Inspection on 08/09/05 for Caddington Hall

This inspection was carried out on 8th September 2005.

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 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

Caddington Hall 02/05/07

Caddington Hall 10/05/06

Caddington Hall 16/02/06

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 8 September 2005 08:45 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 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 I52 s19305 caddington hall v228973 040805 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Caddington Hall Address Luton Road Markyate Hertfordshire AL3 8QB 01582 840336 01582 842335 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) BUPA Care Homes (Bedfordshire) Ltd Linda Cornfoot Care Home 42 Category(ies) of DE(E)Dementia, over 65 - 18 registration, with number OP Old Age - 42 of places Caddington Hall I52 s19305 caddington hall v228973 040805 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: There are no additional conditions of registration. Date of last inspection 9 March 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 I52 s19305 caddington hall v228973 040805 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first unannounced inspection of the inspection year and took place over one day, starting at 8.45am. Two inspectors visited the home, and the majority of time was spent observing and talking to residents and staff. Some time was also spent looking at records and care plans, and the results of the inspection were discussed with the manager. Eight residents, five members of staff and two visiting relatives were spoken to during the inspection. The residents and relatives praised the quality of care provided by the home, and were complementary of the staff. This was generally a positive inspection, and the majority of the standards were met or partially met. All the requirements made in the last inspection report were met. New requirements were made concerning risk assessments, medication, the storage of personal information, maintenance, health and safety and provision for dementia care. What the service does well: What has improved since the last inspection? The requirements made in the last inspection report have been met. Caddington Hall I52 s19305 caddington hall v228973 040805 stage 4.doc Version 1.30 Page 6 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 I52 s19305 caddington hall v228973 040805 stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Caddington Hall I52 s19305 caddington hall v228973 040805 stage 4.doc Version 1.30 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 standard(s) 3 and 4 A comprehensive assessment of the needs of the residents was seen to be in place, and appropriate risk assessments are carried out to ensure that the residents live in a safe environment. The home has sufficient information on residents’ needs and access to appropriate services to enable the needs to be met. However the services provided for residents with dementia should be more specific to their needs. EVIDENCE: Care records of residents were inspected and there was evidence of a preadmission assessment of needs being carried out in most cases. The assessment includes a pressure area assessment and moving and handling assessment, as well as details of the personal dare and health care needs for each resident. The home receives a copy of the pre-admission assessment of needs of prospective residents for those who are funded by the Social Services. Caddington Hall I52 s19305 caddington hall v228973 040805 stage 4.doc Version 1.30 Page 9 The staff members were observed to have a good relationship with the residents and to treat them with respect. A member of staff offered one resident a fresh cup of tea as her tea had cooled before she could drink it. The home has sufficient levels of staff to meet the needs of the residents. The residents spoken to said that the staff are very good and very kind, and understand their individual needs, and two visiting relatives said that they a\re very happy with the services provided by the home. However there is no evidence of specific facilities for people with dementia. The two units for dementia care are no different in appearance, staffing or facilities provided than the other units. There is no environmental differentiation, such as colour coding or pictorial cues to assist orientation. There is no evidence of specific activities such as reminiscence or facilities for sensory stimulation. The staff are not specific to the dementia units, and may work in any of the units on each shift. Specific training on dementia care is available, but not all the staff who work on the dementia units have done the training. Although the quality of care provided is satisfactory, the home must also provide specific facilities for dementia care in order to meet the conditions of registration. Caddington Hall I52 s19305 caddington hall v228973 040805 stage 4.doc Version 1.30 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 standard(s) 7, 8, 9 and 10 The individual needs of residents are clearly set out in care plans to ensure that all their needs are identified and can be met. Residents said that staff treat them with respect, and the policies and practice in the home also promote service user privacy and dignity. EVIDENCE: Detailed case tracking was carried out through the files of five residents. They contain clear and easily accessible