Inspection on 26/04/05 for Margaret House (Abbots Langley)

This inspection was carried out on 26th April 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

Margaret House (Abbots Langley) 13/03/07

Margaret House (Abbots Langley) 03/11/05

Margaret House (Abbots Langley) 24/08/04

Margaret House (Abbots Langley) 11/06/04

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 Margaret House Parsonage Close Abbots Langley Hertfordshire WD5 OBQ Lead Inspector Pat House Unannounced 26 April 2005 12:00 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. Margaret House I52 s19457 margaret house v223422 260405 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Margaret House Address Parsonage Close Abbots Langley Hertfordshire WD5 OBQ 01923 261190 01923 299902 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) Quantum Care Limited Mrs Isabel Darby Care Home 51 Category(ies) of DE(E) Dementia over 65 51 registration, with number OP Old Age 51 of places PD(E) Physical Disability over 65 51 Margaret House I52 s19457 margaret house v223422 260405 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 24 August 2004 Brief Description of the Service: Margaret House is a care home for men and women who are usually over 65 and who may also have a physical disability or dementia. The home comprises six purpose-built, single storey units, or bungalows, two of which are for residents with dementia and are now managed and staffed together. The resulting five units each has its own lounge and dining area and small kitchenette. There is one other bungalow dedicated to dementia care, while two are for those with higher needs, leaving one bungalow for those whose needs are lower. There are two courtyard gardens outside and also a patio area. Car parking is in an adjacent area to the front of the building. The home is situated in a residential area of Abbots Langley and there is a nearby walkway leading to the High Street where there are shops, pubs and restaurants. Margaret House I52 s19457 margaret house v223422 260405 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over one afternoon, from 12 noon, with two inspectors. There were 45 service users resident in the home on the day and people in all units were spoken to, as well as several visitors to the home. Everyone spoken to praised the care staff and management and said they were happy with all aspects of the day to day running of the home. Care staff appeared confident and said they felt supported and happy to work in the home. Most areas were inspected during the visit, it is therefore commendable that there were no Requirements or Recommendations made from this inspection. What the service does well: What has improved since the last inspection? What they could do better: Margaret House I52 s19457 margaret house v223422 260405 stage 4.doc Version 1.30 Page 6 The activities co-ordinator has received accredited training recently and is developing an excellent range of events for residents. Individual histories and preferences are also being recorded so that these can drive what is offered. However, to fully provide activities for the wide range of abilities in the home, including one-to-one input, and to increase the numbers of regular participants, it is felt that more than one person would need to be involved in the provision, a dedicated assistant co-ordinator role would be of great benefit. 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. Margaret House I52 s19457 margaret house v223422 260405 stage 4.doc Version 1.30 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 Margaret House I52 s19457 margaret house v223422 260405 stage 4.doc Version 1.30 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, 2, 3, 4 and 5. Standard 6 does not apply to this home. The home provides good information to service users as well as a detailed contract, which allows informed choices to be made. Full assessments are made of each service users needs and all prospective residents are given time to sample the home before any decisions are made, to ensure the home is suitable. EVIDENCE: A copy of the home’s Statement of Purpose and Service User’s Guide were displayed in the reception area of the home on the day of the inspection, and have been at all previous inspections. These documents contain detailed information about facilities for service users. The family of one new resident spoken to, said they had been given a copy of the Service User’s Guide on their relative’s admission. Records of service users examined contained signed copies of the home’s contract and these listed all relevant information, including the room to be occupied. Details of assessments, both from referring agencies and from staff at the home, were available on all records examined. There were two new service users in the home during the inspection, and they were both having on-going assessments to ensure the home was suitable. Margaret House I52 s19457 margaret house v223422 260405 stage 4.doc Version 1.30 Page 9 Evidence was seen of meetings taking place with other agencies about one of these service users as the Manager said that there was some doubt that the home could fully meet the individual’s needs. The relative of the other new service user confirmed that trial visits were offered before entry to the home. The home provides separate living accommodation for those who have a dementia and for those who have not and staff and families spoken to felt this separation enabled the differing needs of both groups to be met. All staff receive on-going training in all aspects of care including dementia care. Margaret House I52 s19457 margaret house v223422 260405 stage 4.doc Version 1.30 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, 8, 9, 10 and 11. The individual needs of service users are set out in care plans to ensure all needs are identified and can be met. The homes procedures for medication administration are sound and help protect service users from error. Policies and practice in the home also promote service user privacy and dignity especially at times of illness and death. EVIDENCE: Care plans were tracked for service users spoken to during the inspection and were generally well recorded with monthly reviews in place. Most contained photographs of the individuals concerned and there were photographs being taken on the morning of the inspection for those who did not already have one. The information in the plans was up to date and relevant to the individual and appropriate risk assessments were in