CARE HOMES FOR OLDER PEOPLE
Stanborough Lodge Great North Road Welwyn Garden City Hertfordshire AL8 7TD Lead Inspector
Bijayraj Ramkelawon Unannounced 13 May 2005 10:30 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. Stanborough Lodge I52 s19585 stanborough lodge v226553 130505 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Stanborough Lodge Address Great North Road Welwyn Garden City Hertfordshire AL8 7TD 01707 275917 01707 258405 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) RMD Enterprises Limited Sheila Pearce Care Home 25 Category(ies) of OP Old Age 25 registration, with number of places Stanborough Lodge I52 s19585 stanborough lodge v226553 130505 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 26 August 2004 Brief Description of the Service: Stanborough Lodge is a detached two storey Georgian-style property that has been converted to its present use. The building comprises of twenty-three bedrooms, each with an en-suite facility. The bedrooms are located on both floors. There are two main lounges one of which is delegated as the smoking lounge, a conservatory and dinning room. There are separate bathrooms and toilets available on each floor. All parts of the building are accessible to persons with restricted mobility. Aids and adaptations include a passenger lift; grab rails and a ramp leading from one door to aid those with restricted mobility access the garden and patio areas. There is a large, well-maintained garden with level pathways. The home is located in a quite cul-de-sac close to the A1M motorway. It is located within short distance from parkland, a local public house, local shops and amenities. Stanborough Lodge I52 s19585 stanborough lodge v226553 130505 stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a positive unannounced inspection and feedback received from service users, their relatives and visitors was excellent. The standard of care and practices observed were high. The majority of time was spent talking to residents, visitors and staff. Some time was spent in the office scrutinising care plans, staff files and other records. Discussions were held with the deputy manager and the proprietor to whom the feedback of the inspection was given. What the service does well:
All feedback received from service users was very positive. Care practices observed were individualised and dignified. The home was generally kept clean and offered a comfortable and homely environment. Staffing levels in the home were adequate. During inspection one service user said ‘ they look after me so well and everyday they ask me what I want to eat and will make the things I want especially for me’, ‘there are lots of activities but can’t do much myself’ as I have Arthritis’. Another commented that ‘generally the home is very good’ they bring in dog for activities and I like to pat the dog. I would also like my bedroom windows cleaned so that I can enjoy the view from my bedroom’. Others said that they have no complaints and generally the home is well run. Another service user said ‘I am incredibly well looked after they would do anything they can for you here. Staff are extremely good’. The home provides a wide range of activities and entertainment organised by the staff. Staff members spoken to were very positive about the home and appeared committed to their work. The home has a yearly development plan including opportunities for staff to progress within their role and undertake training. Care plans were easy to follow with all aspects of care being person centred and with service users’ input. Care plan progress notes were kept up to date and these were reviewed on a regular basis. A risk assessment was carried out for each service user and these indicated how the risk would be managed and minimised. Activities of daily living were also reviewed on a monthly basis. Medical records were maintained and progress notes reflected the care plans in practice. Other records including Fire records were maintained in good order. No complaints have been received since last inspection. Previous complaints were recorded and the outcome fully recorded including any disciplinary and investigation carried out. Stanborough Lodge I52 s19585 stanborough lodge v226553 130505 stage 4.doc Version 1.30 Page 6 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. Stanborough Lodge I52 s19585 stanborough lodge v226553 130505 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 Stanborough Lodge I52 s19585 stanborough lodge v226553 130505 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) 1-5 Adequate information was available to prospective service users and their relatives to assist them in their decision making process when chosing the home. Each service user has a detailed assessment of needs carried out by the home prior to an offer of placement made. Staff’s approaches and interaction with service users were appropriate to the delivery of care. EVIDENCE: The home has a written ‘Statement of Purpose’ and a ‘Service User Guide’ and both documents were available to prospective and current service users and their relatives. These were also displayed on the general notice board. Service users and relatives spoken to confirmed that they were encouraged to visit the home prior to admission. Care plans scrutinised showed that a senior member of staff had carried out a pre-admission assessment of needs of the service users either in their homes or place of residence prior to admittance. Each service user has received a ‘Terms and Conditions of Residency’ which contained the rights and obligations of the service user and registered provider. Stanborough Lodge I52 s19585 stanborough lodge v226553 130505 stage 4.doc Version 1.30 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 standard(s) 7-11 Service users observed during the course of this inspection appeared to be well cared for, were comfortable and received care and attention in a timely manner. Good care practices and interactions were observed supported by equally good care plans. Care plans were comprehensive and reviewed regularly to reflect the changing needs for health, personal and social care needs of the service users. Records of medicines including the receipt, storage and administration were kept in good order. Although, prescribed medicines no longer required had not been returned to the pharmacy for disposal. EVIDENCE: Care plans inspected were comprehensive and had all the information required including assessment of needs, risk assessments and how the needs of the service users were being met. These were person-centred and the progress notes reflected the care plan in practice. These were also reviewed on a regular basis and signed by the service users or their relatives. Service users who required nursing input were seen by the District Nurse. The visiting GP spoken said that ‘Stanborough Lodge is one of good homes. Staff are very responsible and call them appropriately’. Each service user has a nutritional assessment on admission, which is reviewed, if needed, based upon monthly weight gain or loss.