information on the resident’s health and personal care needs, with comprehensive procedures for meeting the needs. Appropriate goals are identified for each person, related to personal care, health care and activities. Regular reviews are held, and for one person the last review noted that she now has high dependency needs, and a review of her placement at Caddington Hall may be needed if her needs increase significantly. Caddington Hall I52 s19305 caddington hall v228973 040805 stage 4.doc Version 1.30 Page 11 Risk assessments are in place for each resident, including for the risk of falls for all residents, and for individual needs such as for the use of a wheelchair and the use of bedrails. However some risk assessments needed review. For one resident, the falls risk assessment stated that she is at low risk of falls, but she has had several falls recently. She was observed sitting on a settee with cushions on the seat and behind her back. The risk assessment does not describe the procedures needed to prevent falls, which could include appropriate seating. Another resident had a risk assessment for the use of a wheelchair. The risk assessment is a standard format, and not specific to the risks and needs of the individual resident. The care plans are stored in each unit in a plastic crate. In one unit this was on a table in the dining room, and on another unit it was on the worktop in the kitchen area. 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 care plans contain good information on the residents’ health care needs, with appropriate monitoring of specific health concerns and recording of all contacts with medical practitioners. All the residents said that the staff treat them with respect and provide a good quality of care. The home has appropriate procedures for administration of medication, and all the staff who administer medication have had training on the safe handling of medication. However several areas of poor practice were observed in the administration of medication: 1. Staff were observed administering eye drops to a resident in the dining room. Although this is not an intrusive treatment, consideration should be given to administering personal treatments, such as eye drops, in the residents room, to ensure their privacy and dignity. 2. PRN (when required) medication, such as paracetamol, is supplied in individual dosage blister packs. For one resident there was a supply of paracetamol, but it was not recorded on her MAR (medicines administration record) chart. For another resident there were two sets of blister packs of paracetamol, and it was not clear when each was started so that it was difficult to carry out an accurate audit. 3. There is no thermometer in the clinical room where the controlled medication is stored. The medication trolley and surplus stocks of medication are stored in a cupboard. There is a thermometer on the door of the storage cupboard, but it does not record maximum and minimum temperatures, so the temperature is only monitored when the door is open. The temperature of all rooms used to store medication must be regulated to below 25°C. Caddington Hall I52 s19305 caddington hall v228973 040805 stage 4.doc Version 1.30 Page 12 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 standard(s) 12, 13, and 14 The residents are happy with the activities and daily life in the home and maintaining contact with families and friends is promoted by staff in accordance with the residents’ wishes. EVIDENCE: The activities organiser was not in the home during the inspection and no activities were observed during the time that the inspectors were in the home. It was reported that the care staff organise activities on each unit in the mornings, and some residents spoke of activities that they enjoy, including bingo and darts. There was a party for the VE day anniversary in June. Families and friends are welcomed into the home, and family members are consulted about the resident’s care. The home promotes the residents’ autonomy, and all the bedrooms seen contained evidence of the resident’s own furniture and decorations. Caddington Hall I52 s19305 caddington hall v228973 040805 stage 4.doc Version 1.30 Page 13 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 standard(s) These standards were not assessed on this occasion. EVIDENCE: Caddington Hall I52 s19305 caddington hall v228973 040805 stage 4.doc Version 1.30 Page 14 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 standard(s) 19 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. Unfortunately the attractive appearance of the garden is diminished by netting covering the flowerbeds, which is needed to prevent the peacocks eating the plants. Caddington Hall I52 s19305 caddington hall v228973 040805 stage 4.doc Version 1.30 Page 15 The home is starting to show its age in several respects. The kitchen units need refurbishing. In one unit the cupboard doors do not close properly and the taps are loose and constantly dripping. There are no dishwashers in the unit kitchens, which means that the care staff spend time doing the washing up that could be better spent with the residents. The garden furniture in the courtyard garden is scruffy and needs repainting, and the door from the courtyard into the home has cracked and flaking paint. The handle of a toilet door was broken. 