Care Home: Herrick Lodge

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What the care home does well Herrick Lodge is able to support people with regards to their diverse and cultural needs, this is achieved by the staff group being representative of the cultures and backgrounds of those living at the home, which enables staff to converse with people in their first language, and understand issues which are important to them. The home provides culturally appropriate meals and observes religious practices and festivals. Surveys that we sent to people asked them what they thought the service did well, they wrote:`As mentioned, some workers are very good and helpful.` `Offers all residents the care and respect they need, offers activities and outings to anyone wishing to take advantage. Provides all meals, drinks which my relative thoroughly enjoys.` `Contacting close relatives immediately in case of emergency.` `The home does well to accommodate the needs of residents of multi-cultural backgrounds, such as in food and the celebration of festivals and languages.` What has improved since the last inspection? The owners of Herrick Lodge, Leicester City Council are aware of a number of shortfalls in the service and have/and are taking positive action to ensure that they are remedied and resolved. Medication storage facilities for controlled drugs have been reviewed. An audit has been undertaken to identify training needs within the home. A representative of the organisation visits the home on a monthly basis as part of their quality assurance, to identify areas for improvement and comment on good practice, these visits are carried out accordance with Regulation 26 of the Care Homes Regulations 2001 and are carried out by the organisations Regulation and Investigation Officer. What the care home could do better: Care plans and other documentation need revising, to ensure that the information they contain is accurate and up to date and provides clear and concise information to ensure that the needs of people are met and that the service they receive is individual to them and is as they would wish. Environmental improvements are needed to provide those in residence with a comfortable and welcoming environment, which is able to meet their individual needs including supporting those people with Dementia. People who use the service and their relatives need to be confident that individual rights and welfare will be protected by robust systems and procedures which are understood by all. Training needs to be provided to staff to enable them to provide good quality care based on the needs of people living at the home. Management and administration of the home need to be improved through a consistent management team, who receive training that enables them to develop the service. Effective communication opportunities need to be established to ensure those who receive a service influence the care they receive, and that good support and communication systems are put into place for staff. Surveys that we sent to people asked them what they thought the service could do to improve, they wrote:`More staff who are better trained. Stable management. Better co-operation between management and staff at all levels.` `Herrick Lodge has very old furniture.` `More outings to places of Worship and day trips.` `Could keep it cleaner.` Key inspection report Care homes for older people Name: Address: Herrick Lodge 28 Orchardson Avenue Leicester Leicestershire LE4 6DP     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Linda Clarke     Date: 0 1 1 2 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 37 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. 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 Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: Herrick Lodge 28 Orchardson Avenue Leicester Leicestershire LE4 6DP 01162531304 01162629169 socis217@leicester.gov.uk socis209@leicester.gov.uk Leicester City Council care home 40 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability sensory impairment Additional conditions: No one falling within category DE(E) or MD(E) may be admitted into Herrick Lodge when 20 persons who fall within categories/combined categories DE(E) or MD(E) are already accommodated within the home No one falling within the category PD(E) may be admitted into Herrick Lodge where there are 10 persons of category PD(E) already accommodated within the home. No one falling within the category SI(E) may be admitted into Herrick Lodge where there are 10 persons of category SI(E) already accommodated within the home To be able to admit the named person of category DE named in variation application dated 28th November 2002. Date of last inspection Care Homes for Older People 1 5 0 1 2 0 0 9 0 0 0 0 0 Over 65 20 20 40 10 10 Page 4 of 37 Brief description of the care home Herrick Lodge is a residential care home run and owned by Adult Social Care within Leicester City Council, and is located close to the centre of Leicester. Accommodation is on the ground and first floor and accessible by the stairs or the passenger lift. The home consists of several small and large lounges on the ground and first floor, dining room, designated smoking lounge, prayer room and temple room. Bedrooms are located on both floors with sufficient numbers of bathrooms/shower and toilets facilities. There is parking to the front of the home, and the home has a central garden. A copy of the lastest Care Quality Commission Inspection Report is located in the foyer of the home, and information regarding fees is available by contacting the Manager of Herrick Lodge. Care Homes for Older People Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We as it appears throughout the Inspection Report refers to the Care Quality Commission. The inspection process consisted of pre-planning the inspection, which included reviewing the Annual Quality Assurance Assessment (AQAA), which is a self assessment tool, completed by a representative of the service, reviewing previous