Care Home: Howard Lodge

Similar services:

• Claremont House
• Oak Ridge
• Sun Court Nursing Home
• Ashville House
• Bilney Hall
• Hill Barn
• Mabbs Hall Nursing Home
• Henrietta House

What the care home does well Residents spoken with felt satisfied with the standard of care they received at Howard Lodge and all those who completed surveys with staff felt that staff listened to them and acted on what they said. Relatives also commented positively about the care provided, for example "is very well cared for here" or "it is excellent here, we are very satisfied with the care". Compliments received by the manager included thanks for "love, care and professionalism that you showed". Residents, relatives and health professionals told us that people`s health is monitored and advice sought to promote this. One health professional commented "care for their clients to the best of their ability" and another said "they make service users feel at home and enhance their sense of belonging". Discussion with residents indicated that they were satisfied with the food and all comments received were complimentary about the quality and quantities of food served. Residents were offered choices of drinks, including tea or coffee, as part of everyday practice. Howard Lodge provides a clean and homely environment for the people who live there. Residents said their rooms were comfortable, they had been able to bring keepsakes and other items to make them homely, and that they enjoyed the accessible patio and garden areas. Several relatives spoke of how clean the home is and also that there are never any unpleasant odours. One survey said "the home is always spotlessly clean". Residents and relatives spoken with also spoke positively about the staff and said things such as "the staff are nice" or "the staff are friendly and responsive and check in on (resident) regularly and are very good at keeping us informed or getting the GP if necessary". There is a low turnover of staff at Howard Lodge, with many staff having worked at the home for a number of years, so offering continuity of care and familiar faces for residents and relatives. Visitors spoken with told us that they always feel welcome at Howard Lodge. All those spoken with said that the staff and management team are approachable and that they would be able to tell them if they had any concerns or complaints. What has improved since the last inspection? There has been decoration and refurbishment of a number of resident bedrooms as well as some of the communal areas to enhance the environment for residents. The needs of people living with dementia are being more carefully considered in some ways. Large print name signs have been put on each residents` bedroom door and signs indicate other rooms to help residents with a sight impairment or those living with dementia to recognise rooms and find their way about more easily. The service user guide and statement of purpose have been updated so that people planning to or using the service have access to current information about the home. Other improvements to give people more information or help them to remember things include having a photograph and name of the person`s key worker in each resident`s bedroom and the name and photograph of all the members of staff displayed in thefoyer. Care plans are being developed and written from a person centered approach which shows respect for the individual resident and identifies more clearly their individual abilities, needs and wishes. This would give staff more information on how to provide care and support to each person on a daily basis in the best way for them. The manager told us that regular events of outside entertainment have been booked for the coming year. A new summer house has been built in the garden and has been decorated and fitted with memorabilia to provide a nice place to sit in the summer and allow residents with dementia to be able to use it "as if it was their own place". The deputy manager has trained as a trainer in subjects such as moving and handling and adult abuse. This enables staff to receive training on these subjects soon after starting or as updates are required, so their knowledge and skills remain current to meeting residents needs in the areas. What the care home could do better: Residents should be given a copy of their contract or a statement of terms and conditions so they have information on their rights and responsibilities while living at Howard Lodge. The way that information is written in each person`s care records needs to be given better attention, so that it is a true reflection of their plan and the care actually given, is accurate and up-to-date and has not become repetitive and disinterested. The assessment of risks for equipment such as bedrails needs more detail to ensure that people`s safety and well being are promoted. A survey from a relative suggested that one way the home could improve would be to "possibly spend a little more time interacting with the residents". As the home is registered to provide care to people living with dementia, all staff should be given a good standard of training on the condition so that they are well equipped to meet the needs of the residents in all aspects of care and support. All staff should have opportunity to attend regular fire drills and practices to keep their skills up to date to promote the safety of all at the home. Recruitment formats should be reviewed to ensure they capture all the required information and are dated, to clearly show that robust recruitment procedures are in place to safeguard residents of Howard Lodge. