Inspection on 01/10/07 for Evergreen Lodge Nursing Home

This inspection was carried out on 1st October 2007.

CSCI 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 CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Evergreen Lodge Nursing Home 07/08/06

Evergreen Lodge Nursing Home 05/01/06

Evergreen Lodge Nursing Home 19/09/05

Evergreen Lodge Nursing Home 04/02/05

Evergreen Lodge Nursing Home 20/09/04

Evergreen Lodge Nursing Home 28/01/04

Evergreen Lodge Nursing Home 15/09/03

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Haddon Nursing Home Haddon Road Rock Ferry Birkenhead Wirral CH42 1NZ Lead Inspector Julie King Key Unannounced Inspection 10:30 1st October 2007 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 Haddon Nursing Home DS0000034955.V344217.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. Haddon Nursing Home DS0000034955.V344217.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Haddon Nursing Home Address Haddon Road Rock Ferry Birkenhead Wirral CH42 1NZ 0151 643 1068 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) Haddon Nursing Home Ltd Elizabeth Ann Nolan-Davies Care Home 34 Category(ies) of Dementia - over 65 years of age (34) registration, with number of places Haddon Nursing Home DS0000034955.V344217.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate one named person under 65 years of age Date of last inspection 7th August 2006 Brief Description of the Service: Haddon House is purpose built care home providing personal care and support for 34 older people with dementia. The home is located in the Rock Ferry area on the Wirral and is easily accessible by public transport. All of the residents’ accommodation is provided in single bedrooms on the ground and first floor of the home. The home has a large sitting room, conservatory and dining room on the ground floor. The home is staffed twentyfour a day by qualified Registered nurses. The home has various aids to promote the residents’ independence and safety such as: grab rails, assisted baths, passenger lifts and hoists. The fees are from £490.93 to privately arranged, depending upon the level of care required. Haddon Nursing Home DS0000034955.V344217.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. As part of a key inspection, this site visit was conducted over one day; during which a full tour of the premises took place, and staff and care records were examined. The registered manager and nurse in charge accompanied the inspector throughout this visit. A selection of staff on duty plus some residents were spoken to during this visit. No relatives or multidisciplinary healthcare professionals were present during this site visit, but a number of questionnaires were sent out to obtain their views about the service. What the service does well: What has improved since the last inspection? What they could do better: Corridors, some bedrooms & bathrooms and the dining area could do with brightening up with pictures, etc, The staff personnel files require improvement which should be evidenced by all staff having enhanced, up to date CRB & POVAs, two references (including one from the last employer), and all the other documents and records required. Also the environment should be made safer by not allowing staff to leave resident’s toiletries out in communal areas, especially pots of barrier cream. Haddon Nursing Home DS0000034955.V344217.R01.S.doc Version 5.2 Page 6 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. Haddon Nursing Home DS0000034955.V344217.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 Haddon Nursing Home DS0000034955.V344217.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents assessed needs are being met, and the home is able to provide assurances to residents and their representatives that assessments will be a continuous process throughout the resident’s stay. EVIDENCE: The registered manager provides a Statement of Purpose that is specific to the individual home and the resident group they care for, and clearly sets out the objectives and philosophy of the service, supported by a Service user Guide. The guide details what the prospective resident can expect and gives a clear account of the services provided, the accommodation, qualifications and experience of staff, how to make a complaint and recent CSCI inspection findings. All the residents have access to a copy of the Guide, and if requested Haddon Nursing Home DS0000034955.V344217.R01.S.doc Version 5.2 Page 9 the provider can supply a copy of the Statement of Purpose and Guide in a different language to suit the needs of the resident A detailed pre-admission assessment is undertaken on all prospective residents either by the registered manager or one of the qualified nurses. This assessment is completed to ensure that the home can identify and meet the prospective resident’s individual care needs, and involves gathering information from the resident, their family, GP, hospital staff and any other person involved in their care. The assessment also identifies any specific equipment necessary to meet the resident’s needs and enables the home to obtain the equipment prior to the resident’s admission where necessary. If the assessment has been undertaken through care management arrangements the manager obtains a summary of the assessment and a faxed copy of the care plan from the liaising social worker. During the site visit the pre-admission assessments on all recently admitted residents were inspected. These were found to be detailed and contained all the necessary information to enable a plan of care to be produced. Information is recorded about individual preferences in addition to the care needs to enable special diets or other requirements to be planned. Prospective individuals are given the opportunity to spend time in the home as either a trial visit, or just a look around and a chat with the current residents. Residents spoken to said that they “had seen someone” from the home prior to admission, and examination of records evidenced that families are involved during this process. New residents are provided with a Statement of Terms and Conditions/Contract; this sets out in detail what is included in the fee, the role and responsibility of the provider, and the rights and obligations of the individual. This gives a clear understanding of what residents can expect, and the manager offers the opportunity for discussion and clarification. Standard 6 was not assessed as this home does not provide intermediate care. Haddon Nursing Home DS0000034955.V344217.