Inspection on 08/08/05 for Littledene House

This inspection was carried out on 8th August 2005.

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 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 16/05/07

Littledene House 06/09/06

Littledene House 17/02/06

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 WD2 2JJ Lead Inspector Hazel Wynn Unannounced 08/08/05 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. Littledene House I52_S19451_Littledene_v241909_080805 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Littledene House Address 54 Bushey Grove Road, Watford, HERTS. WD2 2JJ 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) 01923 245864 Ms Margaret Ang Ms Margaret Ang CRH 12 Category(ies) of DE registration, with number DE (E) of places OP Littledene House I52_S19451_Littledene_v241909_080805 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 17.12.2004 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. Littledene House I52_S19451_Littledene_v241909_080805 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out during the late afternoon/evening of the 8th August 2005. The inspection covered the key National Minimum Standards; not all of the National Minimum Standards were covered. The inspection included looking at records, talking with service users and staff and a discussion with the proprietor. The home was well maintained, clean and comfortable and the grounds were very well kept. All but one of the National Minimum Standards inspected were met; a requirement was made for an identified risk in respect of one service user to have a clear risk assessment document with guidance to staff. A recommendation was also made that staff, who use a shelf of the large refrigerator to keep their own food cool should label this for ease of identification. What the service does well: What has improved since the last inspection? To support service users with changing needs staff have attended Dementia Care training. A new hand basin had been installed in the laundry and in some Littledene House I52_S19451_Littledene_v241909_080805 stage 4.doc Version 1.40 Page 6 areas new flooring curtains and blinds had been added. New progress notes have been introduced and these will support ease of tracking progress. 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. Littledene House I52_S19451_Littledene_v241909_080805 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 Littledene House I52_S19451_Littledene_v241909_080805 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) 1 - 5 Prospective service users and their representatives have the information they need to make an informed choice as to whether the home is suitable for them and visits support the provision of assurance that the home will be able to meet their needs. EVIDENCE: The Statement of Purpose was seen at the previous inspection and this meets the criteria of the National Minimum Standards and Regulations and is kept reviewed. A Service Users Guide is provided to service users prior to taking up residence and this provides a summary of the Statement of Purpose and provides the service user with important information including the environment, services, aims and objectives and philosophy of care. The files seen contained a signed copy of the agreement, which includes the room number to be occupied; they also contained the original comprehensive assessment prior to admission. Littledene House I52_S19451_Littledene_v241909_080805 stage 4.doc Version 1.40 Page 9 Service users or their representatives are invited to visit the home prior to the offer of a trial placement to see for themselves whether they feel that the home will be able to meet their needs. Littledene House I52_S19451_Littledene_v241909_080805 stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 - 11 The health and personal needs of the service users are met in accordance with their individual care plans. Where risks are concerned the home needs to ensure clear guidelines are in place for consistency and safety. Dignity and respect is afforded to service users and their families, including in dying and death. EVIDENCE: The service users care plans seen contained the necessary information and guidance to meet their personal and social care needs with the exception of one risk identified that did not have a sufficient risk management plan. A requirement was made to fully assess this risk and provide clear guidance to staff to manage the risk; a requirement has been made under Standard 38 of this report. The progress notes and discussion with service users evidenced that all assessed needs were met. One of the service user discussed with the inspector that the proprietor was looking into providing some additional activities. A Policy and Procedure in is place for the management of medication. The pharmacist supports and advises the home. Medication was well stored, Littledene House I52_S19451_Littledene_v241909_080805 stage 4.doc Version 1.40 Page 11 accurately recorded and administered in accordance with policies and guidelines and the service users needs/abilities. Service users spoken with stated that their dignity is upheld and that they felt they were always treated with respect. Policies and procedures are in place in respect of a death in the home and historically the home has been well complemented on their handling and support of this event. Littledene House I52_S19451_Littledene_v241909_080805 stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 -15 The lifestyle experienced in the home matches service users expectations, and preferences and satisfies their social, cultural, religious, recreational interest and needs. Contact with family friends and the community is in accordance with the service users’ wishes. Independence is encouraged and views sought in order that service users are supported to exercise control over their lives. A wholesome diet is provided at times suitable to individual service users and is served in pleasing surroundings. EVIDENCE: Services users stated that they were happy in the home and they were able to maintain their social, cultural religious, recreational interest and needs. They said that their family and friends were able to freely visit. Service users said that their were activities available and some said that they still get out about in the local community with family or friends on a fairly regular basis. The home provides a questionnaire as part of their quality assurance systems and these provide valuable feedback to the home, and help the service users to remain in control of their lives and exercise choice; the proprietor collates the information and takes action where she identifies this as a need and this evidence was seen on the files. Quotes are being obtained in the endeavour to provide some additional activities identified as a need by the proprietor. Littledene House I52_S19451_Littledene_v241909_080805 stage 4.doc Version 1.40 Page 13 The menu seen provided for well balanced, varied and nutritional diets and the service users stated that the food in the home is very good and plentiful. The dining area was seen to be comfortable. Littledene House I52_S19451_Littledene_v241909_080805 stage 4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 -18 Service uses and their relatives and friends can be confident that their complaints will be listened to, dealt with seriously and acted upon. Service users’ legal rights are protected and they are protected from all forms of abuse. EVIDENCE: