Inspection on 03/07/08 for High View Lodge

This inspection was carried out on 3rd July 2008.

CSCI 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 11/05/09

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE High View Lodge Cherry Orchard Gadebridge Hemel Hempstead Hertfordshire HP1 3SD Lead Inspector Sheila Knopp Unannounced Inspection 3rd July 2008 08:40a 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.V367300.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.V367300.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(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 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.V367300.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. 26th June 2007 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 £525 to £625 per week. Different rates per bed are applied to local authorities purchasing placements. High View Lodge DS0000019423.V367300.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 an unannounced visit to the home by two regulation inspectors. As people with dementia are not always able to tell us how they feel one of the inspectors spent an extended period of time with a group of residents observing their experiences and the interaction and support they receive from staff. We also had discussions with individual residents, groups of residents and staff in other areas of the home. To make sure we obtained a wide range of views about the quality of the service provided we sent survey forms to 20 residents & relatives. Thirteen residents (65 ) and 11 relatives (55 ) replied. Surveys were also sent to health care professionals who visit the home and we made 20 survey forms available to staff who work in the home. We received responses from 4 health care professionals and 3 staff (15 ). We have also reviewed the information we have received since our last inspection and the Annual Quality Assurance Assessment (AQAA) that the manager sent to us. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Ann Hill joined the home as manager in March and this inspection gave us the opportunity to meet with her. A senior manager responsible for reviewing and assessing the quality of Runwood Homes was also present. What the service does well: Good information is available to people looking to use the service. A detailed assessment is carried out before people come to live in the home to make sure it is suitable for them and that staff can meet their needs. Residents told us ‘All carers are kind and understanding’, ‘ Regarding my stay at High View Lodge I am happy and pleased with all that is done for me’, ‘I am happy and content’. One person who has lived in the home for a number of years said ‘It’s first class, three meals a day and a bed what more could I want’. A relative told us the home makes their relative ‘feel safe, secure and above all happy’. High View Lodge DS0000019423.V367300.R01.S.doc Version 5.2 Page 6 The home has a bright fresh feel to it with a variety of areas for people to sit, including courtyard style gardens. The home is closely monitored by Runwood Homes to make sure appropriate standards are maintained and the training provided reflects current professional practice for the care of older people and people with dementia. What has improved since the last inspection? What they could do better: Many of the issues identified by this inspection have already been recognised by the service provider and we are confident that the management and quality monitoring systems are robust enough to ensure the required action is taken. People with dementia need to experience consistent patterns of care that recognise them as individuals and promote their sense of well being and comfort. Suppertime arrangements need to be reviewed so that people are able to make individual choices and there is enough food to go round. Medication must be given according to the prescriber’s instructions as failure to do so can put people at risk. There must be accurate records of all medicines received into the home to enable staff to check that the correct amounts have been given. To make sure there are no side effects medicines, which are required to be given at a specific time or before the person has eaten, must be given according to the pharmacists instructions. High View Lodge DS0000019423.V367300.R01.S.doc Version 5.2 Page 7 Where appropriate residents particularly those receiving respite care and returning home should be encouraged to carry on managing their own medicines to maintain their independence. The current deployment of staff means the choices and experiences of people living in the home can be reduced when key people are not there or minimum levels of cover are applied. The manager needs to review the frequency of supervision sessions for care staff to ensure their practice is being monitored and they are being supported. 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.V367300.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.V367300.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 (Standard 6 does not apply to this service) People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People can be confident that the home will be able to offer appropriate care and support because staff will meet with them before they come to stay to assess their needs and preferences. EVIDENCE: We reviewed the care records of a resident who had recently come to live in the home. 