Care Home: Hatfield Lodge Residential Home

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What the care home does well The service has worked very hard to ensure that a good standard of care is being provided, despite the major refurbishment going on in the home. Feedback from the people who use the service include the comments: `I am happy with the care and attention I receive`. `They look after me well and they listen`. `I am quite happy, there is not a lot else they can do`. `I like all the new decoration`. `They are very caring people and provide good food`. `This is an excellent home, very kind and attentive staff. I have no complaints, this is a very comfortable home`.Hatfield Lodge Residential HomeDS0000069773.V376943.R01.S.docVersion 5.2The Expert by Experience states: `In spite of the difficulties at present with the refurbishment, I found the home congenial and most residents appeared happy and contented. The décor was pleasing in the lounges and dining room. The residents comments to me were as follows: `I have been here for several years and I am very happy here. I am well cared for and have everything I need.` `I have only been here for a couple of months but have decided to stay here permanently.` Care Managers comment: `The home tries to meet all residents` needs, offering activities and social functions to meet their requests. They communicate well`. `I am very pleased with the response from this home. The Manager is extremely helpful and residents love the home. Also the rooms are kept to a reasonable price and decoration is good`. `Carers are very accommodating to all residents needs and are approachable and friendly`. `They treat the people with individuality, giving choice, freedom and independence within the home. They have friendly approachable staff`. `Good communication between the home, agencies, clients and families`. Staff comments: `The home supports and manages the needs of the residents who live here`. `We care for their needs, entertain them in the process, ensure the residents are happy and content and well fed`. We give them the options they deserve, as they are someone`s Mum or Nan`. `Staff and residents appreciate the refurbishment and we are making the home a better place to live and work in`. `We support and care for our residents. We provide good balanced meals and care and understand their needs. They take care of my needs too. A warm and friendly place to live and work` What has improved since the last inspection? It is clear that the owners of the home are committed to improving the environment and standards in the home and the refurbishment will continue for approximately another year. There are areas of the home which have been completed to a high standard. The lounges and dining room are very well decorated and are homely and comfortable. There are two new shower/wet rooms, a specialised bath has been installed in one of the bathrooms and a sluice is in place. The new en suite bedrooms are also completed and the windows have all been replaced. The entrance to the home is currently being refurbished and a ramp has been built to access one of the main doors. The gardens are also in the process of being landscaped. What the care home could do better: Hatfield Lodge Residential HomeDS0000069773.V376943.R01.S.doc Version 5.2 Care plans and risk assessments require further detail to provide staff with written guidelines of how to meet individual care needs. Improvements are required in most areas of recording to make sure that dates and signatures are in place. Daily records do not always show detail of the care provided at that time. All medication, including ear drops must to be recorded when administered. Individuals should be prescribed their own pain relief medication. The development of activities and leisure pursuits is required so that all of the people have the opportunity to participate in an active life. Staff files are not in good order to clearly show that all the required documentation is in place. When asked what the agency could do better the people who use the service comment: ‘To have a proper housekeeper to see the domestic work is done properly. Also to provide the right types of food for the elderly, stewed fruit and milk puddings`. A care manager comments: `The general hygiene of Hatfield Lodge could be improved. i.e. bathrooms and toilets. The older rooms tend to be generally in need of a thorough clean`. The Registered Manager told us that some of the bedrooms have not been refurbished; however, they are included in the next phase of refurbishment. The Registered Manager is aware of the comments regarding the domestic standards in the home and is currently addressing these issues. A staff member comments: `Employ more staff so the carers do not have to do their own job as well as other jobs they are not employed to do. This would give carers more time to concentrate on their own job and care for their clients a lot better`. `The Company could appreciate their staff more, i.e. a bonus for not being off sick each month or a good pay rise`. The Registered Manager told us that there is an employee of the month scheme and a prize is awarded to the winner. Key inspection report CARE HOMES FOR OLDER PEOPLE Hatfield Lodge Residential Home 1-3 Trinity Gardens Folkstone Kent CT20 2RP Lead Inspector Mrs Penny McMullan Key Unannounced Inspection 11th August 2009 09:30 DS0000069773.V376943.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Hatfield Lodge Residential Home DS0000069773.V376943.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Hatfield Lodge Residential Home DS0000069773.V376943.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hatfield Lodge Residential Home Address 1-3 Trinity Gardens Folkstone Kent CT20 2RP 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) 01303 253253 hatfieldlodge@fsmail.net Mr Kanagaratnam Rajamenon Mr Kanagaratnam Rajaseelan Mrs Yvonne Copleston Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Hatfield Lodge Residential Home DS0000069773.V376943.