Inspection on 11/05/09 for High View Lodge

This inspection was carried out on 11th May 2009.

CQC found this care home to be providing an Adequate service.

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

High View Lodge 14/12/09

High View Lodge 03/07/08

High View Lodge 26/06/07

High View Lodge 05/07/06

High View Lodge 02/12/05

High View Lodge 06/07/05

High View Lodge 30/01/05

High View Lodge 28/06/04

High View Lodge 05/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE High View Lodge Cherry Orchard Gadebridge Hemel Hempstead Hertfordshire HP1 3SD Lead Inspector Sheila Knopp Key Unannounced Inspection 11th May 2009 09:20 DS0000019423.V376037.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. High View Lodge DS0000019423.V376037.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) 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. www.cqc.org.uk Internet address High View Lodge DS0000019423.V376037.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service High View Lodge Address Cherry Orchard Gadebridge Hemel Hempstead Hertfordshire HP1 3SD 01442 239733 01442 239154 manager.highview@runwoodhomes.co.uk www.runwoodhomecare.com Runwood Homes Plc Telephone number Fax number Email address Provider Web address Name of registered provider Name of registered manager Type of registration No. of places registered (if applicable) Manager post vacant Care Home 77 Category(ies) of Dementia - over 65 years of age (77), Old age, registration, with number not falling within any other category (77), of places Physical disability (77) High View Lodge DS0000019423.V376037.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 Only - Code 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 - Code OP Dementia over 65 - Code DE(E) Physical disability - Code PD The maximum number of service users who can be accommodated is 77. 3rd July 2008 2. Date of last inspection Brief Description of the Service: High View Lodge is a purpose built residential care home, which can accommodate up to 77 service users. The home is divided into four units, one of which is a specialist dementia care unit. There is also an additional respite unit. Each unit has a lounge and dining area and there is a large communal lounge at the front of the home. Bedrooms are single occupancy however couples can be accommodated if necessary. All bedrooms have en-suite facilities. The home is situated in a residential area of Hemel Hempstead and is accessible by public transport. The home’s Statement of Purpose, Service User’s Guide and last CSCI Inspection Report, which provide information about the service, are kept on display in the entrance area and available on request from the manager. The current fees for those that are privately funded range from £545 to £644 per week. Different rates per bed are applied to local authorities purchasing placements. High View Lodge DS0000019423.V376037.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The information in this report is based on a visit to High View Lodge by one inspector and an ‘expert by experience’ who was present for part of this inspection. An expert by experience is someone who has been recruited by an independent organisation, such as Age Concern, to visit a service with an inspector. They have shared experiences or knowledge to help them get a picture of what it is like to live in or use the service. Experts by experience are involved in inspections to encourage people who use care services to share their experiences more openly. To make sure we include a range of views in this inspection we made survey forms available to residents, their relatives and health and social care professionals, who have regular contact with the people living at High View Lodge. We received completed surveys from 13 residents, 8 relatives and 3 health and social care professionals. We have reviewed the information received about High View Lodge between our visits. This includes the Annual Quality Assurance Assessment (AQAA). Each year managers of care services are required to send us their Annual Quality Assurance Assessment. This document tells us how well outcomes for people using the service are being met. It also provides us with some numerical data. We have also reviewed the notifications we receive about accidents and incidents in the home. We have not received any complaints about this service between our visits or been contacted directly by any other professionals who have contact with the people who live at High View Lodge. At the time of this inspection a new manager had just started working in the home. This report tells us that the while the service improves in some areas there are still areas, which have resource implications, for the registered provider to address in order to improve the quality outcomes for people living at High View Lodge. High View Lodge DS0000019423.V376037.R01.S.doc Version 5.2 Page 6 What the service does well: People living at High View Lodge and those that visit them tell us the staff are kind and caring. A resident told us ‘everyone’s kind here’, they treat you as a ‘friend’. People told us that the staff listen to them and act on what they say. A relative said ‘staff are polite and cheerful and appear to be kind to all’. Another person told us the ‘care home does a very good job at looking after their relative. They always appear very happy. The staff are lovely’. The expert by experience told us High View Lodge is a ‘clean and tidy, well run home. The service users all appeared to be well cared for with clean clothes and were well groomed’. A relative told us High View Lodge ‘caters well for individual needs and staff will always take time to talk to family members about their relative’. The comments we received support the managers self assessment that ‘at present the home offers a relaxed and homely environment with caring staff who will endeavour to meet the needs of the residents to the best of their ability ..’