Inspection on 26/06/07 for Stanborough Lodge

This inspection was carried out on 26th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Stanborough Lodge 21/07/08

Stanborough Lodge 22/08/06

Stanborough Lodge 12/10/05

Stanborough Lodge 13/05/05

Stanborough Lodge 26/08/04

Stanborough Lodge 13/05/04

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 Stanborough Lodge Great North Road Welwyn Garden City Hertfordshire AL8 7TD Lead Inspector Marian Byrne Key Unannounced Inspection 10:00 26 June and 24th July 2007 th 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 Stanborough Lodge DS0000019585.V342015.R04.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. Stanborough Lodge DS0000019585.V342015.R04.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stanborough Lodge Address Great North Road Welwyn Garden City Hertfordshire AL8 7TD 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) 01707 275917 01707 258405 rmd@ukgateway.net RMD Enterprises Limited Ms Sheila Pearce Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Stanborough Lodge DS0000019585.V342015.R04.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd August 2006 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. They fees range from £385 - £496 per week. Stanborough Lodge DS0000019585.V342015.R04.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over two days by one inspector. The first day of the inspection was carried out in the morning and early afternoon and the second day was late afternoon and early evening. The inspector toured the premises, observed lunch, spoke with four service users, two members of staff, the Registered Provider and the Registered Manager were present at the time of the inspection. What the service does well: What has improved since the last inspection? What they could do better: Some of the requirements left at the last inspection were not met. There was an odour that could be associated with incontinence in the corridor on the ground floor. More care must be taken in the recording of the administration of medication. Although the home is not registered to admit people with a dementia, residents in the home can have memory loss. Staff do not have the training to care for people who have memory loss and suffer from confusion. Dementia training would benefit both residents and staff in providing person centred care. The care plans are not detailed enough to enable staff to meet the needs of the service users. Where a care need has been highlighted there must be sufficient information and training in place to recognise needs and to meet them. Stanborough Lodge DS0000019585.V342015.R04.S.doc Version 5.2 Page 6 The Registered Manager must be more pro-active in ensuring assessments are very clear and that the home does not collude in the family’s wishes for service users without considering the needs of the actual service user. An example of this was one service users family did not want the person told that the placement was permanent. The Registered Manager must put the best interests of the service user to the fore at all times and not get involved with collusive practices. There is little useful occupation for the service users. The home has organised activities two afternoons per week the remainder of the week they are left to their own devices and other than the television and some books there is no other stimulation. 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. Stanborough Lodge DS0000019585.V342015.R04.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 Stanborough Lodge DS0000019585.V342015.R04.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 does not apply in this home. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Pre-admission assessments do not contain sufficient information to meet the needs of the service users. EVIDENCE: While assessments are carried out, two of the four care plans inspected showed that there was not enough information on the needs of the service users to understand and meet their needs. One service user has a problem with their vision that may cause them to have hallucinations; the person doing the admission did not explore this. There was not information to help staff recognise when the service user is having hallucinations or how to care for them when it is happening. Another service user’s family did not want the service user to know that the placement was to be considered permanent (it Stanborough Lodge DS0000019585.V342015.R04.S.doc Version 5.2 Page 9 was not a respite placement) this was recorded on her family history. There was no evidence on file that this had been discussed with the service user in question and their wishes and feelings taken into account. The inspector spoke with the service user in question and found them to be confused and unsure of what was happening to them. Stanborough Lodge DS0000019585.V342015.R04.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans do not contain enough information for staff to meet the social and health needs of all the service users. The administration of medication was not recorded appropriately and may leave people at risk. Service users can be assured that they will be treated with respect and dignity. EVIDENCE: There was not enough information on the service users care plans at the point of admission, to ensure their needs are met. The Social Service referral for one service user recently admitted stated that they suffered from an eye problem that may cause hallucinations. No further information was given, there was no guidance for staff on how to recognise this or how to offer support to the service user. Issues relating to this service user were raised by the inspector on the first visit and by the second visit to the manager had found out more Stanborough Lodge DS0000019585.V342015.R04.S.doc Version 5.2 Page 11 information from the person’s family. The manager accepted this service user into the home without knowing what their needs might be and therefore not knowing if the staff could meet their needs. Another service user the inspector spoke with was unclear why they were in the home as they have their own home. Their care plan showed that their family requested that the person should not be told the placement was to be permanent; the family requested this, as they do not want to upset the resident. The records showed that the home had colluded in the deception of service users. Two other care plans were clear and gave good detail on the needs of the service users. Medication records were being recorded prior to the medication actually being given to the service users rather than after the service user had taken it. When omissions in recording had been noted they were traced back to the person who had made the omission and then the initials were filled in rather than a note being made on the back of the medication record sheet. The inspector observed service users being treated with respect and dignity at all times. Stanborough Lodge DS0000019585.V342015.R04.