Inspection on 15/12/09 for Hazelhurst

This is the latest available inspection report for this service, carried out on 15th December 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.

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.

Other inspections for this house

Hazelhurst 05/08/08

Hazelhurst 29/02/08

Hazelhurst 18/07/06

Hazelhurst 15/02/06

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Hazelhurst 23 Kings Road Horsham West Sussex RH13 5PP Lead Inspector Shelia Gawley Key Unannounced Inspection 15th December 2009 09:00 DS0000065774.V378725.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Hazelhurst DS0000065774.V378725.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Hazelhurst DS0000065774.V378725.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hazelhurst Address 23 Kings Road Horsham West Sussex RH13 5PP 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) 01403 276333 01403 276344 hazelhurst@ashbourne.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Mr James Elder-Ennis Care Home 38 Category(ies) of Dementia (0) registration, with number of places Hazelhurst DS0000065774.V378725.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Dementia (DE). The maximum number of service users to be accommodated is 38. Date of last inspection 10th February 2009 Brief Description of the Service: Hazelhurst is a care home that is registered with the Care Quality Commission to provide personal and nursing care for up to 38 persons aged 65 years and over with dementia. The registered provider is Ashbourne (Eton) Ltd, a subsidiary of Southern Cross Healthcare Group Plc. The registered manager is Jim Elder-Ennis who is responsible for the day-to-day management of the home. Mr Mark John Cash is the responsible individual. The home is located near to public transport links and the town is within walking distance. Accommodation is provided on three floors accessed by a passenger lift. There are 32 single and 3 double bedrooms and 3 bedrooms on the top floor offer en-suite toilet facilities. Communal space consists of an upstairs sitting room, a large sitting/dining room downstairs and a further sun lounge. At the time of the inspection the fees charged were £730 to £800. Hazelhurst DS0000065774.V378725.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 2 star. This means the people that use this service experience good quality outcomes. This site visit as part of the inspection process took place on 15th December 2009. It was undertaken by a lead Inspector from the Care Quality Commission. The registered manager for the service facilitated the inspection and five staff, two people who use the service and two relatives were involved in the inspection process. Prior to the visit all files held were reviewed, this included complaints and safeguarding issues. The home had sent us their AQAA and it gave us the information we needed and any documents required on the day were made available. Overall people expressed satisfaction with care on offer in the home. People using this home experience good outcomes. What the service does well: People have a full assessment prior to admission to the home. Care needs are assessed, set out in a plan of care and are met. There is an activities programme in the home and two activities coordinators have been employed. People living in the home enjoy a varied nutritious diet and are offered drinks, fruit, cakes and snacks throughout the day. What has improved since the last inspection? Hazelhurst DS0000065774.V378725.R01.S.doc Version 5.2 Page 6 The recording of needs in care plans has improved. The requirement on activities of the last inspection has been met. Seventeen rooms have had new carpets as have all the corridors and the remaining rooms are being recarpeted at the rate of three a month. Staff supervision is in place and staff have a clear sense of the ethos of care in the home. There is a training and development plan in the home. The home is well managed and run in the best interests of the people living there. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Hazelhurst DS0000065774.V378725.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 Hazelhurst DS0000065774.V378725.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience excellent/good/adequate/poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service experience good outcomes in this area because needs are assessed prior to admission. EVIDENCE: People who use the service are fully assessed prior to admission to the home. All medical, nursing and personal care need is assessed and recorded. This includes physical and mental health needs, continence, mobility and dexterity, sight, hearing and communication, and oral and foot care. Social need and carer and family involvement is recorded. Hazelhurst DS0000065774.V378725.R01.S.doc Version 5.3 Page 9 Four people who use the service were case tracked and their preadmission assessment was present in the care plans. The preadmission assessment for a person being admitted the day after the inspection was also seen. The AQAA states “We do not admit residents until we are certain that everything is in place to meet their needs”. People and/or their representative are encouraged to visit the home prior to admission. Hazelhurst DS0000065774.V378725.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience excellent/good/adequate/poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service experience good outcomes in this area because the improvements introduced into care planning identified during the last inspection have been maintained. This ensures needs are assessed and met. EVIDENCE: Four people who use the service were case tracked and their documentation was inspected, one of these people was spoken with as was her relative. Both stated they were happy with the care on offer. A professional who wrote to us commented that there was good cooperation from the nurse on duty who had a pleasant and caring nature. All had a plan of care to meet assessed needs. Assessed need covered wound care and all daily personal and nursing care. Wishes at time of death were also recorded. There was evidence of monthly review. Hazelhurst DS0000065774.V378725.R01.S.doc Version 5.3 Page 11 Risk assessment is recorded such as risk of pressure wounds. A body map is in place in the plans. There was suitable pressure relieving equipment in place but for two people it was not clear in their care plans what equipment was to be used and what pressure it was to