. What has improved since the last inspection? There is now a much more consistent approach to recording the action taken to meet people’s health care needs. There are now reliable and safe systems in place to make sure people have the medicines they need and regular checks are carried out to make sure staff are following the correct procedures. Staff training in providing a more person centred approach based on the needs of each individual has continued to develop the service and provide improved responses to people with dementia. However it is recognised by the management of the service that this needs to be continued. The arrangements for ordering people’s choice of supper have improved so people are now getting what they want. People’s comments at this inspection tell us they are confident they will receive a consistent approach from staff. Staff are more confident in managing the needs of people with dementia and we have seen a reduction in challenging situations. During her year in post the out-going manager continued to make improvements in the service by making sure that staff received the training and supervision they need. High View Lodge DS0000019423.V376037.R01.S.doc Version 5.2 Page 7 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. High View Lodge DS0000019423.V376037.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 High View Lodge DS0000019423.V376037.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 (standard 6 does not apply to this service) People using the 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 can be confident that the home will be able to offer appropriate care and support to meet their health & personal care needs because staff will meet with them before they come to stay to carry out an assessment and review information from other health & social care professionals. However as detailed in other areas of this report staff availability may not be sufficient to meet their social needs and aspirations. EVIDENCE: We reviewed the care records of a resident who had recently come to live at High View Lodge. This confirmed that staff had carried out a detailed assessment before the person arrived in the home. Information from key family members, doctors, hospital staff and social workers is also included to High View Lodge DS0000019423.V376037.R01.S.doc Version 5.2 Page 10 make sure staff have the skills and equipment required to meet the needs of the person concerned. Two staff are involved in the pre-admission assessment visits to people in their own home or hospital. The assessment recognises that people may have very different needs and expectations according to their disability, gender, religious or cultural background. A relative said staff at the home were ‘very helpful and told us about the home’. Many people living at High View Lodge are introduced through the day centre or respite stays, so they know the home. The manager’s self assessment told us that on occasions they carry out a 24 hour assessment that involves the person coming to the home to stay the night to see if staff are able to meet their needs. Good information is available for people looking to use the service. Our last inspection identified the need to increase the skills of staff providing support to people with dementia. Training is continuing. A sensory room has been created and there are plans to introduce a SONAS programme which is a multi-sensory stimulation technique developed specifically for people with dementia. We noted better interaction between residents and staff during this visit. High View Lodge DS0000019423.V376037.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 & 10 People using the 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 living in the home have their personal and health care need met by staff who respect their privacy and dignity and involve other health and social care professionals as necessary. People can be confident that any medicines they need will be managed safely. EVIDENCE: We followed the care of 4 residents through their care plans and by talking with them. Together with information gathered from relatives, staff and professionals who visit people in the home, we have been able to assess the quality of personal and health care provided. We have looked at the systems for managing medicines within the home. High View Lodge DS0000019423.V376037.R01.S.doc Version 5.2 Page 12 All the people we met had been helped to achieve good standards of personal care and hygiene. Staff contact with people during the day was discreet and respectful. People being cared for in bed were comfortable. Drinks were available to them and charts indicating the care given to prevent pressures sores and ensure they received a good food and fluid intake were up to date. A relative confirmed they were very satisfied with the care provided and the care we observed during out visit was provided consistently. Senior staff have continued to develop a more person centred approach to planning and delivering each person’s care. The manager recognises this is an area that needs further development through continued staff training. We are told that community nursing staff have provided staff with specific training on health care issues such as supporting people with diabetes, catheter care and pressure area care. The care records we reviewed were up to date and showed us that residents and their