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 33. Date of last inspection 28th September 2007 Brief Description of the Service: Hatfield Lodge is registered to provide residential and personal care for up to 33 older people over the age of 65. The home is located in the busy seaside town of Folkestone and is within walking distance to the town centre and all the local facilities. It is also close to the Leas promenade and the other seaside amenities, including the Leas Cliff Hall. It is on the main bus route and is close to Folkestone Central train station. It is approximately 5 minutes drive from the M20. There are no parking facilities on site, however, there is local off street parking close by. The property is an older style detached premises, providing accommodation over four floors. There is a lift in situ for easy access to all floors. Two of the bedrooms are in the basement of the building. A chair lift is provided on the first floor where steps would otherwise make access difficult for those with mobility problems. All rooms are registered for single occupancy and have wash-hand basins and call bells. Eleven rooms have en-suite facilities. Several bedrooms are in the style of small apartments and are very spacious. A garden is provided to the side and a shaded patio to the rear of the property. Communal rooms include a large lounge, dining room and foyer area. Many residents have had private telephone lines installed in their bedrooms. Currently, the weekly fee for accommodation and services starts at £328 rising Hatfield Lodge Residential Home DS0000069773.V376943.R01.S.doc Version 5.2 Page 5 to £550 and is revised annually. This fee can be increased to the assessed needs of residents. There are additional charges for chiropody, hairdressing, newspapers and toiletries. Information on the homes services and the CQC reports for prospective residents/relatives will be referred to in the statement of purpose and service user guide. Hatfield Lodge Residential Home DS0000069773.V376943.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was carried out over a period of time and concluded with a visit to the home on 11 August 2009, between 09.30 am and 6.30 pm. An Expert by Experience accompanied the inspector at this unannounced visit. This is someone who has a special knowledge of the needs and issues, which are likely to be important to the people who live in the home. The Expert by Experience discussed with the people who live in the home their daily lifestyle and views of the home. The report of her findings is included throughout this report. Postal surveys were forwarded to the home to distribute to the people who use the service, staff and health care professionals. We sent ten surveys to the people who use the service, ten to the staff and five to health care professionals. Four surveys were received from the people who use the service, three from staff and five from social care professionals. Feedback from all of the surveys and any comments has been included in this report. The care of three people was tracked to help gain evidence as to what it is like to live in the home. A partial tour of the home was made and we also looked at care plans, risk assessments, training records, staff files and complaint records. Three members of staff were also involved in the inspection. The Annual Quality Assurance Assessment (AQAA) that was sent to us by the service was clear and comprehensive. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. The agency returned the Annual Quality Assurance Assessment (AQAA) within the required timescale. The quality rating of this home has been judged as a two star good service. What the service does well: The service has worked very hard to ensure that a good standard of care is being provided, despite the major refurbishment going on in the home. Feedback from the people who use the service include the comments: I am happy with the care and attention I receive. They look after me well and they listen. I am quite happy, there is not a lot else they can do. I like all the new decoration. They are very caring people and provide good food. This is an excellent home, very kind and attentive staff. I have no complaints, this is a very comfortable home. Hatfield Lodge Residential Home DS0000069773.V376943.R01.S.doc Version 5.2 Page 7 The Expert by Experience states: In spite of the difficulties at present with the refurbishment, I found the home congenial and most residents appeared happy and contented. The décor was pleasing in the lounges and dining room. The residents comments to me were as follows: I have been here for several years and I am very happy here. I am well cared for and have everything I need. I have only been here for a couple of months but have decided to stay here permanently. Care Managers comment: The home tries to meet all residents needs, offering activities and social functions to meet their requests. They communicate well. I am very pleased with the response from this home. The Manager is extremely helpful and residents love the home. Also the rooms are kept to a reasonable price and decoration is good. Carers are very accommodating to all residents needs and are approachable and friendly. They treat the people with individuality, giving choice, freedom and independence within the home. They have friendly approachable staff. Good communication between the home, agencies, clients and families. Staff comments: The home supports and manages the needs of the residents who live here. We care for their needs, entertain them in the process, ensure the residents are happy and content and well fed. We give them the options they deserve, as they are someones Mum or Nan. Staff and residents appreciate the refurbishment and we are making the home a better place to live and