Inspection on 16/05/07 for Littledene House

This inspection was carried out on 16th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Littledene House 16/12/09

Littledene House 23/07/09

Littledene House 30/05/09

Littledene House 05/05/09

Littledene House 08/04/09

Littledene House 12/11/08

Littledene House 30/04/08

Littledene House 06/09/06

Littledene House 17/02/06

Littledene House 08/08/05

Littledene House 17/12/04

Littledene House 30/06/04

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 Littledene House 54 Bushey Grove Road Bushey Watford Hertfordshire WD2 2JJ Lead Inspector Alison Jessop Unannounced Inspection 16th May 2007 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 Littledene House DS0000019451.V339907.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. Littledene House DS0000019451.V339907.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Littledene House Address 54 Bushey Grove Road Bushey Watford Hertfordshire WD2 2JJ 01923 245 864 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) m.ang@btopenworld.com Ms Margaret Ang Ms Margaret Ang Care Home 12 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (12), Old age, not falling within any other of places category (12) Littledene House DS0000019451.V339907.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home may accommodate one named service user under the age of 65 with Dementia. If the names service user ceases to be accommodated at the home then the variation to the category shall cease. The manager must inform CSCI if the service user permanently leaves the home for any reason. 6th September 2006 Date of last inspection Brief Description of the Service: Littledene House is a care home providing personal care and accommodation to twelve elderly people, in single rooms. The home is registered for Dementia Care (Elderly). Littledene is privately owned and managed by a provider with nursing qualifications and management in care award. The large, converted, property is located in a quiet residential street in Bushey, Hertfordshire. The home is close to the attractive village of Bushey and also not far from Watford Town Centre; both places are about two miles each away, so large selections of amenities are reasonably close. There is also a row of shops just a couple of minutes walk away which offer fish and chip shop, oriental takeaway, newsagent and essential groceries and provisions store. Relatively small, Littledene radiates a very homely and friendly atmosphere. The house is well presented and comfortable; a lift offers access to all parts of the home for people who are not fully ambulant. The frontage of the property is attractively paved and allows for the parking of several cars. The rear garden is mainly laid to lawn with an extended patio and is neatly kept. A copy of the Service User Guide and previous inspection reports can be gained from the manager. The weekly fees currently range from £425 to £760. Littledene House DS0000019451.V339907.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One Regulatory Inspector carried this unannounced inspection out over two days. The first day was spent talking to residents, staff and visitors. Observations were made of care practice and records relating to the care of people who live there were inspected. The environment was also inspected and records pertaining to health and safety were scrutinised. As the manager was unavailable during the inspection, a second visit was arranged to inspect staff training records and a meeting was held with the manager to feedback the outcome. What the service does well: What has improved since the last inspection? All of the previous requirements have been met and the manager always strives to make improvements. Many areas of the inside and outside of the home have been redecorated. New carpet has been fitted in the hallway and new curtains fitted to the lounge and dining area. An alarm system has been installed on the upstairs doors increasing resident’s safety. Littledene House DS0000019451.V339907.R01.S.doc Version 5.2 Page 6 Hand washing facilities have been provided in the laundry room, maximising infection control procedures. 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. Littledene House DS0000019451.V339907.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 Littledene House DS0000019451.V339907.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 Quality in this outcome area is excellent. Standard 6 does not apply, as the home does not provide intermediate care. This judgement has been made using available evidence including a visit to this service. The service considers carefully the needs assessment for each prospective resident before agreeing admission to the home. Prospective residents and their family, always have the opportunity to visit and spend time in the home prior to agreeing admission. EVIDENCE: Each resident is provided with a statement of terms and conditions prior to moving to the home. This sets out in detail what is included in the fee, the role and responsibility of the provider, and the rights and obligations of the resident. Littledene House DS0000019451.V339907.R01.S.doc Version 5.2 Page 9 The manager carries out the needs assessment and carefully considers the application to ensure that the needs of each prospective resident can be met. The home cannot currently provide care to people who require hoisting. This is clearly explained in the residents guide and mobility is fully assessed prior to being accepted for accommodation. Littledene House DS0000019451.V339907.