CARE HOMES FOR OLDER PEOPLE
Holly Lodge 12 Clarence Road Harpenden Hertfordshire AL5 4AJ Lead Inspector
Angela Dalton Unannounced Inspection 22nd February 2006 10:45 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 Holly Lodge DS0000019432.V284351.R01.S.doc Version 5.1 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. Holly Lodge DS0000019432.V284351.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Holly Lodge Address 12 Clarence Road Harpenden Hertfordshire AL5 4AJ 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) 01582 712 640 01582 765 555 Fairheart Limited Janet Petersen Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Holly Lodge DS0000019432.V284351.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 2nd August 2005 Brief Description of the Service: Holly Lodge is a large Victorian, three storey, detached house that is set in its own grounds and located in a quiet residential area of Harpenden. All three floors are served by a passenger lift and a mezzanine floor is fitted with a step lift to enable service users to access the main lift. The home offers all single occupancy bedrooms (two with en-suite facilities), two lounges, a dining room, six toilets, two bathrooms and a shower. There is also an office, a kitchen and a laundry. The well-kept gardens are easily accessible from the house and offer attractive outlooks from the building, and there is off-road parking available at the front. Relatively close is a small parade of shops and the town centre; the railway station and bus services are also easily accessible from the home. Holly Lodge DS0000019432.V284351.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One inspector conducted this unannounced inspection on 22nd February 2006 between 10.45am and 2.50pm. A full inspection had previously been conducted on August 2nd 2005 and in light of this some of the standards have not been revisited. The manager was on a day off and the cook was unwell on the day of the inspection, and the inspector liaised with the deputy manager and the proprietor. What the service does well: 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. Holly Lodge DS0000019432.V284351.R01.S.doc Version 5.1 Page 6 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 Holly Lodge DS0000019432.V284351.R01.S.doc Version 5.1 Page 7 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): 4 Specific needs could be better met with professional input. EVIDENCE: Service users have informative and descriptive care plans in place. For new service users comprehensive assessments are used and form the baseline for the development of the care plan. A recommendation has been made to access training and information on specific needs such as communication and diabetes. Care plans contain guidance on how to manage individual needs but staff would benefit from professional input to meet specific needs. If training was not accessible information should be available to staff to further enhance the high standard of care delivered. Holly Lodge DS0000019432.V284351.R01.S.doc Version 5.1 Page 8 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): 9,10 & 11 Medication recording requires improvement to ensure the welfare of service users is safeguarded. EVIDENCE: On the whole the medication system works well but some issues must be addressed to ensure that service users are protected. A requirement has been made. There were several occasions where amounts of medication had not been carried forward from the previous Medication Administration Record Sheet (MAR) or on opening from the stock supply. Controlled drugs were checked and the amount did not reconcile with the records. The reason for the missing medication was not recorded. A service user who self medicates does not have access to lockable space to ensure drugs are kept securely. There is also no lock fitted to their bedroom door and a recommendation has been made. Letters were on display complimenting the home on the care that service users had received. Holly Lodge has experienced a difficult time recently as several service users who have died. A high level of care is delivered and this was reflected in families’ comments and care plans.
Holly Lodge DS0000019432.V284351.R01.S.doc Version 5.1 Page 9 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 & 15 Activities meet service users’ needs. Displayed menus could better reflect choices available. EVIDENCE: Service users who reside at Holly Lodge are fairly independent and plan their day accordingly. Some activities occur and the proprietors often take service users out on a one to one basis. The proprietor and manager plan to develop the activities schedule to better reflect the schedule of activities that occur or are offered within the home. As the cook was off alternative plans were made for lunch. Alternatives are offered to service users but those whom the Inspector spoke with were not aware of what the option for each day were. A recommendation has been made to evidence the alternative meals available. Holly Lodge DS0000019432.V284351.R01.S.doc Version 5.1 Page 10 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): EVIDENCE: Not inspected on this occasion. Holly Lodge DS0000019432.V284351.R01.S.doc Version 5.1 Page 11 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 The home is clean and well maintained. EVIDENCE: As service users vacate the home each room is decorated and recarpeted (if necessary). The environment is homely and welcoming. Fresh flowers are on display and individual belongings personalise areas throughout the home. Holly Lodge DS0000019432.V284351.R01.S.doc Version 5.1 Page 12 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): EVIDENCE: Not inspected on this occasion. Holly Lodge DS0000019432.V284351.R01.S.doc Version 5.1 Page 13 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): 38 The health and safety of service users could be better safeguarded. EVIDENCE: One service user has an iron and ironing board in their bedroom. This aids in maintaining independence but no risk assessment is in place. This would reflect that the individual needs had been assessed and reviewed and that any potential risks could be avoided. There were no risk assessments in place for service users using recliner chairs and reclining beds. Holly Lodge DS0000019432.V284351.R01.S.doc Version 5.1 Page 14 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 X 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 2 Holly Lodge DS0000019432.V284351.R01.S.doc Version 5.1 Page 15 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) Timescale for action Medication Administration Record 25/02/06 (MAR) Sheets must reflect the amount of medication received or carried forward. Medication must be stored securely. Controlled drugs must reconcile. Risk assessments must reflect 25/02/06 how the health and safety of service users is assured. Requirement 2. OP38 13(4)(b)& (c) Holly Lodge DS0000019432.V284351.R01.S.doc Version 5.1 Page 16 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 3 Refer to Standard OP4 OP10 OP15 Good Practice Recommendations Input from a speech and language and diabetic specialist is advised to meet individual needs. All bedrooms should be lockable. Meal alternatives should be better advertised to service users. Holly Lodge DS0000019432.V284351.R01.S.doc Version 5.1 Page 17 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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