Inspection on 03/06/08 for Hazelwood House Residential Home

This is the latest available inspection report for this service, carried out on 3rd June 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.

Other inspections for this house

Hazelwood House Residential Home 09/08/06

Hazelwood House Residential Home 21/02/06

Hazelwood House Residential Home 10/08/05

Hazelwood House Residential Home 25/11/04

Hazelwood House Residential Home 15/06/04

Hazelwood House Residential Home 12/02/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Hazelwood House Residential Home 58-60 Beaufort Avenue Kenton Middlesex HA3 8PF Lead Inspector Judith Brindle Key Unannounced Inspection 3rd June 2008 08:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hazelwood House Residential Home DS0000054194.V364405.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. Hazelwood House Residential Home DS0000054194.V364405.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hazelwood House Residential Home Address 58-60 Beaufort Avenue Kenton Middlesex HA3 8PF 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) 020 8907 7146 020 8907 5901 hazelwoodhouse@btconnect.com Mr Ramnarain Dyanan Sham Mr Ramnarain Dyanan Sham Care Home 15 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (0), Old age, of places not falling within any other category (15) Hazelwood House Residential Home DS0000054194.V364405.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th June 2007 Brief Description of the Service: Hazelwood House is a registered care home providing personal care and accommodation for a maximum of 15 older people aged over 65 years who have mental health needs. The home is located in a quiet residential road in Kenton. It is fairly close to shops, pubs, and other community amenities. Bus and train public transport facilities are within a few minutes walk, or drive from the care home. The home has a passenger lift. It has 11 bedrooms, 5 have ensuite facilities, and four bedrooms are shared. There are two bathrooms on the first floor, and a shower room on the ground floor. The home has a garden to the rear of the property, which is well maintained and accessible to people using the service. There is parking for several cars on the forecourt of the home. Information/documentation about the service and the range of fees (£550£600) is accessible from the care home to prospective residents and others. Additional costs are recorded in resident’s statement of terms and conditions, and in the statement of purpose. Hazelwood House Residential Home DS0000054194.V364405.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 unannounced key inspection took place throughout nine and a half hours during a day in June 2008. A regulation inspector and a regulation manager carried out this inspection. There was one vacancy at the time of the inspection. We were pleased to meet, and spend a significant part of the inspection with the people living in the home. The registered manager/owner was present during the inspection. Prior to this unannounced key inspection the manager supplied the Commission for Social Care Inspection (CSCI) with a completed Annual Quality Assurance Assessment (AQAA) document. The AQAA is a self- assessment of the service provided by the care home that is carried out by the owner and/or manager. It focuses on the quality of the service, and how well outcomes for people using the service are being met by the care home. It also includes information about plans for improvement, and it gives us some numerical information about the service. Reference to some aspects of this AQAA record will be documented in this report. This document was not comprehensively completed. The reason for this given by the manager/owner was due to the problems that he faced accessing the document from the Commission, and of only having a week to complete it. This was discussed with him during the inspection. A number of feedback surveys were supplied to the care home prior to this inspection. These requested feedback from people using the service, relatives/significant others, health and social care professionals, and staff. At the time of writing this report, we had received 7 surveys from people using the service, 3 from relatives/visitors, 3 from health care professionals and others, and one survey from a staff member. Other information received by the Commission for Social Care Inspection (CSCI) about the service since the previous key inspection was also looked at. This included what the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. Also relevant information from other organisations, and from what other people might have told us about the service, was assessed. We spoke with most of the people using the service, and with the staff on duty during the inspection. Hazelwood House Residential Home DS0000054194.V364405.R01.S.doc Version 5.2 Page 6 Documentation inspected included, five care plans of people using the service, risk assessments, staff training, and staff personnel records, and some policies and procedures. The inspection included a tour of the premises. Assessment as to whether the requirements and recommendations from that inspection had been met also took place during this inspection. The requirements and most of the recommendations were found to have been met. 25 National Minimum Standards for Older Persons, including Key Standards, were inspected during this inspection. The inspectors thank the people living in the care home, staff, the registered manager/owner, and all those who supplied us with completed feedback survey forms, for all their assistance in the inspection process. What the service does well: What has improved since the last inspection? The inspection requirements and most recommendations from the previous inspection were judged to have been met. Hazelwood House Residential Home DS0000054194.V364405.R01.S.doc Version 5.2 Page 7 The décor of the care home has improved. Communal areas and bedrooms have been repainted. Furnishings including armchairs and dining chairs have been replaced with new items. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hazelwood House Residential Home DS0000054194.V364405.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 Hazelwood House Residential Home DS0000054194.V364405.