place. One family member spoken to said they had recently attended their relative’s review in the home. Individual likes and dislikes were also recorded and “memory books” are being completed for service users and included in the care plans. Records of appropriate health checks were seen and good pressure sore monitoring was documented with details of District Nurse involvement. Currently three service users have pressure sores, one of which originated outside the home. Risks of falls are monitored as are nutritional issues and service users are weighed regularly. Margaret House I52 s19457 margaret house v223422 260405 stage 4.doc Version 1.30 Page 11 Staff said that the combination of the two dementia bungalows has meant that there is now one dining area for both in one unit and one lounge area in the other. This means that the residents in each unit have to walk either to the dining room or the lounge, and, as a consequence, are getting more exercise which has benefited their health and mobility. During the inspection, service users in the higher needs units were seen moved, using handling techniques and hoists, and all practices were undertaken well by staff. Service users spoken to confirmed that staff treat them with respect at all times and knock and wait before entering their bedrooms. Visitors said that their relatives always wear their own clothes and that visits can take place in private if required. Some service users have their own telephone and said any resident could have access to a phone if they needed. There are no shared rooms in the home. The home has written policies on death and dying and staff said that all possible care is provided for service users and their families at such times. The procedures for administering medication were checked and were sound although there were one or two gaps in the records on one unit. Great detail is now recorded for non-blistered medication, with a double recording system in place and two staff signatures for each entry. Senior staff said that this system has greatly improved accuracy and that the detail recorded could be gradually reduced as staff become more confident. A new medication store has been set up which has air-conditioning to ensure safe storage. Staff were clearly more sure of procedures than noted at previous inspections and explained the system for ensuring that those residents who self-medicate were doing this safely. Margaret House I52 s19457 margaret house v223422 260405 stage 4.doc Version 1.30 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, 13 and 15. Service users are happy with activities and daily life in the home and maintaining contact with families and friends is promoted by staff in accordance with service user wishes. Service users benefit from and enjoy the meals provided in the home and maintain their independence by making coices about the food and how they spend their days. EVIDENCE: Service users and families spoken to, confirmed that there are a variety of activities offered in the home and that they could choose to join in or not. A list of forthcoming activities was given to the inspectors and there were a wide range of things to do on offer, including Bird Watching, Reminiscence, Quizzes, Hand Massage and trips to the pub. There is also a mobile shop and Communion Church services are held monthly. The activities co-ordinator has been on a NAPA training course and families spoken to said there had been more activities on offer in the home recently, and that staff encourage residents to join in. There is an activities book in the home which records who takes part in each session and this was seen on the day. New staff spoken to felt that residents, including those with dementia, were stimulated by the activities. The recent training and increased recording of “memories”, likes and dislikes, should enable more residents to be encouraged to join in the events, although the home may well need to provide more staff assistance to the activities co-ordinator, if a wider number of residents and preferences are catered for. Margaret House I52 s19457 margaret house v223422 260405 stage 4.doc Version 1.30 Page 13 Visitors to the home confirmed they were welcomed at any time by staff and were invited to celebrations in the home. Service users told the inspectors that they enjoyed the food in the home and the mid-day meal, seen on the day, looked appetising, well-balanced and there was plenty offered. Menus were seen displayed and there is always a choice of meal and service uses were also seen choosing drinks. Those spoken to said they could have drinks or snacks if they wanted and that they could take as long as they wished at meal times. One lady was seen refusing to go to the dining room to eat so staff brought her meal to the lounge on a tray. Margaret House I52 s19457 margaret house v223422 260405 stage 4.doc Version 1.30 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, 17 and 18. Complaints procedures in the home encourage service users and families to feel comfortable in voicing concerns and staff are aware of current policies which aim to protect adults from abuse. EVIDENCE: The home has an appropriate written complaints policy, which some visitors spoken to were aware of. Service users generally confirmed that they felt comfortable telling staff of any concerns and the only complaint recorded in the home’s complaint book was that of one service user complaining about another. This complaint had been listened to and dealt with appropriately. Staff said that anyone they thought might benefit from an advocate would be referred to the Manager who would try to access this service. Service users were asked if they had been registered to vote in the forthcoming election, and all spoken to had, with most opting for a postal vote. The home has written procedures in place for Adult Protection and a Whistleblowing Policy, which staff were aware of. The home also has policies for handling service users’ money, which were checked at previous inspections and were sound. This area will be checked again at the next inspection. Margaret House I52 s19457 margaret house v223422 260405 stage 4.doc Version 1.30 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, 22, 23, 24, 25 and 26. The home is clean and well maintained and promotes service user safety and comfort. Individual and communal facilities are adequate to meet all service user needs. EVIDENCE: The home is well decorated and maintained and the grounds looked attractive on the day of