Inspection on 27/04/05 for Heath Lodge

This inspection was carried out on 27th April 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Heath Lodge 01/05/07

Heath Lodge 20/04/06

Heath Lodge 29/12/05

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Heath Lodge Danesbury Park Road Welwyn Hertfordshire AL6 9SN Lead Inspector Julia Bradshaw Unannounced 27 April 2005 10:00 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. Heath Lodge I52 s63065 Heath Lodge v222405 270405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Heath Lodge Address Danesbury Park Road Welwyn Hertfordshire AL6 9SN 01438 716180 01438 716181 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) Gold Care Homes Limited Mrs Liz Green (awaiting registration) Care Home 50 Category(ies) of DE Dementia 1 registration, with number DE(E) Dementia - over 65 - 50 of places OP OP Old age - 50 Heath Lodge I52 s63065 Heath Lodge v222405 270405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: The home may accommodate one named service user who is currently under the age of 65. The above condition applies only to this named service user and ceases to be in force when the service user permanently leaves the home for any reason. Date of last inspection 1/4/05 Brief Description of the Service: Heath Lodge provides residential care for up to 50 older people. This includes a separate dementia unit accommodating up to 13 service users. The residential accommodation is arranged on three floors. The dementia unit is on split-levels and thus is not suitable for wheelchair users. The third floor comprises privately rented flats and does not form part of the registration.The premises are set in extensive grounds but, whilst accessible by car, are not close to either public transport or local amenities such as shops. Heath Lodge I52 s63065 Heath Lodge v222405 270405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the first unannounced of this year. It took place in morning to mid afternoon. The inspector-spent time talking to several staff on duty, 15 service users and the newly appointed manager, who is awaiting registration Time was spent with the manager discussing the progress and plans for the future, looking through records and care plans. Time was also spent touring all areas of the building and the grounds. What the service does well: Several service users spoken to during the inspection stated that they were “very happy” with the service that they receive and have noticed an improvement in several areas of the service since the new organisation took over. Care practice observed was individualised and dignified. All relatives and visitors spoke highly of the service. Some of the service users bedrooms are beautifully decorated, displaying family photos, pictures and items of personal interest. Staffing levels provided in the home are adequate. Staff members spoken to were very positive about the home and appeared committed to their work. There is plenty of opportunity for staff to progress within their role and training and development is very much encouraged. Heath Lodge I52 s63065 Heath Lodge v222405 270405 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. Heath Lodge I52 s63065 Heath Lodge v222405 270405 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 Heath Lodge I52 s63065 Heath Lodge v222405 270405 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) 1,3,5,6 Prospective service users individual aspirations and needs are assessed and reviewed, enabling the service user and the home to continuously review the individuals care package provided. Information provided to the service user about the home is inadequate. EVIDENCE: The current Statement of Purpose is held within the home and all prospective and current service users are provided with a copy. However the current Statement of Purpose must contain all the information for the service user to make an informed choice about where to live. The content must be suitable to meet individual needs. The Statement of Purpose requires amendments to reflect the new organisational changes and the change in management. Assessments of each service users needs and aspiration are made before the service user moves into the home. The assessments carried out within the home are continuous and changing needs are identified. The manager carries out these initial assessments. The home also receives and seeks external Heath Lodge I52 s63065 Heath Lodge v222405 270405 Stage 4.doc Version 1.30 Page 9 specialist support to meet the individual service users needs. The previous management had not held whole life reviews regularly. However the newly appointed manager has stated that these reviews will be arranged and held on a regular basis and completed for all service users by the end of 2005.The home provides a respite care service and records checked on the day of the inspection demonstrated that the current service users receiving this provision had been assessed appropriately. New contracts must be provided in order to reflect the new changes to the organisation. Heath Lodge I52 s63065 Heath Lodge v222405 270405 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) 7,9,10 Personal care and assistance offered to service users has improved considerably since the new manager has been in post. There are now adequate numbers of staff on both the morning and evening shifts to ensure that service users receive the support and care they require. All staff observed on the day of the inspection approached the service users with of a high regard for their dignity and were unobtrusive and sensitive in their manner. EVIDENCE: Manual handling risk assessments were available on file and the manager has worked hard to implement individual risk assessments for service users living within the MPE unit. Service users care plans are currently being revised and updated using the company’s new format and therefore these documents will be fully inspected during the next visit. in order to allow the new manager and staff to complete this important and complex task. The home appears to have well-established links with various outside professional health care experts, including the local mental health service. The home also receives a positive and effective service from the local GP’S and health care professionals. Service users are able to maintain their own GP Heath Lodge I52 s63065 Heath Lodge v222405 270405 Stage 4.doc Version 1.30 Page 11 wherever possible. There are regular visits from other professionals, which include opticians, dentist and chiropodist. The manager is currently revising the current medication procedures within the home and has appointed a senior member of staff as the medication cocoordinator. The home has also just arranged a new pharmacy