Inspection on 14/02/06 for Vesta Lodge

This inspection was carried out on 14th February 2006.

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

Vesta Lodge 26/04/07

Vesta Lodge 16/05/06

Vesta Lodge 17/02/05

Vesta Lodge 23/11/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Vesta Lodge Watling View St Albans Hertfordshire AL1 2PB Lead Inspector Mrs Judith Kent Unannounced Inspection 14th February 2006 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 Vesta Lodge DS0000019602.V282825.R01.S.doc Version 5.1 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. Vesta Lodge DS0000019602.V282825.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Vesta Lodge Address Watling View St Albans Hertfordshire AL1 2PB 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) 01727 799600 01727 799663 vesta@quantumcare.co.uk www.quantumcare.co.uk Quantum Care Limited Care Home 61 Category(ies) of Dementia - over 65 years of age (61), Old age, registration, with number not falling within any other category (61), of places Physical disability over 65 years of age (61) Vesta Lodge DS0000019602.V282825.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd August 2005 Brief Description of the Service: Vesta Lodge offers accommodation to sixty-one older people on two floors of a purpose-built home (completed in 1997) set in extensive gardens. The ground floor comprises two units – Willow, for people with dementia, and Laburnum for people with high physical dependency needs; the first floor has Freesia unit for dementia care and Mimosa for high dependency. Each unit consists of dining room, lounge, en-suite bedrooms, small preparation kitchen bathroom, shower room and sluice. At the front of the ground floor there is a large reception area, sun lounge, day care and activities room, offices, kitchen and laundry. There is a small parade of shops close to the home and St Albans town centre is easily accessible via public transport. Vesta Lodge DS0000019602.V282825.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted during the morning and afternoon by two inspectors. Each of the four units in the home was visited and service users, staff and visitors spoke with the inspectors. Overall service users and visitors expressed satisfaction with the care provided by the home, but there were some areas of concern raised by the inspectors. The majority of the key standards were assessed at the inspection on 2nd August 2005, and if there is no reference to them in this report, they were found to have been met and comments may be found in the report for that inspection. What the service does well: What has improved since the last inspection? What they could do better: As a result of several incidents involving one particular service user, a requirement was made that all care staff receive training in falls prevention – this has not yet taken place. There is little evidence of care plans being reviewed and amended to reflect current care needs. Although activities programmes are posted on each unit, comments heard were that ‘there is not much going on’ and that ‘activities have dropped off recently’. The absence of records of activities lends credence to this view. Vesta Lodge DS0000019602.V282825.R01.S.doc Version 5.1 Page 6 Care must be taken on the units looking after people with dementia to make sure that their nutritional needs are met and that their clothes and bed linen are cared for. The percentage of care staff who hold the minimum qualification in care is well below the required level. 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. Vesta Lodge DS0000019602.V282825.R01.S.doc Version 5.1 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 Vesta Lodge DS0000019602.V282825.R01.S.doc Version 5.1 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 the following standard(s): These standards were not assessed on this occasion EVIDENCE: Vesta Lodge DS0000019602.V282825.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 Care plans are in place but are not always reviewed or amended to include upto-date information; daily records are brief and repetitive and give little information about people’s day-to-day activities. As a result service users’ needs may not be met in the most appropriate way. There is some poor practice in the administration and recording of medication which could adversely affect service users’ health. EVIDENCE: Each service user has a written care plan which sets out their daily routines and health and care needs, and assessments are in place for identified risks. Both inspectors noted that monthly reviews are not always completed and that information from these and the six-monthly reviews is not always translated onto the care plan, e.g. one review said that a service user enjoyed playreading and poetry but there was no reference to this in the care plan itself. The daily records that care staff write were in many instances very brief and repetitive with little mention of social events or visitors, outings, activities people had taken part etc. However, health care records showed interventions by GPs or district nurses