in the care home, staff receive an appropriate induction programme that is recorded. Staff also receive appropriate training that enables them to gain the knowledge and skills to meet the needs of the people using the service. The majority of staff have now achieved an appropriate care and health qualification. Regular service checks of equipment including the passenger lift are carried out. There have been improvement to the décor of several areas of the environment including to some bedrooms and communal areas. Appropriate window restrictors have been fitted. Whitchurch Lodge DS0000017565.V375465.R01.S.doc Version 5.2 Page 7 The home tells us promptly as required about significant events that occur in the home, which helps us monitor that serious issues are resolved appropriately. 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. Whitchurch Lodge DS0000017565.V375465.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Whitchurch Lodge DS0000017565.V375465.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2, 3, 5 (6 is not applicable) People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service and their representatives have the information needed to decide whether the home will meet their needs. People using the service have their needs assessed prior to moving into the care home, and have the opportunity to visit Whitchurch Lodge, which makes certain that the home knows about the person, and the support that they need. EVIDENCE: We were told by the manager and AQAA (Annual Quality Assurance Assessment/pre inspection information) that Whitchurch Lodge has documentation and information about the service provided by the care home and that this was given to each person using the service. The manager told us that the service user guide information was in the process of being reviewed. Whitchurch Lodge DS0000017565.V375465.R01.S.doc Version 5.2 Page 10 This was accessible on the computer, but not accessible in paper format at the time of the inspection. There should be copies of these documents (service user guide) available in the home. The manager told us that she would make sure that this documentation was readily available to people. The information in the service user guide should be in a more accessible format for people using the service who have difficulty reading, or who have English as a second language. The manager spoke of plans for developing and improving the format of the service user guide. We were informed by the AQAA that the home ensures that a ‘very comprehensive assessment for every new service user’ is carried out before ‘they are admitted into the home’. We were told that assessment information about the prospective resident’s needs is also obtained from the person, their relative/friend, the social worker and/or health care professional (hospital nursing and medical staff) prior to the person moving in to the home. AQAA told us that prospective residents are encouraged to visit the care home before moving in, which gives them the opportunity to ‘sample our food, meet the care manager and staff and ask as many questions as they like about the services provided’ by Whitchurch Lodge. The manager told us that the type and number of visits to the home vary according to the wishes of the person planning to use the service and their relatives/friends. A resident told us that she had visited the care home before moving in, which she said had been ‘very helpful’. A relative of a resident told us that she had visited the home before their family member had moved into the home. Care plans looked at by us included evidence of initial assessment being carried out by senior staff prior to a person moving into the care home. Senior staff told us that there was an ‘on-going’ assessment of the person’s needs, during their ‘settling in’ period, of living in the care home. AQAA told us the home accepts emergency placements but only if they have as ‘much information about the person as possible from the relevant source of placement’, and that if the needs of the prospective resident ‘fitted the criteria for residential care’. We were told by a deputy manager and shown records which informed us that people using the service have a contract (statement of terms and conditions) with the care home. Whitchurch Lodge DS0000017565.V375465.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9,and 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person using the service has a plan of care, in which residents’ health, personal, and social needs are set out. These could be further developed, the recording in the care plans could be better, and it could be more evident that people using the service participate fully in their plan of care. People using the service are respected and their right to privacy upheld, and are protected by the home’s policies and procedures for managing and administrating medication. EVIDENCE: Each person using the service has a plan of care. The care plans looked at, were based upon the assessed needs of each individual person. These needs included; a profile (life story) of each resident, mobility, dressing/undressing, personal care, and other dependency needs. The care plans could include a record of a broader spectrum of the person’s assessed needs (based upon the Whitchurch Lodge DS0000017565.V375465.R01.S.doc Version 5.2 Page 12 initial assessment of the resident) that should include information with regard to the person’s equality and diversity needs (race, gender identity, disability, sexual orientation, age, religion, and belief), social/activity needs, emotional, and other needs. AQAA told