relatives are being involved in planning and reviewing their care. Specific risks related to health conditions and use of equipment and aids to independent living are assessed and recorded. The nutritional needs of residents are assessed on admission to the home and kept under review. Where concerns have been identified, we saw that people had been monitored more closely and referred to their doctor. Staff were much more confident in their approach to supporting people with dementia and creating a supportive atmosphere to reduce anxiety. Our surveys told us that 83 of residents said they always or usually received the care and support they needed. Fifty per cent of relatives said their relative always received the care they need and 50 said this was usually the case. There has been an improvement in the management of medication. One of the senior staff has been given additional time to manage this area. Our review told us there are safe systems in place for the ordering, storing and administering the medicines people need. The assessments that check staff are following the correct procedures have all recently been reviewed. The medication systems are regularly audited to pick up any problems at an early stage. High View Lodge DS0000019423.V376037.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 & 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not feel they are provided with a level of stimulation and contact with staff that enables them to lead fulfilling lives. People are able to maintain contact with their family friends and local community. People are provided with meals that meet their nutritional needs and they usually enjoy. EVIDENCE: Our expert by experience said, “I was able to talk to several people both men and women and to one relative. I was also able to chat with a few of the care workers. I didn’t actually receive any complaints! Some of the comments were ‘I am very happy here’ ‘Most of the food is good’ ‘Nobody need go hungry. If we don’t like what’s on the menu we can always ask for something else’ ‘I’d rather be in my own home but my son wanted me to be looked after. I miss pottering about in the kitchen’ ‘I like to play chess but there is no one to play High View Lodge DS0000019423.V376037.R01.S.doc Version 5.2 Page 14 with. There’s not much male company’ ‘The staff are always busy, I don’t like to bother them if I don’t have to’.” Only 15 of people who completed our survey said there were always activities arranged that they could take part in. Two people said there were never activities they could take part in but 81 said activities were usually or sometimes available. Three relatives who completed surveys commented specifically on activities. One person said ‘my relative would like the chance join in more activities’. Another said there ‘could be more activities and entertainment for the more able residents’. One person said there were ‘lots of activities to keep their relative occupied’. A social care professional said that many of the people they see ‘talk about not being able to get out as there are no staff’. Staff did say they were able to take people out on occasions to visit local shops. A shop trolley is also taken around so people can buy things for themselves. Our expert by experience observed that in spite of the good standard of basic care given the carers didn’t seem to have time just to chat with the service users. The activity co-ordinator was busy on the dementia unit and therefore those on the first floor were mostly sitting in the lounge with not much stimulation. One lady was reading a magazine. The television was on so loud that any conversation was difficult and no one seemed to be actually watching it. On one of the units residents told us staff put the television on but don’t ask what they would like to watch. A group of residents the inspector spoke with in one are described themselves as being ‘fed up’ and terribly fed up’. They said staff don’t have time to sit and talk. The manager reported that new member of staff had been appointed to coordinate activities and was putting a planned 4 week programme in place. A sensory room has now been fitted out with suitable equipment to provide a relaxing place for individuals or small groups of people to be. It is planned that a sensory programme called SONAS, which will provide staff with additional skills to enable them to communicate more effectively with people with dementia, is to be introduced. High View Lodge has a day centre, which is available to people living in the community. Our expert by experience and a health professional who gave us their comments observed that this is a valuable resource that would be very beneficial to people living in the home if they were offered a similar level of stimulation and activity. High View Lodge DS0000019423.V376037.R01.S.doc Version 5.2 Page 15 People are provided with meals that will meet their nutritional needs but the responses we received to our surveys indicate there is not a high level of satisfaction with the choices offered as 58 of people said they usually or sometimes liked their meals. Only 33 said this was ‘always’ the case. The chef manager reported she meets with residents to discuss meal choices and individual preferences. Our expert by experience observed that at lunchtime most people ate in the dining room. There was a choice of main course but not desert although there was a bowl of fresh fruit on each table. They noticed that there were bowls of fresh fruit in the lounges, which were easily accessible to those sitting there, but didn’t see anyone take any. Squash was also available to drink at all times. The same two carers who were serving