Random inspection report
Care homes for older people
Name: Address: Littledene House 54 Bushey Grove Road Bushey Hertfordshire WD23 2JJ zero star poor service 17/11/2008 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: 0 5 0 5 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. The property is a large detached house, which has been converted to provide single room accommodation. Six of the bedrooms have
Care Homes for Older People Page 2 of 17 1 7 1 1 2 0 0 8 Brief description of the care home 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 £495.00 to £609.00 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 together with the last CSCI inspection report. The home also has an internet web site. Care Homes for Older People Page 3 of 17 What we found:
The last key inspection of this service was completed on 17th November 2008. Since that time an additional random inspection took place on 8th and again on 30th April. On 30th April an immediate requirement was made that two appropriate care workers must be on duty in the home every night to ensure that the care needs of all residents can be met. This inspection visit was made to assess compliance with this requirement and as a result of information provided to the Commission about four new care workers who had started work at the home. There is a continuing investigation taking place about the home under the Hertfordshire County Council Adult Care Services joint agency safeguarding vulnerable adults procedures. The information in this report is based on an unannounced inspection of the home which took place on one afternoon with two regulation inspectors carrying out the work of the Commission. For the purposes of this report the Commission will be referred to as we. The inspection took place on the afternoon of 5th May. The manager was not on duty initially but came back to the home during the visit. We checked the staff work roster and the daily care notes and spoke with four care workers individually. We checked four staff recruitment records and spoke with the manager before we left. We also removed specific documents from the home under the Commissions legal powers. These documents included a copy of a staff work roster and copies of staff recruitment records. What the care home does well: What they could do better:
During the visit made to the home on 30th April, the manager showed the inspector the recruitment records of two care worker candidates. We established that all recruitment checks were not yet in place and said that these two candidates could not start work until evidence of all appropriate checks had been received. Information has been provided for the Commission since that visit that these two people and two additional staff had started work at the home. During the inspection we spoke individually with care staff and they confirmed that four new named staff had been working at the home since 30th April or before. We saw three of these peoples names recorded on the staff roster, and two of these new people were rostered to work together at night. Two of the named care workers were the candidates whose recruitment records we saw on 30th April. We checked the recruitment records for the four new staff, two of whom were the records of the candidates we had been shown on 30th April. We were told that one of these
Care Homes for Older People Page 4 of 17 people had already left the home. We saw that none of the staff concerned had evidence in place of clearance from the Criminal Records Bureau or from the Protection of Vulnerable Adults register. We saw evidence that complete work histories had not been completed on application forms and three of the staff did not have two verified written references in place. The manager confirmed that she had asked the candidates to provide references and had not written for these herself. None of these people should have been working in the home until these recruitment checks were in place as they could put residents of the home at risk of harm from receiving care from unsuitable people. We saw no evidence that induction training had taken place and one staff member said they had themselves provided some training for these new staff members. The four care workers we spoke with during the inspection confirmed that the new staff had been providing personal care for residents and, as stated, two new care workers were rostered to work together at night, which could put residents at risk of harm as these individuals were not adequately checked or trained. We advised the manager that new staff members must not work at the home unless they at least have clearance from the Protection of Vulnerable Adults register and must not work unsupervised or provide personal care until all recruitment checks are in place. These checks must include two appropriate and verified references. We were told by the manager that she was not prepared to employ agency staff while permanent staff were recruited as she did not feel they would understand the needs of the residents and were expensive to employ. In the report of the key inspection of 17th November 2008 we made a requirement that all staff in the home must have adequate employment checks in place before they start work at the home. At the inspection on 8th April we found evidence that another staff member had been employed at the home after the requirement was made and had not had recruitment checks made and the requirement was carried forward. The Commission may now take enforcement action. 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 5 of 17 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 15 The service user or their 18/05/2009 representative must be consulted and involved in the written care plan whenever possible. This is to ensure that all parties are clear about the care to be provided. 2 7 15 The care for each resident must be regularly reviewed and documented in detail in their care plan. This is to ensure that all staff are aware of the current needs of the resident and aware of how these needs are to be met. 01/02/2009 3 7 15 All residents in the home must have a written plan which details all their needs and shows how these needs are to be met in a Person Centred way. This is so that all residents are supported by staff in a way that reflects their personal wishes and goals. 18/05/2009 4 8 13 Service users must have regular reviews of incontinence aids and must not be left in wet pads and 15/04/2009 Care Homes for Older People Page 6 of 17 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 wet beds all night. This is to ensure that service users are comfortable at all times and so that their skin integrity is maintained. 5 10 12 Service users must not be transported through the home in wet night clothes with no cover around them. This is to ensure that service users are comfortable at all times and can maintain their dignity. 6 10 12 All residents must be 01/01/2009 provided with their own toiletries and these, together with their own toiletries must be left in their own bedrooms. This is to ensure the dignity and privacy of residents is maintained. 7 12 16 A suitable range of activities must be provided for residents in the home on a daily basis. This is to ensure that adequate stimulation is provided. 8 13 38 Service users must not be left unsupervised in dangerous situations including being left alone on an over bath seat or left alone on a shower chair in 08/04/2009 18/05/2009 10/04/2009 Care Homes for Older People Page 7 of 17 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 the lift. This is to prevent the risk of harm to service users. 9 13 38 Full moving and handling assessments must be completed and updated by appropriately trained staff, for all service users. Details in plans must show how any risks are to be managed. This is so that care staff are clear about moving plans and any associated risks to prevent the risk of injury to residents and care staff. 10 13 38 Service users must be 08/04/2009 transferred safely at all times using a hoist where appropriate and they must not be transferred with their feet dragging on the floor or lifted by staff using an under arm lift. This is to protect service users and staff from the risk of harm. 11 14 12 Efforts must be makde to 01/02/2009 provide residents with choices in their daily lives so that they can decide the time they get up and go to bed, choose what food to eat and have the option of going to their room in the day. This is to ensure that residents dignity, privacy and right to make choices is
Care Homes for Older People Page 8 of 17 08/04/2009 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 maintained. 12 15 17 Records must be kept of the actual food eaten by residents. This is to ensure that individual diets are satisfactory. 13 18 13 All staff at the home must 18/05/2009 complete up to date training in Adult Safeguarding and Whistle Blowing and must demonstrate their understanding of these topic. This is to ensure that people living at the home will be protected from harm and abuse. 14 26 13 All communal bathrooms and 01/01/2009 toilets must contain liquid soap, soft paper towels and toilet paper and individual bedrooms must contain appropriate soap, towels and toilet paper. This is to ensure that good infection control is maintained in the home. 15 26 13 Soiled laundry must be transported through the home in appropriate sealed bags. This is so that good infection control is maintained in the home and so that service users and staff are not put at risk of harm.
