CARE HOMES FOR OLDER PEOPLE
Caddington Hall Luton Road Markyate Hertfordshire AL3 8QB Lead Inspector
Mr Neil Fernando Key Unannounced Inspection 11th May 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Caddington Hall DS0000019305.V294656.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Caddington Hall DS0000019305.V294656.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Caddington Hall Address Luton Road Markyate Hertfordshire AL3 8QB 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) 01582 840336 01582 842335 cornfool@bupa.com BUPA Care Homes (Bedfordshire) Ltd Linda Cornfoot Care Home 42 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (42) of places Caddington Hall DS0000019305.V294656.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 16th February 2006 Brief Description of the Service: This purpose built home is situated near the village of Markyate, just within the borders of Hertfordshire. The home occupies a secluded position off a country road with no easy access to amenities or public transport. The home was purpose built for Bedfordshire County Council 24 Years ago, and in 1998 the care provider was transferred to Care First (a subsidiary of BUPA). All the beds, (except six) are contracted to Bedfordshire County Council. The home is organised in five units, of which two accommodate people with dementia. All the accommodation is on ground level and all the bedrooms are single; only one offers en-suite facilities. There are extensive grounds that are accessible to residents, including a wildlife area and sufficient car parking spaces. The weekly placement fee for each service user is between £ 375 and £591. Caddington Hall DS0000019305.V294656.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the first inspection for the inspection year 2006/7. The last inspection (Unannounced) was carried out on 16.02.06. Caddington Hall is one of many Care Homes managed by BUPA Care Homes Ltd in the Hertfordshire area. It is registered to accommodate up to 42 older people including 18 persons with dementia. All the beds, bar 4, are contracted to Bedfordshire County Council. On the day of the visit, there were 34 people in residence. This unannounced inspection took place on 10 and 11 May 2006 and lasted for a total of 8.5 hours. During this period, 12 service users, 7 staff members including the Registered Manager were spoken to, in order to seek their views regarding the quality of life at this establishment. A number of records were examined and a tour of the premises (all 5 Units) was also undertaken. What the service does well:
All the service users observed had received assistance to achieve a good standard of personal care; they were wearing smartly laundered matching and accessorised clothing. Staff were observed to offer discrete support to service users requiring intimate personal physical care. Staff members were seen to be attentive and encouraging additional fluids as appropriate. All service users had access to drinks, which was well appreciated by them. The home’s assessment and admission process is satisfactory thus ensuring that the residents’ needs could be met on admission to the home. There is some evidence to demonstrate that the health and personal care needs are being identified and monitored internally through a monthly review system, involving the service user and their family where possible. The catering facilities appeared to be managed and delivered to the satisfaction of the resident group. Residents’ interests, expectations and aspirations are being sought by staff members and fulfilled wherever possible. Good evidence is available to demonstrate that service users are treated with dignity and respect, and their right to privacy is upheld. The protection systems including the management of complaints are adequate to ensure the safety of service users. The care staff members spoken to are enthusiastic about their work, and said that they have a good level of training to enable them meet the needs of Caddington Hall DS0000019305.V294656.R01.S.doc Version 5.1 Page 6 service users. They also spoke positively regarding the Manager and support they receive from the management team. Copies of the homes monthly unannounced visits by a representative of the company are sent to the home and the Commission. The manager reports incidents under Regulation 37 as required. In the main, health and safety matters are being attended to. What has improved since the last inspection? What they could do better:
There are 5 requirements and 2 recommendations arising from this report, which need addressing. The service users’ guide needs updating and once this is achieved, a copy must be supplied to the Commission and each service user, as appropriate. Care plans and staff’s recruitment files require improvement. It is crucial that essential training in Adult Protection (for those members who have not received this training) and Care Planning (all care staff including senior members) is made accessible to staff. The frequency of staff formal supervision needs some attention. The Activities Coordinator’s hours should be increased, so that service users benefit from a higher level and variety of activities; this would assist to maintain an adequate level of stimulation for their general wellbeing. Equally,