us how the home meets the equality and diversity needs of people using the service, including meting their dietary, religious and cultural needs. Comments from the pre inspection paperwork included ‘we give full consideration to service users who may have sensory, visual and physical disabilities’. We were told that staff had recently completed some training with regard to understanding people’s equality and diversity needs. These care plans could be more ‘person centred’ (where the resident’s care plan is central to them, and led by them), and be more of a ‘working tool’, as well as show more evidence of the resident being involved in the development and review of their plan of care. This was discussed with the manager, who spoke of reviewing the format of resident’s care plans, and putting systems in place to make sure people using the service are more fully involved in their care plan. Records told us that the care plans of each person using the service were reviewed regularly. These monthly reviews were brief, often stating ‘no change’. The manager told us that the recording of care plan reviews would be improved. There were gaps (i.e. one person had no personal care record from 13th-16th May) in the recording of people’s bathing/showering, and other assisted personal care. We noted that several of the care plans looked at, recorded mainly assisted wash, rather than shower or bath. There were in a number of plans, a significant number of days between showers/baths (i.e. one person last had a shower recorded on the 29th April). It needs to be clearly evident in the care plans of what people’s bathing choices are, and any changes to this be documented. It was not clear as to whether it was resident’s choice not to have a regular shower or bath, or whether the records were not up to date. The manager spoke of looking into this issue. We were told by staff that no residents have a pressure sore. Care plans told us that people using the service are weighed regularly. A care plan informed us that there was a resident who had lost weight during the last four months. There was no indication that this had been written as a particular need in the person’s plan of care, nor was it evident that a nutritional assessment of this person’s needs had been carried out. The manager spoke of ensuring that this would be put in place promptly, and that all the recorded weights of people using the service would be reviewed. All staff need to be aware of the importance of updating people’s care plans as their needs change. We were told following the inspection of the appropriate action had been taken when this person’s loss of weight was noted. This action has included contact with the GP, and appropriate blood tests carried out, plus possible referral to the dietician. This information should have been clearly documented in the person’s plan of care. The manager told us following this inspection that this Whitchurch Lodge DS0000017565.V375465.R01.S.doc Version 5.2 Page 13 resident’s care plan has now been fully updated and that she would check (and update as necessary) each resident’s care plan with regard to their nutritional and any changing needs, with regard to their weight. We were told by a relative of a resident that their family member had been supported positively with regard to their nutrition and was ‘eating well’ and had gone from being underweight to now being ‘fine’. Care plans included information about the level of assistance (with regard to each resident’s personal care needs) to be provided by care staff. Staff spoke of their role in supporting residents with their personal care, which included ensuring that resident’s dignity and privacy were respected. During the inspection, staff provided assistance, and support to residents in a sensitive and respectful manner. It was evident from observation, and from talking with staff that they have an understanding of the importance of upholding resident’s right to privacy. Staff were seen to interact with residents in a positive way. We noted that in the morning, prior to the activity’s person coming on duty that the large sitting room was unattended by staff for sometimes several minutes (7 minutes the longest measured time). Residents could fall or there could be another kind of incident during this time. Following the inspection the manager told us that she had put systems in place to ensure that the lounge is not left unattended when residents are in the room. A senior staff member now remains in the lounge in the morning. Residents told us that they were supported to make choices. These choices include; deciding what to eat, times of getting up, choice of clothes etc. People were observed to be dressed appropriate to their culture and age. A person using the service spoke of choosing what to wear each day. We spoke to people using the service who told us that they are treated with respect. Visitors were positive about the staff, and confirmed that there friend/relative and themselves were treated in a positive, respectful manner. A resident confirmed that they had the use of a call bell, which was generally answered promptly by staff. A record of each person’s possessions, including clothes were seen in the care plan. It was not evident that these had been updated since the person’s admission to the home, which for some people was several years. The inventories of the possessions of people using the service should be updated/reviewed regularly. Care plans included some evidence of risk assessment (i.e. risk of falls, and mobility assessment). These incorporated some clear staff guidance