Inspection on 16/05/06 for Vesta Lodge

This inspection was carried out on 16th May 2006.

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

Vesta Lodge 26/04/07

Vesta Lodge 14/02/06

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 Jeffrey Orange Key Unannounced Inspection 16th May 2006 08:15 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.V295684.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. Vesta Lodge DS0000019602.V295684.R01.S.doc Version 5.2 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 Patricia Marie Smith 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.V295684.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: There are none Date of last inspection 14th February 2006 Brief Description of the Service: Vesta Lodge offers care and accommodation to sixty-one older people on two floors of a purpose-built home set in extensive gardens. The ground floor comprises two units - Willow, for people with dementia, and Laburnum for people with high dependency; 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 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. The home has an information brochure, Statement of Purpose and Service User’s Guide available to prospective residents, together with copies of the latest inspection report from the Commission for Social Care Inspection.(CSCI) Current fees range from £400 to £565 per week. (At April 2006). (Additional charges are made for items and services such as newspapers, toiletries, hairdressing and chiropody.) Vesta Lodge DS0000019602.V295684.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection report has been compiled following a visit to Vesta Lodge during which the experience of living in the home was discussed with service users, visitors, relatives, staff and management. It is also informed by any information received by the CSCI since the last inspection in February 2006. What the service does well: What has improved since the last inspection? What they could do better: Care plans require further improvement to support staff to meet the developing needs of service users. The home recognises that the level of staff holding NVQ level 2 is below that required and action is being taken to address this. The home, whilst homely and comfortable overall, does require some attention to any areas that are now looking rather tired, so that those living in the home can continue to do so in pleasant, well maintained surroundings. Vesta Lodge DS0000019602.V295684.R01.S.doc Version 5.2 Page 6 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.V295684.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 Vesta Lodge DS0000019602.V295684.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 3 5 (Standard 6 does not apply to Vesta Lodge) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Those considering Vesta Lodge as a home, either for themselves or someone they are responsible for, are given full information about the home and can also make visits, so that they can make a well-informed decision about living at Vesta Lodge. Only those whose needs can be met are admitted to the home. EVIDENCE: Service users’ files showed that an appropriate assessment, often including a home or hospital visit by a manager had taken place and that where applicable, Adult Social Care staffs’ assessment of service users’ needs had been obtained. Vesta Lodge DS0000019602.V295684.R01.S.doc Version 5.2 Page 9 Each person is given a copy of the Service Users’ Guide, which gives information about the home and the service that it provides. Vesta Lodge DS0000019602.V295684.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. 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. Further work is required to ensure that care plans reflect the action required to meet the initial and developing care needs of service users in every case. Some improvement following the previous inspection and requirements made is acknowledged and continuing progress will be monitored. Medication records, whilst much improved require some further adjustment to improve the safe administration of service users’ medication. Throughout this inspection visit staff were seen to treat service users with respect and to provide care in an appropriate and sensitive manner. EVIDENCE: Some of those care plans seen did not contain the necessary information to fully reflect either the initial assessment of need or how this had been met. Vesta Lodge DS0000019602.V295684.R01.S.doc Version 5.2 Page 11 (Care plans are however being reviewed and improved and this progress is acknowledged). Medication records checked were generally accurate. Some medication was not being stored at temperatures within recommended levels for it, which could adversely affect it. Medication returns records were not always dated and where medication had been prescribed in variable dosages the precise dose administered had not always been recorded. “We are well cared for, the “girls” (sic) are lovely” was a quite typical comment by one service user. Vesta Lodge DS0000019602.V295684.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The quality in some areas is good and it is expected that the overall outcome will become good once the activities programme is further developed in line with the intention of the home’s management and activities organiser. The range and scope of activities provided in the home varies, and for those with dementia requires increased specialist input. Some progress is however recognised and those primarily responsible for activities are aware of the need for improvement. Service users are supported to make decisions about how they wish to live at the home and enjoy well-cooked and nutritious meals. Visitors are welcomed into the home at any time. EVIDENCE: “We do very well for food here, one service user remarked and the comments received by other service users were positive about the food in the home too. There is a cooked breakfast option available each day. Vesta Lodge DS0000019602.V295684.R01.S.doc Version 5.2 Page 13 Meals were observed and were generally very sociable occasions. There is already a range of activities in place although some service users spoken to seemed not always to be aware of what was available and the completion of the activities records in care plans was of variable quality. A very positive discussion was held with the home’s activities co-ordinator and it is expected that if the plans that he has are realised, that further improvement will result. It is recognised that the provision of activities for those with some degree of dementia is a challenging task requiring specialist input in line with current best practice. The success of the dementia tea afternoon shows how effective activities can improve the experience of life for those with dementia as well as those without. Visitors to the home were very positive about their welcome and the support given to their relatives. Vesta Lodge DS0000019602.V295684.