Inspection on 11/12/07 for Hengrove Lodge

This inspection was carried out on 11th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hengrove Lodge 29 Petherton Road Hengrove Bristol BS14 9BX Lead Inspector Sandra Garrett Unannounced Inspection 09:30 11 & 12 December 2007 th 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 Hengrove Lodge DS0000069867.V354889.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hengrove Lodge DS0000069867.V354889.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hengrove Lodge Address 29 Petherton Road Hengrove Bristol BS14 9BX 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) 01275 833006 www.AbleCare-homes.co.uk Willcox Bros Ltd t/a AbleCare Homes Mrs Margaret Osborne Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Hengrove Lodge DS0000069867.V354889.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - (Code OP) The maximum number of service users who can be accommodated is 15. 2. Date of last inspection Brief Description of the Service: Hengrove Lodge was taken over by AbleCare Homes and registered with the Commission for Social Care Inspection (the Commission) on 16 April 2007. A single owner had run the home previously. No changes to the conditions of registration have been made since it was registered to AbleCare Homes. The home is situated in the residential area of Hengrove, near Whitchurch in Bristol. The building, that was once a family home, has been well extended to give accommodation to fifteen older people. It’s partly accessible to disabled people and has a passenger lift, although the entrance has shallow steps. Some rooms are large enough for wheelchair users although corridors are narrow. Fees for living at the home range from £400 to £410 (for rooms with en-suite facilities) per week. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority fees payable are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk http:/www.oft.gov.uk A copy of the most recent inspection report was pinned up on a notice board by the front door. Hengrove Lodge DS0000069867.V354889.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was to do a first key, or main inspection since Hengrove Lodge was taken over by AbleCare Homes. The visit took place over two days. Before the visit, all information the Commission has received about the service since the last inspection was looked at. Twelve people living at the home and three staff were spoken with. The manager Mrs Margaret Osborne was welcoming and open to the inspection process. The new owner and ‘responsible individual’ (a representative of the company that keeps in contact with the Commission and makes sure the home is run to the required standard), was also at the home for the second day of our visit. This person, Mrs Samantha Hawker together with the manager, gave us information about changes made since AbleCare Homes had taken over. A variety of records were looked at in detail. These included care plans, staffing records, health and safety and fire records. Thirteen of the fifteen people living at the home had answered questions from a survey we use as part of each inspection. Comments from them are used in the report. What the service does well: What has improved since the last inspection? Hengrove Lodge DS0000069867.V354889.R01.S.doc Version 5.2 Page 6 No requirements had been made at the last visit in January 2007. One good practice recommendation made at that time had been adopted. This was to do checks of water temperatures more often so that any change is picked up quickly and people are kept safe. The new owners had redecorated parts of the home. Areas included a room used as a study or visitors room and the manager’s office. New equipment such as an industrial washing machine and tumble drier had also been bought that the manager said had helped a lot with the laundry being done at the home. What they could do better: It was disappointing to note that three out of four other good practice recommendations hadn’t been adopted since the last visit. These were to do with; Exploring further the use of aids and equipment for both hearing and visually impaired people. This would enable them to have an equal quality of life with other people living at the home; Adding exercise sessions to the regular activities and entertainments in order for people to feel that they are keeping active and healthy and; Putting in place a development plan showing how issues from the home’s quality assurance survey reports are dealt with. From these, two requirements were made. The first was to make sure exercise sessions suitable to meet the needs of older people (that they told us they still want), is added to a regular activities programme. One person told us she ‘would really love to do some exercise’ and helping people do it will benefit their health and mobility. The second requirement was to make sure a development plan is put in place when the results of the home’s quality assurance or satisfaction survey are recorded. This will make sure that issues raised by people living at the home and their families are taken seriously and acted on for their benefit. Two new requirements were also made: Information for people such as the service users guide must be put into a size and format suitable for people that have difficulty in seeing. The current service users guide whilst detailed and giving useful information, is set out in a booklet form with very small print. People must be given any information about the home in ways that meet their needs so that they are aware of their rights and responsibilities. Hengrove Lodge DS0000069867.V354889.R01.S.doc Version 5.2 Page 7 From looking at records it was clear that not all accidents or incidents that affect people living at the home are reported to the Commission. Therefore we aren’t made aware of what action the home takes when people are injured, nor whether they are being kept safe and protected from further risk of harm happening to them. Regular reports of any incident that results in injury must therefore be sent to us. One further good practice recommendation was made to look at the use of extractor fans in en-suite bathrooms that have no heating. The use of some fans leads to draughts that people told us make the room cold when in use. People should be able to feel comfortable in their rooms and not subject to sudden changes in temperature that may affect their health. