Care Home: Monread Lodge

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What the care home does well The staff were seen to interact well with the residents and spoke sensitively and discreetly when supporting them in meeting their care needs. The home maintenance was well managed and the maintenance person was decorating a bedroom at the time of this inspection as they were moving a resident to better meet their needs as it would be nearer to the nurses station. all staff have received basic dementia care training. Staff spoken to were clear about safeguarding and complaints procedures. Some care plans provided entailed information about how a persons care needs are to be met. comments people made about the staff included "they are lovely" "they are knowledgeable about the needs of the people" " are well looked after" "very happy place" What has improved since the last inspection? Monread continues to a have low staff turnover which provides the residents with consistent care by knowledgeable staff. The premises continue to be maintained and a continuous redecoration programme is in place to provide a homely atmosphere. What the care home could do better: Access to the building must be made safe as on arrival we were able to access the home and walk around for over five minutes before we were challenged. During the past year there have been a number of thefts at the home. An immediate requirement was made to ensure people who live or work at the home are kept safe. Since the completion of this report we have received confirmation that they have put measures in place to rectify and make the home safe. A fire risk assessment must be in place to safeguard all people who enter and live in the home in case of a fire, this should include a plan of the home detailing areas were oxygen is stored. Some care plans need to be more detailed to ensure they provide staff with the information on how to meet a persons needs. The provider needs to continue to review the staffing levels to ensure they are able to meet the needs of the residents at all times especially in regard to the nursing staff on days as we found that there is only three permanent nursing staff to cover the home over a seven day period. A review of the activity co-ordinators role should be undertaken to ensure that all residents are able to receive activities and interest support of their choosing including one to one support. A programme of activities should be available around the home in a suitable format so residents are able to make an informed choice of whether to join in or not. Key inspection report Care homes for older people Name: Address: Monread Lodge London Road Woolmer Green Hertfordshire SG3 6HG     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: Alison Butler     Date: 1 2 0 1 2 0 1 0 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 24 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 24 Information about the care home Name of care home: Address: Monread Lodge London Road Woolmer Green Hertfordshire SG3 6HG 01438817466 01438817484 monread@lineone.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Monread Lodge Nursing Home Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 64 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The home may accommodate one named service user who has not yet reached the age of 65 years of age. This condition will be removed when the service user attains the age of 65 years or permanently leaves the home for any reason. This home may accommodate 14 older persons who require personal care. This home may accommodate 50 older persons who require general, respite and convalescent nursing care. Date of last inspection Brief description of the care home Monread Lodge is registered to provide residential care and general nursing care to older people and was taken over by Maria Mallaband Group in October 2009. The single storey building is situated between the villages of Woolmer Green and Knebworth. There are good parking facilities for visitors and a local bus service stops Care Homes for Older People Page 4 of 24 Over 65 64 0 Brief description of the care home very near to the entrance to the home. All accommodation is in single rooms with ensuite facilities, including a shower, wash hand basin and toilet. Assisted baths and toilets are also provided. There are a variety of lounges and quiet areas around the home with a central conservatory and a dining area. For information on the up to date fees contact should be made to the home. Information about the services that are provided at Monread and a copy of the last inspection report can be obtained from the home . Care Homes for Older People Page 5 of 24 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: The last key inspection was carried out in January 2008 in which the service was given a 3* rating, this was followed the following year by an Annual Service Review We do an annual service review when there has been no key inspection of the service in the last 12 months. It does not involve a visit to the service but is a summary of new information given to us, or collected by us, since the last key inspection. This key inspection was brought forward following information received by us regarding issues around safeguarding. The ownership of the home has been transferred to the Maria Mallaband Group in October 2009. This inspection was carried out by two inspectors over the course of the morning and early afternoon. The home submitted an annual quality assurance assessment (AQAA), which is a self assessment document that sets out in detail how well the outcomes are being achieved for people living in the home together with some statistical information for example about staff training being provided. The AQAA provides the opportunity for assessing Care Homes for Older People Page 6 of 24 progress over the last year and how improvements are going to made over the coming year. Whilst at the home we spoke with residents, staff and visitors. We observed staff interaction with residents, examined care plans and key documents for example medication administration records, staff personnel files, training records etc. Care Homes for Older People Page 7 of 24 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 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 8 of 24 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 9 of 24 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. The people living at Monread Lodge can be assured that a comprehensive assessment is carried out which forms the basis of the care plan, this ensure that they only accept people who needs they are able to meet. Evidence: There is a Statement of Purpose available which provides information to prospective residents about what health, care and support they are able to provide and what facilities the home has. A comprehensive assessment is carried out which includes areas of personal and health care, social interests and family involvement etc. this happens prior to prospective residents being offered a