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Howard Lodge Howard Lodge Road Dudbrook Brentwood Essex CM14 5TQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Bernadette Little     Date: 1 2 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 31 Information about the care home Name of care home: Address: Howard Lodge Howard Lodge Road Dudbrook Brentwood Essex CM14 5TQ 01277373603 01277375090 pat.ryland@btconnect.com 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) : St Michaels Homes Limited care home 44 Number of places (if applicable): Under 65 Over 65 0 44 dementia old age, not falling within any other category Additional conditions: 44 0 The maximum number of service users who can be accommodated is 44 The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Howard Lodge is a large established care home providing personal care and accommodation for 44 older people including those who have dementia. It is privately owned and the providers have another home in the same area. It is a purpose built home providing single occupancy rooms on two floor levels. Some of the bedrooms have en-suite facilities and others have small conservatories attached. The ground floor bedrooms with conservatories lead out to the large pleasant gardens. There is a passenger lift access to the upper floors. Communal accommodation Care Homes for Older People Page 4 of 31 Brief description of the care home consists of a choice of lounges, a quiet room, two dining rooms and a small chapel. The home is situated in a rural location with the nearest bus route, approximately one mile away. There is a large attractive garden for the resident use. Most of the downstairs rooms lead directly into this area. There is ample car parking to the front and rear of the property. A brochure, statement of purpose and service user guide with information about the home are available form the manager. The current rate of fees, as advised by the manager, range from 520 pounds to 600 pounds per week and there are additional charges for hairdressing, chiropody, newspapers and toiletries. Care Homes for Older People Page 5 of 31 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: two star good 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: The last key inspection of Howard Lodge was undertaken on 30th April 2007. An Annual Review of the service was undertaken in April 2008 that identified that we had enough information to judge that the home continued to offer good care outcomes to people using the service. This key inspection site visit was undertaken over an eight and a half hour period on one day. Time was spent with residents, visitors and staff and information gathered from these conversations as well as from observations of daily life and practices at the home have been taken into account in the writing of this report. A tour of the premises was undertaken and records, policies and procedures were sampled. Care Homes for Older People Page 6 of 31 The manager submitted an Annual Quality Assurance Assessment (AQAA) as required prior to the site visit. This is to detail their assessment of what they do well, what has improved and what they plan to do better. The AQAA contained a satisfactory level of information that was considered as part of the inspection process. Prior to the site visit, we sent the manager a variety of surveys to distribute to residents, relatives, staff, care managers and health professionals. Subsequent to the site visit, surveys were received from seven residents, the majority of whom had been helped by staff to complete them, six staff, four relatives and three health professionals. The information provided and comments made are included in this report. The manager was present during the site visit along with the deputy manager and both assisted with the inspection process. The outcomes of the site visit were fed back and discussed with the manager and deputy manager and opportunity given for clarification where necessary. The assistance provided by all those involved in this inspection process is appreciated. What the care home does well: What has improved since the last inspection? There has been decoration and refurbishment of a number of resident bedrooms as well as some of the communal areas to enhance the environment for residents. The needs of people living with dementia are being more carefully considered in some ways. Large print name signs have been put on each residents bedroom door and signs indicate other rooms to help residents with a sight impairment or those living with dementia to recognise rooms and find their way about more easily. The service user guide and statement of purpose have been updated so that people planning to or using the service have access to current information about the home. Other improvements to give people more information or help them to remember things include having a photograph and name of the persons key worker in each residents bedroom and the name and photograph of all the members of staff displayed in the Care Homes for Older People Page 8 of 31 foyer. Care plans are being developed and written from a person centered approach which shows respect for the individual resident and identifies more clearly their individual abilities, needs and wishes. This would give staff more information on how to provide care and support to each person on a daily basis in the best way for them. The manager told us that regular events of outside entertainment have been booked for the coming year. A new summer house has been built in