CARE HOMES FOR OLDER PEOPLE
Humfrey Lodge Rochelle Close Thaxted Dunmow Essex CM6 2PX Lead Inspector
Diana Green Unannounced 13 July 2005 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 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. Humfrey Lodge I56-I05 S17855 Humfrey Lodge V238435 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Humfrey Lodge Address Rochelle Close Thaxted Dunmow Essex CM6 2PX 01371 830878 01371 831187 Telephone number Fax number Email 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 Care Home 48 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (48) of places Humfrey Lodge I56-I05 S17855 Humfrey Lodge V238435 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1 Persons of either sex, aged 65 years and over, who require care by reason of oldage only (not to exceed 48 persons) 2 Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 24 persons) 3 The total number of service users accommodated in the home must not exceed 48 persons 4 Staffing levels will be monitored over the first six months and will be reviewed with the inspectors six months after the date of registration 5 The registered person must not admit persons subject to the Mental Health Act 1983 or the Patients in the Community (Amendment) Act 1995 6 Training on therapeutic activities in dementia care to be provided within three months of registration Date of last inspection 18 April 2005 Brief Description of the Service: Humfrey Lodge is a care home for older people over the age of 65 years. The home is registered to care for 36 individuals, up to 18 of who may have dementia. All rooms are for single occupancy; all are on ground floor level.The home is located in the village of Thaxted, in a residential area close to the centre of the village.On the day of the inspection building work to expand the capacity of the home by 12 had been completed and a site inspection was made with regard to registration of the rooms. Humfrey Lodge I56-I05 S17855 Humfrey Lodge V238435 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on the 13/07/05, lasting 6.5 hours. The inspection process included: discussions with the manager, care team manager, five staff, five service users, two relatives and two district nurses; a tour of the premises including a sample of residents’ rooms, bathrooms, communal areas and the laundry; and inspection of a sample of policies and records (including any records of notifications or complaints sent to the CSCI since the last inspection). Twenty standards were covered, and seven requirements made including one repeat and two second repeat requirements. The manager and staff were welcoming and helpful throughout the inspection. What the service does well:
Humfrey Lodge provides a welcoming, homely environment and good standards of personal care: residents and their relatives said that care staff were very respectful and caring. One relative said “this is a first class home” “the attention is very good, staff are friendly and they always follow up needs” Another relative said the manager and staff are very helpful and “the main carers are very genuine”. Residents’ health needs are met appropriately and well monitored and prompt referrals are made to GP’s and relevant health professionals where required. The home is well supported by the local GP practice. Positive feedback was received from district nurses who said that care staff were caring and sensitive to residents’ needs and always followed their advice. A large proportion of the care staff have been retained from their previous employer (Essex County Council) who provided a comprehensive training programme. This therefore provides continuity of care for residents and a supportive environment for new staff. The well-established key worker system ensures that residents receive personalised care by staff who know them well. Humfrey Lodge I56-I05 S17855 Humfrey Lodge V238435 Stage 4.doc Version 1.40 Page 6 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. Humfrey Lodge I56-I05 S17855 Humfrey Lodge V238435 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Humfrey Lodge I56-I05 S17855 Humfrey Lodge V238435 Stage 4.doc Version 1.40 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 standard(s) 3 The admission procedure ensures all residents are assessed on admission ensuring their care needs can be met. EVIDENCE: The manager and/or care team manager undertake assessment of all prospective residents prior to admission, and information on the person’s needs is recorded. Evidence of pre-admission assessments was present on all three files inspected. Care management assessments were obtained prior to admission and present on all those sampled. The manager showed a good awareness of the needs that the home is able to meet, and this was clearly taken into account when considering prospective admissions. This home does not provide intermediate care. Humfrey Lodge I56-I05 S17855 Humfrey Lodge V238435 Stage 4.doc Version 1.40 Page 9 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 standard(s) 7, 8, 9 & 10 The care planning process provides good information for care staff to satisfactorily meet residents’ needs. Residents health and personal care needs are generally well met but due to low staffing levels, baths are not provided as frequently as some residents would like. The standard of medicines administration and recording is good but medicines stored at too high a temperature means their safety cannot be assured. Staff have a caring approach towards residents and ensure their privacy and dignity is upheld. EVIDENCE: Three care files were inspected. These contained care plans that covered the majority of key needs (physical and social) with the exception of foot care although foot-care was provided through regular chiropody treatment. All three care plans had been regularly reviewed and agreed with the resident and/or their relative as evidenced by signature. Assessments for moving and handling/mobility, risk of falls, pressure areas and continence needs were recorded in all of the files inspected. Residents on the care programme approach had six monthly reviews undertaken.
