Inspection on 14/04/05 for The Lodge

This inspection was carried out on 14th April 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Lodge 08/08/07

The Lodge 28/02/07

The Lodge 05/04/06

The Lodge 03/11/05

The Lodge 01/12/04

The Lodge 16/06/04

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 The Lodge 5 Broad Street Hemel Hempstead Hertfordshire HP2 5BW Lead Inspector Alison Jessop Unannounced 14 April 2005 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. The Lodge I52_s19578_The Lodge_v221026_140405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service The Lodge Address 5 Broad Street, Hemel Hempstead, Hertfordshire, HP2 5BW 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) 01442 244722 01442 240401 B & M Investments Limited (Trading as B & M Care) Susan Wilson CRH Care Home 54 Category(ies) of DE(E) - 54, OP - 54 registration, with number of places The Lodge I52_s19578_The Lodge_v221026_140405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 01/12/04 Brief Description of the Service: The Lodge is a residential care home for older people who may have a diagnoses of dementia. The home is located in Hemel Hempstead. The home can currently accomodate 54 service users. There are several lounges on the ground floor and a large dining room. The building has been extended and the first and second floors are on two levels, some of the bedrooms are served by a chair lift. The enclosed gardens consist of small paved courtyards and are attractively decorated with window boxes, flower pots and garden ornaments. The Lodge I52_s19578_The Lodge_v221026_140405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was the first in the current inspection year and took place over half a day. A lot of time was spent talking to staff and observing care practice. Most of the service users were unable to give feedback due to their dementia. Care practice observed was good, particularly with those who have dementia. Visiting the home that day was a mobile shoe shop and an exercise class facilitator both offering a stimulating environment. What the service does well: What has improved since the last inspection? Information in care plans has increased and risk assessments now give guidance on how to deal with risks identified. The home has employed a second assistant manager which appears to have been a positive addition to the management team. A policy on managing challenging behaviour has been introduced and specific guidance is contained on service users plan of care. The Lodge I52_s19578_The Lodge_v221026_140405 Stage 4.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Lodge I52_s19578_The Lodge_v221026_140405 Stage 4.doc Version 1.20 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 The Lodge I52_s19578_The Lodge_v221026_140405 Stage 4.doc Version 1.20 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) 1,2,3, 4 & 5 The homes assessment and admission procedures are robust ensuring that service users needs can be met on admission to the home. EVIDENCE: Prospective service users are given information about the home including a copy of the aims and objectives, statement of purpose, a good care guide to choosing a home and a service user guide. Each service user signs a written contract on admission to the home. Where service users are unable to understand, an appropriate representative can sign on their behalf. The home has a comprehensive pre-admission assessment procedure and all prospective service users have an opportunity to visit the home. In circumstances where the prospective service user is unable to visit personally, a representative is invited on their behalf. The manager and/or assistant manager visits the prospective service user to carry out a needs assessment prior to any decisions to admission being made. Information is also gathered from the original assessment undertaken by Adult Care Services. A summary is made of the applicants care needs to ensure that needs can be met. The Lodge I52_s19578_The Lodge_v221026_140405 Stage 4.doc Version 1.20 Page 9 Service users are admitted on a six-week trial period and a review is carried out to determine permanent residency. The home does not provide intermediate care. The Lodge I52_s19578_The Lodge_v221026_140405 Stage 4.doc Version 1.20 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 Care practice observed was good, staff appeared to offer a sensitive and individualised approach, particularly to those service users who have dementia. This created a relaxed and secure environment and minimised distress. EVIDENCE: Each service user has a comprehensive Care Plan and those observed had been reviewed regularly. Since the last inspection report, work had been done on improving risk assessments, which included plans on how to respond to inappropriate, violent or aggressive behaviour in a sensitive and appropriate way. Services users health is promoted and records are maintained. There is a keyworker system in place and new procedures have been implemented to enhance care practice. The assistant manager stated that staff have been supplied with nail cleaning equipment and are asked to ensure that finger nails are clean on a daily basis thus minimising the risk of infection. Keyworkers now regularly check service users clothing to ensure they are well maintained. A jug of juice is