Inspection Reports, and any information we have received. We sent surveys to people who reside at the home of which three were returned, we also sent relatives surveys of which seven were returned, we received four surveys from members of staff and one from a health care professional. We refer to comments and information gathered from surveys throughout the Inspection Report. The unannounced site visit commenced on the 1st December 2009, and took place Care Homes for Older People Page 6 of 37 between 8am and 5.30pm. The focus of the inspection is based upon the outcomes for people who use the service. The method of inspection was case tracking. This involved identifying people with varying levels of care needs and looking at how these are being met by the staff at Herrick Lodge. Four people accessing services were selected. Discussions were held with one of them, and we observed staff supporting them. We also observed staff supporting other people in residence at the home. We spoke with staff and representatives of the Management Team. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? What they could do better: Care plans and other documentation need revising, to ensure that the information they contain is accurate and up to date and provides clear and concise information to ensure that the needs of people are met and that the service they receive is individual to them and is as they would wish. Environmental improvements are needed to provide those in residence with a comfortable and welcoming environment, which is able to meet their individual needs including supporting those people with Dementia. People who use the service and their relatives need to be confident that individual rights and welfare will be protected by robust systems and procedures which are understood by all. Care Homes for Older People Page 8 of 37 Training needs to be provided to staff to enable them to provide good quality care based on the needs of people living at the home. Management and administration of the home need to be improved through a consistent management team, who receive training that enables them to develop the service. Effective communication opportunities need to be established to ensure those who receive a service influence the care they receive, and that good support and communication systems are put into place for staff. Surveys that we sent to people asked them what they thought the service could do to improve, they wrote:More staff who are better trained. Stable management. Better co-operation between management and staff at all levels. Herrick Lodge has very old furniture. More outings to places of Worship and day trips. Could keep it cleaner. 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. Care Homes for Older People Page 9 of 37 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. On admission a comprehensive assessment process is completed to ensure that the service can meet an individuals needs. Evidence: We wanted to find out how people were supported to move into the home, and to find out how their needs were assessed to ensure that the staff at Herrick Lodge could support people well. We looked at the assessments of four people whose records we viewed. Assessments had been carried out by a Social Worker prior to the person moving into the home, the assessment is then sent to the home for the Acting Manager to view, the assessments provide information as to the persons needs, and the reason for their requiring residential care. We sent surveys to people who live at the home, and we asked them whether they were given enough information about Herrick Lodge to help them determine if the home was the right one for them, all responded that they didnt know. Care Homes for Older People Page 11 of 37 Evidence: Information provided by the Acting Manager within the Annual Quality Assurance Assessment (AQAA) which we received prior to our visit told us that individuals and their family are encouraged to visit the home before making a decision, and that the initial assessment is used to develop a care plan. Care Homes for Older People Page 12 of 37 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people are met, however records and documentation are not detailed or regularly reviewed. This can have an impact on the quality and well being of people in residence. Evidence: We looked at the care plans and records of four people who are living at Herrick Lodge, and other documents including risk assessments and daily records. We found inconsistencies in the information contained within care plans, and instances where the information was not comprehensive or reviewed. Information provided within the AQAA completed by the Acting Manager which we received prior to our visit told us that care plans contain all the information needed to enable staff to assist people with all aspects of their care, and that care plans are monitored by staff, and involve the person receiving care and their relative. We found no evidence that consultation with people was carried out, in that daily records did not detail that a persons care plan had been reviewed with them, or what the person had said. Care plans did not indicate when they were reviewed, and were often not dated Care Homes for Older People Page 13 of 37 Evidence: or signed by the person or their representative, impacting on quality of life. We found an example of where a persons care had been reviewed by a Social Worker, who had recommended that a nutritional assessment be carried out, we found no evidence that the assessment had been carried out, the home had liaised with the persons Doctor about weight loss. The persons food intake and weight are being monitored, the care plan advised staff to discuss concerns with a Manager, but no guidance was provided as to when staff should be concerned, or what was considered sufficient food intake. We looked at the records of someone who had been observed by Managerial staff being moved by staff using a hoist inappropriately. We found that the person