CARE HOMES FOR OLDER PEOPLE
The Lodge 5 Broad Street Hemel Hempstead Hertfordshire HP2 5BW Lead Inspector
Mrs Alison Butler Unannounced Inspection 8th August 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.V346504.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.V346504.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 thelodge@bmcarehomes.co.uk 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.V346504.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 28th February 2007 Brief Description of the Service: The Lodge is a residential care home for older people who may have a diagnosis of dementia. It 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. For information regarding the service, the fees and terms and conditions and a copy of the last CSCI inspection report you should contact the manager of the home. The Lodge DS0000019578.V346504.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted with the manager and area manager, staff and those who live at the home. Time was spent talking with staff, residents, and management of the home. Care records were also examined. This report has been written following a visit to the service and information already known to the Commission, where standards remain the same this information has been carried forward into this report. Whilst it is recognised that a lot of work has been carried out to improve the standard of care, the providers also realise they have some way to go to ensure that staff all have the skills to be fully competent to carry out their role. What the service does well: What has improved since the last inspection?
A number of areas have improved since the last inspection; all new care plans are in place. A plan is also in place for the individual who displays challenging behaviour; this provides some detail on the action required by staff to manage this. The flooring on bluebell unit has been replaced which improves the appearance of this area. A training programme is underway (although not yet complete) to ensure that staff have the skills and competency to meet the needs of individuals.
The Lodge DS0000019578.V346504.R01.S.doc Version 5.2 Page 6 The manager has started all formal supervision and a matrix is to be put in place, this ensures the staff receive the support they require to fulfil their role. A deputy manager has been appointed which will provide much needed support to the manager and will be able to take on additional responsibilities to benefit the home and the residents. 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.V346504.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.V346504.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Standard 6 is not applicable to The Lodge. 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 that people who use the service have their needs assessed prior to admission. EVIDENCE: There are admission policies and procedures in place to ensure that prospective residents needs are assessed. Two new admission folders were examined and were found to have assessments carried out prior to admission. This now needs to be sustained and ensure that a full assessment is carried out prior to or on admission at all times. The Lodge DS0000019578.V346504.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. New care plans are in place to show how they are to meet individuals. Additional medication procedures have been put in place to safeguard residents from medication administration errors. EVIDENCE: The new care plan formats are now in place and are being used. Staff feel that these are less bulky and are user friendly. From those examined more detail would aid staff in supporting residents better e.g. where it states ‘displays inappropriate behaviour’ this should be detailed by the what the behaviour is and how staff should respond. Where information is placed in the care plan the author should ensure that it is signed and dated. One person who has recently been admitted the information stated that they go to church every week. However, there is no information on how this need is met, who supports them in this or how they get there. The Lodge DS0000019578.V346504.R01.S.doc Version 5.2 Page 10 A form is sent to families asking them to provide a past history to enable staff to have a better understanding of the resident, especially those who have dementia. Daily recording is in two places as this has yet to be included in the all individual’s files. The manager said this would be actioned as soon as possible to ensure consistency. There has been a serious medication error where two individuals were given the incorrect medication for three days before a vigilant member of staff identified the error. The area manager carried out an investigation and informed the Commission of the outcome. Staff have been retrained, additional checks have been put in place and a monthly audit has been introduced, this should eliminated this from happening again. Medication procedures are in place but it appears the staff members concerned did not follow these on this occasion. Observations carried out during the inspection showed that staff were treating the individuals with care and were encouraging them to be as independent as possible. The Lodge DS0000019578.V346504.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 adequate. 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: A daily activity co-ordinator is in post and has spent time getting to know the residents. The providers are looking to create an activities room in the small dining room as they have received a small grant to provide some craft materials etc. More outings are to be arranged to ensure all those who wish to go get a chance to experience this. All staff are getting involved in activities and ensuring that time is spent talking with residents and supporting them when activities are taking place. People with less communication do not experience the same level of support - this appears to be down to training of staff (see staffing section for further information). The TV in the lounge on bluebell unit is rather small for such a large room, residents would benefit from a larger screen that could be mounted so it is higher and much easier to see. The Lodge DS0000019578.V346504.R01.S.doc Version 5.2 Page 12 The activities programme has yet to be put into user-friendly format although the inspector was told this is in hand. Those spoken to were happy with the activities on offer and state they are asked if they would like to take part. Risk assessments have been put in place for people who may show signs of choking when eating. Residents were complimentary about the food on offer although some did say it not like home but are aware it is hard to cater for such a large number. The menu for the day was eventually written on the board, but staff must remember to change this daily and not rely on the cook, as on arrival for the inspection it was two days out of date. The Lodge DS0000019578.V346504.