be set at. The registered manager stated that he would rectify this today. Moving and handling risk assessments and requirements were recorded such as “needs two carers, slide sheet and stand hoist”. There are not any pressure wounds in the home at present. Managing agitation and challenging behaviour was recorded. People who use the service have access to local national health services. The general practitioners visit frequently and there is support from the psychiatrist and community psychiatric services, the chiropodist also visits. The registered manager holds one or two weekly clinical meetings with the registered nurses to discuss peoples’ ongoing care needs and to discuss any new issues. This is separate to the daily handovers between shifts. The AQAA stated “Carers have been encouraged to take an active part in care planning and delivery of care and are encouraged to highlight issues with nursing staff and manager and also encouraged to follow up on concerns. We have trained more people in dignity and encouraged them to put this into practice”. Medicines are received, recorded and correctly stored in the home. Medicine administration charts were up to date and they all contain the photograph of the person they refer to. Controlled drugs are correctly stored and the controlled drug records and drugs were accurate. The registered manager stated that the care plans are continually under review and development. Hazelhurst DS0000065774.V378725.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience excellent/good/adequate/poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service experience good outcomes in this area because EVIDENCE: There are two activities coordinators employed in the home providing 37 hours for activities per week. The activity coordinator on duty today was spoken to. That activity to meet the needs of the people living in the home was a requirement of the last inspection. The activities coordinator stated that the activities provided are mostly one to one as this is best suited to the needs of the people using the service. They read newspapers and magazines with the people, do manicures, and arts and crafts. The AQAA states “We have in the last year ensured that all residents have an activities care plan. We encourage contact with the local community by having connections with a local primary school. For a recent 100th birthday the chair of the local council attended the party.” Activities records were seen and were up to date. Hazelhurst DS0000065774.V378725.R01.S.doc Version 5.3 Page 13 There is well maintained garden which people use in the good weather. The home held a summer barbeque for the first time this summer and the home had a Halloween party. A Christmas party is planned for later in the week and relatives are invited to these events. The local schools mentioned in the AQAA will come in to sing carols. A church choir visits weekly and there is a church service once a month. Birthdays are celebrated. One person who uses the service who was very agitated in the sitting room was seen to have a head massage form the registered nurse on duty and this had a calming effect on her. There were pictures of events on the notice board and a letter of thanks from Great Ormond Street hospital for some fundraising the home did for them. People have choice in day to day routines and person spoken with who was in bed said she chooses to go downstairs when she wishes. Her relative confirmed this. The requirement on activities of the last inspection has been met. Hazelhurst DS0000065774.V378725.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience excellent/good/adequate/poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service experience good outcomes in this area because Complaints are listened to and people are protected from abuse. EVIDENCE: There are safeguarding policies and procedures in place and there was evidence of staff training in staff files. The AQAA states “We have reported concerns to our local safeguarding and co-operate fully with the safeguarding teams during investigations and work from the outset to introduce more effective systems” The home is cooperating with a recent level 2 safeguarding investigation and social services are happy with the systems the home has put in place. There is now a protocol for staff to follow should a person using the service have a fall. Staff spoken with confirmed training. All complaints are logged. There have been six since the last inspection and all have been dealt with within timescales and to the satisfaction of the complainants. One person who uses the service and two relatives spoken with all stated they would know how to complain and that any concern is quickly dealt with. Hazelhurst DS0000065774.V378725.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience excellent/good/adequate/poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service experience good outcomes in this area because they live in a safe and well maintained environment. EVIDENCE: Accommodation is provided in 35 single rooms and three double rooms. Screens are available in the double rooms. There are comfortable well furnished communal spaces, a large sitting/dining room downstairs and a smaller sitting room upstairs. There is a further sun lounge downstairs. There is a programme of routine maintenance and carpets have been replaced in all corridors and seventeen of the bedrooms. This is being continued at a Hazelhurst DS0000065774.V378725.R01.S.doc Version 5.3 Page 16 rate of three bedrooms a month. The home on this occasion was neat clean and free from offensive odours except for one bedroom which is due to have the carpet replaced. The registered manager stated that the carpet cleaner was broken and an order had been raised with head office. He contacted head office and confirmed by telephone the next day that a carpet cleaner was being couriered to the home. Curtains and bedding has been replaced in many rooms. People are encouraged to personalise their bedrooms. The garden is well maintained and accessible. There are suitable hoists, pressure relieving equipment, bath aids, grab rails, a call bell system and door closure devices to meet the needs of people living in the home. There are laundry facilities which are equipped with the necessary machines with the temperature cycles needed to prevent the spread of infection. There are sluicing facilities and the staff has received training in infection control. Hazelhurst DS0000065774.V378725.