Inspection on 29/12/05 for Heath Lodge

This inspection was carried out on 29th December 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 27/04/05

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 Claire Farrier Unannounced Inspection 11:30 29 December 2005 th 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 Heath Lodge DS0000063065.V259298.R01.S.doc Version 5.0 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. Heath Lodge DS0000063065.V259298.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Heath Lodge Address Danesbury Park Road Welwyn Hertfordshire AL6 9SN 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) 01438 716180 01438 716181 Gold Care Homes Limited Care Home 50 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (50), Old age, not falling within any other of places category (50) Heath Lodge DS0000063065.V259298.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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 leaves the home for any reason. 27th April 2005 Date of last inspection 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 has been converted to provide additional accommodation, which has not yet been registered for use as part of the home. The premises are set in extensive grounds but, while accessible by care, are not close to public transport or local amenities such as shops. Heath Lodge DS0000063065.V259298.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place during one day, and including preparation time it took a total of 8 hours. The main focus of the inspection was the dementia unit. The inspector spoke with four residents and three members of staff, and discussion took place with the manager. The interaction between residents and staff was observed. A tour of the premises was carried out, and the records were checked of residents’ care, health and safety, staffing and residents’ money. Further improvements have been made in the home since the last inspection. One additional visit were made to the home on 2nd August 2005 by the Pharmacy Inspector to undertake a specialist pharmacist inspection of the service, and 7 requirements and 2 recommendations were made on this occasion to improve the administration of medication in the home. The Regulation Inspector carried out a further additional visit on 15th October 2005. This was the second inspection of the year. Core standards that were not inspected on this occasion were assessed to have been met in the previous inspection report, to which reference can be made. What the service does well: The home looked clean and comfortable, and the residents spoken to were relaxed and happy. The home is now fully staffed. All the care staff spoken to were enthusiastic about their work. The staff were observed to have a good relationship with the residents and to treat them with courtesy and respect. Heath Lodge DS0000063065.V259298.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? The last inspection found that considerable improvements were required to most areas of the home. A serious concerns meeting took place on 4th October 2005, and an additional visit was carried out on 15th October 2005. There were several areas of concern relating to the environment, and the following requirements were made: 1. The privacy and dignity of service users must be observed. 2. The garden must be suitable and safe for use by service users. 3. There were several areas of the home in a state of disrepair. These included: curtains in service users bedrooms that were hanging from broken rails, a very poor standard of bedding/hygiene was discovered in three service users bedrooms, faeces was smeared over one service users bedroom wall, broken furniture was discovered in two service users bedrooms and marker pen had been used to “label” service users clothes. 4. The home must be free from offensive odours. 5. Menus had not been reviewed since 2001. There was very little evidence to confirm that service users have the benefit of fresh fruit and vegetables. The dry food cupboard was sparse and stock was very limited. The proprietors have worked hard to make improvements in the home since the last inspection. The home has been redecorated and new furniture is currently being installed in residents’ bedrooms. The home looked very clean throughout, and there was no evidence of offensive smells. New industrial laundry equipment has been installed, and the procedures for control of hygiene are satisfactory. The manager and chef have worked together to provide a four week cycle of menus that provides a good choice of nourishing meals. Evidence was seen that the meals are prepared using fresh vegetables and fresh fruit was available for the residents. All the care plans have now been updated, and they provide a good format although in some cases not enough detail of the residents’ care needs. Heath Lodge DS0000063065.V259298.R01.S.doc Version 5.0 Page 7 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 DS0000063065.V259298.R01.S.doc Version 5.0 Page 8 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 Heath Lodge DS0000063065.V259298.