Care Home: Minchenden Lodge

What the care home does well Minchendon Lodge has a friendly and supportive atmosphere. The manager and staff are committed to providing an excellent level of care to all residents. The staff understand the needs of individual residents and work hard to meet these needs in a way that respects their privacy and dignity. The home is decorated and furnished to a very good standard. Residents are encouraged to be as independent as they wish and are able to have a say in how the home is run. The manager of the home is professional and committed to providing a caring and supportive environment. Staff are appropriately trained for the work they carry out. One person who uses the service said, "If I`ve got to be in a home this is the one. It`s not a home, it`s my home". What has improved since the last inspection? Two requirements and five good practice recommendations were issued at the last key inspection in July 2007. The registered person has now complied with all of these requirements and recommendations. As a result of this; The procedure for administering medication to residents has improved. The recruitment procedures are now more robust. Access for residents with physical disabilities has improved. The home`s brochure now has a clear statement on equality and diversity within the home and residents have more of a say in how their care is being delivered. What the care home could do better: As a result of this inspection we have made two good practice recommendations that relate to fire safety at the home. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Minchenden Lodge Blagdens Lane Southgate London N14 6DD     The quality rating for this care home is:   three star excellent 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: David Hastings     Date: 0 9 0 6 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 25 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 25 Information about the care home Name of care home: Address: Minchenden Lodge Blagdens Lane Southgate London N14 6DD 02088861222 02088861299 minchendenlodge@scimitarcare.co.uk 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) : Scimitar Care Hotels Plc care home 25 Number of places (if applicable): Under 65 Over 65 4 21 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 0 Scimitar Care Hotels PLC owns Minchenden Lodge. The company owns a number of other homes in the North London area. Minchenden Lodge is a long established home in a residential part of Southgate. There is easy access to public transport and shops. The home now has twenty-one single rooms and no longer has double rooms. The home is registered to care for twenty-five older people but this is no longer relevant given the new changes to the double rooms. The home has a condition on the registration that allows the home to admit up to four people with a diagnosis of dementia. The home aims to provide personal care only for older people. The aim of the home is to deliver good quality care in comfortable surroundings ensuring that service users needs are met as individually as possible. Fees are between six hundred pounds and eight hundred pounds per week. This report is available through the internet. Copies may also be obtained from the provider of this service. Care Homes for Older People Page 4 of 25 Brief description of the care home Care Homes for Older People Page 5 of 25 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: three star excellent 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: This Key Unannounced inspection took place on Tuesday 9th June 2009 and was completed on the same day. The inspection lasted six and a half hours. We spoke with nine staff on duty during the inspection. We spoke with eleven residents of the home and we met two visitors. We observed the interactions between staff and residents. We inspected the building and examined various care records as well as a number of policies and procedures. The home also prepared a self-assessment (AQAA) and this was submitted to the Commission. This information was used as part of the inspection. Care Homes for Older People Page 6 of 25 What the care home does well: What has improved since the last inspection? 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 7 of 25 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 8 of 25 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. Prospective residents have accurate information about the home in order to make an informed choice about where to live. The home carries out an assessment of individuals needs so that they know that the home is able to meet their needs before they decide to move in on a trial basis. Evidence: We examined the homes Service User Guide. This document describes the aims and objectives of the home and the facilities available to people coming into the home. This document also informs social workers looking for placements for people. The document has been updated and contained clear information to prospective residents about what services are available as well as the aims and objectives of the home. There is a clear statement that people with moderate or severe dementia cannot be supported at the home. This document also clearly describes how the needs of people from different backgrounds and cultures will be met. Care Homes for Older People Page 9 of 25 Evidence: Pre admission assessments were examined for three people who are now living at the home. The information was satisfactory and clearly outlined each persons individual needs. There was evidence that these identified needs were also being recorded in each persons individual care plan. People who use the service and their relatives told us that they were involved in this assessment process and, where possible, had visited the home before moving in on a trial basis. Most people we spoke with told us that the home had been highly recommended to them by someone who had used or was using the service. We also saw evidence that people have a review of their placement after 4-6 weeks to see if they would like to stay at the home on a permanent basis. Care Homes for Older People Page 10 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans clearly set out residents health, personal and social care needs so that staff know how best to support everyone at the home. Residents have good access to health care professionals and they are treated with respect. Residents get the medication they require, at the right times and by appropriately trained staff. Evidence: Six care plans were examined. Each plan gave clear instructions to staff about how best to care for each person. All care plans covered the physical, emotional and cultural needs of the individual. Care plans also contained a social history of the individual resident. Care plans were being reviewed on a regular basis and updated where needed. There was evidence that people were being asked what they thought about their own care plans and records were being maintained about the residents views about the