Inspection on 16/02/06 for Caddington Hall

This inspection was carried out on 16th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Caddington Hall 02/05/07

Caddington Hall 10/05/06

Caddington Hall 08/09/05

Caddington Hall 09/03/05

Caddington Hall 04/05/04

Caddington Hall 04/09/02

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Caddington Hall Luton Road Markyate Hertfordshire AL3 8QB Lead Inspector Claire Farrier Unannounced Inspection 16th February 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.V283877.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.V283877.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.V283877.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th September 2005 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 18 Years ago, and in 1998 the care provider was transferred to Care First (a subsidiary of BUPA). All the beds, (except four) are contracted to Bedfordshire County Council. The home is arranged as five units, of which two provide accommodation and care for people with dementia. All the accommodation is on ground level and all the bedrooms are single. Only one has en-suite facilities. There are ample grounds that are accessible to residents, including a wildlife area and sufficient car parking spaces. Caddington Hall DS0000019305.V283877.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out this unannounced inspection, and including preparation time it took a total of 16 hours. During their time in the home the inspectors spoke with four residents, one visitor and five members of staff, and discussions took place with the manager. The interaction between residents and staff was observed. The records were checked of residents’ care and residents’ money, staff files and rotas and health and safety records. This was the second inspection of the year. Core standards that were not inspected on this occasion were assessed to have been met in the previous inspection report, to which reference can be made. The focus of this inspection was on facilities for dementia care, which were found to be lacking during the last inspection. Brief visits were made to Units 1, 2 and 3. The staff members were observed to have a good relationship with the residents, and the residents spoken to said that the staff are very good and very kind. However the comments and requirements in this report mostly relate to units 4 and 5. For a holistic and balanced view of the care provided throughout the home, this report should be read in conjunction with the report of the previous inspection. What the service does well: What has improved since the last inspection? Caddington Hall DS0000019305.V283877.R01.S.doc Version 5.1 Page 6 Most the requirements from the last inspection have been met. In particular: • The kitchens on three units have been refurbished, and dishwashers installed. The remaining two units will also be refurbished. • The medication round was observed, and medications were seen to be administered and recorded appropriately. • Code locks have been fitted to all cleaning cupboards to ensure that COSHH (Control of Substances Hazardous to Health) items are stored securely. • All bath water temperatures have been regulated to a safe temperature What they could do better: 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.V283877.R01.S.doc Version 5.1 Page 7 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.V283877.R01.S.doc Version 5.1 Page 8 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): 4 The care workers provide adequate care to meet the personal care needs of the residents. However there is no provision for meeting the specific needs of people with dementia. The provision for residents in the dementia units is of containment rather than skilled and responsive care. The staff and management showed no clear understanding of working with people with dementia. There is a major shortfall in specific dementia care, with regard to knowledge, training, care plans, activities and environment. Caddington Hall DS0000019305.V283877.R01.S.doc Version 5.1 Page 9 EVIDENCE: Brief visits were made to Units 1, 2 and 3. The staff members were observed to have a good relationship with the residents, and the residents spoken to said that the staff are very good and very kind. However the focus of this inspection was on facilities for dementia care, which were found to be lacking during the last inspection. Units 4 and 5 provide accommodation and care for eighteen residents diagnosed with dementia. However, apart from providing separate accommodation, no evidence was seen to show that the home provides facilities to meet their needs. The two units for dementia care are no different in appearance or facilities provided than the other units. There is no environmental differentiation, such as colour coding or pictorial cues to assist orientation, although some signage has been put in place to identify bathrooms and toilets. There was no evidence of specific training in the needs of people with dementia, although it was reported that a request for more dementia training has been agreed by BUPA (see Standard 30). The staffing levels on the dementia units are for two care staff throughout the day, and a duty senior for the whole home. At night there are three care staff in the home, with none specifically allocated to the dementia units. The units do not have their own specialised team of care workers, and any of the staff may be asked to work on the dementia units at any time (see Standard 27). There was no evidence seen of appropriate activities and stimulation. The home does not currently have an activity organiser, and there is a lack of activities throughout the home (see Standard 12). The staff working in Units 4 and 5 had no knowledge or training in dementia tracking and reality and reminiscence activities, and they were observed to have little interaction with the residents (see Standard 10). The care plans seen had no information on the needs