contract with a local pharmacist. Staff were observed assisting service users with their lunchtime meal within the main diningroom. Several issues were identified during this time including, ONE member of staff endeavouring to assist two service with eating their meal. This issue was discussed with the manager and addressed with the member of staff immediately. Heath Lodge I52 s63065 Heath Lodge v222405 270405 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) 12,13,15 Recently, the choices and individual preferences of service users have been recognised much more effectively by the new manager and staff and service users have been involved and consulted about aspects of daily life and recreational activities. Visitors are welcome and the home appears to have a very open and inclusive atmosphere. The standard of meals within the home was inadequate and failed to meet some of the service users dietary needs. EVIDENCE: The home’s location is both isolated and removed from any local shops or amenities and therefore effects service users opportunities to be independent. This therefore requires the home to be more creative in providing useful and meaningful recreation and social pursuits within the home. The new manager has planned for a local entertainer to come into the home in May and also a clothes party for all service users to enjoy. There is also a hairdresser that visits twice a week. The home should endeavour to provide trips out of the home during the summer months. The manager has been using the activities co-coordinator from a sister home to provide activities within the home for the past month. However this arrangement is not a long-term solution and therefore a new activities co-ordinator will hopefully commence work within the home in the next week. Several service users complained about the standard Heath Lodge I52 s63065 Heath Lodge v222405 270405 Stage 4.doc Version 1.30 Page 13 of the food and stated “they never receive roast or new potatoes, not even on Christmas day”! Only one choice of desert was offered on the day of the inspection. The choice of drinks appeared limited. There was a discussion with the manager regarding the possibility of offering a small sherry before Sunday lunch as an appetizer would be beneficial .The meal sampled on the day of the inspection was quite bland and the vegetables over cooked. There is a recommendation that the manager reviews the current menus and involves the advice and support of the local dietician. Heath Lodge I52 s63065 Heath Lodge v222405 270405 Stage 4.doc Version 1.30 Page 14 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) 16,18 The complaints procedure within the home is sufficient and adequate in order for the service users to feel that their individual views are listened to. EVIDENCE: The home is currently using an existing complaints procedure from the previous proprietors. However, this is in the process of being replaced by the new proprietors policy, which will details all complaints are responded to within 28 days. A record is maintained within the home of complaints made detailing actions and outcomes as necessary. Several service users spoken to confirmed that they knew how to complain and were able to point out in various parts of the home where the complaints procedure was displayed. The complaints procedure requires updating to include the correct contact details of the CSCI. However, the home must ensure that all staff receives the appropriate Adult protection training in order to carry out their role effectively. There was inadequate information to confirm that this had been carried out within the past year. Staff employed within the home are all subject to enhanced Criminal Records Bureau (CRB). Staff personnel files were not inspected on this occasion as a a staff audit needs to be completed on all staff working within the home to ensure all the correct recruitment procedures were carried out by the previous manager. There are some concerns that a proportion of overseas staff who were recruited by the previous manager have not completed all the necessary paperwork required.( see requirements) Heath Lodge I52 s63065 Heath Lodge v222405 270405 Stage 4.doc Version 1.30 Page 15 Heath Lodge I52 s63065 Heath Lodge v222405 270405 Stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,24,25,26 There are considerable improvements required to most areas of the home. The service users independence is currently restricted due to the home’s location and inaccessibility to the external areas of the home. The service users health and safety is currently compromised due to unsafe practices and procedures within the home. EVIDENCE: All areas within the dementia unit require attention, including eradicating the pungent odour within the main corridor and in some of the bedrooms. The communal areas also require brightening up as the walls are bare and offer no interest or stimulation to the service users. Service users are encouraged to bring personal items such as furniture and pictures into their room when they move in. However there is a vast difference in the standard of furnishings and fittings within the home. The area manager has recently completed an audit in relation to bedding and furnishing and fittings throughout the home and therefore service users should enjoy the benefits of new bedding and furniture before the next inspection takes place. There was a lack of evidence on the day of the inspection that the fire procedures within the home are being adhered to with no evidence of a recent fire drill. Therefore an immediate requirement has been made. Some of the Heath Lodge I52 s63065 Heath Lodge v222405 270405 Stage 4.doc Version 1.30 Page 17 bedroom doors do not have locks fitted and therefore service users privacy and independence is currently compromised. The manager has been asked to carry out a full audit of the building in relation to monitoring of maintenance and repairs that require attention. Generally the home appeared clean and the service users laundry is being well managed and all individual clothing is labelled. The manager and staff are working hard to improve and develop the communal areas of the home and the new proprietors are committed in providing the financial support to do this. Hot water temperatures within the home are checked on a regular basis and on the day of the inspection were being delivered within safe limits. The bedroom window in room 34 requires attention as it has been sealed up and currently provides limited ventilation for the service user. The fire extinguisher outside room 47 needs re-attaching to the wall. Heath Lodge I52 s63065 Heath Lodge v222405 270405 Stage 4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 Staffing levels have