Inspection on 11/04/07 for Houndswood House

This inspection was carried out on 11th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Houndswood House 02/12/08

Houndswood House 03/06/08

Houndswood House 13/02/08

Houndswood House 09/11/06

Houndswood House 18/04/06

Houndswood House 05/01/06

Houndswood House 22/06/05

Houndswood House 20/10/04

Houndswood House 04/05/04

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Houndswood House Harper Lane Radlett Hertfordshire WD7 7HU Lead Inspector Jeffrey Orange Unannounced Inspection 11th April 2007 08:40 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 Houndswood House DS0000019459.V335943.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. Houndswood House DS0000019459.V335943.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Houndswood House Address Harper Lane Radlett Hertfordshire WD7 7HU 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) 01923 856 819 01923 853 509 houndswood.manager@craegmoor.co.uk Speciality Care (REIT Homes) Limited Paul Draper Care Home 65 Category(ies) of Dementia - over 65 years of age (23), Old age, registration, with number not falling within any other category (45), of places Physical disability over 65 years of age (4) Houndswood House DS0000019459.V335943.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. This home may accommodate 4 older people who require personal care. This home may accommodate 45 older people with need for convalescent and respite care who require nursing care. This home may accommodate 4 older people with physical disability who require personal care. Houndswood House may admit service users with elderly needs until a maximum total of 45 service users are resident. The condition will be removed once the Commission for Social Care Inspection is satisfied that the home is able to comply with and maintain regulatory requirements. This home may accommodate 23 named individuals with dementia who require personal care. If a named individual is no longer resident at the home for any reason the CSCI must be informed and the number will be reduced appropriately. 10th January 2007 5. Date of last inspection Brief Description of the Service: Houndswood House is a care home providing accommodation, nursing and personal care for older people as set out above. The home is owned by Craegmoor and registered under Speciality Care (REIT Homes) Limited. Houndswood House was opened in 1997 and is situated in a rural area between London Colney and Radlett. It is a period house with modern extensions, set in extensive parkland gardens with pathways and a large patio area, which can be reached via the lounge, dining room or conservatory. The home is divided into two areas, identified by staff as the ‘main house’ and the ‘extension’. The older part of the house has one large ground floor lounge and a small sitting room. The ‘extension’ has communal areas all on the ground floor, which include dining, lounge and conservatory areas. All bedrooms in the new area have en-suite facilities with toilets. A lift serves each end of the home and a wheelchair lift has been added to enable improved access to one part of the older building. The premises are reached via a driveway from Harper Lane. Car parking facilities are provided to the front and rear of the building. Houndswood House is not served by public transport, but is close to Junction 22 of the M25 Motorway. Houndswood House DS0000019459.V335943.R01.S.doc Version 5.2 Page 5 The service user guide includes contact details for the Commission for Social Care Inspection (CSCI) and copies of the latest inspection report are available in the home. Current fees range from £500 - £900 (April 2007). Additional charges apply for newspapers, hairdressing, personal toiletries, chiropody and private dentistry Houndswood House DS0000019459.V335943.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit took place over approximately 7 hours, during which time it was possible to talk to people who live in Houndswood House, to the staff who care for them and to the management team responsible for the running of the home. Key records were inspected, including those for staff recruitment and the administration of medication. This inspection report also draws on information received by the CSCI about or from Houndswood House since the previous inspection site visit in January 2007. What the service does well: What has improved since the last inspection? Houndswood House is in a position of transition, with a newly appointed manager and deputy manager and with a new administrator for the home. Staff spoken to were positive about the changes being introduced and morale was said to be improving. The previous inspection report acknowledged a series of improvements in key areas of the home’s operation, including the way that the dignity of those people who live in Houndswood House is promoted and protected and in the way that medication is administered and recorded. It is positive to note that these and other improvements have been maintained and taken forward. Houndswood House DS0000019459.V335943.R01.S.doc Version 5.2 Page 7 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. Houndswood House DS0000019459.V335943.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 Houndswood House DS0000019459.V335943.