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 make sure staff have the skills and equipment required to meet the needs of the person concerned. The manager told us that the admission process had been recently reviewed and to ensure accurate and detailed information is collected two staff are High View Lodge DS0000019423.V367300.R01.S.doc Version 5.2 Page 10 involved in the pre-admission assessment visits to people in their own home or hospital. A resident told us their social worker had been ‘extremely helpful’ in supporting their move into the home. Another person confirmed two people had visited them as home to assess their needs. The assessment recognises that people may have very different needs and expectations according to their disability, gender, religious or cultural background. Good information is available to people looking to use the service. However this report identifies that more work needs to be carried out to build on the training and skills of staff to enable them to fully deliver the organisations approach to dementia care described in the home’s information pack (Statement of Purpose). People are encouraged to visit the home before they come to stay. The contracts issued once a person’s place has been confirmed, provide clear information on what is included in the fee, the role and responsibility of the provider, and the rights and obligations of the individual. High View Lodge DS0000019423.V367300.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 & 10 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the service will each have an individual plan of care setting out their needs and how they wish to be supported but for people with dementia this needs to give staff clearer information about how they work with people’s strengths to maintain their individuality and sense of well being. People can be sure they will receive the help they need to achieve a high standard of personal care and have access to doctors and community health services when they need it. However, visiting community staff do not always respect peoples’ dignity and privacy when they carry out procedures in public areas of the home. People in the home may be put at risk because staff are not following the medication procedures in place on all occasions. High View Lodge DS0000019423.V367300.R01.S.doc Version 5.2 Page 12 EVIDENCE: To check whether people where having their personal, health care and social care needs met we reviewed the surveys we had received, the managers self assessment, met with individual residents, observed the interaction between staff and residents and reviewed individual care plans. On the day of our inspection the residents we spoke to expressed a high level of satisfaction with the care and support they receive form staff. Nine (69 ) out of 13 residents who completed surveys said they always or usually received the care and support they needed. Eleven people (85 ) confirmed they always or usually received medical support when they needed it. The three doctors who returned questionnaires to us said people’s individual care needs were usually met by the service. A relative commenting on the experiences their family member has had in hospitals and other care homes said ‘this is the one where they have been most at peace. I think it speaks for its self’. Our direct observation of people who cannot communicate their feelings so clearly due to their memory loss showed us that staff were inconsistent in their approach and were task led rather than approaching each person as an unique individual. We observed a member of staff showing warmth and comfort by holding a persons hand and kneeling down to talk to them. They also included other residents in conversation and prompting while assisting another individual at the lunch table. Staff were able to show people both the lunch options so they could make a choice from what they saw in front of them. In contrast we saw interaction which would be confusing and distressing to people trying to make sense of what was happening to them. Staff were routinely taking residents to the toilet before lunch without asking them or telling them where they were going. We heard someone telling a resident to stand and then leading them off by the hand without telling them where they were going. Tabards were put over people’s heads at lunchtime without asking them or commenting on the action being taken. We observed that lunchtime was chaotic as there is too little room in the dining room to have everybody seated at once. We noted people struggling to get to their places and a member of staff accidentally injured the leg of one of the residents as they tried to move about. People were sat down a long time before lunch was served and understandably became restless. Staff ignored people as they walked around and went in and out of the lounge. People who were observed to be withdrawn at the start of our observation remained so during the time we were there and staff did not appear to notice this. A resident indicating they wished to go out into the garden was stopped and told it was too windy. Staff were not listening to what people were telling High View Lodge DS0000019423.V367300.R01.S.doc Version 5.2 Page 13 them. We heard a resident telling a member of staff about an incident in which they had clearly felt threatened and at risk. The member of staff did not acknowledge what the person had said and turned away to talk to another resident. People were being led by the hand in a child like manner with staff walking in front of them. We heard some one saying ‘good girl’ to one of the residents. The 3 care plans we looked at in this area make statements about the individual rather than providing staff with details of how they can promote peoples sense of well-being and maintain independence building on the strengths of the person concerned so they retain their sense of personhood. The staff records we looked at indicated that 3 out of the 4 staff working that day had received training in dementia care but clearly need positive role models to change the pattern of care we observed. The manager has told us that care plan training has taken place but more is needed to develop a more person centred approach to care. The care plans we reviewed identified areas of risk and the action taken to prevent specific problems such as weight loss and pressure sores. Specialist equipment to prevent pressure sores is provided by the community nursing service. It was reported that no residents in