the food and giving assistance to those that needed it, were also washing dishes as food was being eaten. These same carers were taking food to those eating in their rooms and one lady who was bed bound had to wait till nearly 1.30pm before she got her meal. I also noticed that meals were taken uncovered to the rooms. The music in the dining room, although pleasant, was again very loud and made conversation difficult. Extra staff at this busy period would have made this experience more pleasant for all concerned, service users and staff. The support provided at lunch time to people with dementia was much better than we saw on our last visit. Staff had space to sit beside people to help them and people were not kept sitting at the table too long before their lunch was served. The experience of people may have been improved by serving people on the same table together. This provides cues for people to follow and they do not become restless watching each other eat. Staff report that improvements to the ordering of supper choices have been made so that they are provided with suitable amounts to give people what they want. Again we noted the supper dishes prepared by the kitchen staff are made up just after lunch and refrigerated until needed. The care staff reheat and cook items on the units at supper time. This is because there are no catering staff available during the afternoon and evening. We were told at our last visit that this was being reviewed but no further action appears to have been taken. The catering manager reports that she now visits residents to get their views. Residents told us that biscuits run out during the week. On the day we visited staff were offering buttered crackers because they had run out of sweet biscuits. High View Lodge DS0000019423.V376037.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 People using the 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 can be confident that their views will be listened to and action taken to address their concerns. Staff are provided with training so they can recognise and report bad practice, to protect people living in the home. EVIDENCE: We have not received any complaints about this service between our inspections or been contacted by any other health & social care professionals who are in regular contact with people living at High View Lodge. Prior to our last visit and the appointment of the out-going manager there were complaints about standards in the home. These have not been repeated. The record of complaints received by the manager provides details of the investigations carried out and the action taken to address the issues raised. Where residents have raised concerns they have been appropriately investigated and dealt with. Ten out of 11 residents confirmed staff listened to them and acted on what they said. Seventy five percent of residents who completed surveys confirmed they knew how to make a complaint. People are not so sure who they should High View Lodge DS0000019423.V376037.R01.S.doc Version 5.2 Page 17 speak to if they are not happy as only 36 said they always knew how to speak to. Relatives confirmed that staff kept in touch with them and informed them about important issues. The manager works within the guidance of the Hertfordshire Safeguarding Adult procedures in place to protect people by multi-agency working when issues arise. Staff receive training in protecting people from abuse and discrimination. Our contact with staff indicates they understand their responsibilities in this area. Information we receive about events in the home between inspections indicate that the number of challenging incidents has been reduced. We have been told that Runwood Homes are introducing policies and procedures to reflect the requirements of the Mental Capacity Act. This is so people’s ability to make decisions about their lives is protected. The manager told us the implications of the act have been discussed at staff meetings but staff have not yet received formal training. High View Lodge DS0000019423.V376037.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 & 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Highview Lodge provides people with a safe, well maintained, clean home to live in, which they can make more familiar by adding their own personal belongings. People can be confident that there are systems in place to support good hygiene practices and manage their laundry but more attention needs to be given to providing staff with facilities to wash their hands in the laundry rooms on each unit. EVIDENCE: The home is divided into small units which have their own lounge and kitchen / diner. Everyone has their own en-suite bathroom. Bathrooms are provided for High View Lodge DS0000019423.V376037.R01.S.doc Version 5.2 Page 19 people who need assistance. People are able to bring personal possessions into the home with them and we saw many of examples of how residents and their families had created a homely familiar environment for them to live in. Residents and relatives who completed our surveys confirmed the home was kept clean. People on the ground floor have direct access to the gardens, which have a variety of seating areas, pathways and points of interest. There are seating areas around the home where people can meet people form other areas or sit quietly. Some of these areas have books and equipment for playing music. The layout of furniture, decoration and features on the specialist dementia care unit has been reviewed to make this a calmer place to be and enable people to move more easily around. All areas of the home we visited were found to be fresh and clean and 11 (85 ) out of 13 residents who