CARE HOMES FOR OLDER PEOPLE
High View Lodge Cherry Orchard Gadebridge Hemel Hempstead Hertfordshire HP1 3SD Lead Inspector
Julia Bradshaw Key Unannounced Inspection 5th July 2006 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.V302161.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.V302161.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) 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.V302161.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 2nd December 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.V302161.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Julia Bradshaw and Alison Butler carried out this Unannounced Inspection from 10 a.m until 3 p.m. This was a positive inspection and although there was an immediate requirement made regarding the level of staffing within Verway Unit the home was being well managed and staff were seen to be very caring and professional in their approach to service users. The home is currently in the process of having all its kitchenettes replaced and this work is 75 completed to date. Generally the environment was at a good standard with the exception of Gadeview where there was a strong mal odour that requires further investigation and replacement flooring should be provided, if necessary. Care plans within the home were detailed and comprehensive. Generic and individual Risk assessments were in place and had been updated within the last six months. A few issues were raised with the manager regarding infection control, including waste bins without lids and carpets that smelt of urine. The manager has agreed to rectify these immediately. Service users spoke very highly of the staff at the home with comments “ This place feels like home” and very positive comments about the standard of meals offered. The manager and staff should be congratulated on endeavouring to provide meaningful and varied activities within the confines an inadequate staffing and resources budget. The manager has recognised the need for service users living within the Dementia unit to receive specialist day-care activities and is therefore in the process of developing a new programme to include pictorial aids and the possibility of introducing memory bags. What the service does well:
The manager and staff provide a caring and professional service to people living within High View Lodge. There were several examples observed during this inspection where staff were seen to providing excellent care to the two service users who were in bed. Records relating to their care were accurate and up to date, including two hourly turn records and fluid charts. Residents receive a good standard of care within a pleasant and comfortable environment. The staff team are given the training they need to equip them with the necessary skills to safely care for residents. Staff were very open to the inspection process and were both helpful and informative with any questions raised by the inspectors. The standard of food on the day of this unannounced inspection was excellent. The inspector sampled the main mid-day meal and this proved to be both nutritional and plentiful with care and attention to detail and presentation clearly given. The manager and staff work extremely hard to provide meaningful activities within a budget, which is clearly inadequate. The home should be provided with a full time activities co-coordinator, especially with
High View Lodge DS0000019423.V302161.R01.S.doc Version 5.2 Page 6 service users within the dementia unit requiring additional support and specific day care activities provided. The home currently has a 20-hour post for activities for a total of 77 service users! The standard of record keeping, including those to do with medication was good, which helps to promote the safety and well being of the home’s service users. What has improved since the last inspection? 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. High View Lodge DS0000019423.V302161.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.V302161.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 & 6 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. There is a good system of pre-admission assessment in place to ensure that the care needs of people who may want to move into the home are fully understood and can be fully met. Staff are provided with the necessary training and support to give them the knowledge and skills that they need to be able to meet the varied care needs of residents. EVIDENCE: Visitors spoken to during the inspection spoke highly of the home and the care that their relatives were receiving. “It’s a friendly and welcoming home”” and the managers door is always open if you have a problem. This comment by one relative during the inspection was typical of several made by both service users and visitors. High View Lodge DS0000019423.V302161.R01.S.doc Version 5.2 Page 9 Care plans were examined and a robust and thorough assessment process was seen to be in place to ensure that only those people whose care needs could be appropriately met were admitted. Staff spoken to were very positive about the standard of training they receive, which includes for example specialist dementia care training and this was supported by those training records seen. High View Lodge DS0000019423.V302161.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Personal care and assistance offered to service users is of a very high standard, meeting the individual needs of the residents, whilst maintaining dignity and respect. Care staff are unobtrusive and sensitive in their approach. Care plans are detailed and are reviewed on a monthly basis ensuring changes to health and social care needs are recognised and met. Consent must be obtained for the use of bedrails. EVIDENCE: Good records are maintained regarding the health needs of each service user and for contacts and visits from medical practitioners, including GP’s, district nurses, dentists, chiropodists, dietician and ophthalmologist. Each service user has a care plan file that includes details and objectives for personal care, health care, mobility, continence, diet and mental stimulation. There is a