work in. We support and care for our residents. We provide good balanced meals and care and understand their needs. They take care of my needs too. A warm and friendly place to live and work What has improved since the last inspection? What they could do better: Hatfield Lodge Residential Home DS0000069773.V376943.R01.S.doc Version 5.2 Page 8 Care plans and risk assessments require further detail to provide staff with written guidelines of how to meet individual care needs. Improvements are required in most areas of recording to make sure that dates and signatures are in place. Daily records do not always show detail of the care provided at that time. All medication, including ear drops must to be recorded when administered. Individuals should be prescribed their own pain relief medication. The development of activities and leisure pursuits is required so that all of the people have the opportunity to participate in an active life. Staff files are not in good order to clearly show that all the required documentation is in place. When asked what the agency could do better the people who use the service comment: ‘To have a proper housekeeper to see the domestic work is done properly. Also to provide the right types of food for the elderly, stewed fruit and milk puddings. A care manager comments: The general hygiene of Hatfield Lodge could be improved. i.e. bathrooms and toilets. The older rooms tend to be generally in need of a thorough clean. The Registered Manager told us that some of the bedrooms have not been refurbished; however, they are included in the next phase of refurbishment. The Registered Manager is aware of the comments regarding the domestic standards in the home and is currently addressing these issues. A staff member comments: Employ more staff so the carers do not have to do their own job as well as other jobs they are not employed to do. This would give carers more time to concentrate on their own job and care for their clients a lot better. The Company could appreciate their staff more, i.e. a bonus for not being off sick each month or a good pay rise. The Registered Manager told us that there is an employee of the month scheme and a prize is awarded to the winner. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Hatfield Lodge Residential Home DS0000069773.V376943.R01.S.doc Version 5.2 Page 9 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 Hatfield Lodge Residential Home DS0000069773.V376943.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service and their relatives have the information they need to make an informed choice about moving to this home. The care needs assessment is in place to make sure their needs will be met. EVIDENCE: The Statement of Purpose is in the process of being updated to reflect the work already completed in the on-going refurbishment. We looked at the information provided to people before they decided to move into the home. We spoke to the people living at Hatfield Lodge and they told us that they or their family were given information about the home before they moved in. One person said that he had visited the home and stayed for a meal prior to coming to live there. A full care needs assessment is carried out Hatfield Lodge Residential Home DS0000069773.V376943.R01.S.doc Version 5.2 Page 11 before the person moves into the home or in some cases when they spend the day at the home, deciding if they wish to move in. Three assessments were seen at the time of the inspection and the forms cover all aspects of care. In some cases the forms were not consistently completed in all sections to evidence that the person has agreed with their plan. Improvements are therefore required to include full information throughout the assessment to make sure that all of the care needs are identified and met. People living in the home told us that they discussed their care needs when they decided to move into the home, however, evidence to confirm this is not always recorded. The care needs are reviewed weekly for the first month to ensure that any changes or additions to the plans can be added. These shortfalls were acknowledged by the Registered Manager who told us that improvements would be made to the assessment process. We are confident that action will be taken, therefore no requirement or recommendation will be made in this report. The home had taken four admissions in the previous week which had an impact on staffing levels. With major refurbishment still ongoing and four people coming into the home, puts additional pressure on the staffing levels. Admissions should be phased so that each person can have the individual attention they need whilst settling into their new home and staffing levels are sufficient to enable all of their needs to be met. The Project Manager has been supporting the home through the major refurbishment; however, the Registered Manager was not available when the admissions took place. The home is in the process of recruiting new staff in line with the increase of the admissions. At the time of the inspection interviews were being held and a new carer is scheduled to start next week. Hatfield Lodge Residential Home DS0000069773.V376943.