CARE HOMES FOR OLDER PEOPLE
High View Lodge Cherry Orchard Gadebridge Hemel Hempstead Hertfordshire HP1 3SD Lead Inspector
Alison Jessop Unannounced Inspection 2nd December 2005 10:00 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 High View Lodge DS0000019423.V270650.R01.S.doc Version 5.0 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. High View Lodge DS0000019423.V270650.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service High View Lodge Address Cherry Orchard Gadebridge Hemel Hempstead Hertfordshire HP1 3SD 01442 239733 01442 239154 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) Runwood Homes Plc Jacqueline Smith 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 over 65 years of age (77) High View Lodge DS0000019423.V270650.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 6th July 2005 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. High View Lodge DS0000019423.V270650.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day by two Regulatory Inspectors. On arrival at the home the inspectors were given access and were not met by staff. The inspectors walked around the home for several minutes and were passed by several members of staff, none of whom asked for identity. During the time that was taken walking around, the atmosphere was positive and relaxed. A meeting was held with the Registered Manager and time was spent talking to service users, staff and visitors. Records were also observed. What the service does well: What has improved since the last inspection? What they could do better:
Staffing levels on the dementia unit are inadequate. An extra carer was provided in the evening but levels of staffing throughout the day are not adequate. An immediate requirement was made for staffing levels to be increased throughout the day and night in order to be able to provide a ‘specialist’ dementia care service. Staff should be more aware of noise levels during lunch and at other times of the day, particularly on the dementia care unit where service users are more sensitive to noise. High View Lodge DS0000019423.V270650.R01.S.doc Version 5.0 Page 6 One service user spoken to said ‘my clothes don’t always come back from the laundry, and I sometimes end up wearing other peoples clothes.’ The area around the smoking room on the first floor smelt of smoke. An extractor fan is required in order to prevent this. Kitchenettes on units are worn and cupboard doors are hanging off, these require replacing as they cause a health and safety hazard, particularly as work surfaces are worn. 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. High View Lodge DS0000019423.V270650.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection High View Lodge DS0000019423.V270650.R01.S.doc Version 5.0 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 the following standard(s): 1,3 & 6 The pre-admission assessment enables managers to determine if the home can meet prospective service users needs. EVIDENCE: Records observed confirmed that pre-admission assessments had been carried out prior to service users moving in. Standard six is not applicable, as the home does not provide Intermediate Care. High View Lodge DS0000019423.V270650.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10. Service users in the dementia unit do not receive a specialist service, as staffing levels are inadequate. EVIDENCE: Although care practice observed throughout the home was sensitive and caring, the care on Gadeview, the dementia care unit did not appear to be more specialised than on the other units. Service users have higher dependency levels and staff did not have time to offer them more individualised and sensitive care. Service users were observed sitting in the dining room for long periods of time before lunch and waited for staff to assist them with their lunch. One service user who is being cared for in bed looked comfortable and staff were providing her with regular fluids. Staff were also providing and recording pressure relieving care. The service users bedroom had been decorated with Christmas decorations and music was playing quietly in the background. Her relative stated ‘I am very happy with the care being provided here’. It was observed that many of the service users were walking around with illfitting shoes or slippers. This causes a risk and could increase falls.
High View Lodge DS0000019423.V270650.R01.S.doc Version 5.0 Page 10 Procedures relating to the storage, administration, handling and disposal of medication were generally satisfactory. An error had occurred in the home prior to the inspection however the manager and staff dealt with this appropriately. A lot of work has since been done to improve medication procedures. The duty manager was carrying out an audit on the day of the inspection and took great care in ensuring that stock balances were correct. A new Controlled Drugs book has been implemented. High View Lodge DS0000019423.V270650.R01.S.doc Version 5.0 Page 11 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 the following standard(s): None of these standards were inspected on this occasion. EVIDENCE: See report dated 6 July 2005 for the most recent assessment. High View Lodge DS0000019423.V270650.R01.S.doc Version 5.0 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 An allegation of theft had been dealt with following the correct procedure which should contribute to the prevention of further issues. EVIDENCE: Service users have made two allegations of theft since the last inspection. One had been dropped however one has been investigated but not resolved. The manager followed the Protection of Vulnerable Adults Procedure and reported the incident to CSCI. High View Lodge DS0000019423.V270650.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 25 & 26 Kitchenettes on units are worn and need replacing, work surfaces cause a risk to health and safety as food preparation is carried out on these surfaces. EVIDENCE: Kitchenettes on units are worn and cupboard doors hang off. The work surfaces are worn and locks on cupboards that contain cleaning products are broken. The dishwasher in Fairway unit was also not working. Some hand soap dispensers are empty and paper towels provided are not soft, this could lead to the spread of infection. A strong smell of cigarette smoke was detected on the first floor around the smoking room. High View Lodge DS0000019423.V270650.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27. Staffing numbers on the dementia care unit are inadequate. This causes a risk to service users who require close monitoring and specialist care. EVIDENCE: Gadeview provides care to up to 15 people who have dementia. The unit has two staff on duty at all times of the day with one extra person that floats between units. Staffing levels should be a minimum of three at all times with an extra person during busy times. It was noted that during the day staff on the unit constantly carried out care tasks. During times when two staff were required for personal care, no staff were observed on the unit to monitor the other service users. Other than provide care to service users, care staff are responsible for preparing supper and snacks on units and laundry of service users personal clothing. This inevitably removes them from their ‘caring role’, leaving service users without monitoring or assistance. High View Lodge DS0000019423.V270650.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 & 38 Funding appears to be insufficient as there is no dedicated budget for activities or gardening. EVIDENCE: The home does not have a dedicated budget for activities or gardening and the care staff undertake laundry and cooking as part of their day to day work. It appears that the home has to use volunteers or organise fund raising events in order to raise money for activities which should be included as part of the charge. A copy of the homes annual financial plan has been requested. Cleaning materials were observed in kitchen cupboards that had no locks. This is a potential danger to service users and a requirement has been made for these to be stored safely. High View Lodge DS0000019423.V270650.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X 2 2 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X 2 X X X 2 High View Lodge DS0000019423.V270650.R01.S.doc Version 5.0 Page 17 Are there any outstanding requirements from the last inspection? YES 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 OP27OP8 Regulation 18(1)(a) Requirement Staffing levels on the dementia unit must be increased to ensure that service users needs are met and service user safety is maintained. Immediate Requirement made. An audit of service users footwear must be carried out to ensure that falls are prevented. Kitchenettes on units must be replaced and made safe. An action plan must be submitted to CSCI. The dishwasher on Fairway unit must be repaired or replaced. Liquid soap and soft paper towels must be provided in all areas where hand-washing facilities are available. An extractor fan must be fitted to the window in the smoking room in order to prevent the smell of smoke in other parts of the home. A copy of the homes most recent business and financial report must be submitted to CSCI. Timescale for action 02/12/06 2. 3. OP8 OP19 12(1)(a) 16(2)(g) 31/12/06 30/06/06 4. 5. OP19 OP26 23(2)(c) 13 (3) 31/12/06 31/01/06 6. OP26 16(2)(k) 31/03/06 7. OP34 25(3)(b)& (c) 31/01/05 High View Lodge DS0000019423.V270650.R01.S.doc Version 5.0 Page 18 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations High View Lodge DS0000019423.V270650.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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