High View Lodge DS0000019423.V302161.R01.S.doc Version 5.2 Page 11 separate file for assessments for all the service users, a separate file for the health record for all service users, a separate file for monthly reviews for all service users and a separate file for the daily log for all service users. The service user or their representative signs the service user plans. There was evidence on individual files that care plans are reviewed on a monthly basis. The staff complete the daily log three times a day, the information from the log is then transferred to the care plan or the health record. Any changes are noted on the care plan and incorporated into the care plan goals at the next monthly review. The system was seen to work for the staff in the home. Current information is recorded in the individual care plan file and all the required records are maintained for each service user. The manager must obtain consent for the use of bedrails from either the occupational therapist or G.P. A recent bulletin on the use of bed rails from the Medical Devices Agency (MDA) has been sent to all care homes for action so ensuring the safe use of bed rails. High View Lodge DS0000019423.V302161.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Where possible the home tries to accommodate everyone’s individual preferences and feedback and suggestions are sought in all aspects. This promotes autonomy and choice. Visitors are welcome and the home promotes integration with the local community in accordance with service users preferences. The home does not currently provide adequate opportunities for service users to take part in activities within the home due to insufficient hours allocated to the manager. Meals provided are both adequate and nutritious. EVIDENCE: The home endeavours to provide a range of in-house activities for its service users, which include craft sessions, music and bingo. However there are insufficient hours provided to offer meaningful and varied activities for all service users living at the home and in particular people living within the dementia unit. The manager is working hard to develop an activities
High View Lodge DS0000019423.V302161.R01.S.doc Version 5.2 Page 13 programme specific to the meet the needs of people with dementia. This programme will include pictorial aids and the possibility of introducing “memory bags” into the unit. The home is currently allocated 20 hours per week for 77 service users. The home has a very welcoming atmosphere and several visitors were seen during the day of the inspection. There are few restrictions on visiting times, which mainly include mealtimes. Evidence was available to indicate that service users are able to bring personal possessions with them, in order to personalise their bedrooms The manager ensures that service users and relatives are aware of their rights to access personal records, in accordance with the Data Protection Act. The current menus provide are both well balanced and a variety of food is offered. The meal provided on this unannounced inspection was both flavoursome and nutritious. The cook was both knowledgeable and experienced in the provision of wholesome and creative meals. Positive comments were received from service users regarding the food/meals provided at High View Lodge. High View Lodge DS0000019423.V302161.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17 & 18 Quality in this outcome area is adequate This judgement has been made using available evidence, including a visit to this service. The complaints policy and procedure together with staff training in the recognition of adult abuse and the correct response if it is suspected should provide confidence in this service for service users, their relatives and those who care for them. Service users are at risk due to inadequate numbers of staff in Verway unit. EVIDENCE: Training records inspected confirmed that all staff have received the necessary training in detecting signs of Adult Abuse and have received training in the Hertfordshire County Council policy. However some staff spoken to appeared vague about the policy and the procedure they would be required to follow. This was feedback to the manager and would be raised during the next staff meeting and in supervision. The home has a robust complaints procedure and service users and relatives spoken to during this inspection visit confirmed that they felt confident that any complaint or concern raised would be dealt with. “ I can always speak to the manager, her door is always open”. The manager should endeavour to develop a complaints procedure in pictorial form for service users who would have difficulty understanding or remembering the written word. High View Lodge DS0000019423.V302161.R01.S.doc Version 5.2 Page 15 There have been no complaints since August 2005 received by the home or the Commission. The home also invites relatives and carers to raise any concerns or issues through the family forum. These meetings are held quarterly. High View Lodge DS0000019423.V302161.R01.S.doc Version 5.2 Page 16 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): 19 - 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. High View Lodge provides a pleasant environment for service users and is maintained to a good standard. Service users rooms are well furnished and can be personalised with familiar items of furniture, pictures and ornaments to reflect the personality and taste of individual residents. The overall standard in terms of safety is good with only one issue that requires attention. EVIDENCE: “It almost as comfortable as home” was the comment of one service user about her room. “I am very comfortable here, it is nice and clean” was another service users comment on the home. Housekeeping staff were active throughout this inspection visit and generally the home was clean throughout.