the home had pressure sores, which is a positive indicator of good standards of personal care, hygiene and nutrition. To check on whether people were having the medicines they are prescribed in a safe way we looked at the systems for ordering, storing, administering and disposing of medicines. We particularly checked the systems for managing medicines for people on anticoagulant therapy (Warfarin) as this requires staff to implement frequent changes of dose based on instructions from hospitals and doctors surgeries. We were also notified of an incident involving this medication. The administration records showed us that staff were recording the correct amount of medicine according to the revised prescribing instructions but we were not able to check on the accuracy of these records because staff are not recording the stock levels kept on each unit or in the main storage cupboard. Night staff are also signing to say they have audited the medication records but are clearly not able to check the stock balance of these tablets. The quantity of other medicines received were clearly recorded on the administration charts. We also found that staff had not given one resident their heart medication on 15 occasions because the supply had run out. Another person was having medication (Alendronic Acid) with their breakfast when the pharmacy instructions clearly states to be given 30 minutes before the first food or drink. A health care professional commenting on how staff manage people with dementia who may be physically and verbally challenging said ‘The home can look for medication as a treatment before attempting management strategies’, and while the approach to many clients is good some staff appear to ‘take against resident who are verbally aggressive by showing obvious dislike or through their management of them’. This information arrived after our visit High View Lodge DS0000019423.V367300.R01.S.doc Version 5.2 Page 14 and we have not been able to follow this through but have discussed it with the manager. Although the medication procedures support people being encouraged to continue to manage their own medicines, subject to an assessment of risk, we found that no one in the home is currently maintaining their own independence in this area. This included people who will return home after their respite stay and people who used inhalers. We are aware following a medication incident involving a community nurse that there have been meetings between the home and community nurse managers to set up agreed protocols for the conduct of staff visiting the home, which include ensuring all procedures are carried out in private. This inspection identified from our discussions with staff that there are still reports of community nurses and chiropodists treating people in public and this needs to be challenged by the staff on duty. High View Lodge DS0000019423.V367300.R01.S.doc Version 5.2 Page 15 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): Standards 12, 13, 14 & 15 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are able to maintain links with family and friends and are offered a range of activities to choose from to occupy their time but opportunities may be limited depending on staff availability. People have mixed opinions on the standard of meals they are provided and the supper arrangements need to be reviewed so dishes do not run out and people can have what they choose. EVIDENCE: The manager has told us of developments being made to improve staff interaction with residents to provide a more stimulating environment and staff told us about recent training they had attended. Additional resources in terms of things for people to do have been provided on each unit and it was reported that sensory equipment, which can be moved around the home has been ordered. High View Lodge DS0000019423.V367300.R01.S.doc Version 5.2 Page 16 A group of residents we spoke to recognised there were things for them to do should they choose but felt very content with the way things were. However because the activity lady was on holiday the reality for a group of residents spending a short time in the home receiving respite care was that no activities were taking place. Nine (69 ) out of 13 people who completed surveys said there were usually or sometimes activities they could take part in. The activity staff complete a profile for each person, which identifies their interests and preferences, and how they respond to the activities offered. We thought it would be helpful for the care staff to have access to the profiles to help them find further areas of stimulation throughout the day. We observed residents busying themselves helping with washing up and laying tables. There are a variety of seating areas a round the home where residents can sit quietly and library books are available. A number of units have pet birds, which residents help to look after. A trolley shop enables people to do their own shopping and there is a hairdressing salon people can visit. People who smoke have access to a smoking room. Residents are able to use the day centre attached to the home and we were made aware of arrangements for people to visit church. A monthly service is also held in the home. Information about community events is available in the foyer. Each person has a key worker who is able to take a special interest in them. The staff we spoke to had a good understanding of their role in encouraging people to maintain contact with their families and supporting people where there were no family links. The current menu provides people with a range of home style cooking. People who completed surveys had mixed opinions on whether they like the meals with 61 (8) saying they usually or sometimes liked them. Only 4 people said they always liked their meals. Two people said there is no variety and it is tasteless. We understand from the manager that the menu is under review and residents will be involved in giving their opinions. We