Inspection on 18/04/08 for Hawthorns Residential Care Home

This is the latest available inspection report for this service, carried out on 18th April 2008.

CSCI found this care home to be providing an Good 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.

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Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Hawthorn Residential Care Home 33 Christchurch Road Cheltenham Glos GL50 2NY Lead Inspector Mr Tim Cotterell Unannounced Inspection 18th April 2008 9:30 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 Hawthorn Residential Care Home DS0000070649.V360532.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. Hawthorn Residential Care Home DS0000070649.V360532.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hawthorn Residential Care Home Address 33 Christchurch Road Cheltenham Glos GL50 2NY 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) 01242 221710 01242 572202 Camelot Healthcare Ltd Miss Clare Louise Munn Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Hawthorn Residential Care Home DS0000070649.V360532.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of care only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 20. 22 February 2007 Date of last inspection Brief Description of the Service: In October 2007 Camelot Healthcare became the new providers. The Hawthorns is a double fronted, Victorian house, which has been extended and adapted to provide accommodation for 20 older people. The property is situated in a residential area of Cheltenham, within a mile of the shopping centre and near to the railway station. A bus route passes the door, and the parish church is at the end of the road. The rear of the home overlooks the playing fields of Cheltenham Ladies College. There are twenty single bedrooms, eighteen of which have en-suite facilities with the remaining two having the use of a toilet near-by. The bedroom accommodation is on three floors. All floors are served by stair lifts. On the ground floor there is a large lounge and a separate dining room. There are parking spaces available and a side entrance provides level access to the rear of the property, which has a large garden, patio area and two pergolas. The accommodation fees range from approximately £500.00 to £650.00 and additional charges include hairdressing, chiropody, escort duties and newspapers. Hawthorn Residential Care Home DS0000070649.V360532.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 The inspection was undertaken in a day by one inspector. During the inspection we saw the directors of the company, the operations manager, the registered manager of the home and the care staff and cook who were on duty. Most of the residents were seen and spoken to; this was done individually and with some in small groups. We also looked at the environment and the records relating to medication, care planning, risk assessments and the homes Statement of Purpose. We were also given copies of the minutes of the residents and relatives meeting held on March 11 2008. It was refreshing to note that the subjects discussed all related to matters, which would directly affect the quality of life for the residents, e.g. activities and food. Lunch was seen and this included the preparation, the delivery and staff responding to the wishes of the residents during the meal. The home submitted a completed Annual Quality Assurance Assessment and the contents helped us to gain a clearer picture of what happens in the home. The Commission also sent surveys to the home both for staff and residents however only four completed residents surveys were completed and returned. All of the resident’s surveys said that they were happy in the home and felt safe and comfortable. However three of the four residents said they were “usually” happy with the meals provided and this was discussed with the manager who felt that the home addressed specific issues and concerns as and when they were raised. What the service does well: The atmosphere in the home was relaxed and everyone looked well cared for and comfortable. Staff were seen as attentive and good listeners and responded to requests from residents quickly and quietly. The relatives and residents meetings ensure that opinions and views are known, and wherever needs are identified every attempt is made to meet them. Hawthorn Residential Care Home DS0000070649.V360532.R01.S.doc Version 5.2 Page 6 Some relatives were seen and complimented the staff on how the home cared for their relatives, the ability given to them to be involved in the care and the welcome when they visited. The completed residents surveys indicated that they were happy with the service provided by the home and felt safe and comfortable. The care plans are specific and updated as needed so there is a clear picture of what residents need. The meal seen during the inspection was carefully prepared and delivered in a professional and unhurried manner. Residents said that they enjoyed the meals. The home has been well maintained and the outside areas provide a pleasant alternative in the summer. What has improved since the last inspection? 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 Hawthorn Residential Care Home DS0000070649.V360532.R01.S.doc Version 5.2 Page 7 be made available in other formats on request. Hawthorn Residential Care Home DS0000070649.V360532.R01.S.doc Version 5.2 Page 8 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 Hawthorn Residential Care Home DS0000070649.V360532.R01.S.doc Version 5.2 Page 9 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): 1 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s needs are assessed in a comprehensive manner before admission. The pre-admission visits assists the assessment process and ensures needs are known and recorded. EVIDENCE: The home has a formal procedure for all new admissions and we saw the assessment of the last admission. The assessment of need is then adapted to provide an individual plan of care. The plans seen were comprehensive and included any problems/needs. The procedure for new admissions is thorough and enables the new residents to visit and meet residents