available in all the lounges and drinks are served throughout the day, preventing dehydration and infection. The Lodge I52_s19578_The Lodge_v221026_140405 Stage 4.doc Version 1.20 Page 11 A staff member was observed assisting a service user with his lunch, the service user was frail and sleepy, however the carer pursued her task in a delicate and patient manner whilst ensuring that he had sufficient food and fluid intake. Medication procedures were mainly satisfactory however some errors were found. One gap on a MAR (Medication Administration Record) was found. The temperature in the medication room has not been monitored and recorded. A requirement has been made for the safe recording, handling, administration and storage of medication in the home. There is a communication diary in the medication rooms which appears to be an effective way to ensure that all staff are aware of changes to medication. One service user has complex needs around alcohol addiction and the staff are having difficulty managing the situation as the service user has relapsed and has started to drink quite heavily. The service users primary care needs are now in relation to his alcohol addiction and are therefore the home is offering care services that are outside their category. The assistant manager stated that a meeting has been arranged with Adult Care Services where this will be reviewed. The Lodge I52_s19578_The Lodge_v221026_140405 Stage 4.doc Version 1.20 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) 15 The home offers a range of activities that are suitable for the service users needs. The main lounge was vibrant and stimulating, whilst the dementia lounge was tranquil offering a relaxed atmosphere which minimised distress. EVIDENCE: Meals served during lunch looked appetising and service users confirmed that they enjoy the food offered. The chef ensures that service users receive a healthy, balanced diet and alternatives are available to meet individual preferences. Meals are provided to service users who are Diabetic and liquidised food is served in individual portions. Hot lunches are available at lunchtime and on three evenings a week. On the other four evenings a choice of sandwichs and/or hot home made soup is available. The atmosphere in the dining room was relaxed and the chef chatted to the service users as they arrived for lunch. A recommendation was made for the plates to be cleared inside the kitchen rather than in a waste bucket on a trolley in view of service users. Service users with dementia ate their meals in a dining area in the Bluebell Lounge. The atmosphere was relaxed and care practice observed was good. The Lodge I52_s19578_The Lodge_v221026_140405 Stage 4.doc Version 1.20 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 Although a complaints procedure is in operation, complaints received in relation to allegations of abuse issues must be addressed more rigorously in accordance with Hertfordshire Adult Protection procedures and guidelines. This will ensure that service users are safe and are protected from abuse. EVIDENCE: Three complaints had been received by the home since the last inspection. One of these remains unresolved. One complaint that was considered to be resolved should have been dealt with following the Protection of Vulnerable Adults Procedure. The registered manager must ensure that any complaints received are fully investigated ensuring that service users are protected from abuse. Staff confirmed that they are aware of the Protection of Vulnerable Adults Procedure, this included kitchen and laundry staff. In house training on Adult Abuse is organised annually. Awareness of the whistle blowing procedure should be raised within the home as some staff spoken to did not appear of this. The Lodge I52_s19578_The Lodge_v221026_140405 Stage 4.doc Version 1.20 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) 19,21, 24,26 The home has been extended and is arranged around a square. Service users with dementia may walk around. This appeared to satisfy the need to exepand their energy, however there are areas without staffs presence which could jeoporidse safety as service users cannot be monitored easily. EVIDENCE: The home is attractively decorated and was found to be clean and tidy in all areas. The décor in the lounges are themed using wild flowers such as poppies and bluebells. Bluebell lounge is used by the service users who have dementia. This tranquil colour offers a relaxing environment and therapeutic lights decorate the ceiling. Service users have sufficient access to lavatories, bathing and washing facilities. Bathrooms provide appropriate equipment and are clean and hygienic. One service user was seated in an electrical recliner chair. A requirement has been made for a risk assessment to be carried out, and all risks identified must be minimised. The Lodge I52_s19578_The Lodge_v221026_140405 Stage 4.doc Version 1.20 Page 15 On the hallway wall next to the small office there is a large display of training certificates which state ‘Care of the deceased’. A recommendation has been made for these to be placed more appropriately out of sight of service users as this could cause unecessary distress. A requirement was made in the last inspection report for bedroom keys to be offered to service users. New locks have been ordered and