Inspection on 05/02/08 for Hadleigh House Care Home

This inspection was carried out on 5th February 2008.

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

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

Hadleigh House Care Home 20/01/09

Hadleigh House Care Home 13/10/08

Hadleigh House Care Home 13/03/07

Hadleigh House Care Home 14/02/06

Hadleigh House Care Home 04/10/05

Hadleigh House Care Home 18/11/04

Hadleigh House Care Home 16/07/04

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

CARE HOMES FOR OLDER PEOPLE Hadleigh House Care Home 350 Pelham Road Immingham North East Lincs DN40 1PU Lead Inspector Mrs Jane Lyons Key Unannounced Inspection 5th February 2008 09:00 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 Hadleigh House Care Home DS0000002861.V358995.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. Hadleigh House Care Home DS0000002861.V358995.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hadleigh House Care Home Address 350 Pelham Road Immingham North East Lincs DN40 1PU 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) 01469 572514 Mr Michael Thomas Bailey vacant post Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38) of places Hadleigh House Care Home DS0000002861.V358995.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th March 2007 Brief Description of the Service: Hadleigh House provides comfortable, homely accommodation for up to 38 people over the age of 65. The home is situated close to all amenities in Immingham. It has pleasant gardens; its own car park and is on a bus route. The home is a two-storey building with access to the first floor via stairs and a passenger lift, it is well maintained in terms of décor and furnishings. There are 32 single bedrooms and 3 shared, en-suite facilities are provided for the five new single bedrooms on the first floor. There are four bathrooms and a shower room with separate WC facilities provided on each floor. The home provides 3 lounges and a pleasant dining room for people to use. The rear garden has been landscaped and an attractive courtyard area provided, with seating and shade for individuals and their visitors. Ample car parking space is provided. The home is owned by Mr M Bailey. There is no registered manager currently in post. Weekly fees are: £345.45- £360. The home operates a system whereby the fees include a third party contribution of £15. Additional charges are made for the following: toiletries, newspapers/magazines, hairdressing, chiropody and escort fees. Information on the service is made available to prospective and current people who use the service via the statement of purpose, service user guide and inspection report. Documents are made available prior to and following admission, copies are available in the lounge area of the home. Hadleigh House Care Home DS0000002861.V358995.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 1 star. This means that the people who use this service experience adequate quality outcomes. The site visit took place over one day in February 2008. Surveys were posted out prior to inspection; three were returned from people who use the service, eleven from relatives, two returned from staff and three from health professionals. In addition to this one health professional was contacted by telephone. Some of their comments have been included in this report. Mrs Jane Lyons carried out the visit. During the site visit we spoke to the acting manager, the registered person, three care staff, the activity co-ordinator, the cook, nine people who use the service and four relatives to find out how the home was run and if the people who lived there were satisfied with the care and facilities provided. We also looked around the home and looked at lots of records, for example; people’s care plans and risk assessments, daily records, supervision schedules, recruitment records and other records relating to the running of the home. Prior to the visit we referred to notifications sent to the us, the event history for the home over the past year and the completed Annual Quality Assurance Assessment which was also considered in forming a judgement about the overall standards of care within the home. What the service does well: The home was very welcoming and had a relaxed and homely atmosphere, all individuals were observed to be very settled and comfortable in their surroundings. There were numerous visitors throughout the day who all said how friendly and welcoming the staff were. Lots of comments were received during the day and from surveys about the cleanliness of the home, the standards of care and the friendliness of the staff: some of these include “Overall a warmly, caring environment with some good, caring members of staff that are helpful and understanding.” “Only in for respite, but made very welcome by the staff and other residents, wouldn’t hesitate to return in the future” and “The care is very good, the rooms are very clean, the food excellent and they provide entertainment for the residents.” Hadleigh House Care Home DS0000002861.V358995.R01.S.doc Version 5.2 Page 6 People who live at the home have good access to professional medical staff and are able to access external services such as dentists and opticians as needed. Health professionals commented that they considered the staff promoted and supported a very positive approach to maintaining individual’s independence. Medicines were looked after well and staff assisted people to take their medicines safely. People who use the service were helped to enjoy lots of activities both in the home and in the community. New menus have been produced, individuals were offered choices, all meals were home cooked and people who use the service liked