Care Home: The Lodge

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What the care home does well The home had a welcoming but busy atmosphere. Residents were complimentary about the care they received and comments included "they are lovely girls" and "they always find time to have a chat". Staff were seen to interact well with the residents and had a good knowledge of peoples individual needs. A rolling training programme is in place to ensure that staffs` skills are kept up to date and any changes in care practises are known. This means that the people who live in the home benefit from trained staff. We are appropriately informed of anything that affects the well being of the residents, so that we can monitor the quality of the service provided. What has improved since the last inspection? The environment of the home has improved with the introduction of an activities room where residents can go and relax or take part in craft activities of their choice. Some new seating has been purchased of various heights to accommodate the differences in the resident`s height to ensure they are comfortable. The manager confirmed that the risk assessments had been put in place following the previous inspection and when the work on the conservatory takes place a risk assessment will be put in place to protect the residents from any harm. What the care home could do better: Although no regulatory requirements were made following this inspection an area for improvement following this inspection is to ensure that resident`s medication does not run out to ensure they are kept pain free. The staff should not use acronyms within the care plans to ensure all staff are clear about what is being addressed and they understand the content. Staff should be reminded about terminology and not use terms such as `good girl` or refer to `bibs` this is not appropriate for the age range of the residents and can feel disrespectful. Regulation 26 reports need to demonstrate that the residents, visitors and staff have been spoken to about the conduct of the home. This shortfall does not provide the provider with information on how the service is meeting the needs of the residents or any issue that may have arisen. CARE HOMES FOR OLDER PEOPLE The Lodge 5 Broad Street Hemel Hempstead Hertfordshire HP2 5BW Lead Inspector Mrs Alison Butler Unannounced Inspection 22nd July 2008 09:45 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Lodge DS0000019578.V368813.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Lodge DS0000019578.V368813.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Lodge Address 5 Broad Street Hemel Hempstead Hertfordshire HP2 5BW Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01442 244722 01442 240401 thelodge@bmcarehomes.co.uk B & M Investments Ltd t/a B & M Care Marion Campbell Care Home 46 Category(ies) of Dementia - over 65 years of age (46), Old age, registration, with number not falling within any other category (46) of places The Lodge DS0000019578.V368813.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th August 2007 Brief Description of the Service: The Lodge is a residential care home for older people who may have a diagnosis of dementia. It is located in Hemel Hempstead and can accommodate up to 46 service users. There are two lounges on the ground floor and a large dining room. Bluebells is a unit for people who have dementia, where there is a large lounge. There is a dedicated activity lounge residents are able to access this at all times if they wish. They have built a conservatory on the lower ground floor and they have created a lounge which will be used by up to eight residents, a small kitchen is also available. The building has been extended and the first and second floors are on two levels, some of the bedrooms are served by a chair lift. There is a dedicated hairdressing room on the first floor. The enclosed garden consists of small paved courtyards, which are attractively decorated with window boxes, flowerpots and garden ornaments. For information regarding the service, the fees and terms and conditions and a copy of the last CSCI inspection report you should contact the manager of the home. The Lodge DS0000019578.V368813.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. We (The commission for Social Care Inspection) carried out this key unannounced inspection between 9:45 and 15:45 and it took just under 6 hours to complete. We looked at documentation, toured the home, observed staff working and what life was like for the people who live in the home, we spoke with people who live in the home and their visitors and staff. We sent an Annual Quality Assurance Assessment (AQAA) form, which was completed and returned to us within the timescales. This is a self assessment document which gives us information about the home including some statistical information. What the service does well: What has improved since the last inspection? The environment of the home has improved with the introduction of an activities room where residents can go and relax or take part in craft activities of their choice. Some new seating has been purchased of various heights to accommodate the differences in the resident’s height to ensure they are comfortable. The Lodge DS0000019578.V368813.R01.S.doc Version 5.2 Page 6 The manager confirmed that the risk assessments had been put in place following the previous inspection and when the work on the conservatory takes place a risk assessment will be put in place to protect the residents from any harm. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Lodge DS0000019578.V368813.