Care Homes for Older People Page 9 of 17 18/05/2009 08/04/2009 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 16 26 13 Appropriate disinfectant must 08/04/2009 be used to decontaminate the shared bath between uses. This is so that good infection control is maintained in the home and so that service users and staff are not put at risk of harm 17 26 13 Appropriate closed storage must be provided for used incontinence pads. This is so that good infection control is maintained in the home and so that service users and staff are not put at risk of harm. 08/04/2009 18 26 13 Single use blood glucose 08/04/2009 monitoring systems must not be used for more than one service user. This is to comply with Department of Health guidelines to prevent the spread of infection which could put service users at risk of harm. 19 26 13 Care staff must have access 08/04/2009 to adequate supplies of disposable gloves and aprons and must use these whenever appropriate. This is so that good infection control is maintained in the home and so that service users and staff are not put at risk of harm. Care Homes for Older People Page 10 of 17 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 20 26 13 Liquid soap and paper towels 08/04/2009 must be available in all communal bathrooms and toilets and in all rooms where staff wash their hands. This is so that good infection control is maintained in the home and so that service users and staff are not put at risk of harm. 21 27 18 There must be two 30/04/2009 appropriate staff members on duty at night in the home. This is to ensure that all the needs of service users can be safely and appropriately met. 22 27 18 Staff numbers and deployment must be immediately reviewed in the home. This is to ensure that service users are provided with adequate care at all times and not put at risk of harm. 08/04/2009 23 29 19 A signed record must be kept 01/02/2009 in the home of the Terms and Conditions agreed with each member of staff including the hours they are employed and paid for each week and in what position they are employed. This is to ensure that staff are clear about their duties and responsibilities and can Care Homes for Older People Page 11 of 17 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 provide appropriate care for people in the home. 24 29 19 No individual must be 08/04/2009 allowed to work in the home until they have been appropriately recruited and until evidence of all essential employment checks are in place. This is to ensure that service users are protected from possible abuse by inappropriate care staff. 25 29 19 All staff must provide details 01/02/2009 of all employment histories and two appropriate written references must be obtained before new staff start work. This is to help protect residents from risk of abuse. 26 30 18 All staff in the home must be 18/05/2009 provided with assistance, including time off, for training. This training must be planned with staff. This is to ensure that staff have the necessary skills to meet the needs of residents. 27 31 10 The manager must 01/02/2009 undertake periodic training and must keep herself informed of current research and guidelines for the provision of care. This is to ensure that residents in the home receive
Care Homes for Older People Page 12 of 17 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 the best support in meeting their needs. 28 31 13 The manager must ensure 18/05/2009 that appropriate written policies and procedures are in place and that these are reviewed and kept up to date. Policies must be updated quickly for Safeguarding Adults, Whistle Blowing, Infection Control and the Administration of Medication. This is so that staff especially are aware of procedures to be followed for the benefit of all parties in the home, and to ensure the safety of residents. 29 33 24 A formal quality assurance 18/05/2009 system must be in operation at the home. This is to ensure the views and wishes of the residents and their families are used to improve services at the home and to affect the running of the home. 30 38 23 Fire doors in the home must not be wedged open or closed. This is to ensure fire safety in the home. This was required to be met by 17.11.08. The proprietor has responded to this requirement and has confirmed compliance.
Care Homes for Older People Page 13 of 17 17/11/2008 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 31 38 13 The homes Health and 18/05/2009 Safety Policy and Statement must include appropriate general risk assessments for the use of two recliner chairs in the home. These must then be identifiedin the individual persons file with appropriate detail to ensure the people are kept safe. This is to protect residents from any unnecessary accidents. Care Homes for Older People Page 14 of 17 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 27 25 A copy of the homes latest audited financial accounts must be sent to the Commission. This is so that it can be established that adequate funding is provided for the employment, training and retention of staff in the home. 08/06/2009 2 29 19 No member of staff may start work at the home until clearance has been received from the Protection of Vulnerable Adults register. This is so that no service users are put at risk of harm. 06/05/2009 3 29 19 No member of staff may 06/05/2009 work unsupervised or provide service users with personal care until clearance has been received from the Criminal Records Bureau. This is so that no service users are put at risk of harm Care Homes for Older People Page 15 of 17 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 16 of 17 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 17 of 17 - 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!
