CARE HOMES FOR OLDER PEOPLE
High View Lodge Cherry Orchard Gadebridge Hemel Hempstead Hertfordshire HP1 3SD Lead Inspector
Julia Bradshaw Key Unannounced Inspection 26th June 2007 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.V342956.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. High View Lodge DS0000019423.V342956.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 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) www.runwoodhomecare.com 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.V342956.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 5th July 2006 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 are kept on display in the entrance area. Current fees for the home range from £486 to £642 per week. High View Lodge DS0000019423.V342956.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was undertaken by one inspector who was present in the home for just over five hours. There were 75 service users in residence and, during the inspection at least fifteen spoke with the inspecting officer. In addition, a tour of the premises was undertaken, several of the staff on duty were spoken to and records were examined. This was a positive inspection with the majority of standards being met. The atmosphere of the home was calm and friendly. The staff work hard to maintain a homely environment for its service users. The home has a good system in place for assessing service users needs and review their care plans regularly. What the service does well: What has improved since the last inspection?
The manager has successfully increased the staffing levels in Verway unit since the last inspection took place. The flooring in one of the bedrooms was replaced after the last inspection; several areas of the home have been reHigh View Lodge DS0000019423.V342956.R01.S.doc Version 5.2 Page 6 decorated. The re-furbishment of all kitchen areas is now complete and carpets have been replaced in various areas of the home. The manager stated that the home was currently fully staffed. The manager and staff have worked hard to further develop communications with relatives and carers and provide family meetings on a regular basis in order to ensure that there are opportunities for everyone concerned to express their views and opinions in maintaining standards and improving services. The manager and staff have also further developed the daytime activities programme with a specific focus on the people living within the dementia unit. 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. The summary of this inspection report can be made available in other formats on request. High View Lodge DS0000019423.V342956.R01.S.doc Version 5.2 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.V342956.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,5. Standard 6 does not apply to this home. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Full assessments are completed for all prospective service users to ensure the home can meet all individual needs. Prospective service users are provided with enough information and have every opportunity to make sure that Highview Lodge will be suitable for them. EVIDENCE: Six case records were examined in detail and these demonstrated that service users, their relatives and/or representatives are involved in the initial assessment of care and social needs and that the identified areas of care can be provided by the staff at the home. Service users confirmed that, as part of the admission process, they and their supporters were invited to visit the home to make sure that the facilities on
High View Lodge DS0000019423.V342956.R01.S.doc Version 5.2 Page 9 offer suited their needs. Full assessments are also required from referring agencies for any new service. High View Lodge DS0000019423.V342956.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8, 9 and 10. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Individual care plans in the home are detailed and evidence that care staff are meeting individual health needs. Procedures in the home ensure that the privacy and dignity of service users is promoted. Medication procedures must improve to ensure that service user health and welfare is protected. EVIDENCE: Six service users care plans were inspected and contained the required information. Detailed records of visits carried out by other professionals were recorded and up to date. District nurses records are held separately, in a designated office on the first floor. The manager must ensure that service users or their representative sign the care plan. Records of food and fluid monitoring were seen and health professional visits were detailed. Full risk
High View Lodge DS0000019423.V342956.R01.S.doc Version 5.2 Page 11 assessments were in place. The monthly management report includes the monitoring of all falls, accidents, complaints and other incidents, so that any trends can be identified and dealt with. Service users spoken with confirmed that staff always treat them with respect and promote their right to make choices. Several residents in the home have their own telephone lines. The medication trolleys are held within large locked cupboards on each floor. There are rigorous medication procedures in place and an identified member of staff is responsible for the ordering and returning of medication. The home uses the dosette system for the dispensing medication on a weekly basis. On the day of the inspection however, the Medication Administration Sheets (MAR) were checked and several gaps were found. Also it was discovered that there was inadequate information regarding the administration of PRN medication, as a running record of paracetemol had not been maintained. The manager must ensure that all medication procedures are adhered to at all times. High View Lodge DS0000019423.V342956.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 –15. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Budgetary restrictions and insufficient hours currently compromise the opportunities for service user to benefit from experiencing a full range of social and leisure interest. Service users are provided with a varied and wholesome diet. EVIDENCE: The inspector was disappointed to discover that the home remains inadequately resourced with regard to the number of hours currently allocated for activities. There is also inadequate financial support to provide the materials for the activity worker to carry out her role effectively and efficiently. This is in particular regard to the service user with dementia who requires specialist and individual resources, which are lacking. This is not a reflection on the current activity worker, staff or manager who provide an adequate service within the confines of the current provision. Recent activities include a planned trip to Southend, arts and crafts, quiz, games and music sessions, films and
High View Lodge DS0000019423.V342956.R01.S.doc Version 5.2 Page 13 cheese and wine on Sundays. The activity worker was also in the process of planning a summer fayre for August. The inspector joined a group of people enjoying their mid-day meal and the food was found to be both nutritious and plentiful. Service users confirmed that they have a choice of meals and alternatives were ready available. One service user stated that, “the food is always interesting and tasty”. Another service user stated that it “couldn’t be better”. Those residents who could express an opinion said that they were involved in the daily running of the home and that visitors were always made welcome. The most recent service user meeting was held in April and various comments were minuted regarding the service “you can have a good laugh here”, “I like to keep busy”, “ The people are lovely here” and “I like to help other people less able than myself” Service users were generally very happy with the service but commented on wanting more activities and the opportunity to go out more. High View Lodge DS0000019423.V342956.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 –18. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Policies and procedures followed in the home ensure that service users are protected from abuse and have any concerns listened to and acted on. EVIDENCE: The home has written policies for making a complaint, for the protection of adults and for whistle-blowing. Residents spoken with confirmed that they would not hesitate to voice any concerns to staff if they had any. Training in safeguarding adults has been provided for all staff and this topic is included in induction training. There are currently no safe guarding adult’s issues within the home. There have been 4 complaints since the last inspection was carried out and all these have been resolved to a satisfactory conclusion for both parties involved. High View Lodge DS0000019423.V342956.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 –26. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is well maintained and provides a pleasant and hygienic environment, which is clearly enjoyed by the residents. EVIDENCE: A tour of the building revealed that the premises are maintained to a good standard of maintenance and decoration and the whole premises are kept to a good standard of cleanliness. Staff were well versed in appropriate infection control practices. The garden was both safe and attractive and no hazards were identified both within the building and the surrounding grounds. Service users confirmed that they were encouraged to personalise their bedrooms and that their bedrooms were both appropriate to their needs and comfortable.
