Inspection on 25/06/05 for Mountbatten Lodge

This inspection was carried out on 25th June 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

Mountbatten Lodge 14/04/09

Mountbatten Lodge 17/04/08

Mountbatten Lodge 23/10/07

Mountbatten Lodge 19/02/07

Mountbatten Lodge 20/01/06

Mountbatten Lodge 14/01/05

Mountbatten Lodge 17/08/04

Mountbatten Lodge 26/02/04

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 Mountbatten Lodge Old Crabtree Lane Hemel Hempstead Hertfordshire HP2 4EX Lead Inspector Sheila Knopp Unannounced Saturday 25 June 2005 14:20 - 18.30 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. Mountbatten Lodge I52 s19476 mountbatten lodge v234855 250605 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Mountbatten Lodge Address Old Crabtree Lane Hemel Hempstead Hertfordshire HP2 4EX 01442 244188 01442 282546 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 Lin Kirby Care Home 60 Category(ies) of DE(E) Demential over 65 - 60 registration, with number OP Old Age - 60 of places PD(E) Physical Disability over 65 - 60 Mountbatten Lodge I52 s19476 mountbatten lodge v234855 250605 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 14 January 2005 Brief Description of the Service: Mountbatten Lodge is a purpose built home for up to sixty older people. The home is on two floors and divided into four individual units with single en-suite bedrooms, a lounge, dining room and asissted bath and shower rooms. Two units cater for people with dementia and these are on the ground floor with access to an enclosed garden area. Parking for cars is available. Mountbatten Lodge is situated in the Jarman Park Area of Hemel Hempstead, close to the town centre with its local shops and fascilities and adjacent to a large supermarket and leisure park. Mountbatten Lodge I52 s19476 mountbatten lodge v234855 250605 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on a Saturday afternoon to enable the inspector to see how the home was being run outside the normal working week and to meet with a wider range of visitors. The information in this report is based on group and individual interviews with 11 residents, 4 visitors, 8 staff and the manager who was on duty. Four care plans were examined and a review of medication including observation of a medicines round was carried out. Personnel, complaint, accident and fire records were also checked. The records of CSCI contact with the home and notifications received between inspections were reviewed. Approximately 6 hours of inspector has been allocated to this inspection. This was a very positive inspection that found the home to be running well with residents receiving a high standard of personal care and support. Residents were bright and alert and happy to talk about their experiences at Mountbatten Lodge. Gentle good humoured interaction between residents and staff was observed indicating that residents have positive relationships with staff. A visitor stated that they valued the ‘personal touches by staff who go over and above with little extra touches’. A relative said they had ‘great admiration for the staff’. Residents described the staff as ‘kind’. A resident was heard praising a member of staff for the caring task they had carried out. During the afternoon residents enjoyed a concert by a visiting choir in the main ground floor lounge. Some residents had chosen to watch the tennis or racing and staff were available to sit and talk with other residents. All areas of the home visited by the inspector were fresh and clean. The high standard of housekeeping was commented on by a relative. What the service does well: Staff provide high standards of care and support to residents at Mountbatten Lodge by using an individual approach to meeting physical, psychological and social needs and promoting a sense of well being and value. The stability of the staff and management team enables consistent standards to be maintained by staff who are familiar to the residents. Quantum Care has an excellent training and induction programme in place. The focus on person centred dementia care training for all staff has had an impact on the individual approach being taken to the care and support required by all residents. Mountbatten Lodge I52 s19476 mountbatten lodge v234855 250605 stage 4.doc Version 1.30 Page 6 Staff work as a team and there is an open atmosphere and management style which protects residents. What has improved since the last inspection? 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. Mountbatten Lodge I52 s19476 mountbatten lodge v234855 250605 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 Mountbatten Lodge I52 s19476 mountbatten lodge v234855 250605 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) 3, 4, & 5 Visits are made to prospective residents and information obtained from other health and social care workers to ensure that the home can meet the needs and expectations of the individual before admission. This process includes visits to the home and a trial period in which the resident can make decisions about their continued stay. EVIDENCE: Discussion with a resident who made the decision to move into Mountbatten Lodge following a stay in hospital confirmed they had visited the home before admission and had been involved in the review to decided whether they would remain in the home. This person felt that Mountbatten Lodge met their expectations. The care records of a newly admitted resident confirmed that a pre-admission assessment was carried out. The training and development programme provides staff with the skills to carry out their job competently and safely. Six monthly reviews take place to ensure the home can continue to meet needs and residents remain within the home’s registration category. Mountbatten Lodge I52 s19476 mountbatten lodge v234855 250605 stage 4.doc Version 1.30 Page 9 Information about services in the home is available to residents and their