place. There is then a period of further assessment followed by a review to which a decision can be made by either party if they wish to make this a more permanent arrangement. Care Homes for Older People Page 10 of 24 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 people who live at Monread can be assured that their health and care needs will be met although more information needs to be recorded within their care plans to ensure all staff are clear and consistent in how to meet the persons needs. Evidence: Care plans seen for new residents showed they had been written from the information gained through the initial assessment process. The AQAA stated that the care plans have become more person centred, however they do not say what the person can do for themselves, where it states they need encouragement to carry out personal care the information is not clear what the care worker should do to encourage them. Where a residents has been identified as having challenging needs we found that there was no plan in place for how staff are to manage this so to provide the person with a consistent approach and safeguard staff from possible difficult situations. We saw that reviews are recorded although on most they state no change, therefore the review provides no information on how the care plans demonstrate they are continuing to meet the persons needs. Health care needs are usually dealt with by the nursing staff at the home and further assistance is sought if required for example contacting the Care Homes for Older People Page 11 of 24 Evidence: tissue viability nurse where a pressure sore is not healing adequately. Where risks have been identified for example bed rails, self medication, or the use of oxygen, control measures have not been identified or detailed to reduce the risk. Where bed rails are in place staff have signed the forms but there is no evidence of other people who have been involved in the decision making for example other professionals or the residents representative. A discussion with the acting manager (previously deputy) and the area manager stated they are introducing new paperwork used by the company in their other homes and all care staff are to have training in care planning and recording. They have plans to separate the paperwork and responsibilities of residential and nursing residents and introduce a key working system. This is hoped that it will provide all members of the care staff to take responsibility and to take ownership of each persons care plan in which they are recording information. Examination of the medication storage, administration and disposal showed that it was well managed and no errors were noted on the spot checks, with the exception that a risk assessment including the control measures for reducing the risks where possible must be completed for the person who self medicates. During the inspection staff were seen to provide support and care to the residents in caring, unhurried and respectful way Care Homes for Older People Page 12 of 24 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. People living at Monread can be assured that they will be provided with some opportunities to take part in activities although these are not advertised throughout the home in a suitable format. Evidence: The home have a activities co-ordinator who is employed for 18 hours a week, on the day of the inspection we saw no specific activity in progress, with the exception of the hair salon where residents were having their hair done. Those residents spoken to were very happy with this service and love to feel pampered. A member of staff works alongside the hairdresser and arranges for the residents to come to the salon and makes tea or coffee. A discussion took place with the acting manager and the area manager about the need to review the number of activity hours and how they are utilised to provide appropriate opportunities for up to 64 residents. Some residents would be unable or may choose not to get involved in activities within the home but would possible benefit from some one to one social interaction that is not just when personal care needs are being met. The proprietor stated that activities are advertised in the main reception area and copies are in the residents bedrooms. We spoke with the activities co-ordinator about advertising activities in suitable format so they can be easily seen and understood. We observed breakfast and lunch during our inspection, Care Homes for Older People Page 13 of 24 Evidence: residents spoken to enjoyed the food but we saw that a large number of people were left in wheelchairs instead of being moved into alternative seating. One person told us that her back was aching and felt that it was the wheelchair. The resident stated that the wheelchair did not belong to them, but was used to bring them to the dining room as they were unable to walk the distance from their room to the table. The cook told us they were looking into changing the menu in consultation with the residents. The area manager has already identified that mealtimes need to be changed to make them more pleasurable experience and the aim is to encourage the staff to take their meals with the residents. Some of the plastic crockery being used was looking tired and scratched, and we have been assured that it will be replaced over the coming months. The area manager hops that where residents are able or need minimum support, that vegetable dishes will be placed on the tables so that they are able to help themselves. Care Homes for Older People Page 14 of 24 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. People who use the service can not be assured that they will always be safeguarded from abuse although their complaints are listened to and acted upon appropriately. Evidence: The company have a detailed complaints procedure in place and it is accessible to all. There is a folder available for the recording of all complaints and any outcomes and actions are recorded. The AQQA states they have had one complaint in the last 12 months and the outcome of the investigation showed it was upheld. On the day of the inspection a complaint had been received which was to be dealt with by head office and we were assured that this would be dealt with promptly and any action and outcome would be recorded appropriately. The AQAA states we ensure the safety and protection of the service users however on arrival at the home we were able to freely gain access to the building and walked around for approximately five minutes before we were challenged and asked who we were. This was extremely worrying as the home had a number of thefts in the past six months and we were also made aware that the police had visited the home prior to Christmas and had raised concerns that the front door was not adequately secured. We made an immediate requirement that door must be securely closed to prevent free access and safeguard the residents from potential harm. During the inspection it was identified that although rooms had been provided with lockable