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are currently provided with the personal and health care they need, however the lack of detail in some care plans has the potential to result in inconsistent or incorrect care. Improvements are required in the management of the medication records. The people in the home feel they are treated with respect and their dignity is upheld. EVIDENCE: Three care plans were seen with details of how to meet the people’s health, personal and social care needs. There was also evidence that they had been reviewed on a regular basis. The signing by the manager and the person agreeing to the plan was inconsistent. This also applied to the risk assessments and other documentation for example, nutritional needs. The lack of dates and signatures in the plans, make it difficult to know who completed the form and what date it was completed. In some cases the plans are not clear as to what Hatfield Lodge Residential Home DS0000069773.V376943.R01.S.doc Version 5.2 Page 13 current information the staff should be following. This was because outdated information had not been removed from the care plan. Another plan showed that a person had suffered a fall. An accident form had been completed and appropriate action taken. This information was also recorded in the daily notes but for that day only. There was no further mention as to how his condition was over the next few days. There was also a recommendation from the GP to monitor fluid intake. The home does have fluid charts in place for other people, however, there was no information recorded for this individual. Care plans contain a variety of risk assessment, for example, nutrition, moving and handling, falls and psychological profile and mental health assessments. As previously mentioned in some cases these are not signed or dated. The moving and handling risk assessments are not always clear of what assistance is required or what this means, to make sure people are moved safely. For example, the assessment states, Mr X could fall when trying to dress himself, ensure that the carer is assisting at all times, but it does not clarify what this means and how they should be minimising the risk. Nutritional needs identified that certain vegetables are not suitable for one person but it did not clarify what these were. The plans do not always provide detailed information to make sure staff have written guidelines to meet the peoples needs. Some of the plans contain good information as to how to promote the peoples independence by detailing what they can do for themselves, for example Mr X can shave himself, encourage Mrs C to wash hands and face. The plans also identify choices and preferences in getting up and going to bed, choice of beverages etc. This is good practice and this detailed information should be consistent throughout the plan. The AQAA states that the home has a key worker system in place. At the time of the visit, this was not happening. There was evidence that some of the staff had been allocated to a person to become their key worker, but the system has not started to operate. Staff spoken with at the time of the inspection demonstrated their understanding and what to do to meet individual needs, but this is not always reflected in the care plans. Daily records are only initialled by the carers and should be signed fully to identify clearly who has provided the care at that time. There are also entries in the daily notes which state alls well and although in some cases further information is written it does not clarify what alls well means to that individual. A carer told us that they are so busy that they do not have time to look at the care plans and it is evident that they pass on information verbally and do not always record the detail in the care plans. The majority of the people living in the home are able to tell the carers of their choices and personal care needs. This minimises the risk of their needs not being met however improvements are required to make sure staff have written guidelines and are clear of how to care for the people. Hatfield Lodge Residential Home DS0000069773.V376943.R01.S.doc Version 5.2 Page 14 The Registered Manager acknowledges the shortfalls in this area and told us that it has been difficult keeping up with everything due to the ongoing refurbishment. The refurbishment started over a year ago and will not be fully completed for approximately another year. She told us that this additional work has impacted on the time spent monitoring the care plans. There are plans to delegate some of the work to the Deputy Manager and Team Leaders. We are confident that action will be taken. We are aware that the current service users have a good level of autonomy and independence, and are able to say what their care support requirements are. But accurate and up to date care plans are essential, so that, when support needs change, wishes and feelings about personal support is clearly documented. Therefore, while the overall outcome area for personal care is judged to be ‘good’ a requirement will be made for improvement. The home will be given a timescale of three months to improve the care plans and confirm in writing to the Commission that this has been done. Feedback from the people at the time of the visit, and information from the postal surveys was very positive with regard to being treated with privacy and dignity. Staff were overheard talking to people in a respectful manner, calling some by their first names and those who preferred by Mrs or Mr. Carers were seen knocking on doors before entering the bedrooms and making sure people were given the choice of where to sit or what they wished to do. There was one concern at the time of the inspection when an agency staff member did not lock a bathroom whilst supporting a person to have a bath. The majority of the people living in the home are supported to take their medication. Those who are able to self medicate have risk assessments in place. In one care plan it was recorded that the person was required to have ear drops administered on a weekly basis. There was no record in place to identify at what time this was due to be carried out, how often, how many drops and who administered the drops. The deputy manager told us that this is usually recorded on the back of the medical administration sheets but there was no record in place to confirm this. She told us that this would be put in place as soon as possible. There is a separate medication room with a refrigerator for cold storage. Storage and the medication administration sheets (MAR sheets) are in good order. The MAR sheets are audited by the manager on a regular basis and all staff administering the medication have been trained to do so. Hatfield Lodge Residential Home DS0000069773.V376943.