had a risk assessment for the use of a stand aid, however the person no longer used this equipment but instead used a hoist. The incident observed by Managerial staff did not result in the Management revisiting the persons care plan or risk assessment, if this had taken place it would have been noted that the persons risk assessment was not up to date and reflected equipment which was no longer in use. There was no evidence as to who had written the risk assessments, and training records we reviewed on the day did not identify that staff had received training. Subsequently we were provided with an updated training matrix identifying this. As part of the homes quality assurance the home is visited by the Regulation and Investigation Officer who is employed by the organisation and visits on a monthly basis to ensure the home is meeting the needs of people, and identifies any improvements that need to be made. The two most recent visits which were carried out in October and November 2009 identified that care plans were not signed or dated, and that their were inconsistencies and gaps in the information provided, they also found that risk assessments for some areas of concern were not in place, it was also found that risk assessments were not signed or dated. The Regulation and Investigation Officer following their visit in October 2009, within their report recommended these areas be addressed, however similar were concerns were recorded on their subsequent visit in November 2009. This demonstrates that issues are not dealt with expediently to minimise risk. Records showed that people at Herrick Lodge have access to health care professionals, and that their visits are documented. We sent surveys to health and social care professionals, one of which was returned, information gathered from the survey told us that in their view the health and social care needs of people are usually met, and that the service respects the privacy and dignity of those in residence. One health care professional to the question what does the service do well wrote:- Care Homes for Older People Page 14 of 37 Evidence: Overall I feel service provision is adequate. We sent surveys to people who reside at Herrick Lodge, information gathered from surveys told us that a majority of people receive the care and support they need, and that staff are available when they need them and listen and act on what they say. Surveys asked what they thought the home does well, comments written included:Care on an individual basis. Herrick Lodge is a very caring place. We sent surveys to relatives of those living at Herrick Lodge, information gathered from surveys told us that they have mixed views as to whether the needs of their relatives are being met and had mixed views as to whether staff have the right skills and experience to look after people. Surveys asked relatives what they thought the home did well, they wrote:Some of the workers are very good and helpful, but some are not helpful at all. Offers all the residents the care and respect they need. We are generally happy with the service provided. The service provides respite for the family, the care my relative gets at Herrick Lodge is exceptional. The staff are caring and understanding and they feel comfortable at the home. I would like to thank all the staff at Herrick Lodge for their dedication and caring since my relative has been a resident. Services are well at Herrick Lodge, provide good care. Contacting close relatives immediately in case of emergency. Surveys asked relatives what they thought the home could do to improve, they wrote:Provide more information and options available to us. Care Homes for Older People Page 15 of 37 Evidence: We sent surveys to staff who work at the home, information gathered from surveys told us that staff are not satisfied with the information they are given about the needs of people, and feel that the training they receive does not enable them to understand the needs of people, or provide them with the knowledge about their health care. Responses to questions about their ability to meet the diverse needs of people were mixed. At the previous Key Inspection which we carried out on the 15th January 2009, we made a requirement that staff were to receive training in the areas the home is registered to provide. Herrick Lodge is registered to provide care for people with Dementia, Sensory Impairment, Physical Disability and those with a Mental Disorder. We looked at the training records that we were provided with on the day of the site visit, and found that no staff have received training in any of these areas. The lack of training in these areas limits the understanding and awareness of staff in supporting people with different needs, and care plans are not sufficiently detailed or person centred to reflect lifestyle choices of people which support their health and well-being, this impacts on quality of life. Visits carried out by the Regulation and Investigation Officer in October and November 2009, including speaking with those living at the home. The report written following the visits showed that positive comments had been received which included comments about the care they receive and the ability of care staff to converse with them in their first language, our evidence supports this. Observations on the day of the our visit showed that staff conversed well with people, with many staff speaking an Asian language and were therefore able to speak in the persons first language. We observed staff using a hoist, which they managed well, we spoke with the keyworker for one person whose records we had viewed, they had a good understanding of the persons needs. The Team Manager for Herrick Lodge advised us on our site visit that the Assistant Manager of Herrick Lodge is currently being supported by managerial staff from other homes owned and managed by Leicester City Council, to enable them to review and update care plans to ensure they are person centred and focus on desired outcomes, wishes and