storage keys were no longer available to allow residents to lock their valuables to lock them away if they Care Homes for Older People Page 15 of 24 Evidence: chose to. The area manager stated they would do an audit of rooms where keys were no longer available to provide lockable storage or to record where people did not want to take responsibility for their own belongings. Care Homes for Older People Page 16 of 24 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 who live at Monread can be assured that are provided with a well maintained, homely and clean Evidence: There is an on going maintenance programme and a redecoration plan is being devised to include bedrooms and communal areas. There were no areas of concern regarding the maintenance identified during the tour of the home during this inspection. One room was in the process of being decorated as a resident was moving rooms this had been decided through discussions between the person and their family, this would enable the home to better meet their needs. There are polices and procedures in place for the control of infection to safeguard the residents. See also the section on Complaints & Protection and the Management section regarding keeping the residents who live at Monread safe. Care Homes for Older People Page 17 of 24 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. People who live at Monread can be assured that the required staffing levels are being reviewed to ensure that they will be able to meet their health & personal care needs Evidence: The AQAA states that an excellent induction programme is in place, there is an on going training programme in place and staff confirmed they have the training appropriate to meet the residents needs. The manager stated in the AQAA staff receive regular supervision. We spoke with a number of staff who were on duty and they said that had not received regular supervision and some couldnt recall when they had last received it whilst others told us that it was at least a couple of months ago. There is a low turnover of staff at Monread which provides consistency to the residents in meeting their social and personal care needs. Since the change in provider some staff were feeling a little unsettled with some changes that were being made and one of those changes has been a review of the staffing levels, a decision was made to reduce the staffing levels from a total of 14 staff during the day to 12. Some staff felt there has not been a detriment effect on the residents, whilst other staff felt they had even less time to spend time with residents other than meeting their personal care needs. From our observation it appeared that residents personal and health care needs were being met but staff did not always have the time to chat. Visitors commented that staff always appear to be busy and not spend a lot of time talking without doing a task. The area manager stated they would continue to review the Care Homes for Older People Page 18 of 24 Evidence: staffing levels to ensure that the residents needs can be continued to be met. There are three qualified permanent nurses who cover the day shift and the home arrange to use agency nurses where required to ensure the residents nursing needs can be met. There is no shortage of nursing staff to cover the nights Care Homes for Older People Page 19 of 24 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. People who use the service can not be assured that they will be safeguarded at all times leaving them at possible risk. Evidence: The home was acquired by Maria Mallaband Group in October 2009. The manager resigned and left the service the previous week. The deputy manager has taken on the responsibility of acting manager and is being supported by the Area Manager. She has been provided with two days where she is supernumerary to the rota, this will continue to be monitored to ensure there is sufficient time to meet the management requirements of Monread. They have advertised for a manager and it is hoped that a new person will be in place as soon as possible. The deputy manager has been at the home for a number of years and continues to up date her skills in line with best practice. It is not known at this inspection how long this will continue but the area manager has stated she will keep us informed of any changes to the arrangement. Maria Mallaband have a quality assurance system in place and it will be introduced to Monread to ensure they can review the service and put in place an annual Care Homes for Older People Page 20 of 24 Evidence: development plan. A Regulation 26 visit took place in December and an action plan has been drawn up to make some improvements to the service and ensure the residents care and personal needs are met appropriately. On our tour of the home we noticed compressed oxygen is stored within the home. When we asked to see the Fire Risk Assessment to ensure that the areas containing the oxygen were highlighted, they were unable to find a copy. The Area Manager immediately contacted a colleague and asked for a fire risk assessment template to be sent over for completion with the maintenance person following the inspection. As already stated on arrival at the home we were able to gain access to the home and walk around for over five minutes before we were challenged. In view of the lack of safety and a number of recent thefts we left an immediate requirement. The home have had a number of thefts in the home since June 09 some of which we had not been informed about by the manager. The staff informed us that the police had been to the home just before Christmas and they too were able to gain access to the home and explained to the deputy that they should get the access sorted out. The area manager said to us that they would lock the door and put a note in place for visitors to inform staff when they are leaving to ensure the door is locked. As part of the action plan it stated that Staff supervisions are to be reintroduced on a regular basis. See also section on complaints an protection for further information. Care Homes for Older People Page 21 of 24 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 22 of 24 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 1 18 13 4(c) The provider must ensure that the front door is securely locked at all times To ensure that residents are safeguarded from abuse 19/01/2010 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 38 13 4 (c) The provider must ensure that a fire risk assessment is in place This is to ensure that everyone who lives, works and visits the home can be assured they are safeguarded in the event of a fire. 31/01/2010 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 36 Staff supervision should be reintroduced to ensure staff receive formal supervision at least six times a year and it covers all aspects of practice, the philosophy of the home and career development. Care Homes for Older People Page 23 of 24 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. 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