the food provided and were encouraged to eat a healthy diet. What has improved since the last inspection? What they could do better: The interim management arrangements have improved staff moral and the general atmosphere in the home. A new manager needs to be registered for the home so that improvements can be made to the management and administration systems, which will better protect the health, welfare and safety of the people who use the service. They could provide more up to date information about the services provided and any extra charges that can be expected in the home within the statement of purpose. Hadleigh House Care Home DS0000002861.V358995.R01.S.doc Version 5.2 Page 7 People’s care plans must improve; some records did not have enough information about all the needs of individuals. This means the home was not able to show that all aspects of the health and personal care needs of individuals were identified and planned for. Risk management in the home must improve to ensure people’s health risks are identified and action is taken to minimise those risks; these areas include nutrition, falls, pressure damage and use of bed rails. All aspects of the home’s fire safety measures need to be fully risk managed which will better ensure the safety of all who use the service. They must fully investigate all complaints and maintain more detailed records of investigations. They must ensure that the home has a clear safeguarding policy for staff to follow to offer full protection to people who use the service. When people who use the service have accidents such as falls, it is important that appropriate records are completed to ensure the correct action for the individual has been taken. More thorough audits of all accidents by the manager would better ensure that risks of accident re-occurrence have been addressed and the safety and welfare of the individuals are better protected. They must make sure that the risk of assisting people who use the service with mobility are reduced by ensuring all staff have had training to move and handle people safely. The staff need to access more regular individual time to talk to a senior staff member about how well they were doing, or if they needed more training or support with their work. This better ensures that they can provide a good standard of care for the people who use the service. The management need to consult more regularly with the people who live in the home, their representatives and other interested parties, so they can have a say in how the home is run. A report needs to be produced to show how they have done this and what improvements have been made. 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. Hadleigh House Care Home DS0000002861.V358995.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 Hadleigh House Care Home DS0000002861.V358995.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 5 and 6. People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. Individuals were provided with basic information to assist them to make an informed choice to live at the home and they were provided with a written contract. People’s needs were fully assessed before they were admitted so that they could be assured their needs would be met by the home. EVIDENCE: The home had a statement of purpose and a service user guide, which gave information about the home. Both these documents now need to be updated to show changes in management and staffing. In discussion during the visit one of the visitors commented on how surprised she had been to receive a bill for escort fees incurred from her relative’s hospital appointment, she said that although she did not object to the payment she would have liked to have been informed of the additional cost. The charges for escort fees should be included in the statement of purpose so new people Hadleigh House Care Home DS0000002861.V358995.R01.S.doc Version 5.2 Page 10 to the home have that information and the registered person should write to all existing people who use the service to inform them of the additional charges. The admission procedure was sufficient to guide staff on the actions to be taken to ensure prospective individuals needs are properly assessed and planned for. Copies of the Local Authority assessment and care plans had been obtained prior to admission for those individuals referred through the local Social Services care management teams. The format of the homes needs assessment covers all required areas. Improvements were noted in the standard of the completed documentation; all areas were completed and signed/ dated. People who use the service confirmed that the acting manager had visited them prior to admission and they had been invited to visit the home with their family before making up their minds to move in to the home. One relative commented that they had visited the home to view it before admission and was very satisfied and found staff very helpful. There was evidence that the home writes to potential new people and their representatives to inform them that the home could meet their needs and all files checked during this visit contained copies of the home’s statement of terms and conditions/ contract if privately funded. The home does not provide intermediate care dedicated to accommodate individuals with intensive rehabilitation needs although feedback from health care professionals confirmed that the home had provided very good support in promoting independence for those individuals admitted for short term respite care to enable them to return to their homes. At the present time people who use the service are able to have a choice of staff gender when receiving personal care as far as practicable, as the home employs both male and female staff. Hadleigh House Care Home DS0000002861.V358995.