Care Home: Vesta Lodge

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What the care home does well "Vesta Lodge staff consistently provide patient and devoted care - mother is looked after very well."Vesta Lodge is clean and pleasant, with a lovely garden" "It`s all go in here!" These quite typical comments reflect what were in general very positive views of the home expressed to us and the standard of care that we saw during the inspection was generally good. The standard of medication administration and record keeping is usually good and the home benefits from an enthusiastic and motivated activities team, led by the home`s activity coordinator. Staff told us that they feel well-supported and the training that is provided by Quantum Care is good and enhances the care experience of people living in the home. What has improved since the last inspection? Storage does not seem to be as much of a problem as was previously noted to be the case and there have been a number of improvements to the home`s environment which make it a pleasant place for people to both live and work in. The standard of care plans has continued to improve in that they are more consistently well completed, there are still times however when the standard of some falls below that of the best. What the care home could do better: The use of shower rooms which now have non-operational showers should be looked at to see if better use could be made of them. Some people felt that the food provided was not very varied, however they also acknowledged that alternatives to the menu are always available. There were isolated incidents when the standard of care was not as good as was usually the case and some surveys made reference to lapses in care on occasions, whilst invariably also paying tribute to the overall care experience. This suggests that supervision and ongoing training is important to ensure that the standard of care remains at the high level usually experienced by people living in the home, and that the care practise of the best care staff becomes the standard for all. The same is true of care planning where the usually high standard is not always consistently maintained in some cases. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Vesta Lodge Watling View St Albans Hertfordshire AL1 2PB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jeffrey Orange     Date: 2 4 0 4 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 26 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 26 Information about the care home Name of care home: Address: Vesta Lodge Watling View St Albans Hertfordshire AL1 2PB 01727799600 01727799663 vesta@quantumcare.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) : Quantum Care Limited care home 61 Number of places (if applicable): Under 65 Over 65 61 61 61 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home 0 0 0 Vesta Lodge offers care and accommodation to sixty-one older people, who may also have dementia or a physical disability. Vesta Lodge is a purpose-built home set in extensive gardens and is operated by Quantum Care a not for profit organisation. The ground floor comprises two units - Willow, for people with dementia, and Laburnum for people with high dependency; the first floor has Freesia unit for dementia care and Mimosa for high dependency. Each unit consists of dining room, lounge, en-suite bedrooms, small kitchen, bathroom, shower room and sluice. At the front of the ground floor there is a large reception area, sun lounge, day care and activities room, offices, kitchen and laundry. There is a small parade of shops close to the home and St Albans town centre is easily accessible via public transport. The home has an information brochure, Statement of Purpose and Service User?s Care Homes for Older People Page 4 of 26 Brief description of the care home Guide available to prospective residents, together with copies of the latest inspection report from the Care Quality Commission (CQC) Current fees range from £555 to £650 per week. (At April 2009). (Additional charges are made for items and services such as newspapers, toiletries, hairdressing and chiropody.) Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We last inspected this service on the 26th April 2007. We also carried out an annual service review of the service on the 11th April 2008. This unannounced inspection was carried out by one inspector. Where this report refers to we it recognises that it is written on behalf of the Care Quality Commission (CQC). The inspection began early in the morning which provided an opportunity to observe the routine of the home as the night staff were preparing to hand over to the day time staff and as people were being assisted to get up and ready for the day ahead. We were able to speak to people who live in the home, people visiting the home, including health care professionals and members of the staff team. We also had discussions with the manager and her team. We observed the breakfast and lunchtime routines in two different units and spent some time with the activities organiser. We were able to look Care Homes for Older People Page 6 of 26 at some key records, including care plans, medication administration records and staff recruitment and training files. We have received information both from people who live in the home and from their relatives in the form of surveys returned to us, and these have been read, noted and the views expressed are incorporated in this report. The report also draws on any information received about Vesta Lodge since the last inspection, this may be from people associated with the home or from the home in the form of notification about significant events that have happened there. We have also made use of the information provided to us by the home in their annual quality assurance assessment or AQAA. The AQAA is a self-assessment document that assesses how well care outcomes are being achieved for people who live in the home and also contains some valuable statistical information, for example about complaints and staff training. 