the garden and has been decorated and fitted with memorabilia to provide a nice place to sit in the summer and allow residents with dementia to be able to use it as if it was their own place. The deputy manager has trained as a trainer in subjects such as moving and handling and adult abuse. This enables staff to receive training on these subjects soon after starting or as updates are required, so their knowledge and skills remain current to meeting residents needs in the areas. What they could do better: 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 set out 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 31 Care Homes for Older People Page 10 of 31 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 11 of 31 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. People thinking of living at Howard Lodge will have their needs assessed to determine if they can be met there and they will be given information on which to base their decision. Evidence: The statement of purpose and service user guide had been updated as required in the last inspection report. While they contained information that Howard Lodge offers care for people with dementia, there was limited information on how this is achieved, such as the good practice seen in relation to providing pictures of staff so that people know who was on duty or the use of signage to help residents with orientation. The service user guide could be in larger print and use symbols to make it easier for people using the service to read and understand. The manager stated that a brochure and additional information are sent out to all Care Homes for Older People Page 12 of 31 Evidence: enquirers and that people are welcome to visit the home. The manager confirmed the information in their AQAA that the service user guide is given to people on or just after admission and a copy is available in everybodys bedroom. Best practice advice was given on sending the document to prospective residents or giving it to people at the time of pre-admission assessment and recording this on the assessment documentation. This would ensure that that people have the full information about the service on which to base a decision to live there. All the surveys received from residents, who were supported by staff to complete them, stated that they did not know if they had received a contract or enough information about the home before they moved in, or could not remember. Surveys from relatives indicated they felt they were provided with enough information about the care home to help them make decisions. The manager stated that a member of the management team at Howard Lodge or a representative of the company would always undertake an assessment of needs prior to admission that would enable them to ensure they could provide the right care for that person. Documentation was reviewed for two more recently admitted people and contained satisfactory basic information on the persons needs. These documents were not signed and dated by the person undertaking the assessment to evidence that they had been completed prior to admission and the manager was recommended to review this. Supplementary information was available from one persons placing authority. The manager stated that they do not write to the prospective resident as required, to confirm that, based on their assessment, the home can meet the persons needs, but will now implement this practice. In their AQAA, the manager states each resident received a written contract and a copy of the homes terms and conditions. The file of one resident on private funding reviewed contained a copy of their contract. The file of the other person, on local authority funding, did not contain a contract or statement of terms and conditions. This should be reviewed and all residents provided with information on their rights and responsibilities whilst living at Howard Lodge. Intermediate care is not offered at Howard Lodge. Care Homes for Older People Page 13 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, residents can expect their care and health needs to be met, their medication to be safely managed and their privacy and dignity to be respected. Evidence: All the residents spoken with said that they were satisfied with the care provided to them at Howard Lodge with comments such as I am well cared for here and the care here is as good as it is anywhere. All surveys received from relatives confirmed they felt the home met the needs of the residents, gives them the support expected, met peoples differing needs, kept relatives updated and that care staff had the right skills and experience to look after residents properly. Comments included the care and service are very good the residents are always well dressed and cared for and very good communication. Care plans were reviewed for four residents and were found to vary in the quality of the information provided to staff on how to provide care to individuals. Baseline assessments were in place such as for tissue viability, falls and moving and handling Care Homes for Older People Page 14 of 31 Evidence: but were not always updated. Care plans included the persons likes and dislikes such as times for going to bed and getting up, which is good practice. However they were not signed by the residents or their representative. As it was clear that some residents would be able to participate in this process, practice should be reviewed. The last inspection report identified a need for care plans to be updated following review. Care plans viewed on this occasion continued not to be rewritten