High View Lodge DS0000019423.V342956.R01.S.doc Version 5.2 Page 16 All fire records were up to date and the most recent fire alarm check was carried out on the 25/06/07. The maintenance person checks hot water temperatures and the last record was on the 20/06/07. Fire training was carried out on the 28/03/07. There are several areas of the home that have been decorated and refurbished including, all kitchenettes (which were re-fitted last summer), the lounge carpet in Gadeview has been replaced, 2 new beds have been purchased and the matting outside in the foyer has been replaced. The home is part of the provider’s rolling programme for repairs and maintenance and minor/major works. The home has a laundry and sluice room and care staff confirmed that they used red alginate bags for soiled laundry and that there were always good supplies of disposable gloves for their use. High View Lodge DS0000019423.V342956.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 –30. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users are protected and have their needs met by well-trained staff members and through sound recruitment procedures. EVIDENCE: The Staff spoken with during the inspection appeared to be clear of their individual roles and responsibilities. The members of staff on duty was seen to support the main aims and values of the home. The home has clearly defined job descriptions. All staff have received a series of mandatory training course in order for them to meet the needs of the service users Recruitment practices were inspected and proven to be accurate and adequate. The three staff files were checked and contained all the required information. The manager stated that the home was currently fully staffed with a recent appointment of a deputy manager. The home has a variety of ancillary staff that carry out their tasks both effectively and efficiently with positive comments from service users and visitors with regard to both the standard of the meals provided and the standard of cleanliness. Recent training includes, Dementia 03/04/07, manual handling 18/05/07 safeguarding adults 24/05/07 and first aid training is planned for the 20/08/07.
High View Lodge DS0000019423.V342956.R01.S.doc Version 5.2 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,37 and 38. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is well managed and is run with input from staff and service users, which ensures people feel involved in their home. Procedures in the home promote safety and help protect service users and staff. EVIDENCE: The manager communicates a clear sense of leadership within the home, and promotes a sense of belong to it’s service users. Pride and dedication is taken in every aspect. Service users commented on how the manager is efficient and effective in addressing issues raised and responds appropriately.
High View Lodge DS0000019423.V342956.R01.S.doc Version 5.2 Page 19 Staff files contained minutes of supervisions. Staff meetings are held regularly and minutes of these minutes were seen on the day of the inspection. Service users appear to be happy living at Highview Lodge and were seen to be relaxed in their environment. The relationship between the service users and the staff is well balanced with interactions observed being appropriate and supportive. The ethos and management approach of the home creates an open, positive and inclusive atmosphere; staff and the service user spoken to comment that they feel supported. A clear commitment is made to equal opportunities within the home, with staff and service users expressing positive views with regards to this. The staff and manager within the home are adequately and suitably trained in order to meet the changing needs of the service users. The home has various systems in place to ensure that service user’s choices are respected, within their abilities and understanding. The care planning system in place provides an opportunity to share and discuss each person personal goals and aspirations with the relevant key worker and outside professionals. However the manager must ensure that confirmation that the service users are consulted in this process by ensuring they sign their care plan. If this is not possible the manager must ensure that the service users representative signs on their behalf. Records and documentation are audited by the organisation. The manager must ensure that medication procedures are followed and strictly implemented. Policies and procedures were in place for the protection of service users. The manager has various systems in place for auditing the service which include, weekly medication, care planning, financial checks as well monthly health and safety checks. High View Lodge DS0000019423.V342956.R01.S.doc Version 5.2 Page 20 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 3 3 High View Lodge DS0000019423.V342956.R01.S.doc Version 5.2 Page 21 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 OP9 Regulation 13 (2) Requirement Timescale for action 27/07/07 2. OP12 16 (2) (m) & (n) The manager must ensure there is a running record and reconciliation of PRN medication carried out and maintained at all times. The manager must be vigilant in ensuring that there are no gaps on the MAR sheets. The providers must consult with 31/08/07 service users about activities and social interests and provide appropriate facilities as an outcome to those consultations. 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 OP7 OP12 Good Practice Recommendations Service users or their representative should sign their care plan as a demonstration of their involvement in creating the plan. The proprietors should increase the current hours available for activities from 20 hours per week. High View Lodge DS0000019423.V342956.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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