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 8 of 26 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 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering Vesta Lodge as a home for themselves or someone they are responsible for can be confident that they will be able to visit the home before they make a decision about moving in and that they will be given all the information they need to decide if the home is a place that can meet their needs and where they can be happy. They can also be assured that the pre-admission process carried out by the home is thorough and should ensure that only if their needs can be appropriately met will they be admitted to Vesta Lodge. Evidence: When we asked people if they had received enough information before they moved in for them to decide if it was the right place for them, all of those asked told us that they had. they also confirmed that they had all received a contract setting out the terms and conditions of their stay at the home.One person told us; I had visited several homes before I moved to Vesta Lodge and it was far the best in the area. Care Homes for Older People Page 10 of 26 Evidence: When we spoke to relatives and people who live in the home they also confirmed that they had been able to visit Vesta Lodge before they moved in, so that they could get a feel for the home and to meet staff and see the facilities.When we looked at the Quantum Care Personal Guide we found that it contains a very good level of information, in a very clear and accessible format that should enable people to understand what the home can provide, what is included in the basic cost and what can be provided at additional cost.This information is also available on the homes website for people who prefer to access it on-line. When we looked at care plans for some people who have recently moved into Vesta Lodge, we found that a pre-admission assessment had been completed in each case to determine what the persons care needs were and to make sure that the home could appropriately meet them.This should mean that only people whose needs can be met are admitted to Vesta Lodge. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Vesta Lodge can be assured that they will have access to the health care services that they require, either in the home or community and that where they rely on the home to help them with their medication this will be done effectively and safely. People who live in Vesta Lodge can be reasonably assured that their care plans will accurately reflect their care needs and how they are being met and that if their needs change this will be reflected in the way that care is provided. Evidence: When we asked people who live in the home if they received the medical support they need 85 of those who responded said that they always did and 15 that they usually did.The majority of people that responded said that they either always or usually received the care and support they needed. Where concerns were raised it was about the response time of staff to call bells, particularly at night. Comments received from relatives of people living in the home included; I was particularly impressed by the management of my mothers medication, The staff have been very helpful and my fathers health seems to have improved and We had some concerns about Care Homes for Older People Page 12 of 26 Evidence: incontinence issues and the home suggested a better product which has helped. When we spoke to two community health workers and a GP during the course of our visit to the home they told us; Things work well, there is good communication although on occasions it can be difficult to find staff good communication, always made to feel welcome, office excellent some staff could do with more training, this has been raised and is in hand and Care very good, appropriate referrals, good communication. When we looked at care plans we saw that they included records of the visits of health care professionals and also routine and emergency use of hospital services. This suggests that people who live in the home have access to the health care services they need both in the home and in the community. When we looked at the medication records on units in the home we found that these were accurate and that the system in place for monitoring the administration of medication appeared effective and robust. This means that people who rely on care staff to help them with their medication can be confident this is done safely and only by staff who have received the necessary training in the administration of medication in line with Quantum Cares policies and procedures. When we asked people who live in the home if staff listen to and act on what they say, the vast majority that responded said that they did and throughout this inspection we observed a generally good standard of interaction between care staff and people who live in the home, demonstrating an appropriate and respectful attitude by care staff for the people they provide care for. When we looked at care plans we found that they were in general satisfactory, some being very good and others less so, with varying amounts of meaningful information and cross referencing between constituent parts of the care plan found.We saw evidence of a regular review process that should ensure that where peoples needs change this is identified and appropriate action taken to revise the care plan so that they are being met. