Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Manor Lodge 27-29 Alexandra Road Watford Hertfordshire WD17 4QX The quality rating for this care home is:
two star good service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Yoke-Lan Jackson
Date: 0 9 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 24 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home
Name of care home: Address: Manor Lodge 27-29 Alexandra Road Watford Hertfordshire WD17 4QX 01923221451 01923253114 manorlodge@follettcare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Follett Care Limited Name of registered manager (if applicable) Mrs Julie Parker Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 34 The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Manor Lodge is a residential care home for older people. It changed its registration category to include older people with dementia in May 2008. The home is situated in a residential area within walking distance of the town centre of Watford and Watford Junction railway and bus stations. There are a limited number of free parking spaces outside the home. The administrative office, staff room, kitchen and laundry room are all on the ground floor. There are bedrooms on the ground floor and first floor. There is Care Homes for Older People
Page 4 of 24 care home 34 Over 65 0 34 34 0 Brief description of the care home a lift to the first floor. The assisted bathroom and toilet facilities are easily accessible. The lounge and dining area overlooks the large patio and garden. There is an additional lounge which is used as a quiet room for residents and their visitors. The home has an enclosed garden and patio which is accessible from the main lounge. Handrails have been installed in this area and steps have been replaced by ramps where necessary. The garden has shrubs, flowering plants, and sitting areas. The home charges £400 to £500 per week. Information about the home and the service it offers is contained in the Statement of Purpose and the Service User Guide. A copy of these and the most recent inspection report are available in the home. Care Homes for Older People Page 5 of 24 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection was carried out on 09/12/2008. The registered manager and the deputy manager were present. There are currently 22 people in residence. The inspection included a tour of the premises. Time was spent observing how the staff interacted with the residents. Staff and residents were interviewed and documents were examined. The inspection included a visit by an expert by experience. The expert from the organisation, Help the Aged, spent three hours in the home speaking to residents. An expert by experience is a person who, because of their shared experience of older people, contributes to providing a better picture of what it is like to live in or use a Care Homes for Older People
Page 6 of 24 service such as Manor Lodge. The use of an expert by experience was arranged by us. The information and feedback received from the expert by experience are incorporated into this inspection report. Information received by us since the last inspection was reviewed. This included the Annual Quality Assurance Assessment (AQAA) which providers of registered services are required to complete. The AQAA focuses on how the outcomes are being met for the people using the service and also provides us with some statistical data. Survey questionnaires were sent to residents and their relatives and their responses and other information received were also reviewed. What the care home does well: The expert by experience observed that residents are happy living in the home and that they are well taken care of. She said that the residents were given choices and that members of staff treated the residents with respect and kindness. She noted that the staff were all caring towards the residents and interacted well with them. The expert by experience had lunch with the residents and observed that lunchtime was unhurried and that residents were offered a choice of dishes. She noted that each resident was addressed by their name as the meals were served to them and that members of staff were very supportive and assisted residents who needed help in a respectful manner. The expert also spoke to two residents in their bedrooms. The expert stated that Manor Lodge is a happy home and that the food served was nice and the activities were good. She was particularly impressed by the enthusiasm of the activity co-ordinator, who was present in the afternoon. However, she was concerned about the welfare of a respite resident having spoken to the resident. Since the inspection, a referral has been made to the local Social Services for a social worker to visit the person in her own home. The expert by experience had a tour of the premises and bedrooms and noted that the environment is clean and tidy. In a recent written survey by us, some relatives made the following comments about the service and staff. I have observed everything that goes on when visiting (my relative) and the staff are very caring and the home is well run. Food is quite good and (my relative) is well attended to. Staff provide good day-to-day care. I have visited many care homes and Manor Lodge rarely has the associated smell. My (relative) is always clean. The staff at Manor Lodge provide my relative) with all the care and support needed. They care for (my relative) well. Any comments or suggestions put to the management are taken seriously and acted upon. Should action not be possible or practical this is always discussed. I have always had the chance to talk to staff whenever I visit. Usually they come to talk to me before I ask for their attention. The management is always available and on the rare occasions when I have had concern, they have been dealt with immediately and amicably. I find staff very easy to talk to. Care Homes for Older People Page 8 of 24 What has improved since the last inspection? What they could do better: 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 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 24 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A prospective client can be assured that a pre-admission assessment will be completed before they are admitted to ensure that the home can meet all their care needs. They have the information they need to make an informed choice about using the service. Evidence: The home has a revised Statement of Purpose to reflect the additional service offered to those with dementia. The pre-admission assessment form has been revised and it includes a section that identifies the care needs of people with dementia. The preadmission documents for two recent admissions had detailed information about their personal, health and social care needs. Each new resident was given the Service User Guide. Both residents seemed settled in their new home. Care Homes for Older People Page 11 of 24 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can expect to be treated with respect and can rest assured that their personal and healthcare needs can be met. They are protected by the homes medication policy and procedures. Evidence: On the day of the site visit, most of the residents were in the main lounge. They seemed relaxed and content. A couple spoken to said that they are very pleased to have found a home with a double room and they are very happy and settled in their new home. Another resident had the house pet, a black cat, sitting on the residents lap as the resident watched television. Each resident has a person-centred written care plan. The care plans examined have sections detailing the personal, healthcare and social care needs of each of the residents. Risk assessments have been carried out where appropriate. The home has two versions of the written care plans, one for residents who have dementia and one for those without. The manager is working towards a more user friendly version that