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Lodge DS0000019578.V368813.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Standard 6 is not applicable to The Lodge Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that they will have their needs assessed to identify any needs, which ensure that the service is able to appropriately meet the resident’s needs. EVIDENCE: Pre-admission assessments are carried out which from the basis of the initial care plan to ensure individual needs have been identified and can be met. The Annual Quality Assurance Assessment (AQAA) states that over the next twelve months they intend to offer trial visits to potential residents and ensure they keep the information provided to them up to date. The Lodge DS0000019578.V368813.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that the care provided to residents is by staff who are aware of people’s individual needs from the detailed information provided in the care plans and will treat them with respect. EVIDENCE: New care plans have been introduced and an examination of these showed they contain a lot of useful information about how the resident’s needs are to be met. Care plans we looked at contained a history of the resident usually completed by the family; this helps staff in understanding resident’s backgrounds, which helps with the care of them. Information had been recorded following visits from other professionals and also information in carrying out any follow up appointments that have been requested i.e. ‘a blood test is required’. Staff do need to refrain from using acronyms within the care plans, as when we asked a member of staff what one meant they were unable to explain to us what it was. There is now a daily recording system that helps The Lodge DS0000019578.V368813.R01.S.doc Version 5.2 Page 10 staff in detailing the events of the day these are then placed on the main care plan at the end of the month, which helps with the reviewing process. One care plan examined appeared not have been reviewed since April 2008 and the manager agreed to look into this and find out the reason. All other care plans examined had been reviewed monthly. The manager has identified that further work is to be carried out on care planning and staff are to receive further training, this has not affected the outcome for the residents and staff are knowledgeable about their needs to ensure they are met appropriately. We saw that staff were seen to interact well with the residents and support them as appropriate. Residents we spoke to about the care provided were happy. Medication policies and procedures are in place. However one resident had been unable to have pain relief the previous evening as the medication had run out, this was being addressed and further supply was being sought. To ensure a robust medication administration system there is a procedure in place for dealing with missed signatures and these are followed up by the manager and through supervision. A new trolley has been purchased to assist in the administration by staff and this is contained within a locked room that has the temperature recorded daily to ensure it is kept within safe limits. The Lodge DS0000019578.V368813.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that they will be supported to have contact with their family and to be offered a choice of activities to ensure that their recreational interest and needs are met. EVIDENCE: Information is available in the home for residents about regular activities some of these have been produced into a picture format making them easier to understand by those who suffer from dementia. They have created an activities lounge and residents are able to access this at any time; the activities co-ordinator also arranges craft activities and games in the room. Residents are able to choose to take part and those we spoke to look forward to joining in. On the day of the inspection Pets As Therapy (PAT) dog came to the home, the organiser carried out a check in the lounge before allowing the dogs to enter. A member of staff went round to each resident making sure that they were happy to stay, as the dogs would be coming into the lounge. When the dogs arrived the faces of the residents lit up showing well-being, they very much The Lodge DS0000019578.V368813.R01.S.doc Version 5.2 Page 12 enjoyed stroking the dogs. The organiser then put on music and residents joined in doing exercises. The residents were given the opportunity to throw things for the dogs to catch and bring back to them. This weekly activity was enjoyed by a number of residents and is very much looked forward to. We observed the lunch being served in one of the small dining areas, all the residents meals were already plated up on the trolley and it is assumed everyone likes the same and amount. This could be improved by the use of a hot trolley and staff asking residents about the vegetables, a small number of the residents would be able to serve themselves if the vegetables were placed in small serving bowls on the table. Some staff were seen to support residents appropriately although one member of staff started to assist a resident and as they were taking their time, the staff member went off to carry out another task before returning to assist the resident, this could lead to the meal getting cold and making the resident feel that they are being rushed. There were no menus displayed in this lounge to remind residents of what was being offered and staff when asked were unable to answer the question. When the desert arrived which was rice pudding a senior member of the team asked that they were not served until all residents had finished. This then resulted in the desert cooling down before being given to people. Residents spoken to were complimentary of the meals although it was not always to their liking but alternatives are offered. The Lodge DS0000019578.V368813.