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): Standards 1 3 4 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The needs of prospective service users are adequately assessed to ensure that only those whose care needs can be appropriately met are admitted to the home. The home’s Service User’s Guide needs to be revised as it does not include the level of information about fees. (This is now required following a revision of the Care Homes Regulations). Prospective residents and their relatives/carers are able to visit the home before making a decision about moving in so that they can satisfy themselves that it is somewhere they would be happy, safe and well-cared for. The home needs to develop and improve the standard of its dementia care services in order to show that it is demonstrably based on current good practice and reflects relevant specialist and clinical guidance. This judgement has been made using available evidence including a visit to this service. Houndswood House DS0000019459.V335943.R01.S.doc Version 5.2 Page 10 EVIDENCE: Those care plans seen for recently admitted residents all included satisfactory pre-admission assessments of their needs and how these were to be met. In speaking to residents it was confirmed that several of them had taken the opportunity to visit the home with their families, prior to making a decision about moving in. The Service User Guide does not meet the revised requirements of the Care Homes regulations. The physical environment of the home, the provision of activities, specialist staff training, staffing levels and nutrition for example, have not yet been systematically assessed by accredited specialists in dementia care in order to inform any potential development of dementia care within this service. It is however acknowledged that some progress has been made, for example in the provision of additional staff training. Houndswood House DS0000019459.V335943.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans provide adequate information to identify the care needs of people living in the home and to record how these are being met. Residents can be confident that the administration of medication is effectively and safely carried out so that they will receive the medication they require as part of their care. People living in the home generally receive care in a way that recognises their right to dignity and respect. EVIDENCE: A sample of care plans were seen and provided adequate information for staff to enable them to identify the care needs of residents and how they are to be met. There was also evidence of a process of regular review of resident’s care needs. The home’s care plans format is to be revised and improved in the near future. Houndswood House DS0000019459.V335943.R01.S.doc Version 5.2 Page 12 Care plans included details of the involvement of a range of community healthcare services and professionals. One person was being taken to hospital for a routine appointment during the inspection site visit. Throughout this inspection site visit residents were treated with appropriate respect and their dignity was generally protected whilst care was being provided. Residents who require assistance at mealtimes were being helped by staff in an unhurried and gentle way. Those medication records checked were found to be correct and there appears to be a robust system for routine reconciliation of medication in place. One recommendation is made in respect of the recording of medication when longer required. Houndswood House DS0000019459.V335943.R01.S.doc Version 5.2 Page 13 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home are able to take part in activities organised in the home and a few are able to access community activities on a regular basis. Visitors to the home are welcome. Residents are reasonably well able to influence the way that their care is provided and are given a varied menu for food, which allows choice and provides alternatives for them. EVIDENCE: There is an activities programme set out for the home and additional trips have been arranged outside of the home. Some service users recently had a small group communion service in one of the resident’s rooms and also attend a weekly group at a local church. Houndswood House DS0000019459.V335943.R01.S.doc Version 5.2 Page 14 A meal was observed and staff were seen to be helping those residents who needed assistance appropriately. “The food is very good you know” was a typical comment made about the food in the home, most other comments made about the food were also very positive. A number of residents spent much of their time during this inspection visit asleep in chairs in the lounge with the television on. The activities team are facing a considerable challenge to provide activities appropriate for the wide range of abilities and dependency within the home, including those residents with dementia. For example some of the more able residents indicated that they did not take part in activities themselves because they did not feel comfortable with residents who they thought were less able than they are. Houndswood House DS0000019459.V335943.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements in staff training and awareness of safeguarding procedures, recognised at the last inspection, have been maintained and should provide residents and those who care for them with confidence that residents are safe and that any concerns or complaints that they have will be appropriately dealt with. EVIDENCE: The home has a comprehensive complaints procedure in place. There have been no complaints recorded since the last inspection in January 2007. Staff spoken to confirmed that they had received recent, appropriate training in issues around adult abuse and safeguarding. There is clear information about whistle blowing displayed in staff areas of the home. Residents spoken to about the home indicated that they would feel able to take any concerns to the manager or staff; “I have done that more than once” and that action is then taken “they did follow it up” said one resident. Houndswood House DS0000019459.V335943.