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hengrove Lodge DS0000069867.V354889.R01.S.doc Version 5.2 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 Hengrove Lodge DS0000069867.V354889.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Lack of easy to read information doesn’t give people with difficulties in seeing the same rights as others. Clear and detailed assessments make sure that the home is the right place for people and that staff are able to meet their needs. EVIDENCE: From our survey nine people said they had been given enough information about the home before they moved in. However four people said they hadn’t. Comments about this included: ‘I came straight from hospital’. ‘I was able to have a look around and look at the procedure for the home and what was going on’. Hengrove Lodge DS0000069867.V354889.R01.S.doc Version 5.2 Page 10 ‘My daughter hunted round looking for the right place for me’. ‘I had a trial period here and it was my decision completely’. ‘I don’t think so but I can’t really remember it was 7 or 8 years ago’ and ‘I came for a day & then decided to move here’. (Two similar comments also). A new AbleCare Statement of Purpose was seen. This gives lots of information about the company and the various homes it owns. Information about Hengrove Lodge has been added to the Statement and it holds all the information required under the Care Homes Regulations 2001. It gives people that are thinking about coming to the home and their relatives, enough information to be able to decide if it’s the right place for them. The service users guide also meets the regulations and includes a statement on equality and diversity. This means respecting peoples race, culture, religion, sexuality, disability and age and meeting their individual needs in relation to it. However the guide is set out in a small booklet form that’s hard to read because the size of text is very small. This doesn’t meet the needs of older people who may simply wear spectacles or have more serious sight problems. The guide isn’t available in other formats such as on tape, although Mrs Hawker said a statement is usually put in the front of the booklet about this being available on request. However this wasn’t on the front of the home’s guide. The guide has a section on ‘sensory impairment’ (difficulties with seeing and hearing that affect peoples daily lives and may mean they are discriminated against because of it). This states that: ‘although the home is not specifically designed with this special need in mind, extra adaptations can be put in place if needed for an incoming resident’. A number of people living at the home have sight or hearing difficulties. A good practice recommendation had been made at the last visit in January ’07 for the home to consider making the environment easier for people with these difficulties to live in. At this visit we found that the recommendation hadn’t been adopted. The corridors had been recently decorated. However they are long and narrow on the ground floor and don’t have any signs in size or colour that people with sight problems can follow. Textures aren’t used to help people feel their way. People did tell us however that the use of the new handrails in all corridors was very useful to them. In one person’s care plan review it was noted that a personal loop system had been tried to help with hearing difficulties although this hadn’t been useful. Pre-admission assessments are done before people come to live at the home. The assessments are usually done by social workers and cover all the needs people have. The manager also does her own assessment and a copy of one of Hengrove Lodge DS0000069867.V354889.R01.S.doc Version 5.2 Page 11 these was seen. This was clear and detailed and helped to form the care plan for the person based on her/his needs. People are able to visit the home before they decide to move in and spend a day meeting the people living there plus staff and having a meal. If they decide that they want to move in they then have a four–week trial period followed by a review before their stay is made permanent. Hengrove Lodge DS0000069867.V354889.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good documentation of care plans that includes regular checks makes sure that staff are given the information they need to care for people living at the home. Good management of healthcare needs keeps people healthy and safe. People living at the home are looked after well in respect of their medication needs, although recordkeeping could be improved. Being treated with dignity and respect benefits people using the service. EVIDENCE: Since being taken over by AbleCare Homes, ways of keeping various records have changed to bring the home in line with others that the company runs. Care plans had therefore changed completely from those seen at the last visit. The main change was that instead of having a separate and clear plan for each Hengrove Lodge DS0000069867.V354889.R01.S.doc Version 5.2 Page 13 issue such as personal care, mobility, behaviours etc, the plan is now one document. This includes each separate issue but has less space to record individual needs. It does give a clear picture of each person’s overall needs and had enough detail to show how needs were