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): Standards 1, 2, 3 and (6 is not applicable) People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective residents have the information that they need to make an informed choice about where to live. People using the service have their needs assessed prior to moving into the care home, which makes certain that the home knows about the person, and the support that they need. Some equality and diversity aspects of this assessment could be further developed. People using the service have a contract, but some people are not aware of this record/document. EVIDENCE: The care home has accessible documentation and information about the service provided by the care home. The manager/owner told us that he reviews both documents annually. Copies of the service user guide (in written Hazelwood House Residential Home DS0000054194.V364405.R01.S.doc Version 5.2 Page 10 format), and the previous inspection report were located in the ‘quiet’ room/visitors room in the home. The manager reported that the service user guide has been supplied to all the people using the service, and that he provides both documents to people who enquire about the care home including prospective residents. The manager/owner could review the format (i.e. pictorial format) of the service user guide with people using the service, to improve its accessibility to those who have difficulty in reading, and/or speak a language other than English. This was a previous recommendation. The manager told us of the plans that he had to review the format of this document. The home has an admission procedure, which includes details of the assessment, and admission criteria for people using the service. The manager spoke of having knowledge, and understanding of the importance of carrying out a comprehensive initial assessment of a prospective resident, and to not rely just on referral assessment information supplied by the placing/funding local authority. He told us that he had learnt from a safeguarding issue (in 2007) with regard to a previous resident who had been admitted to the home with significant needs that the home had difficulty in meeting. This resulted in a complaint, and the instigation of Local Authority Safeguarding Adult’s procedures, and the resident moving to another care facility. This issue was discussed during the inspection. The manager told us he had learnt a great deal from this incident, and was confident following his review of the care home’s practices and procedures that a similar issue would not occur. The manager/owner confirmed that a full assessment of the prospective resident’s needs (including specific care needs, medical, physical, social and emotional needs) is carried out generally by him. An example of an assessment was located in the care plan file of a person using the service. We were informed that the prospective resident is supported in being as involved as much as they can in this process of assessment, and that hospital staff (when a resident is admitted from hospital) are also consulted to gain information about the person’s needs. A resident told us that she/he had been asked some ‘questions’ about herself/himself before she moved into the care home. The manager gave us examples of how family members are sometimes involved in this process of assessment. Prospective residents also receive an assessment of their needs from the funding Local Authority. Copies of these documents were located in care plans inspected. Assessment information recorded within the care plans inspected indicated that spiritual and religious needs are recognised by the service. Further development of recorded assessment (documented in the person’s care plan) of some equality, and diversity needs could be more evident to ensure that the care home shows a comprehensive understanding, and respect for all aspects of diversity including gender, age, sexual orientation, race, and disability. Hazelwood House Residential Home DS0000054194.V364405.R01.S.doc Version 5.2 Page 11 The manager confirmed that resident’s have a six week ‘settling in’ period, before a review of their needs takes place (with their full involvement), and the placement is then confirmed. This enables people using the service to make up their mind in deciding if they would be happy living in the home. Care plans inspected included copies of individual resident’s statement of terms and conditions, which generally recorded the fees. Some of the contracts in the care plans inspected were signed by the person using the service. Feedback surveys from two people using the service told us that they were not aware of this contract. The manager should ensure that each resident has knowledge of this statement of terms and conditions, with a record of the amount of fees paid. Each person should be given the opportunity to sign it (it should indicate on the record if they are unable to sign the contract), and be given a personal copy of the document. Hazelwood House Residential Home DS0000054194.V364405.R01.S.doc Version 5.2 Page 12 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): Standards 7,8,9, and 10 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Each person using the service has a plan of care, in which residents’ health, personal, and social needs are set out. Some could be further developed to ensure that it is evident that the care plans are always updated with involvement from people using the service, when resident’s needs change. People using the service are respected and their right to privacy upheld. People using the service are protected by the home’s policies and procedures for managing and administrating medication to people using the service. EVIDENCE: All the people using the service have a plan of care. Five care plans were inspected. Some people using the service had signed them. These plans included a photograph, and a personal profile of the person. Hazelwood House Residential Home DS0000054194.V364405.R01.S.doc Version 5.2 Page 13 These plans recorded evidence of assessment of personal, health, communication, social, spirituality/religious, and mobility needs. There was some recorded guidance for staff to ensure that assessed needs are met. We spoke with the manager/owner with regard to developing more understanding of equality and diversity needs within the home, by providing more staff training in this area, and further developing this in the care plans of people using the service. The manager reported that he had plans to ensure that staff receive more equality and diversity needs training. It was not very evident in these care plans that residents had been asked questions about some of their individual needs. ‘Life Story’ books could be looked into for some people using the service particularly those with communication and particular care needs. Care plans inspected informed us that care plans are reviewed generally on a monthly basis. There was a section within these recorded reviews for resident’s comments. This section was sometimes