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. People felt happy with the standards of care they received but some of the care documentation remains inadequate and places them at risk of not receiving the care they need. Medication was generally well managed in the home and people felt they were treated with respect. EVIDENCE: Care files for four of the people living at the home were examined. There was no indication during the site visit that people’s health needs were not being met and there had been some improvement in the level of detail recorded in care plans, diary records, evaluations and records of professional healthcare visits. However the standard of many of the care plans remained inconsistent, as not all problems identified on assessment had been identified in the care plans and some of the plans had not been updated to reflect changes in need. For example one individual has problems associated with depression and regularly exhibits some challenging behaviours which have not Hadleigh House Care Home DS0000002861.V358995.R01.S.doc Version 5.2 Page 12 been identified on a care plan although there was evidence that the acting manager had sought support from care management with this issue. Another individual had recently been provided with a pressure relieving mattress from the community team and daily records evidenced specific care support in this area however there was no care plan in place, yet another individual’s file contained a very detailed care plan to support their needs regarding tissue viability. One individual had been experiencing problems associated with continence yet there was no support plan in place. Improvements had continued with the frequency and quality of recording the daily records of care and there was evidence that staff were completing records after each shift and daily entries gave more indication of the care given and were better linked to the plans. Staff had also maintained good records of communications with the relatives and health care professionals. There was evidence from examination of the care files and discussion with the acting manager that the majority of care files had been reviewed, however a number of the senior staff are not yet competent in the care planning process which has resulted in some of the inconsistencies in the quality of the recording. Three of the senior staff including the acting manager have now accessed training in this area, there have been some staff changes and it is now vital that all staff responsible for developing care plans must access this training to improve their competence. The use of risk assessment documentation to form a basis for care was very inconsistent. None of the recent admissions had nutritional risk assessments in place although their nutritional needs had been generally assessed on admission. Advice at the previous visit to reconsider the use of the “Waterlow” risk assessment tool (which is a nursing based assessment) had been carried out however the home had not fully put into place the alternative “traffic light assessment tool”, provided by the community tissue viability co-ordinator; which meant some individuals’ risks of developing pressure damage were not being identified and planned for. One individual had experienced recent falls yet there was no falls risk assessment or care plan in place to identify the care/ equipment required to reduce further risks of reoccurrence. Up to date moving and handling risk assessments were in place for all individuals, which clearly detailed any equipment or care support required. Some of the weight monitoring in the files seen was also inconsistent; one individual admitted in December had not had their weight recorded. Records Hadleigh House Care Home DS0000002861.V358995.R01.S.doc Version 5.2 Page 13 showed that other individual’s weights were being recorded regularly however the staff were not always calculating an accurate cumulative balance and where individuals had lost significant amounts of weight over a short period this had not been checked nor was there evidence this had been referred to the G.P. or community dietician for support. There was evidence in the files and through observation during the visit that staff had implemented individual programmes to support continence management and pressure relieving support with positive results; individuals were regularly supported to mobilise to the toilet or regularly stand/ move position. Surveys indicated that health care professionals were generally satisfied that the staff at the home have a good knowledge of the people’s needs and follow specific, specialist formal instructions. Comments included “ Staff have an encouraging attitude towards clients, and have done a good job in promoting independence appropriately” and “The staff are always friendly and willing to help”. All discussions with relatives and all surveys returned with the exception of one evidenced that the home informed them and kept them up to date with important issues. Numerous relatives commented that they were very happy with the standards of care in the home. Improvements with the recording of accidents and specifically falls in the home is still required; the home also maintains incident records and staff need clarity around what incidents/ accidents need to be formally documented on the official accident documentation, as a number of falls had not been recorded. This was identified at the previous inspection and now needs to be actioned. New medication procedures have been put in place which were generally more detailed and cover all aspects of the system however they were generic in style and now need to be personalised to the