This inspection was carried out on 16th December 2009.
CQC found this care home to be providing an Poor service.
The inspector found no outstanding requirements from the previous inspection report,
but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.
Random inspection report
Care homes for older people
Name: Address: Littledene House 54 Bushey Grove Road Bushey Hertfordshire WD23 2JJ zero star poor service 23/07/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Patricia House Date: 1 6 1 2 2 0 0 9 Information about the care home
Name of care home: Address: Littledene House 54 Bushey Grove Road Bushey Hertfordshire WD23 2JJ 01923245864 Telephone number: Fax number: Email address: Provider web address: m.ang@btopenworld.com Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ms Margaret Ang care home 12 Number of places (if applicable): Under 65 Over 65 12 12 dementia old age, not falling within any other category Conditions of registration: 1 0 If the names service user ceases to be accomodated at the home then the variation to the category shall cease. The home may accommodate one named service user under the age of 65 with Dementia. The manager must inform CSCI if the service user permanently leaves the home for any reason. Date of last inspection Brief description of the care home Littledene House is a care home providing personal care and accommodation for twelve elderly people who may also have a dementia. Littledene is privately owned and the proprietor also manages the home.
Care Homes for Older People Page 2 of 10 2 3 0 7 2 0 0 9 Brief description of the care home The property is a large detached house, which has been converted to provide single room accommodation. Six of the bedrooms have en-suite toilets. The house is well presented and provides residents with comfortable surroundings in a homely atmosphere. There is a passenger lift for easy access to the upper floor and an enclosed garden to the rear. The frontage of the property is attractively paved and allows for the parking of several cars. A single storey extension at the back of the house provides living accommodation for three members of the care staff. Littledene is situated in a quiet residential road in the village of Bushey and is approximately two miles from the village High Street and also about two miles from the extensive amenities of Watford Town. There are local shops a short walk away. There are nearby bus and rail services and the home is close to several major roads and motorways. Current charges for the home range from £525.00 to £595.00 per week. Further information can be found in the homes Statement of Purpose and the Service Users Guide, which are displayed in the entrance hall. The home also has an internet web site. Care Homes for Older People Page 3 of 10 What we found:
The inspection took place with one regulation inspector and was conducted to assess compliance with the requirements made at the previous key inspection. The inspection started mid morning when two care workers were on duty. The manager returned to the home soon after the inspection started. When we arrived there were four residents in the dining room and one in a recliner chair in the lounge. One resident had gone to a day centre. We checked the staff roster and this showed that there were always two members of staff on duty and that sometimes the manager was supernumerary to these numbers. Care staff confirmed that the senior member of staff previously employed has now left the home. The care staff said that three residents now need assistance with transfers and that two residents need the use of a hoist when assisted to move. They said however that current staff numbers were adequate to meet peoples needs. Staffing numbers would need to be reviewed if the number of people resident in the home increased. What the care home does well:
We checked the care plan of a new resident and this was completed in a person centred format and provided details of all the persons health and social needs and preferences. The new format has appropriate areas to record monthly reviews of all the areas of need. The manager said that all the care planning in the home will be in this format and we saw that other peoples planning was being transferred to these new forms. We saw appropriate monthly reviews documented in the additional care plans we checked. A new washing machine with sluicing facilities has been installed in the laundry and staff confirmed this was used for incontinent washing. The door to the bathroom on the ground floor now opens outwards and there is a curtain in place to ensure peoples dignity is maintained when they use this room. However the care staff we spoke with said that it was still difficult to manage in the space available when they need to use a hoist to transfer people to the bathroom. The manager confirmed that an assessment has been made of the bathroom by an occupational therapist but on the day the report was not available for our examination. Since the inspection the manager has confirmed that a copy of the report has been sent to the Commission for consideration. The bathing facilities at this service are currently not adequate to meet the needs of people who become increasingly physically dependent and are therefore under review. We checked the staff records and saw evidence that all the staff have completed training in safeguarding, whistle blowing and diabetes care. The staff we spoke with demonstrated a clear understanding of these topics. We noted that visitors are signing the visitors book when they enter the home. We also saw that the first aid box is now installed on the wall of the kitchen for the staff to use when they need to. We saw the mid day meal cooked and served by the two care workers during the visit. The meal looked very appetising and was clearly enjoyed by the residents.
Care Homes for Older People Page 4 of 10 What they could do better:
Although the care plan of the new resident listed their likes and dislikes we did not see any documented evidence that their preferences for activities had been provided or met. However the manager said that appropriate activities were offered and that these would now be recorded in more detail. The care staff confirmed that the visits from the violinist and guitarist had now stopped as they said the residents were not interested in these events. The reminiscence sessions have also not been taking place as the manager said the person providing this activity had not been well for several weeks. Care staff said they endeavour to provide activities for the residents during the day. One member of staff was cleaning the home during the inspection. This worker was not listed on the roster for that day and the manager confirmed they did not have a contract for domestic work. The worker has an on-going contract as a care worker and staff said the worker provides night cover. The manager said their contract would be amended and their name included on the roster when they provide domestic duties. We also found no evidence that four of the care staff, who had non EEC passports, had current work permits and the manager said she would pursue this matter. The manager said that three of these staff are students but we saw that they have been rostered to work for 45, 54 and 66 hours on that and other weeks. They had all signed the opt out clause of the European Working Time Directive, enabling them to work long hours, but if they are students should probably not be working these hours in term time. The manager said she would pursue appropriate documentation to evidence thier employment situation. The care staff we spoke with confirmed that there were currently four care workers living in the building in the garden. It has been established previously that this building should only accommodate three people. The manager must ensure staff are living in appropriate accommodation at all times, where this is provided on site. On the day of the inspection the care staff confirmed that there were no red alginate bags in the home although they were dealing with incontinent laundry. These bags are important for good infection control. The manager said that these bags were on order. We noted that the front door is still locked with a key and we saw this key kept on a hook in the kitchen. When the door needed opening, we saw that staff had to enter the kitchen, using the key pad code, take the key from the hook and then go to the front door. We suggested this could be a fire hazard and could put people at risk of harm. The manager said that alternative arrangements would be made for opening the front door. The manager also said that she has not completed the update of the homes written policy on infection control and has also not obtained a copy of the publication Essential Steps, seen as essential for providing information for staff about maintaining good infection control in care homes. The manager said she will obtain this publication and that the policy would be completed soon. The care staff we asked were also not aware of the Mental Capacity Act and the issues around deprivation of peoples liberty. The recent national directives mean that all staff in care homes must receive training in this legislation. The manager said that this training
Care Homes for Older People Page 5 of 10 would be provided for all staff. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 10 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 10 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 26 13 An up to date written policy 08/01/2010 on good infection control in the home must be available at all times together with the publication Essential Steps and the corresponding infection control audits must be completed. This is to ensure that people living in the home are protected from the risk of the spread of infection at all times. 2 26 13 Red alginate bags must be available in the home at all times and used for all soiled laundry. This is to ensure good infection control is maintained in the home. 08/01/2010 3 29 19 Evidence must be provided and kept of the status of all staffs right to work in the home before employment commences. This is to ensure that all staff 08/01/2010 Care Homes for Older People Page 8 of 10 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action are fit and legally able to work at the home. 4 30 18 All staff must receive training 08/01/2010 in, and understand the implications of, the Mental Capacity Act and Deprivation of Liberty legislation. This is for the continuing protection of the rights of people living in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 9 of 10 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 10 of 10 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