been increased within the home and now provide adequate cover on all three shifts. Recruitment policies and personnel records must be fully audited by the new manager in order to ensure procedures have been followed in the protection and safety of the service users. The manager is providing adequate staff training (except with regard to Adult Protection). EVIDENCE: On the day of the inspection the rota confirmed that there were adequate care staff on duty to support the 48 service users. The manager is supernumerary to these ratios. The manager has recently reviewed the current working practices of staff working in excess of 12-hour shifts. This practice has now ceased and staff receive adequate breaks to ensure they are not exceeding the working time directive. Service users were complimentary about the staff and management of the home. Stating ‘ the carers are good, they look after us and are very kind’. There was inadequate evidence to confirm that existing staff who were appointed by the previous manager have all the necessary documentation to meet this standard. Therefore a requirement has been made for the manager to carry out a full audit on ALL the staff files. All new staff had Criminal Record Bureau Certificates on file. Heath Lodge I52 s63065 Heath Lodge v222405 270405 Stage 4.doc Version 1.30 Page 19 Staff spoken to have received appropriate training, including 3 staff who will be commencing NVQ level 2 training in May 2005, medication training, infection control, safety compliance. The manager has also arranged for dementia care training, moving and handling, to be held in May. However there was insufficient evidence to confirm that all staff have received Adult Protection training. Therefore a requirement has been made. The manager is currently endeavouring to recruit two activity co-ordinators into the home, as this is an area that needs to improve and develop. The current co-ordinator has been loaned to the home from one of the “sister” homes and is therefore not an adequate or permanent arrangement. Heath Lodge I52 s63065 Heath Lodge v222405 270405 Stage 4.doc Version 1.30 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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) 31,32,38, The new manager is working hard to improve and develop the service currently provided at Heath Lodge. There is an open and consultative approach by the manager that fosters an inclusive atmosphere for both service users and staff. The new proprietors and manager are working hard to implement new policies and procedures into the home. Current health and safety practices are inadequate and compromise service users safety. Heath Lodge I52 s63065 Heath Lodge v222405 270405 Stage 4.doc Version 1.30 Page 21 EVIDENCE: The new manager communicates a clear sense of leadership within the home, and promotes a sense of belong to its service users. Pride and dedication is taken in every aspect. Service users commented on how the manager is available at all times to consult and discuss any issues or concerns they may have. Service user meetings are currently being re-introduced into the home and the manager has just held the first of several family and carer meetings. This was both well attended and productive in providing useful information to families about the planned changes to the home and also for the families to have an opportunity to give feedback to the new manager regarding the service currently provided. All records are secure within the home and were up to date and held in accordance with the Data Protection act 1998 ensuring that service users rights and best interests are safe guarded by the homes polices and procedures. The health and safety records did not demonstrate that all the fire checks were being carried out regularly and line with the current health and safety legislation. There was no evidence that a recent fire drill had taken place.(see requirements) Heath Lodge I52 s63065 Heath Lodge v222405 270405 Stage 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 3 x 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 2 2 x x x 1 1 1 STAFFING Standard No Score 27 3 28 x 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 3 3 x x x x x 1 Heath Lodge I52 s63065 Heath Lodge v222405 270405 Stage 4.doc Version 1.30 Page 23 yes 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. 2. Standard 38.2 29.1 Regulation 23 (4) (e) 17 (2) Shedule 4 and 19.(1) (b) Paragraph s 1 to 7 of Schedule 2. 18 (1) (c) (i) 23 (2) (b) (c) & (d) 23 (2) (p) Requirement The manager must carry out a full fire drill immeidately. The manager must conduct a complete audit of all new and esxiting staff files to ensure all the required documntation has been obtained. Timescale for action 27/4/05 31/5/05 3. 4. 5. 30.1 19.1 25.2 6. 7. 8. 7.1 38.2 15.1 15.(1) 23 (4) (c) (iv) 16.2 (i) 9. 9.1 13 (2) The manager must provide Adult protection training for all staff. The manager must carry out a full environmental audit. The window in room 34 must be unsealed to allow adequate ventilation into the room.Also a window restrictor must be fitted. All service user plans must be reviewed and completed before the next inspection takes place. The fire exstinguisher outside room 47 must be attached to the wall. The manager must review the current menus and arrange for a dietician to visit the home to provide advice and training where necessary. The manager must carry out and complete a full medication audit. 30/6/05 31/5/05 30/4/05 30/6/05 28/4/05 30/6/05 31/5/05 Page 24 Heath Lodge I52 s63065 Heath Lodge v222405 270405 Stage 4.doc Version 1.30 10. 19.3 23(2)(o) 11. 1.1 4 (1) & (2) 22(1) 12. 16.1 13. 2.1 5 (1) (c) The garden area of the home must provide suitable access and protection for all service users.A suitable boundary fence must be erected. The statement of purpose and service user guide should be updated and amened to reflect the new organisation The complaints procedure must contain all the necessary information for service user to access the procedure effective and easily. The current contract must be updated to reflect the new organisations terms and conditions and signed by the service user or their representative. 30/6/05 31/5/05 31/5/05 31/5/05 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 14.1 Good Practice Recommendations The manager should consider offering sherry to service users on request. Heath Lodge I52 s63065 Heath Lodge v222405 270405 Stage 4.doc Version 1.30 Page 25 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 © 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 Heath Lodge I52 s63065 Heath Lodge v222405 270405 Stage 4.doc Version 1.30 Page 26 - 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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