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 4 The care workers provide adequate care to meet the personal care needs of the residents. However there is no provision for meeting the specific needs of people with dementia. The residents in the dementia unit live in a safe and caring environment, but the provision is of containment rather than skilled and responsive care. EVIDENCE: Serious concerns have been reported on the care provided by the home, and Social Services have taken the action of stopping all admissions. The company has worked very hard to improve the levels of staffing, training, care plans and environment, and a few days after this inspection the restriction on admissions was lifted, although only to a maximum of 45 places. The care plans provide the care workers with appropriate information to enable them to meet the needs of most of the residents, although in some cases the details could be improved (see Standard 7). The home has a team of permanent staff, and all staff undertake the minimum requirements for mandatory training (see Standard 30). Heath Lodge DS0000063065.V259298.R01.S.doc Version 5.0 Page 10 Some of the residents have been assessed for nursing care, and it is understood that appropriate placements are being identified for them. In some cases it is difficult to place a precise timescale on this, but the acting manager is aware that the home cannot provide accommodation indefinitely for residents whose need cannot be met there. The home is registered to provide dementia care for all the residents, and there is a separate dementia unit for up to 13 residents. However no evidence was seen of any specific provision for people with dementia. The care plans do not address the specific needs of people with dementia, and there are no behaviour programmes in place. The care plan for one resident stated, “She sometimes hits others. Staff advised to monitor.” Another care plan stated, “Distraction if she is agitated. Discourage disruptive behaviour.” But there were no further details for understanding and managing these behaviours. The environment provides no aids for orientation and differentiation to enable the residents to recognise where they are and find their way around more easily. One resident chooses to sleep in a chair rather than the bed, and this is recorded in her care plan. But there is no easy chair in her room, and it was reported that she usually sleeps in a chair in the lounge. Her room is at the furthest distance from the lounge, and she does not like going there, but no consideration has been given to moving her room to one closer to the lounge, and providing a suitable chair in her room for her to sleep in. The corridors and doors to the rooms are decorated in the same dark colours and there are no different textures, lighting or colours in any part of the unit. The unit does not have its own specialised team of care workers, and any of the staff may be asked to work on the dementia unit at any time. There is no evidence of liaison with mental health services for support and advice, and none of the staff have had training in dementia care. The staff were observed to be attentive and caring. They reacted to the way the residents were behaving to ensure their safety, but there was no sense of proactive measures to understand and manage the behaviours. If Gold Care Homes wish to continue to offer a provision for dementia care, they must take measures to ensure that the staff have the training and professional support to enable them to understand and meet the complex needs of the residents. The Responsible Individual is also advised to consider reducing the number registered for dementia care. Heath Lodge DS0000063065.V259298.R01.S.doc Version 5.0 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9 The needs of residents are clearly set out in care plans to ensure that all their needs are identified and can be met. Further details are needed for individual needs for personal care and health care, and for appropriate risk assessments. Several errors have been identified in the administration and recording of medication, which could cause a risk to the health of the residents. EVIDENCE: Detailed case tracking was carried out through the files of three residents. All the care plans that were seen have been rewritten into a new format. They contain clear and easily accessible information on the resident’s care needs, with comprehensive procedures for meeting the needs. Appropriate goals are identified for each person, related to personal care, health care and activities. Examples seen include personal care needs, activities and a night care plan. However there are no specific care plans or details for behaviour management for people with dementia (see Standard 4). Heath Lodge DS0000063065.V259298.R01.S.doc Version 5.0 Page 12 The goals and procedures for personal care, although detailed, are the same for each person. There is no evidence that the residents or their relatives have been involved in writing their care plans, and the care plans are not signed by the residents or their representative. It is recognised that a great deal of work has taken place to implement the new care plan format. The next stage should be to ensure that the individual needs and wishes of each resident are effectively recorded and implemented. This can be completed through the process of comprehensive annual reviews. Risk assessments are in place for each resident, including for the risk of falls for all residents, and for individual needs such as being unable to use the call bell. However there were no risk assessments for the use of a free standing oil-filled radiator in bedrooms (see Standard 38) or for the appropriate and safe use of a reclining chair (see Standard 38). The care plans contain details of each resident’s health needs. Every resident has had recent assessments for moving and handling, pressure areas, continence and nutrition. There is good recording of contacts with GP and district nurses, and the district nurses visit regularly to attend to dressings. None of the residents had pressure sores at the time of the inspection. The Waterlow assessment for pressure areas for one resident showed that she is “at