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Inspection on 23/06/10 for Hawthorn Lodge Nursing Home

Also see our care home review for Hawthorn Lodge Nursing Home for more information

This is the latest available inspection report for this service, carried out on 23rd June 2010.

CQC found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People living at Hawthorn Lodge Nursing Home are happy with the care and service provided. The home has a welcoming atmosphere. Visitors are made to feel welcome at any time. During the inspection staff were observed to interact well with people that use the service. Staff approached people in a supportive and respectful way. The homes food menu is varied and people that use the service enjoy the food that is provided. Comments made by people spoken to during the visit included, "Staff are always happy to help" "The staff are very good and some of the residents are good company, you can have a good chat" "People are very friendly. I like to sit in the lounge area and watch television. I get visitors every day" "The food is good. If you don`t like what is on the menu you can have something else. everyone tries to accommodate you"

What the care home could do better:

Care plans need further development to ensure that they are individual to the person. Care plans need to include limitations, abilities, preferences, assistance required and evidence of personal choice. Hand written entries of medication on Medicine Administration Records (MAR) should contain the signatures of two staff. Two staff should check and sign a MAR for handwritten entries to make sure the medication has been written up correctly to avoid any errors. The upstairs sluice should be made secure so that it can only be accessed by staff. The induction training programme should be developed to meet with the standard as set by skills for care. Staff should receive supervision at least six times a year.