being met. Headings on the plan included, among others: Personal assistance and hygiene Continence Sleep pattern Mobility Falls history Emotional wellbeing Social network/leisure interests Medical history and health needs Personal preferences and: Nutrition. Plans also included a summary assessment of the person’s current situation and showed that her/his views and choices are thought of. The manager or deputy had completed plans and signed them. People had agreed their plans and also signed them. Background information that helps staff know more about each person was also included in care records. All the plans were properly recorded and picked up care needs that needed further attention. Risk assessments e.g. for going out (for a person with confusion or memory problems), going into other peoples rooms and falls were also seen. The records of personal preferences were filled in for e.g. religious needs. Review sheets are attached to the plan and give an ongoing record of care that’s updated monthly. The sheets show any changes to personal or healthcare needs, behaviours or choices. Reviews were being done monthly and properly recorded. The manager said that care staff read the basic plan then make sure they read the monthly review sheet to keep themselves up to date. Reviews showed not only changing care needs but also records of social activities. To the question in our survey:’ Do you receive the medical support you need?’ people commented: ‘Whatever I need they get for me’ ‘Yes if I need it’ (three comments) ‘As and when needed’ ‘Yes if you want it’ and: ‘Yes it’s very good’. All thirteen people who answered our questions said they ‘always’ get the medical support they need. Hengrove Lodge DS0000069867.V354889.R01.S.doc Version 5.2 Page 14 Care plans also had a medical visits sheet that includes any visit by people such as GP’s, chiropodists, district nurses and dentists etc. From daily records seen it was clear that staff are very good at picking up health issues e.g. when talking to a person a staff member noted a problem with her/his eyes. This had been followed up and treatment for an eye infection had started quickly. This is commended. Daily records were written often and in enough detail to show that people get the care they need. Risk assessments were seen for a range of different issues for each person. Some of these were checked every month although others weren’t done so regularly. A check of medication was done. At this visit the medication cupboard was being re-organised to make room for each person’s medication to be kept separately. These were in separate named boxes that were easy to see. Medication administration sheets were all properly filled in and photographs of each person were kept at the front of them. Some medicines such as eye drops are kept in the kitchen fridge and all had been dated when opened. The controlled medication (or CD - drugs that are controlled by legislation) cupboard is kept locked within another locked cupboard that’s fit for the purpose. Peoples medication kept in it was counted but there were no records to show if numbers were right. Some medications (including those in use at this visit) have to be stored in a CD cupboard but the regulations don’t require them to be recorded in a CD register. However these could be misused so the home needs to make sure that whatever recording system is used staff can easily check balances. There was no controlled medication book or sheets in place although staff giving and witnessing the giving had both signed the administration record. Guidance from the Royal Pharmaceutical Society states that: ‘giving of medication should be recorded on both the Medication Administration Sheet and in the CD record book. The records must be kept in a bound book with numbered pages. There should be a separate page for each CD and include the balance remaining for each product. This should be checked against the amount in the pack or bottle at each administration and also on a regular basis e.g. monthly’. Records seen at this visit didn’t show clearly enough that this was being done. A good practice recommendation is therefore made to make sure medications are kept safely. The home’s Statement of Purpose includes a policy on privacy and dignity. This tells staff what they need to do when treating people with respect and also tells people living at the home what they can expect from staff. Staff were seen and heard treating people respectfully. Hengrove Lodge DS0000069867.V354889.R01.S.doc Version 5.2 Page 15 To the question in our survey ‘do you get the care and support you need?’ comments were very positive: ‘I tried 3 other homes and this one is by far the best,’ ‘They are very good’, ‘I’m very well satisfied,’ ‘So far, so good,’ ‘Yes I do’, ‘They are all brilliant, very nice indeed’, ‘Very well. There are no worries here at all’ and: ‘The care is brilliant. They are absolutely wonderful’. Hengrove Lodge DS0000069867.V354889.