Inspection on 07/06/07 for Hadley House Nursing Home

This inspection was carried out on 7th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Hadley House Nursing Home 28/02/06

Hadley House Nursing Home 14/10/05

Hadley House Nursing Home 08/03/05

Hadley House Nursing Home 02/11/04

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

CARE HOMES FOR OLDER PEOPLE Hadley House Nursing Home 24/26 Jersey Avenue Stanmore Middx HA7 2JQ Lead Inspector Clive Heidrich Key Unannounced Inspection 7th June 2007 13:45 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 Hadley House Nursing Home DS0000022926.V340587.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. Hadley House Nursing Home DS0000022926.V340587.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hadley House Nursing Home Address 24/26 Jersey Avenue Stanmore Middx HA7 2JQ 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 7047 020 8933 2051 nalin.joshi@btinternet.com Mr Nalin Joshi Mrs Anila Joshi Mrs Anila Joshi Care Home 14 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (14), Old age, not falling within any of places other category (14) Hadley House Nursing Home DS0000022926.V340587.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The number of people accommodated must not exceed 14. Elderly persons with enduring Mental Health, aged 60 years and over. Minimum staffing notice applies Date of last inspection 28th February 2006 Brief Description of the Service: Hadley House is a home providing nursing care for up to 14 older people. It has been operating successfully since 1995. The owners, Mr and Mrs Joshi, also have a home providing personal care to older people situated in the same road. The home is situated in a quiet turning, close to Kenton Lane, on the edge of both Stanmore and Kenton. It is close to local shops and bus routes, with local train and underground links being around thirty minutes’ walk away. Hadley House has off-street parking at the front of the property and there is parking available in the road outside the home. The home consists of two floors and there is a passenger lift to assist movement within the home. There are bedrooms, toilets and bathing facilities on each level of accommodation. Communal space is situated on the ground floor and consists of an open-plan area where there are lounge and dining areas. There is a large attractive garden at the rear of the house. There is one shared bedroom in the home and all other bedrooms are single rooms. At the time of the inspection, there were no vacancies. There is a standard fee for services at the home, details of which are available from the provider on request. The service user guide is similarly available on request, or can be viewed on the main board near the office. See also standard 1. Hadley House Nursing Home DS0000022926.V340587.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place across two weekdays in early June. It lasted just under nine hours in total. The focus was on inspecting all of the key standards, and with checking on compliance with requirements from the last inspection report. The inspector spoke with a number of residents and a few relatives during the visit, most of whom were able to provide feedback about the services in the home. In terms of resident feedback, a CSCI residents’ survey was also sent to a number of homes in early January. At the time of writing, six of the surveys for this home had been returned to the CSCI. Feedback was generally positive. Details of the surveys are noted throughout this report. The inspection process within the home also involved observations of how staff provided support to residents, discussions with staff, checks of the environment, and the viewing of a number of records. Feedback was provided to the manager at the end of the visit. The inspector thanks all involved in the home for the patience and helpfulness before, during, and after the inspection. What the service does well: There was good evidence of residents’ needs being well met during the inspection. For instance, one resident explained how they had been supported to be more independent since moving in, and there was recorded evidence of heath improvements for some residents. There was feedback and observations of staff diligently noticing the support needs of individual residents, such as spotting a resident sweating and hence performing a blood sugar check. The overall health support of residents remains at an excellent level. The home benefits from an experienced and qualified manager and co-owner. There are generally strong standards of health and safety monitoring in the home, with issues being identified and rectified. Staff recruitment processes protect residents. The service continues to appropriately support new people to move into the home. There are strong standards of medication support to residents. The service benefits from the daily weekday visits of an occupation therapist, and staff provide activity support beyond this, both in and outside of the home. Hadley House Nursing Home DS0000022926.V340587.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hadley House Nursing Home DS0000022926.V340587.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 Hadley House Nursing Home DS0000022926.V340587.