the visit. There is no CCTV at the home. The communal lounges are comfortably furnished and many service users have brought their own possessions and furniture for their own bedrooms. Service users and staff said there were enough bathrooms and toilets in the home and that there were never times when residents had to wait to use these. Five of the bedrooms in the home also have en-suite facilities. There are two smoking rooms in the home and the main kitchen and the laundry were clean and well equipped and staff confirmed that procedures followed with food preparation and laundry, promoted the control of infection. The Manager said that the home had a new senior Housekeeper and a full domestic staff team. During the inspection visitors commented that they had noticed an improvement in cleanliness standards in the home. Margaret House I52 s19457 margaret house v223422 260405 stage 4.doc Version 1.30 Page 16 The home has appropriate aids and adaptations in place and the family of one service user spoken to said that staff had recently discussed the need, and their plans, to provide mobility aids for their relative. Bedrooms in the home are of adequate size and none are shared. These rooms are all well furnished and service users confirmed they had been offered the key to the door. The bedrooms have lockable storage space and radiators with low temperature surfaces. A dishwasher on one unit was broken and not working but the Manager confirmed that this machine was due to be repaired or replaced. There is emergency lighting throughout the home and hot water was being delivered at safe temperatures on the day of the inspection. Margaret House I52 s19457 margaret house v223422 260405 stage 4.doc Version 1.30 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, 28, 29 and 30. Staff numbers in the home are generally adequate to ensure that all service user needs are met. Good recruitment procedures and staff training make sure that, as far as possible, service users are supported and protected in the home. EVIDENCE: There were adequate care staff working in the home on the day of the inspection and rotas seen showed that these staff numbers were normal. There were nine care workers on duty throughout the day, as well as the Manager and Deputy. At night, three care workers and a Care Team Manager would be on duty. The home uses regular agency staff when there are absences and one agency worker was on duty on the day of the inspection. This care worker spoke to the inspector and had detailed knowledge of the home and the service users and had received appropriate training. Service users praised the care provided by this member of staff, saying he was “brilliant”, and he was clearly accepted as part of the staff team. In the bungalows where there were higher needs and staff often had to work in pairs, there was a higher ratio of staff on duty. Figures provided to the CSCI show that currently 30 of care staff have the NVQ training award and that when all staff have finished their present course, more than 50 will have NVQ level 2 or above. Records examined showed that all new staff receive good induction training and one new care worker of two weeks had finished induction, had other courses booked and said she was still “shadowing” other carers during her working shifts. Margaret House I52 s19457 margaret house v223422 260405 stage 4.doc Version 1.30 Page 18 Staff whose training records were checked had all completed mandatory training as well as dementia training and other courses. Recruitment files checked contained all the elements required to ensure staff were safely recruited and were very well kept. Margaret House I52 s19457 margaret house v223422 260405 stage 4.doc Version 1.30 Page 19 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, 32, 36, 37 and 38. Service users benefit from a good management team in the home where staff are well supervised and where procedures promote safety and the residents best interests. EVIDENCE: The Registered Manager at the home has appropriate qualifications and many years experience and has kept up to date with changing studies and legislation relating to care. The Manager works as part of a team with other seniors and those spoken to said that this group works effectively and well. Staff and service users said that they were clear about procedures in the home and that the Manager and Deputy were approachable and supportive. One care worker who had been in the home for two weeks said she had been anxious about her new role but that everyone had been “brilliant” and she felt very supported. Staff and service users confirmed that staff and residents meetings were held and were minuted. Margaret House I52 s19457 margaret house v223422 260405 stage 4.doc Version 1.30 Page 20 Residents said they had made suggestions for activities at these meetings and these had been implemented. Care staff spoken to said they had regular supervision, as well as reviews and appraisals. Family members spoken to said they were kept informed of all changes or incidents that affected their relatives. Records were being kept appropriately, locked in cabinets. Staff were aware that service users and families could access their records, subject to individual permission and the Data Protection Act. The accident records were well kept, with an overview maintained so that trends could be monitored, and the system complies with the Data Protection Act. Fire checks and drills take place regularly and maintenance and servicing records were up to date. The home provides the CSCI with details of all significant accidents and incidents and with regular reports from Head Office staff visits. Margaret House I52 s19457 margaret house v223422 260405 stage 4.doc Version 1.30 Page 21 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 N/A 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 x 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 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 3 x x x 3 3 3 Margaret House I52 s19457 margaret house v223422 260405 stage 4.doc Version 1.30 Page 22 No 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 Regulation Requirement Timescale for action 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 Good Practice Recommendations Margaret House I52 s19457 margaret house v223422 260405 stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Address 1 Address 2 Address 3 Address 4 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. 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