home. The management have changed the storage area for the medications; they were now held in the storage area under the stairs in the hall. The space is very limited with staff having to crouch in the area to be able to open the medication cupboard; there was no light in the area at the time of the visit. The management need to consult with the fire safety department to ensure that the use of this area is safe and does not compromise the home’s fire safety management practices. It would be beneficial if a more spacious area could be sought where staff have better access to the medications stored in the trolley and cupboard. Checks carried out on a sample of medication records identified satisfactory standards of recording and transcribing. Storage and recording of controlled medications was checked and found to be satisfactory. Hadleigh House Care Home DS0000002861.V358995.R01.S.doc Version 5.2 Page 14 Evidence from staff training records and staff discussion indicated that staff who administered medication to people at the home had received accredited medication training. People who use the service confirmed to us that they were always treated with dignity and respect and the staff used their preferred term of address, knocking on their doors before they entered. This was also observed to happen during our tour of the premises. Hadleigh House Care Home DS0000002861.V358995.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People were provided with choice and diversity in the meals and activities provided by the home, which met with their expectations. Relatives and visitors were made welcome and the home was developing better links to the community, which will further enrich the peoples social and leisure opportunities. EVIDENCE: Observation during the visit indicated the home operated very flexible routines these included the time people get up, go to bed, where they ate their meals and how they spent their time. One individual commented, “I am my own boss and choose how I spend my day”. Relative surveys indicated that they were able to visit their relative at any time and there was no restriction on visiting. Those relatives and friends visiting during the inspection confirmed that they were made to feel very welcome and could visit at any time. Hadleigh House Care Home DS0000002861.V358995.R01.S.doc Version 5.2 Page 16 In discussion staff displayed a good knowledge of people’s needs, likes/ dislikes, family support and records contained information about people’s religious observances. People were provided with the opportunity to become involved in varied activities arranged through the activity co-ordinator. Records and a weekly plan of activities held in the home were available; outside entertainers visited the home monthly. People were supported to attend clubs and events in the local community; some individuals attended the local Blind Club in the town, one individual attended the local church service every Sunday with their relative and some people regularly participated in organised activities held at a venue in Grimsby. The management have provided a computer in one of the lounges for people to use. In discussion during the visit many people said how much they enjoyed the regular manicures, quizzes and games of Bingo that were arranged. Generally the people were very happy with the activities made available to them. All the comments received from surveys and during the visit confirmed that the home provided a high standard of meals, which people really enjoyed. Comments included “the food is excellent” and “the home provides a good nutritional diet.” The meal served during the visit looked tasty and well presented. The majority of people use the dining room and the mealtime was seen to be a relaxed and social occasion with the staff interacting well with the people who use the service. Aids were provided to encourage people to maintain independence where possible and staff assisted individuals where required in a sensitive and discreet manner. Menu boards in the corridor displayed the daily choices. Concerns were identified in a survey from one of the health professionals regarding issues around the staff not implementing informal guidance to provide extra supplements and snacks for one of their clients; at the time of the visit this individual was no longer residing at the home and also there had been significant changes of staff and the acting manager had not been made aware of the issue at the time. The kitchen was clean and there were good stocks of food in the fridge, freezers and stores. There were no special diets required by people at the time of the inspection except low sugar diets. Discussions with the cook identified that she had the knowledge of how to access any special dietary needs that were required by individuals. Hadleigh House Care Home DS0000002861.V358995.R01.S.doc Version 5.2 Page 17 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 and 18. People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. Although some procedures and staff training are in place to protect individuals from harm, the failure to investigate allegations and complaints fully may leave people at risk. EVIDENCE: The home had appropriate policies and procedures for dealing with complaints. The complaint procedure was made available to people in information provided and was also displayed in the home. Information received prior to the inspection indicated that the home had received one complaint and this had not been substantiated. The complaint investigation records were examined and evidenced that the acting manager had not fully investigated the allegations regarding the conduct of a staff member; the staff member concerned had been allowed