of people with dementia, and no specific behaviour programmes for individuals (See Standard 7). The home is currently not meeting the conditions of registration, and if BUPA wish to continue to offer a provision for dementia care, they must take measures to ensure that the staff have the training and professional support to enable them to understand and meet the complex needs of the residents. The action plan submitted following the last inspection report stated, “Internal audit taking place to establish areas that can be improved to meet the needs of people with dementia.” But little evidence was seen of the effects of this audit. Caddington Hall DS0000019305.V283877.R01.S.doc Version 5.1 Page 10 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, 9 and 10 The needs of residents are set out in care plans to ensure that all their needs are identified and can be met. Further details are needed for individual needs for personal care and health care, and specifically for dementia care. The care plans provide no indication of provision for the person’s well being. There was very little interaction between the staff and the residents, and there was an impression of a lack of concern and care for each person as an individual. Caddington Hall DS0000019305.V283877.R01.S.doc Version 5.1 Page 11 EVIDENCE: Detailed case tracking was carried out through the files of four residents in the dementia units. The last inspection found that the care plans in the home contained clear and easily accessible information on the resident’s health and personal care needs, with comprehensive procedures for meeting the needs. On this occasion it was found that several care plans were not fully completed. One had not been updated since the end of December, and made no reference to the person concerned currently spending all her time in bed. It was very hard to identify the reason for bed rest from the care records, and there was no plan of care for her needs while in bed, although a risk assessment was in place for the use of bed rails. There was no plan for turning her regularly to ensure that she was not at risk of pressure sores, and no turning chart to monitor this need. It was observed that she was not turned after the care staff had washed her. One man was lying on his bed shouting. His file contained a care plan for allowing him a cigarette every two hours, and a care plan for memory and behaviour related to smoking. Another care plan was a goal to find him an activity or hobby. However the details of the care plan were functional, with only the times of meals, cigarettes, washing and dressing. There was no information on how he was spending his time or any involvement in an activity programme. One person had a care plan in place for preventing pressure sores, but very little information or recording of the care and treatment she was receiving. It was not clear whether there was a pressure area problem. The care plan files include a map of life, but none of those seen were fully completed and some were blank. Assessments for falls, pressure areas and nutrition are in place, but the information does not clearly relate to the person’s care plan. Most of the care plans did not relate to dementia care. Where there was a care plan for behaviour such as shouting or aggression, it was seen to be a control measure rather than validating the person’s well being. The care plans are very task orientated, and provide no indication of provision for the person’s well being, and no details of the person’s feelings or of how they spend their time. The manager reported that she is currently introducing a new format for the care plans to make them clearer, and training in writing and recording in care plans is planned for all the care staff. The care plans contain appropriate information on the residents’ health care needs, with recording of all contacts with medical practitioners. The manager has been proactive in ensuring that there is no link between several recent incidents of pneumonia in the home. Caddington Hall DS0000019305.V283877.R01.S.doc Version 5.1 Page 12 The care plans are stored in each unit in a plastic crate. In one unit they are still stored openly on the worktop in the kitchen area. When the care staff were writing in them they were tipped onto the dining room table, and left unattended. It is accepted that the care plans need to be accessible for staff to read and to record in, but they are also easily accessible to any visitor to the units. Personal information must be stored securely. The home has satisfactory procedures for administration of medication, and all the staff who administer medication have had training on the safe handling of medication. The medication round was observed, and medications were seen to be administered and recorded appropriately. A new pharmacist has been employed, who will provide training for the staff and carry out regular audits of the medication. On one unit there was very little interaction between the staff and the residents. The residents were dressed in clothing that was not smart, with pop socks rolled down on their legs and unkempt and greasy hair. The general appearance was of a lack of concern and care for each person as an individual. Staff were observed to do things to the residents rather than for them and there was very little explanation of what they were doing. One lady woke to find a care assistant putting a cushion behind her back with no explanation, and seemed distressed. The television was turned on with no discussion or explanation of the choice of programmes. For a period of fifteen minutes during the morning, and again after lunch, the residents on one dementia unit were left totally unsupervised while the care staff were with another resident or having their break. Caddington Hall DS0000019305.V283877.