completed, but it was not evident as to how much involvement people using the service had in their review of their care plans. These reviews were not generally signed by the resident. Individual daily and night progress records are documented by staff. The manager reported that no residents have pressure sores, but that a resident did have on occasions a ‘sore’ area on his/her hips, which staff attended to with barrier cream. This was recorded in the handover book, but needs to be included in this persons care plan. It could be more evident that care plans are working documents. Personal care issues of people using the service are recorded and communicated clearly to staff, but sometimes the care plan is not updated to include particular observations and guidance to meet the need such as when someone has a bruise. The practice of recording (particularly in the care plans, and incident records) bruises needs to be reviewed to ensure that people using the service can be confident that this is taken seriously and acted upon appropriately to ensure that there needs are met and that they are safe. The home has a risk management policy/procedure. Care plans include risk assessments, such as risk of falls, nutritional needs, pressure sore, moving and handling, and health and safety risk assessments. These are generally reviewed regularly. A note in the handover book recorded that a resident was not to use the stairs. This person had a risk assessment with regard to risk of fall. This should have been developed to include assessment of his/her risk in using the stairs. Following the inspection the manager supplied the Commission with a record of developed and improved guidance (which included reference to use of the stairs) with regard to this resident’s risk of falling. Hazelwood House Residential Home DS0000054194.V364405.R01.S.doc Version 5.2 Page 14 People using the service have access to care, and treatment from a variety of healthcare professionals, and specialists, including GP, dentist, and chiropody treatment and care. A resident told me that he/she had ‘seen the doctor’. Hospital appointments are recorded. A person using the service spoke of several hospital appointments that he/she had recently attended. The manager told us that a staff member always accompanies residents to hospital appointments. Records and staff confirmed that each person using the service have their weight monitored closely. Staff provided assistance and support to residents in a sensitive and respectful manner, and have an understanding of the importance of upholding their right to privacy. Staff were observed to regularly ask some residents if they wanted to use bathroom/toilet facilities. A resident spoke of making choices, which included choosing his/her own clothes, and of the time he/she wished to go to bed. Some people using the service told us that they went to bed early when at times they would prefer to stay up later. The manager informed us that residents start to get ready for bed following supper, and that unless they request it, they don’t’ go to bed prior to 8pm. The care plans did not record individual’s particular preferences with regard to night time routine. This needs to be included in the plans. People using the service were observed to be dressed appropriate to their culture and age. The manager told us of how a resident’s cultural needs were met by the home with particular regard to his/her hair and skin care. Though this person was observed to have his/her hair appropriately cared for, guidance with regard to this person’s particular personal care needs was not evident in the care plan record. A female resident was seen to be wearing lipstick. Several female residents had nail varnish on. Another was having it applied later on the day. Feedback surveys from relatives/visitors informed us that they felt that the home meets the varied needs of people, and that the care home gives the care that they expect. The home has a medication policy/procedure. Medication is stored securely. Records, and staff confirmed that they had recently received medication training. The manager spoke of the process carried out to ensure that staff are competent to administer medication to people using the service. This includes ensuring that new staff observe more senior staff administering medication, and ensuring that staff have read and understood the medication policy/procedure. He told us that staff do not administer medication for six months from the commencement of their employment. The manager/owner should ensure that this process of training staff to be competent in administering medication is recorded to provide documentary evidence that staff competent to administer medication to residents. Following the Hazelwood House Residential Home DS0000054194.V364405.R01.S.doc Version 5.2 Page 15 inspection the manager/owner supplied the Commission with a record of guidelines for staff to follow with regard to the safe handling and administration of medication to people living in the care home. A resident told us that he/she felt sleepy for long periods of time, and felt that it could be due to his medication. His/her medication was discussed with the manager, who reported that it had been recently reviewed by the GP, and was concluded that it was unlikely to be the cause of sleepiness. The manager should continue to examine possible reasons as to why this person feels sleepy, including the possible need for more activity/stimulation. Medication administration record sheets confirmed that there were no gaps in recording. The registered manager confirmed that he had obtained an up to date British National Formulary (BNF) from a pharmacist. This details medicines prescribed in the UK, with special reference to their uses, cautions, contra-indications, side effects, and dosage, which is useful to staff working in the care home. Hazelwood House Residential Home DS0000054194.V364405.R01.S.doc Version 5.2 Page 16 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): Standard 12,13 14 and 15 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People have the opportunity to take part in activities, but there could be further development in the provision of daytime activities, including community based leisure pursuits. The visiting arrangements are flexible and meet the needs of visitors and residents, so as to ensure that residents have the opportunity to develop and maintain important relationships. People using the service are supported to make choices. Meals provided are varied, and wholesome. The menu could be more accessible to people using the service. EVIDENCE: Records informed us that people using the