back to work prior to the completion of the police investigation and not all parties involved had been formally interviewed by the acting manager. Given the timescales involved further investigation of the concerns would not be appropriate however the management should ensure the conduct of the staff member concerned is more closely monitored and risk strategies put in place where necessary. The home had a copy of the local multi- agency safeguarding procedures in place however the management needs to ensure there is a safeguarding adults Hadleigh House Care Home DS0000002861.V358995.R01.S.doc Version 5.2 Page 18 policy and procedure for the home which ties in with the multi- agency document. More staff have accessed safeguarding adults training with 85 of the staff now having attended courses; the acting manager confirmed that the remainder of the staff were scheduled to attend this training this year. In the surveys returned and during discussions all staff showed good knowledge of the procedures. All people spoken with were very happy with the service they received. One individual commented, “The staff are very nice and kind, they are always very patient especially when dealing with the people who are a bit confused.” Hadleigh House Care Home DS0000002861.V358995.R01.S.doc Version 5.2 Page 19 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 and 26. People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People felt at home at Hadleigh House, they were provided with a warm and comfortable environment suitable to their needs. EVIDENCE: The home provides and maintains very comfortable and safe facilities. All areas of the home were decorated and furbished to a good standard; several bedrooms and the upstairs corridors had recently been redecorated. Work was in progress during the visit to provide en- suite facilities in one of the larger bedrooms. The home benefits from having a number of lounges in which the people who use the service could choose to socialise, or have some private time in. The toilets and bathrooms were all close to the communal and bedroom areas. The Hadleigh House Care Home DS0000002861.V358995.R01.S.doc Version 5.2 Page 20 communal areas were all well utilised during the visit; people who use the service commented on how happy and settled they were at the home. All of the rooms in the home had a call bell system in them. People who use the service confirmed to the inspector that when the call bell was activated the staff were generally quick to respond. The bedrooms were all decorated and furbished to a good standard with evidence that the rooms were personalised to the extent the chosen by the individual. All areas of the home were exceptionally clean and tidy, although odour control in two of the individual’s rooms required more thorough management; domestic staff were employed daily. Staff confirmed that there were adequate supplies of protective clothing; there were no specific infection control measures in place during the visit. Positive comments were received during the visit and from surveys returned regarding the facilities, these included “The cleaning of my mother’s clothes and of the home is of high standard” and “They provide a clean, well kept home for my mother.” Staff told the inspector that they had a good range of moving/ handling equipment to meet the needs of the people who use the service and that the acting manager had recently provided a new type of hoist. The gardens were attractive and well maintained. The acting manager had provided more waste bins which has ensured the collection area is more tidy and safe. Hadleigh House Care Home DS0000002861.V358995.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. Staffing levels were appropriately maintained so that people’s needs could be met. Not all staff had received training or updates in mandatory areas, which may put people’s health and safety at risk. Recruitment practices generally afford sufficient protection for people who use the service. EVIDENCE: Twenty-nine people were living at the home at the time of the visit. The staffing arrangements were the same as for the previous visit with five care staff on duty in the morning, four on the afternoon shift and two waking staff at night. The acting manager does not currently use the Residential Forum guidance to determine the number of staff that were required for each shift at the home; although there was evidence during the visit that the staffing levels in the home were appropriate to the dependency levels of the people accommodated at the time of the inspection. Surveys returned from people who use the service and their relatives indicated that the staffing levels were usually satisfactory and the care staff were very kind and considerate, comments during the visit confirmed that staffing levels had improved in recent months. Information provided prior to the visit indicated that the staff turnover had settled although comments from surveys indicated that some people felt that Hadleigh House Care Home DS0000002861.V358995.R01.S.doc Version 5.2 Page 22 there were still a lot of changes with staff and that the management had employed a number of younger staff who they felt did not always have the necessary skills and understanding for the needs of the service. Comments included “ Some younger, newer members of staff lack skills but are obviously being trained and guided and soon learn” and “Perhaps the home could employ more mature staff who would understand the needs of the elderly more” and “There are many young care assistants nowadays, who have not got the experience of looking after older people; some older people preferred to be cared for by mature experienced staff,” and “Recently there has