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that they will be listened to and concerns will be acted upon. Staff have received appropriate training to ensure that residents are safeguarded from abuse. EVIDENCE: There is a complaints procedure in place and they are recorded although more detail could be reflected, copies of all correspondence are held to provide an audit trail. Staff are aware of their responsibilities for whistle blowing and safeguarding. They received regular updates in safeguarding training. We (The Commission) appear to have been informed of all incidents appropriately and a copy of the Regulation 37 form is held at the home as a record. The Lodge DS0000019578.V368813.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at The Lodge can be confident that the home is clean and well maintained, and provides an environment that meets people’s needs. EVIDENCE: A tour of the home showed that it was clean and well maintained. The ground floor building work has now been completed with the creation of a conservatory and a small kitchen, this has not been opened yet but it is hoped that it will soon be accessed by up to eight residents (and staffed appropriately). The seating in the lounge has been purchased although they are all the same fabric and colour; the manager has ensured that they are different in heights to accommodate people’s differing needs. A further conservatory is in the construction stage leading from a small lounge/dining room this will create further room and be more spacious for the residents giving them more choice in where they would like to sit. The Lodge DS0000019578.V368813.R01.S.doc Version 5.2 Page 15 Policies and procedures are in place to control, the spread of infection and all staff receive training in this area as part of their induction. The Lodge DS0000019578.V368813.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use the service can be confident that residents will be supported by appropriate numbers of competent staff who have been thoroughly checked to ensure that people are kept safe and their care needs met. EVIDENCE: From the 3 files we examined they showed us that all the relevant checks had been carried out prior to people starting their employment. This is to ensure that residents are safeguarded as far as is practicably possible. The amount of agency staff used in the home has been reduced since the last inspection. Where agency staff are still used the manager tries to use people who have already worked at the home to provide consistency to the residents using staff who are known to them. A training matrix is in place and this identifies where there are any shortfalls and the manager can plan for any training updates etc. Skills for care training has been introduced to ensure that staff have the skills needed to meet the residents needs, training in dementia care is conducted to meet the increase need of the residents residing at The Lodge. The Lodge DS0000019578.V368813.R01.S.doc Version 5.2 Page 17 Good interaction was observed during the inspection although staff need to remember who they are interacting with and remember the people who use the service are adults and using the term ‘good girl’ or ‘bib’ is not appropriate in respecting them as adults. The Lodge DS0000019578.V368813.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that the home is run for the benefit of those that live there and there is a good management structure in place to support this. Health and safety procedures are in place to protect all those who live, work and visit the home. EVIDENCE: The manager is now registered with the Commission. The management of the home appears to be working well and staff have their own responsibilities. Staff receive regular supervision and this is recorded to ensure they are supported in their roles. The manager is preparing for accreditation with Hertfordshire County Council Adult Care Services. The Lodge DS0000019578.V368813.R01.S.doc Version 5.2 Page 19 The manager showed us that she is aware of the areas that need to be improved and she has put in a plan and has prioritised these to ensure they are completed in a timely manner. We saw that the Regulation 26 reports still do not show that responsible person talks to the residents, staff or visitors to form an opinion of the standard of care provided in the home and acknowledge the good work that the staff do in making the residents feel at home. Policies and procedures are in place for managing the residents’ financial interests to ensure they are safeguarded. The manager maintains appropriate records for the health and safety of all who live; work and visit the homed staff follow the home’s policies and procedures. The fire equipment service check was being conducted during this inspection and all went well and a record made by the officer. The Lodge DS0000019578.V368813.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 The Lodge DS0000019578.V368813.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Lodge DS0000019578.V368813.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Lodge DS0000019578.V368813.R01.S.doc Version 5.2 Page 23 - 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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