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 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents’ needs are assessed and considered before placement is offered. Visits can be made before choosing to move in. Written information about services is not however made individually available, just communally so. The home has a consistent record of meeting residents’ needs. EVIDENCE: The admissions documentation for two residents recently admitted to the home were checked. These were suitable. Both had assessments in place that were undertaken by either the home, health and social care professionals, or both, in advance of the person moving in. Key issues from these assessments were in place within the care plans for these residents, and it was apparent from feedback and records that the home has been able to meet the needs of these people. For instance, feedback from staff found them to be aware of Hadley House Nursing Home DS0000022926.V340587.R01.S.doc Version 5.2 Page 9 individual residents’ preferences and needs with food. Residents also fedback about being visited by the manager before they came to visit the home. Feedback from newer residents and their visitors was generally very positive about the experience of moving into the home and meeting needs. However people had not been given information in writing, just that the manager “had had a good chat with them” to explain things and answer questions on the day of moving in. This tallies with survey feedback, wherein only one person of the six said that they had received a contract. It is necessary to supply current residents with a copy of the service user guide that must include a statement of terms and conditions of residency, and for any new resident to be supplied with this written information at latest on the day of moving into the home. This is to help clarify to residents and their representatives about how the home operates and the services that are provided. A copy of the statement of purpose and the service user guide was available to people on the notice board in the dining area. The documents were last revised in 2004. It would be good practice to review them to ensure that any necessary updates have been carried out. Feedback from residents and relatives found that new residents can come for initial tea or day visits, and for trial stays across a number of days. One resident said that they had had doubts about whether home would work for them before came, but they were clear now that it very much meets their needs. They were hence very pleased. Hadley House Nursing Home DS0000022926.V340587.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home provides excellent standards of individualized healthcare and personal support to residents, with clear evidence of specific health improvements noted in a number of cases in conjunction with community health professionals. Staff are responsive to residents’ individual needs and preferences, treat residents respectfully, and generally enable independence. Each resident has an up-to-date care plan that reflects their individual needs. The care-planning process is yet to significantly involve residents where appropriate. There are robust standards of medication systems in the home, enabling residents to receive prescribed medications appropriately. EVIDENCE: Feedback from surveys found five of the six replies stating that staff listen to and act on what the resident says, and that staff are always available when needed. One resident stated to the inspector that, “staff are tremendous.” Hadley House Nursing Home DS0000022926.V340587.R01.S.doc Version 5.2 Page 11 When asked about less-able residents, they explained that staff clearly look after them too. Residents were seen to be wearing well-fitting and appropriate clothing from the start of the inspection. Clothing had been ironed where appropriate, and was in good condition. There were no concerns about hair or nail-care. Discretion was observed when offering residents support to move to the toilet. Staff quickly and patiently attended to one resident whose clothing had become entangled. Staff showed good patience with slower residents. They provided appropriate guidance to help residents move around, for instance guiding someone reassuringly into the dining chair that they were moving to. This standard of personalized care and independence-enabling allows standard 10 to be judged overall as excellent. The care plans of three residents were checked through and found to be generally suitable and up-to-date. They explained the specific needs of each resident, what the support should be from staff, and what the aim of the support is. So for instance, for a very independent resident, their plans considered mainly about community presence and mental health needs. Moredependent residents had care plans that for instance included about their washing and dressing support needs. There was occasional and generally very dated evidence of residents signing parts of their care plans. It would be good practice for residents to be more involved in the formation and adjustment of their care plans, and to own a copy of the plan. It was agreed with management that this could cause anxiety for some residents, and be relatively meaningless for others, however a targeted and individualized approach to this could significantly empower some residents, including at monthly reviews of the plans. Five of the six survey replies stated that they always receive the medical support that they need. Standard health checks such as for weight are generally taken at least monthly for each resident by staff, more often where the service identifies a concern. There was evidence of some appropriate weight gain for a couple of residents, and many had stable weight. There were a number of risk assessments on file for each resident. This included for such areas as manual handling, falls, and pressure care. Management stated that no residents have either pressure sores or the need for any pressure care equipment. There were also sometimes specific assessments based on needs, such as for malnutrition, aggression, and diabetes. It was agreed with management that it would be good practice to undertake regular nutritional assessments, in support of evidencing how concerns are addressed. Manual handling assessments in particular had clear actions for specific scenarios, but lacked the actual assessment component that considers such Hadley House Nursing Home DS0000022926.V340587.R01.S.doc Version 5.2 Page 12 things as the resident themselves, the environment of the transfer, and the needs of staff. There is consequently no evidence of