the assistant manager stated that they will be available soon. The Lodge I52_s19578_The Lodge_v221026_140405 Stage 4.doc Version 1.20 Page 16 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, 28, 30 Mandatory training (i.e required by law) is offered to staff periodically updating their knowledge, skills and competence. Staffing levels appear to be inadequate to match the assessed needs of service users whilst also taking into account the layout and size of the building. This could effect the quality of care being provided may jeopodise safety of service users. EVIDENCE: Whilst staff did attend to basic care needs, a number of examples were found to suggest that the delivery in care has been delayed. The home currently has several vacancies and a variation is imminemt due to further bedrooms being developed. Therefore, the commission recommends a review of staffing levels to ensure that the number of staff working in the home are appropriate to the assessed needs. This should also take into account future increasing dependency levels expected nationally. Staff confirmed that they have attended mandatory training and several staff including the manager are undertaking NVQ training. A district nurse visits the home to provide training on infection control. Kitchen staff are trained in food hygiene and assessed by Oaklands College. The home has employed a handyman who undertakes all minor and non-skilled maintenance tasks. It is required that mandatory Health & Safety training is attended. The Lodge I52_s19578_The Lodge_v221026_140405 Stage 4.doc Version 1.20 Page 17 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) 37, 38 Records are maintained in relation to service user needs and are up to date and accurate ensuring that their assessed needs are met and information is safeguarded. Polices and procedures observed are comprehensive and available to staff ensuring availability if required. EVIDENCE: Care plans observed had improved since the last inspection report and all requirements had been met. Although all service users have individual risk assessments a requirement has been made for a further generic risk assessment and individual risk assessment to be completed in relation to the use of recliner chairs. The Lodge I52_s19578_The Lodge_v221026_140405 Stage 4.doc Version 1.20 Page 18 The chef reported that the most recent Environmental health Inspection was carried out approximately six months ago and that no requirements were made ‘we passed with flying colours’. The door to the kitchen and dining room had been propped open using a small table. A requirement has been made for a safe method to be adopted with recommendation form the Fire Safety Officer. The Lodge I52_s19578_The Lodge_v221026_140405 Stage 4.doc Version 1.20 Page 19 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. Where there is no score against a standard it has not been looked at during this inspection. 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 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 x 3 x x 3 x 3 STAFFING Standard No Score 27 2 28 3 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x x x x x 3 2 The Lodge I52_s19578_The Lodge_v221026_140405 Stage 4.doc Version 1.20 Page 20 YES 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. 2. 3. Standard 9.3 9.4 9.4 Regulation 13 (2) 13 (2) 13 (2) Requirement Medication must be given as prescribed and the reasons for any omissions must be recorded. All medication must be dated on opening including eye drops. Medication storage room temperatures must be monitored and recorded to ensure the safe storage of all medicines The home must review needs of service user with alcohol addiction and ensure that care offered is within catergory. Outcomes to be submitted to CSCI following review. All complaints received in relation to allegations of abuse must be dealt with following the Hertfordshire Adult Protection Procedure and any action taken recorded. Risk assessments must be undertaken on all recliner chairs and any risks identifed so far as possible eliminated. The homes handyman must receive appropriate training in Health and Safety. Doors must be held open with systems apporoved by the Fire Timescale for action With immediate effect With immediate effect With immediate effect By 31/5/05 4. 8.1 14 (i) (d) 5. 18 13 (6) With immediate effect 6. 38.6 13 (4) (c) 30/4/05 7. 8. 30.1 38.2 18 (1)(c) (i) 23 (4) (c) (1) By 27/5/05 By 27/5/05 Page 21 The Lodge I52_s19578_The Lodge_v221026_140405 Stage 4.doc Version 1.20 Authority. 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 15.1 19.1 27.3 Good Practice Recommendations After meals plates should be cleared inside the kitchen, away from the direct view of service users. Training certificates should be displayed in appropriate areas of the home. A review of staffing levels should be carried out, taking into account dependancy levels, the layout of the home and future capacity variations. The Lodge I52_s19578_The Lodge_v221026_140405 Stage 4.doc Version 1.20 Page 22 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City Herts 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 The Lodge I52_s19578_The Lodge_v221026_140405 Stage 4.doc Version 1.20 Page 23 - 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. 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