to minimise these risks. There could be further development of risk assessment including bathing assessments, road safety assessments etc. This was discussed with the manager. Whitchurch Lodge DS0000017565.V375465.R01.S.doc Version 5.2 Page 14 Records, staff, residents, and feedback surveys told us that people using the service have access to care, and treatment from a variety of health professionals, and specialists. These include GP, community nurse, optician, dentist and chiropodist. A resident told us that he/she had ‘seen the doctor’ recently. Surveys from people using the service told us that they receive the medical support that they need. Staff told us that the home has close liaison with the GP service, and that they review the medical needs of the residents on a regular basis, and make referrals to specialists as and when required by people using the service. AQAA told us that staff accompany residents to hospital appointments. The home has a medication policy/procedure. We found that the home has appropriate medication storage (including medications that need cooler temperatures) and administration systems. We were informed that no person using the service self-medicates any tablets, however the home would support this if requested and assessed as capable. We found that the administration of medicines was being recorded correctly, and that this process was up-to-date. We saw a Controlled Drugs register that recorded each occasion of medication being given to a resident. Two staff members signed these. Dates of opening liquid medications, to enable appropriate and safe disposal in due course, was taking place. We were told by staff and records that staff receive medication training. The content of this could be looked at, particularly in the area of ensuring that staff who administer medication to people using the service, have knowledge and understanding of the indicators, contra-indications and side effects of all medication administered to people using the service. It was noted that a staff member who administers medication was unsure of what condition three medications (which were being prescribed to a resident), were prescribed for. The staff with the inspector member looked these up in the British National Formulary (BNF). The British National Formulary (BNF) was dated 2005, so the home should obtain an up to date BNF. A visitor told us that their relative ‘gets her medication on time’, which due to her particular ‘health needs is very important’. Whitchurch Lodge DS0000017565.V375465.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14, and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the opportunity to take part in a variety of preferred activities. Activities at weekends and evenings could be better developed. The visiting arrangements are flexible, and meet the needs of visitors and residents, so as to ensure that people using the service have the opportunity to develop and maintain important relationships. Meals provided are varied, and wholesome, and meet the choice, cultural and specialist dietary needs of people using the service. EVIDENCE: The home employs an activity co-ordinator, who works part time (11.3017.00hrs) during weekdays. We were informed from records that there was a monthly entertainment session provided by a variety of performers, who presented, piano recitals, singing sessions and other activities to people using the service. During the inspection some residents were observed to take part in a number of leisure pursuits, including playing cards, looking at photographs, and arts Whitchurch Lodge DS0000017565.V375465.R01.S.doc Version 5.2 Page 16 and crafts. A resident spoke about enjoying the craft activity that she had taken part in. Some individual activity sessions were prepared for certain people living in the home, at a level to meet their needs. Records informed us that people using the service regularly participate in arts and crafts, ball games, reminiscence sessions, word games, including quizzes and other memory games, and bingo. Several residents had their ‘hair done’ by a visiting hairdresser during the inspection. Two people using the service told us how much they enjoyed having their hair done. Staff and residents told us about a recent birthday celebration that had taken place. The cook told us that she had baked a cake for the resident whose birthday it was. It was noted that there were some residents (three in the sitting room) who slept during most of the morning activity session, and did not take part in a leisure pursuit. The home could look into developing activities (possibly very small sessions) that meet the particular individual needs of those residents who have a very short attention span, and/or lack concentration. Advice could be sought from relevant organisations with regard to this. This was discussed with the manager. There was evidence of people using the service having choice. Some people were asked if they wanted to do some activity but declined, and their wishes were respected. We were told that residents do have the opportunity to participate in some community activities, and that some had recently gone on a shopping trip. The manager told us that accessing community activities was continuing to be developed. Activities participated in by people using the service were generally recorded on a daily basis, but there were some gaps in this recording. Some feedback from people commented that there could be more activities provided to people using the service. It was not clear with regard to the activities/leisure pursuits available at weekends and evenings