received comments from residents, relatives and staff about the arrangements at suppertime. People told us portions were small and staff had to sometimes ask other units for further supplies. This appears to be due to the morning staff ordering half of each supper option rather than individual choices. The evening staff then offer people a choice of what has been supplied and some items run out. Arrangements are made for people who need special diets and a range of diabetic juices and jams were available. However there appears to be an over reliance on fruit and yogurts for people with diabetes as the catering staff report they do not always have time to make diabetic desserts that match the choices given to other people. High View Lodge DS0000019423.V367300.R01.S.doc Version 5.2 Page 17 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): Standards 16 & 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People can be confident that their concerns will be listened to and acted on by the manager who is also looking at ways of improving communication and customer care so issues are dealt with by staff at an earlier stage. Staff are provided with training so they can recognise and report bad practice to protect people living in the home. EVIDENCE: All the residents (100 ) who completed survey forms said staff always listen and act on what they say. However despite the complaint procedure being available in each room and in the information provided on admission only 7 people (53 ) said they knew how to make a complaint. The manager has identified this as area for further improvement. We have recently been contacted by two people concerned about the standards of care provided at the home earlier in the year, but particularly the management of residents who appear to be more challenging. Runwood Homes were asked to investigate using their complaint procedure and responded within the timescales set out in their complaints procedure. One of the investigations they undertook told us we had not been informed about medication errors that occurred in the home. The new manager is aware of her responsibilities in this area. This inspection identified that more work is High View Lodge DS0000019423.V367300.R01.S.doc Version 5.2 Page 18 required to bring up the skill levels of staff working with people who have dementia so that they benefit from a positive approach that recognises them as individuals. A record of complaints received by the manager is kept. Details of the investigation and further action taken is recorded and communicated to staff. Where residents have raised concerns about the approach of staff they have been appropriately investigated and dealt with. A relative told us they had complained about the standard of personal care but met with the manager and has not had any problems since. Along side the record of complaints many compliments have also been received. The manager has told us that planned improvements in this area over the next 12 months include building ‘a better rapport with residents staff and multi disciplinary teams to alleviate concerns and ensure all concerns are acted upon’. She has identified the need for staff to be trained in better customer care to address concerns at an early stage before they become a more serious problem. Our interviews with staff confirmed they receive training in protecting residents from abuse and understand their responsibilities to report any concerns. However as reported earlier in this report staff need to listen carefully to what residents who have dementia may be trying to tell them. High View Lodge DS0000019423.V367300.R01.S.doc Version 5.2 Page 19 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): Standards 19 & 26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Highview Lodge provides people with a safe, well maintained, clean and hygienic home in which to live. However, thought to the layout of the specialist dementia unit should be given to ensure it is suitable to meet the needs of the people who live there. 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 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. High View Lodge DS0000019423.V367300.R01.S.doc Version 5.2 Page 20 People on the ground floor have direct access to the gardens, which have a variety of seating areas, pathways and points of interest. We found that space on the unit specialising in dementia care did not give people the space they need to move freely about or for staff to move people safely because of the way the dining room and lounge are currently organised. Everyone is having their meals at the same time and the lounge chairs are close together which reduces personal space and does not enable staff to get beside them when using moving and handling technique. Some of the decorations like the insect mobiles hanging from the walls, a flashing clock and highly patterned table clothes may cause difficulties for people trying to make sense of their surroundings. 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. High View Lodge DS0000019423.V367300.R01.S.doc Version 5.2 Page 21 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): Standards 27, 28, 29 & 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live in the home are generally satisfied with the support they receive from staff although in some areas over stretched staffing levels may have an impact on the quality of the service provided. People can be confident that staff are checked for their suitability to work with vulnerable people and are provided with the training they need to carry out their jobs. EVIDENCE: Twelve out of 13 people living in the home who completed survey forms said staff were always available when needed. Relatives who provided additional comments on staffing when they completed their survey forms said they select ‘ staff that seem to have the interests and well being of patients at heart’, the ‘care team is very good’, ‘the staff are very good they also