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. JUDGEMENT – we looked at outcomes for the following standard(s): 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. The people who live in the home look well cared for and staff offer kind and caring support. Inappropriate techniques for moving and handling residents were observed. This compromises the safety of both the staff and the people who live there. EVIDENCE: All residents have a robust care plan. The home has effective systems in place to ensure the care plan is reviewed and updated monthly and arranges additional reviews when changes take place. The people who live in the home look clean and nicely dressed. The manager stated that residents are offered a bath or shower every day. Residents Littledene House DS0000019451.V339907.R01.S.doc Version 5.2 Page 11 receive visits from health care professionals and health care needs are closely monitored. During the inspection an unsafe moving and handling technique used by two staff was observed. Although staff have all received training on this it was apparent that they require more practical training in this area. The current method for moving and handling training is by staff watching a video. Procedures relating to the administration of medication are generally satisfactory, however it was noted that medication is administered into small pots and put onto trays, which is served with the lunch. This practice is unsafe and a requirement has been made for medication to be administered in accordance with the Royal Pharmaceutical Society Guidelines. On arrival at the home one of the residents was sitting in the lounge, fully dressed on a shower chair. The resident was left in the chair by staff as they stated that she was soon due to be taken into the dining room for lunch. This was not only undignified practice but caused a risk to the resident who had a high-risk level of pressure sores. Littledene House DS0000019451.V339907.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. 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. More social intervention and occupational stimulation could be provided in order to enhance the lives of the people who live in the home, particularly those that are unable to move around or communicate verbally. EVIDENCE: Each resident has a life story on their file, which offers staff an overview of the lives of the people who live there. Not much evidence was observed that this is used to offer occupational activity. On the day of the inspection soft music was being played in the dining room and the television provided background stimulation in the lounge. Some of the people who live there were happily strolling around and were able to access the garden at the back of the home. Apart from this there was very little interaction and stimulation. When staff were questioned about activities they Littledene House DS0000019451.V339907.R01.S.doc Version 5.2 Page 13 replied ‘we try to get them to do games and things but they are not interested.’ It was pointed out to the manager that up to date training on dementia care would be beneficial to the manager and staff and would improve the lives of the residents. An entertainer comes to the home once a month although the manager pointed out that some of the residents find this overwhelming. One of the relatives spoken to said ‘it’s a lovely home, the people are really well cared for, although they could do more activities.’ The people who use the service are encouraged to maintain contact with family and friends. One resident stated ‘I phone my wife every day.’ The manager stated that he will often phone his wife more than once a day and is assisted by staff to do this. People who use the service are offered a healthy, balanced diet. The lunch on the day of the inspection was fish, chips and peas followed by arctic roll. Juice and tea was served with lunch. One resident stated ‘the food is good and there is plenty of it.’ Littledene House DS0000019451.V339907.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Outcomes of complaints are managed very effectively with sensitivity. The service can evidence that it has learnt from the process, and the same issues do not reoccur. EVIDENCE: Only one complaint has been received by the service since the previous inspection. This was in relation to the temperature in the lounge. This was immediately rectified and no further complaints have been upheld. A strategy meeting was held by Adult Care Services following concerns raised by the local hospital after a resident was sent to the Accident and Emergency department after several days of a reported injury to a service user. The manager or staff had not witnessed a fall however following concerns about the resident’s mobility the GP had been called and had prescribed pain relief medication. As the resident was able to weight bear and did not display severe pain the manager did not feel the need to immediately send the resident for the x-ray. The manager stipulated that under no circumstances would she have not referred the resident if she suspected that a serious injury had occurred. No further action is being taken following the meeting and the manager has since introduced new procedures to ensure that this does not occur again in the future. Littledene House DS0000019451.V339907.R01.S.doc Version 5.2 Page 15 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): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a very well maintained, safe, comfortable environment. The