service had individual recorded activity programmes. Activities included bingo sessions, exercise sessions, and piano/music sessions. The manager told us that a weekly piano session had now ended. The activity programmes should be reviewed to indicate this. Activities that took place during the inspection included, manicure sessions, a Hazelwood House Residential Home DS0000054194.V364405.R01.S.doc Version 5.2 Page 17 one to one session of a game of dominoes, and a resident was observed to do some drawing. Other activities that residents participated in included reading the newspaper, reading books, completing a crossword, and watching television. A resident told us that he had his hair cut during the inspection, and that he was ‘pleased’ with it. It was noted that there was a radio on with popular’ music playing for several hours during the morning. A resident told us that the radio goes on all day and that ‘it would be nice if there was different music’. She/he told us that she/he had been asked in the past what she would like to listen to, but that others didn’t like her choice. This issue was discussed with the manager, who agreed to review the issue of the radio being on for long periods. A comment in one care plan recorded that a resident was ‘contented staying with her husband (who also lives in the home) hence not bothered about other activities’. We discussed the role that some residents have in helping with household duties. A staff member spoke of a resident who sometimes helps with cleaning. This area could be developed with residents and possibly include supervised (in accordance to individual assessment) cooking sessions or having the opportunity to make snacks for themselves. This could help some residents to gain skills and/or retain skills that they already have or had. A comment from a relative/visitors feedback form informed us that the home could improve by ‘having more activities for residents, they seem to sit an awful lot’; another comment was that there should be ‘more activities for the elderly’. During the inspection, though some residents took short walks (sometimes with staff) within the communal areas of the care home, it was observed that some residents sat for significant periods of time. Two residents were observed to sleep for sometime during the morning of the inspection, which could be linked to inactivity. (See health and social care section with regard to medication). A resident spoke of enjoying going out in the garden during fine weather. Another person using the service spoke positively of the regular mobile library service that brings him/her a regular supply of books. Comments from him/her included ‘I love reading’, ‘books are important to me’. The provision and development of activities has been discussed with the manager during the previous inspection. There appears to have been some development in improving the number and variety of activities, but it is evident that further improvements in this area could be made. The manager/owner and the staff team should further develop the type and number of activities for residents. The home could seek advice from organisations that could provide advice on activities for older people with varied needs to ensure that people using the service lead a stimulating and active life. The home could examine ways to develop activities for those with particular care needs, including those with communication needs, and include Hazelwood House Residential Home DS0000054194.V364405.R01.S.doc Version 5.2 Page 18 understanding and incorporating the role of sensory stimuli (colour, smell, touch and sound) in helping to improve communication with them. This could mean for example having available soft cuddly toys, and a scented garden The visitor’s record book indicated that people regularly visited the home. There were generally two entries a day, and included maintenance people, healthcare professionals and a keyboard player. Residents spoke of visitors that they had. A resident spoke of his/her son visiting her. Another told us that her daughter visits. Feedback survey confirmed that relatives/significant others are kept informed of issues that concern their relative/friend living in the care home. A comment from a visitor/relative feedback form in response to the question ‘Are you kept up to date with important issues affecting your relative?’ was, ‘yes always by a phone call’. The home has a menu. This is recorded in a book located in the kitchen. The accessibility of the menu to people using the service was discussed with the manager. He spoke of plans to ensure that it is more accessible to people using the service. These plans include having a number of photographs of meals provided by the home. As well as displaying prominently the appropriate meals on a daily basis to inform, and remind people using the service of the choice of meals planned to be served to them that day. Improving the accessibility of the menu was a previous recommendation, and should be met. Staff confirmed that residents had choice of meals, and spoke of the particular food preferences of several people using the service, and of how they are met by the home. Food ‘likes’ and ‘dislikes’ were recorded in care plans inspected. Residents spoke of enjoying the meals. Staff had an understanding of the various specialist and cultural dietary needs of residents. They told us that people using the service are offered a choice of meals on a daily basis. Records with regard to this were accessible. Comments from people using the service included “ I like the meals”, “I like the puddings”, “I have choice” ‘ If I ask I would be given a snack if I felt hungry’, the ‘food is lovely’, ‘I like the food’. Residents told us that they enjoyed the lunch that was provided during the inspection. This meal was mince or meatballs, mixed vegetables, and mashed potatoes, and ice cream for pudding. Feedback from a relative included ‘food is always very acceptable’. Several residents ate lunch sitting in the lounge. The manager told us that they chose to eat in the lounge rather than the dining room. Most of those eating in the lounge wore adult bibs. One person using the service told me that he/she felt that this was infantile. We discussed this with the manager/owner who agreed to offer napkins as an alternative. It should be clearly evident in the care plan (agreed by the person) when someone chooses to eat in the lounge and when he or she wish to wear a bib. Hazelwood House Residential Home DS0000054194.V364405.R01.S.doc Version 5.2 Page 19 Staff employed by the home cook the meals. The manager told us that staff that cook the food have received training