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 and 15 Residents benefit from and enjoy the whiolesome and varied meals provided in the home, but the residents are not offered sufficient drinks to maintain their health. There are no activities in the home due to a vacancy for the activities co-ordinator. EVIDENCE: There was no evidence anywhere in the home of any planned activities for the residents. The activities notice board contained only a notice of a sale of chocolate, and pictures displayed of outings were five years old. There was no recording of any activities in residents’ files since October or November 2005. The home has no activities co-ordinator, but interviews for the post were taking place on the morning of the inspection. On units 1, 2 and 3 the residents were generally happy and able to provide some activity and entertainment for themselves. However on the dementia units the residents were left for long periods of time with little interaction with staff, no stimulation, and on occasions no supervision (see Standard 10). There was no evidence of any social activity, and no books, newspapers or other things for the residents to pick up. The staff spoken to had no knowledge or training in dementia tracking and reality and reminiscence activities. Most of the residents spoken to on all five units said that the food provided is good, and that they have a choice of what they wish to eat. Caddington Hall DS0000019305.V283877.R01.S.doc Version 5.1 Page 14 One said it’s not as good as it was, and there is not as much choice, but it is OK. The menu includes a roast dinner at weekends, and fish on Fridays. Lunch was observed on two units. The main choice was sausages, bacon, chips and beans, with the option of an egg salad. The main choice looked over cooked and unappetising. One resident was not able to eat the sausage because it was too hard, but others seemed to enjoy it. The dessert was jam roly-poly and custard, which most residents seemed to enjoy. The chef uses fresh ingredients to prepare the meals, and all the meals including pies and pastries are home made. There is a four week menu, and the chef is currently planning a new menu. BUPA provides a menu box with guidance on nutritional menu planning. Pureed meals are prepared for residents on a soft diet, and special diets are provided for residents with diabetes, and for one person who has a nut allergy. Tea and biscuits were provided for the residents during the morning and afternoon, but on one unit the biscuits were given to the residents ten minutes before their cup of tea. There was no water available in the bedrooms and lounges, and it was reported that it is not the practice to leave jugs of drink in the lounges on the units. Squash is stored in the main kitchen, and jugs are taken to the main kitchen to be filled. Drinks must be made freely available at all times for the residents, and offered to them frequently, to avoid the risks of dehydration. This may be easier for the staff if squash was stored on the units rather than in the main kitchen. Caddington Hall DS0000019305.V283877.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): 16 and 18 Policies and procedures are in place to safeguard the residents from abuse. Residents and relatives are confident that any complaints will be properly investigated. EVIDENCE: The home has a satisfactory complaints procedure in place and a leaflet is available for all residents and visitors. Residents and their relatives are encouraged to make their concerns and complaints known. No complaints have been recorded in the home, and there is no format for recording complaints. However the manager has investigated a complaint in another home and the procedure included the investigation, the result, an action plan and the response of the complainant. The home has comprehensive procedures for prevention of abuse, which cover the different types of abuse, and each person’s responsibility to report any concerns. Although most of the residents are from Bedfordshire and their placements are commissioned by Bedfordshire County Council, any allegations of abuse would be investigated by Hertfordshire County Council (HCC), as the home is situated in Hertfordshire. The HCC procedures are in the home, and a summary of the procedures is displayed on the office wall. However the BUPA procedures state that the home manager or person in charge must undertake an investigation, which is contrary to the HCC procedures, and this should be amended. Caddington Hall DS0000019305.V283877.R01.S.doc Version 5.1 Page 16 The staff spoken to were aware of their responsibilities for whistle blowing. Some members of staff were not aware of the procedures for prevention of abuse, but they felt confident about reporting any concerns to the manager. Caddington Hall DS0000019305.V283877.R01.S.doc Version 5.1 Page 17 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, 22 and 26 The home and gardens provide a comfortable and attractive environment for the residents, but maintenance is needed in some areas. Individual and communal facilities are generally appropriate for the residents’ needs. The provisions of the home ensure that the residents are able to maximise their independence and live in a safe and comfortable environment. EVIDENCE: Caddington Hall is a purpose built single storey building, set in large grounds. The decorations and furnishings in the home are domestic in style, and provide a homely and comfortable environment. The gardens are accessible from each unit, and the grounds are inhabited by a flock of peacocks that add character and interest, but they are a mixed blessing. There is a courtyard garden at the centre of the home, which is arranged as a sensory garden with raised flowerbeds. Caddington Hall DS0000019305.V283877.R01.S.doc Version 5.1 Page 18 Unfortunately the attractive appearance of the garden is diminished by netting covering the flowerbeds, which is needed to prevent the peacocks eating the plants. There was also peacock mess on the patio and garden bench outside unit 5. The kitchens on three units have been refurbished