for people using the service. The manager agreed that improvements could be made in developing evening and weekend leisure pursuits for residents. She spoke of plans to include care staff in the provision of activities so that they can support the activity worker and carryout activities with people using the service when the activity co-ordinator was not on duty. Staff told us how the religious/spiritual needs of people using the service are identified, and met by the care home. AQAA and the manager told us that people could move into the home with their pets. She told us that a resident has their cat living with them in the home. She spoke of having ensured that the other residents were happy with this arrangement and spoke of the importance of making certain that pets are well behaved and are of no risk to the safety of residents. We were told of how having a person’s pet in the home enhances their stay and of how it contributes to them feeling more content, and to them ‘settling down’ in the home more quickly. Whitchurch Lodge DS0000017565.V375465.R01.S.doc Version 5.2 Page 17 The visitor’s record book indicated that a significant number of people regularly visited the home. Residents spoke of the regular visitors that they have. A resident spoke of a family member visiting her often, another person said that their relative visited everyday. We spoke to visitors during this inspection. They told us that they are happy about how their relative is looked after, and that the home keeps them well informed of the progress of their friend/relative. A visitor spoke of the pleasant atmosphere at the care home. We noticed that visitors were warmly greeted and supported by staff. We noted that a resident went out with a visitor during the inspection. The home has a menu. Meals that were recorded on the menu were judged to be wholesome and nutritious. The menu was exhibited in small print in a file in the kitchen. We spoke to two residents who told us that they did not know what was for lunch. We spoke with the manager about ways of improving the accessibility of information, including the menu to people using the service. Particularly with regard to those residents who have short term memory needs, or who have difficulty in reading. She spoke about her plans for obtaining pictures of the meals recorded on the four-week menu and displaying them in the dining room. It is of importance that ways of improving the accessibility of this information to people using the service is sought. The cook told us that the menu is flexible. She told us that she spoke to each resident each day to ask them what they wanted to eat the following day, and would also make a particular meal (i.e. an omelette, sandwich etc) that was different to what was being served if a resident asked prior or during a meal. Residents were seen to make choices about their meals during the inspection. It was noted that the lunch served on the day of the inspection was different to what was on the menu. The cook told us that this was because of people using the service having wanted a different meal to what was recorded on the menu. Staff including the cook spoke of the particular food preferences and dietary needs of people using the service, and of how these are met by the home. A resident told us that the ‘food is good’, and ‘I can choose what to eat’. Feedback from surveys completed by people using the service and/or their relatives told us that the residents ‘enjoy’ the meals, which are described by one person as ‘plain’ and ‘wholesome’. Other comments included ‘if my (relative) does not eat what they give her. It is always replaced to her wish’. During the inspection, some residents were assisted with their meal. This was carried out sensitively, and in an unhurried manner by staff. Residents told us that they had enjoyed their lunch. We were told that most residents chose to eat their breakfast in their bedroom. A person using the service told us that she had chosen what to have for her breakfast. Drinks were regularly provided to residents during their meals and throughout the inspection. Food eaten is recorded. There was a variety of fresh, dried, frozen and tinned food items available. Whitchurch Lodge DS0000017565.V375465.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service and others are confident that their complaints will be listened to, looked into and action be taken to put things right. Residents are protected from abuse, neglect and self-harm by the home’s safeguarding policies. EVIDENCE: AQAA and previous inspection told us that the care home has an appropriate complaint’s procedure. We were told that a summary of this is included in the service user guide. The complaints procedure includes timescales with regard to responding to a complaint. The home should look at ways of improving and developing the format of the complaints procedure to improve its accessibility to people using the service who have difficulty in reading. Feedback from surveys completed by residents or their relative/friends told us that people using the service and others knew who to speak to if they were not happy. AQAA told us that there have been eight complaints within the last twelve months, which had all been resolved within 28 days. The manager spoke of the ways that she and the staff team respond to ‘concerns’/complaints from people using the service, and others, and told us that she ensures that complaints are resolved promptly, and monitored closely. A record is kept of Whitchurch Lodge DS0000017565.V375465.R01.S.doc Version 5.2 Page 19 all complaints made about the home. A