been a significant change of staff.” The acting manager should consider these comments when recruiting new staff to the home and when completing the duty rotas to ensure the skill mix of staff is appropriate to the needs and preferences of the people who use the service. Two of the surveys returned from people who use the service commented about the staff using inappropriate language around them; this was looked into during the visit and none of the individuals or their visitors spoken to, could substantiate this, they all confirmed that they always found the staff to be courteous and polite. This issue was passed on to the acting manager to follow up with the staff at team meetings and during supervision. Employment records for four staff appointed since the last inspection were examined. This showed that all workers had Protection of Vulnerable Adult register checks (Pova 1st) or Criminal Records Bureau check (CRB police check) in place prior to commencing employment. There was evidence that staff working with a POVA check were closely supervised when working with people who use the service until the CRB check was in place. All the files contained application forms and two written references; it was identified that a number of the personal references were not dated which should be followed up to ensure that the reference is current and valid. The number of staff currently qualified at level 2 NVQ has dipped due to staff turnover with the current figure at 20.9 . The home has also experienced problems with the providers of the training courses however the acting manager has secured new funding, new training providers and thirteen staff are now enrolled on level 2 and level 3 courses. Individual training records indicated that members of staff have access to a range of mandatory and service specific courses. Training consisted of inhouse videos, distance learning and access to courses provided by the local authority and local primary care trust. The staff are now paid to attend three training days per year. The acting manager kept an overview of the staff training to assist her in the planning of training in the home. Records showed that not all the staff had received formal training or an annual refresher course in moving and handling, Hadleigh House Care Home DS0000002861.V358995.R01.S.doc Version 5.2 Page 23 however the acting manager had arranged for the provision of a more up to date training video which she confirmed all staff would complete and also she was arranging practical sessions for staff to attend. Records showed that staff were generally up to date with other mandatory courses such as, fire safety, first aid and basic food hygiene. Over the last twelve months staff have accessed training in areas such as infection control, safeguarding adults, risk assessment, Diabetes, Dementia, Strokes and medication. As previously stated in section 2 of the report, three of the senior staff have completed courses in care planning. Evidence from case tracking through the care plans would indicate that some of these staff members still require support from the deputy manager regarding their competence with this and new senior staff would also benefit from attending the course. New staff complete an in- house induction programme, not all records examined had been signed off and completed. All new staff must also complete the Skills for Care induction programme however there was little evidence that the staff had completed this training at the home in recent months. Hadleigh House Care Home DS0000002861.V358995.R01.S.doc Version 5.2 Page 24 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, 35, 36 and 38. People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. There was no registered manager at the home however people considered the management of the home had improved somewhat in the last few months with the interim management arrangements put in place. The lack of formal quality monitoring systems do not fully allow people to affect the way the service is operated and aspects of the management of health and safety may place people at risk. EVIDENCE: The previous manager left the home in September 2007 and since that time the deputy manager has been covering the role as “acting manager”. Surveys received from health care professionals, relatives and staff indicated that the general atmosphere in the home had been much more positive in the last few Hadleigh House Care Home DS0000002861.V358995.R01.S.doc Version 5.2 Page 25 months, staff felt more supported and there was an improved team approach. Some of the comments included “ A happier atmosphere now under new management”, “Last couple of months have been much improved under new management. Home is definitely happier and in some ways more relaxed. Feel it is more considerate towards resident’s needs and requests,” and “The home is now a happy place to work in.” The acting manager is working towards the level 4 NVQ Award, she is very enthusiastic and has clearly enjoyed the challenges of her new position however given the deficiencies in many of the management and administration systems in the home over the last three years and as this inspection has identified, the number of outstanding requirements, it is now imperative that the registered person employs an experienced home manager who fully understands the work in hand, is competent in their role and can move the home forward. Little progress had been made towards the implementation of a formal quality assurance programme. The acting manager had arranged regular meetings for staff and people who use the service; there was some evidence that views and suggestions had been sought and action taken in respect of these, such as choice of outings and menu