expectations of people receiving care. We observed a member of staff administer the lunch time medication which was managed well, we noted that a drink was offered with medication and that people who were prescribed pain relief were asked if they needed medication. Care Homes for Older People Page 16 of 37 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Herrick Lodge provides opportunities for people to be involved in activities and recreational events reflective of peoples cultural needs these however are not frequent and are dependent upon the availability of staff. Herrick Lodge provides meals which are reflective of the cultural needs of those in residence. Evidence: We wanted to find out how people spend their day, and what opportunities were available to them. We noted that people were supported with personal care, before going to the dining room for breakfast. Some people chose to remain in their room, whilst others returned to their room after breakfast. A majority of people however sat in one of two lounges. One lounge is open plan with the dining room, we noted that several people sat in individual chairs, sitting in front of the television. We noted that the television remained on during the day. We did not observe at anytime discussions taking place between staff and those living at the home as to which channel they wished to watch or whether they wanted the television on. The television remained on an English speaking channel, however over 80 of those in residence as referred to by Leicester City Council are BME (Black Minority Ethnic) clients. Herrick Lodge also has a separate lounge, which people choose to sit in, this lounge Care Homes for Older People Page 17 of 37 Evidence: has two doors leading into the room, we observed that staff often entered via one door and left via the other, when staff do this they have to walk in front of the television obscuring the view of those watching television. We noted throughout the morning that staff did come into the lounges and speak with people, and that people living at the home enjoyed this. We did not observe any activities in the morning. A majority of people remained in the lounges until lunchtime at which point they went to the dining room, after lunch returning to the lounges where the television remained on, we observed no activities in the afternoon. We sent surveys to people who live at the home, information gathered from surveys told us that the home does arrange activities that people take part in. When we asked what they thought the home did well they wrote:Lovely meals. Activities. We sent surveys to relatives of those residing at Herrick Lodge, they wrote the following as to what Herrick Lodge does well:Offers activities and outings to those wishing to take advantage. Whilst some comments to the question what could Herrick Lodge do to improve included:More outings to places of Worship and day trips. We spoke with staff who told us that they encourage people to engage in activities which includes baking biscuits, and information which we read in the report carried out by the Regulation and Investigation Officer told us that they had received positive comments about activities from those living at the home and that they had visited the Highcross Centre and had been to the shops. One lady we spoke with told us that they had taken part in the Diwali celebrations in Leicester. We noted on the wall opposite the dining room that a pictorial history of Leicester was displayed, and described in English but not translated in to an Asian language representative of those who living at the home. Information provided by the Acting Manager in the AQAA told us that when someone moves into the home, they encourage them and their relatives to provide information Care Homes for Older People Page 18 of 37 Evidence: about their lives to enable them to have an insight into the persons life. We found in information about individuals family and work life, cultural needs or hobbies and interests in care plans but this information was not used to develop person centred care. An activities programme was in place for the week, which included an activity each day, which included Bhajans, cookery or craft work. We asked a member of staff if Herrick Lodge received Asian television channels, we were told that the home did, but we noticed that the satellite dish for the home is currently out of action, as we noted it lying on the ground, we were told that winds had blown it down. We were subsequently advised by Leicester City Council that the satellite dish is owned by a resident and its maintenance is managed by the family. The home is now looking into installing satellite television and how this can be accessed in the different areas. We were told that in the evening many people in the home who are Asian watch films reflective of their culture. The Assistant Manager told us their are plans for a lounge on the first floor to be decorated and used as an activities room. We looked at staff training records and found that staff have not received training about providing creative activities or activities for people with dementia, which further limits the scope and aspirations of those living at Herrick Lodge. We asked staff for comments as to what Herrick Lodge does well, one person wrote:The home does well to accommodate the needs of residents of multi-cultural backgrounds, such as in food the celebrations and languages. The dining room is a large room painted in a neutral colour, due to its size and the lack of occasional furniture and pictures, it has an institutional feel. The dining room has two commercial style serving hatches, which cater for the different dietary needs of people living at Herrick Lodge being European, Asian and vegetarian diets. There are several dining tables which were laid with table cloths and condiments, we noted that several people conversed with each other throughout the meal which assured us that they were relaxed within the environment. The menu is on a white board