CARE HOMES FOR OLDER PEOPLE
Henrietta House 3 Dynevor Road Bedford MK40 2DB Lead Inspector
Leonorah Milton Announced 26 May 2005
th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Henrietta House I51 S15001 Henrietta V215050 AI 260505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Henrietta House Address 3 Dynevor Road Bedford MK40 2DB Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01234 356194 01234 359194 www.lansgladehomes.co.uk Lansglade Homes Limited Ms Lidia Cunto Care Home 25 Category(ies) of OP Old Age - 25 registration, with number PD(E) Physical Disability over 65 - 25 of places DE(E) Dementia over 65 - 25 Henrietta House I51 S15001 Henrietta V215050 AI 260505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 04.11.04 Brief Description of the Service: Henrietta House was a large double fronted Victorian building located in a pleasant residential area of Bedford. The property was within walking distance of the town centre and local amenities including the train station and various bus routes. The home had a large and attractive garden at the rear. Parking spaces for a few vehicles was available at the front of the house. The home was registered to provide care for up to twenty-five older people who may also have dementia and/or physical disabilities. Langsglade Care Homes Ltd was the registered provider. The directors of the company had changed two ago and had continued to improve on the high standards of care that had been noted at successive inspections. Mrs L Cunto had managed the home effectively for a number of years. The accommodation had been suitably adapted to meet the needs of frail people and was arranged over three floors. The home had twenty-three single rooms, two with en-suite facilities, and one room for shared occupancy. A large lounge and a large dining room were situated on the ground floor of the property as was a smaller lounge/diner. Toilet and bathing facilities were located for convenient access through out the building. The home was attractively decorated and well maintained. The home had a very welcoming atmosphere and there was a strong emphasis on Henrietta House being a “home” and on respecting individual’s rights. Satisfactory arrangements were noted to meet service user needs.
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This is an overview of what the inspector found during the inspection. This announced inspection was carried out over 7.15 hours. Co-director, Mr Esmail and manager, Mrs Cunto were present in the home to assist throughout the inspection. The methods of inspection included discussions with five service users and two visitors, a visiting hairdresser, four members of staff, Mrs Cunto and Mr Esmail; records were assessed in relation to the care of two service users and other aspects of the operation of the home; a partial tour of the building, observation of the lifestyle in the main lounge including the arrangements for activities and sharing the mid-day meal with service users in the smaller lounge/diner. This was a most positive inspection. The few requirements from the previous inspection had been dealt with and there were no requirements arising from this inspection. What the service does well:
Respect for the individual was accorded to all those who lived, worked and visited the home. This had resulted in a high standard of service that was focused on supporting service users in an unobtrusive manner to maintain their dignity. The staff on duty showed a genuine interest in service users’ welfare and demonstrated knowledge and skill in relation to meeting the care needs of frail older people. It was evident that they took pride in the performance of the home and their role within the team. The home was well managed and administered. Mrs Conto was supported by an experienced senior team to assist her with the support and direction of the staff. A skilled administrator had been in post for a number of years. A director visited every weekend and took the time to speak to each service user and all staff on duty. The service users who contributed to this inspection were extremely complimentary about the arrangements for their care and were particularly positive about the staff: One person stated that she “had never regretted moving into the home and that the staff were very good.” Another who had lived in the home for a number of years said that she was very “happy”. Visitors to the home were similarly satisfied with the care their relatives had received and stated that they found the manager to be very approachable.
Henrietta House I51 S15001 Henrietta V215050 AI 260505 Stage 4.doc Version 1.30 Page 6 The flexibility of the service was commendable. A visitor to the home described her relative’s abilities and needs as variable with “good days and bad days.” On bad days the service user had been given additional assistance and on good days the level of support was less and the service user was then encouraged to participate in the daily activities. This practice was seen in operation and confirmed that the arrangements for this person’s care were flexible and sensitive to her needs. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Henrietta House I51 S15001 Henrietta V215050 AI 260505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Henrietta House I51 S15001 Henrietta V215050 AI 260505 Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4. Comprehensive written guidance about service were available to service users and their families to enable them to make an informed choice about moving into the home. Pre-admission assessments of need had been carried or obtained prior to admission so that the home could determine that it could meet the needs of prospective service users. EVIDENCE: There had been no changes to the written guidance to the service that had been assessed as satisfactory at previous inspections. A service user guide was available for reference in every bedroom. Pre-admission assessments of need were thorough and had taken account of the input of the placing authority’s input. Training, guidance and the overall culture of kindness and care in the home had equipped the staff with the ability to meet service users needs.