Random inspection report Care homes for older people Name: Address: Hawthorn Lodge Nursing Home 2 Canberra Grove Hartburn Stockton-on-Tees TS18 5EL one star adequate service The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Katherine Acheson Date: 2 3 0 6 2 0 1 0 Information about the care home Name of care home: Address: Hawthorn Lodge Nursing Home 2 Canberra Grove Hartburn Stockton-on-Tees TS18 5EL 01642570100 01642652604 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Jacqueline Jane Pallister Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs K Ramdhan,Mr M Ramdhan care home 30 Number of places (if applicable): Under 65 Over 65 30 0 old age, not falling within any other category physical disability Conditions of registration: 0 30 The maximum number of service users who can be accommodated is: 30 The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 30 Physical disability - Code PD, maximum number of places: 30 Date of last inspection Care Homes for Older People Page 2 of 12 Brief description of the care home Hawthorn Lodge is a care home providing both nursing and personal care for older people. It is a converted Victorian building with an extension. The 26 single bedrooms are a minimum of 10 sq.m. The 2 double bedrooms are a minimum of 16 sq.m. There are 3 lounges and a large dining room. There is a passenger lift giving access to both floors. The home is opposite a parade of local shops. There is a small car park at the back of the home. Care Homes for Older People Page 3 of 12 What we found: This unannounced random inspection took place on 23 June 2010. The manager completed and returned an Annual Quality Assurance Assessment, (AQAA). The AQAA is the services self assessment on how they think that they are meeting National Minimum standards. This information was received before the inspection and was used as part of the inspection process. Before this inspection visit we looked at all of the information that we have received since last inspection of the service in June/July 2009. The reason for this inspection was to check/monitor compliance of requirements identified at last inspection in June/July 2009 and to see how good a job the home does in meeting the national minimum standards set by the Government for care homes. Numerous records were examined including care records of people living at the home, medication records, risk assessments, complaints and staff records. People living the home and staff working there were also spoken to. Discussion also took place with the deputy manager and a senior manager of the service. Before the inspection, surveys for people that use the service and staff were sent to the home for the manager to distribute . Surveys for people that use the service asked for comments on care received. Surveys for staff asked for comments on what it was like working at the home and training received. We did not receive any surveys from people that use the service. We received five surveys from staff. The manager was on holiday at the time of this inspection visit, however the deputy manager ensured that the inspection process ran smoothly. Choice of home The deputy manager said that people who are to use the service are assessed before coming into the home. First they receive an assessment from a social worker or another health care professional. This assessment is sent to the home for the manager to look at. Once this assessment has been reviewed the manager or deputy manager then visit the person at home or in hospital to carry out a further assessment. These assessments are used to decide if the home can meet their needs. People are encouraged to visit the home before they move in. Three files of people that use the service were looked at during the inspection visit. All three files contained appropriate assessments. Health and personal care The care files of three people that use the service were looked at during the visit. Care Care Homes for Older People Page 4 of 12 files contained a detailed assessments of needs, evidence of nutritional screening, moving and handling assessments and pressure area assessments. Care plans and risk assessments were also available on file. The deputy manager said that once people have been assessed a care plan is developed for each individual need or problem. Care plans are records used by care services to show what sort of help each person needs and how staff will provide that care. Care plans would benefit from further development. Some care plans appeared to be more of a task list. One plan of care for hygiene stated, Staff to give full body wash and ensure has shave another plan of care for another person stated, Offer a bath or shower at least twice weekly and ensure hair is brushed. Care plans should be developed to include what the person can do for themselves and what help is needed. Care plans should be individual and include evidence of personal choice. Care plans looked at during the visit had been updated on a monthly basis or more often if needed. There was clear evidence of the involvement of GPs, District Nurses and other health care professionals such as chiropodists. People living at the home confirmed that if they were feeling unwell, the GP would be called. During the inspection visit the deputy manager and staff were observed to interact well with people that use the service and visitors. Staff approached people in a supportive and respectful way. People spoken to during the visit were complimentary about life in the home and care received. Comments made included, I came to live at the home in February. Its quite good and the staff always help when they can. If I buzz for help staff are always there Its nice here everyone is really helpful The matron, deputy matron and carers are lovely The last inspection of the service highlighted that arrangements needed to be put in place to ensure that medication records are accurately maintained. Medication Administration Records (MAR) needed to detail the reason for non administration of medication, the medicine policy needed updating and the temperature of the medication room needed to be monitored. Examination of records highlighted that appropriate action had been taken to to address the requirements and recommendations highlighted at the last inspection. This inspection highlighted that hand written entries of medication on MARs did not always contain the signature of two staff. Two staff should check and sign a MAR for handwritten entries to make sure the medication has been written up correctly to avoid any errors. Daily Life and Social Activities. A senior manager of the service said that a volunteer comes into the home twice a week and stays for about an hour and a half and does activities with people that use the service. The senior manager said that appropriate recruitment checks including applying for a Criminal Record Bureau check had taken place. At other times care staff arrange Care Homes for Older People Page 5 of 12 activities. The deputy manager said that people like to have quizzes, sing-a-longs and play games. Various entertainers visit the home every three months to sing to people. The notice board in the entrance to the home informed people that entertainers had been booked for the 30 July 2010 and 19 October 2010. Once a month a Pets As Therapy Cat visits the home with its owner. The purpose of the visit is to provide therapeutic support, companionship and comfort to people that use the service. The deputy manager said that people get lots of pleasure from holding and stroking the cat. One person that uses the service was preparing to watch the England match on television that afternoon. On the day of the inspection six people that use the service were observed to be sitting in the garden and enjoying the sunshine. People spoken to during the