written with a marker pen, their are two menus reflecting the European and Asian diet provided, which is written English and Gujarati, the writing of the menu on the white board is another factor which contributes to the lack of homeliness, and gives an institutional feel. We noted that people of Asian origin were served their food on Thali (molded stainless steel platters), reflective of their culture, whilst people of European origin received Care Homes for Older People Page 19 of 37 Evidence: their meals with the main dish already served on the plate, vegetables are placed in tureens and put onto tables, staff assist those who need help. There is a choice of two main dishes. Our observations during the main meal identified areas for improvement, which could improve the dining experience for people, we noted that the dining room was very drafty with serviettes and table clothes blowing, one lady sitting at the table told me that she found it to be drafty and sometimes cold. The explanation provided to us was that the draft was generated from the kitchen fans. The kitchens themselves are noisy with kitchen staff carrying out their tasks, which increases the need for people to speak louder in order to be heard. We sat next to someone in the lounge attached to the dining room prior to the lunch time meal being served, we noted that three members of staff on separate occasions asked them if they were going to sit at the dining table and what they would like to eat. On each occasion they told staff that they didnt want to sit at the table and that they werent hungry so didnt want anything to eat. The person upon each time being asked became more insistent that they didnt want anything. After being asked for the third time a member of staff returned with a large plate of food, and left it next to the person on the coffee table, the person once again said they didnt want anything, the plate of food was left. Another member of staff then came to ask if their was anything else theyd prefer to eat, they said no and the plate of food was removed. We spoke with someone who used to work at Herrick Lodge, who now manages another home within the organisation, who was working at the home on the day, told us that if the persons care plan was up to date it should state that the person usually says no to wanting anything to eat, and that they should be asked once if they want something, and that if a small amount if food is put onto a plate, the person will usually eat it, however we did not observe this. Meetings have recently taken place with both European and Asian residents to find out their views about the food, we noted both groups of people had raised comments as to what they would like to eat, including changes to both menus, which was acted upon. Care Homes for Older People Page 20 of 37 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems to protect the safety and welfare of people residing at the home are not sufficiently understood by staff, and the lack of procedures and understanding of good practice has the potential to put people at risk. Evidence: We wanted to find out how the safety and welfare of those residing at Herrick Lodge was promoted, we did this by looking at information we had received from the Acting Manager within the AQAA, by speaking with staff and viewing records in the home, and looking at information we gathered from surveys. Information in the AQAA told us that the home has received twelve complaints within the last twelve months, however this was incorrect, records we looked at showed us that three complaints had been recorded, and investigated. Records did not always detail the response following the investigation which were given to the complainant. The Regulation and Investigation Officer who visits the home on a monthly basis on behalf of the organisation to ensure the home is providing good quality care noted in their visit of the 8th October 2009 that the informal complaints book needs to be reformatted and the home has an informal complaints book, the last entry was on the 8th October 2009, there was evidence to show this had been dealt with appropriately, our evidence supports this. We sent surveys to people in residence at Herrick Lodge and asked them if they had Care Homes for Older People Page 21 of 37 Evidence: anyone they could speak with if they were unhappy and whether they knew how to make a complaint. Information gathered from surveys told us that whilst some people could speak with someone if they were unhappy others did not know any one, and not everyone was aware of how to make a complaint. We sent surveys to relatives of people living at the home which asked them if they knew how to make a complaint and the answers were mixed, with four out of six saying they were aware, however two indicated they were unaware. Surveys which we sent to staff asked them if the knew what to do if someone wished to make a complaint, half of staff indicated they were not aware of what they should do, this could have an impact on the well-being of those living at the home. We noted that the complaints procedure is displayed within the home and is in both English and Gujarati. We were told that a copy of information about the home which includes how to make a complaint is in each persons bedroom, however their is no system to check that people have read or understood the information provided. Information in the AQAA told us that the home had within the last twelve months referred and had investigated six safeguarding events, this was incorrect as their was actually two which the Assistant Manager was aware of, and all had been satisfactorily concluded. We discussed with the Assistant Manager the safeguarding referral process, they were not aware of the safeguarding referral form. We asked to look at the procedure for referring safeguarding concerns, we found a policy dated April 2005, but their was no procedure that tells staff the action they should take and who they should inform. Information about safeguarding