Inspection on 29/01/09 for Heath Lodge

This inspection was carried out on 29th January 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Heath Lodge 02/03/10

Heath Lodge 22/01/08

Heath Lodge 11/07/06

Heath Lodge 31/10/05

Heath Lodge 05/07/05

Heath Lodge 29/09/04

Heath Lodge 13/04/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Heath Lodge St Georges Avenue Weybridge Surrey KT13 0DA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lesley Garrett     Date: 2 9 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Heath Lodge St Georges Avenue Weybridge Surrey KT13 0DA 01932854680 01932851792 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Surrey Rest Homes Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 26 Number of places (if applicable): Under 65 Over 65 0 26 dementia old age, not falling within any other category Additional conditions: 26 0 The maximum number of service users to be accommodated is 26. The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE) Date of last inspection Brief description of the care home Heath Lodge is a registered care home for up to 26 older people. It is one of four homes owned by Surrey Rest Homes Ltd. The home is a large detached house with a purpose built extension, set in a large garden in a residential road close to Weybridge railway station and town. The accommodation is on two floors with a chair lift that falls short of the last few steps to the ground floor. The home has single and double rooms, some with en-suite facilities. There is a garden to the rear of the premises and parking Care Homes for Older People Page 4 of 27 Brief description of the care home to the front of the building. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection of the care home was an unannounced Key Inspection. Mrs Lesley Garrett, Regulation Inspector, carried out the inspection and the manager represented the service. The inspector arrived at the service at 09:50 and was in the home for seven hours. It was a thorough look at how well the home is doing. It took into account information provided by the home and any information that CSCI has received about the service since the last inspection in January 2008. The manager supplied CSCI with an AQAA (Annual Quality Assurance Assessment) but it was returned to the office two months late despite a reminder letter. A discussion took place with the manager about prompt return of this document.It was recognised that this is new manager who had only been in place for a short period. This document Care Homes for Older People Page 6 of 27 was used to assist with the inspection. The inspector also spent time talking with some of the people using the service, relatives and staff members. The inspector looked at how well the service was meeting the key national minimum standards and complying with the regulations and has in this report made judgements about the standard of the service. Documents sampled during the inspection included the homes care plans, daily records and risk assessments, medication procedures, staff files, training records, and the homes safeguarding and complaints policies and procedures. From the evidence seen by the inspector and comments received, the inspector considers that the home would be able to provide a service to meet the needs of individuals who have diverse religious, racial or cultural needs. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who wish to use the service only move into the home following an assessment of their needs and the assessor is confident that their needs can be met. Evidence: During the inspection a new person was admitted to the home and it was observed that the manager and staff took time to settle the person into the home and introduce them to other people using the service. Relatives were spoken to and arrangements made with them to complete the required paperwork. A pre-admission assessment had been carried out by the manager and this contained detailed information about the person so that staff had information about the person prior to the admission to the home. During the visit we observed the person using the service who was happy to sit in the lounge talking to the person nearest to her. When we spoke to her to wards the end of the day the person using the service confirmed that they had settled in and was Care Homes for Older People Page 10 of 27 Evidence: happy with their room. The manager said that she does the pre-admission assessments. We also sampled another care plan of a person that was admitted two weeks ago and again all the necessary paperwork to allow the staff to care adequately for the person was in place. The homes statement of purpose and service user guide is available to all new admissions and both documents had been recently reviewed and updated. The home does not offer intermediate care. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people using the service receive is based on their individual needs and they also benefit from other healthcare professional support. Evidence: Three care plans were sampled. They contained detailed information about the people who use the service which enables the care staff to deliver the care that is needed to each individual. All contained individual care plans and risk assessments but they had not been reviewed since November 2008. Looking at the three care plans with the manager it was identified that the risk assessments were now out of date. The risk assessment scores on admission for these people were high. During the inspection we met and spoke with these people and how they were on the day did not match their assessment scores. The manager said that she has been at the home for a short time and that staff were in the process of reviewing all of the individual care plans. It is noted that the dependency levels of these people using the service had improved and not deteriorated and staff demonstrated a good knowledge of their care needs. A requirement will be made at the end of the report for the care plans to be kept under Care Homes for Older People Page 12 of 27 Evidence: review and in consultation with the person using the service and their representative. The care plans sampled did not show evidence that they were person centred. The manager said this was another area that the staff were to address and that this would involve input from relatives or friends. Equipment that includes hoists and height adjustable beds are provided to encourage independence for the people using the service. The person in charge said that people who use the service are registered with a local GP. A visit to the home by the GP is made every week and the manager said that the surgery is a good support to them. People who use the service have the option to retain their own GP if that doctor is willing to retain them. Other support comes from the district nurse who visits weekly, opticians who visit every month and the chiropodist who visits every six weeks. The person in charge said that a large chain pharmacy is used for the supply of medications to the home and they are delivered in blister packs. The homes policy and procedures for the safe handling of medicines was sampled and staff have access to this documentation. The manager said that the homes GP has recently reviewed the medication at the home of the people who use the service. During the inspection we observed staff knocking on the bedroom and bathroom doors prior to entering and speaking to the people who use the service in a respectful and appropriate manner. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to take part in social, religious and recreational activities and are able to exercise some choice in their daily lives. Evidence: The manager said that the home has not had the benefit of an activity organiser but a member of staff has volunteered to co-ordinate the activities in the home. The manager said that she will then produce a programme so that people who use the service, their family and friends and the staff will have information about the activities organised for that week.The manager said that most afternoons staff arrange an activity. On the day of inspection the staff had organised ball games in the lounge. We observed this activity and found that staff were interacting well with the people and encouraging them to catch the ball and throw it back to the staff member. Other activities include bingo, quizzes, music therapy and every month an entertainer visits. The manager said that the people who use the service usually enjoy the music entertainer as they explain the origins of the songs they are about to sing which brings back fond memories for them. The mobile library visits the home regularly and leaves a selection of books for the Care Homes for Older People Page 14 of 27 Evidence: people using the service to enjoy. A church service is held every month and an electric piano has been left on loan at the home so that hymns can be sung with accompaniment. During the inspection relatives and visitors were in and out of the home and regularly going into the office to speak with the manager. Individual bedrooms at the home had been personalised. During the tour of the building it was observed that the new admission had settled into their bedroom and had some of their own furniture items from home. The manager said that they encourage people to bring their own items into the home and furniture can come if the room can accommodate it. On the day of inspection the chef was on annual leave but the manager said they have the benefit of an assistant cook who was in the kitchen that day. There had recently been inspected by the environmental health officer and the home had been awarded five stars for its kitchen. The home has developed a four week menu in conjunction with other homes in the group. The manger said this was for ease of ordering food for the group. We were assured that the people who use the service still have choices about the kind of food they would like to eat. On admission the staff find out their food preferences and the chef is then informed. There is a four week rota and an alternative is available for those people who do not like the main dish. Care Homes for Older People Page 15 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident that their complaints are listened to and that they are protected from abuse. Evidence: The manager stated that all people using the service had access to the homes complaints policy and it was displayed throughout the home the manager said that they had received one complaint since the last inspection. The complainant had told the manager that it was to be dealt with as an observation/comment rather that a complaint. the manager has spoken with the person and the issue is resolved. The manager has the local authoritys safeguarding adults 2008 policy and procedure. The manager said that staff are instructed to follow these procedures. a requirement was made at the last inspection that the home must ensure that its internal policy matches the local authoritys. The homes policy in the procedure book had not been updated. The manager stated that she knew this policy had been reviewed and changed. All other homes in the group had the revised policy but it had failed to be put in Heath Lodge folder. This was rectified during the inspection so that the home has the current amended policy. Staff spoken to on the day had good knowledge of the procedures to take in the event of witnessing an incident of abuse. All staff stated that they would always inform their Care Homes for Older People Page 16 of 27 Evidence: line manager in the event of a safeguarding incident.A discussion took place with the manager about the staff being given the confidence to be able to refer incidents of abuse themselves if the occasion arose. This will be incorporated into the training. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home enables people who use the service to live in a safe, and comfortable environment but the home does not have sufficient and appropriate bathrooms to meet their needs. Evidence: The people who use the service are able to personalise their bedrooms and this was seen during a tour of the building. The home is easily accessible for wheelchair users and there was plenty of equipment to enable the staff to care adequately for the people using the service. All corridors have been painted. The carpets in the corridor were all stained with paint but the manager stated that these are all about to be replaced when the painting is completed. On the ground floor there are two bathrooms. One has an assisted bath with a hoist to assist those people who use the service with mobility problems. This bath is not in use as the handset to power the hoist is not working. The manager said she would contact the bath supplier to arrange for them to repair it. There is also a bathroom that is currently used by the hairdresser. This contains a very old in style sit in half shower. The seat in this shower had the plastic covering peeling off and the chair was rusty underneath. This would not allow the staff to clean the Care Homes for Older People Page 18 of 27 Evidence: shower adequately so this now cannot be used. The foot tray was also very dirty and stained. On the first floor there are two half showers with attached chairs. The shower in the newly decorated small bathroom is not used. Staff said the