Caddington Hall DS0000019305.V294656.R01.S.doc Version 5.1 Page 7 identifying a budget for residents’ social and recreational activities would be very helpful. Whilst health and safety matters are being attended to, it is required that fire extinguishers are serviced yearly, at minimum. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Caddington Hall DS0000019305.V294656.R01.S.doc Version 5.1 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 Caddington Hall DS0000019305.V294656.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 5. Standard 6 is not applicable. Prospective service users have the opportunity to visit the home and on admission, they all have a review to assess if the placement is appropriate and could be finalised. The service users’ guide requires updating and a copy must then be supplied to the Commission and each service user, as appropriate. Based on available evidence including a visit to this service, the quality in this outcome area is judged to be satisfactory. EVIDENCE: A copy of the statement of purpose setting out the aims and objectives and philosophy of care is available at the home. A service users’ guide to the home is also available but this is not suitable for the service users it accommodates. This should be updated to reflect the required details in accordance with regulation 5 of the Care Homes Regulations 2001. Evidence available indicates that a copy of the current guide has not been made available to service users and their representative, as appropriate. The Manager is aware that remedial action must be taken. The case records for 7 service users were examined and these include satisfactory details of the completed pre-admission assessment carried out by
Caddington Hall DS0000019305.V294656.R01.S.doc Version 5.1 Page 10 a member of the home management team. Records examined and information gained from service users including a new resident and staff members provides some evidence that the arrangements to enable service users and significant others the opportunity to visit and make an informed decision about the facilities offered at this establishment is satisfactory. The service user is offered a trial period and this assists them to decide if they want to live at Caddington Hall. The process also offers staff the time to further assess the needs of the resident. A review meeting is held at the end of the trial period involving the service user, relatives and placing authority, and the placement is then finalised. Good evidence is available to demonstrate that service users and their relatives are being empowered to participate in the decision making process, on issues that matter to them. Caddington Hall DS0000019305.V294656.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 10. There is a care planning process and monthly review system in operation. However, the identified needs must be comprehensively reflected in the service users’ care plans. Staff members continuously monitor residents’ health and general well being, and maintain relevant records. Based on available evidence including a visit to this service, the quality in this outcome area is judged to be satisfactory. EVIDENCE: Based upon the pre-admission assessment, an initial care plan is formulated. Further assessment of needs is carried out during the trial period and the care plan is adjusted accordingly. A new care plan format has been introduced following the last inspection undertaken in February 2006. Care plans for 6 service users were tracked; these reflected some aspect of the residents’ identified health, personal and social care needs. Whilst some progress has been made in this area, further action is required, in order to ensure that the identified needs of each service user are comprehensively reflected in their care plan. Each care plan should include details of how the identified needs are to be met and the action required by staff. Caddington Hall DS0000019305.V294656.R01.S.doc Version 5.1 Page 12 Evidence available indicates that the above shortcoming is mainly due to a lack of skills on behalf of care staff. Essential and specific training on care planning must be made accessible to all care staff including senior members; this would improve their knowledge and skills on the care planning process, implementation of identified needs and review system. The training issue is however more appropriately dealt with under Standard 30 of the report. Documentary evidence is available to show that good health assessments are undertaken with respect to individual service user. Visits from GPs and other health professionals are well documented. Identified health care needs are being addressed and observations are maintained, in order to respond quickly to any change; as noted from the daily record of relevant occurrences. The privacy and dignity of service users is considered to be of paramount importance; this is included in the induction programme and supervision for all staff members. Information gained from service users and observation made, clearly demonstrates that residents are treated with dignity and respect, and their privacy upheld at all times. The staff team are to be commended for their achievement in this area. Caddington Hall DS0000019305.V294656.