is displayed on posters around the home, this information details what takes place with the safeguarding information once the referral has been received by Social Services. We found no system in place to follow up safeguarding referrals, or documentation for recorded subsequent action, this places people at risk. At the previous Key Inspection which took place on the 15th January 2009, we made a requirement that a programme of training be established to ensure that all staff receive training which provides them with the knowledge and understanding as to the forms and types of abuse, and that enables them to identify when abuse may be occurring. We looked at the training records which were provided to us on the day of our visit to Herrick Lodge, we found that some staff have received training this year, whilst others received training in excess of two years ago whilst some have not received any training. We were told that all staff have received on site training with Care Homes for Older People Page 22 of 37 Evidence: regards to safeguarding, which was delivered by the staff work development team, in Gujarati. We spoke with a Senior Carer who was unclear as to their role and responsibility in managing allegations of abuse, and made no reference to ensuring the welfare and safety of the person. We are not confident in the level of understanding of those who have received training. We looked at the written findings of the Regulation and Investigation Officers visit carried out in November 2009, they visit the home on a monthly basis to ensure that the home is providing good quality care and is being run well. In their report of November 2009 they wrote care staff were asked about their understanding of safeguarding; they struggled to give a clear indication of their understanding and did not relate it to protecting service users from harm, staff could however recall work force development talking to them about safeguarding. Our evidence supports this. We reviewed the training matrix provided on the day of our visit and found that Managerial and care staff had not receiving training on the Mental Capacity Act or Deprivation of Liberty Safeguards. We have subsequently been informed that staff have received training. Care Homes for Older People Page 23 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People residing at Herrick Lodge are provided with an environment which is adequately decorated that would benefit from improvements to furnishings and fittings to create a homely and relaxing environment in which to live. Evidence: Herrick Lodge has communal rooms located on the ground and first floor, many people choose to use one or two lounges located on the ground floor, one of which is open plan with the dining room. Communal areas, including corridors are basic in decor with neutral coloured walls and limited pictures and ornaments to create a homely and inviting feel to the home. The lay out of communal areas do not make for an intimate feel to the home, with chairs arranged around the outside of a room facing towards a television. We sat on some chairs and found them to have an odour of urine. This impacts on the quality of life experienced by those living at the home. We sent surveys to people in residence at Herrick Lodge and asked them if the home was fresh and clean, a majority of people indicated that it was. Surveys we sent to people living at the home, relatives and staff provided comments about the environment which included:- Care Homes for Older People Page 24 of 37 Evidence: Could keep it cleaner, sometimes it is dirty. Herrick Lodge has very old furniture. The dining room is large and has an institutional style with an commercial kitchen and limited decor to enable the room to be homely and intimate. The lay out of communal rooms mean that staff walk often into the rooms and front of televisions, interrupting the viewing for those watching television. Bedrooms are single without en-suite facilities. The home has communal bathrooms and toilets and it has been identified that some toilets within the home are very small for those with mobility difficulties, and that doors are a potential hazard as they open and close in both directions and quickly close. As identified by the visits carried out by the Regulation and Investigation Officer. Information provided in the AQAA states that improvement plans are in place with regards to decor, however their is no information that suggests that the decor of the home will be reflective of the needs of people with Dementia, to aid them in moving about the home and identifying significant rooms such as toilets or their bedroom. Herrick Lodge has a garden to the rear, this area does not reach its potential, with limited shrubs and plants, with mainly a lawned area. There are no features in the garden for people to look at and the garden is not visible from the lounges where most people choose to sit. There is limited access to the garden restricting peoples freedom of movement. At the front a patio area has been made safe which enables residents to sit outside with a range of benches and an awning. There is a wide range of border plants and a bird table in situ for residents to enjoy. Care Homes for Older People Page 25 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who receive care and support at Herrick Lodge are supported by staff who have undergone a robust recruitment process and are employed in sufficient numbers to meet personal care needs, the care people receive could be improved by the provision of specialist training in areas such as Dementia. Evidence: We arrived at the home at 8am in the morning, as information we had gathered from staff surveys told us that they were concerned about staffing levels in the home. On the morning of our visit we found that the Assistant Manager was at the home, along with a Senior Carer and five members of care staff, our observations were that staffing levels enabled staff to meet the personal care needs of those in residence. We also noted