since the last inspection, with new kitchen units and dishwashers. The remaining two units will also be refurbished. The dining chairs and tables in units 4 and 5 are poor quality and were observed to be wobbly and unstable. These should be replaced to prevent any risks to the residents. The dementia units are no different in appearance from the other units in the home, and there is no environmental differentiation, such as colour coding or pictorial cues to assist orientation (see Standard 4). The home appeared to be generally clean, and appropriate procedures are in place for the control of hygiene and for effective management of laundry. However there was a pervasive smell in the lounge of unit 5, which may be due in part to the peacock mess on the patio outside the lounge. There were also decaying leaves on the patio, and a broken flowerpot and chair. The dining chairs on units 4 and 5 were marked with drips and spills and need to be cleaned after every meal. The bathrooms and toilets looked dowdy, and one bath surround was cracked and broken. The home provides sufficient equipment for the residents, with a variety of hoists and baths, and handrails in the corridors, bathrooms and toilets. Bed rails are provided following a risk assessment for their use, and suitable mattresses and cushions are available for the management of pressure area care. Caddington Hall DS0000019305.V283877.R01.S.doc Version 5.1 Page 19 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 Staff numbers in the home are not currently sufficient to ensure that all the residents’ needs are met. The staff receive appropriate training, but the training for dementia care is inadequate. Good recruitment procedures make sure that, as far as possible, service users are supported and protected in the home. EVIDENCE: All the members of staff spoken to during the inspection were enthusiastic about their work in the home, and several said that they like the residents, and that they feel well supported. There are two care workers in each of the two dementia units during the day, and one on the other three units, with a duty senior for the whole home. At night there are three care staff in the home, with none specifically allocated to the dementia units. The care staff work in all the units of the home, and there are no staff who work specifically on the dementia units (see Standard 4). For a period of fifteen minutes during the morning, and again after lunch, the residents on one dementia unit were left totally unsupervised while the care staff were with another resident or having their break (See Standard 10). The home has robust policies and procedures for recruitment. Two staff files were inspected for recently recruited members of staff. They both contained all the required information, including good references and a satisfactory CRB (Criminal Record Bureau) disclosure. Caddington Hall DS0000019305.V283877.R01.S.doc Version 5.1 Page 20 All the staff spoken to said that they take part in regular training. BUPA provides a good standard of internal training, including Personal Best training. However there is no training available in dementia care, although it was reported that a request for more dementia training has been agreed by BUPA. Training also requested for Dementia and Challenging Behaviour. Several members of staff have done an introduction to dementia consisting of going through a workbook in the home. The deputy manager has completed a two day course on Training in Protection of Vulnerable Adults with Dementia, and it is intended that she will cascade this to the other staff. All staff working on the dementia unit must have appropriate specialised training in meeting the needs of people with dementia. An appropriate certified training should be considered for senior staff on the dementia unit. All the staff are encouraged to undertake NVQ qualifications, and eleven of the 34 care staff currently have NVQ level 2. All new staff follow an approved induction training course, and there is an expectation that they will then register for NVQ training. Caddington Hall DS0000019305.V283877.R01.S.doc Version 5.1 Page 21 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, 33, 35, 37 and 38 The home is well managed. The views of the residents and other involved people are actively sought in order to ensure that a good quality of care is provided. Generally adequate records are maintained for the effective management of the home and monitoring of health and safety procedures, and appropriate procedures are in place to ensure that the personal money of the residents is looked after and recorded. EVIDENCE: The 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. A sound quality assurance system is in place that meets the needs of the service. Annual questionnaires are sent to all the residents and their families, and a satisfaction survey report is produced which includes comments from the residents. Caddington Hall DS0000019305.V283877.R01.S.doc Version 5.1 Page 22 BUPA carries out an annual audit of all aspects of the service provided by the home, with a resulting an action plan. The BUPA Operations Manager makes monthly visits to the home to monitor the quality of care provided. The arrangements for management of residents’ money were inspected and appeared to be accurate. Systems for managing the residents’ finances are transparent and backed up with signatures and invoices. Money is stored safely and adequate records are maintained in order to protect service users from financial abuse. Appropriate records are maintained for the health and safety of the residents and staff in the home, and staff follow the home’s policies and procedures. The policies are regularly reviewed and updated. The policies for medication and prevention of abuse were seen, and with one exception (see Standard 18) provide good details and information for the staff. All the staff have training in moving and handling, fire safety, food hygiene and infection control as part of their induction. Two health and safety concerns were noticed during the inspection. 