risk”, and her care plan stated that she should have cream applied daily as she “gets redness at times”. However not all health needs are recorded appropriately. One care plan stated that the resident is a diet controlled diabetic, but there were no details of her need for a specific diet. One resident is seated in a reclining chair in the lounge without effective support, and poor moving and handling techniques were observed to move her (see Standard 38). The care plan contained no details of the need for using a reclining chair, and no procedures to ensure its safe use. There was no professional assessment for the need to use the reclining chair as a restraint, in order to protect the resident from harm. The acting manager had written a care plan that had not been put into the resident’s file, although the chair was already in use. The care plan seen did not fully address the concerns above, and the need for a professional assessment. Medication was not inspected on this occasion. The Pharmacist Inspector visited the home on 2nd August 2005 and made seven requirements and two recommendations to improve the administration and recording of medication in the home. Heath Lodge DS0000063065.V259298.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 and 15 The staff respect the right of the residents to make choices about their lives and maintain their independence. Wholesome and varied meals are provided within the home presenting a well-balanced nutritious diet for the residents EVIDENCE: Residents are able to look after their own finances if they wish to, although in practice for the majority their families take care of their financial affairs. They are able to bring their own possessions into the home. The manager has a contact number for Age Concern advocacy service if it is needed. It was suggested that some Age Concern leaflets should be made available in the home. An improvement was seen in the standard of food provided in the home. The manager and chef have worked together to provide a four week cycle of menus that provides a good choice of nourishing meals at lunchtime. A cooked breakfast is available every day, and the kitchen assistant prepares an evening meal, for example soup, burgers, macaroni cheese or sandwiches. Evidence was seen that the meals are prepared using fresh ingredients. Meat is delivered every day and fresh vegetables are used. Fresh fruit is available for the residents. Heath Lodge DS0000063065.V259298.R01.S.doc Version 5.0 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 the following standard(s): 16 and 18 The home has a satisfactory complaints procedure in place, which ensures that any complaints will be properly investigated. Training on prevention of abuse has been made available for the staff, but the training and polices are not currently robust enough to ensure confidence in protection of the residents. EVIDENCE: The complaints procedure contains the procedure for investigating complaints, but it should be amended to state that a complaint may be referred to the CSCI at any stage of the proceedings. The complaints file was seen. It contains letters of complaint and the manager’s response. The complaints seen concerned cleanliness, laundry, smells and the level of care. The responses were satisfactory, and it was reported that all the complainants are satisfied with the responses. However there is no record of the complaints and the investigation process. It is recommended that a complaints log should be maintained to record and monitor the process and outcome of the investigation. Heath Lodge DS0000063065.V259298.R01.S.doc Version 5.0 Page 15 Training in prevention of abuse has been arranged. Two courses have taken place and two more are arranged. One member of staff who has already attended the training was aware of her responsibilities for reporting any concerns, and felt confident to do so if needed. However the manager was not confident of the procedures for dealing with allegations of abuse, and he was not aware of the role of Social Services in investigating complaints. There was no copy of the Hertfordshire joint agency procedures in the home, and the home’s policy on prevention of abuse does not relate to the Hertfordshire joint agency procedures. Heath Lodge DS0000063065.V259298.R01.S.doc Version 5.0 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 the following standard(s): 19, 20, 24, 25 and 26 A great deal of improvement has been made to the decoration, furnishings and cleanliness of the home. The home provides a comfortable environment for the residents. Some further improvements are needed, especially to ensure that the individual and communal facilities are appropriate for the residents’ needs. Heath Lodge DS0000063065.V259298.R01.S.doc Version 5.0 Page 17 EVIDENCE: The last inspection found that considerable improvements were required to most areas of the home. A serious concerns meeting took place on 4th October 2005, and an additional visit was carried out on 15th October 2005. There were several areas of concern relating to the environment, and the following requirements were made: 1. The privacy and dignity of service users must be observed. 2. The garden must be suitable and safe for use by service users. 3. There were several areas of the home in a state of disrepair. These included: curtains in service users bedrooms that were hanging from broken rails, a very poor standard of bedding/hygiene was discovered in three service users bedrooms, faeces was smeared over one service users bedroom wall, broken furniture was discovered in two service users bedrooms and marker pen had been used to “label” service users clothes. 