CARE HOMES FOR OLDER PEOPLE
Courtland Lodge Courtlands Drive Watford Hertfordshire WD1 3HR Lead Inspector
Mrs Alison Butler Key Unannounced Inspection 20th December 2006 09:00 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 Courtland Lodge DS0000019325.V324669.R01.S.doc Version 5.2 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. Courtland Lodge DS0000019325.V324669.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Courtland Lodge Address Courtlands Drive Watford Hertfordshire WD1 3HR 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) 01923 681231 01923 689867 www.quantumcare.co.uk Quantum Care Limited Amanda Liles Care Home 60 Category(ies) of Dementia - over 65 years of age (60), Old age, registration, with number not falling within any other category (60), of places Physical disability over 65 years of age (60) Courtland Lodge DS0000019325.V324669.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 26th January 2006 Brief Description of the Service: Courtland Lodge is a purpose built two-storey building providing sixty residential places in four self contained units. The fees for the service range from £420.00- £565 per week (these were correct as of 20th December 2006). 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 administrator’s office are located centrally on the ground floor. The home has a landscaped garden and ample off road parking. It is located close to a parade 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 DS0000019325.V324669.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report has been written following a visit to the service and from information that has been gained from previous inspections or has been know to the Commission For Social Care Inspection. The majority of the time was spent observing and talking with residents and staff. Care records were also examined. What the service does well: What has improved since the last inspection?
The care plans have greatly improved since the last inspection and give detailed information about what the residents are able to do for themselves and then instruction on what assistance is required by staff to meet their personal care needs. There is information on what daily activities the residents like to do for example dusting, laying tables etc. The decoration around the home has improved and the laundry has been brought up to an acceptable standard with the machines in full working order. Courtland Lodge DS0000019325.V324669.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Courtland Lodge DS0000019325.V324669.R01.S.doc Version 5.2 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 Courtland Lodge DS0000019325.V324669.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Standard 6 is not applicable to Courtlands Lodge Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is available to residents and their representatives to enable them to make an informed choice. Assessments are carried out on all residents prior to a place being offered or taken up EVIDENCE: A comprehensive Statement of Purpose and Service User Guide is available to all prospective residents and their representatives. Residents spoken to confirmed that they or their families received information about the home. Pre- admission assessments are carried out prior to admission and this forms the basis of the care plan. Each resident is provided with the terms and conditions of admission etc.
Courtland Lodge DS0000019325.V324669.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Quality of information recorded is generally good. Residents receive a good quality of care and are supported by knowledgeable and experienced staff. Medication procedures need to be adhered to, to prevent errors. EVIDENCE: Care plans examined had greatly improved since the introduction of the new format, the information recorded was detailed including information on what service users like to wear, make up that is used, toiletries to be purchased, type of bedding and number of pillows, what activities they enjoy including household chores such as dusting, laying the table etc. There was good information on the size of the food portions and what size the pieces of food should be. On the personal care daily living record it went into detail of what they are able to do for themselves and then what staff were required to do to assist them in meeting their needs. There had been information recorded but it appears not to have been followed through, as tests had been taken but no results recorded. Where recording charts are contained within the file and no
Courtland Lodge DS0000019325.V324669.R01.S.doc Version 5.2 Page 10 longer used it would be beneficial if these are removed and archived. Daily records should ensure that the date is added to every page to enable an audit of the information, also the two dates for each night staff should be added, covering the night period as it is very confusing that some staff appear to use the start of the night shift and some the finish of the night shift. Information recorded on daily records should be followed through, (for example when a resident had been sick after 2 meals, the GP visited but there was no mention of the GP’s advice regarding the sickness and what, if anything, staff should watch out for etc.). When staff review the care plans monthly they should be more detailed looking at the individual’s plan of care and if they are still continuing to meet it. Observation of staff carrying out moving and handling of residents especially whilst using the hoist showed they must remember to protect the residents dignity by the use of a blanket especially when the residents are wearing a dress. Staff must remember that they must not use the underarm lift when assisting residents to settle them in their chairs, correct equipment needs to be identified for the individual for example a handling belt. The examination of the medication showed that improvements are still required as a number of errors were found these were discussed with the manager during the feedback at the end of the inspection. Some medication could not be reconciled with the amount left and the signatures on the record sheet, where medication is given as required there appeared to be 2 places in where this can be recorded making it difficult again to reconcile. Some packets had not been dated on opening. A requirement has been made. Courtland Lodge DS0000019325.V324669.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Contact with family and friends are maintained. Autonomy and choice is promoted within the home. EVIDENCE: Residents told the inspectors that they have trips out in the spring, they have not had many activities lately although “staff try to do something after tea”. Nothing is planned on a weekly basis. On Berrygrove there was a weekly activities plan and on the day of the inspection there should have been videos in the morning although it appeared it did not happen and in the afternoon arts and crafts were planned. A staff member did sit in the lounge with 4 residents and carried out a small quiz. Once a week a volunteer takes a trolley round the home and sells sweets and toiletries. The recommendation remains that additional activities hours should be allocated to provide more stimulation for the residents, as some of those spoken to felt that they would enjoy more activities although some felt they were happy with what is on offer, where as some chose not to join in at all. The residents on the dementia units would benefit from one to one, as they are unable to concentrate for long periods of