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a comprehensive, robust and well publicised complaints process which should provide confidence to both service users and those connected with them that any complaint or concern will be dealt with appropriately. Service users can be confident that they will be protected from abuse. EVIDENCE: Staff at the home have been given training in adult protection and the Hertfordshire County Council Adult Protection handbook is available for staff to consult at all times. Adult protection training is included in the induction course provided for staff when they join the home. There has been one adult protection strategy meeting held in March 2006 under the auspices of Hertfordshire Adult care Services. The home co-operated fully in this procedure and the outcome was satisfactory. There is a complaints procedure, which is given to service users in their information pack when they move into the home and which is publicised throughout the home. Vesta Lodge DS0000019602.V295684.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 21 24 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The overall environment of the home is satisfactory with a generally good standard of cleanliness. Some areas require relatively minor attention to maintain a good standard of décor and the bathing areas need to be reviewed as they are sometimes being compromised by inappropriate storage of ancillary equipment. EVIDENCE: One bathroom had a showerhead missing and broken furniture was being stored in it. Other bathrooms and shower rooms also had items stored in them inappropriately. Where soap containers had been removed from the walls, the wall had not always been made good. Vesta Lodge DS0000019602.V295684.R01.S.doc Version 5.2 Page 16 Whilst signage on some bathrooms and toilets is very appropriate for those with dementia this has not been extended to every facility for example a shower room on Willow unit does not have this style of signage. Service users’ rooms and communal areas are well furnished and in the case of service user’s rooms, are personalised with items to reflect their personality and interests. Vesta Lodge DS0000019602.V295684.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Trained and competent staff provide a good standard of care. The recruitment practice is robust and thorough, which should provide protection and confidence in the staff team for those dependent upon them for their care. EVIDENCE: Staff undertake induction training within six weeks of joining the home, which gives them an understanding and knowledge of basic care skills. Those training records seen confirm that staff have attended a range of courses including mandatory training in moving and handling, fire safety, first aid and health and safety at work. The home does not currently have 50 of its care staff holding the appropriate NVQ care qualification, although this is actively being addressed. The use of agency staff in the home has continued to reduce, which should benefit service users who will have a stable and consistent staff group. Recruitment files looked at during the inspection showed that the necessary checks had been carried out to ensure protection for service users. Vesta Lodge DS0000019602.V295684.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is currently in a process of transition following the registration of a new manager, the management team including the deputy, activities organiser and administrator appear to be working well together and described plans for the future of the home which, if carried through, should benefit those living at Vesta Lodge. EVIDENCE: Records of resident’s and relatives meetings were seen. Staff spoken with were generally positive and very positive discussions also took place with various members of the home’s management team. Vesta Lodge DS0000019602.V295684.R01.S.doc Version 5.2 Page 19 Financial records were spot- checked and a robust and thorough system of accounting was seen to be in place, which should offer protection for service users. There were no obvious breaches of good health and safety practice observed during this inspection visit. Vesta Lodge DS0000019602.V295684.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 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 2 X X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Vesta Lodge DS0000019602.V295684.R01.S.doc Version 5.2 Page 21 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 Regulation 15(2)(b) Requirement Care plans must continue to be reviewed and updated to reflect current care needs and how they are being met. (This revised requirement has not yet been fully met although progress is acknowledged. A revised timescale is therefore given) Records must show the exact dose of each medicine given to service users. (This previous requirement has not yet been fully met) Minor repairs to those areas of the home affected by wear and tear or where work carried out has left making good required must be attended to in a timely way. A review of the use of communal bathing facilities for storage must be carried out and appropriate action taken in the light of that review. This review must also consider extension of DS0000019602.V295684.R01.S.doc Timescale for action 31/07/06 2 OP9 13(2) 16/05/06 3. OP19 23 30/08/06 4. OP21 23 30/06/06 Vesta Lodge Version 5.2 Page 22 improved dementia signage where this is not already in place 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 OP9 OP9 OP12 Good Practice Recommendations Medication returns records should include the date. The storage of Lactulose should be reviewed in conjunction with the home’s pharmacist. A review of bathing and mealtime routines and environment should be undertaken, involving service users if possible, and certainly from their viewpoint, to see if these can be changed to provide an enhanced experience for service users. The development of activities within the home, particularly those for service users with dementia, should make use of research and current best practice and should be given an appropriate priority within the home. The home must ensure that every effort is made to increase the proportion of care staff with NVQ2 in care to at least 50 . 4 OP12 5 OP28 Vesta Lodge DS0000019602.V295684.R01.S.doc Version 5.2 Page 23 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. 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