with regard to food safety. He showed us a record that confirmed that food and hygiene training for several staff was planned to take place shortly. A variety of food items were stored. These included fresh, frozen, dried and tinned foods. Fresh fruit was available. A staff member spoke of ensuring that residents are supplied with fresh fruit on at least a daily basis, by including it in fruit salads and other puddings, as well as offering a choice of fruit to people. We were told that supper is provided at approximately 4.30 to 5pm. A resident told us that this time was fine for him. Staff confirmed that hot drinks, biscuits and other snacks were provided prior to bedtime to ensure that residents receive the nutrition they need until their breakfast. Hot and cold drinks were regularly provided to residents during the inspection. Jugs of squash and water were accessible in the communal area of the home. Hazelwood House Residential Home DS0000054194.V364405.R01.S.doc Version 5.2 Page 20 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): Standards 16 and 18 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People using the service and others are confident that their complaints will be listened to, looked into and action taken to put things right, but there could be development in the recording of “comments/concerns”. Residents are protected from abuse, neglect and self-harm, and the care home takes action to follow up any allegations. EVIDENCE: The care home has a complaints procedure, a summary of which is recorded in the service user guide, and displayed in the entrance hall. The displayed complaints procedure should be reviewed to include up to date details with regard to contacting the Commission. The complaints procedure includes timescales with regard to responding to a complaint. The registered person should examine ways (with people using the service) to improve the accessibility of the complaints procedure for those who have difficulty reading, and for those for whom English is not their first language, to help anyone living at, or involved with, the service to complain or communicate a concern. This was a previous recommendation. There were no complaints and/or concerns recorded in the ‘complaints register’. The registered person spoke of the ways that he and the staff team respond to ‘concerns’ from people using the service. This told us that Hazelwood House Residential Home DS0000054194.V364405.R01.S.doc Version 5.2 Page 21 residents were listened to and that action was taken to resolve issues of concern, but this was not evident in records. The manager should examine ways of ensuring that it is evident that all verbal concerns from residents and relatives/visitors are supported, appropriately documented, and action taken to resolve each issue. He confirmed that he would review and improve the systems for recording ‘concerns’. Staff who spoke with us, had an understanding of the importance of taking complaints and or ‘concerns’ seriously and of the action that they should take in response to a complaint from a person using the service, or from others including visitors. A feed back survey from a staff member included the comment ‘we have a complaints book’. Feedback surveys from relatives/visitors and healthcare professionals and from people using the service informed us that they knew how to communicate a concern/complaint. Comments included ‘concerns are channelled to the manager and appropriate action is usually taken, individual concerns are also appropriately taken care of’. A comment from a resident with regard to making a complaint was ‘ I would write it (the complaint) down and send it to the manager’. Feedback from residents during the inspection told us that residents would speak to the manager, care staff, or family members if they had a concern. The home has a protection of vulnerable adults policy. Staff who spoke with us were knowledgeable of the reporting and recording procedures with regard to an allegation or suspicion of abuse, and confirmed that they had received training in abuse awareness. The care home has a consistent record of notifying the Commission and other agencies of incidents, and of recording action taken by the service. Staff reported that they had received ‘protection of vulnerable adults training’, and that information with regard to abuse awareness is included in the induction programme. Annual Quality Assurance Assessment (AQAA) documentation informed us that the care home has policies and procedures to ensure that verbal and physical aggression by people using the service is managed appropriately by staff. Hazelwood House Residential Home DS0000054194.V364405.R01.S.doc Version 5.2 Page 22 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): Standard 19, 23, and 26 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The environment of the home is safe, warm, clean and comfortable. The premises are suitable for the care home’s stated purpose. Resident’s bedrooms, meet their individual needs, but could be more individually personalised. EVIDENCE: The care home is located within a few minutes walk from local shops and bus public transport facilities. There is parking for several cars on the forecourt of the care home. The inspection included a tour of the premises. The care home is well maintained, homely, clean and airy. The living environment is appropriate for the particular lifestyle, and needs of people living in the home. Houseplants, Hazelwood House Residential Home DS0000054194.V364405.R01.S.doc Version 5.2 Page 23 pictures and a fish tank are located in the communal sitting room of the home. The home has a ‘quiet’ room where visitors can meet their relatives and friends, and where meetings, and staff training can take place. The garden area is enclosed and well kept. It contains a variety of plants and shrubs. Seating is accessible to people. Residents told us that they enjoy the garden facility and access it frequently during nice weather. Handrails and other aids were located in the care home. Bathrooms, toilets and the laundry were named, and bedrooms had the name of the resident on them. The care home could examine ways of making it easier for people who use the service (particularly those with communication needs) to find their own rooms and other rooms, such as by colour coding and/or putting pictures on doors to better identify each room. The manager informed us of the considerable amount of redecoration within the home that has been carried out since the previous unannounced key inspection. Areas redecorated include communal areas and the bedrooms of the home. Furnishings have also been improved. Armchairs