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. There are policies and procedures in place to safeguard those who live at the home. EVIDENCE: The management have met with one concerned family and have addressed the issue raised and they are happy with the outcome. The manager now appears to have been notifying the Commission appropriately of issues that affect the well-being of residents and a discussion took place of the issues that should be notified to the Commission. In the past the home have failed to notify the Commission appropriately. Staff are clear on the procedure to follow in the event of an allegation being made to them or any that they may see. Training has been completed and is part of the induction for all new staff. The Lodge DS0000019578.V346504.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. Those who live at the home live in a reasonably well-maintained environment although not all areas were safe. EVIDENCE: The providers are looking to move residents who have dementia to the ground floor where they will have free access to a small patio area. The builders are in creating a conservatory, and creating a lounge/dining area. There is access to a small kitchen that can be used for tea, coffee and small snacks can be prepared. Unfortunately this area had not been risk assessed as the doors to both the main room and kitchen, which contained building materials and were accessible. Speaking with the staff they are going to look at the layout of the seating areas and try to put the chairs in smaller groups rather than have them round the edge of the room, this would allow the residents to speak in small groups if
The Lodge DS0000019578.V346504.R01.S.doc Version 5.2 Page 15 they wish. The company still need to look at the chairs and ensure that they are less uniformed and meet the needs of those who live at the home. A small training room has been created on the second floor, which will contain training materials and small groups of staff will be able to have training covered on site. Two rooms are waiting to be furnished, two to be refurbished and four waiting to be redecorated. The home was clean and no odours were detected during the tour. Recently there was a small outbreak of sickness and this appeared to have been managed very well and all universal precautions were followed and all necessary processes were put in place with the support of the infection control nurses. Staff lockers have been purchased so they are now responsible for locking all their belongings away whilst on shift. The Lodge DS0000019578.V346504.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. Adequate staff are available to meet the personal needs of those who live at the home. Training has commenced to enable the staff to be able to meet the needs at all times. EVIDENCE: Staffing numbers appear to be adequate to meet the needs of those who live at the home. A number of interviews have been conducted for night support workers and day care workers and all post have been offered subject to the relevant checks being carried out. They have a vacancy for a weekend kitchen assistant, an additional care worker covers this at the moment when required. Staff spoken to say that they have commenced a distance-learning course on supporting people who have dementia, staff appear to be enjoying this course and say that they are enjoying putting their learning into practise. Training that has taken place recently includes, care planning, moving and handling, infection control, safeguarding, COSSH, and food safety. NVQ’s are being completed in care, food hygiene, housekeeping and catering. They are also exploring distance learning in Heath & safety and medication. The company have employed a training manager who is looking at the shortfalls in the training and ensuring all the staff have up to date skills. The manager has put
The Lodge DS0000019578.V346504.R01.S.doc Version 5.2 Page 17 a training matrix in place although this is not yet up to date this will provide an overview of the skills and identify any training gaps in the staff team. A deputy has been employed for the home who will be able to assist the manager in ensuring that the home is run in the best interest of those who live there. Formal supervision has commenced and a matrix is in place. Good interaction was observed during the inspection and staff were seen to be discreet when managing toileting needs of those who require support. The Lodge DS0000019578.V346504.R01.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, 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 reasonable well managed although there are still some areas for improvement. Heath and safety is not always promoted at all times. EVIDENCE: The manager has yet to be registered with the Commission For Social Care Inspection, she states that all the required paperwork has been submitted and she is waiting an interview to complete the process. The staff have made a number of improvements for the benefit of those who use the service although it is recognised there is still some way to go to ensure a good quality of care and support is received by all. The manager now needs to step back and prioritise what needs to be done, as there was so much to be carried out no task is fully completed before she commences another. This
The Lodge DS0000019578.V346504.R01.S.doc Version 5.2 Page 19 should be helped by the employment of a deputy who will be able to take on responsibility once their induction has concluded. A risk assessment is not in place for the building works that is being carried out on the ground floor to protect those residents who have rooms in the area. Regulation 26 reports (available in the home) do not meet the regulation, as they do not show that interviews have taken place with those who live at the home, staff and visitors to form an opinion of the standard of care provided in the home. The reports appear to mainly cover the environment. Although the Commission do not routinely ask that these be forwarded to them, the reports must be available in the home. The Statutory Requirement Notice has been actioned and plans are put in place although these need to be more detailed at times. The company have introduced new policies and procedures although some of these will require additional information to ensure that they relate to the individual home. The manager stated this will be happening over the coming months as managers will be getting together to discuss them in more detail. The Lodge DS0000019578.V346504.R01.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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 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 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 The Lodge DS0000019578.V346504.R01.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 OP7 OP38 Regulation 13 (4)(a)&(c) Requirement A risk assessment must be in place for the building work that is being carried out on the ground floor and that locks are placed on the doors to ensure that residents are protected at all times. Timescale for action 28/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP19 Good Practice Recommendations Seating in the lounges should be comfortable, chosen in consultation with the residents and meet their needs. The Lodge DS0000019578.V346504.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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