CARE HOMES FOR OLDER PEOPLE
Queensway House Residential Care Home 148 Jupiter Drive Hemel Hempstead Hertfordshire HP2 5NP Lead Inspector
Mrs Patricia Rogan Unannounced Inspection 11th September 2007 13:30 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 Queensway House Residential Care Home DS0000063303.V350615.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. Queensway House Residential Care Home DS0000063303.V350615.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Queensway House Residential Care Home Address 148 Jupiter Drive Hemel Hempstead Hertfordshire HP2 5NP 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) 01442 266088 01442 261818 queensway@goldcarehomes.com Queensway@goldcarehomes.com GCH (Queensway) Limited vacant post Care Home 60 Category(ies) of Dementia - over 65 years of age (60), Old age, registration, with number not falling within any other category (60), of places Physical disability over 65 years of age (60) Queensway House Residential Care Home DS0000063303.V350615.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 25th April 2006 Brief Description of the Service: Queensway House is a sixty-bedded care home for older people, who may also have a physical disability or dementia. The home does not provide nursing services. The building is two-storey and has a passenger lift. Service users have access to all parts of the home and gardens. Bedrooms are spread across both floors. On the first floor, there are bedrooms and a large lounge / dining area for people with dementia. People with dementia can also share facilities in other parts of the home and garden. All bedrooms are single occupancy and have en-suite facilities. The main dining room is on the ground floor but each floor has its own lounge. There is a large, secure garden to the rear of the home and a parking area at the front. The home is situated in a residential area, near to the town of Hemel Hempstead, which has extensive shopping areas, leisure facilities and good transport links. The fees range from £500 to £650 per week and the fees are based upon the persons assessed care needs. These are explained in the service user guide, which is available from the home. Queensway House Residential Care Home DS0000063303.V350615.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection report includes some of the comprehensive information provided by the manager and proprietors. People who use the service and their families and/or their representatives were asked for their views of the service either face to face or via confidential questionnaires. Health and social care professionals and people who work in the home were also asked for their opinions about the way that care is provided and support is given to the people living in Queensway House. One inspector visited the service and spent time meeting residents and speaking privately about what it was like for them living in the home. Observations of the way care staff interacted with the residents took place on the ground floor in communal areas and considerable time was spent observing practice in the unit for people with dementia. A tour was made of the premises and some bedrooms were viewed. What the service does well: What has improved since the last inspection?
The unit for people with dementia is colourful and stimulating and each residents door is signposted with pictures and photos relevant to the person whose room it is, making it much easier to recognise. The manager has said staff training has been increased and this includes recognising all forms of abuse and understanding the procedures for challenging and reporting poor practice. The recommendations made at the previous inspection have been addressed:
Queensway House Residential Care Home DS0000063303.V350615.R01.S.doc Version 5.2 Page 6 People who move into the home are given an individual service contract. Oxygen trolleys have been provided in order to keep the oxygen cylinders stable. Risk assessments have been completed for the keypad locking systems. A more robust recruitment procedure is being followed. 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. The summary of this inspection report can be made available in other formats on request. Queensway House Residential Care Home DS0000063303.V350615.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 Queensway House Residential Care Home DS0000063303.V350615.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Standard 6 is not applicable to this service) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prior to moving into the home, prospective residents and their families or representative are provided with information about the service. The assessments are relevant and wide-ranging. EVIDENCE: The pre-admission assessments of people who had moved into the home within the past five months were inspected. All but one assessment had been signed by the resident or a member of the family. The one which was not signed at the time of the assessment, had been signed at a later date and the reason why was written against the signature. All residents were given a copy of the service user guide, which is at the moment being reviewed to ensure the information is up to date. One person said that she felt pleased to be shown around the home and have the opportunity to meet residents and staff before deciding to move in and said it took away many of her anxieties about moving into residential care.
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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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are comprehensive and individualised. Access to health care professionals is prompt. Medication policies are in place and medication administration is audited by a senior member of the team. People who use the service were seen to be treated with respect. EVIDENCE: There has been a review of the way that care plans are written and a comparison of the previous care plans and the later format shows that more information is now included. Staff responded to the residents in a friendly manner and one person described her relative as ‘taking on a new lease of life’ since coming to Queensway. Discussion with a health care professional during the visit to the service confirmed that residents had regular access to medical care and related support such as dentistry, opticians and chiropody. Staff were heard speaking kindly with residents and when a person had become confused with dressing, the staff were discrete and reassuring. Queensway House Residential Care Home DS0000063303.V350615.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The activities co-ordinator provides residents with interesting activities. When she is not on duty or in another part of the home, the staff do not continue this work. The staff were kind when providing care tasks for people with dementia, but more training is needed in person centred dementia care and communication skills. Meals are nutritionally balanced and served hot. EVIDENCE: The activities co-ordinator was not on duty on the day the inspector visited the home. Staff were gentle in their approach and friendly towards the residents but staff were carrying out tasks and no activities were going on in the lounge or area outside the dining room. Some of the residents were seeing the hairdresser or the chiropodist and some were reading the paper. However throughout the observation, some residents had nothing to do at all. The unit for people with dementia had age appropriate music playing which the residents appeared to enjoy. There was just two members of staff on duty and this did not allow staff the time to familiarise themselves with the residents personal and social history in order to prompt memory and stimulate conversation in a meaningful way. An inspection of the menus showed that a variety of seasonal meals are available . The dining room is to be refurbished.