completed survey forms said this was always the case. A relative said ‘The home is always clean and fresh smelling’. Staff on each unit are responsible for laundering personal clothing and we observed that this provided people with smart fresh clothing. Staff are provided with the equipment and training they need to prevent the spread of infection. A problem with running out of items such as disposable gloves which staff who completed survey forms told us about appears to have been resolved and people confirmed they were freely available. The manager needs to review staff access to wash hand basins and soap and towel dispensers in the laundry rooms on each unit to make sure staff can use them. The washing machine had been placed in front of the sink in one of the units. Staff told us they don’t find the staff room a pleasant place to take their breaks. There is no window. They report the shower is not working and the toilet opens out directly into the room where people are sitting. There is an industrial scale laundry on the ground floor to manage the bulk of the laundry. Two relatives took the opportunity to tell us they felt the laundry service could be improved as things go missing. Suitable systems are in place for the management of soiled items. Staff have access to disposable protective aprons and gloves and training in the management of infection. Following our last visit we raised concerns that staff were not using the hand washing provided in the laundry rooms on each unit as the equipment is placed in front of the sinks and soap and towel dispensers. This is still the case and does not reflect good infection control practice as staff have to leave the room to wash their hands and this can spread infection. As this has not been managed internally we now need to take further action. High View Lodge DS0000019423.V376037.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 & 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at High View Lodge cannot be confident that staff will be available in sufficient numbers to support the quality of life they would like. People can be confident that are safe recruitment procedures in place to make sure only suitable staff are employed to work with vulnerable people. People can be confident that staff receive the training they need to understand the needs of older people and continue to develop their skills in supporting people who have dementia. EVIDENCE: People living at High View Lodge told us ‘they seem short staffed’. A relative told us that they would like to see ‘higher staffing ratios so that the staff have the time to talk to each person on an individual basis’. A resident told us ‘I would like more activities to take part in and keep my brain active’. A health professional who visits people living at High View Lodge said ‘the support that people with dementia require is not being reflected in the staffing ratios that are on each shift’. High View Lodge DS0000019423.V376037.R01.S.doc Version 5.2 Page 21 The manager told us in the AQAA that ‘we have a good ratio of staff on each unit to cater for the residents ..’. This is not the experience of people who live in the home as detailed in the social care section of this report. The roles, responsibilities and number of staff need to be reviewed as these have an effect on the provision of social care. Seven (63 ) out of 11 residents who completed the question on whether staff were available when needed said ‘usually’, 2 ‘always’ and 2 ‘sometimes’. A resident commenting on staff said ‘they’re always very good’. Fifty seven percent of relatives who completed surveys said staff usually have the right skills and experiences to look after people properly. Forty three percent said staff ‘always’ have the right skills. One person added ‘The staff appear very well trained, they are very friendly and supportive and give help without being intrusive’. The out going manager’s AQAA identifies the difficulties of creating a stable staff team but feels things are ‘starting to settle with all the core staff now in place, also it is re-educating staff to the new way of working with regards to person centred care, activity based care and to move away from just focusing on task orientated work but to deal with the emotional needs of the residents especially Dementia care’. The AQAA identifies the need to ‘review staffing levels as residents now being referred to the home have higher dependency levels’. Two health professionals who regularly visit people living at High View Lodge told us the staff are ‘very caring’. However another person said ‘the support for people with dementia is unsatisfactory at times. This is mainly down to staffing’. As well as attending to people’s personal care, medication, serving meals and washing up the staff on each unit also laundered each person’s personal clothing and return items to their rooms. Staff report not having breaks on occasions as difficulties completing care records within the shift. Three staff were allocated to the dementia care unit on the day we visited but one person was moved to another area to cover sickness. The patterns of staff allocation appear to be fixed for each unit and creative ways of providing additional staff at peak times, for example to support the serving of meals and domestic arrangements, have not been considered. The manager’s AQAA identifies recruitment as an on-going issue and heavy reliance on casual staff. This means there is more difficulty covering evening and weekend shifts where agency staff are more likely to be used. We reviewed the personnel records of 4 care staff and found that the recruitment checks required to demonstrate people were safe to work with High View Lodge DS0000019423.V376037.R01.S.doc Version 5.2 Page 22 vulnerable people were all in place. These included references and criminal records checks. New staff receive induction training and the managers AQAA confirms that the 50 of the care staff have NVQ care qualifications at level 2 and above, which achieves the national standard. There is an annual development and training plan for staff that is signed off as each area is completed. High View Lodge DS0000019423.V376037.