have time to speak to me’, the staff are ‘always helpful’, staff at High View Lodge are generally very caring and understand the different needs of the residents’. High View Lodge DS0000019423.V367300.R01.S.doc Version 5.2 Page 22 Three relatives commented on the different approaches of staff and said ‘certain members of staff are more caring then others i.e. they have more patience when getting them (residents) to do something’, and ‘some locum staff are not as careful but more senior staff are very good’, ‘More experienced staff required, Reminders have to be made’. A health care professional commenting directly on the experience of people with dementia said ‘the loss of experienced staff has meant new employees are comparatively less skilled and trained to deal with dementia’. In some areas staff and residents are expressing feelings of staffing levels being stretched. One person receiving respite care when asked about the provision of activities during their stay said ‘The girls don’t have time they’re busy’. The activity organiser was on leave at the time of our visit and the absence of a key member of staff has an impact on the experience of residents. A health care worker said ‘Due to staff shortages it is not always possible to escort people outside’. Staff discussing recent activity training were concerned about how they would put it into practice. A new shift pattern has been introduced and there is no overlap to support busy periods of the day. Staff were observed sitting writing care plans while sitting in the lounge with residents and say they don’t always take their breaks. The current catering team consists of two cooks and a kitchen assistant to cover 7 days a week and meals for the adjoining day centre as well as the home. We identified that the cook does not visit new residents to discuss the menu options or meet with residents on a regular basis to get their views on the meals being served. When we left the kitchen at 12.55 pm the sandwiches for tea time had already been made, covered with cling film and placed on trolleys ready to go to each unit. The quality manager confirmed they were looking at the catering staff establishment. We reviewed the personnel records of 4 care staff and found that the recruitment checks required to demonstrate people were safe to work with vulnerable people were all in place. These included references and criminal records checks. New staff receive induction training and the managers assessment completed on 14/4/08 told us 46 of staff achieved National Vocational Qualifications (NVQ) in care with a further 8 people working towards it. We spoke to staff on duty that had achieved awards at level 3. High View Lodge DS0000019423.V367300.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 & 38 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People can have confidence in the service because it is well managed and there are systems in place to make sure people living and working in the home are safe, people’s views are listened to and their financial interests are protected. EVIDENCE: The home has a new manager who started work in January. Managers are required to apply to the Commission for registration and it is understood that Runwood Homes are in the process of forwarding an application on to us. We were able to see from the annual quality assurance assessment, the manager completed for us, that she has reviewed all aspects of the service and High View Lodge DS0000019423.V367300.R01.S.doc Version 5.2 Page 24 knows what needs to be done to make further improvements. Many of the issues identified in this report have already been recognised by Runwood Homes through the systems they have in place, which tells us the service is regularly monitored and audited by company managers. It has been recognised that more needs to be done to create a stimulating environment and staff are receiving training on how to incorporate meaningful activities into people’s daily lives. A relative told us there had been an ‘improvement in care under the new manager’. People are able to give their views on the service through quality assurance surveys, resident, relatives and staff meetings. 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. It was identified from staff surveys and discussion with staff and care team managers that the frequency staff receive formal one to one supervision has fallen behind schedule as staff changes have occurred. The manager is aware of this and taking steps to address it. The health & safety records we looked at showed us 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. The manager told us a health & safety committee has been set up. Staff receive training in safe working practices and first aid. High View Lodge DS0000019423.V367300.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 2 8 3 9 1 10 2 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 3 x x x x x x 3 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 3 x 3 x 3 2 x 3 High View Lodge DS0000019423.V367300.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 OP9 Regulation 13(2) Requirement To protect residents from harm suitable arrangements must be put in place to ensure that prescribed medicines for service users in safe control and custody of the home are given in accordance with the doctors instruction as specified by the pharmacy issuing the medicine. Accurate records of all medicines received into the home must be maintained to enable staff to check medicines are being given as prescribed. Timescale for action 31/07/08 2. OP9 13(2) 31/07/08 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.V367300.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact 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 © 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 High View Lodge DS0000019423.V367300.R01.S.doc Version 5.2 Page 28 - 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. 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