and staff before a decision is made. From the information given by the registered manager it was evident that residents make a positive choice about being admitted to the Hawthorns. A copy of the Statement of Purpose was provided at the inspection. Hawthorn Residential Care Home DS0000070649.V360532.R01.S.doc Version 5.2 Page 10 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 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care plans indicate individual needs and wishes and how they would be met. Residents are protected by the homes medication procedures and are treated in a dignified manner by staff. EVIDENCE: Three care plans were seen and the assessments were based on the “activities for daily living”. They are reviewed monthly. The daily reports and weekly reviews ensure that the plans are updated. The plans also include nutritional records and social and recreational aspects of the resident’s lives. Residents have day and night care plans. Healthcare needs have been met and there is a record of all appointments and treatments. Where specialist healthcare is required the registered manager was aware of the resources available e.g. speech and language therapist for Hawthorn Residential Care Home DS0000070649.V360532.R01.S.doc Version 5.2 Page 11 diet/swallowing issues. Residents, wherever possible, are involved in their care planning and where appropriate other carers. The home keeps a record of the receipt, administration and disposal of medication. The administration chart was seen and the records were clear and up to date. All of the requirements made in the last inspection report have been met. All staff who administer medicines have received accredited training. There was a record of the administration of controlled medication and any homely medication administered has the approval of the doctor. One resident self-administers a spray and a risk assessment has been completed to enable the medication to be kept unlocked in the resident’s bedroom. Hawthorn Residential Care Home DS0000070649.V360532.R01.S.doc Version 5.2 Page 12 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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Relatives are made welcome and encouraged to take part in the overall care of the residents. The residents exercise choice and control over the day-to-day life in the home and the regular meetings were seen as a useful forum. Considerable time and thought is given to meal preparation and wherever possible individual needs and wishes are met. EVIDENCE: During the inspection a number of visitors were in the home and we took the opportunity of talking to them. It was clear that they felt welcome in the home and that their view was that their relatives were being well looked after. The manager has made great efforts to ensure that the activities provided meet their needs and the relatives/residents meetings included discussion around appropriate activities. One resident had expressed an interest in painting and the manager had provided the equipment to enable this to happen. The resident was pleased that her interest had been acted on. Hawthorn Residential Care Home DS0000070649.V360532.R01.S.doc Version 5.2 Page 13 Residents have been involved in decision-making in the home and are consulted over every aspect of their daily lives in the monthly residents/relatives meetings. One of the topics at the last meeting was the question of food and choice. The minutes indicated that residents were invited to provide suggestions and the manager assured them that wherever possible their need would be met. The home has recently appointed a new cook and we were able to meet and speak to him. The menu was seen and the cook confirmed that residents are consulted over what food is provided, and that he was able to offer alternatives. The cook attends the monthly residents meetings but was also seen to be talking to individual residents throughout the day. Residents confirmed that he is a good listener and provides good meals, which are presented in an appetizing manner. The dining room offers a pleasant environment for the meals to be enjoyed. Three of the residents who completed our surveys said that they were usually happy with the meals provided. This was reinforced by the discussions we had on the day of the inspection when all residents who we spoke0 to were complimentary about the quality, presentation of the meals and the opportunity to influence the menus. Hawthorn Residential Care Home DS0000070649.V360532.R01.S.doc Version 5.2 Page 14 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, 17 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents live in an environment that protects them and are cared for by staff who are able to identify abuse. Many relatives are involved in the care of the residents, this gives added protection and support. EVIDENCE: All of the residents have a complaints procedure and when asked were clear about what to do and who to see if they had a concern or complaint. The regular meetings and the easy availability of the registered manager offers the residents informal and regular access to staff in the home. This has ensured that concerns are dealt with quickly and without the need to raise any “formal complaint “. Staff were seen as attentive and good listeners providing residents with time to express their wishes throughout the day. The manager has an up to date training profile for staff and advised us that all staff have received training in respect of the identification of abuse. Hawthorn Residential Care Home DS0000070649.V360532.R01.S.doc Version 5.2 Page 15 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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has been maintained to a good standard and provides a pleasant and comfortable environment. There is an ongoing programme of refurbishment. EVIDENCE: The registered manager showed us around the home and all of the communal rooms were seen, together with a random sample of the resident’s bedrooms, we also saw the garden area. The home has been maintained to a high standard and the bedrooms reflected the individual interests of the residents. A number of bedrooms