visitor told us that staff are very approachable and any ‘concern’/complaint is always responded to appropriately. Two residents spoke of speaking to their relative if they had a ‘concern’ or complaint. Both residents told us that they found the staff friendly and amenable. The home also has a compliment file. This file included a number of ‘thank you’ cards, and letters from relatives of residents, and included a number of very positive comments about the service that their friend/relative had received whilst living in the care home. Records indicated that staff had recently attended a funeral of a person who had lived in the home. The home has a safeguarding adult’s policy, and a whistle blowing policy. The manager told us that she was fully aware of the lead local authority safeguarding procedure. AQAA told us that there have been no safeguarding issues in the home within the last twelve months. A staff member who spoke to us had knowledge and understanding of what to do if there is an allegation or suspicion of abuse. Records confirmed that they had received training in abuse awareness. The manager told us that the home has an understanding and awareness of the Mental Capacity Act 2005 (this Act governs decision-making on behalf of adults who may not be able to make their own decisions). She told us that there was planned staff training with regard to the Mental Capacity Act/Deprivation of Liberty Safeguards, which was planned to take place during the day following the inspection, which should ensure that staff know about their role with regard to the Act, and understand what this Act means to people using the service. Visitors and staff had to ask for a key to leave the property. The home needs to carryout a risk assessment (and incorporate it in the fire risk assessment) with regard to the front door being locked. To demonstrate and assess the restraint, and health and safety aspects of the need for this door to be locked at all times. Whitchurch Lodge DS0000017565.V375465.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 24 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment of the home is safe, warm, clean and comfortable. The premises are suitable for the care home’s stated purpose. There are some areas of the home that could be redecorated. Resident’s bedrooms are individually personalised and meet their individual needs. EVIDENCE: The care home is located a few minutes walk from local shops, and is close to the facilities and amenities of Edgware. The front of the property is tidy and attractive, and there is parking for a number of cars on the forecourt of the home. There is an attractive enclosed garden at the rear of the property, which is accessible to people using the service. We were told by staff that residents make use of the garden facility during nice weather. A resident Whitchurch Lodge DS0000017565.V375465.R01.S.doc Version 5.2 Page 21 spoke of enjoying spending time in the garden, and of particularly liking the trees. There was a garden table and chairs located in the garden. We were told that some areas of the home, including some bedrooms had been recently redecorated. There are aspects of the premises that could be redecorated to ‘brighten up’ the environment to make it more attractive to people using the service and to visitors. These areas include the communal entrance/passage way, dining room, and some of the communal corridors (where the paint is chipped in some places due to wheelchair usage). The manager could contact relevant organisations to obtain advice with regard to colours of paint (i.e. on bedroom, and bathroom doors) which might improve some resident’s orientation skills in the home. There are hand rails located throughout the care home. Some pictures were displayed rather high up, and could be difficult for residents to see. It could be considered replacing some furnishings including pictures, with a selection possibly chosen by residents. The manager agreed and spoke of plans to change the lay out of the dining room and to replace rectangle tables with round ones to make it more conducive with regard to promoting interaction between people using the service. This is positive. A resident spoke positively of his/her bedroom. Comments from people using the service included ‘I’m happy with my room’. The manager told us that prospective residents can choose to have their bedroom redecorated with regard to a colour of their choice. We were shown several bedrooms where residents had chosen the décor. We were told that residents are supported and encouraged to bring to the home personal items (including furniture) of their choice. Bedrooms looked at by us, were all individually personalised. Laundry facilities are located away from food storage, and food preparation areas. The staff member responsible for the care and laundering of resident’s clothes spoke positively about the laundry systems that are in place in the home. She told us that all the resident’s clothes were marked with their name. Hand washing facilities are located throughout the home. Several light switch cords located in the bathrooms appeared to be not clean. These cords and the light pull fittings should be cleaned or replaced. There were paper hand towels, and soap in the bathrooms. Staff were observed to wear protective clothing including disposable gloves, as and when needed. Records confirmed that staff had received infection control training. AQAA told us that the home’s water system is regularly tested for Legionella bacteria. Records and the manager told us that the home last had an inspection from the Environmental Health department took place in June 2008, and the home received a 4* rating with regard to food safety. Whitchurch Lodge DS0000017565.V375465.