Humfrey Lodge I56-I05 S17855 Humfrey Lodge V238435 Stage 4.doc Version 1.40 Page 10 The home was well supported by the local GP practice and district nursing service. District nurses spoken with said that the standard of personal care was good, care staff recognised residents’ care needs, referred appropriately to them and followed advice as given. Pressure relieving equipment was provided following assessment by the district nursing service. The standard of personal care was observed to be good. However one resident said that they were offered only one bath per week and they once waited ten days as there were too few staff. They said they found that insufficient and there were no exercise sessions provided. Records confirmed that nutritional assessments were undertaken on admission and weights regularly monitored. Referrals were made to other health professionals including physiotherapy ensuring residents’ health needs were appropriately met. There were no residents who were self-medicating. Lockable facilities were provided in the event that residents chose to administer their own medication. There was no medicines trolley. Medicines were stored in four separate locked cupboards in each of the units. The storage temperature was above that recommended as safe. The temperature of one storage facility was 25.7degrees centigrade and 27 degrees centigrade in a second unit. Medication records were checked and were correct. Good practice was evident in that medication profiles were maintained with details of medication and the reason for prescription. There was evidence of constant medications monitoring and there was no evidence of over prescribing. Medication was given by trained care team managers; some medication was given ad hoc by designated trained care assistants. Residents spoken with said that staff were respectful, caring and helpful and this was confirmed by district nurses. Staff spoken with said they were instructed at induction on how to treat residents with respect and this was generally evident from their care practice. Humfrey Lodge I56-I05 S17855 Humfrey Lodge V238435 Stage 4.doc Version 1.40 Page 11 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 standard(s) 12 & 15 Humfrey Lodge does not provide residents with a stimulating and varied daily life. The meals in the home are varied and nutritious but residents’ preferences are not always provided EVIDENCE: Due to the disruption of the building works, few activities were being provided. There had been no entertainment since Christmas. Activities comprised twiceweekly quiz or lotto session and there were no therapeutic activities or physical exercises being provided. There was no information on activities circulated and no social stimulation provided. Residents spoken with said they watched television for much of the day. Residents spoken with said that they were enabled a choice of getting up, going to bed and where they ate their meals and this was confirmed through observation and discussion with staff. Residents were enabled a choice of eating in the dining room or their own room. Several residents were observed to take their time in eating lunch with no pressure on them. Staff were observed to assist those residents who required assistance with eating in a sensitive and discreet manner. The menu
Humfrey Lodge I56-I05 S17855 Humfrey Lodge V238435 Stage 4.doc Version 1.40 Page 12 was displayed for residents’ information and their choice discussed daily with them. The records were being maintained appropriately and evidenced a balanced, nutritious diet with specialist needs catered for. Liquified meals were not served separately but with meat and vegetables combined. All residents looked well nourished. The lunchtime meal of lamb in red wine, mashed potatoes, fresh cauliflower and carrots followed by semolina or fruit was observed and looked appetising. One resident said “the food is very good.” A second resident said “the food is ok” and another resident said the salad was boring and there was not enough fruit provided. Concerns were raised by one resident that they were not given an early morning cup of tea but had to wait until breakfast. Humfrey Lodge I56-I05 S17855 Humfrey Lodge V238435 Stage 4.doc Version 1.40 Page 13 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 standard(s) 16 Humfrey Lodge has robust procedures for dealing with complaints that assures residents and relatives their concerns are listened to and appropriately addressed. EVIDENCE: The home had a complaints procedure that included the timescales within which complainants can expect a response and advised them of their right to refer to the CSCI at any stage. Three complaints had been received since the last inspection and all had been investigated appropriately. Residents spoken with said they had no cause to complain and were satisfied with the care at Humfrey Lodge. Two relatives said that their loved one was happy at the home and the manager and staff were very helpful. Humfrey Lodge I56-I05 S17855 Humfrey Lodge V238435 Stage 4.doc Version 1.40 Page 14 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 standard(s) 19 & 26 Humfrey Lodge is safe, well maintained and accessible and provides a homely environment for residents. The standard of décor in the original accommodation is in urgent need of refurbishment. The home was clean and hygienic with safe infection control practices evident. EVIDENCE: A partial inspection of the premises was made that included communal areas, the kitchen, bathrooms, sluice facilities, a number of residents’ rooms and the laundry. The twelve new bedrooms were pleasantly decorated and furnished providing comfortable single accommodation with all but two having en-suite facilities. However the original bedrooms and communal rooms are need of refurbishment and whilst plans were in place, no timescale had been agreed for completion. Residents spoken with said their rooms were always kept clean. The gardens were well maintained and there was good access for residents. Records provided evidence that the building complied with the requirements of the local fire and environmental health department.