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 and 15. Service users’ interests, expectations and aspirations are being sought and addressed to an extent. Service users and those with dementia in particular, would benefit from an increase in the Activities Coordinator’s hours; equally, a budget for social and recreational activities should be identified. The food offered is of a good quality and is served in comfortable settings. Based on available evidence including a visit to this service, the quality in this outcome area is judged to be good. EVIDENCE: Service users are being assisted to follow the lifestyle of their choice to an extent, as discussed and agreed during assessment. Service users spoken to generally expressed satisfaction in this area. The home has recruited an Activities Coordinator in March 2006 and is welcomed. Information available indicates that residents are encouraged to participate in social and recreational activities to suit their taste and preference. The Inspector spent time discretely observing service users participating in an outdoor activity facilitated by the Activities Coordinator. The service users were engrossed in what they were doing and clearly enjoying each other’s company. There was a lot of laughter and encouragement. Service users spoken with expressed a good deal of satisfaction regarding recreational activities being facilitated over the recent weeks but most of them
Caddington Hall DS0000019305.V294656.R01.S.doc Version 5.1 Page 14 felt that there is room for improvement. Considering the number of service users’ accommodated and their dependency levels, in particular those with dementia, the Activities Co-ordinator’s hours are clearly inadequate. The Manager also reported that the home does not have a budget for social and recreational activities, which needs to be addressed. Contact with family, friends and significant others are being encouraged and supported. Residents are encouraged to express their opinions regarding how their expectations and preferences are being met and there is good evidence to demonstrate that remedial actions are taken to remedy dissatisfaction, if any. It is also positive to note that arrangements are in hand to initiate “residents; meetings” and no doubt, this would assist service users further on issues that matter to them. Evidence indicates that residents are regularly consulted regarding the menu to reflect their taste and preference. The four-week menu viewed included good variety, the provision of good nutrition and choice. All service users spoken with expressed a high level of satisfaction about food – “the food is excellent and plentiful”, stated many of them. Caddington Hall DS0000019305.V294656.R01.S.doc Version 5.1 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Service users are confident that any concern/complaint would be taken seriously and responded satisfactorily. Once the remaining members receive training in Adult Protection, this would reinforce the existing systems and would further ensure the safety of service users. Based on available evidence including a visit to this service, the quality in this outcome area is judged to be good. EVIDENCE: The home has procedures on how to make a complaint; service users stated that “if anything was troubling them the staff would soon put it right”. The Manager reported that a referral could be made for Advocacy service, if a service user needs support. The complaints record indicates that there have been no complaints made to the home since the last inspection in February 2006. The home has policies and procedures on the protection of vulnerable adults and whistle blowing. Staff members were seen to interact well with the service users. There were no adult protection matters pending at the time of the inspection; there have not been any staff members referred to the POVA and POCA Registers. 10 staff including members of the management team have received training in Adult Protection; an element of this is also included in the NVQ assessment. The remaining members should also receive training on this subject. Caddington Hall DS0000019305.V294656.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. The premises provide a safe, comfortable and homely environment suitable for the needs of service users. The standard of cleanliness was good. Based on available evidence including a visit to this service, the quality in this outcome area is judged to be good. EVIDENCE: The physical environment continues to be maintained to a satisfactory standard. It is decorated and furnished in domestic style and provides a homely, comfortable and safe environment. Bedrooms are painted different colours chosen by the residents where appropriate; they are well personalised to reflect the tastes and interests of the occupants, with gadgets, pictures and other personal effects. Since the previous inspection visit, some upgrading work has been undertaken; this include 1 bathroom and replacement of the kitchen unit in 3 of the houses. The Manager said that arrangements are in hand to replace the dining chairs and kitchen unit in 2 of the houses and redecoration of both houses accommodating residents with dementia. Caddington Hall DS0000019305.V294656.R01.S.doc Version 5.1 Page 17 A good standard of cleanliness was evident throughout those areas viewed. There were no mal-odours present. The laundry facilities are suitable and adequate for the residents accommodated. There are infection control policies and procedures in place. The arrangements for the storage and collection of domestic and clinical waste remain satisfactory. There were no health hazards noted. Caddington Hall DS0000019305.V294656.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Staffing levels are adequate to meet the needs of the current service users. Whilst there is a good skill mix of staff, specific training identified must be addressed to enables them to deliver an improved quality of service. Based on available evidence including a visit to this service, the quality in this outcome area is judged to be satisfactory. EVIDENCE: Staff duty roster for the period between 16.04.06 and 13.05.06 was scrutinised and discussion with staff members including the Registered Manager shows that day and night staffing levels are adequate to meet the needs of service users. Information gathered suggests that staff members have a wide rage of skills and experience to enable them deliver a good quality service to the resident groups. Staff members spoken with indicated that they have good opportunities for relevant training. 