4. The home must be free from offensive odours. Further improvements were seen in the home on this occasion. Every carpet has been deep cleaned, and it was reported that the domestic staff have been trained in the use of cleaning products to prevent offensive odours. New furniture and bedding has been provided for the bedrooms, and all the bedrooms are thoroughly cleaned when they are refurnished. Some bedrooms still need redecoration, but the work is in progress. The majority of bedroom doors still have no handles and no locks. There were no chairs in any of the bedrooms seen. Comfortable seating for two people should be provided in all bedrooms. A comfortable chair is particularly important for one resident who chooses to sleep in a chair rather than the bed. This is recorded in her care plan but there is no easy chair in her room, and it was reported that she usually sleeps in a chair in the lounge. (See also Standard 4.) A new laundry has been installed in the basement, with modern industrial washing machines and tumble driers. The laundry procedures ensure that laundry is handling and washed appropriately. Individual name labels have been purchased for each resident, and the staff are in the process of sewing them onto their clothes. Heath Lodge DS0000063065.V259298.R01.S.doc Version 5.0 Page 18 The inspection took place on a cold December day, when the outside temperature was 0°C. Although the heating was on, several bedrooms felt very cold. The running hot water hand tested in all bathrooms and a sample of bedrooms varied between cold and lukewarm. The record of water temperatures showed temperatures between 38°C and 40°C. It was reported that a problem with the boilers is being addressed, but effective measures must be taken to ensure that heating and hot water in the home are a sufficient temperature for the comfort of the residents. A member of staff was observed running a bath for a resident. The water was lukewarm and there was no thermometer available to check the temperature of the water. The acting manager gave an assurance that residents are not bathed in cold water, but there was no evidence to support this and the inspector did not feel confident about the risk of residents being bathed in cold water. It was reported that a fence will be installed around the patio area outside one of the lounges. The work is scheduled to be carried out in January, but the requirement has been repeated as it was not completed within the timescale given in the last report. Heath Lodge DS0000063065.V259298.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Staff numbers in the home are sufficient to ensure that all the residents’ needs are met. There is sufficient basic training, but a lack of training for specialised dementia care. Good recruitment procedures and make sure that, as far as possible, the residents are supported and protected in the home, but further training in adult protection is needed. EVIDENCE: The home is fully staffed with a team of permanent staff, and no agency workers have been employed in the last two weeks. The staffing rotas show that there are seven care assistants and one senior in the morning, six care assistants and one senior in the afternoon and evening, and three care assistants and one senior during the night. It was reported that there are two care assistants in the dementia unit at all times. The dementia unit does not have a dedicated staff team, and none of the care assistants spoken to have had any training in dementia care (see Standard 4). The training attendance file shows that the training that has recently taken place includes fire safety, emergency first aid, health and safety and risk assessment. The induction training programme for new staff includes all the mandatory training and takes place during the 16 week probationary period. Training in prevention of abuse has been arranged. Two courses have taken place and two more are arranged, to include all the staff in the home. (See Heath Lodge DS0000063065.V259298.R01.S.doc Version 5.0 Page 20 Standard 18.) The staff spoken to said that they have had no training in dementia care. It was reported that this has been arranged, but there was no evidence of this. All staff working on the dementia unit must have appropriate specialised training in meeting the needs of people with dementia, including an appropriate certified training for senior staff on the dementia unit. (See Standard 4.) No staff have NVQ qualifications, but six are currently working towards NVQ level 3, one towards NVQ level 2, and others are being encouraged to apply for the training. The home is actively working towards achieving the standard of 50 qualified staff. The files of five members of staff were inspected. It was reported that an audit has been carried out to identify the missing information in each staff file, but this has not yet been completed. There was no evidence of references in three of the files, and only one reference in another. It was reported that the references were seen, but they were then sent to the Home Office with applications for work permits, and copies were not kept. Many of the staff are recruited abroad to work in the home, and they have accommodation provided for them at Heath Lodge. Work permits are in place where appropriate. The staff who are recruited abroad have criminal record declarations from their country of origin, but for one person this was from the home country of the Philippines, although they were recruited in Israel. The regulations state that a CRB (Criminal Record Bureau) and POVA (Protection of Vulnerable Adults register) disclosure must be in place for every member of staff. It is accepted that this is impractical for staff recruited from abroad, and it is recommended that a CRB and POVA disclosure should be applied for within three months of entering the country and starting work in the home. Authorised copies of the original references must be kept in the home. Heath Lodge DS0000063065.V259298.R01.S.doc Version 5.0 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Gold Care is in the process of implementing procedures to ensure that the home is managed effectively for the benefit of the residents. 