and recorded visits to or by opticians and dentists. Care plans include a food preference questionnaire with reference to religious and cultural needs. Vesta Lodge DS0000019602.V282825.R01.S.doc Version 5.1 Page 10 Medication records and administration were looked at on two units; records were generally in satisfactory order although when instructions on tablets state ‘1 or 2 to be taken as required’ the Medicines Administration Record (MAR) should clearly indicate how many were taken on each occasion. Medicines are audited regularly but the time of audits as well as the date should be recorded when the medication is taken more than once a day, so as to be able to reconcile tablets and records. One inspector watched while a careworker gave medication to a service user on one of the dementia units at lunchtime – several tablets were placed in a pot and poured into the service user’s hand, she then transferred them all to her mouth. She was unable to swallow them and ended up chewing them. This incident indicates a need to give care staff clear guidance on how to give medication. Vesta Lodge DS0000019602.V282825.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 15 Although there is a full programme of activities planned for each unit they do not always take place. There is a range of nutritious meals offered but people who need special diets are not always catered for and people are not always encouraged to eat their meals – both these practices could lead to a deterioration in their health. EVIDENCE: A programme of general activities is posted on each unit, along with a programme of activities designed for the service users on each unit. The home was busy on the morning of the inspection with a clothes sale in the sun lounge and hairdresser and chiropodist attending to service users. There was little evidence of the specified afternoon activity taking place on one of the dementia units, although a lively Valentine’s Day quiz took place on one of the high dependency units to which service users from the other high dependency unit were invited. The atmosphere was cheerful and communicative with service users greeting each other warmly. Comments from service users included that ‘there is not much going on’ and that ‘activities have dropped off recently’, although other people said that staff do activities with them and there are visiting entertainers and a person brings in a ‘sheepdog’. Film nights and ‘indoor pub nights’ are also organised. The activities record sheet included in some care plans showed that either few Vesta Lodge DS0000019602.V282825.R01.S.doc Version 5.1 Page 12 activities take place or alternatively that the records are not being completed by care staff as there were few entries on the majority of them. The unit activity book seen on one unit had not been written up since November 2004. There was general satisfaction with the catering in the home and the lunch served on the day of the inspection was nutritious, hot and plentiful. There is always a choice of main course, and the home is able to cater for special diets so it was disappointing to see that although neither of the two dishes was suitable for a service user with a lactose intolerance on one of the units caring for people with dementia, no alternative was offered. The care staff were aware of the intolerance and were prepared to serve her just vegetables until the inspector intervened. Staff should be aware that there is a danger of malnutrition if peoples’ special dietary requirements are not catered for. On the same unit several people left large quantities of food uneaten on their plates, which were taken away without any attempt to persuade them to eat a little more. Other poor practice was observed: care staff standing beside someone who needed help to eat, rather than sitting and helping discreetly; a fruit pie being presented without a plate; a service user not being given the appropriate cutlery to eat his pudding; a main meal served in a pudding bowl. All these instances indicate a need for some guidance and training particularly for staff who are working with people with dementia. There was a bottle of sauce in one unit ‘fridge with a use-by date of November 2004. Vesta Lodge DS0000019602.V282825.R01.S.doc Version 5.1 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 the following standard(s): These standards were not assessed on this occasion EVIDENCE: Vesta Lodge DS0000019602.V282825.R01.S.doc Version 5.1 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 the following standard(s): 19, 24, 26 The décor in the home is in need of refurbishment in some areas. There is some poor practice in the care and attention given to service users’ clothes and linen, indicating a lack of awareness of their dignity. EVIDENCE: Although the home was clean and odour-free, there were some areas which were looking distinctly shabby and in need of redecoration and refurbishment. One service user told an inspector that the home was ‘wonderfully clean’. Inspection of some rooms on one of the dementia units showed that several beds were poorly made and that in one room bed linen was not as clean as it should be. The wardrobe in the same room had clothes tumbled on the floor and caught in the door. The inspectors also noted that shower rooms are used for storage of wheelchairs and hoists and there were some items of outdoor clothing belonging to staff members hanging in one; however, the manager said that should any service users express a preference for a shower, the appropriate room would be cleared. Vesta Lodge DS0000019602.V282825.