have been replaced in the sitting room and we were told that all the dining chairs are new. Some curtains and carpets have also been replaced with new ones. The combination of redecoration and improved furnishings have contributed in making the atmosphere of the home more pleasing, fresh, and homely. This is positive. All the communal chairs had ‘seat mats’ on them. This was commented on during the previous inspection with regard to them being unsightly. The manager told us that they were needed to prevent residents sliding whilst seated on the new armchairs. Residents spoke of being happy with their bedrooms. There are four shared rooms. A person using the service told us that he enjoyed sharing a room with another resident. Bedrooms are furnished appropriately, but personal items and pictures in some bedrooms were not very evident. The manager informed us that some residents bring few possessions with them, and have few relatives to purchase items for them. The home could look at ways to make bedrooms more personalised and homely. A resident spoke of having had a television that now no longer worked. This was discussed with the manager who told us that he would arrange for this person to have a new television in their bedroom. There is a call bell located in each bedroom. It was noted that in one bedroom though there was a call bell, there was not a cable to ensure that when the resident was in bed, they could reach the call bell. This needs to be in place. The manager should to assess each bedroom with regard to call bell cables and ensure that they are in place, and so accessible to people using the service. A resident reported that she/he had a bell to ring and it is always answered’. Hazelwood House Residential Home DS0000054194.V364405.R01.S.doc Version 5.2 Page 24 The home has an infection control policy/procedure. The home is very clean. A comment from a resident feedback form included ‘ my room is vacuumed every day’, a comment from a person who visits the home ‘there is a conducive environment for service users especially cleanliness’. Care staff complete cleaning duties in the home. Records confirmed that staff had received infection control training. Feedback from a healthcare professional confirmed that they thought that the home was clean. Laundry facilities are located away from food storage, and food preparation areas. We were informed that the clothes drying machine was broken. Laundry was spread out in various places in the care home to dry. The manager told us that the engineer was coming to the home to fix the dryer the following day. Hand washing facilities are located throughout the home. In some bathrooms/toilets the cotton hand towels were used for drying hands. There are wall mounted containers for paper towels, but these were empty. This was discussed with the manager who told us that he had recently had difficulty in obtaining paper towels. With regard to infection control and hygiene issues, there needs to be accessible paper towels in the bathrooms for drying hands. Staff were observed to wear protective clothing including disposable gloves, as and when needed. Hazelwood House Residential Home DS0000054194.V364405.R01.S.doc Version 5.2 Page 25 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): Standard 27,28 29 and 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff receive appropriate training, and support from their manager to ensure that they have the skills and knowledge to carry out their roles and responsibilities in meeting the varied care and support needs of people using the service. Sufficient numbers and skill mix of staff are employed to ensure that there are enough competent staff on duty at all times to meet the needs and changing needs of people using the service. People using the service are supported and protected by the care home’s recruitment policy and procedure. EVIDENCE: The staff rota was available for inspection. There are four staff including the manager on duty in the home in the mornings, and three care staff on duty in the afternoon. At night there is a ‘wake’ night and a ‘sleep in’ staff member on duty. Comments about the staff from people using the service included ‘ I find everyone on the staff very helpful’, and staff ‘listen to me and act upon what I say’, ‘staff are friendly’. During the inspection residents confirmed that staff were kind. A feedback form from a healthcare profession included the comment ‘very well looked after residents, clean home, good hygiene, well trainee staff attentive to residents and appear to know their residents well’. A recorded comment Hazelwood House Residential Home DS0000054194.V364405.R01.S.doc Version 5.2 Page 26 from a staff member included ‘there is always enough staff to meet the individual needs of all the people who use the service’. A resident told us that he/she knew the night staff well. Staff carry out the cooking, and cleaning as well providing care and support for people using the service. Staff were observed to be sensitive in meeting residents needs, but seemed to have little time (particularly in the morning) to sit with people using the service, or spend one to one time with them apart from when they were assisting them with their personal care needs. The manager should review the staffing numbers to ensure that there are enough staff on duty to ensure that all residents have the opportunity to participate in a variety of activities Feedback from relatives/visitors informed us that they generally felt that staff have the right skills and experience to look after people properly. Recorded feedback from relatives/friends included ‘I feel they (staff) really care for my (relative), she is always happy, which is important to me’, and ‘the young carers are always kind and helpful’, ‘all the staff are pleasant’. Recorded comments from a healthcare/social care and other professionals in response to a question asking what improvements they thought could be made to the service included ‘ could improve team work, which facilitates effective care to individuals’. The manager told us that since the autumn of 2007, 6 staff had left employment at the home; the reason being for some was to work in another part of the country. He spoke of the process of recruiting new staff, and the issues of building up the staff team, to its present stable situation. He told us that staff teamwork has improved significantly, and was aware that this was an on-going process. Communication systems are in place. These include staff meetings, handover book, verbal staff handovers, and communication books. Recorded comments from staff included ‘communication is good’, ‘we always pass information (via) the handbook’. Feedback from a staff member indicated that this person felt the staff meetings could take place more regularly. We were shown a staff induction record book. Staff, and records and a staff survey form confirmed that new staff receive an induction programme when they commence employment, and that this included ‘shadowing’ more senior care staff. A staff member told us that she received a three day induction, which she confirmed was positive in helping her to understand her role and responsibilities with regard to her job. AQAA information recorded that 60 of home staff have NVQ 2,3 or 4. The manager told us that all staff except for two new staff had completed an NVQ (National Vocational Qualification) care level 2 qualifications, and that several staff were in the process of achieving a Registered Manager’s Award qualification. Hazelwood House Residential Home DS0000054194.V364405.R01.S.doc Version 5.2 Page 27 Other staff training included, medication training, fire awareness, First aid, manual handling, health and safety, Mental Capacity Act training, mental health awareness, and infection control training. Feedback from a staff survey included the comment ‘moving and handling training helped me a lot’. A staff member told us that she had had moving and handling training and kitchen safety training as part of her induction. AQAA information told us that equality and diversity information is incorporated in the staff induction programme, and in staff supervision. Also that further changes to promote equality and diversity include reviewing policies and procedures were planned. Staff, and the manager reported that some staff training was carried out via videos. When using these as a tool for ‘refresher’ staff training. It should be evident that staff have gained knowledge, and understanding of the topics they have viewed. Questionnaires completed by staff should be part of this training and so it is evident that staff have gained the knowledge required for them to be able to carry out their duties. Staff spoke positively of training that they had received in the care home, and feedback confirmed that they were given training relevant to their role. The manager reported that staff that have English as a second language complete English language courses at college. He spoke of monitoring closely staff communication. A staff member spoke of the support she received from the staff team in understanding the needs of residents, when she was first employed when her English was basic. Some comments from feedback from relatives/significant others included ‘sometimes new staff are not aware of what needs to be said or done’, ‘new staff need to be trained’. The manager told us that this comment could be linked to the recent staffing issues with regard to the significant number of new staff who have been fairly recently employed in the home, but felt that the ability and skills of new staff had significantly improved. He confirmed that he monitors staff competency closely. The care home has a recruitment and selection procedure. Three staff personnel files were inspected. These contained confirmation that staff have received an enhanced Criminal Record Bureau check to gain information as to whether potential staff have a criminal record. Two staff files only included evidence of one satisfactory reference, and a partial employment record having been obtained prior to employment. Following the inspection the manager/owner supplied documented evidence that these checks had been carried out. Staff confirmed that they receive regular staff one to one staff supervision. Hazelwood House Residential Home DS0000054194.V364405.R01.S.doc Version 5.2 Page 28 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): Standard 31,33,35, 36, and 38 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The registered manager/owner is qualified, competent and experienced to run the care home appropriately. Effective quality assurance, and quality-monitoring systems are in place to monitor, develop and improve the quality of the service provided to people using the service. So far as reasonably practicable the health, safety and welfare of people using the service is promoted and protected, and their financial interests are safeguarded. EVIDENCE: Hazelwood House Residential Home DS0000054194.V364405.R01.S.doc Version 5.2 Page 29 The registered manager is also the owner of the care home. He has managed the home since 2003. He has achieved a NVQ level 4 Registered Manager’s Award qualification. The registered manager reported that he undertakes periodic training to update his skills and knowledge. The manager works in the care home most days, and told us that he was easily accessible by care staff for advice. A staff survey recorded the comment ‘I am always happy to talk to the manager about my work’. The manager is aware that there are improvements to the service that could be made, such as improving the number and varieties of activities, improving some recorded guidance in care plans, and developing better systems for recording ‘concerns’. He spoke of his aims and objectives in continuing to provide a quality service to residents. Records and the registered manager informed us that the care home monitors the quality of its service provided to residents. This includes obtaining the views of those who use the service and their relatives/significant others/visitors. Feedback questionnaires had been supplied to these stakeholders this year. The manager spoke of his plans to complete, an annual development plan (plans and action to be taken to develop and improve the quality of the service provided to residents) for the service in 2008. This should be completed. The AQAA confirmed that required and appropriate policies and procedures were in place to ensure that the residents are provided with a safe, quality service, but did not include information requested as to the date of the last review of policies/procedures used by the home to provide a quality service. A resident said ‘I am very happy at Hazelwood, I am sure that I couldn’t be happier anywhere else’. Resident meetings have taken place in the home. Records confirmed that a meeting had taken place recently and that there had been significant participation from people using the service. The previous meeting had taken place several months prior to this. This was discussed with the manager. People using the service should have the opportunity to participate in regular resident meetings. We were told that relatives, or the local authority manages resident’s finances. The manager said that invoices of purchases for residents are sent to the