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28,29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled and competent to support people who use the service, and to ensure the smooth running of the service. People using the service are generally supported and protected by the care home’s recruitment policy and procedure. EVIDENCE: The staff rota was available for inspection. It told us that there were generally five to six care staff on duty during the day, and three staff on duty at night. The home also employs domiciliary staff including domestic cleaners, cooks and a laundry person. The manager told us that the staff ‘turnover’ is very low. A visitor confirmed this, and spoke of the importance to their relative of having regular permanent staff on duty. AQAA told us that ‘changes to care staffing levels’ would be made to meet the changing dependency levels of people using the service. Staff were observed to carry out a ‘staff handover’ meeting during the inspection where morning staff told the afternoon staff about the progress of each person using the service. We were told that care staff have a key worker role in supporting people using the service. A staff member spoke of being involved in ensuring that resident’s Whitchurch Lodge DS0000017565.V375465.R01.S.doc Version 5.2 Page 23 have the toiletries of their choice, and spoke of their participation in the review of the resident’s care plan. Staff were positive about their jobs, and told us that the home provides good induction training, and other appropriate training to ensure that they have the essential skills for carrying out their roles and responsibilities. We looked at a staff induction record. This was fully completed and matched national induction standards. A staff member told us how recently the staff training had significantly improved. Staff told us via the staff surveys that the standard of care that they provide to residents is ‘very high’. A feedback survey from a health care professional told us that the home is ‘a caring warm, friendly environment’. The home has a training plan. Records told us that staff training included; medication training, fire awareness, First Aid, manual handling, health and safety, food and hygiene, mental health, dementia awareness and challenging behaviour awareness, infection control, safeguarding adults, and pressure area care training. Certificates of staff training were accessible. The manager told us that staff are in the process of doing an ‘open learning’ dementia care, and a health and safety training course. We were told by the manager that most staff had recently completed an equality and diversity course, and also a first aid course. We were told that there were also plans for communication training for staff. Staff confirmed that they have the opportunity to achieve National Vocational Qualifications (NVQ) level 2 (and 3) in care and health. We were told by the manager that six care staff have ‘gone on to’ do the NVQ level 3 qualification and that eleven have a NVQ level 2 qualification in care and health, and that the two cooks and three house keepers have all achieved relevant NVQ qualification. We were informed by the manager that there was one care staff member in the process of achieving the NVQ level 2 qualification and that once this person had completed it, all staff would have an appropriate NVQ qualification. A staff member told us that she had achieved a level 2 NVQ care qualification. AQAA told us how the home has improved considerably in the last 12 months with regard to staff achieving a NVQ care qualification, and that there was now only one new staff member who has yet to carry out this course. A feedback survey from a healthcare professional told us that they were ‘impressed by the knowledge of all the staff with regard to the needs and preferences of all their individual clients’. The care home has a recruitment and selection procedure. Four staff personnel files were inspected. These included evidence that appropriate required checks, (such as obtaining at least two references, and an employment history) are carried out during the recruitment and selection process of staff. One staff file (of a staff member who had been employed in the home for several years) had evidence that a police check had been carried Whitchurch Lodge DS0000017565.V375465.R01.S.doc Version 5.2 Page 24 out (which was satisfactory) but not of an enhanced Criminal Record Bureau check (a check carried out to determine if a prospective staff member has a known criminal record). The manager and deputy manager told us that this check had been carried out and they would obtain the documentation with regard to this and supply this information to us. We were informed following the inspection that the CRB documentation for this person had not been located (the staff member could also not trace her own copy of the document) so the manager had applied for another CRB and POVA (a check carried out to find out if a person applying for a staff position in the home is prohibited from working with vulnerable adults). The manager told us that a deputy manager would be checking all the staff personnel files to make sure that they each included the appropriate required recruitment and selection information. These staff files could be better organised so that staff personnel information is easily accessed. Whitchurch Lodge DS0000017565.V375465.