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities and lifestyle choices don’t fully meet the needs or wishes of everyone living at the home. Encouragement of contact with the community helps people stay in touch with what’s happening outside the home. A lack of restrictions gives people lots of choice in a relaxed atmosphere. Meals at the home are well managed and provide daily variation, good nutrition and social contact for people. EVIDENCE: To the question in our survey: ‘Are there activities arranged by the home that you can take part in?’ seven people said ‘always’, one said ‘usually’ and five said ‘sometimes’. Comments about activities were mixed: ‘I think it’s about every other day’, Hengrove Lodge DS0000069867.V354889.R01.S.doc Version 5.2 Page 17 ‘There are things to go to when there are staff available. They do what they can when they can’, ‘They do but I don’t bother’, ‘They do but I don’t take a lot of interest. I prefer my peace & quiet’, ‘We occasionally play bingo and we rarely have a little concert’, ‘If you want them. They have people coming in to sing’, ‘There are activities but since my eyesight has gone I don’t really take part anymore I just sit in my room’, ‘Yes we do have activities: bingo, music & things like that’, ‘We play bingo sometimes,’ ‘Now & again there is’, ‘We do play bingo once a week & there used to be a sing along on a Thursday’, ‘We don’t really do much. It was brought up at a meeting and a few of us would like to do some exercises’ and: ‘There is but it’s not my thing I just haven’t got the energy’. From the notes of a residents’ meeting held on 22 November ’07,activities were talked about. People were able to say what they wanted including choices of entertainers visiting the home. We were given a Christmas card that was made by people living at the home. A bingo session was held on one of the days of our visit. It was however disappointing that a good practice recommendation made at the last inspection about putting exercise sessions on for people hadn’t been adopted. The manager said she had got some equipment and had done one session this year although no records were seen of this. People told us they would like to do exercises (one person said s/he does her/his own at night) and it had come up in the home’s own quality assurance survey. The previous owner had regularly taken people out in his car and this has now stopped. However people said that they do go out to church, or clubs and one person said s/he was walking to the shops more. Both Anglican and Roman Catholic priests visit and some people take Holy Communion. Visiting is completely open and relatives and friends can visit at any reasonable time. There are few restrictions on people’s daily lives. They’re reminded that they can read their care plans or have them read to them. They’re asked for suggestions for activities and meals. They can choose to stay in their rooms or use the lounge or study. They can choose to have meals in their rooms or in the dining room. Menus are changed weekly. People were asked at the last residents meeting if they had any meals they’d like added to the menus. There is always a choice if people don’t like the main meal. From the Annual Quality Assurance Assessment (AQAA) filled in by the responsible individual and the manager before the inspection, it was noted that food suppliers had been changed that had led to improvements in meal quality. Staff commented on this and said Hengrove Lodge DS0000069867.V354889.R01.S.doc Version 5.2 Page 18 that people enjoy their food more. From our survey eleven people said they ‘always’ like meals at the home and two said ‘usually’. Comments about the meals included: ‘The food is fantastic’. ‘Yes it’s very good’ (three similar comments), ‘Very, very good food’. ‘There might be the odd thing that I’m not keen on but there’s always an alternative’ ‘On the whole it’s good but the meat could be better’, ‘I enjoy what I have and if I don’t like what’s on the menu I tell them and they get me what I want’, ‘There’s always choice if there’s something you don’t like’ and: ‘It’s very good & there are always 2 or 3 choices’. We had lunch with people on the first day of the visit. There were two choices for the first course and several choices of dessert. The food was well cooked, hot and tasty and people told us they liked it. Hengrove Lodge DS0000069867.V354889.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory complaints management and recording ensures people living at the home can be confident in raising concerns about any aspect of their care. Proper management of abuse issues keeps people protected from risk of harm or abuse happening to them. EVIDENCE: To the question in our survey’ Do you know how to make a complaint?’ people commented: ‘I would speak to the head person. I can’t see that there would be anything to complain about’, ‘I would if I had any there’s no good being unhappy and not doing anything about it’ ‘I always make it clear if I’m not happy about something and, something always gets done,’ ‘I would tell my relative & he would deal with it’, ‘Yes I do - not that I’d need to’ and: ‘I would ask for Margaret and tell her and she would put it right’. Eleven out of the thirteen people who answered said they knew who to speak to if they weren’t happy and how to make a complaint. No new complaints had Hengrove Lodge DS0000069867.V354889.R01.S.doc Version 5.2 Page 20 been recorded since the last visit although one relative told us s/he had raised issues about a person’s care that had been resolved. An AbleCare Homes complaints leaflet was seen that’s used by all the homes in the company’s group. The leaflet gives information about what happens when a complaint is made. However again the process used for making a complaint is written in small text that is difficult for people with sight difficulties to see. Further, some of the text is printed on a mauve background that again may make it difficult for some people to see clearly. No incidents of alleged abuse had been made since the last visit. All staff had done safeguarding adults from abuse training in 2005 and 2006. Two new staff are booked to do it shortly and the date was seen in the office diary. A system of checking staff knowledge of abuse and how to recognise it through supervision, had been in place at the last visit. This had been through a questionnaire of examples and staff then discussed whether they thought abuse had happened. None of the questionnaires were seen at this visit and the manager said she hadn’t talked about it with staff recently. Safeguarding adults from abuse is however, discussed in new staff induction and records were seen of this having happened. From each staff member’s records looked at, nearly all had done training in safeguarding adults within the last three years. For those that hadn’t yet done it, dates were seen in the office diary for them to go to the training in January ’08. Hengrove Lodge DS0000069867.V354889.