that their were sufficient staff on duty at lunchtime to serve and assist people with their meal. We sent surveys to people in residence at the home a majority told us that staff were available when they needed them, views were mixed as to whether staff listened and acted on what they say. A survey which we received from a relative included the comment:Some staff were very good and helpful, whilst some are not helpful at all. Care Homes for Older People Page 26 of 37 Evidence: Information provided within AQAA completed by the Acting Manager told us that 85 of staff have attained a level 2 National Qualification in Care. We received four surveys from staff, all indicated that their induction partly provided the information they needed to know, whilst half of staff said their training was relevant to their role and helped them to understand and meet the needs of people with half indicating it was not sufficient. Three of the four surveys told us that training does not keep them up to date with new ways of working, and all surveys stated that training did not give them enough knowledge about health care and medication. At the previous Key Inspection which we carried out on the 15th January 2009, we made a requirement that staff were to receive training in the areas the home is registered to provide. Herrick Lodge is registered to provide care for people with Dementia, Sensory Impairment, Physical Disability and those with a Mental Disorder. We looked at the training records that we were provided with on the day of the site visit, and found that no staff have received training in any of these areas. The lack of training in these areas limits the understanding and awareness of staff in supporting people with different needs, placing people at risk. Information provided within the AQAA and information gathered from surveys we received from staff told us that the recruitment of staff is thorough, and includes the seeking of two references and a Criminal Record Bureau (CRB) disclosure, which ensures people employed are vetted to work with vulnerable adults. Care Homes for Older People Page 27 of 37 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Herrick Lodge is managed on a day to day basis, however the development of the home is hindered by the lack of stability and permanence within the management team. Evidence: Herrick Lodge continues to experience managerial difficulties with regards to a stable Management and senior staff team, which impacts on the homes ability to make the improvements which are required. The organisation is aware of these difficulties and is taking steps to address the issues, which includes Managerial and senior staff from other homes within the organisation providing support, and an acknowledgment that staff work development need to work closely with staff to provide them with the training they need, including improvements to verbal and written communication. Permanent strong leadership is required to stabilise the management of this service. The Team Manager is on site for a significant proportion of the week and has been since September 2009, to offer consistency at a senior staff level. The Team Manager Care Homes for Older People Page 28 of 37 Evidence: is qualified to ILM Level 5 and is currently undertaking a Leadership Course. Information in the AQAA told us that the Acting Manager and Assistant Manager have a qualification in management. We looked at training records and found no evidence that the Management Team had received any training for the current year, which impacts on their ability to keep up to date with good practice and develop the service they manage, this compromises their ability to meet ever changing needs of people who use the service. Herrick Lodge as part of its quality assurance process receives monthly visits from the organisations Regulation and Investigation Officer who monitors systems and records within the home, the two most recent visits have found there to be significant shortfalls, and that recommendations they have made to improve systems have not been acted upon, this is due to Managerial issues within the home, which the organisation tells us it is addressing. At the previous Key Inspection which we carried out on the 15th January 2009, we made a requirement that a system be developed for seeking the views of people who live at the home and their relatives, and that information gathered was used to develop a report which is shared with those involved and includes information as to how issues will be addressed to improve the quality of the service provided. We found that surveys had been sent to people in residence, but that these had not been collated to provide a report. The Assistant Manager told us that specific points are addressed on an individual basis but may not be recorded. We found that some information provided by the Acting Manager within AQAA, not to be accurate and found no reference to requirements we had made at the previous Key Inspection. Training had been identified as an area for improvement, but did not detail the training identified. We sent surveys to staff who told us that their Manager does not meet with them on a regular basis to talk to them about how they are working, and that staff feel unsupported by the Management Team. Surveys from staff included additional comments which included:The management and senior staff dont respect or show understanding towards us as they continually leave us understaffed. We dont have enough time to read the care plans of residents. The management and senior staff do not listen to our views. The management and senior staff are impolite they are not well organised well enough which affects the carers work as we are often become understaffed. Care Homes for Older People Page 29 of 37 Evidence: We asked to look at the minutes of staff meetings, none were provided to us, but we were told that a staff meeting took place in September 2009, and was attended by Senior Management to outline the improvements the home needed