to clearly show the current care needs of the person without having to cross reference with the review information. This was discussed in detail with the manager and deputy manager. Daily care records sampled were repetitive, did not best reflect the plan of care to support monitoring of its effectiveness. The manager advised that a new person centered approach to care planning was being introduced and some had been completed. One of these was viewed and was clearly a noted improvement in supporting positive care outcomes of people living at Howard Lodge. It was recommended to this continue to include all resident care plans and that these be rewritten as necessary following each review. Some care plans looked at contained a consent for a bed rails form to be signed by relatives, although there was no clear assessment to indicate that this was the most appropriate action. The deputy manager was aware that a full assessment should have been in place taking into account relevant factors and this should have been done in conjunction with health professionals. The manager confirmed that this will be undertaken. Care documentation sampled indicated that residents are supported to access health care services such as GP, district nurse, optician and chiropodist. The manager stated that the GP surgery used is very supportive and that doctors come in and out as required to see residents. Surveys were received from three health professionals who visit Howard Lodge. These confirm that advise is sought and acted to manage and improve residents health-care needs, that residents privacy and dignity is respected and that care staff have appropriate skills and experience to support peoples individual social and health care needs. Residents and relatives spoken with confirmed that residents health care needs are well supported at Howard Lodge. Medication storage and a sample of records and medicines were reviewed and found to be well organised and managed. And up-to-date signatory list was available to show the signatures of staff deemed competent by the manager to administer medication. Staff confirmed regular training and competence assessments, that would be reviewed in the upcoming annual appraisal. Entries sampled in the controlled drugs register were appropriately maintained and tallied with the remaining medicines. Senior staff spoken with were clear that should any resident begin to refuse medications the GP would be contacted within 48 hours for support and advice on ensuring the persons well-being. Care Homes for Older People Page 15 of 31 Evidence: Residents spoken with confirmed that their privacy and dignity were respected by the staff at Howard Lodge. They confirmed that staff knock on doors and wait for a response before entering and that doors are closed while personal care is being undertaken. Staff spoke to residents in a courteous manner and allowed them opportunity to respond and be listened to. Residents confirmed that they could spend time alone in their room as they choose and this was noted in a care plan sampled. A resident said staff talk to you nicely, like you are a person, not like you are an inmate. Care Homes for Older People Page 16 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents of Howard Lodge can expect to experience a generally fulfilling lifestyle led by their abilities and choices, and to enjoy a varied menu. Evidence: Residents spoken with were generally satisfied with the opportunities provided and a few explained that they preferred to spend time in their room, and that was their choice which was respected. Other people advised of being able to go for a walk in the garden whenever they chose, or sitting in the lounge or out on the patio to read the newspaper, watching wildlife in the garden or watching football on television. Life histories are generally completed for each person based on the availability at of information from residents and relatives. Care plans viewed varied in the quality of the information provided for staff on how each persons individual social or religious care needs were to be met in practice. The managers AQAA states that funds are limited for the purpose of activities and in house entertainment. An activities person is employed for two hours on two afternoons per week. The remaining time care staff are responsible for ensuring that residents have appropriate meaningful stimulation and are supported to follow personal interests Care Homes for Older People Page 17 of 31 Evidence: and activities. Notice boards outside lounges in different areas showed at least one activity for each day and these included group and individual activities. These included exercises, musical instruments, or bingo. A resident in the higher dependency lounge showed us their nail varnish and their facial expressions indicated pleasure at this. Residents were seen to be actively involved in a singalong led by care staff, or in individual short walks in the garden with a member of staff. Outside entertainers are booked routinely during the year and residents spoken with said they enjoyed these. The staff team also arranged other experiences for residents such as twice-weekly sessions with pat-a-dog. There are regular church services and also volunteers from the church visit and support residents with craft and social activities. The manager advised that 12 residents are going on an outing next week to a variety show which has been organised by resident relatives. Some residents go out with their family and friends and all residents spoken with felt that their visitors