CARE HOMES FOR OLDER PEOPLE
The Lodge 5 Broad Street Hemel Hempstead Hertfordshire HP2 5BW Lead Inspector
Mrs Alison Butler Key Unannounced Inspection 28th February 2007 10:00 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 The Lodge DS0000019578.V331335.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. The Lodge DS0000019578.V331335.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Lodge Address 5 Broad Street Hemel Hempstead Hertfordshire HP2 5BW 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 244722 01442 240401 B & M Investments Limited (Trading as B & M Care) Manager post vacant Care Home 54 Category(ies) of Dementia - over 65 years of age (54), Old age, registration, with number not falling within any other category (54) of places The Lodge DS0000019578.V331335.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 15th September 2006 Brief Description of the Service: The Lodge is a residential care home for older people who may have a diagnosis of dementia. The home is located in Hemel Hempstead and can accommodate up to 54 service users. There are two lounges on the ground floor and a large dining room. Bluebells is a unit for people who have dementia, where there is a large lounge with separate dining area. 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. There is a dedicated hairdressing room on the first floor. The enclosed garden consists of small paved courtyards, which are attractively decorated with window boxes, flowerpots and garden ornaments. The Lodge DS0000019578.V331335.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Two inspectors conducted this inspection, the majority of the time was spent observing and talking with residents and staff. Care records were also examined. This report has been written following three visits to the home and from information that has been know to the Commission For Social Care Inspection. Copies of visits to the home can be obtained on request. What the service does well: What has improved since the last inspection?
Residents whose needs they were unable to meet appropriately have been reassessed and moved on to a more suitable setting that is best able to meet their needs. Staff have received training in meeting the needs of people who have a dementia, how to ensure elderly people are protected from abuse, new management has been appointed although not yet registered, decoration of the lounge on Bluebell has taken place which gives it a very homely and welcoming atmosphere. There have been major works taken place; en-suite facilities in the bedrooms and the upper floor has been completed. A key worker system has been introduced, which will provide a more consistent approach to the residents. Activities for residents are being looked into and a theatre outing has been arranged, further exploration is taken place into seeking the views of the residents. The Lodge DS0000019578.V331335.R01.S.doc Version 5.2 Page 6 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. The Lodge DS0000019578.V331335.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 The Lodge DS0000019578.V331335.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Policies and procedures are in place to ensure resident’s needs are assessed prior to admission. EVIDENCE: There are polices and procedures in place to ensure that residents are fully assessed prior to admission. It was not possible to check if this has been done as there has been no new admissions since the last inspection. This will be tested at the next inspection and there the outcome area remains adequate. The Lodge DS0000019578.V331335.R01.S.doc Version 5.2 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. 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 are being reviewed and are not fully operational making it difficult to see if all their needs are being fully met Medication procedures protect the residents. EVIDENCE: The new care plans for some residents have been introduced but unfortunately have not yet made their way in to full use and the old care plans have not been updated. When we spoke to staff they said new plans are being completed. They were given an extension on the timescale at the previous inspection (27/11/06) to allow them time to meet this standard and introduce the new format. (Again this has not been fully met). This has made it very difficult to track individual care as the information is not always as up to date and is in two places. The completed care plans must be brought into use once completed and the old ones archived. This would allow staff with complete details of how to manage an individual’s care. It is understandable that some residents will be using the old format and some the new until all the
The Lodge DS0000019578.V331335.R01.S.doc Version 5.2 Page 10 information has been transferred to a new format and staff should be made aware that it could be difficult at times. Residents who display challenging behaviour still have no plan in place to enable staff to manage them effectively and protect those vulnerable residents; an enforcement notice has been served. See allow staffing section. Examination of the medication procedures and processes showed they were in good order and no errors were found. Staff stated they had had recent training in the medication procedure. The Lodge DS0000019578.V331335.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are offered a range of activities. There are no restrictions on visitors to the home. EVIDENCE: On the day of the inspection it was noted that a member of staff was sitting with individual residents both male and female and carrying out a hand massage and/or manicure. They looked as if they were enjoying the experience. There was chatter going on amongst other residents in one of the lounges. The residents who have less communication in another were not having the same experience as an agency member of staff , who had to be asked to make a resident more comfortable, appeared oblivious to the needs of the resident. A further member of staff was sat in the lounge and was completing paperwork. These residents could have benefited from some interaction for example a hand massage, looking through a newspaper etc. The TV was on but nobody appeared to be watching it. An activity co-ordinator has been recently recruited and has got lots of ideas. She has carried out some investigation and is trying to arrange outings for the
The Lodge DS0000019578.V331335.R01.S.doc Version 5.2 Page 12 residents. A theatre trip has been booked for 6-8 residents. Residents spoken to were extremely happy with the activities she has been arranging and they have been asked what they would like to do. Staff and residents confirmed that relatives were able to visit the home at any reasonable time. There is an activity plan in place although it is not in a user-friendly format for all residents to access and read, the activity co-ordinator needs to look at ways to advertise the activities for those wishing to attend. Residents were complimentary about the food they were given and are offered a choice. One resident was seen to be choking at lunchtime although staff dealt with this well, no risk assessment was in place and staff stated it is a regular occurrence. See section on management and administration. The Lodge DS0000019578.V331335.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 &18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents are safeguarded appropriately and formal in house procedures are followed. EVIDENCE: There is a new manager in place who has yet to apply for registration. Discussions with staff showed they were clear of the action to follow in the event of an allegation of abuse becoming known to them. The company have taken appropriate action to protect the resident’s rights, and ensure their safety, the outcome of the action is not yet known. They failed to notify the Commission For Social Care Inspection under regulation 37 and there has been previous requirements made for failing to inform the Commission of anything that adversely affects the well being of a resident. The Commission had received information from a relative who was concerned about a member of their family that lived at The Lodge. This was passed to the provider to take the required action and they have since met with the individuals to resolve the issues raised. The Lodge DS0000019578.V331335.R01.S.doc Version 5.2 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. 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. Residents live in a clean environment although not all areas were safe. EVIDENCE: A tour of the home was conducted the lounge in Bluebell has been redecorated and looks clean and fresh, although it has been let down by the uniformed seating as this do not all meet the residents needs (due to varying degrees of ability, stature and mobility). A review of the seating should take place to enable it to look like home for the residents; (maybe they would like to bring in their own seating from home). A larger screen TV has been purchased to enable more residents to watch it if they choose to. The flooring in Bluebell is uneven and could cause a trip hazard this must be replaced by the end of April 07. The dining room is also in need of redecoration and new flooring would improve the overall feel of the unit.