Care Homes for Older People Page 12 of 24 Evidence: can be used for both groups of residents and to enable staff to identify and deliver care in a manner that upholds the persons individuality while meeting their care needs. Each resident has a regular review of their care needs and there is a yearly review that involves all parties including their next of kin and the relevant social worker. The reviewed care plan was properly documented, dated and signed by all the parties involved. The management ensure that residents have access to healthcare services when required. Each of the residents is registered with a general practitioner of their choice. There has been no incident of pressure sores among the current group of residents. The home works closely with the district nurse, who will attend to a residents healthcare needs when necessary. On the day of the site visit, a district nurse was attending to a resident who requires a Vitamin B injection. The local Social Services have been contacted to assist in the welfare of a respite resident who has since been discharged to their own home. The relative has been informed of the referral. The management team are aware of the Mental Capacity Act 2005 and any knowledge gained is cascaded down to care staff. They are also aware of the relevant supporting services regarding dementia and the correct action to be taken to meet any related care needs. A trained member of staff administers the medication. The Medication Administration Record charts examined were correctly filled in and were kept up to date. The medication trolley was securely attached to the wall in the office. There is a controlled drugs cupboard but no controlled drugs are prescribed at the present time. There have been no errors in the administration of medication. Care Homes for Older People Page 13 of 24 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are given every opportunity to participate in all aspects of daily routine living and they receive a wholesome and appealing diet. They are encouraged to maintain links with their family and friends Evidence: The home has a weekly activity programme, which is on display in the lounge. The expert reported that residents enjoy the activities that have been organised for them. Residents look forward to the afternoon recreational activities organised by the activity co-ordinator. The co-ordinator continues to attend training courses on recreational and therapeutic activities to enhance his skills and to cascade the knowledge gained to members of staff who assist with activities to the benefit of the residents. The meals provided are nutritious and wholesome and there is a choice of menu. Lunchtime was seen to be unhurried and members of staff assisted those residents who needed help in a respectful way. A relative commented, My (relative) is unable to take part in activities but staff sit and talk to (my relative). They also help (my relative) at mealtimes. They monitor fluid
Care Homes for Older People Page 14 of 24 Evidence: intake and (my relative) is well nourished. Staff are aware of (my relatives) likes and dislikes and provide meals (my relative) enjoys. Care Homes for Older People Page 15 of 24 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a robust Complaints Policy and Procedure and people can be assured that their complaints will be listened to and acted upon, and that their legal rights will be protected. Evidence: Residents Meetings are held regularly and the residents are well informed about aspects of the home and arrangements that affect them. Minutes are taken and a copy was readily available for inspection. The management deals promptly with issues raised at the meetings. Staff have training on issues concerning safeguarding of the vulnerable, including Abuse Awareness and Whistle-Blowing Policy. The home follows the joint agency Safeguarding Procedures of Hertfordshire County Council Adult Care Services. Care Homes for Older People Page 16 of 24 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that they live in a safe and comfortable environment and that they will have access to all communal areas. Evidence: The premises appeared fresh and clean on the day of the inspection. The residents interviewed said that they are satisfied with their bedrooms, which have personal items on display. All the bedrooms appeared clean and tidy. Since the last inspection, some redecoration and refurbishment have taken place. There is an additional lounge and a double bedroom on the ground floor. The main lounge and dining area has been redecorated and refurbished. The dining tables and chairs have been replaced. An updated risk assessment of the premises has been undertaken and, to ensure additional safety for those residents with dementia, there is an alarm system in place on all exterior doors. Appropriate signs have been placed on doors, and memory boards are available for residents to use in their bedrooms if they so wish. The enclosed patio is accessible from the main lounge and handrails have been installed to this area and steps have been replaced by ramps where necessary. The patio is free of clutter and there are shrubs, flowering plants and sitting areas. Residents often sit in the garden to have their lunch in the summertime. They are encouraged and supported to use the garden as they wish.
Care Homes for Older People Page 17 of 24 Evidence: Care Homes for Older People Page 18 of 24 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that the home has an effective staff team who will support them. They can be confident that they are safeguarded by the homes robust recruitment policy and procedures. Evidence: Residents are well supported by an effective staff team in sufficient numbers and with a skill mix that benefit residents. Staff recruitment records are kept up to date and new recruits only commence working after they have been checked against the Protection of Vulnerable adults (POVA) list and following Criminal Record Bureau checks and clearance. There is a rolling training programme for all staff and training courses included Dementia Awareness, Care and Prevention of Pressure Sores, Care Planning and Safeguarding issues. All new staff have an induction training package that complies with Skills for Care guidance. The management ensures that all care staff are aware of the Mental Capacity Act 2005 and the relevant supporting services regarding dementia and the correct action to be taken to meet any related care needs. Care Homes for Older People Page 19 of 24 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that the service and care provided will continue to be well maintained and they can be assured that their health, safety and welfare are promoted and protected. Evidence: The standards of administration and management of the home are well maintained. In May 2008, an application to vary the conditions of registration to include dementia care was approved by us. Appropriate measures such as skilled and well trained staff in dementia care, an increased staffing level and environmental safety measures were put in place. All records for the protection of the residents are kept secure and handled in accordance with the Data Protection Act 1998. All the maintenance and servicing records are maintained and they are kept up to date. The home is not involved in the residents financial affairs.
Care Homes for Older People Page 20 of 24 Evidence: There is an annual quality assurance and monitoring system that includes survey questionnaires for residents, relatives, staff and others. Information received is collated and analysed and an annual report is produced and a copy is provided to us. The Annual Quality and Assurance Assessment (AQAA) forms issued by us were returned on time for this inspection. Care Homes for Older People Page 21 of 24 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, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 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, Care Homes 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 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 23 of 24 Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 24 of 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. 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!