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 clean throughout, and appropriate procedures are in place for the control of hygiene. Caddington Hall I52 s19305 caddington hall v228973 040805 stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 Staff numbers in the home are sufficient to ensure that all the residents’ needs are met, and staff receive appropriate training. EVIDENCE: There are two care workers in units 1,2 and 3 during the day, and one on the other two units. The care staff work in all the units of the home, and there are no staff who work specifically on the dementia unit (see Standard 4). 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, and all staff are encouraged to undertake NVQ qualifications. 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. The residents feel confidence in their abilities and several said that the staff are very good and very kind. Caddington Hall I52 s19305 caddington hall v228973 040805 stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 Adequate records are maintained for the effective management of the home and monitoring of heath and safety procedures. The practices in some areas must be tightened up to ensure that there is no risk to the health and safety of the residents. EVIDENCE: The home maintains appropriate records for the health and safety of the residents and staff in the home, and staff follow the home’s policies and procedures. All the staff have training in moving and handling, fire safety, food hygiene and infection control as part of their induction. Caddington Hall I52 s19305 caddington hall v228973 040805 stage 4.doc Version 1.30 Page 18 Two health and safety concerns were noticed during the inspection. 1. The sluice room on one unit was unlocked, although there was a notice on the door stating that it must be locked when not in use. Tubes of denture cleaner for each resident were easily accessible, also a container of spray cleaner and a small file of red liquid marked with a ‘corrosive’ COSHH (Control of Substances Hazardous to Health) symbol. The cleaning cupboard close to the sluice cupboard was also unlocked, with items including insect killer and toilet cleaner easily accessible. 2. The temperature of the bath water in the bathrooms tested as between 46°C and 48°C. There is a notice in all bathrooms stating that water temperatures must be tested prior to bathing, and the temperature should not exceed 44°C for baths and 41°C for showers. This practice would ensure that there is no risk to the residents, but the water temperatures should be regulated to a safe level at source. Caddington Hall I52 s19305 caddington hall v228973 040805 stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x 2 Caddington Hall I52 s19305 caddington hall v228973 040805 stage 4.doc Version 1.30 Page 20 NO Are there any outstanding requirements from the last inspection? 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 4 Regulation 12(1) Requirement There is no evidence of specific facilities for people with dementia. The home must provide specific facilities for dementia care in order to meet the conditions of registration. Several risk assessments were seen to be inaccurate or not specific to the individual. Appropriate and specific risk assessments must be put in place for each resident. Effective measures must be put into place to ensure that all medication is administered and recorded according to the guidelines of Royal Pharmaceutical Society and the relevant legislation.In particular: 1. Medication, including PRN medications, must be recorded accurately to enable an effective audit to be carried out. 2. The temperature of all rooms used to store medication must be regulated to below 25°C. Personal records, including care plans that contain personal information, must be stored secirely. Timescale for action 30 March 2006 2. 7 13(4)(c) 31 December 2005 3. 9 13(2) 31 December 2005 4. 10 17(1)(b) 31 December 2005 Page 21 Caddington Hall I52 s19305 caddington hall v228973 040805 stage 4.doc Version 1.30 5. 19 23(2)(b) 6. 38 13(4)(a) 7. 38 13(4) Some areas were seen to be in need of repair and refubishment, and in particular the unit kitchens. The registered person must ensure that the the premisies are maintained in a good state of repair. The unit kitchens need to be refurbished. The sluice room and cleaning cupboard on one unit were observed to be unlocked, providing easy access to hazardous items. All substances that are hazardous to health must be stored securely at all times. The bath water temperatures were measured at between 46 and 48 degrees centigrade. Water temperatures must be regulated to measure close to 43 degrees centigrade in order to prevent the risk of scalding. 31 March 2006 8 September 2005 31 December 2005 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. 2. Refer to Standard 10 19 Good Practice Recommendations Consideration should be given to administering personal treatments, such as eye drops, in the residents room, to ensure their privacy and dignity. It is recommended that dishwashers should be installed in the unit kitchens, for the maintainence of hygiene and to enable the care staff to spend more time with the residents. Caddington Hall I52 s19305 caddington hall v228973 040805 stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City 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 I52 s19305 caddington hall v228973 040805 stage 4.doc Version 1.30 Page 23 - 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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