CARE HOMES FOR OLDER PEOPLE
Monread Lodge London Road Woolmer Green Hertfordshire SG3 6HG Lead Inspector
Patricia Rogan Unannounced Inspection 21st June 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Monread Lodge DS0000019472.V298528.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Monread Lodge DS0000019472.V298528.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Monread Lodge Address London Road Woolmer Green Hertfordshire SG3 6HG Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01438 817466 01438 817484 monread@lineone.net Monread Lodge Nursing Home Limited Mrs Anna Marrah Care Home 64 Category(ies) of Old age, not falling within any other category registration, with number (64) of places Monread Lodge DS0000019472.V298528.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. This home may accommodate 50 older persons who require general, respite and convalescent nursing care. This home may accommodate 14 older persons who require personal care. The home may accommodate one named service user who has not yet reached the age of 65 years of age. This condition will be removed when the service user attains the age of 65 years or permanently leaves the home for any reason. 28th November 2005 Date of last inspection Brief Description of the Service: Monread Lodge is registered to provide personal care and general nursing care (40 places) to elderly service users. The single storey home is situated between the villages of Woolmer Green and Knebworth. There are good parking facilities for visitors. All accomodation is in single rooms with en-suire bathrooms including a shower, wash hand basin and toilet. Assisted baths and toilets are also provided. There are a variety of lounges and quiet areas around the home with a central conservatory and dining area. At the time of this inspection report,the residential care fees range from £500 to £620 per week and the nursing care fees range from £613 to £800 per week. Monread Lodge DS0000019472.V298528.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Two inspectors were present for this unannounced inspection, which took place throughout one day. Time was spent meeting in private with residents to ascertain their opinion of the care which is provided. Several relatives, members of staff and visiting professionals were also asked for their views about the management of the home. Case files, staff records, policies and procedures including the administration of medication were also inspected. Where appropriate, observation was made of the way care was delivered and the way that staff interacted with residents and relatives. What the service does well: What has improved since the last inspection?
The Statement of Purpose and Service User Guide has been revised and is user friendly. The print is small but is easily available in larger print if required. There has been an in depth quality audit and the manager is addressing any areas where necessary changes or improvements have been identified.
Monread Lodge DS0000019472.V298528.R01.S.doc Version 5.2 Page 6 Several residents said they did not like having to wait so long in the dining room for meals to be served and this was recorded at the previous inspection last November. However, the manager is already implementing changes and is arranging for staff training to provide a restaurant style service which will allow for a more flexible meal times. The requirement from the last inspection regarding continence management has been improved so that odours are eliminated. Where necessary bathmats had been replaced. 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. Monread Lodge DS0000019472.V298528.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Monread Lodge DS0000019472.V298528.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Standard 6 is not applicable to this home) Quality in this area outcome is adequate. This judgement has been made using available evidence including a visit to this service. All service users are assessed prior to moving into Monread Lodge. The assessment is carried out by a senior member of staff and the prospective service user and family are involved in this assessment. Although the majority of the assessments were satisfactory, some of the assessments lacked detail regarding care needs and personal social history and not all had been signed by the prospective resident or their representative. EVIDENCE: Several case files were inspected and all had a copy of the assessment which was carried out before the service user moved into the home. Some of the assessments required more detail to explain what the resident’s needs were and what the resident was still able to do. One or two of the assessments had not been signed by the prospective resident or their representative to evidence that they had been involved during the assessment. However, when the inspector followed this up, some of the resident and/or family were able to confirm that they had been involved during the assessment process.
Monread Lodge DS0000019472.V298528.R01.S.doc Version 5.2 Page 9 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 the following standard(s): 7, 8, 9 and 10 Quality in this area outcome is adequate. This judgement has been made using available evidence including a visit to this service. Every case file held a care plan identifying the resident’s individual needs. These were regularly updated. The care plans and the reviews of the care plans which were inspected needed more detail to explain what aspect of care the the resident needs assistance with and how this will be met. This would further improve the care plans to ensure they are even more individualised. The social history of each resident should be expanded and staff should make themselves familiar with this so that conversations with the resident are enhanced. Qualified nurses are on duty all the time and training is ongoing. There are stringent policies and procedures in place regarding the administration of medication including situations where residents have chosen to administer their own medication. The manager requires all staff to treat every resident with respect. Any failure to meet this standard is dealt with and followed up via supervision and staff meetings. The majority of staff were seen to treat the residents in a courteous manner. During a tour of the premises, it was disappointing to note that once or twice, the high standards set by the manager had not been adhered to.
