CARE HOMES FOR OLDER PEOPLE
Courtland Lodge Courtlands Drive Watford Hertfordshire WD1 3HR Lead Inspector
Alison Butler Unannounced 14 June 2005 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. Courtland Lodge I52 s19325 Courtland Lodge v232254 140605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Courtland Lodge Address Courtlands Drive, Watford, Hertfordshire, WD1 3HR 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) 01923 681231 01923 689867 Quantum Care Limited Ms Hilary Woodhouse CRH Care Home 60 Category(ies) of DE(E)-60, OP-60, PD(E)-60 registration, with number of places Courtland Lodge I52 s19325 Courtland Lodge v232254 140605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: There are no additional conditions of registration. Date of last inspection 28 February 2005 Brief Description of the Service: Courtland Lodge is a purpose built two-storey building providing sixty residential places in four self contained units. Four of the bedrooms are used to provide respite care. All bedrooms are for single occupancy and each has an en-suite toilet and wash hand basin. Each of the units has a dining room, kitchenette and lounge. A day centre, the main kitchen, laundry, reception area, communal sun lounge and the administrators office is located centrally on the ground floor. The home has a landscaped garden and ample off road parking. It is located close to a pade of shops that offers a variety of retail outlets and a Post Office. There is a local bus service that provides easy access to the town centre. Courtland Lodge I52 s19325 Courtland Lodge v232254 140605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted by two inspectors and took a total of eight hours. The inspectors spent the majority of their time talking with the residents, staff and visitors. Good interaction was seen between staff and the residents and appropriate support and encouragement given. Discussions and contact was made with 16 residents, 6 staff as well as the manager, deputy manager, care team manager, 5 visitors and the district nurse. Care and administrative records were checked. The manager of the home is due to leave at the end of the month and staff and residents wish her well although they are sad that she is leaving. What the service does well:
A welcoming, calm and friendly environment was provided. There is a comprehensive on-going training programme in place. Supervisions are offered on a regular basis and staff feel it is an effective process to ensure their needs are met. There is a well-structured induction and foundation programme for all new employees. This provides staff with the skills and competency to carry out their jobs. During the inspection a number of visitors were spoken to and comments were very positive and said “the home is the best we could have found”. The staff are committed to caring for the residents and morale appears to be high. They treat the residents with respect and encourage them to be as independent as possible. They were seen to deal with a difficult situation calmly and provided the resident with reassurance that it would all be sorted very soon. The meals were provided offered a variety of choices and the cook regularly visits the units to receive feedback from the residents and then makes changes to the menu with the information received. The quality assurance system actively seeks the views of the service users, relatives and other visiting professionals. There is also an auditor who goes into the home to check the financial procedures and ensure they are in order. Courtland Lodge I52 s19325 Courtland Lodge v232254 140605 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? 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. Courtland Lodge I52 s19325 Courtland Lodge v232254 140605 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 Courtland Lodge I52 s19325 Courtland Lodge v232254 140605 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) 1. Up to date information is available to prospective residents to ensure that they are able to make an informed choice. EVIDENCE: A comprehensive Statement Of Purpose and Service User Guide is available and prospective residents are provided with a copy. Both these copies will require amending as the registered manager is due to leave the company at the end of June 2005. Courtland Lodge I52 s19325 Courtland Lodge v232254 140605 Stage 4.doc Version 1.30 Page 9 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 & 10 The quality of the information recorded is generally good but the is not always very detailed. Residents receive a good quality of care and are supported by experienced and knowledgeable staff. EVIDENCE: Examination of six care plans showed that the care required for residents was very detailed, the progress notes were less so but appeared to be up to date. Although monthly reviews are carried out they do not actually review the care plans but are more of a summary of the daily notes. Photographs were in place to enable staff to identify individual residents more easily. Residents felt that they were treated well and “couldn’t ask for a better place to live”. Residents stated that the staff knock and wait before they enter their rooms. Staff were seen to interact well with residents. One member of staff dealt extremely well with a resident who was angry and upset and they managed to defuse the situation and calm the resident down. A number of issues were identified with the medication on the two units and the controlled drugs which were examined. A number of bottles of liquid medication had not been dated on opening and a bring forward system had not been put in place, therefore medication could not be reconciled by the