quality of the care being delivered. It is a positive reflection of the quality of care being delivered that a number of residents care plans detailed improvements to the persons health and well being. For example a number of people Care Homes for Older People Page 11 of 25 Evidence: had been admitted with specific problems around poor diet. Reviewed care plans showed that these residents appetite and nutritional intake had improved since being at the home. It was clear from observing staff interactions with residents that staff knew the residents well and treated them as unique individuals. Each persons plan of care included an assessment of the risk of falling and how staff are to reduce this risk, for example, having two staff to help with personal care tasks or by supervising the resident when they walk around the home. There were other risk assessments seen in each persons file, including manual handling, pressure care, nutrition and other risks associated with dementia. All these were being reviewed on a regular basis. There was evidence from care plans that people have good access to health care professionals such as doctors, chiropodists, district nurses and opticians. People who use the service confirmed that they had good access to health care professionals. A doctor visits the home every week and most people are registered with this practice however some residents have chosen to keep their own doctor. On the day of the inspection people using the service looked well cared for, their clothes were clean and they were appropriately dressed. Satisfactory records were examined in relation to the receipt, storage, administration and disposal of medication. Records indicated that staff have undertaken medication training and only qualified staff administer medication at the home. Each persons medication chart has a picture of them attached to it so that staff can double check who is receiving the right medication. We saw a number of examples of supportive staff interactions with people and staff were able to describe to us how they ensure the privacy of people they support. We saw staff knocking on residents bedroom doors before entering. People we spoke with told us that the staff were respectful and kind towards them. A resident told us, Im treated with great respect. Care Homes for Older People Page 12 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides varied activities for people who use the service in order to keep them suitably occupied and engaged. Visitors to the home are encouraged and welcomed. Residents are able to exercise choice and control over their lives. The home provides people with a wholesome appealing balanced diet. Evidence: The home now has a full time activities coordinator post. This is shared by two people. Both staff and residents were very positive about the quality of activities now available at the home. The activities coordinator understood the need to not only engage with residents in groups but also on a one to one basis. One resident told us that activities at the home were, Very good. We get mental and physical activities. Residents individual social and recreational interests were recorded in the six care plans we sampled. Visitors to the home told us that they could visit at any reasonable time and that they Care Homes for Older People Page 13 of 25 Evidence: were made welcome by the management and staff. Residents we spoke with said they enjoyed getting visitors and confirmed they were made welcome. Interactions observed between staff and visitors were warm and friendly. One relative we spoke with said they thought the care provided at the home was, Wonderful. Another visitor said, I really like the ethos of the home. Visitors told us that the home always kept them updated about how their relative was doing. The home holds regular residents meetings and residents we spoke with gave us examples of how things had changed as a result of these meetings. One resident told us, Its up to us what we bring up. Records of these meetings were being maintained with examples of follow up action taken as a result of residents suggestions and comments. Staff we interviewed were able to give us practical examples of how they offer choice to people living at the home. We saw examples of staff offering choice in relation to meals and activities during the inspection. People who use the service confirmed that they could exercise choice and control over their lives. One resident told us, You can get up and go to bed when you please. On the day of the inspection we were pleased to see that a few residents were having a lie in and this did not seem unusual. The kitchen assistant told us that people could have breakfast in their rooms or in the dining room. On the day of the inspection the kitchen was clean and well stocked with fresh fruit and vegetables. The cook was aware of any special diets that people needed and told us that cakes would be provided for residents birthdays. Fridge and freezer temperatures were being recorded. We looked at the menu and saw that a choice of lunch is always available. Lunch on the day of the inspection was chicken or baked trout. The food looked and smelt appetising and people told us they get enough to eat. One resident confirmed, its good grub, another resident told us the food was, Very good. Care Homes for Older People Page 14 of 25 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. Complaints are taken seriously and responded to in a professional manner. People at the home are protected from abuse by clear policies and procedures and by an appropriately trained staff team. Evidence: The home has satisfactory policies and procedures in relation to complaints and the protection of residents from abuse. No complaints have been received by the home since the last inspection. Some minor issues have been recorded that came up during residents meetings. Records have been maintained regarding how the home has responded to these issues. All the residents and visitors we spoke with said they had no complaints about the service but were clear that they would say something if they had a concern. Residents told us that they felt the manager was very approachable and would deal with complaints affectively. Staff were able to describe how vulnerable people could be at risk of abuse in a residential care setting. All staff interviewed were clear of their responsibility to report any suspicions of abuse to the appropriate authorities. Residents that we spoke to said they felt safe and well supported at the home. Care Homes for Older People Page 15 of 25 Evidence: Records indicated that most staff have undertaken training in the protection of vulnerable people. The training officer for the organisation has attended a train the trainer course in safeguarding issues and carries out regular safeguarding training for staff. Care Homes for Older People Page 16 of 25 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. The home is clean, well maintained and furnished and decorated to a