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience excellent/good/adequate/poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service experience good outcomes in this area because their needs are met by sufficient numbers of suitably qualified staff. EVIDENCE: Staff rota showed sufficient staff to meet the needs of people using the service. A letter received from a nurse practitioner questioned if there were adequate staff on duty when she visited. There are twenty one people accommodated and the registered manager feel that staffing levels are appropriate. When questioned staff stated that they feel there are enough staff on duty to meet needs. During the visit there was one registered nurse and four carers on duty. One other carer had accompanied a person using the service to a hospital appointment. There was support from an activities coordinator. The staff rota showed sufficient staff to meet the needs of people using the service. There was support from an activities coordinator. There was housekeeping, kitchen and administrative support. The registered manager stated that as admissions increase the staffing will be reviewed. Hazelhurst DS0000065774.V378725.R01.S.doc Version 5.3 Page 18 The AQAA states “We are fully staffed with care assistants, kitchen and ancillary staff. We have a very low turnover of staff. In the last year we used agency on three occassions. We ensure that staffing requirements are adequate to cover the needs of the residents.” Two relatives spoken with stated that the staff are kind and welcoming. Fifty percent of staff have attained National Vocational Qualification Level 2 or above. There is a staff training and development programme offering training on safeguarding adults, moving and handling, first aid, fire, infection control, food hygiene and health and safety. The staff also have had training in dementia, challenging behaviour and dignity training. Altzeimers training is planned for the new year. Although the activities coordinator has had some training in activities it was not specific for people with dementia, the registered manager stated thet he will source this for her. A cleaner on duty spoken with confirmed traininin moving and handling, Control of Substances Hazardous to Health. (COSHH) The AQAA states “We have a rolling recruitment programme to ensure that we have a skilled and sufficient workforce.” There are robust recruitment procedures in place. Staff files inspected contained all the documentation required by the regulations. They contained two references, employment history, enhanced criminal records bureau clearance, evidence of training and in the file of a registered nurse evidence of active registration with the Nursing and Midwifery Council. Hazelhurst DS0000065774.V378725.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience excellent/good/adequate/poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service experience good outcomes in this area because the home is well managed and is run in the best interests of the people who live there. EVIDENCE: The registered manager is a registered nurse in mental health and has a certificate in management studies. He has many years experience in mental health in the National Health Service and the prison service. He has been managing the home since August 2008 and has been registered with us since February 09. During that time he has changed the culture of the care offered Hazelhurst DS0000065774.V378725.R01.S.doc Version 5.3 Page 20 in the home. He has an open door police and staff say the he is approachable and “works hard so they get things right”. The statutory requirement notices served in September of 2008 were found to be met on the inspection of February of 2009. Improvements have been maintained and embedded in practice. The staff were observed interacting with people who use the service in a meaningful and respectful manner. Staff have been on dignity training. The requirement made on the last inspection on activities has been met although the registered manager stated the he will continue to improve on this area. There are quality assurance systems in place. The home sent us their AQAA when we asked for it and it contained the information we needed. The registered manager has weekly or fortnightly meetings with the registered nurse to monitor the ongoing needs of people using the service. The accident book is monitored daily and events are tracked and analysed and changes are made. There are fortnightly staff meetings and staff spoken with confirmed this. One relatives meeting has been held and they are invited to seasonal events. Returned surveys that the home has sent to relatives were seen. Comments included “Warm welcoming atmosphere”, “Very approachable and friendly”, Manager very friendly and addresses any concern I might have”, Bedroom kept very clean”, “We are always grateful that mother is smiling when we visit”, “Dementia improved since been in here”. One professional survey commented “There have been numerous managers but the current one appears professional and knowledgeable”. Staff supervision is in place and is recorded. Records were seen and staff spoken with confirmed that they receive this. Supervision is offered every two months however the registered manager stated that to maintain improvements he will do supervision when any shortfall in practice is identified. This is sometimes group supervision. There are utilities, lift, and hoist maintenance contracts in place. The home has just had a new stand hoist and a further one is on order. The home does not hold money for any person using the service but does manage a bank account for the people using the service who are listed separately on the statements. The health and safety of people who use the service are protected by the Hazelhurst DS0000065774.V378725.R01.S.doc Version 5.3 Page 21 provision of policies and procedures and training on health and safety. Hazelhurst DS0000065774.V378725.R01.S.doc Version 5.3 Page 22 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 3 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 3 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 3 3 X 3 3 X 3 Hazelhurst DS0000065774.V378725.R01.S.doc Version 5.3 Page 23 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 Hazelhurst DS0000065774.V378725.R01.S.doc Version 5.3 Page 24 Care Quality Commission Care Quality Commission South East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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