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from living in a comfortable, safe environment that is well decorated and looked after and meets their needs. However lack of heating in en-suite facilities may affect peoples comfort. Good, proper cleaning and hygiene makes sure people living at the home are protected from risk of infection as far as possible. EVIDENCE: To the question in our survey ‘Is the home fresh and clean?’ everyone said ‘always’. Comments on the environment included: ‘Lovely’, ‘Very much so’ and: ‘It’s spotless’. People told us they were happy with the accommodation and enjoyed being in their own rooms that were each different in size and decoration. Hengrove Lodge DS0000069867.V354889.R01.S.doc Version 5.2 Page 22 However we had received some comments about the lack of heating in the ensuite toilet facilities in some bedrooms. Not all rooms have these facilities but in those that do they were found to lack heating. When we looked at them we found that in the en-suites extractor fans may cause draughts of cold air to come in that would make them feel colder. One person had got round the issue by turning off the fan. Three people felt they were cold. One person said s/he didn’t mind this although another did. A good practice recommendation was made to check the facilities to make sure they’re warm enough and not draughty. Some of the general areas of the home had been decorated since AbleCare Homes had taken over. A small office area has been turned into a study or quiet room. Lighting in this room was dim and the light bulb was of a low kilowatt that made it seem so. The deputy manager changed this immediately. All light bulbs are energy saving ones that may be less bright than ordinary ones. One relative had commented in our survey: ‘Low energy light bulbs that are now in rooms are not bright enough for people with poor sight’. Attention should be given to making sure the lighting in each person’s bedroom is suitable for them, especially if they have difficulties in seeing clearly. The home was very clean and smelled fresh and pleasant. Domestic staff were seen cleaning in several areas. Hengrove Lodge DS0000069867.V354889.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Well-trained care staff are employed in sufficient numbers to meet peoples’ needs. Progress with National Vocational Qualification in Care training for staff makes sure people are looked after well. Proper checks on staff before they come into the job keeps people living at the home safe and protected. People living at the home benefit from a well-trained and qualified staff group that are able to meet their needs. EVIDENCE: To the question in our survey ‘Are the staff available when you need them?’ people gave positive replies: ‘No problems there at all’, ‘If I pull my bell they come instantly’, ‘Occasionally I have to wait for a while when they are with someone else but that’s understandable’, ‘I have a new keyworker now’, ‘They always are’ and: Hengrove Lodge DS0000069867.V354889.R01.S.doc Version 5.2 Page 24 ‘I think they could do with more staff but they cope really well’. Three staff were spoken with and all were positive about the new owners. They went on to say that their jobs hadn’t changed. Speaking about their work they told us that there is no one at the home that has high levels of care needs. This, together with a staff member who comes in just to do teas for people living at the home in the evenings, ‘really takes the pressure off’ staff. Staff said that the responsible individual is approachable and visits weekly to meet with people living at the home. Staff know that they can go to her if they need to. The majority of staff have Qualification in Care Level worker said she has Level was seen in her records. January 2008. or are working towards getting National Vocational 2. Some staff already have Level 3. One domestic 1 and 2 in cleaning and support services and this Another batch of NVQ training is due to start in A sample of staff records was looked at. These showed clear evidence of requests for Criminal Records Bureau information (to make sure staff are able to work with vulnerable older people). All the information needed was gained before a staff member started work. Proof of identity including birth or marriage certificates, passports and proof of address were seen in each person’s file together with a photograph. Application forms, interview notes and two references were also seen for each staff member. Staff told us that they are encouraged to ask for training if they feel they need it. Records of essential training were seen in each staff member’s file. These included moving and handling, fire safety, basic food hygiene, medication and health and safety. Training is also offered in the new Mental Capacity Act that came into force this year. Hengrove Lodge DS0000069867.V354889.