Since the last inspection one complaint has been received and satisfactorily resolved; the Commission for Social Care received the outcome report and noted that action had been taken to the satisfaction of the complainant. The home supports service users to contact agencies providing advocates; and the proprietor stated that: if service user might need support with legal advice, but was uncertain whether it was a solicitor they need to appoint, she would support them to make contact with Age Concern. Policies and procedures, for the prevention of abuse, are in place together with training for staff in abuse awareness. See Standard 7 evidence and Standard 38 of this report for other comments relating to this section. Littledene House I52_S19451_Littledene_v241909_080805 stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 23 and 26 The home adheres to health and safety guidelines and practices and was well maintained. There are adequate safe and comfortable indoor and outdoor communal facilities. There are adequate and suitable bathing and lavatory facilities. Good hygiene practices are in place and the home was clean and comfortable. EVIDENCE: Records were seen of the maintenance of fire safety equipment, drill and fire safety training; water testing and temperature recordings, fridge temperature checks and visual environmental safety checks. The home looked very well maintained at this inspection when a tour of the home was conducted. The home is accessible by all service users and provides a lift to the upper floor. The rear garden is levelled and very well maintained with garden furniture for the comfort of service users who wish to sit outside in fair weather. The front garden is laid to drive and provides for an attractive and accessible entrance. Littledene House I52_S19451_Littledene_v241909_080805 stage 4.doc Version 1.40 Page 16 Some of the service users were relaxing in the communal lounge and dining areas; these provide adequate attractive and comfortable space for service users. A record was seen of the Health and Safety policies and procedures with which staff are inducted. Bathrooms and lavatoriessee during the inspection were clean, very attractively refurbished and accessible. The home is well maintained, clean, comfortable, fresh and hygienic. The inspector discussed with staff that when they use the refrigerator to store their own meal when on duty this should be labelled as staff food and dated; a recommendation was made. Littledene House I52_S19451_Littledene_v241909_080805 stage 4.doc Version 1.40 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 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 - 30 The home is adequately staffed and there is an appropriate skill mix. Staff receive the training they need to generally carry out tasks safely and provide protection to vulnerable adults. New staff are recruited in line with vulnerable adult procedures are subject to an induction process and receive formal supervision. EVIDENCE: The staff rota was seen to provide for adequate cover at all times and provided for a fast response on call in the event of an emergency arising. A thorough induction programme for new staff with ongoing training for all staff is in place and the training records were inspected. Two staff files were inspected and these contained proof of satisfactory Criminal Record Bureau and reference checks being conducted by the employment agency recruiting staff from Western Europe; the files also contained the induction and training record of the member of staff. See Standard 38 of this report where the inspector made a requirement that a risk management guidance document be drawn up to ensure a swift and consistent approach to managing an identified risk is produced. Staff were observed supporting the service users and appeared to be competent and sufficiently trained to carry out their roles. Formal Supervision records were seen and this is provided regularly. Littledene House I52_S19451_Littledene_v241909_080805 stage 4.doc Version 1.40 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 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) 31,33, 34, 35 and 38 The home is run in the best interests of the service users; it is managed by the proprietor who is fit to be in charge, is of good character and able to fully discharge her responsibilities. The service users’ financial interests are safeguarded. The health, safety and welfare of the service users and staff are, overall, promoted and protected. EVIDENCE: The proprietor manages the home and is a qualified nurse with many years of management experience and a good track record. During a discussion at this inspection, the proprietor informed the inspector of how she fulfils her obligation to her NMC registration, ensuring that she keeps her prep requirements (on going appropriate training) up to date. The proprietor regularly conducts a quality assurance audit which includes service user feedback and acts on the information gained to ensure the home is run in the best interests of the service users; copies of the service user survey and the Littledene House I52_S19451_Littledene_v241909_080805 stage 4.doc Version 1.40 Page 19 outcomes were inspected and provided evidence of how service users’ views influence the running of the home. Service users, or their appointed family member, handle finances; there is no involvement in the financial affairs of the service users by the registered proprietor or staff team. Fees are invoiced every three months and matched the figures stated on the service users’ contracts. Other chargeable extras such as hairdressing fees and chiropody are recorded and again invoiced every three months. All records seen were clear, accurate and kept up to date. No valuables or personal monies are held at the home, a nominated relative meets individual residents’ financial support needs and there have been no issues. There was one exception to the meeting of health and safety requirements as discussed in Standard 7 and a requirement has been made under Standard 38; in all of the other areas inspected on this occasion (as highlighted throughout this report) the health, safety and welfare of service users and staff/visitors was being observed and satisfied the meeting of the National Minimum Standards. The home had policies and procedures in place to protect service users and staff. Littledene House I52_S19451_Littledene_v241909_080805 stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 x 3 x x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 x 3 3 3 x x 1 Littledene House I52_S19451_Littledene_v241909_080805 stage 4.doc Version 1.40 Page 21 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 OP38 Regulation 13.4(c.) 13(4)(c) Requirement A risk assessment must be carried out and clear guidance put in place to manage the identified risk of a service user who could be prone to choking. Timescale for action 30/08/05 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 OP26 Good Practice Recommendations Staff should label their food to identify it as their own and date it. Littledene House I52_S19451_Littledene_v241909_080805 stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Mercury House 1Broadwater Road Welwyn Garden City HERTS. AL7 3BQ National Enquiry Line: 0845 015 0120 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 I52_S19451_Littledene_v241909_080805 stage 4.doc Version 1.40 Page 23 - 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!