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further planning of the activity programme would provide all of the people with social stimulation of their choice. People who use the service are able to make some choices about their daily lifestyle. The people need to continue to discuss the meals to make sure they enjoy the food and have a varied diet. EVIDENCE: During the last few months the home has tried to recruit a dedicated activities person to plan and provide a programme to suit all of the people in the home. Unfortunately on two occasions the person has left and the home is now again in the process of recruiting. There are some activities being provided, for example keep fit and music, manicuring and aromatherapy; however individual needs and preferences are not fully recorded in the care plans. A part time carer is endeavouring to provide activities, however she was on annual leave at the time of the visit. In some of the care plans there are life histories of the people who have spoken about their previous hobbies, however, not all of the people have completed this information. The home does have forms in place Hatfield Lodge Residential Home DS0000069773.V376943.R01.S.doc Version 5.2 Page 16 to record this information but these are not always completed. The home has purchased skittles, musical bingo, darts, jigsaw and arts and crafts. We are confident that when the new person is employed the home will be able to improve activities for everyone. The home operates an in house shop for the people and their families. The Expert by Experience states: There appeared to be a lack of activities although the “keep fit man” was in attendance and playing ball with 3 residents in the lounge (maybe there would have been more if the lift had not been out of order). The member of staff responsible for activities is at present away but there did not appear to be any organised programme of activities and it would be useful for residents to have their input regarding this. Residents meetings are held about every 6 weeks. Apparently there is a good programme of activities i.e. parties etc. at Christmas time. One gentleman who spends most of the time in his room said he would appreciate someone to spend some time chatting to him, although he admits that he is not bored. Another gentleman said it would be nice to have someone to play draughts or chess with him and also that he would like to watch travel, countryside and property programmes on television. This was on in the lounge but no one appeared to be watching it as the programme which was on looked most uninteresting for elderly people. A religious service is held once a month and several residents said they enjoyed that very much. A Minister also visits the Home. As the Home is very near to the bandstand and over cliff, some residents who are able walk down to these and also to a shop nearby. Others who are not so mobile would like this opportunity. Some of the people living in the home are able to go out and have the key code for the front door. Visitors are welcome in the home and can see their relative where they wish, in the lounge, dining room or their own bedroom. The people are encouraged to keep in contact with their families and if able visit the local shops and be involved in community events. The AQAA states that the Registered Manager is trying to access a mini bus for regular outings. A relative was seen visiting her father and was complimentary about the home and was happy with the care being provided. Staff were seen welcoming their visitors and offering them a drink. The Registered Manager told us that she is already addressing comments made with regard to the meals in the home. Feedback from the people who live in the home is mixed, mostly complimentary; however there is evidence that on some occasions the meals are not quite so good. The manager is in the process of accessing additional training for the staff. At the time of the visit, Hatfield Lodge Residential Home DS0000069773.V376943.R01.S.doc Version 5.2 Page 17 five people in the dining room said the food was good. Another said that he was always given seconds and if need be would ask for thirds and there was no problem with regard to choosing something else if you did not like what is on the menu. The menus are on the table and one person told me that the staff come round and ask what everyone what they would like each day. She told us that the food was always good and that it was always discussed at the residents meetings. Nutritional needs are assessed in the care plans and likes and dislikes are recorded. We observed the lunch and most people said they enjoyed their meal. Tea time was a choice of cold or hot with home made cakes or jelly and ice cream. The Expert by Experience states: I was able to speak with a number of residents, some had been at the Home for a number of years, others only months and I spoke to one gentleman who was there for respite care whilst his daughter took her holiday. He informed me that he goes to the Home several times a year for respite and enjoys the time there and especially the company and the food. There was a mixed reception to my question regarding the menus and the food. Most residents said the food was good and others were not so complimentary. However, on observing the lunch being served the portions were adequate and the food looked appetising. Hatfield Lodge Residential Home DS0000069773.V376943.