very good standard. Evidence: We looked around the home with the manager and visited a number of residents rooms. The home now employs a full time handyman. The home was well maintained and decorated to a very good standard. The building is an older style property and residents told us that they liked this. One resident said, Theres nothing institutional. Its like a hotel. The manager is ensuring that rooms are decorated on a regular basis with residents input and suggestions. Rooms were personalized with individuals personal possessions. On the day of the inspection the home was clean and tidy. The home employs domestic workers and the residents and visitors were spoken with confirmed that the home was always clean. One visitor told us the home was always, Spotless. Care Homes for Older People Page 17 of 25 Evidence: Bathrooms and toilets were clean and contained anti bacterial soap and paper towels to limit the risk of cross infection. The laundry area was satisfactory except that the flooring was old and worn. The manager told us that this was being addressed and we saw plans for new flooring to be fitted soon. Records indicated that staff have attended infection control training. Care Homes for Older People Page 18 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff at the home work hard to meet the needs of the residents and are provided with good training opportunities to further enhance their knowledge and skills. Recruitment practices are sufficiently detailed in order to protect residents at the home. Evidence: One the day of the inspection there were five care staff on duty in the morning and four staff on duty during the evening. There are two waking night staff on duty throughout the night. The manager has been monitoring peoples dependency levels at the home and as a result more staffing hours have been added to the morning and evening shifts. There appeared to be sufficient staff on duty to meet the needs of the people they support. Residents and their families we spoke with were positive about the staff. One resident told us the staff were, Very patient and understanding. The service manager for the home informed us that seventy four percent of care staff have now completed NVQ level 2 training. Staff were very positive about the training offered by the home and records and Care Homes for Older People Page 19 of 25 Evidence: certificates seen indicated that staff are attending the appropriate training they need to support people properly and safely. This training included medication, moving and handling, adult protection, fire training and first aid. Three staff files were examined from staff recently employed by the home. We checked these files to see if the homes recruitment procedures were being followed so that residents are protected from unsuitable staff working at the home. The files examined contained all the information needed to protect residents including two written references, proof of identity and criminal record checks. The registered manager told us that she would phone referees to confirm the reference. Referees are also requested to include a company stamp or letter headed paper to further confirm the authenticity of the reference. Care Homes for Older People Page 20 of 25 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. The manager of the home knows the residents very well and understands their needs. Residents do have opportunities to have a say in how the home is run. Residents financial interests are being safeguarded. The health and safety of residents and staff are promoted and protected. Evidence: Residents, visitors and staff that we spoke to were very positive about the registered manager. Staff told us that the manager was approachable and understanding. The registered manager has completed the training required to run a residential home. We also saw evidence that the manager attends training courses with her staff to update her own knowledge and skills. It was clear from discussion with the manager that she understands and promotes person centred care and this has a positive effect on the well being of residents and staff. Care Homes for Older People Page 21 of 25 Evidence: The home has a satisfactory quality assurance system. We examined the published results from the last quality questionnaires that were sent to residents and their representatives. These were set out clearly and included action taken to resolve any issues that arose. This means that residents have a say in how the home is run and can see how well the home is doing to meet the aims and objectives of the service. As stated previously residents meetings are being held on a regular basis. Monthly unannounced visits by the organisation are now taking place and provide further opportunities for residents to comment on the care they receive. The home does not usually hold money on behalf of residents. Those people who can look after their own money have lockable drawers in which to store it. Relatives manage the finances of most others. The manager said that she will authorize payment of items or services from the homes money and the relative will then be sent an invoice to repay the home on the residents behalf. Satisfactory health and safety records were seen in relation to electrical installation, PAT testing, gas safety and equipment servicing such as hoists and lifts. We also checked records in relation to fire safety. Records indicated that staff were undertaking fire drills on a regular basis. However most of these drills were taking place during the day. It is important that night staff have regular fire drills so they understand the action they need to take if a fire occurs at night. The fire risk assessment and emergency fire evacuation plan is due to be reviewed. It would be prudent for the service to have a complete review of all fire risk assessments for both the building and the residents as this is an older style property which has been converted to a residential home. Two good practice recommendations have been issued relating to fire safety. Fire training has been given to all staff and staff confirmed they have undertaken this training. Records of checks for the fire alarm, emergency lighting and fire extinguishers were also satisfactory. Care Homes for Older People Page 22 of 25 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 23 of 25 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 38 The registered person should ensure that night staff undertake regular fire drills every three months. This should ensure that night staff are confident about what action to take in the event of a fire occurring at night. The registered person should review and update the fire risk assessment for both the building and individual residents as well as updating the fire emergency evacuation plan. 2 38 Care Homes for Older People Page 24 of 25 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 25 of 25 - 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. 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