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35, 36 and 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect, and has effective quality assurance systems to monitor and improve the quality of the service provided to people using the service. So far as reasonably practicable the health, safety and welfare of people using the service is promoted, and protected, and their financial interests are safeguarded. EVIDENCE: The manager has managed Whitchurch Lodge for many years, and has significant experience of providing care and support for older people. It was evident that she cared about providing a quality service to people living in the Whitchurch Lodge DS0000017565.V375465.R01.S.doc Version 5.2 Page 26 care home, and has worked hard since the previous inspection (July 2008) to make a number of improvements to the service. It was evident from speaking to the manager and from observation that she knew all the residents well, and was seen to spend time sometime speaking to residents during the inspection. The manager spoke of the ways that she ensures she keeps up to date with her knowledge and skills. This includes participating in appropriate training. She has a City & Guilds Advanced Management in Care award. She told us that she will shortly be gaining the Registered Manager’s Award qualification. We were told that a senior staff member had completed the NVQ level 4 in care qualification. The manager told us in the AQAA record that she was aware that there were areas of the service that could be improved and she gave us some details of the plans to achieve this. We met the owner of the care home. He spoke of visiting the home at various times of the day, several times a week. During the inspection, he spent time talking to residents. The manager is supported by several senior staff, who carry out staff supervision, administration duties and other tasks. A feedback survey from a healthcare professional told us that the home is ‘a well run helpful environment’, and that the home is ‘always supportive and responsive to the needs of residents’. We were told from the AQAA and records that the care home has a number of systems in place to ensure that the quality of the service provided to residents is monitored closely, and that action is taken to maintain and develop it. The manager told us that questionnaires about people’s views of the service are supplied regularly to people using the service and to others. We saw records of monthly reports by the owner about the conduct and quality of the home. These were up to date, and they covered appropriate areas such as checks of medication, complaints, staffing levels, and maintenance. Staff told us that they had the opportunity to attend regular staff meetings, including night staff meetings. We were told that there was a night staff meeting that was planned for later that day. AQAA told us that there were policies in place regarding the management of resident’s monies, and that residents were supported to manage their own money if they wished to do so. We looked at two resident’s money accounts including records of expenditure. These records were appropriate and up to date. We were told that a deputy manager monitors these financial records closely. The home has a staff supervision policy. Staff confirmed that they receive regular staff one to one staff supervision, which ensures that they are supported in carrying out their role and responsibilities for meeting the care and support needs of people using the service. We checked the supervision records of a number of staff. These indicated that staff are supervised during a one to one formal meeting. The supervision records indicated that these supervision sessions for staff were significantly brief. The deputy manager Whitchurch Lodge DS0000017565.V375465.R01.S.doc Version 5.2 Page 27 told us that the meetings often last a few minutes unless there are issues of concern with regard to a staff member’s practice. It could be of benefit to staff if senior staff received supervision training. We were told by the manager that this was planned. The pre-inspection records confirmed that all major equipment checks, such as for gas and electrical systems and hoists, are being professionally inspected in a timely manner. In 2008 there was an occasion when the lift was not working for sometime. We were told by the manager that the passenger lift is regularly serviced, and that there ad not been any similar issues since that time. There should be a risk assessment in place (within an emergency plan) which has guidance in place with regard to if the passenger lift breaks down. Required fire safety checks and fire drills are carried out, and the home has a fire risk assessment. We were told that fire drills at night are also carried out, but these were not recorded. All fire drills that take place in the home should be recorded. Emergency fire action guidance was displayed in the home. We noted that there were errors in a fridge and two freezer temperature recordings. The cook told us that the thermometer used for recording these temperatures was faulty. The temperatures of these appliances need to be monitored correctly. New thermometers need to be bought and staff need to all have knowledge and understanding of the safe temperature range of fridges and freezers. The home has health and safety policies and procedures, to ensure staff and residents are protected and safe. The home lets us know about things that have happened; they have shown us that they have managed significant issues appropriately. We checked the accident book for the home. This indicated that accidents/incidents were recorded as required. There was a record of a resident having had a recent fall, which was recorded in the care records but not the accident book. We were told following the inspection that this had been recorded in the accident book used previously. Recorded accidents consisted generally of residents having falls. The manager should ensure that it is evident that she reviews regularly (i.e. monthly) all accidents, and show that she has put systems in place to minimise the risk of accidents occurring in the home. The home has an up to date employer’s liability insurance certificate which is displayed in the care home. Whitchurch Lodge DS0000017565.V375465.