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 & 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People experience an efficient, safe, well managed service, which needs to be maintained as the management of the service changes. However Runwood Homes need to review the resources available to give people more opportunity to interact with staff and improve their quality of life. EVIDENCE: This is the second key inspection, where outcome standards covering the quality of daily life and staffing have not been fully met. Any action, taken by Runwood Homes, in relation to improving these areas in the last year, has not fully addressed these areas. These issues were raised in our last report but we now need to take further action to move these areas forward with the High View Lodge DS0000019423.V376037.R01.S.doc Version 5.2 Page 24 company. While staff are being encouraged to move to a more person centred approach, the allocation of staffing is resource led, rather than being based around delivering outcomes for residents that meet their activity needs and aspirations. Runwood Homes have made the decision to move the registered manager to another of their services and appoint a new manager to High View Lodge. This change had only recently taken place and the new manager was receiving support from the previous manager who had been in post for a year. We will expect an application for registration under the Care Standards Act, to be forwarded to us, so assess their suitability for this role. Discussions on the day of our visit confirmed the new manager had the professional qualifications and management training required for this position, The out-going manager’s self assessment (AQAA) and this inspection tells us that improvements have been made in the experiences of people living in the home in relation to their health care, providing a calmer atmosphere for people with dementia and a more consistent approach from staff. These improvements have been made in line with the action plan put in place following an audit by Runwood Homes last year. People are able to give their views on the service through quality assurance surveys, resident, relatives and staff meetings. Senior representatives from Runwood Homes make regular visit to the home and provide the manager with reports and action plans on the quality of the service being provided. Residents are able to deposit small amounts of money for safekeeping. Records of transactions including receipts are kept. The Runwood systems include a regular audit of money kept on behalf of residents to check it is being managed appropriately. The records in the home are well maintained. The information we needed to look at to confirm that health & safety checks were being carried out were all in order. There are clear procedures in place to ensure the safety of people who live and work in the home. This includes regular fire safety checks and monitoring of accidents. The hot water temperatures we tested were within the required health & safety range to prevent accidents. Radiators are covered so people are protected from hot surfaces and first floor windows are restricted to prevent accidents. Staff receive training in safe working practices and first aid. High View Lodge DS0000019423.V376037.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 2 x x x x x x 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 3 High View Lodge DS0000019423.V376037.R01.S.doc Version 5.2 Page 26 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 OP26 Regulation 13 Requirement Staff must have direct access to liquid soap and disposable hand towels or a suitable hand cleansing system in the laundry room on each unit. This is to reduce the risk of infection spreading because staff cannot cleanse their hands on completion of the task. The registered provider must review the level of staffing available to people on each unit during the 24 hour day. This is so residents receive support to lead more fulfilling lives and there are plentiful staff to support their needs, activities, and aspirations in an individualised and person centred way. The registered provider is requested to provide CQC with written details of the outcome of their review and action taken. Timescale for action 31/08/09 2. OP27 18 30/09/09 High View Lodge DS0000019423.V376037.R01.S.doc Version 5.2 Page 27 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 OP19 Good Practice Recommendations Meet with staff to review and address their concerns regarding the staff room facilities they are provided with. This is to make sure staff have a suitable place to take their breaks. As previous guidance given in inspection reports has not been followed up we would like the registered provider to provide written confirmation that the kitchen flooring identified as being a trip hazard has been replaced. This is to enable us to monitor the actions of the company. 2. OP19 High View Lodge DS0000019423.V376037.R01.S.doc Version 5.2 Page 28 Care Quality Commission Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.eastern@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. 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