home is well lit, clean and tidy and smells fresh. The management has a good infection control policy. EVIDENCE: Since the previous inspection the manager has made some improvements to the environment. The carpet in the hall way has been replaced along with the curtains in the lounge and dining room. The inside and outside of the home has been repainted. New handrails have also been fitted around the home. A ramp has been fitted in one of the first floor bedrooms. It was pointed out that this does not conform to Health and Safety Regulations and must be Littledene House DS0000019451.V339907.R01.S.doc Version 5.2 Page 16 removed or replaced with an appropriate alternative. The manager has since gained advice from an Occupational Therapist and is getting this replaced. The home is kept clean and tidy and the provider/manager is consistently updating and maintaining all areas of the home. The garden provides a safe area for residents to enjoy the fresh air. Hand washing facilities have been provided in the laundry in order to maximise infection control procedures. Littledene House DS0000019451.V339907.R01.S.doc Version 5.2 Page 17 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): 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. The service recognises the importance of training, and delivers, where possible, a programme that meets any statutory requirements. There are still some areas, which need attention. EVIDENCE: Staff confirmed that they complete their induction within a short time and this includes training such as moving and handling, health and safety, food hygiene, adult abuse and dementia. The courses are provided by a video, which also includes a competency test. The video conforms to the Skills for Care induction standards. Evidence gathered during the inspection such as the observation of unsafe moving and handling procedures and the lack of up to date dementia care, suggests that staff require further training in these areas. The manager must also ensure that day-to-day procedures are followed. As previous there has been no previous concerns about the recruitment procedures for this service, the Inspector made a proportionate decision not to fully inspect recruitment records on this occasion. Littledene House DS0000019451.V339907.R01.S.doc Version 5.2 Page 18 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): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has the required qualifications and experience and is competent to run the home. She works to continuously improve services and provide an increased quality of life for residents. There is a strong ethos of being open and transparent in all areas of running of the home however more up to date dementia care training is required in order to enhance the lives of the people who live there. EVIDENCE: The manager is a registered nurse and has completed a City and Guilds Advance Management for Care Award. The manager requires more training in Littledene House DS0000019451.V339907.R01.S.doc Version 5.2 Page 19 dementia care in order to maintain up to date knowledge and practice, which can be used when supervising and training staff. The service has a quality assurance process, which is reviewed annually. Surveys are sent out to residents and relatives to gain feedback about the service. The manager welcomes suggestions on how to improve the service. Records relating to health and safety in the home were adequately maintained. An alarm has been fitted to the upstairs door, which is triggered if a resident is using the staircase. Door closers have been fitted to doors in order to comply with fire safety regulations and the manager has reviewed the fire safety risk assessment. Littledene House DS0000019451.V339907.R01.S.doc Version 5.2 Page 20 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 X 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 2 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 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Littledene House DS0000019451.V339907.R01.S.doc Version 5.2 Page 21 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 OP8 Regulation 13 (5) Requirement The registered person must make suitable arrangements for the safe moving and handling of residents. The registered person must make arrangements for the safe administration of medication. Medicines must not be administered from trays but directly from the medicine cabinet to the service user. The home must be conducted in a manner that respects the dignity of the residents. Residents must not be left to sit on shower chairs. Suitable stimulation must be provided to all people living in the home including those with advanced stages of dementia. The registered person must ensure that staff are competent to carry out moving and handling procedures. The manager and staff must receive up to date dementia care training. Timescale for action 22/06/07 2 OP9 13(2) 22/06/07 3 OP10 12 (4) 22/06/07 4 OP12 16(2)(n) 22/06/07 5 OP30 18(1)(a) 22/11/07 Littledene House DS0000019451.V339907.R01.S.doc Version 5.2 Page 22 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 OP28 Good Practice Recommendations Review the arrangements for training to provide 50 of staff with qualifications in care at NVQ level 2. Littledene House DS0000019451.V339907.R01.S.doc Version 5.2 Page 23 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 Littledene House DS0000019451.V339907.R01.S.doc Version 5.2 Page 24 - 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. 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