Random inspection report
Care homes for adults (18-65 years)
Name: Address: Herons Lodge 138 Northampton Road Market Harborough Leicestershire LE16 9HF one star adequate service 28/05/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Ruth Wood Date: 1 1 0 8 2 0 0 9 Information about the care home
Name of care home: Address: Herons Lodge 138 Northampton Road Market Harborough Leicestershire LE16 9HF 01858465441 01858465441 lucikad@yahoo.co.uk www.mentauruk.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mentaur Limited care home 10 Number of places (if applicable): Under 65 Over 65 0 0 learning disability mental disorder, excluding learning disability or dementia Conditions of registration: 10 10 The maximum number of service users who can be accommodated is 10. The registered persons may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission are within the following category: Learning disability - Code LD Mental disorder - Code MD. Date of last inspection Brief description of the care home Herons Lodge is a care home for people with learning disabilities or mental health problems. Ten people can live at the home. It is close to the town centre of Market Harborough. There are shops, pubs, restaurants and a post office in Market Harborough.
Care Homes for Adults (18-65 years) Page 2 of 9 2 8 0 5 2 0 0 9 Brief description of the care home There are two lounge areas and a dining room on the ground floor. Each person in the home has their own bedroom. There are bedrooms on the first and second floors. You can get to the bedrooms using the stairs. One bedroom has its own toilet and shower. There are four other communal bath and shower rooms for people to use. The home has a garden. It costs between £511 and £2,010 a week to live at the home . People pay extra for hairdressing, clothes, toiletries and holidays. The service users guide tells people about the services in the home. Care Homes for Adults (18-65 years) Page 3 of 9 What we found:
This inspection visit to Herons Lodge took place on 11 August 2009 between 09:30 and 11:30 am. The purposes of the inspection was to monitor the providers response to requirements made at the key inspection on 27 and 28 May 2009, the response made to a recent medication error reported under Regulation 37 by the acting manager and the response to safeguarding incidents, relating to people living at Herons Lodge. The acting manager stated that the service users guide and statement of purpose had been reviewed but the updated version was not available in the home on the day of the inspection. The acting manager agreed to forward a copy of the updated guide to the Commission. The Commission received this information before the publication of the final report. The responsible individual in their response to the key inspection report, asked to retain the reference in the guide to service users being involved in the recruitment process as they hope to develop this. The acting manager confirmed that no service users have been involved in the recent recruitment of new support staff. The acting manager said that changes to one service users needs, have not yet been discussed with their commissioning authority. We looked at the persons care plan. The plan outlined the triggers that may initiate behaviour that could challenge and gave guidance to staff on how they should respond. Staff records show that staff have received training in NAPPI techniques (non-abusive psychological and physical intervention) and that provision is made for this training to be updated. The acting manager has made sure that all staff have re-read the persons care plan and sign to say they they have done so. It is recommended that an addition be made to the plan, that more explicitly deals with the potential risks of this persons behaviour to other people living in the home and how these should be managed. How this persons allocation of one to one hours is managed is now recorded. We spoke to the acting manager about the medication error in which one person living in the home had been given the same medication twice. The investigation of the incident has been finalised. A letter of urgent concern was sent to the provider asking that they confirm in writing the details of the investigation by 20 August together with details of any additional training and supervision that has been put in place as a result. A satisfactory response to this letter, dated 20 August was received prior to the completion of this report. Discussion with the acting manager and examination of medication administration records indicates that although two staff members now routinely sign for all medication administered, there is a lack of clarity about which staff members should administer medication, and if this should include staff working temporarily at Herons Lodge who are routinely employed to work in other Mentaur homes. Again we asked that the medication administration policy be reviewed and updated as a matter of urgent concern by 20 August 2009. A satisfactory response to this requirement, dated 20 August 2009 was received prior to the completion of this report. At the key inspection, we recommended that communication plans be put in place to detail how people living at Herons Lodge, who who could not express themselves formally, would make their feelings known to staff. The acting manager stated that this
Care Homes for Adults (18-65 years) Page 4 of 9 was still to be addressed. We looked at communal areas of the home. A requirement that all bathrooms should have suitable window coverings has been met. Blinds have now been fitted in all bathrooms to ensure that peoples dignity is maintained while they are bathing. The second floor shower room has been re-plastered and re-decorated but the heated towel rail still requires covering before the room is fit for purpose. Radiators in all the identified bathrooms still require covering. The acting manager said that this work was scheduled to be completed before the deadline given in the Key Inspection Report of 31 August 2009. In response to the draft report of this inspection visit the registered manager said that the heated towel rail in the second floor shower room was covered on 29/09/09 and that all bath and shower rooms were now fitted with safe heating. We will check this at the next random inspection of the service. We looked at the deployment of staff on the day of the inspection and also referred to information sent to us by the Provider concerning the length of service of staff members and how they are deployed in the home. We were informed on 30 June 2009 that the acting manager had left the home without giving notice. There had also been recent changes in senior staff members at the home. We were contacted on 07 July 2009 by the acting manger and discussed the deployment of staff members in the home. On that morning only one staff member working in the home had worked at Herons Lodge for longer than four months. Rotas subsequently sent to the Commission show a more reasonable deployment of new and more experienced staff members. On the morning of this inspection visit, four staff members were on duty that had worked at Herons Lodge for between eighteen months and eight years. The rota also showed that sufficient staff were on duty to enable the acting manager sufficient time to meet her management and administrative duties. During discussion the acting manager confirmed that she had been involved in recent interviews for new support staff. What the care home does well: What they could do better:
Additions to one persons support plan would make it clearer how staff should deal with the potential risks to other people living in the home if this person exhibits behaviour that is challenging. The service should continue to address the training needs of staff to ensure that they have the sufficient skills to work with people with learning disabilities and mental health needs.
Care Homes for Adults (18-65 years) Page 5 of 9 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 2. Care Homes for Adults (18-65 years) Page 6 of 9 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 24 23 The registered person must ensure that all the homes bath and shower rooms are equipped with safe heating. This is to ensure that people living in the home can bathe or shower without getting cold and without the risk of burning themselves on uncovered radiators or heated towel rails. 31/08/2009 2 24 23 The registered person must 31/08/2009 ensure that the shower room on the second floor is made fit for use. This is to ensure that people with a room on this floor have easy to toilet and washing facilities on the same floor. 3 35 18 The registered person must 30/09/2009 ensure that all staff have received appropriate training in working with people with learning disabilities and mental disorder This is to ensure that all staff have the training and skills necessary to meet the needs of the people for which the home is registered. Care Homes for Adults (18-65 years) Page 7 of 9 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, 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 1 5 The registered person must 30/09/2009 forward a copy of the revised service user guide to the Commission This is to ensure that the guide is an accurate reflection of the service provided. 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 1 6 It is recommended that an addition be made to the identified persons plan that more explicitly deals with the potential risks of this persons behaviour to other people in the home, and how these should be managed. Care Homes for Adults (18-65 years) Page 8 of 9 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 9 of 9 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