were welcomed. All visitors spoken with confirmed that they always felt welcome at Howard Lodge. Residents spoken with confirmed that they were able to make choices, for example about where to spend their time, what to wear, times for going to bed and getting up and whether or not to join in arranged social activities. A resident told us I go to bed when I feel like it, its never an issue. Another resident told us I can do as I please. To support more active choice for residents, information on activities available could be produced in a clearer format and be more readily available to them. They should also be considered in relation to menus on a daily basis so that more residents know, or can be helped to understand in suitable format, what choices they actually have. The manager stated that they no longer cook meals on the premises, but instead use a food delivery catering service that provides main meals and specific ovens to cook these in. Staff spoken with said that people are offered the choice of main meal the day before, however the manager said they are asked for their choice each day, and that additionally the kitchen can provide alternatives such as omelettes and jacket potatoes. The menu did show a choice of main meal, was in small print and not displayed or available on dining tables for residents. Residents spoken with said they did not know what was for lunch there is no menu available and it is a surprise every day. Ample food stocks were available to support a choice of items such as for hot and cold snacks, breakfasts and drinks. It was noted positively that tea and coffee are included on the drinks trolley and residents are routinely offered the choice. A member of staff said we always ask them what they would like and also how many sugars they take, even though we probably already know. Records of food served noted amounts of Care Homes for Older People Page 18 of 31 Evidence: food eaten. Residents are weighed routinely as part of care monitoring. The managers AQAA explains that should a resident be deemed at nutritional risk, they are moved to the smaller lounge/dining room where they are offered additional monitoring and support with meals. All residents spoken with and able to express a view told us they were satisfied with the food served with comments such as the food is very nice, or the food is lovely here. Care Homes for Older People Page 19 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect their complaints to be listened to and acted upon, and to be safeguarded by the knowledge and competence of staff. Evidence: The complaints procedure is displayed in the foyer and had the current contact information for the Care Quality Commission. It also included information on contacting social services. The complaints procedure includes timescales so people know what to expect and when. Information on the complaints procedure is included in the service user guide. A number of letters and cards of thanks and compliment had been received by the manager and were readily available and shared with staff. A logging system for complaints was available that showed two recent informal complaints from residents about the food, for example insufficient meat in the pie. Records showed these to have been responded to promptly, monitored by the manager and action taken to report this to the food/catering delivery service. Residents and visitors spoken with were clear that they would know how to raise a concern or a complaint and that they felt comfortable to do so at Howard Lodge. This was also confirmed in all of the surveys received from service users and relatives. Comments included the home is always very helpful if we have any concerns. Care Homes for Older People Page 20 of 31 Evidence: One safeguarding referral had been made regarding Howard Lodge in the past year. Documentation relating to this showed that the management at the home had been open and assisted with the process. Outcomes of the investigation identified clearly that there was no safeguarding issue to be pursued and that the home had acted appropriately in the residents care. The deputy manager has undertaken a train the trainer course on adult abuse and so is now to deliver training to staff as required. A number of staff, including the manager had certificates on file to evidence they had recently attended training provided by the safeguarding team at Essex County Council. The manager advised that this included The Mental Capacity Act and Deprivation of Liberty Safeguards, the signs and symptoms of abuse, what action to take and how to keep good evidence. The manager did not have access to the current local guidance, protocols, formats and up-to-date contact details. They were recommended to access these, as while they were clear they would take appropriate action and report it, they were unclear as to who they would report it to and how they could be contacted. Surveys received from staff confirmed that they would know how to respond if a concern was raised with them. A clear whistleblowing procedure was available. Three staff spoken with confirmed they had received training on safeguarding vulnerable people, were aware of whistleblowing and demonstrated confidence in taking steps to report any inappropriate practice to the manager or the registered provider to safeguard residents. Care Homes for Older People Page 21 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is clean, comfortable, generally safe and meets their needs. Evidence: Howard Lodge is set in a rural area in beautiful grounds. All areas of the home