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a care planning system in place for all residents. This provides staff with the information they need to meet the resident’s needs. EVIDENCE: The care files for four residents were inspected. The files contained care plans which gave information regarding the resident’s health care and social needs, together with information on how these needs are to be met. Risk assessments were in place together full information on how the risks will be reduced or eliminated. The care plans include information regarding the resident’s individual preferences and choices to enable staff to meet their specific needs and requirements. Information is also held on the files of visits made to and by GP’s and other health care professionals. Details of action to be taken following these visits Haddon Nursing Home DS0000034955.V344217.R01.S.doc Version 5.2 Page 11 are recorded and appropriate changes are made to care plans as appropriate. The home also keeps a record of communications with family members and other relevant persons. Daily reports completed by the care staff provide evidence of the actual care given by the staff. Medications were found to be ordered, stored, administered and recorded in accordance with the home’s policy and procedure. The storage area was seen to be clean and organised and no unnecessary or unwanted medications were held. Appropriate disposal arrangements were in place for unwanted medications. Policies and procedures are in place to ensure that privacy and dignity are maintained and training in this is given to all staff during the induction training programme. Evidence of this training was seen on the staff files. Personal care is given to residents either in their bedroom or in the bathroom as appropriate. Residents may use their own bedroom or in one of the communal areas as they wish. The office can be made available for private meetings. The use of a mobile telephone is available to enable residents to speak with friends and family in private. Mail is delivered unopened and residents are addressed by the name of their choice. Staff were observed to knock on doors and to wait for an answer prior to entering. Screens are provided in shared bedrooms to ensure that privacy and dignity are protected. Haddon Nursing Home DS0000034955.V344217.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A range of activities are available which provide residents with stimulation to promote social interaction. EVIDENCE: Detailed information is gathered from resident on admission to the home regarding their past life and the social activities that they had previously enjoyed. It was evident from discussion with residents that the staff strived to provide a varied social activities programme in line with their individual preferences and abilities. The home employs an activities co-ordinator who works no less than 20 hours each week. The programme of activities is displayed in the home and includes both in house stimulation and trips out. Resident confirmed that there is a good range of activities and that they are free to choose whether or not they participate. Group activities are provided together with one to one stimulation for those who do not wish to or are unable to participate in group events. Haddon Nursing Home DS0000034955.V344217.R01.S.doc Version 5.2 Page 13 Ministers from local churches make regular visits to the home and provide services to group or individual residents on request. Visitors are welcome to visit the home at any time, and one relative’s questionnaire stated that staff were knowledgeable about the care her mother needed and were always on hand whenever they were needed. Meals are served in the dining room or in the resident’s bedroom as they wish. The menu provides evidence that a well balanced diet is offered and a choice of meal is always available. The meal served during the inspection was attractively served and looked appetising. Residents said that the food was “really good” and evidence was available to confirm that they could choose from the menu or request a particular favourite. Special diets can be provided on the advice of the GP or dietician or on request of the service user. The dining tables were attractively laid with condiments and appropriate cutlery. Haddon Nursing Home DS0000034955.V344217.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have a good knowledge and understanding of Adult Protection issues to protect residents from harm or abuse. EVIDENCE: The manager has developed a complaints procedure which is detailed in the Statement of Purpose and Service User Guide and is also displayed on notice boards within the home. The procedure gives residents and visitors the details of the person to whom complaints should be made and the timescale in which the complaint will be investigated and responded to within. Two complaints have been made against the home in the last twelve months and are being fully investigated currently. Haddon Nursing Home DS0000034955.V344217.R01.S.doc Version 5.2 Page 15 All staff have been given training on the Protection of Vulnerable Adults and are aware of the different types of abuse and of the action to be taken in the event of it being suspected to ensure that residents are protected. Staff spoken to during the inspection were able to demonstrate that they were aware of the procedure to be followed. Haddon Nursing Home DS0000034955.V344217.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most areas of the home are clean and can evidence some upgrading, thus helping to provide residents with a homely place to live. EVIDENCE: Residents are accommodated in single and shared (double) bedrooms, some having en suite facilities. The bedrooms are spacious and bright and it is evident that every effort has been made to assist residents to personalise their rooms with pictures, photographs and items of memorabilia. Some residents have chosen to provide items of furniture to make their room more homely. Specialised equipment such as a lift, assisted bath and shower rooms, hoists and appropriate toilet aids are provided to assist service users and maximise their independence. Haddon Nursing Home DS0000034955.V344217.R01.S.doc Version 5.2 Page 17 There is evidence of wear and tear throughout the home, especially in communal areas such as corridors, were some of the door frames are clearly damaged. Also the dining room is dark and could do with brightening up to make it more cheerful. It is also suggested that additional pictures are obtained in corridors to give the residents something to look at and enjoy, rather than just a plain papered wall. It was concerning to find in every communal bathroom without exception a number of creams, soaps, liquids and other toiletries left out. Some creams (with no names of the resident) were found on top of toilets, which quite clearly poses a significant risk of cross infection. The person in charge was strongly advised to dispose of any ‘communal’ product with immediate effect and to ensure that no items are left out in communal areas at any time. Most areas of the home were found to be clean and fresh, with only a couple of areas that required additional cleaning; however it was recommended that all waste bins have correctly fitting lids. Haddon Nursing Home DS0000034955.V344217.