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 Service users’ welfare and best interests may be placed at risk as the home has an insufficient number of staff trained to the minimum required level. EVIDENCE: The requirement to have 50 of care staff trained to National Vocational Qualification (NVQ) Level 2 in Care is not met – currently the home has only 13 of staff trained to this level, although a further 20 are working towards gaining the qualification and others are waiting to start. The qualification gives careworkers a knowledge base from which to extend their skills and gain further qualifications. Comments on some aspects of care practice made elsewhere in this report reflect the need for an increase in the percentage of trained care staff on duty at any one time. Vesta Lodge DS0000019602.V282825.R01.S.doc Version 5.1 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35, 38 Both service users and other stakeholders in the home are invited to give their views and to influence how the home is run. Service users financial affairs are well managed. Service users’ welfare may not be fully protected as care staff have not been given training in falls prevention. EVIDENCE: A new manager, transferred from another Quantum Care home, has recently joined the management team at Vesta Lodge. Staff members spoken with said that she was supportive and open in her approach. An annual survey questionnaire is sent to relatives and service users from the company head office; the responses are analysed and information is fed back to the home’s manager for action where indicated. A company manager visits the home on a regular basis to audit the quality of the service and reports are forwarded to the CSCI. An annual action plan is developed although there was none available to see at this inspection Vesta Lodge DS0000019602.V282825.R01.S.doc Version 5.1 Page 17 Service users financial records were looked at and were seen to be in good order; some cash balances were checked and all were correct. Individual records of cash held for each person are kept along with receipts for items purchased. The administrator in the home said that these accounts are audited regularly by a person from Quantum Care head office, although there was no evidence that this had happened. An additional visit had been made to the home in September 2005 as a result of several accidents involving one particular service user. The requirement made in the report of that visit, that all staff should have training in falls prevention, has not yet been met, although several recommendations have been met, including that there is a minimum of five waking night staff on duty each night. Vesta Lodge DS0000019602.V282825.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 2 x x x x 2 x 3 STAFFING Standard No Score 27 x 28 1 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 3 x 3 x x 2 Vesta Lodge DS0000019602.V282825.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP38 Regulation 18(1)(c) Requirement Training in falls prevention must be given to all staff. (This was a requirement in the additional visit report of 19.09.05. and has not yet been met) Care plans are to be reviewed and updated monthly to show current care needs. (This was a requirement in the report of the inspection on 02.08.05 and has not yet been met) Records must show the dose of each medicine given to service users. Care staff must be given guidance in the administration of medication to people with dementia. Planned activities must take place and be recorded. Service users dietary needs must be met. Service users must be provided with clean bed linen. Timescale for action 31/03/06 2 OP7 15(2)(b) 14/02/06 3 4 OP9 OP9 13(2) 13(2) 14/02/06 30/04/06 5 6 7 OP12 OP15 OP24 16(2)(m) & (n) 16(2)(i) 16(2)(e) 14/02/06 14/02/06 14/02/06 Vesta Lodge DS0000019602.V282825.R01.S.doc Version 5.1 Page 20 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 4 5 Refer to Standard OP9 OP15 OP19 OP24 OP28 Good Practice Recommendations Medication audit records should show both date and time of the audit. Staff should be given guidance on meal presentation and how to help people appropriately at mealtimes. Several areas of the home are in need of refurbishment. Care should be taken in looking after service users’ clothes. The home should encourage a higher percentage of core staff to undertake NVQ 2 training. Vesta Lodge DS0000019602.V282825.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Vesta Lodge DS0000019602.V282825.R01.S.doc Version 5.1 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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