Stanborough Lodge I52 s19585 stanborough lodge v226553 130505 stage 4.doc Version 1.30 Page 10 All service users are registered with a GP, who refers service users to all other health care agencies as and when required. A log of visits from GP, District Nurses and all other health care agents was maintained. Service users confirmed that GPs and District Nurses visit them as soon as there are any problems and when requested. Service users and their visitors spoken to were very complimentary of the staff and service provision. Records of medicines including the receipt, storage and administration were kept in good order. However, medicines for the same service user were ordered and dispensed in blister packs and ordinary boxes, which were used. This is not a safe practice. Medicines no longer required had not been returned for disposal. All service users were appropriately dressed and well groomed. The home has a “knock and wait” policy on entering service users’ bedrooms, toilets and bathrooms. Staff members on duty were observed to deliver care and to attend to service users’ needs in a manner that is conducive to respect for their privacy, dignity, choice and wishes whilst actively promoting independence where possible. All personal and intimate care practices were carried out behind closed doors. Doctors and District Nurses also see service users in the privacy of their own rooms. A policy and procedures are in place for care of the dying. It was reported that service users are enabled to stay in the home during their last days. Stanborough Lodge I52 s19585 stanborough lodge v226553 130505 stage 4.doc Version 1.30 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 standard(s) 12-15 The home promotes autonomy and choice. Visitors are welcomed and the home promotes integration with the local community in accordance with service users preferences. EVIDENCE: Each service user has a programme of activities as part of their care plans. The home has employed an activity co-ordinator who organise a variety of activities and entertainment 3 times a week. A number of visitors spoken to were very positive about the home. The home has a selection of large print books and three daily newspapers are also delivered. There is a Church of England service held in the home each month and arrangements could be made to facilitate other religious needs. A hairdresser visits the home twice a week and a mobile library also makes regular visits. The records were quite comprehensive, containing many various activities. Service users manage their own financial affairs with the help of their relatives. Personal belongings were evident in service users bedrooms. Confidential and private information is locked away and care plans are securely stored in an office on each floor. Service users have their relatives or social workers or as advocates. The lunch was unhurried with assistance and encouragement given by staff sitting down next to service users.
Stanborough Lodge I52 s19585 stanborough lodge v226553 130505 stage 4.doc Version 1.30 Page 12 Tables were laid nicely and a choice of drinks was available and there was individual cutlery. Service users spoken to were complementary of the food provided. Stanborough Lodge I52 s19585 stanborough lodge v226553 130505 stage 4.doc Version 1.30 Page 13 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 The home has a robust complaints procedure of which all service users and visitors spoken to were aware. The manager and the proprietor have a presence within the home thus safeguarding service users. EVIDENCE: A copy of the complaints procedure is available to prospective and current service users. Those spoken to said that they were aware of the complaints procedure but would prefer to speak to a member of staff or the manager if they had any concerns. There has been no complaints received since the last inspection. Staff spoken to said that they were aware of the ‘Whistle Blowing Policy’. Stanborough Lodge I52 s19585 stanborough lodge v226553 130505 stage 4.doc Version 1.30 Page 14 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) 19-26 The home and its surroundings offer a pleasant, comfortable and safe environment to its service users. The home was kept clean and generally well maintained and bedrooms were personalised offering a homely, lived in feel. However, there were worn and torn carpets and the upstairs bedroom windows from outside needed to be cleaned. EVIDENCE: The home and its surroundings offer a pleasant, comfortable and safe environment to its service users. The home was kept clean and generally well maintained. Bedrooms are personalised offering a homely, lived in feel. However, the carpets on the main stairs were worn and torn at the edges and service users stated that their bedroom windows needed to be cleaned. Rooms have locks fitted and service users can be issued with the keys if they wish. The home has adequate number of domestic staff and records showed that all staff have been provided with training in hygiene and infection control. To minimize infection control liquid soap and paper hand towels must be made available.