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Whitchurch Lodge DS0000017565.V375465.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 14(1)(2) Requirement Timescale for action 01/08/09 2 OP18 13(7) 3 OP29 19 It needs to be clearly evident in the care plans of what people’s bathing choices are,(including if they do not want a regular bath or shower) and any changes to this documented. To ensure that it is evident that people using the service are having their bathing needs, and choices respected and met. The home needs to carry out a 01/08/09 risk assessment (and incorporate it in the fire risk assessment) with regard to the front door being locked. To demonstrate and assess the restraint, and health and safety aspects of the need for this door to be locked at all times. 01/08/09 It needs to be evident that all staff working in the care home have had a enhanced Criminal Record Bureau check and POVA protection of vulnerable adult’s) First check carried out by the home. To ensure that appropriate checks are carried out to find out if staff applicants have a criminal record and/or are prohibited from working with DS0000017565.V375465.R01.S.doc Version 5.2 Whitchurch Lodge Page 30 4 OP38 13(4) vulnerable adults. The temperatures of all fridge 05/07/09 and freezer appliances need to be monitored correctly by thermometers which are in working order. Staff need to all have knowledge and understanding of the safe temperature range of fridges and freezers. This will ensure that food is stored safely. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations There should be paper copies of the service user guide (information about the service provided by Whitchurch Lodge) available and accessible in the care home. The information in the service user guide should be in a more accessible format for people using the service who have difficulty reading, or who has English as a second language. The inventories of the possessions of people using the service should be updated/reviewed regularly. There could be further development of risk assessment including bathing assessments, road safety assessments etc. This ensures that any risk to a resident’s health and safety is looked at and assessed, so any risk identified is managed appropriately. The care home should obtain an up to date British National Formulary (BNF, which records medication names, what they are prescribed for etc), so staff have this up to date information. The home should ensure that all staff who administer medication know the reason for the medication being prescribed and have knowledge of the possible side effects. The home could look into developing activities (possibly DS0000017565.V375465.R01.S.doc Version 5.2 Page 31 2 3 OP7 OP7 4 OP9 5 OP12 Whitchurch Lodge very small sessions) that meet the particular individual needs of those residents who have a very short attention span, and/or lack concentration. Advice could be sought from relevant organisations with regard to this. The provision of activities at weekends and in evenings could be reviewed. To ensure all residents have a choice of activities at all times. The accessibility of the menu information to people using the service could be better. This will assist them in remembering and knowing what choice of meals they have on a daily basis. The home should look at ways of improving and developing the format of the complaint’s procedure to improve its accessibility to people using the service who have difficulty in reading. There are aspects of the premises that could be redecorated to ‘brighten up’ the environment to make it more attractive to people using the service and to visitors. The manager could contact relevant organisations to obtain advice with regard to colours of paint (i.e. on bedroom, and bathroom doors) which might improve some resident’s orientation skills in the home. The light fitting cords in the bathrooms should be cleaned or replaced. It could be of benefit to staff if senior staff received supervision training. This would ensure that staff that carry out staff supervision had comprehensive knowledge and understanding of its role in the management and support of staff. There should be a risk assessment in place (within an emergency plan) which has guidance in place with regard to action to be taken if the passenger lift breaks down for a significant period of time. All fire drills that take place in the home should be recorded. This ensures that the home has a record of the fire drills that each staff member has attended. The manager should ensure that it is evident that she reviews regularly (i.e. monthly) all accidents, and show that she has put systems in place to minimise the risk of accidents occurring in the home. 6 OP15 7 OP16 8 OP19 9 10 OP19 OP36 11 OP38 12 13 OP38 OP38 Whitchurch Lodge DS0000017565.V375465.R01.S.doc Version 5.2 Page 32 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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