representatives. The manager agreed to provide CSCI with a copy of the updated Statement of Purpose and Service User Guide when planned changes have been made. Mountbatten Lodge I52 s19476 mountbatten lodge v234855 250605 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 Each resident has a care plan which sets out their health and personal care needs. The care plans described how each individual wishes to be supported and are regularly reviewed with the involvement of the resident and their relative / representatives. The care practices, staff interaction with residents and promotion of choice supports the privacy and dignity of residents. The information in the care records enables staff to take an individual approach to each resident. Staff receive appropriate training to administer medication safely and there are systems to regularly audit the procedures in place. EVIDENCE: The four care plans examined described out individual care needs in terms of personal, health, psychological and social care needs are to be met including the involvement of other health care professionals such as GP’s, community nurses and chiropodists. Following admission and as part of the six monthly formal reviews residents and their relatives are invited to agree and sign them so that they are kept informed of any changes and can ensure that they are being supported in the way that they would wish. One of the records record checked had not been signed. Staff review the care plans monthly. Risk assessments so that staff can manage the care of residents who may be at risk of falls or developing pressure sores are in place. Mountbatten Lodge I52 s19476 mountbatten lodge v234855 250605 stage 4.doc Version 1.30 Page 11 Good standards of personal care with residents wearing smartly laundered clothing were observed. Staff were observed to be discrete and considerate in their approach to service users requiring support and assistance. One relative was concerned because her husband had missed his regular bath. This was brought to the attention of the manager who also agreed to go through the plan of care with the relative. The medicine administration and storage systems were checked on one unit and against the specific care plans examined. A member of staff was observed carrying out a medicines round on another unit. The records assessing the competency of a member of staff to administer medication were seen. Mountbatten Lodge I52 s19476 mountbatten lodge v234855 250605 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) 13, & 15 A varied programme of activities is in place providing a stimulating environment. Mountbatten Lodge provides a welcoming atmosphere and encourages the involvement of family members. Residents are able to continue to make choices about their lives and express their wishes. A high level of satisfaction was expressed in relation to the choice ad quality of the meals served. Residents are able to choose where they have their meal and arrangements are made to support residents who have special dietary requirements. EVIDENCE: There is a planned programme of varied activities and additional trips and visits are taking place during the summer. There is currently a vacancy on the activities staff team. One resident said that there was not a lot to do on Mondays. The manager agreed to look at this. The relatives spoken with were very positive about the support they receive from the staff and management team. Mountbatten Lodge I52 s19476 mountbatten lodge v234855 250605 stage 4.doc Version 1.30 Page 13 This included staff understanding of their need to carry on with caring tasks and providing support to take their relative out or attend family functions. Relatives have been involved in providing personal touches to the rooms to provide a familiar and comforting environment. The manager is developing individual books for each residents to record photographs and events in the person’s life, while at Mountbatten Lodge, to share with relatives and friends. A social evening has been arranged to meet with relatives and discuss plans to develop a sensory garden, reminiscence area and re-establish a friends group. Relatives are involved in providing life history details to enable staff to plan social events and to understand them better. This is reflected in the care plans. Examples of special arrangements made by staff to provide activities around the positive aspects of a person’s life before the onset on dementia to promote a sense of value and well-being were seen. Residents have a choice of meals from a rotating menu which is seasonally adjusted. Residents confirmed they had had extra salads in the extremely hot weather which is what they preferred. One resident described the puree diet they required and how helpful staff were in mashing up her banana which she enjoyed. This person described how underweight they had been on admission from hospital and their delight at regaining it. Staff were responding to the hot weather and providing additional drinks and keeping residents cool. Three out of the four care plans examined demonstrated that the weight of residents is reviewed. However the monthly update for one resident did not refer to the weight loss which had occurred between reviews. Mountbatten Lodge I52 s19476 mountbatten lodge v234855 250605 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, & 18 There is appositive open atmosphere in which residents, relatives and staff can raise their concerns. This open culture together with staff training and the policies in place provide protection for residents. One resident said ‘they listen to you’. Three relatives confirmed they were kept informed of changes. Staff need to be vigilant in recording incidents of bruising and ensuring relatives are kept informed. EVIDENCE: The visitors and residents all confirmed they were able to raise issues with staff and the management team in an open manner and that they were