were toured, including residents communal areas, bathrooms, kitchen and laundry, and some residents bedrooms were viewed. A generally good standard of decoration and maintenance was observed. A full-time maintenance person is employed. The manager advised that resident rooms are decorated as they become vacant and their AQAA states that several have been redecorated, refurbished and recarpeted since the last inspection. The manager advised that a small number of rooms have not yet been redecorated as some long-term residents are now cared for permanently there and it is not in their best interests to move them to a different and temporary place. Communal rooms were homely and comfortably furnished and there are different lounges and dining areas. New televisions, music centre and standard lamps have been provided recently to help to improve the ambience. People living at the home have access to a patio area around the building which has a shading roof and tables and chairs. This leads on to a beautiful garden, there is a pond and fountain as well as a secure garden area. Some residents spoken with said that they regularly use the garden, to go for a walk or to sit on the patio and read the paper. A new summerhouse Care Homes for Older People Page 22 of 31 Evidence: has recently been erected, and fitted with memorabilia to be a pleasant experience particularly for people living with dementia. Bedrooms were individually personalised and pleasant. The managers AQAA states Residents can bring their own furniture as they wish and they are encouraged to personalise their own room with pictures or other items. This was seen in practice and residents spoken with confirmed that they were comfortable and satisfied with their rooms. Large print name signs have been placed on individuals bedroom doors to enable those with sight impairment and residents with dementia to find their own rooms. Signs were also noted on other rooms to support orientation. Residents spoken with confirmed they could lock their own door to promote privacy and dignity. In comparison to the rest of the home, bathrooms were disappointing and presented as cold, institutional and tired. All areas of the home, including the kitchen and laundry were seen to be clean and well organised. The manager was recommended to review safe storage of latex gloves throughout the home as they can present a potential choking hazard to vulnerable people. Laundry staff were aware of infection control procedures and staff confirmed that they had appropriate equipment including red bags and machines fitted with sluice facilities. There were no unpleasant odours found at any time during the day. Residents and visitors spoken with confirmed that the home is always clean and odour free. One person advised that the pleasant smell of the home the first time they walked through the door was a major influence in their decision to choose Howard Lodge, and had always continued to be the case. Care Homes for Older People Page 23 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to be supported by a stable and friendly staff group, who are adequately recruited and trained. Evidence: Comments received from residents and visitors either through conversations or surveys were positive regarding the care staff at Howard Lodge and included staff are kind and caring. Staff have designated areas of work each shift so they are clear on their role and were observed to work effectively and calmly as a team in supporting residents. There has been little turnover of staff, with many staff being in post for several years, so offering continuity of care for residents. The Manager advised that for the current 39 residents, care staffing levels are eight during the morning shift, five during the afternoon and three at night, including seniors each shift. Additionally the manager and/or deputy manager are available on site between 7am and 7pm on weekdays. Ancillary staff are also provided including housekeepers, laundry and kitchen staff. Residents and visitors spoken with, and information in surveys, confirmed that there are adequate staff to meet their needs and that staff respond promptly to requests for assistance. The report of the last key inspection identified that the management did not evidence Care Homes for Older People Page 24 of 31 Evidence: a robust recruitment procedure. Files were reviewed at this site visit for two staff to assess if appropriate information, references and checks had been undertaken prior to recruitment to ensure the prospective staff are suitable people to care for the residents at Howard Lodge. The recruitment process demonstrated was adequate. The manager was recommended to improve the format of the application form for gathering information on employment history and reason for leaving, ensuring all documents were dated to evidence they were in place prior to employment and to ensure that a detailed record is made if PovaFirst checks are received by telephone. Two staff files sampled evidenced that staff were provided with an induction to Skills for Care standards. They also included evidence of basic training such as moving and handling, safeguarding, health and safety, food hygiene and dignity. All surveys received from staff and discussions during the site visit confirmed they felt their induction covered everything they needed to know to do the job when they started and that they were being given training which is relevant to their role, helped them to meet and understand the individual needs of the residents and kept them up to date with new ways of