Courtland Lodge I52 s19325 Courtland Lodge v232254 140605 Stage 4.doc Version 1.30 Page 10 inspector on the day. The list of prescribed medication that is given as required should be updated as some is no longer prescribed for individuals and can therefore be confusing for staff if they are trying to look for it. Although the temperature of the medication cupboards is being taken staff were not reporting it when it was going above 25 degrees Centigrade. The controlled drugs for two residents were examined. Whilst one persons were well recorded, the other was not and the inspector was unable to reconcile as there had been, according to the Medication, Administration, Record sheet, 7 signed in, and 7 had been signed as administered but there was a balance of two left. As the Care Team Managers are responsible for controlled drugs they must be given further instruction on the procedure for the recording and administration of controlled drugs. Courtland Lodge I52 s19325 Courtland Lodge v232254 140605 Stage 4.doc Version 1.30 Page 11 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, 14 & 15 Where possible, autonomy and choice is promoted within the home. Visitors are welcomed and contact with family and friends is actively encouraged. Residents are encouraged to be as independent as possible. Social activities are provided although these are limited due to time and there is only one person to provide activities to 60 residents. The menu offers a varied well balanced diet. EVIDENCE: Residents spoken to during the inspection said “ we are able to join in activities if we want to”. Others stated “that there was not enough activities although the activities lady is very nice and she tries her best but she has a lot of residents to please”, others stated they would like to go out more. A couple of residents said “we entertain ourselves and play cards to pass the time”. Visitors to the home said they are always made to feel welcome in the home and are offered tea/coffee. One relative comes to the home daily and supports their loved one, they usually have a meal at lunchtime for which they say a small charge is made. They said “the staff are wonderful and work very hard”. The manager should investigate the possibility of providing a further activity co-ordinator to be able to offer more time to each unit, as the residents on the dementia unit would benefit from more 1 to 1 sessions. This should be done in consultation with the residents.
Courtland Lodge I52 s19325 Courtland Lodge v232254 140605 Stage 4.doc Version 1.30 Page 12 Staff were seen to encourage independence and support were appropriate. The tables were laid out very nicely at lunchtime with tablecloths, napkins, condiments and vases of artificial flowers. Most residents were very complimentary about the food, whilst one resident stated “you just have to put up with it don’t you”. Another said, “It’s sometimes awful”. The cook went out during the lunchtime to find out if the residents were happy with what they had been offered on the day. He stated that he regularly visits the units and has tried various dishes for example Chinese and Italian but these have not always been well received by all the residents. They are still provided occasionally as a choice on the rotational menu but not as often. Some residents stated they have enjoyed trying the various dishes, although they have not always been to their taste. Courtland Lodge I52 s19325 Courtland Lodge v232254 140605 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) 16, 17 & 18 Robust procedures are in place to ensure the protection of the residents. EVIDENCE: A copy of the complaints procedure is available. Those residents and relatives spoken were aware of the complaints procedure or who to speak to if they had any concerns or were unhappy with the care provided. No complaints had been received since the last inspection. Staff spoken to during the inspection were aware of the whistleblowing procedure and what to do if an incident of abuse were reported to them. Courtland Lodge I52 s19325 Courtland Lodge v232254 140605 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 & 26. The home is clean, reasonably well maintained and regular maintenance checks are carried out on services and equipment. EVIDENCE: The home was clean and tidy on the day. The dining area of Sherwood was having the carpet cleaned and the dining furniture had been moved out into the open area. A new dishwasher had been recently purchased to allow for thorough cleaning of the crockery etc. Clarendon and Berrygrove kitchenettes had two broken tiles that were in need of replacement as they were sharp and could cause an injury. In Berrygrove bathroom 9 flooring must be repaired or replaced as it is raised and again could cause injury. A number of areas are still in need of decoration but a plan is in place and it is hoped this will be completed soon. Residents were very happy with the decoration around the home and state that it does not cause them any inconvenience whilst work is being carried out during the decorating of communal areas. The laundry facilities are adequate to meet the needs of the residents. Residents were well dressed and were happy with the laundry service. Policies and procedures are