room is too small making it difficult for staff to assist the people who use the service with personal care. The other bathroom which is old in style contains a shower with attached seat and this is the one that staff use as the space is bigger. Staff upstairs said that they only bathroom in use is the one on the first floor. Another staff member said they were using the bathroom downstairs with the rusty seat occasionally. The home is now left with one bathroom that the staff use. All people who use the service that have bedrooms on the first floor now have to go upstairs to shower. No bath is available to use. A requirement will be made at the end of the report. The home has a television in the lounge. Both relatives and people who use the service said the picture is always awful and that they have been promised a new ariel. The picture on the day of inspection looked like a snow storm and we was told this is how it always is. The television picture in the individual bedrooms is also poor. The homes garden was well maintained and appropriate access was available to all people in the home if they chose to visit the gardens. It was observed that liquid soap, hand gel and paper towels were all available for staff to aid infection control procedures. There is also a laundry room and the washing machines have a sluice programme. When the laundry is unattended the door is locked and all staff have a key. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff numbers at the home were sufficient during the day to meet the assessed needs of the people using the service. Night staff numbers should be reviewed due to the layout of the building. Evidence: The manager said that the numbers of staff on duty for each shift is decided by head office. All people who use the service have dependency levels completed in their care plans but these were not used as an indication as to the number of staff that were required. The manager is always supernumerary on the rota. On the day of inspection the home was calm with the staff quietly working with the people who use the arrive to get them up washed and dressed. Currently there are only two members of staff at night. Due to the layout of the home this may not be sufficient to meet the needs of the people using the service. The manager should use her dependency levels for night time assistance and take into account the layout of the building to determine night staffing levels. A requirement will be made at the end of the report. The manager said that the night staff do hourly checks on all of the people and this is documented. Comments received on the day of the inspection regarding the staff at the home were Care Homes for Older People Page 20 of 27 Evidence: positive. Relatives and people who use the service were complimentary. One person said they really look after me well and another said the staff are always in and out they are kind. The manager said that most staff have their National Vocational Qualification (NVQ) at level two. One member of staff has level three and five have the qualification at level four. Two recruitment folders were sampled and both contained the information required to employ staff safely. All staff receive an induction when they first start at the home and this is carried out over three days. Staff then follow a national organisations induction programme which links into the NVQ programme. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good management arrangements are now in place at the home which ensures the staff team is adequately supported but the manager now needs to become registered. Evidence: The person in charge on the day of inspection was the groups marketing consultant. She said she is now based full time at the home and occasionally visit other homes to do their Regulation 26 visits. She had been in post for three months and is now considering becoming registered with CSCI. She has a nursing qualification but has not practised for some time and therefore her registration has now lapsed. She said she will check with the information on the website to ensure that she has the qualifications necessary to become the registered manager. To assist with the planning of the inspection the home sends to us a completed AQAA. The AQAA for Heath Lodge was received by us two months late. This concern was discussed with the manager who assures CSCI that future AQAAs will be returned Care Homes for Older People Page 22 of 27 Evidence: promptly. The management of the home now understand that not returning a completed AQAA on time is an offence. The manager said that surveys are sent to the people who use the service to seek their views and if negative comments are received or suggestions an action plan will be drawn up to address any issues. Meetings for people who use the service are held regularly. The last meeting was in December and minutes are kept. Regulation 26 visits take place unannounced every month and the reports are available for reading at the home. The manager said that some personal allowance money can be kept at the home for people who use the service. All receipts of transactions are kept and only the manager has the key to the safe. Weekly audits of this money take place. The AQAA identified that regular health and safety checks take place. There was no certificate for the stair lift since February 2007 and the manager said that she will contact the company for them to service this piece of equipment. The fire alarms are tested regularly and recorded. Fire awareness and evacuation training takes place for all staff on a regular basis. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The care plans are to be kept under regular review and consultation to take place with the person using the service and where appropriate their representative This ensures that staff have the most recent information to enable them to adequately care for the people using the service. 11/03/2009 2 19 23 Bathing and showering facilities at the home should be improved so that there is more that one usable bathroom for the people who use the service. So that bathrooms are available on both floors of the home and in sufficient numbers to meet the needs of the people using the service. 11/03/2009 3 27 18 The number of staff available at night should be 11/03/2009 Care Homes for Older People Page 25 of 27 reviewed following completion of night dependency levels and taking into account the layout of the building. To ensure that all people who use the service are safe and adequately cared for at night. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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. 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