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The daily life of the home is task led and residents cannot be assured that care is person centred. Visitors are welcomed to the home at all reasonable times. Regular meals are provided that is of a good standard however; residents cannot freely access snacks as they may wish. EVIDENCE: The interaction observed between staff and service users was good but the daily life of the home is task led. The inspector observed a staff member tell a service user that she could not assist them to the toilet because she was wearing a food hygiene apron, the service user – who was clearly in distress – had to wait until another staff member was available to take them. Stanborough Lodge DS0000019585.V342015.R04.S.doc Version 5.2 Page 13 The home was devoid of useful occupation during most of the day. There are organised activities two days a week the rest of the time service users are able to watch the television or read. On the morning of the first day of the inspection service users in the sitting room where the television was on were seen to have withdrawn into themselves and not communicate. Staff were observed to pass service users without speaking to them or have any form of eye contact. This objectifies the service users and leaves them unable to make requests of staff. The food at lunchtime was of good appearance and flavour. Snacks were not freely available to service users. When this was pointed out to the registered manager she stated that staff would make a snack if a service user was hungry. Stanborough Lodge DS0000019585.V342015.R04.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives can be assured that their complaints would be listened and responded to. Residents are protected from abuse by the policies in place the home. EVIDENCE: Complaints are responded to inline with the home’s policies and procedures. All staff spoken with were aware of how to recognise abuse and what to do about it. Stanborough Lodge DS0000019585.V342015.R04.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally residents live in a homely environment that meets their needs. However, some routine maintenance is required to ensure that the homely atmosphere is maintained. EVIDENCE: The service user’s rooms were decorated and furnished to reflect the taste of the service users. The first floor rooms and corridors were in good decorative order. The carpet on the corridor downstairs was stained and there were areas of the downstairs that had an odour that could be associated with incontinence. Plans are in place to replace this carpet. The downstairs bathroom was shabby and had areas that needed to be repaired and re-decorated. However, by the second visit this had started. Stanborough Lodge DS0000019585.V342015.R04.S.doc Version 5.2 Page 16 The refurbishment of the communal areas had been completed and these areas were clean, bright and fresh. Service users have access to the garden, which was pleasant and well tended. Stanborough Lodge DS0000019585.V342015.R04.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff were very caring but need more training to be enabled to fully meet residents needs. A robust recruitment policy is in place ensuring staff are recruited appropriately to protect vulnerable people. EVIDENCE: The home has a core of well-established caring staff. They were observed to be kind and caring to the service users. Mandatory training was completed for most of the staff. The home has residents who show signs of confusion and staff are not trained in the care of people who have dementia. Staff spoken with did not show they have the necessary skills to deliver good quality care to the service users with memory loss as the care provided is task led rather person centred. Three staff files were inspected and were found to contain all the necessary paperwork in relation to the staff member’s identity and security checks had been carried out including a Criminal Records Bureau check and two references. Stanborough Lodge DS0000019585.V342015.R04.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service is not always managed in the best interests of the residents. Residents can be assured that their health and safety will be protected. EVIDENCE: 2 requirements made at the previous inspection remain outstanding. Pre-admission assessments did not contain all the information necessary to ensure a solid judgement is made on whether the home can meet the needs of the service users. Stanborough Lodge DS0000019585.V342015.R04.S.doc Version 5.2 Page 19 Also see comments made in the Choice of Home and Health and Personal care sections. There was no evidence that staff can meet the needs and aspirations of all the service uses. All appropriate checks have been carried out to ensure the health and safety of the service users. The home has a fire plan to be followed in the event of the outbreak of a fire. Stanborough Lodge DS0000019585.V342015.R04.S.doc Version 5.2 Page 20 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X x 3 Stanborough Lodge DS0000019585.V342015.R04.S.doc Version 5.2 Page 21 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 OP9 Regulation 13 (2) Requirement Timescale for action 26/07/07 2 3. OP15 OP10 OP14 16(2)(i) 12 (4) (a) 4. OP26 16 (2) (k) The registered person must ensure that the administration of medicines is appropriately recorded. The Registered Manager must 31/07/07 ensure that snacks are freely available to all service users. The Registered Manager must 26/07/07 ensure that staff interact with service users in a manner that upholds the service user’s dignity at all times and that they don’t put tasks above the welfare of the service users. The Registered Manager must 31/07/07 ensure that the home is free from odours that could be associated with incontinence. This requirement was made at the last inspection and remains outstanding. The Registered Manger must ensure that the staff on duty have the experience and training to meet the needs of the service users. This must be evident in the outcomes for the service users. DS0000019585.V342015.R04.S.doc 5. OP27 OP28 18 (1) (c) (i) 31/08/07 Stanborough Lodge Version 5.2 Page 22 6. OP31 12 (1) & (4) & 24 7. OP7 15(1)(2) This requirement was made at the last inspection and remains outstanding. The Registered Provider and the Registered Manager must ensure the home is managed in a way that recognises the needs of the service users and that the home is run in the best interests of the service users. The Registered Manager must ensure that the care plans contain sufficient details to enable staff to recognise and meet the social care and health care needs of the service users. 30/09/07 30/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Stanborough Lodge DS0000019585.V342015.R04.S.doc Version 5.2 Page 23 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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