The Lodge DS0000019578.V331335.R01.S.doc Version 5.2 Page 15 A toilet needs some attention as there is plaster missing from the wall under the grab rail, this could be a health issue. The flooring that was causing the odours at the previous inspection has been replaced. The upper floor bedrooms have been revamped to include en-suite toilets, they are now working on the middle floor, when the work is complete it will mean a reduction in the number of bedrooms available and a variation will need to be applied for. The Lodge DS0000019578.V331335.R01.S.doc Version 5.2 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 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. Sufficient care staff are available to meet the personal needs of the residents. Some training needs to be addressed to ensure that staff have the skills to care for the residents at all times. EVIDENCE: Staff were seen to be caring in their approach to meeting the residents needs. Some staff have commenced training meeting the needs of those who have dementia and others are waiting to start. It is hoped that all staff will be completing this training. The company have introduced a key worker system and are getting everyone to go back to basics in completing the induction programme to ensure staff are clear about their roles and responsibilities in meeting the needs of the elderly. Examination of the staff records showed that all the required information and checks had been carried out prior to commencing employment at The Lodge. The acting manager should ensure that agency staff are observed during their shift to ensure that the needs of the residents are managed and met appropriately. For example comfort whilst sitting etc. interaction with touch or chatting. Formal supervision must happen to ensure that staff receive appropriate support and training to met the needs of the residents. This should be carried out at least 6 times a year.
The Lodge DS0000019578.V331335.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is managed reasonably well although some areas could be improved especially around care planning and training where identified. Some care practise were not promoting the health and safety of the residents, staff or visitors. EVIDENCE: Since the last inspection the manager has resigned and the acting manager had been acting up, the company have subsequently appointed her as manager. She has yet to apply to become the registered manager, this must be done to comply with regulations. The overall atmosphere in the home was welcoming and staff say that there has been a lot change which have been for the good of the residents. They have currently stopped all admission to the home to ensure that good internal
The Lodge DS0000019578.V331335.R01.S.doc Version 5.2 Page 18 procedures are in place. They have carried out re-assessments on residents whose needs they were finding difficult to manage and a number of these have been move to more appropriate places which are better able to meet their needs. This has been managed by the area manager whose has been supporting the staff and the manager of the home. The area manger said that recent questionnaires that had been sent to families showed a positive overall response; a report is yet to be complied with the information and any areas for improvement. Previous inspections have shown that the financial arrangements are adequate to meet the needs of the residents and ensure they are safeguarded. A risk assessment must be completed for the resident who is at risk of choking whilst eating food and drinking fluids. A health and safety issue was noted with the uneven floor in Bluebell see environment section for further information. A notice has been served for a plan to manage residents behaviour to be put in place to protect the safety of the residents and the staff and ensure that they are clear how to manage the individuals. The Lodge DS0000019578.V331335.R01.S.doc Version 5.2 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. 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 1 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 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 3 X 3 2 X 2 The Lodge DS0000019578.V331335.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 OP7 OP8 Regulation 15(1) Requirement Residents must each have in place a complete and up to date care plan to ensure that their needs are fully met. A clear plan must be in place for the resident who displays challenging behaviour to ensure that staff are able to deal with them in an appropriate and safe manner. This has requirement has
not been met at the last 4 visits A notice has been served Timescale for action 30/04/07 2. OP7 15(1) 13/04/07 3 4 OP19 OP30 13 (4)(b) & (c) 18(1) 5 6 7 OP31 OP36 OP38 8 18(2) 13(4)(b)& (c) The flooring in Bluebell must be repaired and replaced to make an acceptable standard. All staff must receive training to ensure they are able to demonstrate they can meet the needs of the residents at all times including agency staff The provider must put forward a person to become the registered manger All staff must be supervised a minimum of 6 times a year A Risk Assessment must be in place for the resident who is prone to choking when partaking in food and drink 30/04/07 30/04/07 30/04/07 30/04/07 28/02/07 The Lodge DS0000019578.V331335.R01.S.doc Version 5.2 Page 21 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 Further discussions should take place to identify with residents what activities/occupation they wish tio take place. Activities should be advertise in a user-friendly way to ensure all residents are able to access them if they so choose Seating in the lounges should be comfortable, chosen in consultation and meet the residents needs 2. OP19 The Lodge DS0000019578.V331335.R01.S.doc Version 5.2 Page 22 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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