changes. In November 2007, the acting manager issued surveys to all relatives, fifteen had been returned however the results of these have yet to be analysed. Some auditing of the kitchen areas and health and safety in the home had been carried out. Formal visits were made to the home each month by a representative of the registered person, reports of these visits were passed on to us. The home had obtained new policies and procedures; examination of these showed that a small number were not in place such as safeguarding adults and that some of them were very generic in style and needed to be personalised to the home. Examination of a sample of staff supervision records evidenced that staff had not been accessing regular sessions, for example one staff member had supervision in April 2007 and then again in January 2008. All care staff must access at least six sessions per year. Records where the home was assisting people who use the service with finances were clearly maintained. The home obtained receipts when purchasing items or services on behalf of individuals however it would be safe practice for individuals to receive a receipt for all cash transactions carried out in the home. Those accounts checked balanced with the cash held. There was evidence that the equipment in the home had been serviced regularly and at appropriate intervals. The maintenance man completed regular checks of hot water temperatures in the home, records showed that Hadleigh House Care Home DS0000002861.V358995.R01.S.doc Version 5.2 Page 26 there had been problems with maintaining the temperatures below 43 deg C.in October 2007 and January 2008; the acting manager confirmed that the plumber had visited the home during those months, to adjust the thermostatic valves however there were no records of the hot water temperatures following this work which would evidence that they had been made safe. The fire safety equipment and checks were all in place and up to date, with evidence that the staff had accessed regular fire drills. The acting manager was not able to locate the fire risk assessment document during the visit, and was therefore unable to confirm if the previous manager had included in the document the keypad lock which has been fitted to the front door. As previously stated in the report the management must also consult with the fire safety department to ensure the use of the space under the stairs for medication storage, does not compromise the fire safety measures in the home. From case tracking there was evidence that staff were still not completing records on the appropriate documentation when accidents occurred in the home; a number of staff were completing the homes’ incident records and at times only recording accidents/ falls in the daily records. Staff need clarity around the appropriate use of the accident and incident forms. The acting manager needs to complete regular audits of all accidents in the home to determine any management action to take following each incident, which could further reduce risk of reoccurrence. Four individuals had bed rails fitted. Records evidenced that the staff completed risk assessments to support the use of bed rails and that the maintenance man checks the rails on a weekly basis. Guidance issued by the Medical Devices Agency details that the risk assessments should be detailed and cover areas of assessment such as: type of rail used, height of bed, distance from the headboard to the rail, height of mattress etc. The acting manager should review the homes’ risk assessments for use of bed rails in line with the current guidance. Hadleigh House Care Home DS0000002861.V358995.R01.S.doc Version 5.2 Page 27 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 2 3 X X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 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 2 17 X 18 2 3 3 3 3 X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 1 X 3 2 X 2 Hadleigh House Care Home DS0000002861.V358995.R01.S.doc Version 5.2 Page 28 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 OP1 Regulation 4 Requirement The registered person must update the statement of purpose to provide details of the current management and staffing arrangements in the home. All additional charges such as escort fees must be included in the document. This will better ensure that people or their representatives have access to all the information they need to help them decide if the home is right for them. The registered person must ensure that people’s care programmes are sufficiently detailed to identify all problems; they are updated to reflect current care needs and have clear directions for staff to follow. This will better ensure people’s care needs are all documented and met. Previous timescale 30/11/05, 30/09/06, 15/02/07 and 15/05/07 unmet. The registered person must review all current risk assessments for the following DS0000002861.V358995.R01.S.doc Timescale for action 30/04/08 2. OP7 15 30/04/08 3. OP8 12 and 13 30/04/08 Hadleigh House Care Home Version 5.2 Page 29 areas: tissue viability, falls and nutrition. Where necessary risk assessments must be revised, updated and put in place where absent. The registered person must ensure they are agreed to by the people who use the service or their representative. This will better ensure their rights, health and safety. Previous timescale of 30/09/06, 31/01/07 and 15/05/07 unmet. The registered person must ensure all staff responsible for completing care programme documentation and risk assessments have the necessary skills and knowledge. Where required, staff must be provided with care programme training and risk assessment training relevant to the areas of risk being assessed. This will better ensure that the care plans and risk assessments are completed appropriately containing all the relevant information. Previous timescale of 15/10/06, 28/02/07 and 01/06/07 unmet. The registered person must ensure that people’s weights are accurately and consistently recorded. This is needed to ensure the health and welfare of individuals is promoted and any issue with weights are identified and followed up. The registered person must ensure that all complaints/ allegations received by the home are fully investigated. This will better ensure the people who live and work at the home are better protected. 