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff demonstrate a good awareness of their roles and responsibilities, thus providing residents with safe, individualized care. EVIDENCE: Staff rotas show that the home is staffed efficiently, with attention given to busy times of the day and changing needs of the residents. Staff members undertake some external qualifications beyond the basic requirements, and the manager encourages and enables this, recognising the benefits of a skilled, trained workforce, and the home can boast of a high level of NVQ 2 trained care staff. The manager is a member of a local training initiative which allows her to access an extensive range of training for all staff, including housekeeping and kitchen staff. Job descriptions and specifications define the roles and responsibilities of staff. Residents spoken with said that the staff are “nice”, and these comments are supported by the numerous letters of thanks and appreciation from relatives, which were seen on the notice board. Four of the recently employed staff’s personnel files were examined, but none of them evidenced all the required documents and records, including work Haddon Nursing Home DS0000034955.V344217.R01.S.doc Version 5.2 Page 19 permits (if required), CRBs and references from past employers (including the most recent). It is essential that all required information is obtained for all staff employed, as by conducting through and proper checks the manager can help safeguard residents from potentially unfit staff. The service must now recognise the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individual residents. Haddon Nursing Home DS0000034955.V344217.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37,38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager has a clear development plan and vision for the home which they have effectively communicated to residents, staff and relatives. EVIDENCE: The manager is a dual-qualified nurse (RMN & RGN),who also holds qualifications in the care of older people and in training and assessing. She is able to provide evidence of ongoing training and development, and is suitable to run the home and meets its stated aims and objectives. Haddon Nursing Home DS0000034955.V344217.R01.S.doc Version 5.2 Page 21 The manager is able to communicates a clear sense of direction, and is able to evidence an understanding of ‘best practice’ operational systems, particularly in relation to continuous improvement, customer satisfaction, and quality assurance. Equality and diversity issues are given priority by the manager (and provider), who is aware of the varying strands this involves. The manager possess a well-developed awareness and understanding of equal opportunity issues, development and implementation of the service’s policies and procedures. Other professionals spoken to in order to obtain their views on Haddon said the home provides a good quality service. Staff have easy access to training, associated materials and documents. Practice and performance are discussed during supervision, staff training and team meetings. Spot checks and quality monitoring systems provide management evidence that practice reflects the home’s and organisation’s policies and procedures. There is strong evidence that the ethos of the home is open and transparent. The views of residents, their families and staff appear to be listened to and valued. The manager and provider has efficient systems to ensure effective safeguarding and management of individual’s money including record keeping, and overall record keeping is of a high standard. Records are kept securely and staff are usually aware of the requirements of the Data Protection Act 1998. All the working practices in the home appear safe and there are few preventable accidents, evidenced by good monitoring and record keeping systems. The home has a range of policies and procedures to promote and protect residents’ and employees’ health and safety and there is clearly written recording of safety checks and accidents, and there is no evidence of a failure to comply with statutory reporting requirements or other relevant legislation. Haddon Nursing Home DS0000034955.V344217.R01.S.doc Version 5.2 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 3 3 3 3 3 N/a 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 3 18 3 2 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 Haddon Nursing Home DS0000034955.V344217.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? YES 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 OP19 Regulation 23(2)(d) Requirement The registered person shall ensure that all parts of the care home are kept reasonably decorated. Previous timescale of 30/10/06 not met. The registered person shall ensure that the care home is kept in good state of repair. Majority of door frames of residents bedrooms are in need of repair and redecorating. Previous timescale of 30/10/06 not met. No communal soaps or toiletries should be left out in communal areas at any time as this poses a risk to residents of crossinfection or accidental ingestion. Timescale for action 31/01/08 2. OP19 23(2) 31/01/08 3. OP26 13 10/10/07 4. OP29 19 The registered person operates a 31/10/07 thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. Haddon Nursing Home DS0000034955.V344217.R01.S.doc Version 5.2 Page 24 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 OP19 Good Practice Recommendations It is strongly recommended that a re-decoration programme be devised to ensure the standard of decoration is maintained to a high level. Suitable training is provided to all staff responsible for checking and managing bed rails 2. OP38 Haddon Nursing Home DS0000034955.V344217.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Haddon Nursing Home DS0000034955.V344217.R01.S.doc Version 5.2 Page 26 - 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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