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Vesta Lodge can be confident that they will be given the opportunity to take part in meaningful activities individually or together and that they will be able to influence these and other routines of the home, including what, where and when they eat. Evidence: When we asked people who live in the home if there were activities for them to join in, the majority of those who responded said that there were; The activities organiser is very enthusiastic and good at motivating the residents. When we asked relatives about the experience they had of the home one noted; He always seems to be involved, he has been to concerts and on a trip to the seaside. One relative paid tribute to the way that staff had brought in special interest books for a person living in the home who had a particular interest in aircraft. They were also provided with supervision and a tool box to enable them to look at mechanical objects in keeping with their previous role as an engineer. When we spoke to the activities organiser and observed some of the activities sessions she conducted, together with some one to one interaction, we were impressed not only with her energy and enthusiasm, but also by the positive engagement she engendered Care Homes for Older People Page 14 of 26 Evidence: from people living in the home, including those living with dementia. We were told that the activities team work very closely together and we saw an activities programme and other activities records that included for example; poems and reading, knit and knatter, best friends tea room, music for health, hand massage as well as special events such as St.Georges day celebrations. In their AQAA, the home told us that they were constantly looking for new ways to develop the activities programme and the activities staff we spoke to said that they were well supported by training, including in the provision of activities for people who live with dementia. When we observed two mealtimes in the home, breakfast on one unit and lunch on another, we found that they were sociable occasions. We saw generally good interaction between care staff and people living in the home, and where assistance was required, it was usually given tactfully and in a respectful way. We saw choices being offered, for example for cooked breakfast and one relative told us; There isnt a lot of variety. However the carers are very good at preparing alternatives if my mother doesnt like what is on the menu. In their AQAA the home informed us that each resident has a food preference sheet in their care plan, detailing likes and dislikes. This is available to the chef manager and they also seek feedback from people living in the home in one to one contact on a regular basis. When we asked the manager how they ensured that the views of people living in the home are obtained and taken into account in the way the home is run and its routines, they told us that they have resident reviews and meetings, they send out questionnaires and hold Home Forums, there are relatives meetings and periodic audits of the homes activities and operation. The manager is also very visible within the home and talks to people who live in the home and relatives and visitors to find out their views and concerns if any. The manager is very approachable we were told by one relative. Care Homes for Older People Page 15 of 26 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. People living in Vesta Lodge and those responsible for them can be assured that any complaints made will be dealt with appropriately and that if any abuse is seen or suspected action will be taken to protect them. Evidence: In their AQAA the home told us that they had not had any complaints in the last twelve months. When we looked at the documentation given by the home to all people living in Vesta Lodge, we found that it included a clear and detailed information about how to make a complaint and there was also information about the complaints process available in the home. When we asked people who live in the home if they knew how to make a complaint,all those who responded said that they did. One person noted I have never needed to make a complaint and another I tell my daughter and she talks to the staff. When we asked relatives if they knew how to make a complaint, again they all said they did; It was in the information pack when he joined Vesta Lodge was one comment.They also all confirmed that the home had responded appropriately if they or the persons using the service has raised concerns about their care. When we looked at staff training records and spoke to staff we found that training is given to all staff about abuse and what to do if it is seen or suspected. In their AQAA the home told us that there is an informal complaint monitoring sheet in place to Care Homes for Older People Page 16 of 26 Evidence: ensure that trends or patterns in these can be identified and action taken and that safeguarding is discussed in routine supervision and staff reviews.All of this should mean that people can make a complaint if they feel they need to and that it will be listened to and taken seriously and that were any abuse seen or suspected, appropriate action would be taken to protect people living in the home. Care Homes for Older People Page 17 of 26 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 or work in Vesta Lodge can be assured that the homes environment will be kept clean, well-maintained and safe. Evidence: When we asked people who live in the home if it is fresh and clean all who responded said that it was either always or usually, with only one adverse comment about occasional smells. Comments received from relatives of people who live in the home included; The coffee shop also helps as it gives family somewhere to sit and chat in a pleasant environment, The interior of Vesta Lodge is very pleasant, clean and colourful. A coffee lounge is available for residents and visitors-this is most agreeable and Well maintained and modern facilities. When we walked around the home, we did not notice any problems with