Humfrey Lodge I56-I05 S17855 Humfrey Lodge V238435 Stage 4.doc Version 1.40 Page 15 The home was clean and hygienic throughout with no odorous smells. The infection control practices in place were observed to be safe. The home had sluice facilities provided. The laundry was well organised and equipped as required. Laundry and sluice facilities were located away from areas where food was prepared or eaten. Humfrey Lodge I56-I05 S17855 Humfrey Lodge V238435 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 The staffing levels at Humfrey Lodge are insufficient to ensure that residents’ needs are met at all times. The recruitment processes are robust but lack of mandatory training does not ensure the safety of residents or staff. EVIDENCE: There were thirty-two residents at the home. From inspection of the staff duty rota and discussion with staff and residents, there was evidence that staffing levels were not sufficient to ensure residents’ needs were met at all times i.e. to provide social/therapeutic activities, to enable baths to be provided more frequently. The home did however, have a good track record of staff retention who had been well trained by Essex County Council, their previous employer. The files of four staff members were inspected: these contained evidence that all the required checks had been obtained (two satisfactory references, CRB/POVA checks). Copies of birth certificates, passports and photographs were evident on all of the files inspected. All had received a statement of terms and conditions of employment. Staff spoken with confirmed they were provided with a copy of the General Social Care Council Code of Conduct. Individual training records and evidence of induction training were seen. Two had received mandatory training including health and safety, fire safety, basic first aid and moving and handling but no moving and handling or fire safety training had been provided for two staff. Humfrey Lodge I56-I05 S17855 Humfrey Lodge V238435 Stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 36, 37 & 38 The home is well managed and run in the best interest of residents but action is required to ensure residents’ records are secure at all times. Health and safety practices are generally well adhered to but attention is needed to ensure all new staff receive mandatory training. EVIDENCE: The manager is an experienced manager who holds a Diploma in Personnel Management, a Diploma in Management Studies and has seventeen years experience of management in social services including mental health and older people services. An application for registration of the manager had not yet been received by the CSCI. From discussion with staff there was evidence of regular handover meetings held between shifts. Annual appraisals were undertaken and bi-monthly supervision. Residents and relatives spoken with said they found the manager approachable and helpful and were confidant in
Humfrey Lodge I56-I05 S17855 Humfrey Lodge V238435 Stage 4.doc Version 1.40 Page 18 him as a manager. Records required by regulation for the protection of residents and for the efficient and effective running of the business were accurate up to date and in the main held in secure facilities. However care plans were held on each unit in an unlocked drawer and whilst staff said they were supervised, this could not be confirmed. There was evidence from observation, inspection of the records and in discussion with staff and residents, that the manager ensured the health and safety of staff and residents as far as reasonably practicable. Humfrey Lodge I56-I05 S17855 Humfrey Lodge V238435 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x 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 x 14 x 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 x x x x 3 2 2 Humfrey Lodge I56-I05 S17855 Humfrey Lodge V238435 Stage 4.doc Version 1.40 Page 20 yes 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 7 Regulation 12(1) Requirement The registered person must ensure that the care plans include details of a residents social needs and plans for addressing these. This is a second repeat requirement The registered person must ensure that medication is stored below 25degrees centigrade. This is a second repeat requirement. The registered person must ensure that social care activities are provided to meet the needs of all residents including those with dementia. This is a repeat requirement. The registered person must ensure that adequate staffing levels are provided to enable resdents to have a bath more frequently as they choose. The registered person must ensure that all staff receive manual handling and fire safety training at induction. The registered person must ensure that residents records are stored securely at all times. Timescale for action 31/10/05 2. 9 13(4) Immediate 3. 12 12(4) 31/10/05 4. 8 & 27 12(3) & 18(1)(a) Immediate 5. 30 & 38 18(1)(i) & 13(5) 17(1)(b) Immediate 6. 7. 37 Immediate Humfrey Lodge I56-I05 S17855 Humfrey Lodge V238435 Stage 4.doc Version 1.40 Page 21 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 15 15 15 Good Practice Recommendations The registered person should ensure that residents have an early morning cup of tea. The registered person should ensure that liquified food is presented attractively with meat and vegetables served separately. The registered person should ensure residents are offered more fresh fruit Humfrey Lodge I56-I05 S17855 Humfrey Lodge V238435 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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