12 members of staff have received training in Dementia and another 20 are undertaking a 16 weeks certified course in the same subject; no doubt, this would give them greater confidence to do their jobs. The home has not yet achieved the 50 NVQ Level 2 for its staff. 11 care staff members (33.3 ) have completed their assessment and therefore, NVQ assessment should be given a higher profile, in order to meet the stated standard. Other specific training identified includes i) Adult Protection for those members who have not received this training and ii), structured training
Caddington Hall DS0000019305.V294656.R01.S.doc Version 5.1 Page 19 on Care Planning must be made accessible to all care staff including senior members. This would improve their knowledge and skills on the care planning process, implementation of identified needs and review system. The home follows the Organisation’s procedures for the recruitment and selection of staff members. Good evidence is available to indicate that the Manager has made a concerted effort to ensure that all new recruits are subject to in depth checks, prior to them starting work. The personnel recruitment files for 6 staff including 2 recently appointed members were scrutinised. Minor improvement (for example a current photo) is required to reflect the documents stated in Schedule 2 and 4 of The Care Homes Regulations 2001. Caddington Hall DS0000019305.V294656.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 36 and 38. Management systems are being implemented to good effect, which means that staff members are being appropriately supported and managed. The health, safety and welfare of service users, and staff are being safeguarded. However, fire extinguishers must be serviced annually and staff supervision should be regularised. Based on available evidence including a visit to this service, the quality in this outcome area is judged to be good. EVIDENCE: The Registered Manager has been in post at Caddington Hall for four years. She has completed the Registered Managers Award, and she has a Joseph Rowntree certificate in care and NVQ level 4 in care. She is also an NVQ Assessor in care. She has undertaken periodic training to update her skills and knowledge whilst managing the home. The management systems are transparent and service users and staff members confirmed that the Manager is supportive. Observation of care
Caddington Hall DS0000019305.V294656.R01.S.doc Version 5.1 Page 21 practice during the visit also demonstrates that members of staff and service users enjoy a very good relationship. A formal one to one supervision for staff is in operation and details of supervision sessions are maintained. However, the frequency needs improving so that supervision occurs once every two months, at minimum. Staff members have received training to promote safe working practices. Risk assessments are in place and updated regularly. The fire alarm system, hot water temperature and portable electrical appliances are checked as appropriate. Fire drills and weekly tests of break glass points have occurred within the required timescales. A requirement has been made for fire extinguishers to be serviced annually, at minimum. Caddington Hall DS0000019305.V294656.R01.S.doc Version 5.1 Page 22 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 2 x 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 X X X X X x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x x 2 x 2 Caddington Hall DS0000019305.V294656.R01.S.doc Version 5.1 Page 23 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 OP1 Regulation 5 Requirement The registered person must ensure that: i) The service users’ guide is updated to reflect the details in Regulation 5; ii) Supply a copy of the service users’ guide to the Commission and each service user as appropriate. Care plans must reflect the identified needs of each service user, details of how they are to be met and the action required by staff. The registered person must ensure that specified documents in Schedule 2 and 4 are maintained in staff’s files. The Registered Person must ensure that staff receive training in: i) Adult Protection for those members who have not received this training (to be met by 11.08.06); ii) Structured training on Care
DS0000019305.V294656.R01.S.doc Timescale for action 11/08/06 2. OP7 15 10/08/06 3. OP29 17 (2) & 19 (1) 11/07/06 4. OP30 12(1)(b) 15/11/06 Caddington Hall Version 5.1 Page 24 Planning (all care staff including senior members). 5. OP38 23(4) The registered person must 15/06/06 ensure that fire extinguishers are serviced annually. 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 OP12 Good Practice Recommendations The Manager should: i) Increase the Activities Coordinator’s hours so that service users receive an adequate level of stimulation for their general wellbeing; ii) Identify a budget for residents’ social and recreational activities. The frequency of staff formal supervision should be increased to once every 2 months, at minimum. 2 OP36 Caddington Hall DS0000019305.V294656.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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