listened to. The complaint procedure is available and details the process and response times individuals making complaints can expect. The manager reported that no formal written complaints have been made. Day to day issues are recorded in a staff communication book. No complaints have been raised directly with CSCI since the last inspection. No concerns have been brought to the attention of CSCI by other health or social care workers between inspections. Staff demonstrated their awareness of issues related to the protection of residents and confirmed that they received vulnerable adult training. The home works to the Hertfordshire County Council Vulnerable Adult procedures. No incidents have been reported between inspections. Mountbatten Lodge I52 s19476 mountbatten lodge v234855 250605 stage 4.doc Version 1.30 Page 15 One service user was observed to have bruising on their arm. Their relative who noticed it when they visited attributed this to the knocks associated with blackouts that they were prone to. However there was no mention of the bruise in the care plan and the person’s relative had not been kept informed by staff. Mountbatten Lodge I52 s19476 mountbatten lodge v234855 250605 stage 4.doc Version 1.30 Page 16 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) Not inspected. EVIDENCE: Mountbatten Lodge I52 s19476 mountbatten lodge v234855 250605 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 & 29 The needs of the residents were being met by the number and levels of experience of staff on duty. The recruitment policies and procedures in place ensure the suitability of staff to work with older people is checked before they start work in the home. EVIDENCE: The staff on duty with the manager had varying degrees of experience within the home and other care settings. Staff had time to respond to residents and there was an unhurried and relaxed atmosphere. Staff confirmed they had time to spend with residents. No agency staff are being used which provides continuity for residents but also enables staff who are familiar with the home to work efficiently. The rotas indicate that in addition to the duty manager 9/10 staff are provided in the morning and evenings with a reduction in the afternoon and four staff including a care manager work at night. On the day of inspection a new member of staff was shadowing staff as part of her induction and not included in the overall numbers. The units supporting people with dementia have higher staffing levels. Two sets of personnel records were checked and it was confirmed that references and criminal records bureau checks are obtained before appointment. Records of the interview notes are maintained. Health assessments are carried out and contracts of employment issued. Mountbatten Lodge I52 s19476 mountbatten lodge v234855 250605 stage 4.doc Version 1.30 Page 18 Several of the staff interviewed had achieved NVQ qualifications with others studying for the award. Mountbatten Lodge I52 s19476 mountbatten lodge v234855 250605 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) 32, 33, & 36 The management ethos of the home is one of continuous improvement and development. There is a positive approach by the manager of the home and company to developing a service which crates an open and positive atmosphere for residents and staff. The development of the service to residents is supported by a quality assurance system. Staff are supervised to ensure they are working to the policies and procedures of the home and developing their practice. The quality of care received by residents is supported by the companies commitment to the on-going training and development of staff though its induction, foundation, NVQ, statutory and specialist training programmes. EVIDENCE: One relative stated that there was always new things happening. A visitor confirmed that they attended the annual forum held in the home which provides feedback on the quality assurance system. Mountbatten Lodge I52 s19476 mountbatten lodge v234855 250605 stage 4.doc Version 1.30 Page 20 CSCI receive monthly reports of unannounced visits by a senior representative of the company. Records of meetings staff have with residents on each unit are kept to record their views. Staff confirmed that they received regular formal supervision. Records were available to support this. Staff confirmed they could raise issues openly with individual managers and at staff meetings. A new member of staff who was shadowing other staff reported they had dates for their induction training which included moving and handling training. Staff interviewed were also doing their NVQ training. The fire records demonstrated that regular checks are carried out on fire safety equipment as required. The accident records demonstrated that the home had notified CSCI of accidents as required. The records are audited each month however an assessment of the time accidents were occurring had not been completed for several months and it was recommended that this was re-instated to identify any patterns. The previous inspection identified that a high percentage of accidents were occurring at night. Mountbatten Lodge I52 s19476 mountbatten lodge v234855 250605 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 x x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 3 3 x x 3 x x Mountbatten Lodge I52 s19476 mountbatten lodge v234855 250605 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 No requirements were made 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. 2. 3. Refer to Standard 15 18 38 Good Practice Recommendations Ensure changes which occur between monthly reviews i.e weights are recorded as part of that review to alert staff to the need to carry out further monitoring. Ensure all incidents of bruising are reported and next of kin kept informed. Include a review of the times accidents occur in the monthly audit. 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