consideration of the specific needs of the transfer scenario, which could result in unnecessary difficulties or injury. The assessment component should be recorded about. There were ongoing health professional records within residents’ files that reflected their individual health needs and treatments. The home is visited frequently by the consultant psychiatrist, whose records for individual residents show clear evidence of working to improve health. One resident explained about how their specific physical health symptoms had become much alleviated through the support of the home and the GP. They stated that their health needs are fully met here, and that staff are attentive about these things. A nurse later explained about why they were taking the blood sugar levels of one resident at that moment, due to noticing the resident starting to sweat unexpectedly. Another resident spoke of improvements with their skin due to home and GP support. There were also records of referral to the GP for such issues as a resident becoming constipated. One resident had an obvious bruise under one eye. They were unable to clearly say how it had occurred. There were however records of the discovery of the bruise, of liaison with the GP about it, and of ongoing monitoring of it. This is appropriate. There were six accident records about residents for 2007, with evidence of reduction of falls for the main person having accidents. The overall attention of the health of individual residents, and clear evidence of improvements being made in many cases, enables the health standard to remain at an excellent level. Medication is stored securely and tidily within the home. None of the current residents self-medicate. Medication was seen to be offered to residents appropriately. The medications of three residents were checked through. All had a suitable stock of their individual medicines in place, and all were signed for appropriately. Where changes in the medications had taken place, there were records of GP instructions within the resident’s care files. It took at most a day for such changes to take place in practice, which is suitably prompt. Management explained about how re-prescriptions are acquired, the process for which is suitable. Detailed records of this are kept, to audit exactly whether the delivery matches what was ordered. Similarly detailed returns records are kept. The home uses homely remedies for individual residents where needed. A list of these were recorded as approved by the GP shortly after the last inspection. There were also reasonable records of as-needed (PRN) records for specific residents. Hadley House Nursing Home DS0000022926.V340587.R01.S.doc Version 5.2 Page 13 The manager said that all nurses and carers completed a distance-learning medication qualification during the summer of 2005. Sample certificates of this were seen. Whilst nurses retain responsibility for medication administration, the manager expects them to involve care staff within this for personal development and awareness purposes. Hadley House Nursing Home DS0000022926.V340587.R01.S.doc Version 5.2 Page 14 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): All of them. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can undertake reasonably flexible and individual routines within the overall running of the home. Leisure activities are provided in the home, and some community support is provided to more-able residents. Visitors are made very welcome, and privacy is provided. Residents can exercise control over their lives, but the service aims to influence residents towards healthier options. Pleasant standards of homecooked food is provided, with alternatives made available where needed. EVIDENCE: Four of the six surveys stated that there are always activities arranged by the home that residents can take part in. However, one survey stated this as sometimes, and the other as never. Those that stated ‘always’ generally referred to the specific occupational therapist who continues to work weekdays at the home but who was on leave during the inspection. It was apparent nonetheless that staff provided some recreational support to residents instead, such as games, ball-throwing, and puzzles. Individual records confirmed that this happens regularly. Hadley House Nursing Home DS0000022926.V340587.R01.S.doc Version 5.2 Page 15 Personalized routines were observed within the running of the home. One resident for instance likes an additional warm drink outside of the regular supply of teas and coffees, according to records and their feedback. The drink was supplied as expected. Another resident noted to the inspector that they get their newspaper delivered daily. Residents with walking-aids had them within easy reach for independent use. One resident noted positively that they had slept late on the morning of the inspection. They also get involved in helping set the table for meals sometimes. Another resident said that the home had provided equipment to enable independence that they had not had before moving in. A third noted that they have facilities in their room to lock money away, and that they are not disturbed during the night. Staff spoke with good knowledge of individual residents’ needs, identifying those who can be very independent, and others who for instance need guidance to make choices that are more dignified. This is appropriate, and reflects the practice seen, of for instance encouragement towards healthier choices but accepting other choices. The home has a strong routine of residents being asked to come to the dining tables for tea and snacks. This is to help residents to retain mobility. Residents could refuse though, and if so they were provided with any necessary equipment such as coffee-tables at their seats. This shows suitable flexibility of the service for residents. The television in the lounge was seen to have a very deep, red picture colour overall, which could somewhat ruins