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 24 25 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home offers an essentially comfortable and safe environment for those living and working in it. EVIDENCE: A programme of refurbishment is still underway and this has already had a very positive effect on the home, which was favourably commented on by several residents. There were no problems with unpleasant odour on the day of this visit. Those residents’ rooms seen during this visit were comfortable and warm and reflected the personalities and interests of the residents concerned. Houndswood House DS0000019459.V335943.R01.S.doc Version 5.2 Page 17 One fire escape can only be accessed through a resident’s bedroom. This is not satisfactory particularly as that resident will not be able to lock the door. Houndswood House DS0000019459.V335943.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27 28 29 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels whilst basically adequate do not always appear to allow individual staff to spend quality time with residents on a one to one basis, in particular those with higher needs as a result of dementia. The physical layout of the home also provides a challenge for staff as it does not easily facilitate flexible use of staffing at key times. Staff training has improved and now includes some basic dementia care awareness training, which will benefit those residents with dementia. Current recruitment appears to be robust and this offers support and protection for residents in making sure that unsuitable people are not employed to care for them. EVIDENCE: Approximately 57 of staff have achieved NVQ level 2 or equivalent. Deficiencies were found in respect of the number of references obtained for staff employed in the past, recent recruitment files were satisfactory. “It is very seldom that we see carers” and “carers are always so pushed for time” were some comment received from residents. Houndswood House DS0000019459.V335943.R01.S.doc Version 5.2 Page 19 Those staff spoken to did not express any specific concerns about staffing levels although, perhaps not surprisingly, some said that more staff would always be beneficial. The standard of care observed was generally good and there were no adverse comments made by residents about for example call bell response times. Houndswood House DS0000019459.V335943.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31 32 33 35 36 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This is now a well managed home and those who live and work in it feel supported and protected by its policies procedures and practice. EVIDENCE: The manager has recently been registered with the CSCI and has demonstrated that he has the qualifications and experience to discharge his responsibilities to residents and staff. Residents and staff spoken with both at this inspection and the previous one, which took place shortly after the manager took up post, were very positive about the changes in the way the home operates since his appointment. Houndswood House DS0000019459.V335943.R01.S.doc Version 5.2 Page 21 Residents’ accounts were spot checked and found to be up to date and accurate. Although staff supervision is now scheduled to be as frequent as required, that has not been the case. Houndswood House DS0000019459.V335943.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 2 X 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X 3 3 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 X 3 Houndswood House DS0000019459.V335943.R01.S.doc Version 5.2 Page 23 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 OP1 Regulation 5 Requirement The home’s service user guide must be reviewed and revised as necessary to conform to the revised requirements of the Care Homes Regulations 2001. Work continues upon care plans but further information is required to adequately describe how needs are met. Further information is needed of how assessed needs will be met, monitored and managed. This requirement is carried forward from the last inspection with a revised timescale to enable the work already underway to be completed. Timescale for action 31/07/07 2. OP7 12 &15(2)(b) 31/08/07 3 OP19 23 (4)(b&c) 4 OP29 19 31/05/07 The use of any resident’s bedrooms that provide access to a fire escape must be reviewed and where possible action taken to ensure that there is no conflict between service user rights and the safe evacuation of staff or residents in the event of fire. Two written references must be 11/04/07 obtained in respect of any DS0000019459.V335943.R01.S.doc Version 5.2 Page 24 Houndswood House 5 OP36 18(2) person to be employed in the home and the registered person must be satisfied on reasonable grounds as to their accuracy. Staff supervision must meet the requirements of the Care Homes Regulations 2001 and the applicable National Minimum Standards. 31/05/07 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 OP9 OP12 Good Practice Recommendations Medication that is to be returned for appropriate disposal should be recorded at the time it becomes surplus in order to provide an accurate audit trail at all times. Better use should be made of the considerable resources available from a variety of sources, which provide specialist guidance on the provision of activities for people with dementia in line with current best practice. Staffing levels should be kept under active review to ensure that they meet the needs of service users at all times. 3 OP27 Houndswood House DS0000019459.V335943.R01.S.doc Version 5.2 Page 25 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 © 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 Houndswood House DS0000019459.V335943.R01.S.doc Version 5.2 Page 26 - 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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