appropriate person managing the resident’s finances. He showed us several of these invoices. AQAA information told us that ‘outgoing expenditure is appropriately noted on financial records’. The home has health and safety policies and procedures, and fire risk assessment. Fire safety guidance is displayed in the home. Required fire safety checks and fire drills are carried out. An up to date gas safety certificate was available for inspection. AQAA documentation told us that the equipment located in the home has been Hazelwood House Residential Home DS0000054194.V364405.R01.S.doc Version 5.2 Page 30 serviced or tested as recommended by the manufacturer or other regulatory body. Fridge/freezer temperatures are monitored closely. The home lets us know about things that have happened; they have shown us that they have managed issues appropriately. The home has an accident policy/procedure. Incidents and accidents are recorded as required. An up to date certificate of insurance with regard to the care home was displayed. Hazelwood House Residential Home DS0000054194.V364405.R01.S.doc Version 5.2 Page 31 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 3 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 3 X 3 Hazelwood House Residential Home DS0000054194.V364405.R01.S.doc Version 5.2 Page 32 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. 1 Standard OP7 Regulation 12(2) 13(6) Requirement The manager needs to ensure that the person who has a ‘sore’ area on his/her hips (on occasions) which staff attended to with barrier cream, as this included (with guidance) in this persons care plan. So staff Know how to meet this resident’s particular needs. Timescale for action 01/08/08 2 OP23 12(2) 13 (4) The practice of recording all resident’s bruises (particularly in the care plans), needs to be reviewed to ensure that people using the service can be confident that this is taken seriously and acted upon appropriately to ensure that there needs are met and that they are safe. In a resident’s bedroom there 01/08/08 needs to be a call bell cable in place to ensure that the person using the service can easily access their call bell as and when the need. Hazelwood House Residential Home DS0000054194.V364405.R01.S.doc Version 5.2 Page 33 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. Refer to Standard OP1 Good Practice Recommendations The manager could review the format (i.e. pictorial format) of the service user guide with residents to improve its accessibility to those who have difficulty in reading, have communication needs, and who have English as a second language. This was a previous recommendation. The manager should ensure that each resident has knowledge of this statement of terms and conditions, with a record of the amount of fees paid. Each person should be given the opportunity to sign it (it should indicate on the record if they are unable to sign the contract), and be given a personal copy of the document. Further development of recorded assessment of some equality, and diversity needs could be more evident. To ensure that the care home shows a comprehensive understanding, and respect for all aspects of diversity including gender, age, sexual orientation, race, and disability. Care plans/risk assessments should be more of evident that they are working documents and that changing needs of people using the service are always fully recorded in them, so that staff and are aware of how to meet these needs. A persons cultural personal care needs should be recorded in their plan of care. To ensure that staff have recorded information in how to assist this person to meet their hair and skin care needs. The nighttime routine preferences of residents should to be included in the care plans of people using the service to ensure that they receive the care that they want and need from the home. The manager/owner and the staff team should further develop the type and number of activities for residents. The home could seek advice from organisations that could provide advice on activities for older people with varied needs to ensure that people using the service lead a stimulating and active life. DS0000054194.V364405.R01.S.doc Version 5.2 Page 34 2 OP2 3 OP3 4. OP7 5 OP12 Hazelwood House Residential Home 6. OP15 7 8 OP15 OP16 9 OP19 10 OP23 The format of the menu could be improved to include pictures to ensure that it is more accessible for residents who have difficulty in reading. This was a previous recommendation. It should be clearly evident in the care plan (agreed by the person) when someone chooses to eat in the lounge and when they wish to wear a bib rather than a napkin. The registered person should examine ways (with people using the service) to improve the accessibility of the complaints procedure for those who have difficulty reading, and for those for whom English is not their first language. The registered person should continue to develop ways of ensuring that ‘concerns’ as well as complaints are welcomed and documented. To ensure that it is evident those residents and others are listened to and appropriate action taken by the home when they communicate a concern. This was a previous recommendation. The care home could examine ways of making it easier for people who use the service (particularly those with communication needs) to find their own rooms and other rooms, such as by colour coding and/or putting pictures on doors to better identify each room. The home could look at ways to make bedrooms more personalised and homely. The manager should to assess each bedroom with regard to call bell cables and ensure that they are in place, and so accessible to people using the service. With regard to infection control and hygiene issues, there should to be accessible paper towels in the bathrooms for drying hands. The review of staffing numbers should be carried out to ensure that staff are able to provide a choice of activities to residents. This was a previous recommendation. Questionnaires completed by staff should be part of the ‘in house’ video training so it is evident that staff have gained the knowledge from this training needed for them to be able to carry out their duties. People using the service should have the opportunity to participate in regular resident meetings. The manager should complete an up to date annual development plan. 11 12 OP26 OP27 13 OP30 14 OP33 Hazelwood House Residential Home DS0000054194.V364405.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Hazelwood House Residential Home DS0000054194.V364405.R01.S.doc Version 5.2 Page 36 - 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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