residents’ enjoyment of the TV when it was occasionally used. A fully-operational TV must be provided to residents. Residents generally fedback that they can have visitors anytime, and that staff make the visitors welcome. This was confirmed by feedback from family members. One person spoke of having regular conversations with their relative by phone. There is a small, enclosable room next to the lounge that can be used if greater privacy for visits is wanted. It is also used by the hairdresser for her service, as designated facilities in this respect are within that room. Staff noted that communion is provided weekly in the home to Catholic residents. All other practicing residents are Church of England, and receive a pastoral visit monthly. One resident explained how they now access support to go out to church, which they were pleased about. The manager noted that some residents go out with staff or herself for local walks or shopping excursions. Records confirmed this happening sometimes. One resident went out for a walk locally with staff during the inspection, and another went out alone on arrangement with management. Hadley House Nursing Home DS0000022926.V340587.R01.S.doc Version 5.2 Page 16 Four out of six surveys stated that they always like the meals provided in the home, one person noting that they are brought all the food that they like, another that meals are well-presented. Feedback from residents during the inspection generally confirmed this, one person stating for instance that the meals are appetising and they get plenty of food. It was very apparent that staff kept an overview of what people ate and drank, and provided appropriate support and encouragement where needed. Adapted equipment was available to residents where needed, such as lidded mugs to prevent spillage. Some residents were similarly provided with cloth bibs for their meals. Alternative drinks and meals were seen to be offered where necessary. Additional food was also provided on request to one resident. Staff provided good accounts of the food preferences and needs of each resident, clearly knowing them well as individuals. The meals for the day are put on display on a chalk board in the lounge. The home also records monthly checks with each resident about the food provided, adjusting the menu to aim to fit with the feedback. Records are also kept of the meals served an each sitting, from which it was apparent that homecooked meals that meet basic nutritional requirements are provided. Hadley House Nursing Home DS0000022926.V340587.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can rely on staff and management to speak to if they’re not happy, and can be confident of appropriate action being taken. Complaints procedures have however not been distributed to residents. The providers act responsibly if allegations of abuse arise. There is reasonable awareness of whistleblowing procedures amongst staff, however training in this area is dated. Staff handle possible conflicts between residents well. EVIDENCE: Surveys showed everyone knows who to speak to if they are not happy, but that feedback varied a little in terms of making a complaint, with one person clearly stating that they wouldn’t know how to. From speaking with a couple of residents, it was apparent that they felt confident that any complaint would be addressed by the home, but that they had nothing in writing about complaint procedures. This links to the lack of service user guides being distributed to residents, as per standard 1, as these guides would contain the complaints procedure. This must be addressed. Nonetheless, the outcome for standard 16, of residents being confident that their concerns would be listened to and acted on, is met. As one person commented, “I can speak to the staff. They are trained staff and very helpful.” There have been no complaints, concerns or allegations raised with the CSCI about this home since the last inspection. The home’s complaints book was Hadley House Nursing Home DS0000022926.V340587.R01.S.doc Version 5.2 Page 18 checked. It contained two complaints, from one resident, since the last inspection. Records showed how the issues had been considered and resolved. The home has an adult protection procedure for dealing with allegations of abuse. The providers are noted to have acted diligently and responsibly in relation to a previous allegation at the home. Discussions with staff found them to have a reasonable awareness of whistle-blowing procedures. Checks of training records found that staff had however not had any refresher training in adult protection since 2003, when they all attended an external course. To be sure that staff are enabled to act appropriately to any abuse scenarios, and because procedures have changed since 2003, it is necessary to provide update training to all staff in this area. Staff spoke clearly about where certain residents can aggravate each other. It was encouraging to see staff sensitively diffuse a possible conflict through appropriate redirection and support. This shows good protection of individual residents from possible challenging behaviours of other residents. Hadley House Nursing Home DS0000022926.V340587.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): All of them. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is overall kept to a good standard of cleanliness. Residents enjoy safe and suitable facilities and surroundings. The environment is reasonably maintained although the lounge and some bedrooms are showing signs of wear & tear on the walls, and one bathroom needs maintenance improvements. EVIDENCE: Surveys showed that the home is always kept fresh and clean, which tallies with general observations from the start of the visit. One resident commented that, “My room is always kept clean and the cupboards are always in good condition,” and another that, “The home is cleaned every day and is very clean.” It was particularly observed by the inspector that the dining areas are well cleaned-up after being used for meals. A brief tour of all areas of the home was undertaken with the manager. It was consequently clear that there were no lingering offensive odours, and that the Hadley House Nursing Home DS0000022926.V340587.R01.S.doc Version 5.2 Page 20 house is kept suitably clean overall. Bedrooms had locked drawers for more capable residents to use, and generally suitable equipment for residents’ individual use. Rooms were generally individualized. One resident noted that they have a lock to the room but do not use it. The downstairs bathroom had a difficult door lock to use as it barely turned. Its toilet had a mobile raised-grip rail that had become yellow-stained in colour around its lower sections, so presenting as unhygienic. Its wash-basin lacked soap and a plug. All these issues can compromise residents’ dignity and privacy, and so must be fixed. The room did however have thermostaticallycontrolled hot water coming out at a suitable temperature. There was also a fixed hoist-seat for the bath that was suitably clean. The lounge areas were in places showing signs of wear & tear in the wallpaper, such as small tears or holes. The overall effect was just sufficient but clearly in need of redecoration in the near future. A few bedrooms are in a similar position. The manager stated that there are plans to address this. A sample testing of the electronic alarm call, from one toilet, found the alarm to be working and audible. Each room has an alarm point, close to the bed. There were records of regular testing of the alarms. Hadley House Nursing Home DS0000022926.V340587.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): All of them. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There are enough staff working in the home at all times. Recruitment procedures are suitable. There are low levels of staff turnover. Staff demonstrate good individual knowledge of residents, and treat them appropriately. There are excellent standards of training provided to staff. 100 of carers have an appropriate NVQ qualification, and the home specialises in intensive distance-learning courses for its staff. EVIDENCE: Surveys and residents’ feedback found that there are always staff available when residents need them. Comments included that, “The staff are all very good”, and “They are always available and always helpful.” The expected number of staff were working from the start of the inspection. There was clearly a low turnover of staff. The roster for the weeks around the inspection found that staffing levels, of three staff during the day and two at night, are being upheld. This includes for there always being a qualified nurse working. Random checks of PIN qualification numbers of some nurses found them to be up-to-date. Hadley House Nursing Home DS0000022926.V340587.R01.S.doc Version 5.2 Page 22 The manager reported that all six regular care assistants have qualified at NVQ level 2, with three now having completed NVQ level 3. Some nursing staff are being mentors to care staff for the NVQs. This improves slightly on the last inspection, and combined with good feedback and observations about staff, enables standard 28 to be judged as exceeded. One random staff member’s training certificates were checked through, along with the home’s training log. These showed that staff are kept up-to-date in such areas of training as manual handling, food hygiene, and fire safety, and that specific staff have attended for instance courses on nail care and skin/wound care since the last inspection. Distance-learning courses have been successfully used to train staff in detail in the areas of medication and infection control. A similar intensive course in health & safety was almost at the exam stage for staff at the time of the inspection, and there was feedback about a dementia course being about to begin. Two areas for improvement were noted, as the appointed first aid course for staff had elapsed earlier in the year, and staff had not attended specific abuse-prevention training since 2003 (see standard 18). These could put residents at risk due to staff not being kept up-to-date with current practices. The manager agreed to address these. The induction process and records for new staff were found to be out-of-date. Whilst staff clearly acquire very good standards of training in time, national induction standards with timescales are available from the Skills For Care organisation and should be followed, to show that any new staff receive sufficient initial training in good time. Management stated that there had been only one new staff member since the last inspection, who had since left employment. Their recruitment files found checks to generally be suitably in place, including in respect of Criminal Records Bureau disclosures and identification. Two suitable written references were obtained, including from the previous care employer. Hadley House Nursing Home DS0000022926.V340587.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed knowledgeably and conscientiously through a suitably qualified and experienced manager. Quality assurance systems are reasonably in place. Residents’ money is safely and transparently handled where needed. Health and safety systems are in place and generally up-to-date. EVIDENCE: The manager is a registered general and psychiatric nurse. She has completed the NVQ level 4 award. She has also successfully run and co-owned this home for many years. Observations and discussions with the manager showed that she is sensitive to the needs of the residents, and clearly leads the team to ensure that residents’ Hadley House Nursing Home DS0000022926.V340587.R01.S.doc Version 5.2 Page 24 needs are addressed. One resident also fedback that the manager is very perceptive and capable. Quality assurance questionnaires were provided to residents and their families by the home early in 2007. A number of these had been