unpleasant smells and the standard of cleanliness and tidiness was generally very good, with housekeeping staff active throughout the day. When we looked at several of the shower rooms in the home we found that the shower-heads had been removed and we were told these were being stored in the homes loft, which effectively means they cannot be used. We were told that this was because people living in the home did not like showers and that in order to prevent Legionnaires disease, the shower heads were removed. It does mean however that Care Homes for Older People Page 18 of 26 Evidence: greater pressure is put on the bathing facilities in the home and represents a potential waste of valuable space. When, with their permission, we saw several bedrooms of people who live in the home, we found that they were comfortable and included personal possessions, ornaments, pictures and sometimes items of furniture to make the space personal to the person concerned, reflecting their interests and tastes. The overall standard of decor in the home was found to be good,with only some areas appearing in need of attention, for example the carpets on Freesia unit. In their AQAA the home informed us that there are plans to continue with carpet, bed and mattress replacement throughout the coming year and this, together with the work already done, should ensure that the home remains a pleasant and safe environment for people to live and work in. Care Homes for Older People Page 19 of 26 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 living in Vesta Lodge can be confident that they will receive care from a well trained and supported staff team who have been recruited following a robust and thorough recruitment process. Evidence: Most of the day staff are excellent, Training and qualifications are clearly encouraged Vesta Lodge staff consistently provide patient and devoted care and They are wonderful, if I call out in the night they are there before I finish calling are all comments received about the standard of care. When concerns are raised they are invariably accompanied by qualifying compliments and overall the satisfaction and appreciation found was very high. When we spoke to staff they indicated that they could do with more staff but we cope. In their AQAA the home identify the need to continue to recruit more staff. One relative spoken to said that staffing seems reasonable although there could be some delay with toileting. They told us that where they had expressed concern about for example the state of a wheelchair, staff had addressed this. When we spoke to staff about training and when we looked at staff training records we found that a wide range of training is carried out and available and all of the staff spoken to seemed enthusiastic about training and indicated that they felt well supported by training and supervision.In their AQAA the home indicate that at least Care Homes for Older People Page 20 of 26 Evidence: 50 of care staff have achieved a NVQ level 2 in care which meets the requirements of the National Minimum Standards and demonstrates a real commitment to ensure that people living in the home receive care from a skilled team of care workers. When we looked at the recruitment records for recently recruited staff we found that all the necessary checks had been carried out and this should provide people living in the home with confidence that they are being protected from the employment of unsuitable people to care for them. We saw records of team meetings and staff supervision which suggests that staff are regularly consulted and supported with supervision and this not only helps them but also benefits people living in the home for whom they provide care by ensuring standards are maintained and good practice promoted. Care Homes for Older People Page 21 of 26 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. People living in Vesta Lodge and those who are responsible for them can be assured that it is a well managed home. Evidence: When we spoke to care staff, relatives and to people living in the home they all said that the manager was approachable and receptive and that she listened to what they said and acted upon it. The AQAA was fully completed and received on time and appears to be a realistic document, with comments made being borne out by what was actually seen in the home during this inspection and supported by records and documents seen. When we checked the records for monies held on behalf of people living in the home and when we spoke to Quantum Cares auditor we found a robust system of accounting in place which should safeguard the interests of people living in the home who ask the homes administrator to hold money for them. When we spoke to care staff and looked at staff supervision records we found that Care Homes for Older People Page 22 of 26 Evidence: staff receive the supervision and support that they need to help them do their job effectively. In their AQAA the home details the ways that people living in the home and those responsible for them are consulted and this, together with positive comments received from relatives and people living in the home, suggests that their interests and views are taken fully into account when decisions about the homes routines and operation are made. Care Homes for Older People Page 23 of 26 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 24 of 26 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 21 The registered manager should review the use of the homes shower rooms to ensure that their effective incapacity does not compromise the care outcomes for people living in the home or represent an unsatisfactory use of scarce space within the home that could be better utilised. Care Homes for Older People Page 25 of 26 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. 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