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people can feel confident that their concerns or complaints are taken seriously and responded to. There are arrangements in place to make sure that the people are protected from abuse. EVIDENCE: The complaints procedure is on display in the home and all complaints and concerns, together with compliments, are recorded. There is also a suggestions box in the entrance hall to the home which is checked by the Registered Manager each week. There have been three complaints since the previous inspection. The complaints folder showed evidence that all concerns are addressed within appropriate timescales. People spoken to at the time of the visit told us they would raise concerns if they had to and felt sure the staff would listen to then and take action if they needed to. A relative told us that she had raised a concern which was dealt with straight away and to her satisfaction. The home has procedures in place to protect the people from abuse. Training has been provided for most of the staff, however nine require the training. The organisation has an ongoing training programme and the Registered Hatfield Lodge Residential Home DS0000069773.V376943.R01.S.doc Version 5.2 Page 19 Manager told us that the courses will be booked to ensure that all staff are fully trained. Staff told us that they would report any concerns immediately and were aware of the routes to report such incidents, both inside and outside of the home. Improvements are required when recruiting staff to make sure there is a clear record to confirm they have been fully checked and are safe to provide care to the people in the home. The Expert by Experience states: On speaking to a Staff member, she felt the residents were well cared for and would willingly speak to the Manager if she felt there was a need to complain of treatment and care. She also said that she is receiving ongoing training. Hatfield Lodge Residential Home DS0000069773.V376943.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The major refurbishment of the home will make sure that it is maintained to a high standard. The people live in a home which is comfortable, pleasant and hygienic. EVIDENCE: The major refurbishment is ongoing. Some of the areas in the home have been completed and the décor is of a high standard. The dining room and lounges are homely and comfortable. A ramp to the entrance of the home was being completed at the time of the inspection and the gardens were also being landscaped. The rear garden will have a raised flower bed for the people to plant their own flowers. The home has two new wet rooms and a bathroom Hatfield Lodge Residential Home DS0000069773.V376943.R01.S.doc Version 5.2 Page 21 with a specially adapted bath and new windows. On the first floor a sluice room is now in operation. There are still many areas which are due to be redecorated and refurbished, including the corridors, laundry room, steam cleaning of the kitchen and some bedrooms. There are two new washing machines and tumble driers in the laundry. The laundry does not have hand washing facilities; however these will be included when the refurbishment takes place. Hand gel is currently used to reduce the risk of infection. There have been some comments made with regard to the cleaning of the home. The Registered Manager is aware of the shortfalls and is in the process of addressing these issues. Hatfield Lodge Residential Home DS0000069773.V376943.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are adequate numbers of staff with sufficient training and experience to meet the needs of the people. The people are protected from the recruitment process in place. EVIDENCE: At the time of the inspection there were twenty six people in the home, including four people on respite care (staying for a short period only). There had been four admissions to the home in the previous week. The Registered Manager was in the process of requesting an agency staff member to make sure there was enough staff on duty to meet the peoples needs. There was also a problem with the lift and although the engineers had visited and were addressing the fault, the people could only use this with a staff member in attendance. This was having an impact on the staffing levels and carers had to use the stairs to support the people to access their rooms. Although there were three carers on duty they were rushed to make sure everyone had the attention they needed. They did not have sufficient time to spend on peoples social needs, however they worked hard to make sure that the people were cared for. The people living in the home told us that the staff were very busy and felt that they coped well with the lift being out of order. Hatfield Lodge Residential Home DS0000069773.V376943.R01.S.doc Version 5.2 Page 23 The Registered Manager had recognised that this would be additional pressure on the staffing levels and had requested an agency member of staff prior to inspection starting. The agency staff member arrived at 12.15 pm. It is not the normal practice of the home to use agency staff, however due to the recent admissions, the Registered Manager assessed the staffing levels and deemed it necessary to have an agency member of staff. The staff rota was spot checked and showed consistency of staffing levels and it is evident that the manager reviews the staffing levels when required. The layout of the building must also be taken into consideration when assessing staffing levels as the home is over four storeys and the deployment of staff may be difficult. There is also a cook and domestic staff on duty. The home is currently recruiting staff to make sure that when more people come to live in the home there is sufficient staff to meet their needs. During the last year the home has recruited a new team leader and five new members of staff. With this level of change and disruption in the home, it is essential that all staff, established and new, have a good, accurate care planning system to refer to. Additionally there must be sufficient time for staff to become familiar and update these care plans to make sure they are accurate at all times. We have noted that there is required improvement in this area, and we are confident that these and the staffing levels