4. OP7 18 15/05/08 5. OP8 12 15/04/08 6. OP16 22 15/04/08 Hadleigh House Care Home DS0000002861.V358995.R01.S.doc Version 5.2 Page 30 7. OP26 16 (2) k 8. OP30 18 (1) a 9. OP30 18 (1) a 10. OP31 OP32 8 and 9 11. OP33 24 The registered person must ensure that odour management is improved in the two areas identified. This will better ensure the dignity of the individuals concerned and maintain the quality of the environment. The registered person must provide evidence to the Commission that all staff have received training in moving and handling this will better protect the staff and people who use the service. The registered person must ensure that newly employed care staff complete the formal induction programme which is allied to Skills for Care. This will better ensure that new workers are competent in their role and have understanding of the workplace. The registered person must employ a permanent manager for the home and the person must apply for registration with the commission. This will ensure their fitness for the role and that the management and administration systems in the home will be improved to further protect people who use the service. The registered person must ensure that the quality assurance programme is restarted and maintained which is supported by an annual development plan. This will show how the home has consulted with people who use the service, their representatives, staff and stakeholders to influence the running of the home. Previous timescales 30/06/06, 30/11/06 and 30/06/07 not met. Timescale extended. DS0000002861.V358995.R01.S.doc 30/04/08 15/05/08 15/05/08 31/05/08 31/05/08 Hadleigh House Care Home Version 5.2 Page 31 12. OP36 18 (2) 13. OP38 13 (4) The registered person must ensure that the staff supervision programme is maintained and all care staff receive at least 6 supervision sessions per year. This will better ensure the staff are adequately supported by the management of the home and are competent in their role. The registered person must ensure that staff are provided with guidance and training to ensure that they are competent in completing appropriate incident/ accident forms. This will better ensure the safety of the people who use the service. Previous timescale of 30/04/07 not met. The registered person must ensure that there is a fire risk assessment document available in the home. This will better protect the safety of the people who use and work in the service. The registered person must ensure that the front door lock is detailed in the home’s fire risk assessment and fire safety procedures. This will better protect the safety of the people who use and work in the service. Previous timescale of 31/12/06 and 15/05/07 not met. The registered person must ensure that risk assessments accurately determine whether an individual initially requires bed rail provision and evaluations must determine the continued need for them. Bed rails and protectors must be fitted and checked in line with manufacturers instructions and Medical and Healthcare products Regulatory Agency (MHRA) DS0000002861.V358995.R01.S.doc 30/04/08 15/04/08 14. OP38 23(4) 30/04/08 15. OP38 23(4) 30/04/08 16. OP38 13 (4) 30/04/08 Hadleigh House Care Home Version 5.2 Page 32 guidelines. This is to minimise the risk of injury to people who use the service. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP28 OP18 OP8 Good Practice Recommendations The registered person should ensure that 50 of the care staff have gained NVQ level 2. The registered person should make sure the home has a Safeguarding adult’s policy and procedure in place which ties in with the local multi- agency procedures. The registered person should ensure that nutritional risk assessments are carried out on all newly admitted individuals so that an accurate base line assessment is made and risks to the health and welfare of individual’s are minimised. The registered person should provide a more spacious and appropriate area for the medication storage. The registered person should re-implement the Residential Staffing Forum dependency tool to ensure appropriate staffing levels in the home are being maintained. The registered person should ensure that all personal references received are dated to determine the validity and accuracy of the information received about the potential new staff member. The registered person should review the home’s policies and procedures to ensure they are personalised to the home. The registered person should ensure that receipts are issued to people who use the service for each financial transaction completed with their personal accounts. The registered person should consult with the local fire safety officer to determine if the use of the space under the stairs for medication storage, will compromise the fire safety measures in the home. 4. 5. 6. OP9 OP27 OP29 7. 8. 9. OP33 OP35 OP38 Hadleigh House Care Home DS0000002861.V358995.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Hadleigh House Care Home DS0000002861.V358995.R01.S.doc Version 5.2 Page 34 - 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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