Courtland Lodge I52 s19325 Courtland Lodge v232254 140605 Stage 4.doc Version 1.30 Page 15 in place for the control of infection to ensure the protection of both residents and staff. Courtland Lodge I52 s19325 Courtland Lodge v232254 140605 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, 29 &30 Procedures for the recruitment of staff are robust and offer protection to the people living in the home. The numbers of staff and their deployment are sufficient to meet the personal care needs of the residents. EVIDENCE: The four staff files examined showed that all the relevant checks had been carried out prior to them commencing employment which ensures the protection of the residents. At the time of this inspection the rotas showed that adequate numbers of staff were deployed to meet the personal needs of the residents. It is recommended that further hours are allocated to support the daily activities co-ordinator, see section on Daily Life and Social Activities for further information. Residents spoke highly of the staff “they are lovely and are always busy” Some excellent intervention was observed with a member of staff who provided a resident with reassurance in a calm and friendly manner and gave them an explanation to what they could do to alleviate the anxiety. Relatives spoken to were extremely happy with the care that was given at Courtlands Lodge “ I don’t think we could have found anywhere better for my Mother”. One relative visit daily and says “the staff are extremely helpful and can’t help and support the residents anymore than they already do”
Courtland Lodge I52 s19325 Courtland Lodge v232254 140605 Stage 4.doc Version 1.30 Page 17 There is an on-going training programme in place and the induction and foundation programmes are in line with the National Training Organisation. Training needs are identified and recorded within their review and discussion sessions and these are held at least six times a year. Courtland Lodge I52 s19325 Courtland Lodge v232254 140605 Stage 4.doc Version 1.30 Page 18 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) 31, 32, 33, 35, 36 37 & 38 The management style ensures the operation of the home is run in the best interests of the residents. Health & Safety is well managed and ensures that the welfare of everyone who enters Courtlands Lodge is protected. Staff receive supervision on a regular basis. EVIDENCE: The manager has many years of experience working in the field of the elderly. She undertakes periodic training to maintain her skills and competency. The manager is responsible and accountable for the management of the home. She is supported by a manager and a number of care team managers. There are regular staff meetings, resident meetings and a yearly forum is held inviting residents, relatives, friends and professionals. Handovers takes place with staff detailing each resident care and any progress or deteriation and a record is made. The manager ensures she tours the home
Courtland Lodge I52 s19325 Courtland Lodge v232254 140605 Stage 4.doc Version 1.30 Page 19 and speaks with residents whenever she is in the home. They in turn stated they are able to discuss any concerns or just have a chat. There is a quality assurance system in place and looks at improvements that could be made to the benefit of the residents and staff. Monthly Regulation 26 visits take place with a report being forwarded to the Commission For Social Care Inspection. Records showed that review and discussions take place at least every other month. Staff confirmed that they receive on-going supervision in their day-today work. Personal records are kept locked to ensure confidentiality. Staff are aware that discussions about the residents is carried out in private. A note is displayed inviting relatives access to care records although the manager stated that this is in agreement with the residents. All accidents and incidents are recorded and a monthly audit is carried out to determine if there are any patterns occurring. Regular fire checks have been carried out and recorded. Comprehensive policies and procedures are in place to ensure the health, safety and welfare of all who enter Courtlands Lodge is promoted and protected. Courtland Lodge I52 s19325 Courtland Lodge v232254 140605 Stage 4.doc Version 1.30 Page 20 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 3 x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 x 3 3 3 3 Courtland Lodge I52 s19325 Courtland Lodge v232254 140605 Stage 4.doc Version 1.30 Page 21 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 9 Regulation 13(2) Requirement The manager must ensure that all Care Team Managers are fully aware of the policy and procedures in relation to the recording and administration of Controlled Drugs The manager must ensure that the redecoration plan continues and bring all areas of the home is brought up to an acceptable standard. Timescale for action immediate as of 14th June 2005 and henceforth by 31st August 2005 2. 19 23(2)(b) & (d) 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 7 9 Good Practice Recommendations The monthly reviews should reflect the progress on indivdiuals care plans. Medication that is not dispensed in dosette boxes should be dated on opening. A bring forward system should be introduced with medicaton that is given as required to enable them to be reconciled at any point in time. Whilst staff should continue to monitor the temperatures of the medication cabinet and report when the temperature is in excess of 25 degrees Centigrade. The manager should investigate the possibilty of getting a
I52 s19325 Courtland Lodge v232254 140605 Stage 4.doc Version 1.30 Page 22 3. 4. 9 12 Courtland Lodge second activity co-ordinator to provide more time to individual residents especially those who suffer from dementia. Courtland Lodge I52 s19325 Courtland Lodge v232254 140605 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City, Herts AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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