Monread Lodge DS0000019472.V298528.R01.S.doc Version 5.2 Page 10 EVIDENCE: Several care plans were inspected and many were well set out. There were some areas in the care plans where the resident’s care needs required more detail to identify what the resident is still able to do with or without assistance. All residents spoken with said that staff knew about their families and took an interest in them but some residents said staff did not know about the impact of the war years or knew what jobs they had held prior to retirement or about what interests or hobbies they’d had. The resident’s social history had been recorded but most care plans would benefit from more information about important past events during the resident’s long life time. This information should be shared with staff so that residents can be encouraged to chat about these things if they wish. The rota showed that qualified nurses are on duty to ensure twenty-four hour cover to meet all nursing care needs. Feedbackabout the nursing and care staff from visiting medical professionals was very favourable The inspector observed administration and recording of medication. This was carried out correctly by staff who have had the requisite training. The policy regarding residents who may wish to take responsibility for managing their own medication is addressed within the medication policy. All staff know that every resident must be treated with respect and that the resident’s dignity must be protected. This good practice was observed on many occasions during the inspection. However the inspectors noticed lapses in this good quality care. A resident was not properly covered because her blanket had slipped. Two members of staff were seen to glance into the room but did not go into the room to cover her. When this was pointed out to another member of staff, although he was on his way to another resident, he immediately went into the resident’s room to make her comfortable. One member of staff was assisting a resident with personal care but did not ensure the door was closed and what she was doing could be seen from the corridor. Later in the afternoon, in more than one resident’s room, a change of nightwear and a continence pad had been left in full view on the bed. This does not show respect for the residents’ dignity. Monread Lodge DS0000019472.V298528.R01.S.doc Version 5.2 Page 11 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 the following standard(s): 12, 13, 14 and 15 Quality in this area outcome is good. This judgement has been made using available evidence including a visit to this service. Responses from residents and their families were all positive and many expressed satisfaction with the activities available. All residents are supported if they wish to follow a faith and there are visits from local ministers. Visits by residents and families are encouraged and residents can meet with their family in communal areas or in the privacy of their own room. Residents are asked about their views and they are able to exercise choices. If it is not possible to enable a resident’s wishes to be met, the reason why is explained to the resident. There is a varied menu with choices available and the food is served hot. The dining room is light and the tables were attractively laid. Meals are served in two sittings. EVIDENCE: There are regular visitors to the home and one said ‘from the day my mother moved in, I have felt included in what’s going on.’ Records show that ministers visit the home. In order to enhance the existing varied range of activities, entertainers are invited and outings are sometimes arranged. Occasionally a fete is held at the home and all residents are enabled to take part.
Monread Lodge DS0000019472.V298528.R01.S.doc Version 5.2 Page 12 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 the following standard(s): 16 and 18 Quality in this area outcome is good. This judgement has been made using available evidence including a visit to this service. There are stringent policies and procedures in place to respond to any complaint which may be raised. Complaints are very few and the manager responds effectively, recording the complaint and the outcome. The manager ensures that all the staff have training in the protection of vulnerable adults and the manager is scrupulous in her recording of incidents and works closely with the Adult Protection Team and other authorities. EVIDENCE: Those residents and family members who were consulted had been told about the complaints procedure and this is also included in the service users guide. One relative said he had complained that some items of laundry were missing and he felt satisfied that every effort had been made to locate them as soon as possible. The manager takes her role seriously and shows a determination to try to protect her residents from abuse. She has a good relationship with residents and their families and they have said they are confident that she will respond quickly to any concerns or allegations. Monread Lodge DS0000019472.V298528.R01.S.doc Version 5.2 Page 13 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 the following standard(s): 19 and 26 Quality in this area outcome is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained and there is a maintenance programme which is regularly reviewed. During the tour, it was noticed that one or two minor items needed to be replaced. Staff may need to be reminded that they share the responsibilty of reporting such things in order to maintain the high standard. There is an ongoing redecoration programme and the premises were clean and in good decorative order. EVIDENCE: Many people said they thought Monread Lodge was a pleasant place to live in . The rooms were light, well ventilated and individualised. Some things which needed repair or replacement, were noticed during the inspection and these were reported to the manager at the time. It would appear that some staff were aware of the things which were pointed out but had not reported it. All areas of the home appeared to be well decorated and cleaned to a high standard.
Monread Lodge DS0000019472.V298528.R01.S.doc Version 5.2 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this area outcome is good. This judgement has been made using available evidence including a visit to this service. The staff rota showed that there was an adequate number of staff on duty to meet the varying needs of the residents. There is a recruitment policy and procedures are followed correctly. The training programme is comprehensive to ensure that all staff in the home have the necessary skills. EVIDENCE: A Care Team manager monitors training needs and practice of the care team and she works closely with the senior staff nurse who has line management responsibility for the registered nurses. Registered nurses are on duty at all times. All staff are checked by the Criminal Records Bureau and references are followed up. The manager liaises with other authorities when appropriate to A comprehensive training programme ensures that the skills of staff remain up to date. Monread Lodge DS0000019472.V298528.R01.S.doc Version 5.2 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 39 Quality in this area outcome is good. This judgement has been made using available evidence including a visit to this service. The home is run by an experienced manager who takes her role seriously in order to ensure that the residents in Monread Lodge are well cared for. She sets high standards and is supported by her well trained senior team. EVIDENCE: All policies and procedures which were inspected were in depth. The manager works co-operatively with regulatory organisations and other professionals. Financial procedures are carried out by established administrative staff and auditing takes place. Supervision of staff ensures that any training needs are identified and acted upon. Policies are in place regarding the protection of the residents and when needed, the manager has responded immediately and in an appropriate manner by informing the relevant agencies.
Monread Lodge DS0000019472.V298528.R01.S.doc Version 5.2 Page 16 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Monread Lodge DS0000019472.V298528.R01.S.doc Version 5.2 Page 17 Are there any outstanding requirements from the last inspection? no Monread Lodge DS0000019472.V298528.R01.S.doc Version 5.2 Page 18 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 OP10 Regulation 12(4)(a) Requirement Residents must be treated with respect at all times. Privacy should be maintained by closing doors when care is being provided and by ensuring that clothing and covers protect the dignity of the residents. Continence pads should not be left in open view of the resident or others. Discretion is needed. Timescale for action 19/06/06 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 OP3 Good Practice Recommendations When carrying out an assessment, the prospective resident and/or their representative should be asked to sign the assessment as evidence that they have been involved and have understood. The care plans should also include what the resident is still able to do for him or herself and more information about the resident’s personal and social history would give a more holistic picture to enhance understanding. 2 OP7 Monread Lodge DS0000019472.V298528.R01.S.doc Version 5.2 Page 19 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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