have been refurbished and it is planned to complete others. A number of corridor carpets on the first and ground floor require replacing as they are worn and stained, we were advised by staff that this was planned. We note that a gate has been Hawthorn Residential Care Home DS0000070649.V360532.R01.S.doc Version 5.2 Page 16 attached to the stairway from the ground to the first floor and this is seen as a measure, which will reduce the risk of falling. The curtains in the dining room need greater support now they have a heavier lining and at the time of the inspection had come away from the rail and looked unsightly. The outside area is level and accessible and the gardens have been developed and will provide a pleasant alternative in the warmer weather. Residents will be able to bring their own patio furniture and place the furniture outside their patio doors. Hawthorn Residential Care Home DS0000070649.V360532.R01.S.doc Version 5.2 Page 17 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff were seen as competent and caring and providing a flexible service which meets individual needs. However, the home would benefit from additional cleaning staff to ensure care staff have enough time for direct care. Clear employment histories of new staff would improve the protection of residents. EVIDENCE: Staff files were seen and the new appointment had an application form to include health questionnaires, two references and a completed Criminal Records Bureau check. We discussed the need for a clear and precise employment history for applicants. Residents are involved in staff appointments and this is achieved by asking for their comments when prospective staff look around the home before any appointments are made. The staff on duty were seen individually and it was clear that they were aware of the individual needs of the residents and that they were caring and competent and providing a flexible service. On the morning of the inspection there were five members of staff on duty, the registered manager, deputy manager (admin duties), two carers and the cook. We were advised that the usual staffing consisted of four members of staff in Hawthorn Residential Care Home DS0000070649.V360532.R01.S.doc Version 5.2 Page 18 the morning to include the manager, care and ancillary staff. We were also advised that the manager is involved in the provision of direct care to the residents at peak times of activity. We were able to speak to one of the night staff who was still in the home. She told us what duties she had and had considerable knowledge about individual needs and wishes of the residents. The manager told us that they had recently appointed a new cleaner who would be starting shortly. We feel that having sufficient domestic staff is essential in a home of this size as the staff on caring duties may not be able to undertake both roles effectively. The outcomes for the residents on the day of the inspection were seen as good with needs met. It is essential however that the Manager continues to provide direct support to care staff at peak times of activity. It is appreciated that the Registered Manager has other duties, however, the direct personal needs of the residents are paramount. A formal review of staffing, as mentioned in the last report may be helpful and should be recorded to include individual dependency levels and the staff resources required. Hawthorn Residential Care Home DS0000070649.V360532.R01.S.doc Version 5.2 Page 19 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 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager was seen as competent and making great efforts to run the home in the best interests of the residents. The management have a duty to ensure that all staff have sufficient time to provided a caring service in a calm and unhurried manner. EVIDENCE: The registered manager was on duty during the inspection and we felt that she was competent and had the necessary skills and knowledge to manage the home effectively. She is adequately supported by the operations manager who visits the home. Hawthorn Residential Care Home DS0000070649.V360532.R01.S.doc Version 5.2 Page 20 The top floor in the home accommodates the representatives of the company in the group and we met two directors during the inspection. It was evident that they had a close interest and were anxious to maintain/improve the standard of care being provided. The registered manager has to attempt to balance the various tasks of each day and told us that she is able to provide support to care staff with direct care as well as e.g. administering the medicines. It is appreciated that there is considerable record keeping required and at the same time it is possible that the needs of some residents may over time increase. In the circumstances the staffing review mentioned earlier in this report becomes essential if standards are to be maintained and reflect any changing needs. The Annual Quality Assurance Assessment submitted by the home indicated that the electrical circuits in the home had not been checked would you therefore determine the desired frequency and if necessary undertake the checks and record this. Hawthorn Residential Care Home DS0000070649.V360532.R01.S.doc Version 5.2 Page 21 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 3 X 3 X X X 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 3 18 3 2 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 3 X 3 X X 2 Hawthorn Residential Care Home DS0000070649.V360532.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? New Service 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. 1. 2. 3. Refer to Standard OP19 OP29 OP38 Good Practice Recommendations Attention to the dining room curtains. Ensure all of the required information is obtained prior to the appointment of staff. Ensure that a competent person checks the electrical wiring of the home. Hawthorn Residential Care Home DS0000070649.V360532.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Hawthorn Residential Care Home DS0000070649.V360532.R01.S.doc Version 5.2 Page 24 - 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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