inspection said that they were happy with activities provided, one person said, We have an entertainer who comes in quite regularly. He plays the guitar and keyboard and sings all of the pre war songs, which we all enjoy another person said, We have bingo and a quiz. I do lots of letter writing another person said, I prefer to spend time in my bedroom. I have my own television so I am happy. One person spoken to said that she enjoyed the regular visits from representatives of the local Church of England church. She said, They come in on the last Friday of every month, but as I was a regular visitor to St Peters before I came into the home, I get lots of other visits from people from the church. Four out of five surveys received from staff felt that the home could improve by providing more activities and outings. The deputy manager and senior manager agreed that improvement could be made in providing activities for those people who were less able. The last inspection of the service recommended that menus should be reviewed by a dietitian to ensure that the content was nutritious. Following inspection menus were sent to the department of nutrition and dietetic services for consultation. A letter dated 22nd December 2009 was available for inspection that advised that menus had been looked at and were considered to be nutritious. Food provided by the home is enjoyed by people that use the service. On the day of the inspection the lunch time of people that use the service was observed. The lunch time menu of the day was mince, yorkshire puddings, roast potatoes, cabbage and turnip. For dessert it was chocolate sponge and cream. People spoken to said that they liked the food, one person said, The food is quite good and varied another person said, I enjoy everything that is put in front of me. Complaints and protection The last inspection of the service highlighted that a record must be kept of all complaints and that the safeguarding procedure needed to be updated to make sure that it reflected locally agreed procedures and contact details of the local authority and police. Records were evidenced to confirm that appropriate action had been taken. Care Homes for Older People Page 6 of 12 Since the last inspection staff working at the home had received safeguarding training. Environment The last inspection highlighted that the upstairs sluice needed to be made secure so that it could only be accessed by staff. Following inspection a bolt was fitted to the outside of the door, however this should be replaced with a lock and key or another appropriate locking system. The last inspection highlighted that staff notices displayed on the walls in the dining room of people that use the service should be removed, this had been addressed. The last inspection highlighted that net curtains were fitted to glass panels on bedroom doors. It was recommended that an alternative covering be fitted to bedroom doors to increase the privacy of people that use the service. Since the last inspection all doors have been fitted with curtains. Staffing At the time of the inspection there were twenty two people using the service, eleven people who were receiving nursing care and eleven people who were receiving personal care. Duty rotas looked at during the visit informed that there is one nurse and three care assistants on duty on a morning and afternoon until 4pm. From 4pm until 9pm and on night shift there is one nurse and two care assistants on duty. People that use the service and staff spoken to during the visit said that they thought there was sufficient staff on duty. The last inspection highlighted that application forms for new staff should be received before they start working at the home and that any gaps in employment should be explored. Two files of newly recruited staff were looked at during the visit. Records were evidenced to confirm that application forms had been received prior to the start date and that gaps in employment had been explored. The last inspection of the service highlighted that the homes induction needed to updated to meet with the standard as set by Skills for Care, this had not been addressed. The deputy manager said that she would speak to the manager on her return from holiday and ensure that the induction was updated. The deputy manager advised that mandatory training takes place on a regular basis. Care staff spoke to during the inspection also confirmed that this was the case. Care staff said that they had received recent training in moving and handling, fire, safeguarding adults, health and safety and diabetes awareness. The deputy manager said that training is provided by both the provider and external training companies. Management and administration The senior manager spoken to during the visit said that all policies and procures had been updated since last inspection. He also said that visits as required under Regulation 26 had been taking place on a monthly basis. The purpose of the visit required under regulation 26 is to inspect the premises, its record of events, complaints and speak to people and Care Homes for Older People Page 7 of 12 staff about the home. Records of Regulation 26 visits were available in the home for inspection. Records were available to confirm that water temperatures are taken and recorded on a weekly basis to make sure that they are within safe limits. Records of fire drills were available for inspection and included time taken to complete the drill , effectiveness and action points. Last inspection highlighted that staff should receive supervision at least six times yearly. Records were evidenced to confirm that some supervision was taking place, however not as often as it should be. What the care home does well: What they could do better: Care plans need further development to ensure that they are individual to the person. Care plans need to include limitations, abilities, preferences, assistance required and evidence of personal choice. Hand written entries of medication on Medicine Administration Records (MAR) should contain the signatures of two staff. Two staff should check and sign a MAR for handwritten entries to make sure the medication has been written up correctly to avoid any errors. The upstairs sluice should be made secure so that it can only be accessed by staff. The induction training programme should be developed to meet with the standard as set Care Homes for Older People Page 8 of 12 by skills for care. Staff should receive supervision at least six times a year. 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 2. Care Homes for Older People Page 9 of 12 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 10 of 12 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, 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 7 Care plans should be individual and specific to the person. Care plans should be developed to include what the person can do for themself, assistance needed, likes, dislikes, evidence of personal choice and preferences. This will help to promote independance, ensure that care needs are met and that care is delivered in such a way that is acceptable to the person. Hand written entries of medication on Medicine Administration Records (MAR) should contain the signatures of two staff. Two staff should check and sign a MAR for handwritten entries to make sure the medication has been written up correctly to avoid any errors. The upstairs sluice should be made secure so that it can only be accessed by staff. The induction training programme should be developed to meet with the standard as set by skills for care Staff should receive supervision at least six times a year. Page 11 of 12 2 9 3 4 19 30 5 36 Care Homes for Older People Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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