High View Lodge DS0000019423.V302161.R01.S.doc Version 5.2 Page 17 However there was a strong mal odour from within Gadeview Unit and in one of the bedrooms. The manager has agreed to investigate this and if necessary, provide new carpets/flooring. Service users’ rooms had a variety of items in them which they had either brought with them or had obtained after admission and this means that each room is slightly different and has a sense of being personal to the particular resident. All the kitchenettes within the home are in the process of being replaced. Two have been completed, two are in progress and one will be completed within the next month. The manager completed a risk assessment during the inspection, for the “work in progress” and identified any risks to service users. This will be updated and reviewed when and if necessary. High View Lodge DS0000019423.V302161.R01.S.doc Version 5.2 Page 18 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): 27,28,29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. There is insufficient care staff to provide an acceptable standard of care to service users. Staff have the necessary skills and training to provide a professional service to the people at High View Lodge. Supervisions and staff meetings are being held. EVIDENCE: The current staffing levels provided are inadequate and could put the service users health and safety at risk. There are currently two service users who require to be cared for in bed and this currently taking two staff away from the main unit and remaining service users are left with inadequate staffing for significant periods of time. The manager was issued with an immediate requirement to provide three staff on Verway unit at all times in order to protect the welfare of all service users living within this unit. The home also has inadequate staffing to provide meaningful activities to the 77 service users who live at the home. The home is currently given 20 hours per week to provide activities, which equates to less than 10 minutes per week per service user. The dementia unit also requires specialist day care activities, which should be provided with additional hours. Service users and relatives spoken with during this inspection visit were positive and supportive of the quality of
High View Lodge DS0000019423.V302161.R01.S.doc Version 5.2 Page 19 the staff team and the care that is provided even if staff appear very “rushed” was one comment. One visitor commented that it was often difficult to find a member of staff within the unit. Training records, including a new induction programme in line with the requirements of “Skills for Care”, and discussions with some of the staff on duty provided evidence of a good training and support process in operation. Staff receive dementia care training through the Alzheimer’s Society under the “Yesterday, Today, Tomorrow” programme. Four staff currently have NVQ level 2, one person has NVQ level 3,two staff are currently doing NVQ level 3 and four staff are currently doing NVQ level 2. Recruitment records and procedures were checked and found to be sufficiently robust and thorough to provide the necessary safeguards to protect service users. High View Lodge DS0000019423.V302161.R01.S.doc Version 5.2 Page 20 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): 31,33,35,36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The health and safety of service users are currently compromised due to inadequate staffing levels. The manager and her team provide a clear sense of leadership and purpose and have put in place, together with the proprietor, a robust and thorough system of quality assurance to monitor how the home operates. 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.V302161.R01.S.doc Version 5.2 Page 21 Staff files contained minutes of supervisions and staff meetings. Service users appear to be happy with the home and observed 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 and valued and that they feel the home is well managed. A clear commitment is made to equal opportunities within the home, with staff and service users expressing positive views with regards to this. All service user documentation should be produced in pictorial format, where possible i.e. Menu’s for the dementia unit and for people who may not remember the choices they made the previous day. The service users appeared to benefit from this well structured and well run home. The staff and manager within the home are adequately and suitably trained in order to meet the changing needs of the service users. As already discussed within the report current staffing levels within Verway unit are inadequate and therefore compromise service users health and safety. Quality assurance systems are in place and the manager conducts regular monthly audits. The manager has daily contact with each service user and therefore the service users have the opportunity to raise issues or concerns informally. The service users spoken to felt that their views were listened to and considered. All records are secure within the home and were up to date and held in accordance with the Data Protection act 1998 ensuring that service users rights and best interests are safe guarded by the homes polices and procedures. Records regarding staff recruitment were inspected and there was adequate evidence to confirm that the recruitment and selection procedures were being adhered to ensuring protection for service users. Individual and generic risk assessments were in place within home, with all external required safety checks occurring. All fire records were up to date and all health and safety records were in place and being maintained appropriately. However the manager must ensure that all infection control standards are maintained including eradicating mal odours from the home and ensuring that all bins have secure lids fitted. The manager should update the risk assessment in relation to the current building work being carried out and review if necessary. Regulation 26 visits are carried out on a monthly basis but some recent reports were unavailable at the time of the inspection. The manager confirmed that these visits had taken place.
High View Lodge DS0000019423.V302161.R01.S.doc Version 5.2 Page 22 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 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 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 3 18 3 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 2 28 1 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 x 3 1 X 1 High View Lodge DS0000019423.V302161.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? 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 OP27 OP28 OP38 Regulation 18(1)(a) & 12(1)(a) Requirement Staffing levels on Verway unit must be increased to ensure that service users needs are met and service user safety is maintained. Immediate Requirement made. Timescale for action 05/07/06 2. OP18 OP12 12, 13 3. 4. OP26 OP7 13(3) & 16(2)(k) 15(1) The proprietors must increase 31/08/06 the hours that are currently allocated to the activities worker, as 20 hours per week for 77 service users is vastly inadequate. The mal odour within Gadeview 12/08/06 unit must be investigated and eradicated. The manager must obtain 07/08/06 consent for the use of bedrails from either the service user, their representative or G.P. The Flooring in room 8 requires replacing. 30/08/06 5. OP26 16(2)(c) High View Lodge DS0000019423.V302161.R01.S.doc Version 5.2 Page 24 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 OP33 Good Practice Recommendations The manager should replace the current ‘suggestion box’ with a new one as the old one is worn and torn. High View Lodge DS0000019423.V302161.R01.S.doc Version 5.2 Page 25 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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