will be kept under strict review. The Registered Manager is fully aware of the level of recruitment and how this will impact on the home. Until such times as the home is fully staffed, they will continue to use agency staff to make sure the peoples needs are met. As action is being taken to address this issue no requirement will be made at this time. The Expert by Experience states: The residents were appreciative of the care they receive from the Staff but did say there was not enough Staff on duty and they always seemed rushed. I did observe that the Staff had little time to communicate with residents, even when serving coffee. Over 50 of the staff has achieved NVQ 2 or above and there is an ongoing NVQ training programme in place. We saw three staff files and these showed that appropriate checks were taking place, such as police checks. We saw in one case that more evidence should have been in place to demonstrate that particular issues had been explored. The Registered Manager told us that this had been done verbally, but there was no documented evidence to say what support had been put in place. Improvements are therefore required to record and evidence that there are procedures in place to make sure staff are safe to provide care to the people. Hatfield Lodge Residential Home DS0000069773.V376943.R01.S.doc Version 5.2 Page 24 The training matrix shows some gaps in the mandatory training, for example, seven members of staff require Food Hygiene Training and ten require First Aid Awareness. The Registered Manager told us that courses will be booked in the near future. There was evidence of induction on file, however the staff files are not in good order and in some cases it was difficult to collate the information required for the inspection. It is recommended that all staff files are audited to ensure that records are in good order. Some specialist training has been provided in dementia and diabetes. Senior staff have received Mental Capacity Training. The Registered Manager told us that distant learning courses in Equality and Diversity will be provided for all staff. Hatfield Lodge Residential Home DS0000069773.V376943.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed in the best interest of the people who live there. The health, safety and welfare of the residents is promoted and protected. EVIDENCE: The Registered Manager is qualified and experienced. The people who live in the home said they have no hesitation in speaking to her if they need to. Staff told us that they feel supported by the management team. It is acknowledged the home has worked very hard since the last inspection, especially with the ongoing refurbishment. One person living in the home told Hatfield Lodge Residential Home DS0000069773.V376943.R01.S.doc Version 5.2 Page 26 us that she has had enough of the changes but felt that it was improving. Most of the other people told us that the completed areas were lovely. To make sure the home is running smoothly a representative from the organisation undertakes monthly visits to the home. The majority of the people living in the home have completed a quality assurance survey. The Registered Manager told us that similar questionnaires had been sent to relatives and other stakeholders, such as the Care Managers. At the time of the visit not all surveys had been returned, therefore the results had not been analysed. The organisation is introducing a new format to clearly show the outcomes and opinions of the people. Residents and staff meetings are held on a regular basis and a newsletter is also produced. There is a suggestion box in the entrance to the home and people living in the home are encouraged to have their say. There are robust procedures in place to make sure that people’s financial interests are protected. The home supports some of the people with their financial affairs, whilst others are supported by their families or solicitors. All transactions are recorded and receipts filed. The records are audited by the Registered Manager. The Registered Manager told us that the programme of supervision is not fully up to date. Senior staff will be trained to assist in this process to make sure that all staff receive supervision. Staff spoken to at the time of the inspection told us that they feel supported by their colleagues and the management team. The AQAA states that all of the necessary maintenance checks have been made, including weekly checks of the water temperature. All the equipment has also been serviced. The fire safety log book was in good order and accidents are recorded and monitored. There is a fire risk assessment in place, together with environmental risk assessments. A mandatory training programme is being provided and all new carers complete a thorough induction. Hatfield Lodge Residential Home DS0000069773.V376943.R01.S.doc Version 5.2 Page 27 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 3 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 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 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 3 3 Hatfield Lodge Residential Home DS0000069773.V376943.R01.S.doc Version 5.2 Page 28 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 Regulation 15 Requirement To make sure that clear accurate detail information is recorded in the care plans and risk assessments to meet the peoples needs. To consistently dated and sign the care plan documentation to make sure up to date information is in place. Daily records require further information to be recorded so that it is clear what care has been provided at that time. Timescale for action 30/11/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hatfield Lodge Residential Home DS0000069773.V376943.R01.S.doc Version 5.2 Page 29 Care Quality Commission Care Quality Commission South East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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