Courtland Lodge DS0000019325.V324669.R01.S.doc Version 5.2 Page 12 time. Visitors felt they are made to feel very welcome whenever they visit the home. The resident’s comments about the staff stated, “they are wonderful girls and try their best, but they are busy”. One resident felt that the meals have been terrible this week they had complained and the manager sorted it out, although others felt they were “very nice” or “good”, “ can’t please all the people all the time” was another comment. It would be beneficial if larger print daily menus were available in the dining rooms, as this would help the residents instead of having them having to ask all the time. Where clocks are available it would help if they were set at the right time and where there is no clock one should be put in place especially in the lounge, this would help residents with orientation. Courtland Lodge DS0000019325.V324669.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Robust procedures are in place to ensure the protection of the residents. EVIDENCE: A copy of the complaints is available. Residents spoken to were aware of whom to speak to if they were unhappy with the care received. Examination of the complaints log and the information received by the Commission For Social Care Inspection showed that whilst those received had been acted upon details of the outcomes had not necessarily been recorded to show it had been followed through. This was discussed with the manager and she stated that this would be recorded in the future to ensure a full audit trail is completed. Staff spoken to were aware of the whistle blowing policy and what to do if an allegation of abuse occurs. They confirmed they had received training in Adult Protection. Courtland Lodge DS0000019325.V324669.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean and well maintained. Regular checks are carried out on services and equipment. EVIDENCE: A tour of the building showed that the home was well maintained, clean and no odours were detected. The laundry room has much improved and staff confirmed that all the machines were in full working order. They would benefit from additional workspace for sorting out washing etc. this could be a fold up worktop which could be attached to the wall on entering the laundry room, this is then folded away when the trolleys are returned after delivering clothing. Residents looked well dressed and were complimentary about the laundry service, although a number of residents were not wearing socks, stockings etc. When a member of staff was asked why not the said they mustn’t have come up from the laundry, this was discussed with the manager who said she would
Courtland Lodge DS0000019325.V324669.R01.S.doc Version 5.2 Page 15 look into it and ensure that socks, stockings etc are available for all individuals in line with their choice. In the main reception area there is a fireplace and comfortable seating, this would benefit the residents if the lounges on the units could create a similar ambience and they would look less institutional with various seating to meet the residents needs and choices. Courtland Lodge DS0000019325.V324669.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Robust procedures are in place to ensure that residents are protected at all times. The numbers and deployment of staff appear to meet the needs of the residents. EVIDENCE: Two recently employed staff files were examined and these showed that all the relevant checks had been carried out prior to commencing their employment at Courtlands Lodge. Examination of the rotas showed that adequate numbers of staff were deployed to meet the personal care needs of the residents. One member of staff gave reassurance and guidance to a resident who was unsure of where to go to have a cup of tea. Quantum Care provides an on-going training programme to ensure staff have regular updates on care practise and they are competent in their role. Courtland Lodge DS0000019325.V324669.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a good management structure in place. The health welfare and safety of residents, staff and visitors to the home is protected at all times. Risk assessments need to be individualised and contain more relevant information. EVIDENCE: The manager continues to ensure that staff receive appropriate training and also ensure she to updates her skills and competency. All statutory records were available for inspection and were well maintained with the exception of the medication records (see health and personal care section for further details). Good policies are in place cover health, safety and welfare of all residents, staff and visitors.
Courtland Lodge DS0000019325.V324669.R01.S.doc Version 5.2 Page 18 Although a check was not carried out at this inspection previous inspection have shown that residents monies held is well managed and a company audit is also carried out yearly. Policies and procedures are in place for the management of residents’ finances. The manager ensure that the Commission For Social Care Inspection is informed under regulation 37 any events that effect the well being of a resident, examination of the accident and incident records showed these are well documented and a monthly audit is carried out and any trends looked into such as time of incident, where the accident occurred etc. Although risk assessments are in place these are generic form created by the company and these should be individualised for each resident and include information that is relevant to them and their setting. Courtland Lodge DS0000019325.V324669.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Courtland Lodge DS0000019325.V324669.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13 (2) Requirement Timescale for action 31/01/07 2 OP10 12(4)(a) Medication procedures must be followed to ensure that medication can be reconciled at any time. Packets need to be dated on opening. A decision must be made as to where given as required medication is recorded. Staff must be reminded to 31/01/07 protect the privacy and dignity of residents at all times, especially during moving and handling. Courtland Lodge DS0000019325.V324669.R01.S.doc Version 5.2 Page 21 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 OP7 Good Practice Recommendations Daily records should include the date on every page and night sheets should include both the start and finish dates to provide less confusion and allow an audit to take place at any time. Monthly reviews should be more detailed including whether the care needs are being met or not. Health information should be followed through and recorded with the care notes, for example where a test has been taken the results should be recorded. Old recording sheets should be archived when no longer in use. Additional activity hours should be sought to provide more stimulation for the residents and residents consulted for their ideas. Provide daily menus in large print in all dining rooms. An additional worktop should be provided in the laundry for the sorting and folding of clothes. Where generic risk assessments have been written these should be individualised for a specific residents and not just by adding their name. 2 3 OP7 OP8 4 5 6 7 OP12 OP15 OP26 OP38 Courtland Lodge DS0000019325.V324669.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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