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: A new acting manager has been appointed since the last inspection. He has four years experience as an assistant manager and he is a qualified NVQ assessor. He will start the RMA (Registered Managers Award) course when a suitable course is identified. Gold Care continues to provide support for him, and the Operations Manager visits the home several times a week. It was reported that Gold Care has a system for quality assurance that includes internal audits and questionnaires for the residents. Audits of the personnel Heath Lodge DS0000063065.V259298.R01.S.doc Version 5.0 Page 22 files, environment and crisis management have been carried out in the past two months, and evidence was seen during this inspection of improvements in all these areas as a result. A formal system for obtaining and analysing the views of the residents has not yet been set up in the home, but it is intended that bi-annual questionnaires will be circulated, and the results will be published in the services users guide. The arrangements for management of residents’ money were inspected and appeared to be accurate. Money is stored safely and adequate records are maintained in order to protect service users from financial abuse. 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. Since the last inspection two fire drills have been held in the home, one planned and one as the result of a fire alarm. There was no record that these have taken place. Two health and safety concerns were noticed during the inspection. 1. One resident was seated in a reclining chair in the lounge of the dementia unit. The staff said that the chair is used in order to prevent her from crawling on the floor, which causes injury to her legs. There was no care plan in her file on the unit to address this, but a recently written care plan for use of the chair was later seen in the office. The care plan does not contain a procedure for ensuring that she sits safely in the chair, and there is no professional assessment for use of the chair. Although the chair is used in order to prevent further injury, it is also a means of restraint. There is no risk assessment in place for the proper use of the chair as a means of restraint in order to prevent injury. The resident was observed to have slipped down in the chair so that her back was not supported and her feet hung over the end of the chair, putting pressure on her ankles. When this was pointed out two care assistants moved her to a better position using poor techniques and without the use of suitable aids. The acting manager reported that sliding sheets and handling belts are available, but these were not seen. 2. One resident sleeps on a mattress on the floor of her bedroom. It is recorded in her care plan that this is due to the risk of her falling out of bed. She also crawls on the floor in preference to walking. Her bedroom was observed to be very cold, and a freestanding oil-filled radiator had been put in the room, which had very hot surfaces and sharp edges. There was no record of the use of this radiator in her care plan and no risk assessment for its use. Heath Lodge DS0000063065.V259298.R01.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 X X X 2 2 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Heath Lodge DS0000063065.V259298.R01.S.doc Version 5.0 Page 24 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP4 Regulation 12(1)(b) Requirement The home is registered to provide dementia care for all the residents, and there is a separate dementia unit for up to 13 residents. However no evidence was seen of any specific provision for people with dementia. Appropriate and adequate provision must be made to meet the specific needs of people with dementia. This includes an experienced and skilled staff, appropriate environment and appropriate activities. Care plans must address the assessed needs of people with dementia, including and specifically in terms of management of behaviour, and where appropriate seek advice from the mental health services. Timescale for action 31/03/06 Heath Lodge DS0000063065.V259298.R01.S.doc Version 5.0 Page 25 2 OP7 12(2) & (3) The care plans seen contained details of the residents’ needs, but there was no indication of the needs and wishes of individual residents. Measures must be put in place to ensure that residents are involved in decisions about their care, and that these are recorded appropriately. The care plans should be signed by the resident or their representative. Some risk assessments are in place, but specific risks for individual residents have not been recognised and recorded. Appropriate and adequate risk assessments must be put in place for all residents, and kept under review. One care plan stated that the resident is a diet controlled diabetic, but there were no details of her need for a specific diet. All health care needs must be recorded appropriately in order to prevent any avoidable risks to the resident’s health. 