1. A spray canister of flying insect killer was seen in an unlocked cupboard in the kitchen of one unit. Following the last inspection code locks have been fitted to all cleaning cupboards to ensure that COSHH (Control of Substances Hazardous to Health) items are stored securely. It was suggested that the duty manager should make a health and safety inspection of the home every day to ensure that the home’s COSHH procedures are fully put into practice 2. Appropriate records for fire protection are maintained, and at least two fire drills take place each year. However no fire drills take place at night, and there is no evidence that all the staff take part in a fire drill during the year. Caddington Hall DS0000019305.V283877.R01.S.doc Version 5.1 Page 23 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 X X X 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X 3 X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 3 2 Caddington Hall DS0000019305.V283877.R01.S.doc Version 5.1 Page 24 Are there any outstanding requirements from the last inspection? YES 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 OP4 Regulation 12(1), 18(1)(c) Requirement The home is registered to provide dementia care for up to 18 residents in two separate dementia units. However no evidence was seen of any specific provision for people with dementia. Appropriate and adequate provision must be made to meet the specific needs of people with dementia. This includes an experienced and skilled staff, appropriate environment and appropriate activities. Care plans must address the assessed needs of people with dementia, including and specifically in terms of management of behaviour. Previous timescale of 30/03/06 not met. Timescale for action 30/06/06 Caddington Hall DS0000019305.V283877.R01.S.doc Version 5.1 Page 25 2. OP7 12(3), 15 Several of the care plans seen do 30/06/06 not provide sufficient details of the procedures to meet personal care and health care needs. They do not provide information on the needs for dementia care. The care plans are very task orientated, and provide no indication of provision for the person’s well being, and no details of the person’s feelings or of how they spend their time The registered person must ensure that all care plans provide adequate and appropriate information on all the resident’s needs, and that recording in care plans is relevant and informative. Care plans are stored openly, and on one unit were left open and unattended. Personal records, including care plans that contain personal information, must be stored securely. Previous timescale of 31/12/05 not met. There was little interaction between the care staff and the residents on one unit, and the residents were not dressed appropriately. The registered person must ensure that the care staff understand the need to treat residents with respect at all times. 3. OP10 17(1)(b) 30/06/06 4. OP10 12 30/06/06 Caddington Hall DS0000019305.V283877.R01.S.doc Version 5.1 Page 26 5. OP12 16(2)(m) &(n) There was no evidence of any activities within the home. A programme of activities must be implemented in consultation with the service users. Specific activities and interactions are required for residents with dementia. There was no evidence of sufficient fluid intake for all residents, and drinks were not freely available at all times. 30/06/06 6. OP15 12(1)(a) 30/06/06 7. OP19 23(2)(b) Hot and cold drinks must be freely available at all times and offered frequently to all residents in order to avoid the risk of dehydration. Dining tables and chairs are poor 30/09/06 quality and were observed to be wobbly and unstable. The registered person must ensure that the premises are maintained in a good state of repair. The dining furniture needs to be replaced. The dining chairs and tables were marked with drips and spills and there was peacock mess and decaying leaves on the patio outside the lounge of unit 5. The registered person must ensure that all parts of the home are kept clean and hygienic at all times. The residents on one dementia unit were left unsupervised. The dementia units do not have their own dedicated team of staff. The registered person must ensure that sufficient staff are available at all times to meet the needs of the residents. 8. OP26 23(2)(d) 30/03/06 9. OP27 18(1)(a) 30/03/06 Caddington Hall DS0000019305.V283877.R01.S.doc Version 5.1 Page 27 10. OP30 12(1)(b) 11. OP38 13(4)(a) All staff working on the dementia unit must have appropriate specialised training in meeting the needs of people with dementia. An appropriate certified training should be considered for senior staff on the dementia unit. (See also Regulation 18(1)(c) (i)) A spray canister of flying insect killer was seen in an unlocked cupboard in the kitchen of one unit. 30/09/06 30/03/06 12. OP38 23(4)(e) All substances that are hazardous to health must be stored securely at all times. Previous timescale of 08/09/05 not met. Fire drills are not arranged at 30/09/06 times that enable all staff to take part in them. The registered person must ensure that every member of staff, including the night staff, take part in at one fire drill a year. 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 OP18 Good Practice Recommendations The home’s procedure for prevention of abuse states that the home manager or person in charge must undertake an investigation, which is contrary to the HCC procedures. The procedures for prevention of abuse should be amended to make reference to the HCC procedures. Caddington Hall DS0000019305.V283877.R01.S.doc Version 5.1 Page 28 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 © 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 Caddington Hall DS0000019305.V283877.R01.S.doc Version 5.1 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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