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,35,36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home and the staff team continue to benefit from an experienced manager who encourages an open style of management. Failure to use a development plan following quality assurance surveys means people may not have a chance to help change the way the home is run, that will benefit them. Peoples finances are well managed that makes sure they are protected from financial abuse. People get good, regular care from a staff team that has opportunities to regularly reflect on the work they do. Hengrove Lodge DS0000069867.V354889.R01.S.doc Version 5.2 Page 26 Failure to report of accidents and events doesn’t make sure that the Commission is made aware of actions taken to protect people from harm. Good management of health and safety matters keeps people safe from risk of harm. EVIDENCE: The manager Mrs Margaret Osborne and the deputy manager were both working during the two days of our visit. Both were welcoming and open to the inspection process and where necessary acted quickly on our suggestions. Both said that the change of ownership had been unexpected but everyone was getting used to the change now. The new responsible individual Mrs Hawker visits weekly and has worked with the manager on essential changes that need to be made for Hengrove Lodge to fit into the group of homes currently owned by AbleCare. This year the manager has done training to manage fire safety in the home and next year is due to do training to become a moving and handling trainer. The manager has also taken over some of the jobs the previous owner did including health and safety checks. The home’s last quality assurance survey report was looked at. From this peoples high level of satisfaction with the home was seen. However issues that might need to be picked up and acted on weren’t always done (see above re exercise sessions) and there was no development plan in place so that peoples comments and suggestions would be included in future plans for the home. The manager showed us a ‘to do’ list but this was simply a list of jobs that need doing rather than a clear plan for the future. The manager said she had started to do a plan but with the changes that have happened this year it hadn’t been continued. The responsible individual visits often but does a formal visit report, a copy of which is sent to the Commission. This is also used to check the quality of the service. A random sample of peoples’ cash kept for safekeeping, was done. All amounts checked were correct and properly recorded with two signatures and receipts for things bought. Staff induction and supervision records were looked at. These showed that each staff member gets regular opportunities to talk about their work and issues affecting people living at the home, plus training needs and other matters. Each record seen showed that staff have supervision every two or three months and those we spoke with confirmed this. Health and safety records looked at were up to date and essential checks had been done. A good practice recommendation made at the last visit about Hengrove Lodge DS0000069867.V354889.R01.S.doc Version 5.2 Page 27 making sure water temperatures are checked more often had been adopted. The manager now checks the water temperatures monthly instead of three monthly. Temperatures recorded were all at recommended levels. Staff had done fire safety training and records of regular fire drills were seen. A check of accident records was done. When preparing for this visit we had checked records of any incident affecting people living at the home that are required to be sent to the Commission. We hadn’t received any. However on looking at the home’s accident records we found that some people had had a number of accidents that resulted in injury. The manager said that she thought that notices have to be sent to us if the accident results in a person going to hospital. However we need to know what types of accidents happen and what causes them, the frequency of accidents such as falls and what action the home takes to stop it happening again. Therefore the manager must send us clear information so that we can see how people are being protected. Hengrove Lodge DS0000069867.V354889.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 2 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 X 2 Hengrove Lodge DS0000069867.V354889.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP4 Regulation 12(4)(a) Timescale for action The service users guide (and 31/03/08 complaints leaflet) must be printed in a format and text size suitable for people that have difficulty in seeing. This will make sure that every person living at the home will have equal access to information they need. Exercise sessions suitable for 31/01/08 and requested by people living at the home must happen regularly. Sessions must be done by a person qualified to run them. This will make sure that people have opportunities for recreation and fitness that meets their needs and respects their choices. Following the annual quality 31/03/08 assurance survey a development plan must be drawn up that shows how issues raised by people living at the home are being dealt with. This will make sure that people have opportunities to take part in annual planning, action and review of the service and that their comments are taken DS0000069867.V354889.R01.S.doc Version 5.2 Page 30 Requirement 2. OP12 16(2)(n) 3. OP33 24(4) Hengrove Lodge 4. OP38 37(c),(e) seriously. Any accident that results in 31/12/08 injury to a person living at the home must be reported to the Commission with details of actions taken to stop such accidents from happening again. This will make sure the Commission is aware of and can check that people living at the home are being protected and cared for safely. 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 OP9 Good Practice Recommendations Proper records of controlled medication should be kept that includes checking of quantities and numbers left after giving. This will make sure people are protected from risk of mistakes being made. En-suite bathrooms should be checked to make sure they are warm enough for people that use them and that extractor fans don’t cause draughts that lower the temperature. This will make sure people are kept warm and comfortable and free from risk of ill health. 2. OP24 Hengrove Lodge DS0000069867.V354889.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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