7 requirements and 2 recommendations were made following an inspection by the Pharmacist inspector on 2nd August 2005. Medication was not inspected on this occasion. All medication must be administered and recorded in accordance with the Royal Pharmaceutical Society guidelines. 30/06/06 3 OP7 13(4)(c) 31/03/06 4 OP8 12(1)(a) 31/03/06 5 OP9 13(2) 30/09/05 Heath Lodge DS0000063065.V259298.R01.S.doc Version 5.0 Page 26 6 OP18 13(6) Training on prevention of abuse has been made available for the staff, but the training and polices are not currently robust enough to ensure confidence in protection of the residents. 31/01/06 7 OP19 23(2)(o) The registered person must ensure that every member of staff in the home, including domestic staff and including the manager, attend training on prevention of abuse that includes the local Hertfordshire joint agency procedures. The policy on prevention of abuse must be changed to include the role and responsibility of Hertfordshire Social Services to investigate allegations of abuse. A copy of the Hertfordshire adult protection procedures must be kept in the home. (Previous timescale of 30/06/05 for provision of training not met.) 31/01/06 The garden area of the home must provide suitable access and protection for all service users. A suitable boundary fence must be erected. It was reported that this work is scheduled to be carried out during January 2006. (Previous timescales of 30/06/05 and 11/11/05 not met.) Heath Lodge DS0000063065.V259298.R01.S.doc Version 5.0 Page 27 8 OP24 23(2)(e) The majority of bedroom doors still have no handles and no locks. There were no chairs in any of the bedrooms seen. A comfortable chair is particularly important for a resident who chooses to sleep in a chair. All bedroom doors must be fitted with locks to ensure privacy for the residents. Suitable seating must be provided in bedrooms, and in particular a suitable chair must be provided for a resident who likes to sleep in a chair. (Previous timescale of 11/11/05 for provision of locks not met.) Although the heating was on, several bedrooms felt very cold. The running hot water hand tested in all bathrooms and a sample of bedrooms varied between cold and lukewarm. The record of water temperatures showed temperatures between 38°C and 40°C. Effective measures must be taken to ensure that heating and hot water in the home are a sufficient temperature for the comfort of the residents. Thermometers should be provided in all bathrooms to ensure that the bath water temperature is appropriate for the residents’ use. 31/01/06 9 OP25 23(2)(p) 31/01/06 Heath Lodge DS0000063065.V259298.R01.S.doc Version 5.0 Page 28 10 OP29OP37 17(2), 19(1)(b) The staff files seen did not contain satisfactory evidence of the fitness of the person to work in the home. All the required information on staff, as listed in Schedule 2 and Schedule 4(6) of the regulations, must be kept in the home, including appropriate references and evidence of satisfactory CRB and POVA checks. For staff who are recruited from abroad, a CRB and POVA disclosure should be applied for within three months of entering the country and starting work in the home. Authorised copies of the original references must be kept in the home. (Previous timescale of 31/05/05 not met.) The staff spoken to said that they have had no training in dementia care. It was reported that this has been arranged, but there was no evidence of this. All staff working on the dementia unit must have appropriate specialised training in meeting the needs of people with dementia. An appropriate certified training should be considered for senior staff on the dementia unit. (See also Regulation 18(1)(c)(i)) 31/01/06 11 OP30 12(1)(b) 31/03/06 Heath Lodge DS0000063065.V259298.R01.S.doc Version 5.0 Page 29 12 OP38 13(4)(c) One resident is seated in a reclining chair in the lounge without effective support, and poor moving and handling techniques were observed to move her. A full professional assessment must be carried out for the resident who uses a reclining chair. This should ensure that the chair is used for her comfort and not as a measure of restraint. It should also address the measures required to ensure that she is positioned safely and comfortably in the chair at all times. (See also Regulation 13 (5), (7) & (8)) One resident sleeps on a mattress on the floor of her bedroom. Her bedroom was observed to be very cold, and a freestanding oil-filled radiator had been put in the room, which had very hot surfaces and sharp edges. 31/01/06 13 OP38 13(4)(c) 29/12/05 14 OP38 23(4)(e) A risk assessment must be carried out on the use of a free standing oil-filled radiator in any resident’s bedroom where they are installed. Immediate action must be taken to ensure that residents are not at risk of injury. It was reported that two fire 31/03/06 drills have taken place in the home in the last two months, but there was no evidence of this. Records must be maintained to show that all staff take part in at least one fire drill every year. Heath Lodge DS0000063065.V259298.R01.S.doc Version 5.0 Page 30 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 OP4 Good Practice Recommendations The Responsible Individual is advised to consider whether to reduce the number registered for dementia care and make proper provision, or to remove this category altogether. The complaints procedure should be amended to state that a complaint may be referred to the CSCI at any stage of the proceedings. It is also recommended that a complaints log should be maintained to record and monitor the process and outcome of the investigation. 2 OP16 Heath Lodge DS0000063065.V259298.R01.S.doc Version 5.0 Page 31 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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