Stanborough Lodge I52 s19585 stanborough lodge v226553 130505 stage 4.doc Version 1.30 Page 15 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) 27-30 The skills and experience of staff is varied. There was an enthusiastic, dedicated and caring staff team who took great pride in the service provision. EVIDENCE: There was adequate numbers of staff rostered on duty per shift during the day and night. There were also adequate number of domestic and catering staff allocated per day and the home has the services of a fulltime maintenance person and an activity co-ordinator. Service users spoken to were complimentary about the staff and management of the home. Stating ‘ the carers are good, they look after us and are very kind’. Staff files were not inspected on this occasion as the registered manager was off duty. Some staff spoken to confirmed that they have received appropriate training including NVQ. Others had not fully completed the mandatory training manual handling and food hygiene. Stanborough Lodge I52 s19585 stanborough lodge v226553 130505 stage 4.doc Version 1.30 Page 16 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) 31-38 The home has a good management structure and are well supported by the proprietor. The senior staff who have direct involvement, appear to be dedicated to providing a good quality service. Safe practices in relation to fire safety, food hygiene and mandatory training have not always been evident during this visit. EVIDENCE: The manager and the proprietor communicate a clear sense of leadership within the home and have an open-door policy where staff could see them at any time with any issues or concerns they may have. Pride and dedication is taken in every aspect. Service users and their relatives have commented positively on the good practices and quality of service provision. A valid insurance certificate is displayed in the reception area and this offers cover of no less than £5 million. Stanborough Lodge I52 s19585 stanborough lodge v226553 130505 stage 4.doc Version 1.30 Page 17 The home adopts the organisation’s employment policies and procedures and facilitates the induction and training programmes for staff. The home has developed and implemented a programme of formal supervision. All statutory records were available for inspection and maintained in accordance with legislation. Records inspected were up-to-date and accurate and were held securely. Staff spoken to were aware that service users can access their records and information held about them in accordance with the Data Protection Act 1998. The home has policies and procedures in place to ensure that the health, safety and welfare of service users and staff are promoted and protected. These records are accessible to all staff. All accidents and injuries are recorded in the accident book and RIDDOR forms have been completed where applicable. The CSCI has been kept informed of all accidents and admissions to hospital. However, fire doors were wedged open in the laundry room and near the front entrance. Food stored in the fridge was not covered nor dated. New members of care and catering staff had not yet undertaken the required mandatory training. Stanborough Lodge I52 s19585 stanborough lodge v226553 130505 stage 4.doc Version 1.30 Page 18 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 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 3 3 3 2 3 3 2 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 3 3 3 3 3 1 Stanborough Lodge I52 s19585 stanborough lodge v226553 130505 stage 4.doc Version 1.30 Page 19 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 OP 9 Regulation 13 (2) Requirement Prescribed medicines no longer required must be returned to the pharmacy for disposal. Timescale for action From 13/05/05 and thereafter 01/07/05 2. OP 26 3. OP 38 4. OP 38 5. OP 19 13(3) & The registered manager must 13 (4) (c ) ensure that liquid soap and hand paper towels are available in all toilets and bathrooms to minimise the risk of infection. 13 (4) (c ) Food stored in the fridge must be From covered and dated. 13/05/05 and thereafter 23(4)(c) Fire doors are only held in an From (iii) open position by means 13/05/05 approved by the Community Fire and Safety Officer. thereafter 13 (4) (a) Worn and torn carpets on the 29/07/05 16 (2) (c) stairs must be replaced. 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. Refer to Standard OP 38 OP 38 Good Practice Recommendations Kitchen staff should complete the food and hygiene course. New care staff should receive all the mandatory training as
I52 s19585 stanborough lodge v226553 130505 stage 4.doc Version 1.30 Page 20 Stanborough Lodge 3. OP 19 part of their induction programme. Windows from outside should be cleaned. Stanborough Lodge I52 s19585 stanborough lodge v226553 130505 stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection 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
© 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 Stanborough Lodge I52 s19585 stanborough lodge v226553 130505 stage 4.doc Version 1.30 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