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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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are policies and procedures in place to record and report concerns. People who use the service and their families are confident they will be treated seriously if they need to complain. EVIDENCE: When people view the home, included in the information pack is guidance on what to do if there is a concern or complaint. There are meetings with staff and residents and exchanges of ideas or concerns are encouraged. Two residents said they would have no hesitation reporting something that worried them. One person said, I wouldnt like to complain but if something worried me, I know I could speak to my key worker and shed listen. There is an advocacy scheme available to the residents and the manager would arrange for the resident and advocate to meet in private, if they so wished in order to resolve an issue. Staff have had training in safeguarding adults and understand the whistle-blowing policy. Queensway House Residential Care Home DS0000063303.V350615.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is reasonably well maintained but some repairs, which are not the responsibility of the maintenance person, are not carried out in a timely manner. The home was clean and tidy and the unit for people with dementia was very pleasant. EVIDENCE: One relative commented that the home is always clean and bright. There were no malodours anywhere in the home. The bathrooms were clean and tidy and the communal areas had recently been cleaned. Some repairs, which did not directly affect residents, had been delayed and a system for ensuring that repairs are reported and resolved is being set up. The large dining room is looking dull and some of the tablecloths are worn. Funding is now available to refurbish the whole of the dining room. Door labelling in the unit for people with dementia is very effective and helps the residents to find their way to their rooms.
Queensway House Residential Care Home DS0000063303.V350615.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who have dementia would have an enhanced service if there were sufficient staff on duty to allow staff time to sit with the residents and engage with them in a meaningful way. Recruitment and vetting procedures are robust. All staff have induction training and are working towards, or have gained their National Vocational Qualification in care. EVIDENCE: Acts of kindness were observed and favourable comments have been received but it was also evident that there is not always sufficient staff on duty. There have been several comments that the staff are always very busy. Staff were working hard to complete the necessary tasks, leaving little time to learn about the individual lives of the residents or to chat with residents either one to one or in small groups. Several members of staff said they would like to learn more about dementia and offering more in depth, accredited training could encourage their enthusiasm. The experience of a recently appointed member of staff confirmed that the vetting procedures had been followed and she was not appointed until all the mandatory paperwork was in place. She said she had been supported by more experienced staff for the first few weeks until she was considered experienced enough to work alone.
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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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is trained and skilled and is experienced in managing a care home. Policies and procedures are in place, which ensure that the standard of care is audited and quality assurance is maintained. EVIDENCE: One comment by a visitor was that the manager and the team were always helpful and encouraged involvement in the life of the home. Residents and relatives meetings are held to exchange ideas and viewpoints and these are incorporated in the quality assurance. The manager has noted that there is a slightly higher than average number of reports of falls and has already discussed this with the lead inspector. In order to try to reduce the number of falls, a falls prevention auditing system is being set up which will monitor more closely what occurred immediately prior to the person falling.
Queensway House Residential Care Home DS0000063303.V350615.R01.S.doc Version 5.2 Page 15 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 3 x x 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 2 13 3 14 2 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 2 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 Queensway House Residential Care Home DS0000063303.V350615.R01.S.doc Version 5.2 Page 16 Are there any outstanding requirements from the last inspection? no 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 OP14 Regulation 12(2)(3) Requirement Timescale for action 01/12/07 2. OP27 18(1)(a) 3. OP27 18(1)(c) The manager must ensure that dementia care training provides all staff with the skills to communicate effectively with those residents who have dementia and find it difficult to express their needs or explain how they feel. The service provider must 01/11/07 ensure that there are staff in sufficient numbers to ensure that service user’s personal, health and social care needs are met at all times. The manager must ensure that 01/12/07 dementia care training provides all staff with the skills to communicate effectively with those residents who have dementia and find it difficult to express their needs or explain how they feel. Queensway House Residential Care Home DS0000063303.V350615.R01.S.doc Version 5.2 Page 17 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 OP12 Good Practice Recommendations Staff training which included general knowledge about what school and working life may have been like for most residents and what main historical events occurred during the residents lifetimes would provide many relevant topics of interest for all residents, in particular for those residents who need help to recall past events. Queensway House Residential Care Home DS0000063303.V350615.R01.S.doc Version 5.2 Page 18 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: 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
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