working. Information from surveys and discussions with staff confirmed that there are regular staff meetings, formal supervision and annual appraisal to ensure good communication and support staff. Comments from staff surveys included good communication in all aspects of the service and friendly environment and good team, good communication with relatives. The deputy manager is a qualified trainer in moving and handling, safeguarding, health and safety and NVQ assessing, enabling staff to receive training in these areas as it is required. The manager had a training matrix in place to support effective planning and management of staff training. It identified that the majority of staff had up-to-date training in issues relevant to their role such as medication, moving and handling, health and safety, infection control, safeguarding and first aid. The manager advised that 25 per cent of staff have attained either NVQ level 2 or 3. Some staff are currently undertaking this training, but the home are having difficulty obtaining funding, which is limiting their ability to achieve higher levels of NVQ trained staff. Various staff had also attended training on conditions relevant to older people such as oral hygiene, diabetes, tissue viability, falls management, continence management and Parkinsons disease. It was advised that some staff have had training on dementia care and management of challenging behaviour by the registered provider who is not a qualified trainer. It is recommended that, as the home is registered to provide care for people with dementia and the manager confirmed that many of the residents at the home have this condition, all staff are provided with effective training on this condition. Care Homes for Older People Page 25 of 31 Care Homes for Older People Page 26 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents of Howard Lodge can expect to find a home that is generally well run and provides positive outcomes for them. Evidence: The manager has been in post at Howard Lodge for almost three years and had previous experience in managing care homes. The manager had achieved NVQ level 4, Registered Managers Award and is supported by an experienced deputy manager. The AQAA confirms they both have recently attended training on The Mental Capacity Act and Deprivation of Liberty Safeguards so that they are aware current good practice. Residents, visitors and staff spoken with confirmed that the management team are approachable and supportive and that there is good communication. A quality assurance system is in place that includes obtaining the views of residents and relatives about the quality of the care provided at Howard Lodge. Surveys are sent out annually and an action plan developed from any issues raised. Residents meetings Care Homes for Older People Page 27 of 31 Evidence: are also used as ways of gathering residents views. Relatives are written to annually, informing them of the current plan of care in place for the resident and requesting their comments and views. It was not identified that residents agreement had been sought for this, where it was possible to obtain. The registered provider undertakes detailed monthly audits and reports of the home as required to reassure themselves that the home is operating as it should. The monthly monitoring of accidents/falls was recommended to include place and time to identify trends and support preventative care. The management of the home did not look after any personal money on behalf of the people living there. Relatives are invoiced routinely for such items as hairdressing or chiropody services. Findings of the review of records are included throughout this report and indicate that some records need to be improved including care plans and daily care notes. Records were seen to be safely stored to promote confidentiality. The manager completed the AQAA and returned it to us when requested as the information was generally informative. A sample of records of routine safety checks were requested to ensure a safe environment was maintained for residents and staff. Safety inspection certificates were available relating the fire alarm, fire equipment, gas and passenger lift. Checks of water temperatures were not up-to-date. A format to record three monthly fire drills and initial fire training for each member of staff was available that indicated that some staff had attended two fire drills while other staff were not recorded as having opportunity to attend any and needs to be more effectively managed. The managers AQAA confirms that policies and procedures and home risk assessments are reviewed annually. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 29 of 31 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 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 2 All residents of Howard Lodge should be provided with a copy of their contract or a statement of terms and conditions. The person centred approach to care planning should be applied to all care plans and the quality of the recording in care documentation, including reviews, risk assessment and daily care notes should be monitored regularly for quality and accuracy. The manager should review their staff recruitment formats to ensure they are supportive to gathering and evidencing all the required information and ensure that all documents are dated. All staff should be provided with training on dementia care and fire drill practices and at least 50 per cent of staff should achieve NVQ level 2 or above. 2 7 3 29 4 30 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!