to make to improve the quality of lives of people in residence, Senior Managers told us that staff were enthusiastic about changes to the way they work. We found no evidence of other staff meetings prior or subsequent to this. We found shortfalls in record keeping which included information contained within care plans and risk assessments. Daily records were not comprehensive and the recording systems for complaints and safeguarding events were not robust, this leaves people in residence and the home at risk. Information provided by the Acting Manager in the self assessment tool told us that systems in the home such as central heating and fire appliances are well maintained. Care Homes for Older People Page 30 of 37 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 30 18 The registered person to develop a training plan, reflective of the registration categories the home is registered to provide. Care provided to people living at the home is delivered by competent and knowledgeable staff who can meet indivdual needs. 17/04/2009 Care Homes for Older People Page 31 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person shall 03/02/2010 ensure that the care and support people receive is reflective of their needs and is recorded within an accurate and up to date care plan which is regularly reviewed, and whose contents is influenced by the person themselves and / or their representative. To ensure that the care and support provided promotes the health and well-being of the person and takes into account their wishes and views. 2 7 13 The registered person shall ensure that areas of risk are identified and that an assessment of that risk is carried out and the risk assessment is regularly reviewed, dated and signed. To ensure and promote the 03/02/2010 Care Homes for Older People Page 32 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action health and safety of people who use the service by the carrying out or risk assessments that manage and reduce risk. 3 18 13 The registered person to ensure that all staff have a good understanding as to their role and responsibility in safeguarding people from abuse, and know their role in referring safeguarding issues and that their role and responsibilities are supported by a procedure. To ensure that people using the service are protected from abuse and that issues are managed well and effectively to ensure a positive outcome for people. 4 30 18 The Registered Person to 03/02/2010 ensure that staff responsible for the carrying out of risk assessments receive training and that the training includes having their competence assessed to carry out such tasks. To promote the well-being of people using the service and to ensure that risks are minimised and managed well. 03/02/2010 Care Homes for Older People Page 33 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 5 30 18 The registered person to 03/02/2010 develop a training plan to be delivered to all staff that enables them to provide care and support to those service users whose need the home is registered to provide, training which is specific but not necessarily limited to Old Age, Mental Disorder, Sensory Impairment, Physical Disability and Dementia. To promote the well-being of people using the service and who are cared for by staff who are knowledgeable and trained to do so. 6 33 24 The registered person to 03/02/2010 develop a quality assurance system, which seeks the views of people who use the service and significant others, and views expressed are collated and a report produced which details the outcome of the quality assurance process that includes the plans the home intends to take to address the issues raised. The outcome of the quality assurance process is shared with all interested parties. To provide an opportunity Care Homes for Older People Page 34 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action for people who use the service and their representatives to express their views and influence the day to day management of the home and the service they received. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 People who reside at Herrick Lodge are asked if they wish to manage any aspect of their medication, and that risk assessments are carried out to support them with this task. Information provided within care plans as to peoples cultural needs, including religious needs to be improved so that staff have a clear understanding as to the support each person requires, and how their cultural needs affect them on a day to day basis. Staff who are responsible for the provision of activities receive training and guidance which enables them to provide activities reflective of the needs and wishes of people residing at Herrick Lodge. Herrick Lodge employs an activities organiser who has received training relevant to the needs of those in residence. The current system of serving meals be reviewed to provide people with the opportunity to serve themselves and promote independence and choice. The dining experience of people in residence be reviewed with regards to reducing the current institutional style impact on people by creating a homely and pleasant environment. Herrick Lodge to ensure that everyone residing at the home and their relatives are aware of the homes complaint procedure, and that peoples understanding of the Page 35 of 37 2 12 3 12 4 12 5 15 6 15 7 16 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations procedures is ascertained. 8 18 Managerial and Senior Staff receive training and guidance in the Mental Capacity Act and Deprivation of Liberty Safeguards. Planned improvements to the environment consider and reflect good practice and research in the care of people with Dementia. Developmental training programme is put into place for the Management Team reflective of good practice that will influence the development of the service. 9 19 10 31 Care Homes for Older People Page 36 of 37 Helpline: 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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