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The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,10. Service users’ needs had been well met through effective care planning procedures and a skilled workforce. EVIDENCE: Discussions with service users, members of their family and a review of documentation demonstrated that service users had been appropriately supported with their daily needs. Records showed that arrangements had been made for service users to receive routine healthcare check ups and treatment and to General Practitioners and specialist advisors as need be. All of the service users were well groomed and smartly attired. There was a particular emphasis on maintaining service users’ appearance to support them to maintain their self-esteem. Henrietta House I51 S15001 Henrietta V215050 AI 260505 Stage 4.doc Version 1.30 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15. Service users had been supported to experience a fulfilling lifestyle within the confines of their abilities and the sharing of daily living with a large group of people. EVIDENCE: Whilst the home was responsible for a large group of frail people and systems to operate the service were necessary, these were carried out in an unobtrusive manner. Staff, care and ancillary, were observed to all be involved in the day to day contact with service users so the domestic business as well as the care aspect of the service was conducted in a friendly and caring fashion that contributed to the enrichment of service users’ lives: social conversation and friendly banter, that service users responded positively to, was observed. Social stimulation was provided for those who wished to participate as well as a quieter area for less able service users. A range of activities had been provided for entertainment as well as mental and physical stimulation. Aspects of the service that enhanced the daily lifestyle and diet for service users were the serving of sherry before the mid-day meal and the provision of sweets at intervals throughout the day. Service users confirmed that these were usual daily practices.
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The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 Staff on duty at this inspection showed that they understood the vulnerability of service users and measures to prevent the development of institutional and other forms of abuse. EVIDENCE: The home’s complaints procedure was readily available to service users and their representatives. There had been no formal complaints. The manager’s open door policy and the accessibility of the proprietors meant that concerns could be sorted out without delay before they escalated into complaints. Members of staff who were spoken to about protection procedures had undergone appropriate training. They were positive about the training and how it had contributed to their awareness about the vulnerability of service users. Henrietta House I51 S15001 Henrietta V215050 AI 260505 Stage 4.doc Version 1.30 Page 12 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,21,23,24,25. Henrietta House provided a comfortable, clean, safe and well-adapted environment that was suitable for the provision of residential care for frail older persons. EVIDENCE: Satisfactory ongoing redecoration, maintenance and cleaning systems were in place to maintain the standard of the environment, its fittings and equipment. Attention to the detail of the décor and furnishings in the communal areas had resulted in an appearance of comfort and quality. Bedrooms seen at this inspection were similarly well decorated and furnished and had achieved a unique appearance through the personal items of the occupant. Henrietta House I51 S15001 Henrietta V215050 AI 260505 Stage 4.doc Version 1.30 Page 13 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,30 The staff on duty demonstrated that they were aware of service users’ needs and how these could be best met. EVIDENCE: The staff at Henrietta House were a considerable asset to the home. The majority had worked in the home for a significant time and were well versed with service users’ needs and the operational systems of the home. Staff spoken to at this inspection showed insight into the service users’ needs and how these could be best met. They also demonstrated an interest in the service users as individuals and were aware of their past lives so that they were able to take aspects of service users’ previous lifestyles and abilities into account when caring for them. The information provided with the pre-inspection questionnaire indicated a good level of training. A budget forecast was available at the inspection and showed planning for further training. Henrietta House I51 S15001 Henrietta V215050 AI 260505 Stage 4.doc Version 1.30 Page 14 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,37. The home was effectively managed and administered for development of the team and the service to the ultimate benefit of the service users. EVIDENCE: Mrs Cunto was a skilled and committed manager who had continued to develop the service by implementing gradual change to bring the underpinning documentation to evidence practice in line with good practice guidelines. Records seen at this inspection had been well maintained. The effective working relationship between the manager and the proprietor were evident. They each spoke highly of each other’s skills. Both were focused on the quality of the service. Quality assurance procedures and informal discussions with service users and
Henrietta House I51 S15001 Henrietta V215050 AI 260505 Stage 4.doc Version 1.30 Page 15 their families by the manager and the proprietor had ensured they were fully informed about service users’ opinions of their care and which had enabled them to resolve any concerns speedily. Staff communication systems were effective through formal supervision and staff meetings and informal contact. The staff members who contributed to the inspection spoke highly of the support they had received from Mrs Cunto and valued the input of the proprietor. Whilst the financial records for the operation of the home were not seen it was apparent that there had been sufficient investment in the premises and its furnishings and staff development to maintain the quality of this service. Henrietta House I51 S15001 Henrietta V215050 AI 260505 Stage 4.doc Version 1.30 Page 16 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 x 3 3 3 x STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 3 3 3 3 x Henrietta House I51 S15001 Henrietta V215050 AI 260505 Stage 4.doc Version 1.30 Page 17 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action 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. 2. Refer to Standard 7 Good Practice Recommendations Detail on care plans the involvement of the district nursing services in the care of pressure areas and similar. Henrietta House I51 S15001 Henrietta V215050 AI 260505 Stage 4.doc Version 1.30 Page 18 Commission for Social Care Inspection Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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