returned. Management stated that they had been checked and nothing negative had been found in them. They would be providing people with an overall report in due course. Staff noted that they discuss about the quality of the service with residents informally and individually. Group outlets can also assist residents to speak up about how they find the service and what they would like from it, hence residents’ meetings should be considered. The home keeps individual amounts of money securely on behalf of most residents. Checks were made of two residents’ finance records in the home. These showed suitable details, including receipts for significant expenditures. It was also apparent that their overall savings were gradually increasing over time. Every resident’s care plan includes a section on how their money is looked after. Records showed ongoing work with the psychiatrist to clarify about financial issues. One resident noted that issues to do with their personal finances are posted to the home now, and are forwarded to them by staff. The evidence overall suggests that residents’ finances are safeguarded by the home. The home has records of monthly health and safety audits. They showed that issues are identified and addressed, such as with faulty laundry taps and a slightly damaged window. A fire-safety risk assessment for the home was in place dating from July 2006. There were also records evident about regular training and drills, and of weekly fire checks. The local fire authority last visited in 2003, whereas the local environmental health department’s June 2006 visit quoted a “clean, wellrun premises.” Professional safety certification was in place for the gas systems, portable electrical appliances, and against legionella. Lift and hoist certification was technically out-of-date, but there was evidence of a suitably recent professional visit. In terms of a previous requirement about electrical wiring, management provided evidence that professional checks had been made, wherein further work was identified as being needed. There were records in the diary to show that this further input had been booked. Hadley House Nursing Home DS0000022926.V340587.R01.S.doc Version 5.2 Page 25 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 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 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 2 3 3 2 3 3 3 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Hadley House Nursing Home DS0000022926.V340587.R01.S.doc Version 5.2 Page 26 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 OP2 Regulation 5 Requirement It is necessary to supply current residents with a copy of the service user guide that must include a statement of terms and conditions of residency, and for any new resident to be supplied with this written information at latest on the day of moving into the home. This is to help clarify to residents and their representatives about how the home operates and the services that are provided. A fully-operational TV must be provided to residents in the lounge, so that they can enjoy the TV without discoloured pictures. Residents must be provided with a copy of the home’s complaints procedure, to help them understand about the process. To be sure that staff are enabled to act appropriately to any abuse allegation scenarios, and because procedures have changed since 2003, it is necessary to provide update training to all staff on adult DS0000022926.V340587.R01.S.doc Timescale for action 01/10/07 2 OP12 23(2)(c) 15/07/07 3 OP16 22(5) 15/08/07 4 OP18 13(6) 01/10/07 Hadley House Nursing Home Version 5.2 Page 27 5 OP21 23(2)(e) 6 OP30 13(4) 7 OP38 23(2)(c) protection. The downstairs bathroom had a difficult door lock to use as it barely turned. Its toilet had a mobile raised-grip rail that had become yellow-stained in colour around its lower sections, so presenting as unhygienic. Its wash-basin lacked soap and a plug. All these issues can compromise residents’ dignity and privacy, and so must be fixed. There must be an appointed first-aider (with up-to-date training) working in the home at all times, to help ensure that residents are supported appropriately. The manager must ensure that professional checks of the electrical wiring are updated and valid. Previous timescale of 1/6/06 partially met. 01/08/07 01/09/07 01/09/07 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 Refer to Standard OP1 OP7 Good Practice Recommendations The statement of purpose and the service user guide should be reviewed from the current 2004 versions, to ensure that any necessary updates have been carried out. It would be good practice for appropriate residents to be more involved in the formation and adjustment of their care plans, and to own a copy of the plan, as this could help empower some residents. It would be good practice to undertake regular nutritional assessments, in support of evidencing how concerns with weight are addressed. DS0000022926.V340587.R01.S.doc Version 5.2 Page 28 3 OP8 Hadley House Nursing Home 4 OP8 5 6 OP19 OP30 7 OP33 Manual handling assessments should include about the needs of the resident, staff, and the environment of the transfer, to help make the transfer guidance more personalized. Lounges and some bedrooms should be redecorated due to signs of wear & tear in the wallpaper. National induction standards with timescales are available from the Skills For Care organisation and should be followed, to show that any new staff receive sufficient initial training in good time. Group outlets can also assist residents to speak up about how they find the service and what they would like from it, hence residents’ meetings should be considered. Hadley House Nursing Home DS0000022926.V340587.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 Hadley House Nursing Home DS0000022926.V340587.R01.S.doc Version 5.2 Page 30 - 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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